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Thoracic Surgery Clinics

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https://www.readbyqxmd.com/read/27865330/chest-drainage-management-where-are-we-now
#1
EDITORIAL
Pier Luigi Filosso
No abstract text is available yet for this article.
February 2017: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27865329/management-of-chest-drains-after-thoracic-resections
#2
REVIEW
Pier Luigi Filosso, Alberto Sandri, Francesco Guerrera, Matteo Roffinella, Giulia Bora, Paolo Solidoro
Immediately after lung resection, air tends to collect in the retrosternal part of the chest wall (in supine position), and fluids in its lower part (costodiaphragmatic sinus). Several general thoracic surgery textbooks currently recommend the placement of 2 chest tubes after major pulmonary resections, one anteriorly, to remove air, and another into the posterior and basilar region, to drain fluids. Recently, several authors advocated the placement of a single chest tube. In terms of air and fluid drainage, this technique demonstrated to be as effective as the conventional one after wedge resection or uncomplicated lobectomy...
February 2017: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27865328/errors-and-complications-in-chest-tube-placement
#3
REVIEW
Pier Luigi Filosso, Francesco Guerrera, Alberto Sandri, Matteo Roffinella, Paolo Solidoro, Enrico Ruffini, Alberto Oliaro
Chest drain placement is one of the most common surgical procedures performed in routine clinical practice. Despite the many benefits, chest tube insertion is not always a harmless procedure, and potential significant morbidity and mortality may exist. The aim of this article was to highlight the correct chest tube placement procedure and to focus on errors and clinical complications following its incorrect insertion into the chest.
February 2017: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27865327/indwelling-pleural-catheters-a-clinical-option-in-trapped-lung
#4
REVIEW
Luca Bertolaccini, Andrea Viti, Simona Paiano, Carlo Pomari, Luca Rosario Assante, Alberto Terzi
Malignant pleural effusion (MPE) symptoms have a real impact on quality of life. Surgical approach through video-assisted thoracic surgery provides a first step in palliation. In patients unfit for general anesthesia, awake pleuroscopy represents an alternative. Sclerosing agents can be administered at the bedside through a chest tube. Ideal treatment of MPE should include adequate long-term symptom relief, minimize hospitalization, and reduce adverse effects. Indwelling pleural catheter (IPC) allows outpatient management of MPE through periodic ambulatory fluid drainage...
February 2017: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27865326/when-to-remove-a-chest-tube
#5
REVIEW
Nuria M Novoa, Marcelo F Jiménez, Gonzalo Varela
Despite the increasing knowledge about the pleural physiology after lung resection, most practices around chest tube removal are dictated by personal preferences and experience. This article discusses recently published data on the topic and suggests opportunities for further investigation and future improvements.
February 2017: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27865325/suction-or-nonsuction-how-to-manage-a-chest-tube-after-pulmonary-resection
#6
REVIEW
Gaetano Rocco, Alessandro Brunelli, Raffaele Rocco
Despite several randomized trials and meta-analyses, the dilemma as to whether to apply suction after subtotal pulmonary resection has not been solved. The combination of a poorly understood pathophysiology of the air leak phenomenon and the inadequate quality of the published randomized trials is actually preventing thoracic surgeons from abandoning an empirical management of chest drains. Even digital systems do not seem to have made the difference so far. Based on the evidence of the literature, the authors propose a new air leak predictor score (ALPS) as a contributing step toward appropriateness in using intraoperative sealants, opting for an external suction and managing and chest tubes...
February 2017: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27865324/modern-techniques-to-insert-chest-drains
#7
REVIEW
Philip J McElnay, Eric Lim
Both physicians and surgeons insert chest drains by various techniques-including Seldinger and "wide-bore" methods. The indications include hemothorax, pneumothorax, pleural effusion, and postoperative care in thoracic surgery. Given their invasive nature, there is significant potential for complications; however, this can be minimized by following a meticulous technique, which is herein described for both Seldinger and "wide-bore" drain insertion.
