Archive for the ‘Lung Volume’ Category


Lung Volume Reduction Surgery: Conclusion

May 13, 2014 Author: Walter Mcneil | Filed under: Lung Volume

As Tonelli and coauthors point out, the question that every patient brings to his or her physician today is not whether lung volume reduction can be done, but rather, “Should I have it done?” Arriving at a correct answer will take time, and many have expressed discomfort with that, based on the absence of viable alternatives In fact, however, patients who are undergoing surgery have not always exhausted the available options. Pulmonary rehabilitation, for example, provides substantial benefits for patients with severe COPD, including increased exercise capacity and decreased dyspnea. Yet many patients with COPD never participate in pulmonary rehabilitation, either because the programs are not available in their areas, their physicians fail to recognize the benefits, or their insurance carriers refuse to reimburse it. Certainly, pulmonary rehabilitation is initially less costly than surgery and associated with less immediate morbidity and mortality. The value of this and other options will become more evident once the randomized trial now being organized is completed. cialis professional 20 mg
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  • Lung Volume Reduction Surgery: Future Directions

    May 11, 2014 Author: Walter Mcneil | Filed under: Lung Volume

    Lung Volume Reduction Surgery: Future DirectionsEven before the fog has lifted from the landscape of previous applications, LVRS is entering new arenas and is now being employed adjunctively when stage I lung cancer is resected, to wean ventilator-dependent COPD patients, to reduce unilateral hyperinflation of the native lung after single-lung transplantation, and to serve not only as a bridge procedure but as an alternative for patients awaiting lung transplants.
    It is worth remembering that the history of emphysema surgery has been one of repeated cycles of enthusiasm and disillusionment. Among the procedures initially embraced and then discarded are the following: costochondrectomy to mobilize the chest wall; autonomic and peripheral chromoreceptor denervation; and attempts to limit expiratory airway closure using polytef (Gore-tex), rectus sheath, fascia lata, and plastic prostheses. (more…)

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  • Lung Volume Reduction Surgery: Is Surgery Cost Efficient?

    May 9, 2014 Author: Walter Mcneil | Filed under: Lung Volume

    The costs of LVRS have not been well documented and no doubt will continue to change as development costs and inefficiencies are eliminated. Current estimates of hospital charges range from $35,000 to $70,000 per case, not including physician charges and preoperative evaluations, which can add significantly to the expense. Major centers using the criteria of Cooper et al indicate that about 10% of patients screened are suitable candidates for surgery. If the procedure were to be done on only 10% of the 2 million Americans with emphysema, the costs would be upwards of $7 billion. In an era of limited health-care resources, there is clearly a need to determine how the costs and benefits compare with those of optimal medical therapy, especially since the reported improvements from surgery are not always substantially different from those achieved by pulmonary rehabilitation alone. (more…)

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  • Lung Volume Reduction Surgery: Duration of Benefits

    May 7, 2014 Author: Walter Mcneil | Filed under: Lung Volume

    Lung Volume Reduction Surgery: Duration of BenefitsAlthough the initial results of surgery are, on the whole, encouraging, follow-up at most centers has been short, and patient reporting is often selective. Two recent reports are worth noting, however. In one, French investigators reviewed the outcome of unilateral or bilateral volume reduction in 13 patients, some of whom were monitored for up to 4 years. Although all but one patient had significant symptomatic and spirometric improvement 6 months after surgery, those improvements began to decline thereafter. By the 18th month, seven patients continued to report symptomatic improvement, and six of them continued to show gains in their FEV^ By 36 months, four patients (31%) still had dyspnea grades lower than before surgery, and three (24%) continued to demonstrate objective improvement. Neither of the two patients who reached the 4th year evaluation had any remaining benefits from the surgery. (more…)

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  • Lung Volume Reduction Surgery: Mechanisms of Benefits

    May 5, 2014 Author: Walter Mcneil | Filed under: Lung Volume

    Improvements in pulmonary function after LVRS have been attributed to at least four possible mechanisms: enhanced elastic recoil, correction of ventilation/perfusion mismatch, improved efficiency of respiratory musculature, and improved right ventricular filling (Table 2). In all likelihood, one or more mechanisms may be affected to varying degrees. Undoubtedly, the amount and characteristics of the removed and remaining portions of lung will largely determine each patient’s physiologic response. Thus, patients who have normal compressed lung could be expected to have increased elastic recoil and improved compliance after surgery, whereas those who have mainly emphysematous underlying tissue would probably see little change in overall mechanics. By the same token, if areas of low ventilation with preserved perfusion are removed and areas of equal ventilation/perfusion remain, oxygenation would be expected to improve. (more…)

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  • Lung Volume Reduction Surgery: Surgical Procedures

    May 3, 2014 Author: Walter Mcneil | Filed under: Lung Volume

    Lung Volume Reduction Surgery: Surgical ProceduresThe operations used to treat emphysema include the excision of large bullae (bullectomy) and the resection of diffusely emphysematous lung tissue. The latter procedure, variously known as LVRS, pneumonectomy, and reduction pneumoplasty, aims for a 20 to 30% volume reduction in one or both lungs by means of stapler resection, laser application, or both. Acceptable results from stapler resection have been reported through a sternotomy, thoracotomy, clam shell incision, and thoracoscopy, and the choice of one operative approach over another has largely been a matter of personal preference on the part of the surgeon. Kotloff and associates compared the outcomes in 80 patients who underwent stapled resections via median sternotomy and 40 whose surgery was done with video-assisted thoracoscopy and found that both methods yielded similar operative mortality (4.2% vs 2.5%) and functional outcomes. Video-assisted thoracoscopy, however, was associated with a significantly lower incidence of respiratory failure and a trend toward decreased in-hospital mortality, suggesting that it might be the preferred procedure for high-risk patients. generic amaryl
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  • Lung Volume Reduction Surgery: Answering the Crucial Questions

    May 1, 2014 Author: Walter Mcneil | Filed under: Lung Volume

    The largely positive outcome in that series sent a wave of excitement through the medical and lay communities but started a whirlpool of controversy that swirls around the procedure to this day. Although many centers around the country have been performing LVRS and aggressively marketing the procedure to patients, only a few have systematically collected data that would help assess entry criteria or outcomes. As a result, perhaps thousands of people have now undergone a major thoracic procedure about which surprisingly little is actually known.
    Not only are data relatively scarce, many factors conspire to make their interpretation difficult if not impossible. Centers have varied widely not only in the type of procedure they use and their patient selection criteria, but also in their manner of reporting the results. (more…)

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  • Lung Volume Reduction Surgery

    Apr 29, 2014 Author: Walter Mcneil | Filed under: Lung Volume

    Lung Volume Reduction SurgeryAnswering the Crucial Questions
    Emphysema and other forms of COPD currently afflict an estimated 14 million Americans. For many of them, the future looks bleak. Once the FEV1 falls below 30% predicted, the 5-year death rate climbs to 60%. Less easy to quantify, perhaps, is the despair that comes from an inexorable slide into increasing disability and dependency. Although a comprehensive program of bronchodilator therapy, vaccination, and pulmonary rehabilitation can help relieve symptoms and prevent complications, it cannot halt the progression of the disease. Lung transplantation may hold out a hope for those who are relatively young and in good health, but it is not an option for many patients who are either too old to undergo the procedure or too ill to survive until a suitable organ becomes available. Clearly, there is a strong rationale for seeking a more fundamental means of intervention to arrest or reverse the pathophysiologic processes responsible for the relentless decline in respiratory function. canadian family pharmacy online
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