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New treatment modalities for end-stage emphysema
Emphysema, which is related to smoking, represents a major health threat worldwide. It is estimated that in the United States alone there are approximately 2 million adults who have emphysema , and in the year 2000 a total of 16,700 people died from this condition , making this condition, together with other chronic lower respiratory illnesses, one of the top 15 causes of death in that year. Approximately $2.5 billion annually are spent on the treatment of emphysema and its related complications . (Source: Chest Surgery Clinics of North America)
Source: Chest Surgery Clinics of North America - November 1, 2003 Category: Cardiovascular & Thoracic Surgery Authors: Thomas M.T Hwong, Anthony P.C Yim Source Type: research

Cost effectiveness of lung volume reduction surgery
Lung-volume–reduction surgery (LVRS) is a treatment for patients who have severe emphysema. Originally developed in the 1950s, the procedure was abandoned because of excessive rates of complications—primarily air leaks—in patients undergoing the procedure. Advances in surgical techniques led to a resurgence of LVRS in the 1990s; however, methodological limitations of early evaluations of this procedure created uncertainties about its efficacy and concerns about the implications of rapid diffusion of an unproven technology . Although rarely stated explicitly in the early years of its development, economics has always ...
Source: Chest Surgery Clinics of North America - November 1, 2003 Category: Cardiovascular & Thoracic Surgery Authors: Scott D. Ramsey Source Type: research

Results of lung volume reduction surgery for emphysema
Over the last century a number of surgical interventions have been proposed to improve the symptoms and quality of life in patients who have severe emphysema. Costochondrectomy and thoracoplasty were performed in an attempt to alter the configuration of the chest cavity, and phrenic nerve ablation or induced pneumoperitoneum were attempted to restore the curvature of the diaphragm. Numerous efforts were made to treat the airway component of chronic obstructive pulmonary disease using airway de-enervation procedures or prosthetic devices to support the membranous trachea. Improvement of pulmonary blood flow was the intent o...
Source: Chest Surgery Clinics of North America - November 1, 2003 Category: Cardiovascular & Thoracic Surgery Authors: Douglas E Wood Source Type: research

Complications after lung volume reduction surgery
Lung volume reduction surgery (LVRS) is associated with greater morbidity and mortality than the majority of general thoracic surgical operations. Although some centers performing LVRS had good results and acceptable morbidity in 1994 to 1995 , the high rates of morbidity and mortality at other centers led Medicare to stop coverage for the procedure. The results of the National Emphysema Treatment Trial (NETT) show that the procedure can be performed with acceptable morbidity and mortality. (Source: Chest Surgery Clinics of North America)
Source: Chest Surgery Clinics of North America - November 1, 2003 Category: Cardiovascular & Thoracic Surgery Authors: Robert J McKenna Source Type: research

Operative techniques for lung volume reduction surgery
The first lung volume reduction procedure described by Brantigan was performed unilaterally via thoracotomy . The technique was difficult and was associated with high postoperative morbidity and mortality rates. Using a modified technique based on the same principles, Cooper demonstrated significantly improved results . Since then, it has become apparent that the outcome of lung volume reduction surgery (LVRS) is dependent upon careful patient selection and surgical technique. While a discussion of patient selection criteria is beyond the scope of this article, several aspects of surgical technique are relevant, including...
Source: Chest Surgery Clinics of North America - November 1, 2003 Category: Cardiovascular & Thoracic Surgery Authors: Ziv Gamliel, Mark J Krasna Source Type: research

Patient selection for lung volume reduction surgery
Chronic obstructive pulmonary disease (COPD) is a category of heterogeneous diseases with a varying pathophysiologic basis , varying degrees of chronic airflow obstruction, and hyperinflation. The incidence in the United States is estimated to be at least 10 million patient-reported cases, although surveys have suggested that up to 24 million individuals might have impaired lung function . At least two million individuals are estimated to suffer from predominantly emphysema . The economic burden of these disorders is huge and increases with more severe disease . Furthermore, a marked impairment of quality of life is noted ...
Source: Chest Surgery Clinics of North America - November 1, 2003 Category: Cardiovascular & Thoracic Surgery Authors: Fernando J Martinez, Kevin R Flaherty, Mark D Iannettoni Source Type: research

