Update on surgical and endoscopic management of emphysema:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2009
|
| Schriftenreihe: | Thoracic surgery clinics
19,2 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XVI, S. [149]-288 Ill., graph. Darst. |
| ISBN: | 9781437705522 1437705529 |
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Datensatz im Suchindex
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| adam_text | Titel: Update on surgical and endoscopic management of emphysema
Autor: Choong, Cliff K.
Jahr: 2009
Contents
Preface xiii
Cliff K.Choong
The Epidemiology, Etiology, Clinical Features, and Natural History of Emphysema 149
Samuel V. Kemp, Michael I. Polkey, and Pallav L. Shah
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 struc¬
ture, and a subsequent reduction in the area available for gas exchange. The asso¬
ciated 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 em¬
physema is significant and growing, and is a leading cause of disability in middle and
late life.
Update on Radiology of Emphysema and Therapeutic Implications 159
Jonathan G. Goldin and Fereidoun Abtin
Emerging treatments require appropriate CT targeting of a selected lobe or lobes
and target airways to obtain a successful response. CT scan is used in pretreatment
planning to select patients and plan treatment strategy and posttreatment to confirm
correct deployment of devices and assess treatment response. Increasingly treat¬
ments are being developed to treat patients who have emphysema who require ac¬
curate quantitation of extent and distribution of the process. Functional assessment
can be made by inference of detailed anatomic correlates and by direct measure¬
ment of regional function using dynamic scan protocols. This article summarizes
the current role of imaging in the assessment of patients who have emphysema.
The National Emphysema Treatment Trial: Summary and Update 169
Melanie A. Edwards, Stephen Hazelrigg, and Keith S. Naunheim
Emphysema is a chronic and debilitating disease in which affected patients must
deal with diminished quality of life and poor functional status. Because contempo¬
rary medical therapy has had little impact on mortality rates, the National Emphy¬
sema Treatment Trial was designed to provide prospective randomized evidence
for the efficacy of lung volume reduction surgery. This multicenter trial showed a mor¬
tality 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 most consistent
gains in survival, exercise capacity, and quality of live in the long term with lung vol¬
ume reduction surgery. Other subcategories of disease distribution and baseline ex¬
ercise tolerance had variable results with surgery, emphasizing the importance of
patient selection in achieving good outcomes.
Staged Lung Volume Reduction Surgery—Rationale and Experience 187
David Waller and IngerOey
The current convention is for bilateral one-stage lung volume reduction surgery. Uni¬
lateral surgery results in a symptomatic improvement in most patients. A staged ap¬
proach 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 influ¬
enced by the patient and the surgeon. The surgeon may be anxious to avoid the pa¬
tient 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 or her subjective assess¬
ment of health status; therefore, this parameter ultimately should determine the sur¬
gical schedule.
Lung Volume Reduction Surgery in Nonheterogeneous Emphysema 193
Walter Weder, MichaelaTutic, and Konrad E. Bloch
Lung volume reduction surgery (LVRS) is an established, successful, palliative sur¬
gical 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 associ¬
ated with severe hyperinflation, if diffusing capacity is not below 20% of predicted
values and if the CT scan does not show aspects of vanished lungs.
Lung Volume Reduction Surgery for Patients with Alpha-1 Antitrypsin
Deficiency Emphysema 201
James M. Donahue and Stephen D. Cassivi
Alpha-1 antitrypsin deficiency (A1AD) is a rare genetic disorder characterized by
early-onset emphysema and, rarely, liver disease and vasculitis. In the lungs, unop¬
posed and enhanced elastase activity results in accelerated parenchymal destruc¬
tion leading to emphysematous changes predominantly in the lower lung fields.
Medical treatment includes standard therapies for emphysema and so-called aug¬
mentation therapy using purified pooled plasma alpha-1 antitrypsin. Surgical op¬
tions include lung transplantation and lung volume reduction surgery. The option
of lung volume reduction surgery potentially provides palliation of dyspnea and
a bridge to lung transplantation.
Concomitant Lung Cancer Resection and Lung Volume Reduction Surgery 209
Cliff K. Choong, Balakrishnan Mahesh, G. Alexander Patterson, and Joel D. Cooper
Early-stage non-small cell lung cancer is best treated by complete anatomic resec¬
tion. Patients who have resectable lung cancer but associated advanced emphy¬
sema are often precluded from surgery because of severe respiratory limitation.
Certain highly selected patients who have clinically resectable lung cancer and se¬
vere respiratory limitation due to emphysema may have an acceptable operative risk
and functional improvements by combining a suitable cancer resection with lung
volume reduction surgery (LVRS). Several groups have evaluated their experience
of combined lung cancer resection and LVRS and have reported beneficial early
and long-term results. 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.
