Surgery for other pulmonary fungal infections, Actinomyces, and Nocardia.

Surgical participation in the management of fungal infections has changed since the advent of effective antimicrobials. Even so, a surgeon may be called on for a variety of reasons, depending on the specific fungal infection and the evolution of thoracic disease. Specific fungal infections are enumerated.

Thoracic surgery in the elderly: areas of future research and studies.

Elderly patients (defined as those aged more than 75 years) require specialized care due to the problems associated with deteriorating organ function, minimal organ reserve, blunted responses to stress, and general overall frailty; however, careful, well-planned trials for elderly patients undergoing thoracic surgical procedures have been few, sporadic, and nebulous to date. With the help of the Council on Surgical and Related Medical Specialties of the American Geriatrics Society, a thorough review of the body of literature has been conducted and a research agenda has been defined. Important surgical issues remain to be defined and investigated.

Relations of body concerns and exercise behavior: a meta-analysis.

Numerous studies have examined the relations between body concerns and exercise. This meta-analysis is based on 35 studies with exercise programs influencing body concerns. There was an overall effect of .

Acute postoperative compromise in cardiovascular function after chest surgery.

Attention to preoperative cardiovascular risk factors, appropriate preparation, early recognition, and treatment are essential to prevent potential catastrophic cardiac events from leading to life-threatening situations in the postoperative period.

Overexpressed nuclear factor kappaB correlates with enhanced expression of interleukin-1beta and inducible nitric oxide synthase in aged murine lungs to endotoxic stress.

Background: Transcriptional regulation is a major determinant of interleukin-1beta (IL-1beta) protein synthesis. Nuclear factor kappaB (NF-kappaB) plays a central role in the regulation of IL-1beta and subsequent IL-1beta-dependent inflammatory processes. Previously, we observed in a murine endotoxic stress model a progressive increase with age in the amount of IL-1beta mRNA.

A novel instrument for the evaluation of the pleural space: an experience in 34 patients.

Study Objectives: To test a novel semirigid pleuroscope to be used by pulmonologists for the diagnosis and treatment of pleural diseases.

Design: Prospective study.

Setting: Three tertiary referral centers for pulmonary diseases.

Endobronchial ultrasound in therapeutic bronchoscopy.

Endobronchial ultrasound (EBUS) has been introduced as an adjunct to diagnostic bronchoscopy as it allows evaluation of the submucosal and parabronchial structures. Its use in therapeutic bronchoscopy has not been assessed. A large observational study of the value of EBUS in therapeutic bronchoscopy is presented here.

Malignant transformation of the esophageal mucosa is enhanced in p27 knockout mice.

Objective: In a previous study, we showed that experimentally induced gastroduodenal-esophageal reflux in mice treated with a carcinogen can result in Barrett esophagus and Barrett-associated adenocarcinoma. Since we have shown that most Barrett-associated adenocarcinomas in human beings have lost the tumor suppressor gene p27, we sought to determine whether cancer would be more likely to develop in p27 knockout mice than in p27 heterozygous or p27 wild type mice.

Methods: Three groups of mice were treated by esophagojejunostomy resulting in gastroduodenal-esophageal reflux and by a carcinogen (N -methyl-N -benzylnitrosamine): group I (50 wild type), group II (45 p27 heterozygous), and group III (50 p27 knockout).

Successful bronchoscopic placement of tracheobronchial stents without fluoroscopy.

Background: Tracheobronchial stenting is performed increasingly often. Fluoroscopic control, which leads to significant radiation exposure for patients and staff, is recommended for the placement of metal stents.

Methods: All consecutive patients referred to two airway centers in need of airway stenting who received stents (Ultraflex; Boston Scientific, Natick, MA) underwent placement using endoscopic guidance only.

Perfusion with lipopolysaccharide negative blood eliminates lipopolysaccharide induced lung injury.

We investigated whether perfusion with control blood improves pulmonary functions compromised by lipopolysaccharide (LPS) infusion. This was an animal study in a research laboratory at a university hospital by using Sprague-Dawley rats (n = 19), each weighing 325 to 350 g. All animals were pretreated with a 24 hour infusion of either LPS (5 mg/kg) or vehicle, after which, excised lungs were reperfused for 2 hours with either LPS+ or control blood.

