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IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 1, 2009 Category: Cardiovascular & Thoracic Surgery Source Type: journals

Reconstructive Techniques After Diaphragm ResectionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Diaphragm resection requires complete reconstruction to avoid respiratory compromise or herniation of abdominal contents into the chest. Primary reconstruction of the diaphragm is often possible, even with a large defect, as long as the tissue can come together without excessive tension. Larger defects or complete diaphragm resections necessitate reconstruction with synthetic material or autologous tissue. These reconstructions can be accomplished safely and effectively by following specific surgical tenets, and require an in-depth knowledge of the diaphragm's anatomy, innervation, blood supply, and adjacent organs. (Sourc...
Source: Thoracic Surgery Clinics - November 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: David J. Finley, Nadeem R. Abu-Rustum, Dennis S. Chi, Raja Flores Source Type: journals

Tumors of the DiaphragmEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Primary tumors of the diaphragm are very rare. Benign tumors of the diaphragm are resected if symptomatic or if there is concern for malignancy. Malignant tumors are either primary, metastatic, or the result of direct extension to the diaphragm from adjacent malignancy. Malignant tumors are treated based on histology and response to chemotherapy, with surgical resection performed when feasible. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Min Peter Kim, Wayne L. Hofstetter Source Type: journals

Diaphragmatic EventrationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Diaphragmatic eventration is defined as thinning of the diaphragm secondary to a congenital deficiency in diaphragmatic muscle structure. Clinically, diaphragmatic eventration can be impossible to differentiate from acquired paralysis. Diaphragmatic plication is indicated for symptomatic patients and leads to significant improvement in symptoms, quality of life, and pulmonary function tests. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Shawn S. Groth, Rafael S. Andrade Source Type: journals

Acquired Paralysis of the DiaphragmEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Acquired diaphragmatic paralysis is an uncommon cause of respiratory insufficiency in adults. Symptoms of diaphragmatic paralysis range in severity from mild alterations in exercise capacity to severe, life-threatening illness. For well-selected patients, diaphragmatic plication is indicated for symptomatic relief. Plication may be performed via standard thoracotomy or by video-assisted techniques. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Michael Augustine Ko, Gail Elizabeth Darling Source Type: journals

Chronic Traumatic Diaphragmatic HerniaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Traumatic diaphragmatic hernia encompasses a spectrum of disease ranging from acute to chronic. Chronic traumatic diaphragmatic hernia is uncommon and associated with significant morbidity and mortality. Multiplanar CT with coronal, sagittal, and axial reconstructions is most effective in making this diagnosis. Once diagnosed, repair should be undertaken. Open transthoracic repair is preferred. Basic hernia repair principles apply including the construction of a tension-free repair, which may necessitate the use of prosthetics. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Maurice Blitz, Brian E. Louie Source Type: journals

Acute Traumatic Diaphragmatic InjuryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Acute diaphragmatic hernia is a result of diaphragmatic injury that accompanies severe blunt or penetrating thoracoabdominal trauma. The incidence, characteristics, and diagnosis of acute diaphragmatic hernia are discussed. Acute traumatic diaphragmatic injuries are treated by surgical reduction of the herniated organs, if present, and closure of the diaphragmatic defect. The various treatment options are discussed. Outcomes of acute diaphragmatic hernia repair are largely dictated by the severity of concomitant injuries, with the Injury Severity Score being the most widely recognized predictor of mortality. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Waël C. Hanna, Lorenzo E. Ferri Source Type: journals

Paraesophageal Hernia: Clinical Presentation, Evaluation, and Management ControversiesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Few topics within thoracic surgery are as controversial as the management of paraesophageal hernias (PEH). In this article, the types of hiatal hernia are classified and the clinical presentation and evaluation of patients with PEH are discussed. Controversies in the management of PEH including the indications for surgery, the different operative approaches, and the role of esophageal shortening are reviewed. Finally, the evidence regarding the need for fundoplication or fixation of the stomach with gastropexy or gastrostomy and the use of prosthetic material in performing the hiatal closure are examined. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Colin Schieman, Sean C. Grondin Source Type: journals

