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Making the Case for Molecular Staging of Malignant Pleural MesotheliomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Malignant pleural mesothelioma is an aggressive malignancy for which surgical treatment is an option for a subset of patients. A gene ratio test based on the relative expression levels of four genes has been validated in clinical trials to predict which patients will benefit from surgical therapy. A description of the test properties and the independent predictors for outcome are provided. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 12, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Raphael Bueno Tags: Multimodality Management of Malignant Pleural Mesothelioma - David J. Sugarbaker, MD, Guest Editor Source Type: journals

Photodynamic Therapy as an Innovative Treatment for Malignant Pleural MesotheliomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Photodynamic therapy (PDT) of the pleura is an experimental treatment aimed at eradicating residual microscopic disease after macroscopic complete resection of malignant pleural mesothelioma (MPM) by means of intracavitary administration. A light-based treatment, PDT consists of 3 components: a nontoxic photosensitizing compound, oxygen, and visible light. The treatment is FDA-approved for several oncological targets, but remains experimental for MPM. PDT can be combined with lung-sparing pleurectomy and decortication and does not preclude other treatments such as adjuvant chemotherapy and/or radiation therapy. Additionall...
Source: Seminars in Thoracic and Cardiovascular Surgery - October 12, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Joseph S. Friedberg Tags: Multimodality Management of Malignant Pleural Mesothelioma - David J. Sugarbaker, MD, Guest Editor Source Type: journals

Multimodality Strategies in Malignant Pleural MesotheliomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Over the last decade, several improvements have been made in the diagnosis and treatment of malignant pleural mesothelioma, including better understanding of tumor biology, availability of more potent chemotherapeutic drugs, improved surgical management, and optimized multidisciplinary therapy. Radical tumor resection by means of extrapleural pneumonectomy (EPP) is now feasible with acceptable morbidity and mortality, even after neoadjuvant chemotherapy, if performed in specialized centers. To date, the best survival data have been reported after multimodality treatment strategies that include surgical resection. In this a...
Source: Seminars in Thoracic and Cardiovascular Surgery - October 12, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Walter Weder, Isabelle Opitz, Rolf Stahel Tags: Multimodality Management of Malignant Pleural Mesothelioma - David J. Sugarbaker, MD, Guest Editor Source Type: journals

Palliative Care for the Patient With MesotheliomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The role of palliative care in the medical management of malignant mesothelioma is multifaceted, requiring proficiency in multiple disciplines. Pain management is a key aspect of this care. The most common sources of pain are postthoracotomy syndrome, chemotherapy-induced peripheral neuropathy, involvement of the intercostal nerves by tumor invading the chest wall, and dyspnea. The palliative care provider also must be prepared to recognize and treat psychological disorders, to identify other social and spiritual sources of distress, including anxiety and depression, and to provide or arrange for counseling to patient and ...
Source: Seminars in Thoracic and Cardiovascular Surgery - October 12, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Janet L. Abrahm Tags: Multimodality Management of Malignant Pleural Mesothelioma - David J. Sugarbaker, MD, Guest Editor Source Type: journals

Radiation Therapy Options for Malignant Pleural MesotheliomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The role of radiation therapy (RT) in the curative treatment of malignant pleural mesothelioma remains undefined. No data clearly support treatment of unresected mesothelioma with definitive RT. Early reports showed that RT was associated with unacceptable toxicity, but recent limited data suggest that treatment with intensity-modulated radiation therapy (IMRT) may be tolerable. Adjuvant RT after pleurectomy is also challenging, and similarly, no clear efficacy has been demonstrated. Some approaches, such as IMRT to the circumferential pleural envelope, appear feasible, but the fact that this approach does not address the ...
Source: Seminars in Thoracic and Cardiovascular Surgery - October 12, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Elizabeth H. Baldini Tags: Multimodality Management of Malignant Pleural Mesothelioma - David J. Sugarbaker, MD, Guest Editor Source Type: journals

Current Options for Systemic Therapy in MesotheliomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article surveys the current clinical landscape of systemic therapies in mesothelioma and explores the impact of both conventional and targeted agents. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 12, 2009 Category: Cardiovascular & Thoracic Surgery Authors: David M. Jackman Tags: Multimodality Management of Malignant Pleural Mesothelioma - David J. Sugarbaker, MD, Guest Editor Source Type: journals

