Chest Surgery Clinics of North America (Chest Surg Clin )

Publisher: Elsevier

Description

Each issue of Chest Surgery Clinics reviews new diagnostic and management techniques for a single clinical problem--and makes them simple to apply. Its concise, comprehensive, and its editors and authors are respected experts.

  • Impact factor
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  • 5-year impact
    0.00
  • Cited half-life
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  • Immediacy index
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  • Eigenfactor
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  • Article influence
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  • Website
    Chest Surgery Clinics website
  • Other titles
    Chest surgery clinics of North America
  • ISSN
    1052-3359
  • OCLC
    22252779
  • Material type
    Periodical, Internet resource
  • Document type
    Journal / Magazine / Newspaper, Internet Resource

Publisher details

Elsevier

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Voluntary deposit by author of pre-print allowed on Institutions open scholarly website and pre-print servers
    • Voluntary deposit by author of authors post-print allowed on institutions open scholarly website including Institutional Repository
    • Deposit due to Funding Body, Institutional and Governmental mandate only allowed where separate agreement between repository and publisher exists
    • Set statement to accompany deposit
    • Published source must be acknowledged
    • Must link to journal home page or articles' DOI
    • Publisher's version/PDF cannot be used
    • Articles in some journals can be made Open Access on payment of additional charge
    • NIH Authors articles will be submitted to PMC after 12 months
    • Authors who are required to deposit in subject repositories may also use Sponsorship Option
    • Pre-print can not be deposited for The Lancet
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: The concept of nonresectional LVRS appears to be highly promising. Several strategies and approaches are currently available; however, the investigations to date are still just studies, and there remain many unanswered questions. No doubt new modifications and improvements in design will occur and these devices will continue to evolve. Appropriate patient selection is, as always, the key to good outcome. The studies so far have included only patients who have heterogenous disease; whether or not the procedures can be helpful for patients who have homogenous distribution of emphysema remains to be seen. Radioactive isotope scans are currently being used in an attempt to identify patients who have significant collateral flow, and these scans might eventually be useful in selecting patients who are unlikely to benefit from this approach. The preliminary data remain encouraging and suggest that a larger study with long-term follow-up care is warranted.
    Chest Surgery Clinics of North America 12/2003; 13(4):739-53.
  • [Show abstract] [Hide abstract]
    ABSTRACT: LVRS represents a valid surgical option for a limited number of patients who have symptomatic emphysema. The results of recent controlled studies have provided a realistic view of LVRS outcomes and yielded a validated algorithm for selection of optimal candidates for surgery. Furthermore, the NETT has provided simultaneously collected cost data that have provided a unique view of the costs and benefits of LVRS in patients who have advanced emphysema. Additional data collection will better define the long-term benefits of such surgical intervention in patients who have COPD.
    Chest Surgery Clinics of North America 12/2003; 13(4):669-85.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Lung volume reduction surgery (LVRS) is a costly new procedure that could influence quality of life and survival for persons who have severe emphysema. This article reviews the history of LVRS from an economic and policy perspective and provides estimates of the cost effectiveness of LVRS derived from the National Emphysema Treatment Trial, a recently completed multicenter evaluation of LVRS, compared with medical care. Estimates of the potential impact of LVRS on the national health care budget are provided. The high cost and uncertainty regarding the long-term cost effectiveness of LVRS warrant further evaluation after public and private health insurers make coverage decisions for this procedure, particularly if it is adopted as part of the standard of care.
    Chest Surgery Clinics of North America 12/2003; 13(4):727-38, vii-viii.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patient selection remains one of the most important aspects of successful surgery for bullous disease. Operation is indicated for patients who have incapacitating dyspnea with large bullae that fill more than 30% of the hemithorax and result in the compression of healthy adjacent lung tissue. Operation is also indicated for patients who have complications related to bullous disease such as infection or pneumothorax. Patients who have bullous disease in the presence of diffuse lung disease (emphysematous or nonemphysematous) should be evaluated on an individual basis and surgery should be performed on patients in whom even a small increase in pulmonary function might be of major benefit. Smoking cessation and outpatient pulmonary rehabilitation are required of all patients preoperatively. Patients should undergo PFTs including lung volumes by whole body plethysmography, spirometry, diffusion capacity, and arterial blood gas. CT remains the most important preoperative evaluation because it is useful assessing the extent of bullous disease and the quality of the surrounding lung tissue. The authors favor a minimally invasive technique through VATS whenever possible because it might allow for a quicker recovery and might be associated with less pain than is seen following thoracotomy. Modified Monaldi-type drainage procedures are also effective, especially in high-risk patients who cannot tolerate excisional procedures. Special care must be taken to avoid sacrifice of any potentially functional lung tissue. Lobectomies should be avoided whenever possible. The best results are seen in limited resections of large bullae that spare all surrounding functional pulmonary parenchyma. Postoperative complications are minimized through aggressive tracheobronchial toilet and vigorous chest physiotherapy. Adequate pain control in maintained throughout the postoperative period, initially by way of epidural infusion of morphine or fentanyl and later through oral opioids. Early ambulation and pulmonary rehabilitation also help minimize complications.