Congenital Diaphragmatic Hernia in the AdultEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Congenital diaphragmatic herniae (CDH) are uncommon in neonates and extremely rare in adults. The clinical presentation of CDH in adults tends to be very different from neonates. Many adults remain asymptomatic and CDH are diagnosed incidentally. All CDH should be repaired. Minimally invasive surgical approaches are now gaining popularity for the repair of CDH with excellent outcomes. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Lana Schumacher, Sebastien Gilbert Source Type: journals

Foramen of Morgagni Hernia: Presentation and TreatmentEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The article discusses the presentation and treatment of foramen of Morgagni hernia. First, it describes the embryology of the diaphragm along with the incidence of associated anomalies. This is followed by the symptoms, diagnosis, and management. Morgagni hernias are rare and most often asymptomatic; however, there is always a concern about strangulated bowel. Diagnosis is usually by chest radiograph or CT scan. The surgical approach may be either transabdominal or thoracic. Experience is increasing with minimally invasive approaches, which has a low recurrence rate and an excellent prognosis. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Ahmed Nasr, Annie Fecteau Source Type: journals

Surgical Conditions of the Diaphragm: Posterior Diaphragmatic Hernias in InfantsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews the diagnosis and management strategies of congenital diaphragmatic hernia and the outcomes of congenital diaphragmatic hernia patients. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Priscilla P.L. Chiu, Jacob C. Langer Source Type: journals

Imaging the DiaphragmEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article describes the normal and abnormal position, motion and morphology of the diaphragm, on chest radiography and fluoroscopy, as well as on computed tomography and magnetic resonance imaging. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Heidi C. Roberts Source Type: journals

Surgical Conditions of the Diaphragm: Anatomy and PhysiologyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews the anatomic components of the diaphragm, its pivotal role in respiration and in the gastroesophageal mechanism, and the surgical implications of the anatomic structuring. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Masaki Anraku, Yaron Shargall Source Type: journals

PrefaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The integrity and function of the diaphragm is essential to life because of its role in respiration. It is similar to the heart in that the muscle of the diaphragm must contract continuously throughout life. Any breach or dysfunction of the diaphragm may be a threat to life; hence, a thorough knowledge of the anatomy, physiology, and conditions of the diaphragm are essential to the practice of thoracic surgery. Thoracic surgeons must be able to repair or reconstruct the diaphragm when its integrity is breached by congenital abnormalities, acquired hernias, trauma, tumors, or surgical incisions. In acquired conditions that ...
Source: Thoracic Surgery Clinics - November 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Gail Darling Source Type: journals

Forthcoming IssuesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 1, 2009 Category: Cardiovascular & Thoracic Surgery Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 1, 2009 Category: Cardiovascular & Thoracic Surgery Source Type: journals

IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - August 1, 2009 Category: Cardiovascular & Thoracic Surgery Source Type: journals

Thoracic Surgery in the Elderly: Areas of Future Research and StudiesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Elderly patients (defined as those aged more than 75 years) require specialized care due to the problems associated with deteriorating organ function, minimal organ reserve, blunted responses to stress, and general overall frailty; however, careful, well-planned trials for elderly patients undergoing thoracic surgical procedures have been few, sporadic, and nebulous to date. With the help of the Council on Surgical and Related Medical Specialties of the American Geriatrics Society, a thorough review of the body of literature has been conducted and a research agenda has been defined. Important surgical issues remain to be d...
Source: Thoracic Surgery Clinics - August 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Joseph LoCicero, Jason Philip Shaw Source Type: journals

Quality of Life and Ethical Concerns in the Elderly Thoracic Surgery PatientEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
With the high burden of lung diseases in the elderly and the rapid aging of the population, thoracic surgeons increasingly will be confronted with the dilemmas that arise in caring for older persons. Providing the optimal treatment for older persons will involve carefully selecting those who have early-stage disease and who are fit for surgery and providing more limited resections to patients who are frailer. Age alone does not determine whether a patient will benefit from thoracic surgery with a reasonable quality of life. Providing appropriate treatment will require a more focused and geriatric-specific evaluation of eld...
Source: Thoracic Surgery Clinics - August 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Holly M. Holmes Source Type: journals