Surgical Options in Malignant Pleural Mesothelioma: Extrapleural Pneumonectomy or Pleurectomy/DecorticationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Two operations have evolved for the surgical treatment of malignant pleural mesothelioma (MPM): extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D). The goal of surgery in the multimodality treatment approach is to achieve a macroscopic complete resection, with adjuvant therapies directed at residual microscopic disease. Overall survival reported in a recent multicenter analysis of these two operations supports the use of P/D for early stage MPM provided that a complete resection is feasible; otherwise EPP will confer a survival advantage. For stage II disease, however, EPP demonstrates a possible advantag...
Source: Seminars in Thoracic and Cardiovascular Surgery - October 12, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Raja M. Flores Tags: Multimodality Management of Malignant Pleural Mesothelioma - David J. Sugarbaker, MD, Guest Editor Source Type: journals

Surgical Techniques for Multimodality Treatment of Malignant Pleural Mesothelioma: Extrapleural Pneumonectomy and Pleurectomy/DecorticationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Trimodality treatment of malignant pleural mesothelioma with cytoreductive surgery followed by radiation and chemotherapy has resulted in long-term survival for a select group of patients. Knowledge of the similarities and differences between the two operations that have evolved—extrapleural pneumonectomy and pleurectomy/decortication—is prerequisite to understanding the complex issues associated with patient selection, diagnosis, pathologic staging, preoperative assessment, perioperative management, and adjuvant treatment. Both operations are technically complex and should only be performed at experienced high-volume ...
Source: Seminars in Thoracic and Cardiovascular Surgery - October 12, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Andrea S. Wolf, Jonathan Daniel, David J. Sugarbaker Tags: Multimodality Management of Malignant Pleural Mesothelioma - David J. Sugarbaker, MD, Guest Editor Source Type: journals

Mesothelioma: Path to Multimodality TreatmentEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Multimodality treatment of malignant pleural mesothelioma (MPM) with surgery, radiation therapy, and adjuvant or neoadjuvant chemotherapy is the sole path to extended survival for select patients with favorable prognostic factors. No single-modality approach has produced equivalent results. Much effort has been expended since first recognition of this insidious pleural cancer to elucidate the underlying cause and optimal treatment strategy. Despite recent breakthroughs, the principal barrier to achieving a cure rests with the propensity for disease recurrence in the ipsilateral hemithorax. Despite these limitations, howeve...
Source: Seminars in Thoracic and Cardiovascular Surgery - October 12, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Stacey Su Tags: Multimodality Management of Malignant Pleural Mesothelioma - David J. Sugarbaker, MD, Guest Editor Source Type: journals

Pathologic Evaluation of Malignant Pleural MesotheliomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Pathologists play an important role in the surgical management of diffuse malignant pleural mesothelioma, which relies heavily on accurate diagnosis and staging. The pathologist provides crucial input to the determination of many prognostic factors including histologic subtype, extent of local disease progression, resection margins, and nodal status. They consult with the clinical care team at multiple points along the treatment spectrum, preoperatively, intraoperatively, and postoperatively. Finally, they are increasingly called on to guide selection of chemotherapy and measure treatment response. (Source: Seminars in Tho...
Source: Seminars in Thoracic and Cardiovascular Surgery - October 12, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Lucian R. Chirieac, Joseph M. Corson Tags: Multimodality Management of Malignant Pleural Mesothelioma - David J. Sugarbaker, MD, Guest Editor Source Type: journals

Current Trends in Radiologic Management of Malignant Pleural MesotheliomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Malignant pleural mesothelioma (MPM) is an aggressive pleural tumor with a complex growth pattern. Imaging plays a crucial role in diagnosis and management. Computed tomography (CT) has been the mainstay in the clinical evaluation of MPM; however it underestimates early chest wall invasion, peritoneal involvement, and has well-known limitations in nodal metastatic evaluation. Perfusion CT can evaluate the microvasculature of tumors; however its disadvantages, such as high radiation exposure and side effects from iodinated contrast, have limited its use to research settings. Magnetic resonance imaging (MRI) is superior to C...
Source: Seminars in Thoracic and Cardiovascular Surgery - October 12, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Ritu R. Gill, Victor H. Gerbaudo, David J. Sugarbaker, Hiroto Hatabu Tags: Multimodality Management of Malignant Pleural Mesothelioma - David J. Sugarbaker, MD, Guest Editor Source Type: journals