Combined Cardiac and Lung Volume Reduction Surgery 217
Cliff K. Choong, Ralph A. Schmid, Daniel L. Miller, andJulian A. Smith
Coronary artery disease is prevalent in patients who have severe emphysema and
who are being considered for lung volume reduction surgery (LVRS). Significant val¬
vular heart diseases may also coexist in these patients. Few thoracic surgeons have
performed LVRS in patients who have severe cardiac diseases. Conversely, few car¬
diac surgeons have been willing to undertake major cardiac surgery in patients who
have severe emphysema. This report reviews the evidence regarding combined car¬
diac 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 co¬
existing significant cardiac diseases that are operable.
Intraoperative and Postoperative Management of Air Leaks in Patients with Emphysema 223
Joseph B. Shrager, Malcolm M. DeCamp, and Sudish C. Murthy
Air leaks after pulmonary surgery represent a substantial clinical problem. When they
persist beyond a few days, air leaks appear to increase complications and costs.
Clearly, emphysema patients are those at greatest risk for developing problematic
air leaks. This article, after reviewing what is known about the epidemiology and clin¬
ical 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.
Decision Making in the Management of Secondary Spontaneous Pneumothorax
in Patients with Severe Emphysema 233
K. Robert Shen and Robert J. Cerfolio
In patients who have advanced emphysema, development of a spontaneous pneu¬
mothorax 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 dif¬
ficult patients to treat. Early surgical intervention should be recommended for pa¬
tients who have persistent or large air leaks or those who lack parietal-to-visceral
pleural apposition after a trial of nonoperative management. Video-assisted thoraco-
scopy with resection of the offending bulla and pleurodesis or pleurectomy also
should be considered to prevent recurrences in all patients with chronic obstructive
pulmonary disease who are safe operative candidates.
Airway Bypass Treatment of Severe Homogeneous Emphysema: Taking Advantage
of Collateral Ventilation 239
Cliff K. Choong, Paulo F.G. Cardoso, Gerhard W. Sybrecht, and Joel D. Cooper
Airway bypass is a new form of minimally invasive therapy for the treatment of ho¬
mogeneous emphysema. It is a bronchoscopic catheter-based therapy that forms
transbronchial extra-anatomic passages at the bronchial segmental or subsegmen-
tal level. The passages are expanded and supported and the patency is maintained
by paclitaxel drug-eluting airway bypass stents. 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.
Treatment of Heterogeneous Emphysema Using the Spiration IBV Valves 247
Steven C. Springmeyer, ChrisT. Bolliger, Thomas K.Waddell, Xavier Gonzalez,
and Douglas E.Wood
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 im¬
provement in health-related quality of life, but standard pulmonary function and ex¬
ercise 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 bi¬
lateral upper lobe treatment. A redirection of inspired air, an interlobar shift to health¬
ier lung tissue, was the most common mechanism for a valve treatment response.
Endobronchial Treatment of Emphysema with One-Way Valves 255
FedericoVenuta, ErinoA. Rendina, and Giorgio F. Coloni
Numerous endoscopic procedures have recently been studied and progressively in¬
troduced 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.
Update on Donor Assessment, Resuscitation, and Acceptance Criteria, Including Novel
Techniques—Non-Heart-Beating Donor Lung Retrieval and Ex Vivo
Donor Lung Perf usion 261
Jonathan C.Yeung, Marcelo Cypel, Thomas K.Waddell, Dirk van Raemdonck,
and Shaf Keshavjee
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 in¬
crease 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 do¬
nor lungs ex vivo will further increase the rate of lung utilization to the point of meet¬
ing the demand.
Update on Lung Transplantation for Emphysema 275
Chadrick E. Denlinger and Bryan F. Meyers
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 preser¬
vation, 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 emphysema, with attention given to current outcomes and
management strategies.
Index 285
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| spelling | Update on surgical and endoscopic management of emphysema guest ed.: Cliff K. Choong Philadelphia [u.a.] Saunders 2009 XVI, S. [149]-288 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Thoracic surgery clinics 19,2 Therapie (DE-588)4059798-2 gnd rswk-swf Lungenemphysem (DE-588)4036658-3 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Lungenemphysem (DE-588)4036658-3 s Therapie (DE-588)4059798-2 s DE-604 Choong, Cliff K. Sonstige (DE-588)138767971 oth Thoracic surgery clinics 19,2 (DE-604)BV019335438 19,2 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=017701589&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
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| title | Update on surgical and endoscopic management of emphysema |
| title_auth | Update on surgical and endoscopic management of emphysema |
| title_exact_search | Update on surgical and endoscopic management of emphysema |
| title_full | Update on surgical and endoscopic management of emphysema guest ed.: Cliff K. Choong |
| title_fullStr | Update on surgical and endoscopic management of emphysema guest ed.: Cliff K. Choong |
| title_full_unstemmed | Update on surgical and endoscopic management of emphysema guest ed.: Cliff K. Choong |
| title_short | Update on surgical and endoscopic management of emphysema |
| title_sort | update on surgical and endoscopic management of emphysema |
| topic | Therapie (DE-588)4059798-2 gnd Lungenemphysem (DE-588)4036658-3 gnd |
| topic_facet | Therapie Lungenemphysem Aufsatzsammlung |
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