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4.
Chirurg ; 90(8): 681-694, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31218434

RESUMO

In regional chemotherapy of the pleural space a differentiation is made between intrapleural hyperthermic perfusion (IHP) and hyperthermic intrathoracic chemotherapy (HITOC). The HITOC in particular is carried out as an additive procedure after surgical cytoreduction of the pleural tumor manifestation. The main indications are for malignant pleural mesothelioma and thymoma with pleural spread (stage IVa), whereas treatment of secondary pleural carcinomatosis is indicated only in selected patients suitable for resection followed by HITOC. Cisplatin is the standard chemotherapeutic agent and a concentration of 150-175 mg/m2 body surface area is recommended. Postoperative, HITOC-related complications (e.g. renal insufficiency) can be minimized by an adapted perioperative management. Safety measures should be accomplished adhered to for the protection of personnel. The aim of HITOC is to achieve a better local tumor control with a corresponding longer recurrence-free and overall survival.


Assuntos
Hipertermia Induzida , Mesotelioma , Neoplasias Pleurais , Protocolos de Quimioterapia Combinada Antineoplásica , Quimioterapia do Câncer por Perfusão Regional , Cisplatino , Terapia Combinada , Humanos , Recidiva Local de Neoplasia , Neoplasias Pleurais/terapia , Cirurgia Torácica/tendências
8.
Zhonghua Wai Ke Za Zhi ; 57(1): 29-33, 2019 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-30612391

RESUMO

With the emergence of new concepts and new technologies, the mode of diagnosis and treatment of thoracic surgery in China has changed greatly. Under this background, Chinese thoracic surgery ushered in its "golden age" . This paper expounds the new challenges of thoracic surgery in China from many aspects, and points out that with the advent of precision medicine and modern science and technology, thoracic surgery will continue to develop rapidly. We should seize the opportunity, further expand our advantages, and strive to create a new era of Chinese thoracic surgery.


Assuntos
Cirurgia Torácica , Procedimentos Cirúrgicos Torácicos , China , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Medicina de Precisão , Cirurgia Torácica/tendências , Procedimentos Cirúrgicos Torácicos/tendências
10.
Zhonghua Wai Ke Za Zhi ; 56(12): 888-891, 2018 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-30497114

RESUMO

Objective: To study the current development of thoracic surgery in China. Methods: Chinese Society for Thoracic and Cardiovascular Surgery and Chinese Association for Thoracic Surgeons jointly conducted a network survey to directors of thoracic surgery departments in the tertiary hospitals in China from November to December 2018. The contents of the survey included the basic information of the hospital and the status of thoracic surgery department in the hospital. Rank sum test was used to compare the data between different regional hospitals Results: A total of 636 tertiary hospitals participated in the survey. The total number of beds for thoracic surgery departments was 30 646, with M(Q(R)) of 40(20) (range: 3 to 393) for each hospital. The total number of thoracic surgeons was 6 747, with M(Q(R)) of 9(6) (range: 1 to 75) in each hospital. In 2015, a total of 312 425 operations were performed in the 636 hospitals, with M(Q(R)) of 268(484.5) (range: 4 to 8 320) for each hospital. The total number of lung cancer surgeries was 146 601 in 2015, with M(Q(R)) of 100(216) (range: 0 to 6 911) operations in each hospital. The total number of esophageal cancer operations was 67 076, with M(Q(R)) of 40(95) (range: 0 to 1 550) in each hospital. Minimal invasive thoracic surgery was performed in 94.3% (601/636) of the hospitals, with 86.6% (551/636) of hospitals carried out video-assisted thoracoscopic (VATS) lobectomy. Among the hospitals performing VATS lobectomy, 89.3% (492/551) of them started to perform the technique after 2006, and 93.1% (513/551) of them do single-direction thoracoscopic lobectomy. A total of 403 640 VATS lobectomies had been performed until 2015, including 163 682 cases of single-direction thoracoscopic lobectomy. In 2015, 73.74% (108 116/146 601) lung cancer operations and 37.44% (25 110/67 076) of esophageal cancer resections were performed by minimally invasive technique. The development level of hospitals among eastern, middle and Western China was different significantly on number of doctors, number of total operations, number of lung cancer surgeries, proportion of minimally invasive lung cancer surgery, number of esophageal cancer surgeries, and proportion of minimally invasive esophageal cancer surgery (χ(2)∶7.65 to 60.8, all P<0.05). Conclusions: The discipline of thoracic surgery, especially the minimally invasive thoracic surgery in China is now experiencing a rapid development. The proportion of minimally invasive lung cancer surgery is higher than that of in the developed countries. However, unbalanced development among different regions is still a great challenge in China.