Recent Advances in Mesothelioma StagingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Lack of a consensus staging system for malignant pleural mesothelioma has had a profound impact on clinical practice and research, which necessarily relies on comparison of outcomes across multiple institutions and studies for reliable prognostic information. Some lack of agreement arises from the difficulty of conforming this particular cancer to existing staging systems because of its unique biology. The heterogeneous prognosis of patients with differing tumor histology and constant search for new more effective therapies also play a role. Periodic data-driven refinement of staging criteria, based on careful pathologic a...
Source: Seminars in Thoracic and Cardiovascular Surgery - October 12, 2009 Category: Cardiovascular & Thoracic Surgery Authors: William G. Richards Tags: Multimodality Management of Malignant Pleural Mesothelioma - David J. Sugarbaker, MD, Guest Editor Source Type: journals

Current Status of Screening for Malignant Pleural MesotheliomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Malignant mesothelioma is characterized by its association with asbestos, its long latency period, and the propensity for the diagnosis to be obtained in the later stages of the disease. Because the high-risk cohorts for mesothelioma are fairly well defined by the association with asbestos, and the exposure is usually in the workplace, it is hypothesized that early detection of the disease could (1) find patients at an earlier, more treatable stage and (2) result in prolonged survival over the present median 12 months from the start of therapy. Many studies have used standard chest X-ray to characterize changes associated ...
Source: Seminars in Thoracic and Cardiovascular Surgery - October 12, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Harvey I. Pass, Michele Carbone Tags: Multimodality Management of Malignant Pleural Mesothelioma - David J. Sugarbaker, MD, Guest Editor Source Type: journals

Multimodality Management of Malignant Pleural Mesothelioma: IntroductionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Malignant pleural mesothelioma (MPM) is an aggressive cancer of the pleura that is associated with occupational exposure to asbestos and a lengthy latency (up to 50 years) between initial exposure and disease expression. Since recognition of the relationship between the industrial mining and use of asbestos in the 1960s, the incidence of MPM has continued to rise, reaching epidemic proportions in many nations of the world. Despite legislation introduced by numerous industrialized countries in the 1970s, a peak effect will not be observed in many of these nations for at least another decade, owing to the latency of disease ...
Source: Seminars in Thoracic and Cardiovascular Surgery - October 12, 2009 Category: Cardiovascular & Thoracic Surgery Authors: David J. Sugarbaker Tags: Multimodality Management of Malignant Pleural Mesothelioma - David J. Sugarbaker, MD, Guest Editor Source Type: journals

Forthcoming/Previous TopicsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 12, 2009 Category: Cardiovascular & Thoracic Surgery Source Type: journals

Table of ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 12, 2009 Category: Cardiovascular & Thoracic Surgery Source Type: journals

OfficersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 12, 2009 Category: Cardiovascular & Thoracic Surgery Source Type: journals

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(Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 12, 2009 Category: Cardiovascular & Thoracic Surgery Source Type: journals

Poland SyndromeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Poland syndrome is characterized by hypoplasia or absence of the breast or nipple, hypoplastia of subcutaneous tissue, absence of the costosternal portion of the pectoralis major muscle, absence of the pectoralis minor muscle, and absence of costal cartilages or ribs 2, 3, and 4 or 3, 4, and 5. The chest wall defect is often associated with a lung hernia. Clinical manifestations are extremely variable and rarely are all the features recognized in 1 individual. Fortunately it is invariably unilateral, allowing for an easier reconstruction. Single-stage reconstruction of the chest wall combined with simultaneous augmentation...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 28, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Harold C. Urschel Tags: Surgical Repair of Anterior Chest Wall Deformities: the Past, the Present, the Future - Francis Robicsek, MD, PhD, and Alexander A. Fokin, MD, PhD, Guest Editors Source Type: journals

