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Thoracic Surgery Clinics

journal
https://www.readbyqxmd.com/read/30054085/frederick-griffith-pearson-the-father-of-modern-thoracic-surgery
#1
EDITORIAL
Jean Deslauriers, Noriaki Tsubota
No abstract text is available yet for this article.
August 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/30054084/fundamentals-of-airway-surgery-part-ii
#2
EDITORIAL
Jean Deslauriers, Farid M Shamji
No abstract text is available yet for this article.
August 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/30054083/importance-of-a-team-effort-in-success-of-airway-surgery
#3
REVIEW
Farid M Shamji, Jean Deslauriers, Bill Nelems
The thoracic surgeon occupies a unique position in the team of those who are involved in looking after surgical patients in need of airway operations. It may be for urgent and life-threatening situations as in tracheo-vascular fistula or critical airway obstruction. Or it may be semiurgent in the intensive care unit in patients on assisted ventilation requiring tracheostomy (open or percutaneous). It may be elective for patients with tracheal stricture (benign or malignant), cervical exenteration, anterior mediastinal tracheostomy, and tracheo-bronchomalacia...
August 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/30054082/use-of-silicone-tubes-in-the-management-of-complex-airway-problems
#4
REVIEW
Joel D Cooper
Silicone airway stents are extremely useful for both temporary or long-term management of upper airway obstruction, especially in the proximal half of the trachea and in the subglottic region. They cannot migrate are well tolerated, relatively easy to manage, durable, and generally cause little or no injury to the underlying airway mucosa. They are particularly important as part of the management of subglottic strictures. For patients with postintubation tracheal or laryngotracheal stenosis they can be used to temporize for periods up to a year or two, until the patients' condition is optimal for proceeding with a resection or reconstruction...
August 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/30054081/cricothyroid-approach-for-emergency-access-to-the-airway
#5
REVIEW
Alejandro Bribriesco, G Alexander Patterson
Airway emergencies are life-threatening events that face providers of many different backgrounds. In cannot-intubate-cannot-ventilate situations, emergent access to the airway can be obtained through the cricothyroid membrane by cricothyroidotomy. The 3 main techniques are open, percutaneous, and needle cricothyroidotomy. To date, there is no compelling evidence demonstrating superiority of a particular approach. Ultimately, the method used for cricothyroidotomy should be based on the comfort and experience of the provider performing the procedure...
August 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/30054080/blunt-tracheobronchial-trauma
#6
REVIEW
Ealaf Shemmeri, Eric Vallières
This article provides an overview of current literature on blunt tracheobronchial injury, and discusses the presentation of tracheobronchial injuries in clinical and radiographic forms. A review of the current data on repair is provided with an outline of surgical management.
August 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/30054079/principles-of-urgent-management-of-acute-airway-obstruction
#7
REVIEW
Erkan Yildirim
Recognizing and acting early on airway compromise reduces morbidity and mortality in patients with airway obstruction. Causes include foreign bodies, toxic/hot fumes, difficult intubation, laryngeal spasm, and tumors. Before definitive control of the airway is possible, provide 100% oxygen with a tightly fitting mask to optimize body oxygen stores. Pulse oximetry is a poor indicator of airway compromise; a decreasing arterial hemoglobin oxygen saturation is a late sign of impending hypoxemia. Basic airway maneuvers improve the patency of an obstructed airway...
August 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/30054078/recognition-and-management-of-life-threatening-tracheovascular-fistulae-and-how-to-prevent-them
#8
REVIEW
Farid M Shamji, Jean Deslauriers, Bill Nelems
Formation of a fistula between trachea and a major artery or vein in the root of the neck threatens life quickly from combination of major external bleeding and hemorrhagic shock, and asphyxiation from flooding of the proximal airways with blood. This complication can occur after cervical tracheostomy open or percutaneous, tracheal resection, cervical exentration and anterior mediastinal tracheostomy, and laryngectomy. The recognition of its occurrence is clinical based on a high index of clinical suspicion...
August 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/30054077/management-of-malignant-tracheoesophageal-fistula
#9
REVIEW
Farid M Shamji, Richard Inculet
When a malignant fistula develops between esophagus and trachea, the underlying cancer is invariably incurable whether the primary site is in the esophagus or in the trachea. The frequent complication of this fistula is nonresolving aspiration pneumonia, either from ingestion or from backward flow of gastric contents into the esophagus. Pulmonary sepsis causes fatality in about 6 to 12 weeks if aspiration through the fistula is not treated quickly. The fistula develops in untreated esophageal cancer in approximately 5% to 15% of cases, lung cancer in less than 1% of cases, and tracheal cancer in 14...
August 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/30054076/management-of-acquired-benign-tracheoesophageal-fistulae
#10
REVIEW
Rajan Santosham
Acquired benign tracheoesophageal fistula is a rare and challenging clinical condition requiring the combined efforts of team management. Numerous causes have been documented, the most common of which are endotracheal and tracheostomy tube-related injuries. The classic clinical presentation is a persistent and intense cough following deglutition. It is confirmed by endoscopic procedures on the aerodigestive tracts, and graphic displays of the fistula can be obtained from images obtained from contrast studies...
August 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/30054075/experiences-with-prosthetic-airway-replacement
#11
REVIEW
Jean Deslauriers, Nicolas Aubrée, Farid M Shamji
Prosthetic airway reconstruction is seldom indicated in modern airway surgery because more than one-half the trachea can now be safely resected and the trachea be primarily reconstructed. In addition, an ideal prosthesis has yet to be developed with the use of those currently available being often associated with major morbidities and poor long-term outcomes. Recent developments in tracheal transplantation or tissue engineering strategies that promote and accelerate epithelial repair by controlling cell organization remains experimental, but showing great promise...