Assuntos
Pneumonectomia , Centros de Atenção Terciária , Cirurgia Torácica , China , Humanos , Neoplasias Pulmonares/cirurgia , Inquéritos e Questionários , Cirurgia Torácica/tendências
12.
Ann Thorac Surg ; 106(5): 1504-1511, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30086278

RESUMO

BACKGROUND: Several gray areas and controversies exist concerning the management of pulmonary ground-glass opacities (GGOs), and there is a lack of consensus among clinicians on this topic. One of the main aims of the Italian Society of Thoracic Surgery is to promote education and research, so we decided to perform a survey on this topic to estimate current trends in practice in a large sample of thoracic surgeons. METHODS: A total of 160 thoracic surgeons responded, namely, completed our questionnaire (response rate, 53%; 160 of 302). The survey was composed of 36 questions divided into six subsections: (1) demographic characteristics of the respondents; (2) terminology and taxonomy; (3) radiologic and radiometabolic evaluation; (4) diagnostic approach and indications for surgery; (5) surgical management; and (6) radiologic surveillance. RESULTS: We observed some divergence of opinion regarding the definition of mixed GGOs, the role of 18F fluorodeoxyglucose positron emission tomography and computed tomography scans, indications for nonsurgical biopsy, intraoperative techniques for localizing GGOs, indications for surgery, extension of lung resection and lymph node dissection according to the radiologic scenario, use of intraoperative frozen section analysis, and radiologic surveillance of pure GGOs. CONCLUSIONS: This topic warrants more investigation in the future. An upcoming consensus conference of Italian Society of Thoracic Surgery experts (also open to experts in other specialties) could provide updated indications for GGO management based on the literature, expert opinions, and the results of the present survey.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/normas , Inquéritos e Questionários , Tomografia Computadorizada por Raios X/normas , Atitude do Pessoal de Saúde , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Itália , Pulmão/diagnóstico por imagem , Pulmão/patologia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Tomografia por Emissão de Pósitrons/tendências , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências , Medição de Risco , Sociedades Médicas , Cirurgiões , Cirurgia Torácica/normas , Cirurgia Torácica/tendências , Tomografia Computadorizada por Raios X/tendências
15.
Curr Opin Cardiol ; 33(2): 162-167, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29334508

RESUMO

PURPOSE OF REVIEW: As ventricular assist device (VAD) therapy in patients with advanced heart failure continues to grow, experience with concomitant valvular diseases present either before or after VAD implantation continues to accrue. In this review, we discuss recent data and current practice as it pertains to the subject of concomitant valvular disease in patients requiring VADs. RECENT FINDINGS: Persistent aortic valve closure has been identified as a potential contributor to aortic valve 'disuse atrophy' resulting in valve degeneration. Dilation of the aortic root may be predictive of future development of aortic insufficiency. Novel echocardiographic parameters to identify the severity of aortic insufficiency following VAD implantation may be useful for risk stratification. Concomitant repair of significant mitral regurgitation may confer benefit to pulmonary vascular resistance and right ventricular function; however, this remains controversial. Concomitant repair of significant tricuspid regurgitation has not demonstrated early postoperative benefit nor survival benefit. Atrial fibrillation has emerged as a risk factor that may predict accelerated progression of postoperative tricuspid regurgitation. SUMMARY: Management of aortic insufficiency, mitral regurgitation or tricuspid regurgitation in patients requiring VADs continues to be the source of controversy. As experience accrues with varying strategies to prevent or manage these valvular lesions, our understanding of the impact of these strategies continues to evolve.


