Chest Surgery Clinics of North America (Chest Surg Clin)

Publisher: Elsevier

Journal 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.

Current impact factor: 0.00

Impact Factor Rankings

Additional details

5-year impact 0.00
Cited half-life 0.00
Immediacy index 0.00
Eigenfactor 0.00
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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


  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Authors pre-print on any website, including arXiv and RePEC
    • Author's post-print on author's personal website immediately
    • Author's post-print on open access repository after an embargo period of between 12 months and 48 months
    • Permitted deposit due to Funding Body, Institutional and Governmental policy or mandate, may be required to comply with embargo periods of 12 months to 48 months
    • Author's post-print may be used to update arXiv and RepEC
    • Publisher's version/PDF cannot be used
    • Must link to publisher version with DOI
    • Author's post-print must be released with a Creative Commons Attribution Non-Commercial No Derivatives License
    • Publisher last reviewed on 03/06/2015
  • Classification

Publications in this journal

  • [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. DOI:10.1016/S1052-3359(03)00092-9
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    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. DOI:10.1016/S1052-3359(03)00097-8
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    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. DOI:10.1016/S1052-3359(03)00101-7
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    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. DOI:10.1016/S1052-3359(03)00098-X
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    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. DOI:10.1016/S1052-3359(03)00099-1
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    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. DOI:10.1016/S1052-3359(03)00091-7
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    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. DOI:10.1016/S1052-3359(03)00094-2
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    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. DOI:10.1016/S1052-3359(03)00100-5
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    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. DOI:10.1016/S1052-3359(03)00095-4
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    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. DOI:10.1016/S1052-3359(03)00093-0

  • Chest Surgery Clinics of North America 11/2003; 13(4):xi–xii. DOI:10.1016/S1052-3359(03)00102-9
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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. DOI:10.1016/S1052-3359(03)00056-5
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    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. DOI:10.1016/S1052-3359(03)00058-9
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    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. DOI:10.1016/S1052-3359(03)00057-7
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    ABSTRACT: The continued and growing success of lung allotransplantation has intensified the worldwide shortage of donor organs. Yet, xenotransplantation remains a daunting challenge. Additional molecular incompatibilities and unforeseen complications will continue to be discovered. Progress has been made, notably on the generation of alpha-Gal double knockout pigs. Progressive increases in organ survival times have been seen for most organs after significant investments of time and money. The lung continues to be an organ with the lowest supply of cadaveric donors and the least potential for expanded living donation or mechanical alternatives. As such, the impetus for xenotransplantation is strong. The lung appears to be exquisitely sensitive to xenograft rejection and resistant to strategies that have been moderately successful in other organs. A complex program involving genetically modified donor organs, recipient preparation for antibody removal or tolerance promotion, and multitargeted drug therapy will likely be required for successful clinical application.
    Chest Surgery Clinics of North America 09/2003; 13(3):559-76. DOI:10.1016/S1052-3359(03)00054-1
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    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. DOI:10.1016/S1052-3359(03)00059-0
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    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. DOI:10.1016/S1052-3359(03)00053-X
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    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.
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    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. DOI:10.1016/S1052-3359(03)00051-6