To Nuss or Not to Nuss? Two Opposing ViewsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Although the issue of the appropriate approach for the repair of pectus excavatum remained unsettled for decades, just when we thought that the consensus was clear, an entirely new method was introduced: the Nuss operation. This technique now challenges not only the previously established standards, but also the basic conceptual views of pectus surgery. In the following text, 2 opposing views on the subject are presented: the angle from which Francis Robicsek, a pioneer in conventional pectus excavatum surgery, views the issue, and the opinion of Andre Hebra, who has extensive experience with the Nuss operation. (Source: S...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 28, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Francis Robicsek, André Hebra Tags: Surgical Repair of Anterior Chest Wall Deformities: the Past, the Present, the Future - Francis Robicsek, MD, PhD, and Alexander A. Fokin, MD, PhD, Guest Editors Source Type: journals

Minimally Invasive Repair of Pectus ExcavatumEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews the indications for treatment of patients with pectus excavatum, with emphasis on the evolution and outcomes of the procedure known as the minimally invasive repair or Nuss technique. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 28, 2009 Category: Cardiovascular & Thoracic Surgery Authors: André Hebra Tags: Surgical Repair of Anterior Chest Wall Deformities: the Past, the Present, the Future - Francis Robicsek, MD, PhD, and Alexander A. Fokin, MD, PhD, Guest Editors Source Type: journals

Surgical Repair of Pectus Excavatum and CarinatumEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The author discusses different forms of pectus deformities and presents appropriate surgical methods he developed for their correction. For pectus excavatum, the surgical technique includes conservative sub-perichondral resection of deformed costal cartilages and detachment of the xiphoid process. A transverse sternotomy is performed at the upper level of the deformed sternum, which is then bent forward. The corrected sternal position is secured by a “hammock” of synthetic mesh, spread behind the sternum, and attached to the respective cartilage remnants. The pectoralis muscles are then united presternally. The initial...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 28, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Francis Robicsek, Larry T. Watts, Alexander A. Fokin Tags: Surgical Repair of Anterior Chest Wall Deformities: the Past, the Present, the Future - Francis Robicsek, MD, PhD, and Alexander A. Fokin, MD, PhD, Guest Editors Source Type: journals

Preoperative Assessment of Chest Wall DeformitiesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Anterior chest wall anomalies vary by age at presentation, signs, and symptoms as well as evaluation and subsequent surgical treatment. The most common abnormalities include pectus excavatum, pectus carinatum, and Poland syndrome. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 28, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Paul M. Colombani Tags: Surgical Repair of Anterior Chest Wall Deformities: the Past, the Present, the Future - Francis Robicsek, MD, PhD, and Alexander A. Fokin, MD, PhD, Guest Editors Source Type: journals

Anatomical, Histologic, and Genetic Characteristics of Congenital Chest Wall DeformitiesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
There is a large and diverse group of congenital abnormalities of the thorax that manifest as deformities and/or defects of the anterior chest wall and, depending on the severity and concomitant anomalies, may have cardiopulmonary implications. Pectus excavatum, the most common anterior chest deformity, is characterized by sternal depression with corresponding leftward displacement and rotation of the heart. Pectus carinatum, the second most common, exhibits a variety of chest wall protrusions and very diverse clinical manifestations. The cause of these conditions is thought to be abnormal elongation of the costal cartilag...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 28, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Alexander A. Fokin, Nury M. Steuerwald, William A. Ahrens, Karen E. Allen Tags: Surgical Repair of Anterior Chest Wall Deformities: the Past, the Present, the Future - Francis Robicsek, MD, PhD, and Alexander A. Fokin, MD, PhD, Guest Editors Source Type: journals

Surgical Repair of Anterior Chest Wall Deformities: the Past, the Present, the Future: IntroductionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The conditions we call “pectus deformities” were recognized by Hippocrates, the clinical features were described by Bauhinus, treated surgically by Sauerbruch—thus one might rightfully expect that enough time has passed to reach a consensus as to how to move a displaced sternum a few inches higher or lower and keep it in the proper position. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 28, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Francis Robicsek, Alexander A. Fokin Tags: Surgical Repair of Anterior Chest Wall Deformities: the Past, the Present, the Future - Francis Robicsek, MD, PhD, and Alexander A. Fokin, MD, PhD, Guest Editors Source Type: journals