Assuntos
Insuficiência Cardíaca , Doenças das Valvas Cardíacas , Coração Auxiliar , Administração dos Cuidados ao Paciente/métodos , Cirurgia Torácica , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/cirurgia , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/cirurgia , Doenças das Valvas Cardíacas/terapia , Humanos , Cirurgia Torácica/normas , Cirurgia Torácica/tendências
16.
Curr Opin Cardiol ; 33(2): 178-183, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29232249

RESUMO

PURPOSE OF REVIEW: There is a growing emphasis on the conduct of large-scale, multicenter randomized controlled trials (RCTs) to guide decision-making in cardiac surgery. Here we review recent landmark RCTs in cardiac valvular surgery. RECENT FINDINGS: RCTs are the gold-standard level of data in medicine. However, there are unique challenges of conducting large-scale surgical trials including funding, blinding, generalizability, nonstandardization of the surgical technique, crossover, among others. Thus, the vast majority of clinical outcomes data in cardiac surgery are mainly from observational studies and most prospective data are small, single-center trials. The Cardiothoracic Surgery Network is the largest platform focused on the conduct of high-quality, multicenter cardiac surgical trials, which has already produced several seminal guideline-changing and practice-changing contributions to the surgical approach to functional mitral regurgitation, aortic stenosis, atrial fibrillation, and neuroprotective surgical adjuncts. SUMMARY: There continues to be great interest in the conduct of high-quality, RCTs to help guide surgical management of patients with valvular heart disease.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Doenças das Valvas Cardíacas/cirurgia , Cirurgia Torácica , Tomada de Decisão Clínica , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Cirurgia Torácica/métodos , Cirurgia Torácica/normas , Cirurgia Torácica/tendências
17.
Curr Opin Cardiol ; 33(2): 184-189, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29256930

RESUMO

PURPOSE OF REVIEW: The purpose of this article is to review the strengths and weaknesses of systematic reviews and meta-analyses to inform our current understanding of cardiac surgery. RECENT FINDINGS: A systematic review and meta-analysis of a focused topic can provide a quantitative estimate for the effect of a treatment intervention or exposure. In cardiac surgery, observational studies and small, single-center prospective trials provide most of the clinical outcomes that form the evidence base for patient management and guideline recommendations. As such, meta-analyses can be particularly valuable in synthesizing the literature for a particular focused surgical question. Since the year 2000, there are over 800 meta-analysis-related publications in our field. There are some limitations to this technique, including clinical, methodological and statistical heterogeneity, among other challenges. Despite these caveats, results of meta-analyses have been useful in forming treatment recommendations or in providing guidance in the design of future clinical trials. SUMMARY: There is a growing number of meta-analyses in the field of cardiac surgery. Knowledge translation via meta-analyses will continue to guide and inform cardiac surgical practice and our practice guidelines.


Assuntos
Cirurgia Torácica , Humanos , Metanálise como Assunto , Guias de Prática Clínica como Assunto , Revisões Sistemáticas como Assunto , Cirurgia Torácica/métodos , Cirurgia Torácica/normas , Cirurgia Torácica/tendências , Pesquisa Médica Translacional/métodos
18.
Surg Clin North Am ; 97(4): 801-810, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28728717

RESUMO

Cardiothoracic surgical care is a team sport. The increased complexity and sophistication of this field have resulted in the development of highly functioning multidisciplinary and interprofessional teams to optimize clinical outcomes. This article provides an overview of a team-based, patient-centric "systems" approach to the care of cardiothoracic surgery patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Equipe de Assistência ao Paciente , Cirurgia Torácica/tendências , Procedimentos Cirúrgicos Torácicos , Congressos como Assunto , Humanos
20.
Rev. esp. pediatr. (Ed. impr.) ; 72(6): 329-337, nov.-dic. 2016. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-160648