Thoracic Irradiation in the ElderlyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews radiation treatment of thoracic malignancies in elderly patients. In general the literature suggests that thoracic irradiation is equally efficacious in elderly patients as in younger patients and is associated with increased but acceptable toxicity. Technical advances are allowing a further reduction in morbidity with preliminary results suggestive of stable outcomes. Prospective data from elderly specific trials are needed to determine the optimal treatment of lung cancer and to compare innovative radiation technology with standard therapies. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - August 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Kristin J. Redmond, Danny Y. Song Source Type: journals

Chemotherapy in the Older Patient with Operable Non–Small Cell Lung Cancer: Neoadjuvant and Adjuvant RegimensEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Several excellent, non–age-specific review articles and meta-analyses summarize in detail the available trials of surgery and either induction or adjuvant therapy with or without local radiotherapy in the treatment of early non–small cell lung cancer (NSCLC). A detailed review of the literature on the comprehensive assessment of and chemotherapy in the elderly patient with NSCLC is beyond the scope of this article. Instead, the goal is to amalgamate the two topics and develop some practical guidelines to assist the clinician in deciding which therapies most are appropriate for older patients with potentially curable NS...
Source: Thoracic Surgery Clinics - August 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Ilene Browner, Michael Purtell Source Type: journals

Evaluation and Management of the Elderly Patient at Risk for Postoperative DeliriumEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Geriatric patients are at a high risk for the development of postoperative delirium. By recognizing predisposing and precipitating risk factors, preventive measures can be undertaken to reduce this risk. Accurate and timely diagnosis is essential, and we offer therapeutic strategies to help reduce the high morbidity and mortality of this important condition. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - August 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Anita S. Bagri, Alex Rico, Jorge G. Ruiz Source Type: journals

Postoperative Pain Management in the Elderly Undergoing Thoracic SurgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The management of postoperative pain in the elderly patient undergoing thoracic surgical procedures represents a significant challenge to health care providers. Compared with younger patients, the elderly patient generally is at higher risk for postoperative complications. Choice of postoperative analgesic regimens may influence perioperative morbidity, particularly in this high-risk group of patients. The available data suggest that use of regional analgesic techniques (ie, epidural and paravertebral catheters) is associated with a decrease in perioperative pulmonary complications. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - August 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Marie N. Hanna, Jamie D. Murphy, Kanupriya Kumar, Christopher L. Wu Source Type: journals

The Emerging Role of Minimally Invasive Surgical Techniques for the Treatment of Lung Malignancy in the ElderlyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
As a consequence of the general aging of the population, improved diagnostic techniques, and preoperative interventions to enhance the efficacy of surgical therapy, increasing numbers of elderly patients are presenting for pulmonary resection. Clear association between advanced age and the perioperative morbidity and mortality associated with lung cancer surgery has generated considerable interest in applying minimally invasive operative techniques in the geriatric population under the belief that this approach will improve outcome. This review examines the available data regarding video-assisted thoracoscopic lobectomy an...
Source: Thoracic Surgery Clinics - August 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Paul M. Heerdt, Bernard J. Park Source Type: journals

Resection for Esophageal Cancer in the ElderlyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article focuses on the impact of patient age on outcomes following esophageal resection and on potential strategies to improve perioperative management of geriatric patients undergoing esophagectomy for cancer. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - August 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Andrew C. Chang, Julia S. Lee Source Type: journals

Benign Esophageal Disease in the ElderlyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The diagnosis and management of benign esophageal disease in the elderly is not necessarily different from that in the general population; however, the comorbidities associated with an aging population are the critical factors that impact morbidity and mortality associated with treatment in this population. Some of the most minimal procedures, such as injection of botulism toxin, can be associated with significant morbidity because of the comorbidities in patients for whom a more invasive procedure is considered prohibitive. For most benign pathology of the esophagus, there are multiple treatment options. Selection of the ...
Source: Thoracic Surgery Clinics - August 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: M. Blair Marshall Source Type: journals

Benign Thoracic Disease in the ElderlyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Elderly patients present challenges in diagnosis and treatment of various disease processes. Although they may develop thoracic diseases seen in other age groups, older patients often have atypical presentations of these diseases, and may be vulnerable to thoracic pathology as a result of comorbid diseases. Pulmonary function testing of the elderly population shows increased ventilation-perfusion mismatch, decreased forced expiratory volumes, and decreased diffusion capacities. Combined with increased chest wall rigidity, decreasing muscle mass, impaired mucociliary clearance, blunted perception of dyspnea, and possible in...
Source: Thoracic Surgery Clinics - August 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Rita A. Mukhtar, Pierre R. Theodore Source Type: journals