Creating a High-Value Delivery System for Health CareEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Health care reform that focuses on improving value enhances both the well-being of patients and the professional satisfaction of physicians. Value in health care is the improvement in health outcomes achieved for patients relative to the money spent. Dramatic and ongoing improvement in the value of health care delivered will require fundamental restructuring of the system. Current efforts to improve safety and reduce waste are truly important but not sufficient. The following three structural changes will drive simultaneous improvement in outcomes and efficiency: (1) reorganizing care delivery into clinically integrated te...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 28, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Elizabeth O. Teisberg, Scott Wallace Tags: Ethical, Legal, and Health Policy Challenges in Contemporary Cardiothoracic Surgery - John E. Mayer, Jr, MD, Guest Editor Source Type: journals

Assessing Technological Change in Cardiothoracic SurgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Technological innovation—broadly defined as the development and introduction of new drugs, devices, and procedures—has played a major role in advancing the field of cardiothoracic surgery. It has generated new forms of care for patients and improved treatment options. Innovation, however, comes at a price. Total national health care expenditures now exceed $2 trillion per year in the United States and all current estimates indicate that this number will continue to rise. As we continue to seek the most innovative medical treatments for cardiovascular disease, the spiraling cost of these technologies comes to the forefr...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 28, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Alexander Iribarne, Mark J. Russo, Alan J. Moskowitz, Deborah D. Ascheim, Lawrence D. Brown, Annetine C. Gelijns Tags: Ethical, Legal, and Health Policy Challenges in Contemporary Cardiothoracic Surgery - John E. Mayer, Jr, MD, Guest Editor Source Type: journals

Cardiac Surgeons and the Quality Movement: the Michigan ExperienceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The Michigan Society of Thoracic and Cardiovascular Surgeons created a voluntary quality collaborative with all the cardiac surgeons in the state and all hospitals doing adult cardiac surgery. Utilizing this collaborative over the last 3 years and creating a unique relationship with a payor, an approach to processes and outcomes has produced improvements in the quality of care for cardiac patients in the state of Michigan. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 28, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Richard L. Prager, Frederick R. Armenti, Joseph S. Bassett, Gail F. Bell, Daniel Drake, Eric C. Hanson, John C. Heiser, Scott H. Johnson, F.B. Plasman, Francis L. Shannon, David Share, Patty Theurer, Jaelene Williams, Membership of the Michigan Society of Tags: Ethical, Legal, and Health Policy Challenges in Contemporary Cardiothoracic Surgery - John E. Mayer, Jr, MD, Guest Editor Source Type: journals

Regional Collaboration as a Model for Fostering Accountability and Transforming Health CareEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article illustrates an effective working model of regional collaboration focused on improving health outcomes, containing costs, and making efficient use of resources in cardiovascular surgical care. The Virginia Cardiac Surgery Quality Initiative is a decade-old collaboration of cardiac surgeons and hospital providers in Virginia working to improve outcomes and contain costs by analyzing comparative data, identifying top performers, and replicating best clinical practices on a statewide basis. The group's goals and objectives, along with 2 generations of performance improvement initiatives, are examined. These involv...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 28, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Alan M. Speir, Jeffrey B. Rich, Ivan Crosby, Edwin Fonner, Virginia Cardiac Surgery Quality Initiative Tags: Ethical, Legal, and Health Policy Challenges in Contemporary Cardiothoracic Surgery - John E. Mayer, Jr, MD, Guest Editor Source Type: journals

Toward an American Health Care System—Change We Can Believe InEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Eighty percent of Americans are of the opinion that our country is on the wrong track in so many respects. Fuel prices, health care prices, food prices, education prices, the collapse of our home equity, and our investment equity along with financial industry failures all vouch for change. This should make the election for President fairly predictable with the candidate of the “in-party” out and the candidate of the “out party” a shoo-in. However, that has not been the case. Those of us who have spent a professional lifetime working on the role that public policy plays in incenting systemic solutions for these comp...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 28, 2009 Category: Cardiovascular & Thoracic Surgery Authors: David F. Durenberger Tags: Ethical, Legal, and Health Policy Challenges in Contemporary Cardiothoracic Surgery - John E. Mayer, Jr, MD, Guest Editor Source Type: journals