CT fluoroscopy guidance for transbronchial needle aspiration: an experience in 35 patients.

Objective: To demonstrate the usefulness of real-time guidance with CT fluoroscopy to improve the yield of transbronchial needle aspiration (TBNA).

Design: Prospective, observational.

Setting: A tertiary-care, university-affiliated medical center.

Safety of bedside percutaneous dilatational tracheostomy in obese patients in the ICU.

Study Objective: To examine the safety of bedside percutaneous dilatational tracheostomy in obese patients.

Design: Case series of consecutive obese patients (body mass index > or = 27 kg/m(2)) with acute respiratory failure in a medical, cardiac, or surgical ICU unit who required tracheostomy for failure to wean and continued mechanical ventilatory support.

Results: Thirteen obese patients were identified and consented to the procedure.

Barrett's esophagus and associated adenocarcinoma in a mouse surgical model.

Background: The development of Barrett's esophagus (BE) and Barrett's associated adenocarcinoma (BAA) in the rat after experimental inducement of esophageal reflux of gastric, bile, and pancreatic juice has been reported by others. The purpose of this study was to determine whether similar results could be demonstrated in the mouse model.

Materials And Methods: One hundred eight Swiss-Webster mice were used in this study and were divided into three groups: Group I, 37 mice with esophagojejunostomy; Group II, 39 mice with esophagojejunostomy and the carcinogen N-methyl-N-benzylnitrosamine (MBN); and Group III, 32 mice with MBN alone.

Heat shock protein suppresses the senescent lung cytokine response to acute endotoxemia.

Background: Previous reports demonstrate that heat shock protein (HSP) can alter the pulmonary inflammatory cascade. We wished to determine if this mechanism is active in the senescent mouse.

Methods: A dose-response and time-response curve for sodium arsenite (SA) induction of HSP was constructed.

Reliable 18-hour lung preservation with University of Wisconsin solution. An ex vivo rat model with a pulsatile perfusion system.

Objectives: A common experimental model is necessary to assess therapeutic intervention in lung preservation. This study was designed to establish lung preservation in an ex vivo rat model that would enable post-storage lung function to be stably evaluated during the 2 hours following reperfusion.

Subjects And Methods: Lungs isolated from Sprague-Dawley rats (n = 36) were flushed and stored in University of Wisconsin solution at 4 degrees C for the following periods: Group 1: no storage (n = 12); Group 2: 4 hours (n = 8); Group 3: 18 hours (n = 8); and Group 4: 24 hours (n = 8).

Does PGE1 attenuate potassium-induced vasoconstriction in initial pulmonary artery flush on lung preservation?

The standard clinical protocol for lung transplantation employs cold single pulmonary artery flush with Euro-Collins solution or the University of Wisconsin solution. Prostaglandin E1 (PGE1) is usually given by direct injection into the pulmonary artery to reduce pulmonary vasoconstriction caused by these intracellular, high-potassium solutions, however, the efficacy of PGE1 on lung preservation remains controversial. In this study we demonstrated that vasodilator effects of PGE1 were markedly reduced under a high-potassium condition, and that potassium-induced pulmonary vasoconstriction were inhibited by calcium channel blocker nifedipine.

Calcium channel blocker enhances lung preservation.

Background: The standard program for lung transplantation employs PGE1 pretreatment for donor lungs, but its efficacy remains controversial. Calcium channel blocker has been reported more effective for reducing potassium-induced vasoconstriction. We investigate the efficacy of calcium channel blocker in the initial lung flush using rat lung transplant model.

Technology acquisition and credentialing controversies.

In the age of the health care financial squeeze, staying on the cutting edge of medical technology is problematic at best. Surgeons must be proactive to design, specify, and acquire highly sophisticated, functional thoracoscopic technology. Credentialing is a legal process designed to improve patient care quality and must be fair and applied to all.

Pneumostasis of experimental air leaks with a new photopolymerized synthetic tissue sealant.

Air leak is a major contributor to increased length of stay and postoperative morbidity following pulmonary surgery. The effectiveness of a new photopolymerized synthetic hydrogel (FocalSeal, Focal, Inc., Lexington, MA) as a sealant for pulmonary air leaks was determined in 10 mongrel dogs (20-35 kg).