February 2017: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27865323/chest-tube-management-after-surgery-for-pneumothorax
#8
REVIEW
Cecilia Pompili, Michele Salati, Alessandro Brunelli
There is scant evidence on the management of chest tubes after surgery for pneumothorax. Most of the current knowledge is extrapolated from studies performed on subjects with lung cancer. This article reviews the existing literature with particular focus on the effect of suction and no suction on the duration of air leak after lung resection and surgery for pneumothorax. Moreover, the role of regulated suction, which seems to provide some benefit in reducing pneumothorax recurrence after bullectomy and pleurodesis, is discussed...
February 2017: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27865322/thoracic-trauma-which-chest-tube-when-and-where
#9
REVIEW
Tamas F Molnar
Clinical suspicion of hemo/pneumothorax: when in doubt, drain the chest. Stable chest trauma with hemo/pneumothorax: drain and wait. Unstable patient with dislocated trachea must be approached with drain in hand and scalpel ready. Massive hemo/pneumothorax may be controlled by drainage alone. The surgeon should not hesitate to open the chest if too much blood drains over a short period. The chest drainage procedure does not end with the last stitch; the second half of the match is still ahead. The drained patient is in need of physiotherapy and proper pain relief with an extended pleural space: control the suction system...
February 2017: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27865321/chest-tubes-generalities
#10
REVIEW
Federico Venuta, Daniele Diso, Marco Anile, Erino A Rendina, Ilaria Onorati
Insertion, management, and withdrawal of chest tubes is part of the routine activity of thoracic surgeons. The selection of the chest tube and the strategy for each of these steps is usually built on knowledge, practice, experience, and judgment. The indication to insert a chest tube into the pleural cavity is the presence of air or fluid within it. Various types and sizes of chest tubes are now commercially available.
February 2017: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27692207/hyperhidrosis
#11
Peter B Licht
No abstract text is available yet for this article.
November 2016: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27692206/management-of-plantar-hyperhidrosis-with-endoscopic-lumbar-sympathectomy
#12
Roman Rieger
Primary plantar hyperhidrosis is defined as excessive secretion of the sweat glands of the feet and may lead to significant limitations in private and professional lifestyle and reduction of health-related quality of life. Conservative therapy measures usually fail to provide sufficient relieve of symptoms and do not allow long-lasting elimination of hyperhidrosis. Endoscopic lumbar sympathectomy appears to be a safe and effective procedure for eliminating excessive sweating of the feet and improves quality of life of patients with severe plantar hyperhidrosis...
November 2016: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27692205/facial-blushing-patient-selection-and-long-term-results
#13
Smidfelt Kristian, Drott Christer
Facial blushing, associated with social phobia, may have severe negative impact on the quality of daily life. The first line of treatment should be psychological and/or pharmacologic. In severe cases not responding to nonsurgical treatment, surgical sympathetic denervation is an option. A thorough disclosure of effects, complications, and side effects is mandatory and patient selection is crucial to obtain high patient satisfaction from surgical treatment.
November 2016: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27692204/less-common-side-effects-of-sympathetic-surgery
#14
Lyall A Gorenstein, Mark J Krasna
Because of video-assisted thoracic technology and increased patient awareness of treatment options for palmar hyperhidrosis, endoscopic thoracic sympathectomy (ETS) has become a well-accepted treatment for this disorder. Video assistance affords excellent visualization of thoracic anatomy, which allows the procedure to be done quickly with few complications. However, despite the ease of performing ETS, complications can occur unless thoracic anatomy and physiology are well-understood. Awareness of possible intraoperative and postoperative complications is essential if this procedure is gong to be performed safely...