Preoperative Evaluation and Risk Assessment for Elderly Thoracic Surgery PatientsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The elderly population is growing and increasingly presents for thoracic surgery evaluation. Advancing age has been shown to increase mortality after thoracotomy. Multidisciplinary improvements in perioperative care over the last decades have reduced this risk, making surgical intervention safe for selected patients. A targeted preoperative evaluation helps determine appropriate operative candidates and directs care toward measures to limit or prevent complications. Preoperative assessment in the elderly should include evaluation of cardiopulmonary reserve, comorbidities, and functional and cognitive status. Age alone shou...
Source: Thoracic Surgery Clinics - August 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Michael Jaklitsch, Sarah Billmeier Source Type: journals

Normal Changes of Aging and Their Impact on Care of the Older Surgical PatientEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Patients 65 years of age or older constitute a large part of the perioperative population. Because the older patient's physiology is unique, it is essential that health care providers recognize the normal physiology of aging and be able to differentiate normal changes of aging from those of pathology. The normal changes of aging result in the older patient presenting differently with specific care needs. Care to this older population must be individualized by providers who are familiar with geriatrics in order to enhance outcomes. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - August 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Deirdre M. Carolan Doerflinger Source Type: journals

ForewordEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The elderly population in the United States is growing in size and importance. According to the United States Census Bureau, the United States population that is aged 65 and older grew rapidly for most of the twentieth century, from 3.1 million in 1900 to 35.0 million in 2000. It comprised over 12 percent of the overall population in 2000. Except during the 1990s, the growth of the older population outpaced that of the total population and the population under the age of 65. Despite this apparent slowdown in the growth of the population aged 65 and older during the 1990s, the older population is on the threshold of a boom....
Source: Thoracic Surgery Clinics - August 1, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Mark K. Ferguson Source Type: journals

Forthcoming IssuesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - August 1, 2009 Category: Cardiovascular & Thoracic Surgery Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - August 1, 2009 Category: Cardiovascular & Thoracic Surgery Source Type: journals

IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 30, 2009 Category: Cardiovascular & Thoracic Surgery Source Type: journals

Update on Lung Transplantation for EmphysemaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Significant improvements in human lung transplantation have occurred since the first successful single lung transplant in 1983 and the first bilateral transplant in 1986. Despite improvements with donor selection, challenges remain in lung preservation, recipient prioritization, perioperative mortality, and long-term morbidity. In an effort to optimize the benefits derived from lung transplantation, the United Network for Organ Sharing (UNOS) recently reorganized the prioritization scheme by which potential recipients were listed. The focus of this article is to review the current status of lung transplantation for emphyse...
Source: Thoracic Surgery Clinics - April 30, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Chadrick E. Denlinger, Bryan F. Meyers Source Type: journals

Update on Donor Assessment, Resuscitation, and Acceptance Criteria, Including Novel Techniques—Non–Heart-Beating Donor Lung Retrieval and Ex Vivo Donor Lung PerfusionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The shortage of adequate organ donors remains a major challenge in clinical lung transplantation. Use of lungs from non–heart-beating donors has been used to increase the number of lung donors. By expanding the criteria for donor lung selection and by using novel approaches for lung assessment, it is anticipated that the rate of lung utilization will also improve. Ultimately, it is hoped that the repair of injured donor lungs ex vivo will further increase the rate of lung utilization to the point of meeting the demand. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 30, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Jonathan C. Yeung, Marcelo Cypel, Thomas K. Waddell, Dirk van Raemdonck, Shaf Keshavjee Source Type: journals

Endobronchial Treatment of Emphysema with One-Way ValvesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Numerous endoscopic procedures have recently been studied and progressively introduced in clinical practice to improve mechanics and function in patients who have emphysema. Bronchoscopic lung volume reduction with one-way endobronchial valves facilitates deflation of the most overinflated emphysematous parts of the lung. These valves have been designed to control and redirect airflow by preventing air from entering the target parenchymal area but allowing air and mucus to exit. The preliminary results have shown that this procedure is safe and effective at medium term in a selected group of patients. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 30, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Federico Venuta, Erino A. Rendina, Giorgio F. Coloni Source Type: journals