    Chest Surgery Clinics of North America 12/2003; 13(4):631-49.
  • [Show abstract] [Hide abstract]
    ABSTRACT: LVRS provides an exciting opportunity for palliation of symptoms and improvement in quality of life for patients who have severe end-stage emphysema. Because no medical therapy has been able to improve pulmonary function or reverse the inexorable decline of breathless patients who have emphysema, this opportunity to improve lung function and quality of life is one of the most innovative additions to thoracic surgery since the first successful lung transplant procedure 20 years ago. Although initial short-term, case-controlled surgeries were criticized because of incomplete and short follow-up care, substantial long-term data now exist to support the use of LVRS for select patients who have severe emphysema. Patients who have upper lobe predominant disease or low exercise capacity are more likely to have a benefit in exercise capacity and quality of life after LVRS. Selected patients who have upper lobe emphysema and poor exercise capacity are also more likely to have improved survival after LVRS. The individual contributions by the large number of investigators pioneering LVRS development, along with the collective contributions of the NETT investigators, have propelled the knowledge surrounding LVRS far beyond that of any similar new technology or procedure in its adolescence.
    Chest Surgery Clinics of North America 12/2003; 13(4):709-26.
  • [Show abstract] [Hide abstract]
    ABSTRACT: LVRS has greater morbidity than most general thoracic surgical procedures. Proper care of patients after LVRS is a labor-intensive activity, but it is worthwhile because LVRS can be performed with acceptable risk. Patient selection, postoperative care, and an understanding of the potential complications are the keys to successful LVRS.
    Chest Surgery Clinics of North America 12/2003; 13(4):701-8.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Recent advances in the treatment of patients who have COPD include the development of long-acting bronchodilators, recognition of the benefits of ICS, and development of effective initiation and maintenance pulmonary rehabilitation programs. The focus on outcome parameters other than expiratory flow rates, such as symptoms, quality of life, exercise tolerance, and exacerbation frequency, might also allow effective development of novel disease-modifying agents.
    Chest Surgery Clinics of North America 12/2003; 13(4):615-29.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The history of surgery for emphysema is filled with numerous surgical attempts to improve the disorder. Although many of these procedures have proved to be futile, lung volume reduction surgery has now arrived. This article outlines the progression of procedures and the logic for which they were thought to be of benefit.
    Chest Surgery Clinics of North America 12/2003; 13(4):583-8, v.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Current research is providing new understanding in the pathophysiology of emphysema, and this knowledge will be translated in finding better modalities of therapy for patients currently affected by COPD. The single best effort that can alter the course of COPD is promoting policies to remove smoking as an available option to young people, before they become addicted and thus prey of tobacco-producing companies. Landmark studies like NETT and the GOLD initiative are providing tool classify emphysema in the context of physiological criteria and possible therapeutic alternatives.
    Chest Surgery Clinics of North America 12/2003; 13(4):589-613.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Great strides have been made in lung transplantation in the past two decades. Changes in technique, immunosuppression regimens, and treatment of infectious complications have led to improvements in survival and functional results. Current areas of discussion concern the use of single lung transplantation versus bilateral sequential lung transplantation and the criteria for allocating donor lungs. This article reviews the current state of lung transplantation for emphysema and provides insight from more than one decade of experience with Washington University's lung transplant program.
    Chest Surgery Clinics of North America 12/2003; 13(4):651-67, vi.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Recently, LVRS has received renewed public interest. Various surgical approaches and techniques exist, and each has challenges, advantages, and disadvantages. Stapled techniques have been used more commonly than plication techniques or lasers. The choice of staple buttressing material has not been shown to affect outcome. For most patients who are suitable for LVRS, a bilateral procedure is appropriate. Minimally invasive techniques are gaining in popularity and have demonstrated good results. Of the approaches discussed above, bilateral thoracoscopy in the supine position is likely to be the most expeditious with the lowest incision-related morbidity and dysfunction.
    Chest Surgery Clinics of North America 12/2003; 13(4):687-700.
  • Chest Surgery Clinics of North America 11/2003; 13(4):xi–xii.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Over the past decade, improvements in the technique of lung preservation have led to significant reduction in the incidence of ischemia-reperfusion-induced lung injury after lung transplantation. The challenge remains to improve the number of donor lungs available for transplantation. While the number of patients on the waiting list is constantly increasing, only 10% to 30% of donor lungs are currently being used for transplantation. Hence, the development of new strategies to assess, repair, and improve the quality of the lungs could have a tremendous impact on the number of transplants performed. In addition, an improved understanding of the mechanisms involved in lung preservation might help elucidate the potential link between acute lung injury and chronic graft dysfunction. In the future, genetic analysis using novel technologies such as microarray analysis will help researchers determine which genes control the injury seen in the transplantation process. Hopefully, this information will provide new insights into the mechanisms of injury and reveal potential new strategies and targets for therapies to improve lung preservation.
