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2881. What is 'minimally invasive' coronary bypass surgery? Experience with a variety of surgical revascularization procedures for single-vessel disease.
Although the use of small incisions is theoretically appealing, it has been argued that the true advantage of minimally invasive approaches to myocardial revascularization lies in the avoidance of cardiopulmonary bypass.
2882. Activation of eosinophils in the airways of lung transplantation patients.
Eosinophils are important inflammatory cells involved in liver and renal allograft rejection. The role of these cells is less well defined in lung allograft rejection. Eosinophils may be activated in lung rejection and release cytotoxic eosinophil cationic protein (ECP). Other states of disease in lung transplant recipients, such as cytomegalovirus (CMV) and bacterial infection, may also be associated with activated eosinophils. We postulated that ECP may be detectable and elevated in the airway lavage samples obtained from lung transplant patients and may contribute to disease pathogenesis.
2883. Dyspnea response following bilateral thoracoscopic staple lung volume reduction surgery.
作者: M Brenner.;R J McKenna.;A F Gelb.;R J Fischel.;B Yoong.;J Huh.;K Osann.;J C Chen.
来源: Chest. 1997年112卷4期916-23页
Lung volume reduction surgery (LVRS) has shown promise for treating patients with severe emphysema in recent clinical trials. However, response following surgery is difficult to assess due to frequent discrepancies between subjective and objective outcomes. We evaluated the relationship between improvement in dyspnea and pulmonary function response in 145 consecutive patients with inhomogeneous emphysema enrolled in a bilateral thoracoscopic lung volume reduction protocol in order to assess predictors of improved dyspnea outcome and correlation of subjective and objective improvement measures.
2884. Prognosis and quality of life after valve surgery in patients older than 75 years.
作者: O M Shapira.;R M Kelleher.;J Zelingher.;D Whalen.;C Fitzgerald.;G S Aldea.;R J Shemin.
来源: Chest. 1997年112卷4期885-94页
Assessment of quality of life has become an increasingly important aspect of the risk-benefit analysis of any therapeutic intervention, particularly in high-risk populations, such as the elderly.
2885. Bilateral sequential lung transplantation for pulmonary alveolar microlithiasis.
作者: J D Edelman.;J Bavaria.;L R Kaiser.;L A Litzky.;H I Palevsky.;R M Kotloff.
来源: Chest. 1997年112卷4期1140-4页
Pulmonary alveolar microlithiasis (PAM) is characterized by deposition of calcium phosphate within the alveolar airspaces. There is currently no effective medical therapy and affected individuals may progress to end-stage lung disease requiring transplantation. Two patients with PAM underwent bilateral sequential lung transplantation. This study reviews the clinical manifestations of PAM and discusses the particular difficulties that may be encountered in the use of lung transplantation as treatment for this uncommon disease. Also addressed is the question of recurrence in the allograft.
2886. A prospective, randomized comparison of an in-line heat moisture exchange filter and heated wire humidifiers: rates of ventilator-associated early-onset (community-acquired) or late-onset (hospital-acquired) pneumonia and incidence of endotracheal tube occlusion.
To compare the performance of an in-line heat moisture exchanging filter (HMEF) (Pall BB-100; Pall Corporation; East Hills, NY) to a conventional heated wire humidifier (H-wH) (Marquest Medical Products Inc., Englewood, Colo) in the mechanical ventilator circuit on the incidence of ventilator-associated pneumonia (VAP) and the rate of endotracheal tube occlusion.
2887. Innovative therapies for malignant pleural mesothelioma.
Therapy for malignant pleural mesothelioma is in a transitional stage. Recent trials of multimodality therapy for this disease suggest that selected patient subgroups may benefit from extensive treatment. This report discusses new approaches to the treatment of malignant pleural mesothelioma. Two case reports are presented.
2888. Multimodality therapy for esophageal cancer.
Over the past decade and a half, several strategies have been developed to improve the survival of patients with esophageal cancer. Two strategies employ either neoadjuvant chemotherapy or chemoradiotherapy followed by surgery to improve local-regional control and decrease the incidence of distant metastases. A third strategy uses nonsurgical therapy as definitive treatment for patients without metastatic disease. Single-institution pilot trials and randomized comparative trials have been conducted evaluating each approach. The rationale for these trials, results, and current recommendations are presented.
2889. Thoracoscopic management of descending necrotizing mediastinitis.
作者: J R Roberts.;W R Smythe.;R W Weber.;M Lanutti.;B R Rosengard.;L R Kaiser.
来源: Chest. 1997年112卷3期850-4页
Descending necrotizing mediastinitis (DNM) is a lethal process originating from odontogenic, pharyngeal, or cervical infectious sources that descends along fascial planes into the mediastinum. Despite earlier use of antibiotics and surgical drainage, the mortality (>50%) has changed little since the first large series reported in the preantibiotic era. The surgical management remains controversial, with support ranging from cervical drainage alone to cervical drainage and routine thoracotomy. We report a case of thoracoscopic drainage and debridement of a mediastinal abscess resulting from descending necrotizing mediastinitis. The decreased morbidity of this approach compared with posterolateral thoracotomy and the improved drainage of the mediastinum compared with cervical drainage support this method as an attractive management of patients with DNM.
2890. The effect of volume infusion on dead space in mechanically ventilated patients with severe asthma.
Mechanical ventilation of patients with severe asthma is associated with elevated airway pressures that may contribute to increased physiologic dead space. To our knowledge, no previous reports have considered the effect of intravascular volume status on dead space fraction. We herein describe three patients whose dead space decreased by a mean of 4.2% in response to intravascular volume expansion with 250 or 500 mL of normal saline solution administered as part of their routine treatment. No significant changes in CO2 production, minute volume, or airway pressures occurred over the time interval. We conclude with a brief discussion of potential mechanisms to explain these findings and their potential clinical application.
2891. The incidence of respiratory tract infection in adults requiring hospitalization for asthma.
Acute respiratory tract infections (RTI) are known to worsen asthma particularly in children. There are few studies in adults assessing the incidence of RTI in patients hospitalized with acute asthma.
2893. The effect of sepsis on breathing pattern and weaning outcomes in patients recovering from respiratory failure.
To determine the effects of sepsis on breathing pattern and weaning outcome in medical patients recovering from respiratory failure.
2894. DNA fingerprints from Mycobacterium tuberculosis isolates of patients confined for therapy noncompliance show frequent clustering.
To test the hypothesis that individuals chronically noncompliant with antituberculous chemotherapy are vectors for ongoing transmission of the disease in the community.
2895. Salmeterol reduces dyspnea and improves lung function in patients with COPD.
To investigate the short-term effects of inhaled salmeterol on the perception of dyspnea and lung function in patients with COPD.
2897. A consensus approach to diagnosing coronary artery disease based on clinical and exercise test data.
To demonstrate that a consensus approach for combining prediction equations based on clinical and exercise test variables derived from different populations can stratify patients referred for possible coronary artery disease (CAD) into low-, intermediate-, and high-risk groups.
2899. A prospective study of the safety of tracheal extubation using a pediatric airway exchange catheter for patients with a known difficult airway.
To determine the usefulness of routinely inserting a hollow airway exchange catheter (jet stylet) prior to tracheal extubation of adult patients with risk factors for difficult tracheal intubation.
2900. A symptom-based measure of the severity of chronic lung disease: results from the Veterans Health Study.
We developed a symptom-based measure of severity for chronic lung disease (CLD) that can be readily administered in ambulatory care settings and be used to supplement general health-related quality of life (HRQoL) assessments and pathophysiologic indicators in research and clinical care.
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