Treatment of Heterogeneous Emphysema Using the Spiration IBV ValvesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Ninety-eight emphysema patients were treated at 13 international sites during a 3-year series of single-arm, open-label studies with the IBV valve and a multi-lobar treatment approach. Fifty six percent of subjects had a clinically meaningful improvement in health-related quality of life, but standard pulmonary function and exercise studies were insensitive effectiveness measures. Quantitative CT analyses of regional lung changes showed lobar volume changes in over 85% of subjects. Lung volume reduction was an uncommon mechanism for a treatment response with bilateral upper lobe treatment. A redirection of inspired air, an...
Source: Thoracic Surgery Clinics - April 30, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Steven C. Springmeyer, Chris T. Bolliger, Thomas K. Waddell, Xavier Gonzalez, Douglas E. Wood, for the IBV Valve Pilot Trials Research Teams Source Type: journals

Airway Bypass Treatment of Severe Homogeneous Emphysema: Taking Advantage of Collateral VentilationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article provides an overview of airway bypass, outlining its concept, development, and experimental studies, and briefly describes the current multicenter, prospective, randomized, double-blind trial evaluating airway bypass, the Exhale Airway Stents for Emphysema (EASE) Trial. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 30, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Cliff K. Choong, Paulo F.G. Cardoso, Gerhard W. Sybrecht, Joel D. Cooper Source Type: journals

Decision Making in the Management of Secondary Spontaneous Pneumothorax in Patients with Severe EmphysemaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In patients who have advanced emphysema, development of a spontaneous pneumothorax can be a life-threatening event, warranting more aggressive management. Patients who have the most advanced stages of emphysema are at the highest risk to develop spontaneous pneumothoraces, have recurrences, and are the most difficult patients to treat. Early surgical intervention should be recommended for patients who have persistent or large air leaks or those who lack parietal-to-visceral pleural apposition after a trial of nonoperative management. Video-assisted thoracoscopy with resection of the offending bulla and pleurodesis or pleur...
Source: Thoracic Surgery Clinics - April 30, 2009 Category: Cardiovascular & Thoracic Surgery Authors: K. Robert Shen, Robert J. Cerfolio Source Type: journals

Intraoperative and Postoperative Management of Air Leaks in Patients with EmphysemaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article, after reviewing what is known about the epidemiology and clinical significance of air leaks, discusses the various techniques that may be employed to avoid the development of problematic air leaks and to manage them when they do occur. It reviews the data available on newer and more traditional options for the prophylaxis and management of air leaks and offers the authors' opinions about the optimal approaches in various clinical situations. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 30, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Joseph B. Shrager, Malcolm M. DeCamp, Sudish C. Murthy Source Type: journals

Combined Cardiac and Lung Volume Reduction SurgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This report reviews the evidence regarding combined cardiac surgery and LVRS to determine the optimal management strategy for patients who have severe emphysema and who are suitable for LVRS, but who also have coexisting significant cardiac diseases that are operable. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 30, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Cliff K. Choong, Ralph A. Schmid, Daniel L. Miller, Julian A. Smith Source Type: journals

Concomitant Lung Cancer Resection and Lung Volume Reduction SurgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article provides a review in this area and recommends surgical strategies in this group of patients who have concomitant lung cancer and severe emphysema. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 30, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Cliff K. Choong, Balakrishnan Mahesh, G. Alexander Patterson, Joel D. Cooper Source Type: journals

Lung Volume Reduction Surgery for Patients with Alpha-1 Antitrypsin Deficiency EmphysemaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Alpha-1 antitrypsin deficiency (A1AD) is a rare genetic disorder characterized by early-onset emphysema and, rarely, liver disease and vasculitis. In the lungs, unopposed and enhanced elastase activity results in accelerated parenchymal destruction leading to emphysematous changes predominantly in the lower lung fields. Medical treatment includes standard therapies for emphysema and so-called “augmentation therapy” using purified pooled plasma alpha-1 antitrypsin. Surgical options include lung transplantation and lung volume reduction surgery. The option of lung volume reduction surgery potentially provides palliation ...
Source: Thoracic Surgery Clinics - April 30, 2009 Category: Cardiovascular & Thoracic Surgery Authors: James M. Donahue, Stephen D. Cassivi Source Type: journals