    Chest Surgery Clinics of North America 09/2003; 13(3):443-62.
  • [Show abstract] [Hide abstract]
    ABSTRACT: BOS remains a difficult problem to control following lung transplantation, largely because of uncertainties regarding the underlying mechanisms that are responsible for it. Continued work on the pathogenesis of BOS is essential. The progressive nature and poor outlook when BOS stage 3 is reached indicates that current strategies should be focused on prevention and early intervention. There is a great need for randomized, controlled trials on intervention if the international transplant community is to make progress in this area.
    Chest Surgery Clinics of North America 09/2003; 13(3):543-57.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although cadaveric transplantation remains the preferred option for patients who have end-stage lung disease, living lobar transplantation provides organ availability that can be life saving in severely ill pediatric and adult patients who will either die or become unsuitable recipients before a cadaveric organ becomes available. In addition, living lobar transplantation provides acceptable long-term survival when compared with recipients of cadaveric grafts; however, because this procedure presents risks to two healthy donors, appropriate recipient and donor selection and timing of transplantation are critical to minimize the morbidity to the donor and maximize the chance of a successful outcome in the recipient. The results of the authors' experience have demonstrated that the donor procedure is safe, well tolerated physiologically, and that the great majority of donors are extremely satisfied with their decision to donate. Although there have been no deaths in the donor cohort, a risk of death between 0.5% to 1% should be quoted pending further data. These encouraging results are important if this procedure is to be considered as an option at more pulmonary transplant centers in view of the institutional, regional, and intra- and international differences in the philosophical and ethical acceptance of the use of live organ donors for transplantation.
    Chest Surgery Clinics of North America 09/2003; 13(3):505-24.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Lung transplantation usually provides prolongation and marked improvement in quality of life in patients who would otherwise die from end-stage pulmonary disease. Many questions remain unanswered and important deterrents exist to long-term survival of these patients. Included in the list of challenges for the future are (1) means of increasing the donor pool by better donor identification, (2) use of adjunctive therapies that might not only enhance the quality of preservation but also extend the safe period of ischemia. (3) innovative strategies such as use of non-heart-beating donors and living donor lung transplantation, and (4) research into the prevention and treatment of OB. While gene therapy and other interventions are important opportunities on the horizon that might eventually preclude the need for transplantation, optimizing our current understanding of lung transplantation provides the only survival opportunity for patients who are incapacitated with a variety of terminal lung diseases. The spectrum of diseases being treated and the potential for rehabilitation not only separates pediatric lung transplant recipients from their adult counterparts, it also provides unique challenges and opportunities in what is a fascinating patient population.
    Chest Surgery Clinics of North America 09/2003; 13(3):485-504.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The technical aspects of lung transplantation have been refined over the past two decades. Anomalous donor anatomy and suboptimal harvests do not preclude transplantation, but they must be appropriately dealt with to ensure good outcomes. New techniques have been developed to increase the donor pool. Techniques for recipient pneumonectomy and graft implantation have been optimized, and ways of dealing with difficult exposures and anatomic variants have been designed. Novel methods for prevention of ischemia-reperfusion injury have been developed based on experimental studies, but more complete clinical scrutiny is needed to determine their impact.
    Chest Surgery Clinics of North America 09/2003; 13(3):463-83.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The demand for donor lungs currently exceeds the supply of suitable grafts by a significant margin. Legal backgrounds and organizational and logistic issues are of major impact on the available donor pool. Re-evaluation of the donor criteria currently in use and new, innovative approaches such as living donor lung transplantation and non-heart-beating donation will hopefully contribute to improve this situation and reduce waiting time and waiting list mortality.
    Chest Surgery Clinics of North America 09/2003; 13(3):429-42.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Since international recommendations for lung transplant recipients were made in 1998, newer tools for predicting mortality in patients who have end-stage lung disease have been investigated. This article reviews studies for predicting mortality in obstructive, restrictive, pulmonary vascular, and suppurative/bronchiectatic lung disease. Newer considerations for alternative treatments, postoperative risks, and contraindications are also examined. The article aims to provide more accurate data for selecting patients who will benefit from lung transplantation.
    Chest Surgery Clinics of North America 09/2003; 13(3):405-28, v.
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    ABSTRACT: Acute rejection remains a significant problem after lung transplantation. While it generally is a treatable condition, significant resources and therapies are directed toward its prevention and resolution. Its larger significance undoubtedly rests in its contribution to the pathogenesis of BOS. Significant questions regarding the origins of AR, the role of LBB, alternative histologic appearances of acute allograft injury, and optimal therapy remain. Controversy regarding the utility of surveillance bronchoscopy and preemptive treatment of occult AR persists because of lack of conclusive evidence. Future investigations might resolve these matters and provide more efficacious and less toxic therapies that will hopefully reduce the impact of chronic rejection and improve long-term outcomes.
    Chest Surgery Clinics of North America 09/2003; 13(3):525-42.

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