RESUMO

La atención integral de las enfermedades cardiovasculares de la infancia y de las cardiopatías congénitas del feto al adulto, se realiza desde hace más de 40 años en el Hospital General Universitario Gregorio Marañón de Madrid, siendo centro nacional de referencia (CSUR) de trasplante cardíaco infantil, cardiopatías congénitas complejas y neonatales, cardiopatías familiares y cardiopatías congénitas del adulto. El Área del Corazón Infantil es la estructura organizativa que engloba Cardiología Pediátrica y Cirugía Cardíaca Infantil, en colaboración con otros servicios del Hospital Infantil y de Adultos. Se incluyen en la cartera de servicios todos los programas asistenciales específicos relacionados, incluso algunos novedosos, como la rehabilitación cardíaca infantil y la telemedicina. Destacar que es el centro con mayor actividad en trasplante cardíaco infantil (serie de 160 pacientes, un 40% del total nacional). En el período 2013 y 2014, con el nuevo equipo quirúrgico se realizaron 645 intervenciones en menores de l 8 años, con alta complejidad (surgical performance de 7) y bajada de la mortalidad del 3,2 al 1,5 %. Entre 2011 y 2014 se realizaron 1.146 cateterismos intervencionistas en menores de 18 años, cerca de 1/3 en menores de 1 año, con una mortalidad menor del 1 por 1.000; se evaluaron en cardiopatías familiares 725 nuevos pacientes (1/4 casos pediátricos) y se realizaron 758 test genéticos. La actividad docente incluye el pregrado de Medicina, Enfermería e Ingeniería Biomédica, residentes de pediatría y cardiología, post MIR y fellows en cardiología pediátrica tanto de España como de otros países, especialmente de Latinoamérica. Destacan los cursos internacionales anuales de actualización en enfermería y medicina (23 ediciones) así como el preceptorship in pediatric cardiology. La actividad investigadora se estructura como grupo dentro del área cardiovascular del Instituto de Investigación Sanitaria Gregorio Marañón, con participación en la red de investigación cardiovascular (RIC), colaboración con el centro nacional de investigaciones cardiológicas (CNIC). Contamos con investigadores de forma continuada así como proyectos de Financiación pública competitiva desde 2010. Las líneas de investigación incluyen la genética de las miocardiopatías, los ensayos clínicos con células madre en Fontan, el uso de vasodilatadores pulmonares y otros fármacos cardiovasculares, así como el impacto de las infecciones respiratorias en niños con cardiopatía y síndrome de Down. Se han iniciado líneas de innovación en el campo de los dispositivos para intervencionismo cardíaco así como en aspectos organizativos y en cooperación internacional al desarrollo con un centro en Nicaragua. La colaboración con los pacientes y sus familias a través de organizaciones como Menudos Corazones han sido claves para obtener los objetivos ñnales del programa: la obtención de la mayor esperanza y calidad de vida de los niños que tienen una condición cardiovascular (AU)


Comprehensive care of pediatric cardiovascular disease and congenital heart disease from fetus to adult, has been performed at the Hospital General Universitario Gregorio Marañon de Madrid for the last 40 years. Our hospital is national reference centre (CSUR) for pediatric heart transplant, complex and neonatal congenital heart disease and familia] and adult congenital heart disease. The Children's Heart Area is the organizing structure encompassing pediatric cardiology and pediatric cardiac surgery, in collaboration with the other pediatric and adult hospital services. Our service offers all related specific healthcare including novelties such as pediatric cardiac rehabilitation and telemedicine. Our centre has the highest activity as regards pediatric heart transplant (series of 160 patients, 40% of the national total). During the period from 2013 to 2014, with the new surgical team, 645 interventions were performed in under 185, with high complex surgical interventions (surgical performace 7) with low mortality, from 3.2 to 1.5%. 1,146 interventional catheterism were performed in under 185, between 2011 to 2014, near 1/3 under 1 year of age, with mortality rates less tan 1 per 1,000; 725 new patients were evaluated in the familial cardiopathy clinic (1/4 pediatric cases) and 758 genetic tests were carried out. Teaching activity includes undergraduare medicine, nursing and biomedical engineering, residency in pediatrics and cardiology, post MIR and fellowships in pediatric cardiology in Spain as well as in other countries, especially Latin America. Of interest, are the yearly international courses in updates in nursing and medicine (23 editions) as well as the preceptorship in pediatric cardiology. Research activity is encompassed as the group within the cardiovascular area of the Instituto de Investigación Sanitaria Gregorio Marañón, participating in the Cardiovascular Research Network (RIC), collaboration with the National Centre for Cardiological Research (CNIC). Our research is continuous with competitive publicly funded projects since 2010. Research topics include the genetics of cardiomyopathics, clinical trials with stem cells in Fontan, use of pulmonary vasodilators and other cardiovascular drugs, as well as the impact of respiratory infections in children with heart disease and Down's Syndrome. Innovations in the field of devices in cardiac interventionism have been implemented and also in organizational aspects as well as international cooperation for development with a centre in Nicaragua. Collaboration with patients and families through organizations like ‘Menudos Corazones’ have been key in achieving the goals of our program: the longest life-expectancy and highest quality of life in children who have a cardiovascular condition (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Pediatria/métodos , Cirurgia Torácica/métodos , Cirurgia Torácica/tendências , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/prevenção & controle , Transplante de Coração/métodos , Transplante de Coração/tendências , Cardiopatias Congênitas/cirurgia , Cardiopatias/cirurgia
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