November 2016: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27692203/management-of-compensatory-sweating-after-sympathetic-surgery
#15
Nelson Wolosker, José Ribas Milanez de Campos, Juliana Maria Fukuda
Compensatory hyperhidrosis (HH) is the most common and feared side effect of thoracic sympathectomy, because patients with severe forms have their quality of life greatly impaired. The most well-known factors associated with compensatory HH are extension of manipulation of the sympathetic chain, level of sympathetic denervation, and body mass index. Technical developments as well as the proper selection of patients for surgery have been crucial in reducing the occurrence of severe forms of compensatory HH. Therapeutic options include topical agents, botulinum toxin, systemic anticholinergics, clip removal, and sympathetic chain reconstruction, although the efficacy is not well-established for all the methods...
November 2016: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27692202/quality-of-life-changes-following-surgery-for-hyperhidrosis
#16
José Ribas Milanez de Campos, Hugo Veiga Sampaio da Fonseca, Nelson Wolosker
The best way to evaluate the impact of primary hyperhidrosis on quality of life (QL) is through specific questionnaires, avoiding generic models that do not appropriately evaluate individuals. QL improves significantly in the short term after sympathectomy. In the longer term, a sustained and stable improvement is seen, although there is a small decline in the numbers; after 5 and even at 10 years of follow-up it shows virtually the same numerical distribution. Compensatory hyperhidrosis is a major side effect and the main aggravating factor in postoperative QL, requiring attention to its management and prevention...
November 2016: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27692201/reconstruction-of-the-sympathetic-chain
#17
Cliff P Connery
There is a small subset of patients who have undergone endoscopic thoracic sympathectomy for hyperhidrosis or facial blushing who are dissatisfied and would wish reversal. Compensatory sweating is the most common side effect that causes a person to regret surgery. Treatment options are limited and usually not effective in patients with severe side effects from sympathectomy. Nerve graft interposition has been proven to be effective in experimental models and small clinical series. Da Vinci robotic nerve graft reconstruction with interposition graft and direct suturing of nerve and high magnification dissection most closely mirrors standard nerve reconstruction principles when done as a minimally invasive procedure...
November 2016: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27692200/reversibility-of-sympathectomy-for-primary-hyperhidrosis
#18
Conor F Hynes, M Blair Marshall
Endoscopic thoracic sympathectomy (ETS) is an effective treatment of primary hyperhidrosis of the face, upper extremities, and axillae. The major limitation is the side effect of compensatory sweating severe enough that patients request reversal in up to 10% of cases. When ETS is performed by cutting the sympathetic chain, reversal requires nerve grafting. However, for ETS done with clips, reversal is a simple thoracoscopic outpatient procedure of removing the clips. Subsequent reversal of the sympathectomy, ie, nerve regeneration, is successful in many cases...
November 2016: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27692199/targeting-the-sympathetic-chain-for-primary-hyperhidrosis-an-evidence-based-review
#19
Joel M Sternbach, Malcolm M DeCamp
Large case series and randomized trials over the past 25 years have consistently demonstrated thoracoscopic interruption of the sympathetic chain to be a safe and effective treatment of focal primary hyperhidrosis. The surgical technique has evolved toward less-invasive and less-extensive procedures in an effort to minimize perioperative morbidity and effectively balance postoperative compensatory sweating with symptomatic relief. This review summarizes available evidence regarding the surgical approach and the optimal level of interruption of the sympathetic chain based on a patient's presenting distribution of pathologic sweating...
November 2016: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27692198/selecting-the-right-patient-for-surgical-treatment-of-hyperhidrosis
#20
Alan Edmond Parsons Cameron
This article presents a personal view of the indications for surgical treatment of patients with hyperhidrosis based on long clinical experience. Endoscopic thoracic sympathectomy is the preferred opinion for palmar sweating. It is also useful when there is additional axillary sweating but is not the first choice for isolated armpit symptoms. Surgical treatment of craniofacial sweating is much more likely to be followed by undesirable side-effects.
November 2016: Thoracic Surgery Clinics
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