Perspectives and Prospects for Health System ReformEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
As two physicians involved in the leadership of the medical and surgical specialties primarily involved in caring for patients with cardiovascular diseases, which account for a significant percentage of health care expenditures in the USA, we wish to offer several additional observations and recommendations related to health care “reform.” These observations and recommendations are based first on the observation that physicians control at least 75% of health care expenditures through the tests and medications that they order and the procedures that they do. Second, they are based on our belief that medicine remains a p...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 28, 2009 Category: Cardiovascular & Thoracic Surgery Authors: John E. Mayer, James T. Dove Tags: Ethical, Legal, and Health Policy Challenges in Contemporary Cardiothoracic Surgery - John E. Mayer, Jr, MD, Guest Editor Source Type: journals

Ethical, Legal, and Health Policy Challenges in Contemporary Cardiothoracic Surgery: IntroductionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The papers contained in this issue of Seminars in Thoracic and Cardiovascular Surgery were assembled in an attempt to provide an historical context for health care reform, to describe some approaches that have been undertaken to improve quality in cardiothoracic surgery and to then provide some ideas for reform of the American healthcare system. There is general agreement that one of the most important problems facing American society is the continuing escalation of the costs of healthcare at a rate that exceeds the growth of the economy. These differential rates of growth in healthcare expenditures versus the economy are ...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 28, 2009 Category: Cardiovascular & Thoracic Surgery Authors: John E. Mayer Tags: Ethical, Legal, and Health Policy Challenges in Contemporary Cardiothoracic Surgery - John E. Mayer, Jr, MD, Guest Editor Source Type: journals

Forthcoming/Previous TopicsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 28, 2009 Category: Cardiovascular & Thoracic Surgery Source Type: journals

Table of ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 28, 2009 Category: Cardiovascular & Thoracic Surgery Source Type: journals

Association OfficersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 28, 2009 Category: Cardiovascular & Thoracic Surgery Source Type: journals

MastheadEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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Source: Seminars in Thoracic and Cardiovascular Surgery - July 28, 2009 Category: Cardiovascular & Thoracic Surgery Source Type: journals

MR and CT Imaging of the Pediatric Patient with Structural Heart DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Cardiac MRI and CT are imaging modalities increasingly employed in the diagnosis and management of structural heart disease. They are powerful imaging tools that have individual strengths and weaknesses. Rational choice between MRI and CT should be based on a sound understanding of these issues. Management guidelines that incorporate the use of MRI and CT are currently being developed, and their utilizations are expected to grow rapidly in the future. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - June 25, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Frandics P. Chan Tags: Advances in Imaging of Cardiovascular Diseases - Dominik Fleischmann, MD, David H. Liang, MD, PhD, and D. Craig Miller, MD, Guest Editors Source Type: journals

Evolving CT Applications in Ischemic Heart DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Current technological advances in multidetector-row computed tomography (MDCT) have widened the scope of cardiac CT in ischemic heart disease. Initially employed to determine the status of the coronary arteries, assessment of cardiac function, perfusion, and viability has now become a reality. In this article, basic concepts, technical advances, appropriate clinical indications, and current clinical role of cardiac MDCT in this specific clinical scenario are reviewed. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - June 25, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Gorka Bastarrika, U. Joseph Schoepf Tags: Advances in Imaging of Cardiovascular Diseases - Dominik Fleischmann, MD, David H. Liang, MD, PhD, and D. Craig Miller, MD, Guest Editors Source Type: journals

Advances in EchocardiographyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Echocardiography remains the main tool for noninvasive cardiac evaluation. Advances in echo technology and techniques offer new information, which will impact both the timing and method of surgical intervention. Three-dimensional echocardiography, in particular, provides improved tools for quantification both of volumes and of flows. Geometrical relations necessary for understanding functional abnormalities are also preserved with three-dimensional (3D) echocardiography. Finally 3D echocardiography also provides a unique tool for guiding minimally invasive interventions. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - June 25, 2009 Category: Cardiovascular & Thoracic Surgery Authors: David H. Liang Tags: Advances in Imaging of Cardiovascular Diseases - Dominik Fleischmann, MD, David H. Liang, MD, PhD, and D. Craig Miller, MD, Guest Editors Source Type: journals

