摘要:

The indications for video-assisted thoracic surgery continue to evolve. Its evaluation has been based on performance in select patients by experienced surgeons but adequate controlled trials confirming its superiority to conventional open thoracotomy are lacking. This review comments on the technique, advantages and disadvantages, risks and benefits, diagnostic and therapeutic applications, complications and controversies of video assisted thoracic surgery.

ISSN:0952-7907    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Systemic administration of intravenous opioids in combination with non-steroidal anti-inflammatory drugs is still the basic strategy for postoperative pain management in thoracotomy patients. Therefore, it is usually chosen as the control when evaluating other therapeutic regimens. The use of intercostal nerve blockade remains controversial, although paravertebral anaesthesia with intraoperative catheter insertion seems to be the most effective application of this technique. Epidural application of opioids, local anaesthetics or combinations of both is widely used for analgesia after thoracotomy. Thoracic administration of a lipophilic opioid may reduce the risk of side effects through reduced plasma concentrations and tailoring to the level of nociceptive input into the spinal cord. However, the risk of respiratory depression is significant if the patient is more than 70 years old, sedating drugs are also given or dosing with opioids is inadequate.

ISSN:0952-7907    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Chronic liver disease is commonly accompanied by dysfunctions of other organ systems. Profound hypoxaemia develops in some patients with severe chronic hepatic disease. The hepatopulmonary syndrome, a specific pathophysiological pattern of hypoxaemia, is characterized by intrapulmonary vascular dilatation and arteriovenous communication, possibly caused by increased circulation of vasodilating mediators, which results in intrapulmonary shunting, ventilation-perfusion mismatch and a 'diffusionperfusion defect' of the lung. In severe hypoxaemia, liver transplantation is advocated as the most effective therapy, as pharmacological interventions fail to improve oxygenation. Clinical management of patients presenting with hepatopulmonary syndrome is complex and should include accurate cardiopulmonary monitoring.

ISSN:0952-7907    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Recent discoveries in smoke inhalation injury have come from a few investigators only. Our laboratory began looking at an ovine model that isolates the right and left lung to determine whether there was a probable hematogenous spread of the pulmonary response to smoke inhalation and specifically to examine the effect of bronchial blood flow. Nitric oxide has been found to decrease pulmonary edema and L-selectin to decrease plasma conjugated dienes. Also, investigators have documented that the major change in vascular resistance occurs across the venous segment. Metabolically, the breakdown of bradykinin does not change so long as the integrity of the lung's alveolarcapillary interface is maintained. Finally, the alveolar macrophage has shown a marked impairment to fighting a bacterial infection after inhalation injury.

ISSN:0952-7907    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0952-7907    

出版商:OVID    

年代:1997

数据来源: OVID