August 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/30054074/management-of-bronchial-complications-after-lung-transplantation-and-sequelae
#12
REVIEW
Andrés Varela, Lucas Hoyos, Alejandra Romero, José Luis Campo-Cañaveral, Silvana Crowley
Airway complication (AC) after lung transplant, although rare nowadays, leads to increased costs, greater morbidity, and decreased quality of life of patients. Over the years, many risk factors have been described, ranging from surgical technique to immunosuppressive regimen. There are essentially 6 major airway complications (necrosis/dehiscence, infection, bronchial stenosis, granulomas, tracheo-bronchomalacia, and fistula) all of which require a multidisciplinary approach based on the performance status of patients...
August 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/30054073/pathophysiology-and-predictors-of-bronchial-complications-after-lung-transplantation
#13
REVIEW
John H Dark
Bronchial anastomotic breakdown was a major complication in the early days of lung transplantation. Their solution, achieved through an understanding of airway ischemia from the laboratory, was key to the initial clinical success. Subsequently, risk factors, such as prolonged ventilation in both donor and recipient, primary graft dysfunction, and recipient age, have emerged. Innovations, such as local tissue wrapping, telescoping the anastomosis, and bronchial artery revascularization, have not stood the test of time...
August 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/30054072/autologous-tracheal-replacement-surgical-technique-and-outcomes
#14
REVIEW
Olaf Mercier, Frédéric Kolb, Philippe G Dartevelle
Finding a good and durable substitute to trachea and proximal airways has remained the holy grail for thoracic surgeons for many decades. Autologous tracheal reconstruction using armed forearm free flap with rib cartilage achieved satisfactory results in managing extended tracheal lesions without the need for synthetic materials or immunosuppression. This well-vascularized and rigid neo trachea limits postoperative airway collapse, mediastinal infection, and ischemic airway issues, and achieves long-term functional benefit and prolonged survival...
August 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/30054071/tracheal-transplantation-state-of-the-art-and-key-role-of-blood-supply-in-its-success
#15
REVIEW
Pierre Delaere, Toni Lerut, Dirk Van Raemdonck
The trachea is one of the most difficult organs to transplant because its segmental blood supply involves blood vessels that are too small to allow for microvascular anastomosis. Through an ingenious sequence of revascularization and wound-healing mechanisms under temporary immunosuppression, the authors have developed a tracheal allotransplantation technique that allows the creation of a true chimeric trachea. The donor component of this chimeric trachea is tolerated permanently based on immune ignorance. This technique holds great promise for the development of a standardized approach for the repair of large tracheal defects...
August 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/30054070/management-of-postpneumonectomy-bronchopleural-fistula-from-thoracoplasty-to-transsternal-closure
#16
REVIEW
Alejandro Bribriesco, G Alexander Patterson
Development of postpneumonectomy empyema with bronchopleural fistula is a life-threatening condition that requires prompt action. Although measures should be taken to prevent bronchopleural fistula at time of pneumonectomy, many patients experience this complication. Management focuses on drainage of the pleural space, control of the pleural infection including repair of the bronchopleural fistula, and obliteration of the residual pleural cavity. Multiple techniques and procedures have been developed over time to achieve these goals...
August 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/30054069/carinal-pneumonectomy
#17
REVIEW
Reza Mehran, Jean Deslauriers
Carcinoma of the lung can involve the carina. Resection then encompasses resection of the lung with the carina. Success of this complex procedure is based on careful selection of patients, judicious use of multimodality therapies, and expert multidisciplinary care. Selection of patients is based on staging of the cancer and an evaluation of their cardiopulmonary reserve. The surgery must aim at removing all of the malignancy and nodes. The anastomosis must be tension free and buttressed with a vascularized pedicled flap...
August 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/30054068/carinal-resection-and-reconstruction
#18
REVIEW
Tadeusz M Orlowski, Dariusz Dziedzic
The carinal resection is still considered a real challenge, both for a thoracic surgeon and an anesthesiologist. Depending on the indications and the degree of local advancement of the neoplasm, there are 2 techniques of carinal resection and reconstruction. The first one consists of the isolated resection with formation of a new bifurcation, whereas the second one is a combination of anatomic resection of lung parenchyma together with the bifurcation and the subsequent reconstruction. Long-term outcomes after carinal resection procedures, with clear postoperative margins, depend to a large extent on the stage of advancement of the primary disease...
August 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/30054067/bronchoplasties-at-the-segmental-level
#19
REVIEW
Yasuhiro Tsutani, Morihito Okada
Although there is insufficient information in the literature on atypical bronchoplasties, these procedures can be performed on centrally located benign or low-grade malignant tumors or advanced lung cancer at the hilum. In particular, sleeve segmentectomy is performed for low-grade malignant tumors and early lung cancer at the hilum; extended sleeve lobectomy is performed for advanced lung cancer at the hilum; and segmental bronchial sleeve resection is performed for benign or low-grade malignancies. These procedures should be performed after strict evaluation of the lymph node status and bronchial margins using intraoperative frozen section analysis...
August 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/30054066/extended-sleeve-resection-for-lung-cancer
#20
REVIEW
Kenji Suzuki
The bronchoplastic procedure is feasible for lung cancer. However, in modern thoracic surgery, the numbers of the procedure are decreasing. To avoid pneumonectomy, thoracic surgeons should be familiar with sleeve resection and vascular reconstruction for thoracic malignancy. Extended sleeve resection is the resection of more than one lobe with the bronchoplastic procedure, which was reported in 1999. Extended sleeve resection is technically demanding, but the procedure should be one of the options to preserve lung function...
August 2018: Thoracic Surgery Clinics
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