Lung transplantation for emphysema
Great strides have been made in lung transplantation in the past two decades. In 1985 only 13 lung transplants were reported worldwide by the International Society of Heart and Lung Transplantation (ISHLT). This number rose to more than 1500 by 2001. More than 8000 lung transplants were performed worldwide between 1995 and 2001, and emphysema was the indication for transplantation in the majority of these procedures . Between 1990 and 2001 the percentage of patients transplanted for emphysema, including chronic obstructive pulmonary disease (COPD) and α-1-antitrypsin deficiency, rose from 21% to 42%, whereas transplantati...
Source: Chest Surgery Clinics of North America - November 1, 2003 Category: Cardiovascular & Thoracic Surgery Authors: Seth D Force, Clifford Choong, Bryan F Meyers Source Type: research

Giant bullous lung disease: evaluation, selection, techniques, and outcomes
This article reviews the current pathophysiologic mechanisms responsible for the formation of bullous disease, indications for surgery, operative procedures, and the available outcome information following surgical treatment of this disease. (Source: Chest Surgery Clinics of North America)
Source: Chest Surgery Clinics of North America - November 1, 2003 Category: Cardiovascular & Thoracic Surgery Authors: Jacob A Greenberg, Sunil Singhal, Larry R Kaiser Source Type: research

Medical management of chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) has recently been a major focus of research offering hope for therapeutic advances. This effort is in part energized by the recognition that approximately 24 million adults in the United States have evidence of impaired lung function and experience 9.5 million office and emergency room visits, 726,000 hospitalizations, and 119,000 deaths each year . While the death rate finally appears to be stabilizing in the United States at this unacceptable rate, the problem is still escalating worldwide . Factors that impair more rapid progress in COPD treatment include misconceptions that ...
Source: Chest Surgery Clinics of North America - November 1, 2003 Category: Cardiovascular & Thoracic Surgery Authors: Frank C Sciurba Source Type: research

Pathophysiology and classification of emphysema
According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), chronic obstructive pulmonary disease (COPD) is currently defined as a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases . According to this concept, the chronic airflow obstruction characteristic of this condition is a mixture of small airway disease (obstructive bronchiolitis) and parenchymal destruction (emphysema), and the relative contributions of each of these factors ...
Source: Chest Surgery Clinics of North America - November 1, 2003 Category: Cardiovascular & Thoracic Surgery Authors: Cesar A Keller Source Type: research

Historical perspectives
This article attempts to summarize these procedures—many of which proved to be failures—although most of them were initially considered to be beneficial, at least for a short time. (Source: Chest Surgery Clinics of North America)
Source: Chest Surgery Clinics of North America - November 1, 2003 Category: Cardiovascular & Thoracic Surgery Authors: Ibrahim Bulent Cetindag, Peter M Hofmann, Stephen R Hazelrigg Source Type: research

Surgery for emphysema
Emphysema is a chronic debilitating disease with limited therapeutic options. The rejuvenation and promulgation of lung volume reduction surgery (LVRS) in the mid-1990s provided a potential surgical treatment and new promise for selected emphysema patients. Early widespread application of LVRS and the glowing publications reporting overwhelmingly positive results brought this issue to the attention of the entire thoracic surgery community. Debates occurred at both medical and surgical meetings regarding patient selection, surgical techniques, and the true value of the procedure. However, it was in the regulatory, judicial,...
Source: Chest Surgery Clinics of North America - November 1, 2003 Category: Cardiovascular & Thoracic Surgery Authors: Keith S. Naunheim Tags: Preface Source Type: research

Forthcoming issues
(Source: Chest Surgery Clinics of North America)
Source: Chest Surgery Clinics of North America - November 1, 2003 Category: Cardiovascular & Thoracic Surgery Source Type: research

Contents
(Source: Chest Surgery Clinics of North America)
Source: Chest Surgery Clinics of North America - November 1, 2003 Category: Cardiovascular & Thoracic Surgery Source Type: research