Lung Volume Reduction Surgery in Nonheterogeneous EmphysemaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Lung volume reduction surgery (LVRS) is an established, successful, palliative surgical therapy for carefully selected patients with advanced emphysema. Although the experience with LVRS has grown over the last few years, the selection of patients suitable for LVRS is still a matter of controversy and differs between centers. Based on their own experience, the authors conclude that LVRS can also be recommended to selected symptomatic patients with advanced homogenous emphysema associated with severe hyperinflation, if diffusing capacity is not below 20% of predicted values and if the CT scan does not show aspects of vanish...
Source: Thoracic Surgery Clinics - April 30, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Walter Weder, Michaela Tutic, Konrad E. Bloch Source Type: journals

Staged Lung Volume Reduction Surgery—Rationale and ExperienceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The current convention is for bilateral one-stage lung volume reduction surgery. Unilateral surgery results in a symptomatic improvement in most patients. A staged approach to the second lung may reduce the risk of surgery and lead to a slower decline in physiologic improvement. The timing of the second operation can be influenced by the patient and the surgeon. The surgeon may be anxious to avoid the patient becoming inoperable because of excessive physiological decline or the patient succumbing to the inherent mortal risk of emphysema. The patient may be the best arbiter. The operation should be intended to improve his o...
Source: Thoracic Surgery Clinics - April 30, 2009 Category: Cardiovascular & Thoracic Surgery Authors: David Waller, Inger Oey Source Type: journals

The National Emphysema Treatment Trial: Summary and UpdateEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Emphysema is a chronic and debilitating disease in which affected patients must deal with diminished quality of life and poor functional status. Because contemporary medical therapy has had little impact on mortality rates, the National Emphysema Treatment Trial was designed to provide prospective randomized evidence for the efficacy of lung volume reduction surgery. This multicenter trial showed a mortality benefit and improved function in defined subgroups of patients based on the distribution of emphysema and baseline exercise tolerance. Patients with upper-lobe predominant disease and low exercise capacity achieved the...
Source: Thoracic Surgery Clinics - April 30, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Melanie A. Edwards, Stephen Hazelrigg, Keith S. Naunheim Source Type: journals

Update on Radiology of Emphysema and Therapeutic ImplicationsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article summarizes the current role of imaging in the assessment of patients who have emphysema. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 30, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Jonathan G. Goldin, Fereidoun Abtin Source Type: journals

The Epidemiology, Etiology, Clinical Features, and Natural History of EmphysemaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article presents the epidemiology, etiology, clinical features and natural history of emphysema. Emphysema is defined as abnormal, permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by the destruction of their walls and without obvious fibrosis. This destruction results in the loss of acinar structure, and a subsequent reduction in the area available for gas exchange. The associated loss of elastic tissue leads to small airway collapse and the gas trapping that is often a prominent feature of the disease. The burden of disease attributable to emphysema is significant and growing, and i...
Source: Thoracic Surgery Clinics - April 30, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Samuel V. Kemp, Michael I. Polkey, Pallav L. Shah Source Type: journals

Preface: Progress in the Surgical and Endoscopic Treatment of Emphysema: Where Are We Now?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Severe emphysema is a debilitating condition and, in a majority of the patients, is secondary to the effects of smoking. Patho-physiologically, there is destruction of alveolar walls, permanent enlargement of alveoli and alveolar ducts, damage to parenchymal tissues, reduced mechanical support of airways, and expiratory flow collapse. This leads to extensive gas trapping, severe hyperinflation, and a marked impairment of chest wall and diaphragmatic movements, resulting in impaired gas exchange and difficulty breathing. Clinically, patients present with increasing dyspnea after mild exertion or even at rest, and they becom...
Source: Thoracic Surgery Clinics - April 30, 2009 Category: Cardiovascular & Thoracic Surgery Authors: Cliff K. Choong Source Type: journals

Forthcoming IssuesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 30, 2009 Category: Cardiovascular & Thoracic Surgery Source Type: journals