Pre- and Postoperative Imaging of the Aortic Root for Valve-Sparing Aortic Root Repair (V-SARR)Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Valve-sparing aortic root repair (V-SARR) using the David reimplantation method is an increasingly popular alternative to composite valve graft aortic root replacement in patients with aortic root aneurysms or dissections who wish to avoid anticoagulation. Computed tomography (CT) with retrospective electrocardiograph (ECG)-gating has become routine before and following V-SARR at Stanford. CT allows accurate measurement of aortic dimensions and provides unprecedented three-dimensional (3D) images of the sinuses, the aortic valve cusps, and coronary arteries in patients with the Marfan syndrome (MFS), with a bicuspid aortic...
Source: Seminars in Thoracic and Cardiovascular Surgery - June 25, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Dominik Fleischmann, David H. Liang, R. Scott Mitchell, D. Craig Miller Tags: Advances in Imaging of Cardiovascular Diseases - Dominik Fleischmann, MD, David H. Liang, MD, PhD, and D. Craig Miller, MD, Guest Editors Source Type: journals

Imaging of the Thoracic Aorta with Time-Resolved Three-Dimensional Phase-Contrast MRI: A ReviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Time-resolved three-dimensional (3D) phase-contrast (PC) magnetic resonance imaging (MRI), or four-dimensional (4D) flow, is able to provide robust 3D images with three-directional velocities. This review discusses the technique and application of 4D flow in the imaging of thoracic aortic pathologies. It has been instrumental in describing normal flow patterns throughout the cardiac cycle in the ascending and descending aorta and has shown the variety of flow patterns that exist in ascending aortic aneurysms. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - June 25, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Thomas A. Hope, Robert J. Herfkens Tags: Advances in Imaging of Cardiovascular Diseases - Dominik Fleischmann, MD, David H. Liang, MD, PhD, and D. Craig Miller, MD, Guest Editors Source Type: journals

Imaging of the Thoracic Aorta Before and After Stent-Graft Repair of Aneurysms and DissectionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews state-of-the-art pre- and postprocedural imaging for TEVAR, especially focusing on the role of MDCT angiography. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - June 25, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Takuya Ueda, Dominik Fleischmann, Geoffrey D. Rubin, Michael D. Dake, Daniel Y. Sze Tags: Advances in Imaging of Cardiovascular Diseases - Dominik Fleischmann, MD, David H. Liang, MD, PhD, and D. Craig Miller, MD, Guest Editors Source Type: journals

Acute Aortic Syndromes: New Insights from Electrocardiographically Gated Computed TomographyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The development of retrospective electrocardiographic (ECG)-gating has proved to be a diagnostic and therapeutic boon for computed tomography (CT) imaging of patients with acute thoracic aortic diseases, such as aortic dissection/intramural hematoma (AD/IMH), penetrating atherosclerotic ulcer (APU), and ruptured/leaking aneurysm. The notorious pulsation motion artifacts in the ascending aorta confounding regular CT scanning can be eliminated, and involvement of the sinuses of Valsalva, the valve cusps, the aortic annulus, and the coronary arteries in aortic dissection can be clearly depicted or excluded. Motion-free images...
Source: Seminars in Thoracic and Cardiovascular Surgery - June 25, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Dominik Fleischmann, R. Scott Mitchell, D. Craig Miller Tags: Advances in Imaging of Cardiovascular Diseases - Dominik Fleischmann, MD, David H. Liang, MD, PhD, and D. Craig Miller, MD, Guest Editors Source Type: journals

Technical Advances in Cardiovascular ImagingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article provides a brief overview of recent technical developments in computed tomography (CT), magnetic resonance (MR), and echocardiography, which have increased our diagnostic understanding and may modulate treatment planning of patients with cardiovascular diseases: electrocardiographically (ECG)-gated CT, 4D-flow magnetic resonance imaging (MRI), and three-dimensional (3D) echocardiography. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - June 25, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Dominik Fleischmann, David H. Liang, Robert J. Herfkens Tags: Advances in Imaging of Cardiovascular Diseases - Dominik Fleischmann, MD, David H. Liang, MD, PhD, and D. Craig Miller, MD, Guest Editors Source Type: journals

Advances in Imaging of Cardiovascular Diseases: IntroductionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Medical students, house officers, and cardiovascular surgical residents today cannot be expected to marvel at the tremendous advances our colleagues in radiology and cardiology have made when it comes to imaging the heart, aorta, and peripheral vascular system, since they have been spoiled by these breakthroughs. Older cardiovascular surgeons, conversely, shake their heads in disbelief about how they used to rely solely on contrast single plane RAO left ventriculography to quantitate the degree of mitral regurgitation and determine whether the patient might possibly have a Barlow's mitral valve or catheter aortography in t...
Source: Seminars in Thoracic and Cardiovascular Surgery - June 25, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Dominik Fleischmann, David H. Liang, D. Craig Miller Tags: Advances in Imaging of Cardiovascular Diseases - Dominik Fleischmann, MD, David H. Liang, MD, PhD, and D. Craig Miller, MD, Guest Editors Source Type: journals

Robotic-Assisted ThymectomyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We present a review of the experience of robotic thymectomy. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - June 25, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Shannon L. Castle, Kemp H. Kernstine Tags: New Technologies and Procedures in General Thoracic Surgery - James D. Luketich, MD, and Arjun Pennathur, MD, FACS, Guest Editors Source Type: journals

Endoscopic Therapies for the Treatment of Reflux DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Endoscopic techniques for the treatment of reflux disease were first introduced in 2000 as an alternative to laparoscopic antireflux operations. Because of reports of long-term treatment failure with laparoscopic fundoplication and the fact that surgery is increasingly being reserved for the relatively small proportion of patients with complicated reflux disease, attempts to develop safe, effective, and durable endoscopic approaches to antireflux surgery continue. Techniques include radiofrequency ablation, injection therapy, and suturing/stapling techniques. Of these, the suturing/stapling techniques are most similar to t...
Source: Seminars in Thoracic and Cardiovascular Surgery - June 25, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Katie S. Nason, Matthew J. Schuchert, Bart P.L. Witteman, Blair A. Jobe Tags: New Technologies and Procedures in General Thoracic Surgery - James D. Luketich, MD, and Arjun Pennathur, MD, FACS, Guest Editors Source Type: journals

Endoscopic Resection for Barrett's Esophagus with High-Grade Dysplasia or Early Esophageal AdenocarcinomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews endoscopic resection for the management of early esophageal neoplasia, including preprocedural evaluation, appropriate patient selection, available techniques and results of recent clinical trials. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - June 25, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Thomas J. Watson Tags: New Technologies and Procedures in General Thoracic Surgery - James D. Luketich, MD, and Arjun Pennathur, MD, FACS, Guest Editors Source Type: journals

Esophageal Radiofrequency Ablation for the Treatment of Intestinal Metaplasia, Low Grade Dysplasia, and High Grade DysplasiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The presence of intestinal metaplasia (IM) of the esophagus is associated with an elevated risk for developing high-grade dysplasia and invasive adenocarcinoma. Historically, IM has been surveyed with a lifetime of serial endoscopy and biopsy procedures to monitor for the development of high-grade dysplasia and cancer, the early detection of which would permit intervention with surgery. Several nonsurgical endoscopic procedures have been developed with the intent to eradicate IM and dysplasia and halt progression to invasive cancer. However, many of these techniques have been associated with significant morbidity and unacc...
Source: Seminars in Thoracic and Cardiovascular Surgery - June 25, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Seth D. Force, Daniel L. Miller Tags: New Technologies and Procedures in General Thoracic Surgery - James D. Luketich, MD, and Arjun Pennathur, MD, FACS, Guest Editors Source Type: journals

Hyperthermic Chemoperfusion for the Treatment of Malignant Pleural MesotheliomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Malignant pleural mesothelioma is a uniformly fatal disease with a poor prognosis. Multimodality therapy, including macroscopic complete resection, chemotherapy and/or radiotherapy, has improved survival relative to historical controls, but local recurrence remains problematic. Novel strategies are needed to improve local control. Intracavitary chemotherapy (IC) can deliver higher doses of drug locally with less toxicity than corresponding systemic therapy. When combined with hyperthermia, there is also an increase in local drug absorption and cytotoxic effect. Several phase I and II clinical trials have shown IC to be saf...
Source: Seminars in Thoracic and Cardiovascular Surgery - June 25, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Aneil A. Mujoomdar, David J. Sugarbaker Tags: New Technologies and Procedures in General Thoracic Surgery - James D. Luketich, MD, and Arjun Pennathur, MD, FACS, Guest Editors Source Type: journals