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AVATS Surgery Shown to Be Option for Patients Deemed “Inoperable”

Article ID: 694410

Released: 11-May-2018 11:35 AM EDT

Source Newsroom: American Thoracic Society (ATS)

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  • Credit: ATS

    AVATS option for patients deemed “inoperable.”

Session D30 A Better Path Forward:  Improving Patient Outcomes in Lung Cancer

Abstract Presentation Time:  May 23, 9:15 a.m. PST

Location San Diego Convention Center, Room 5 A-B (Upper Level)

AVATS Surgery Shown to Be Option for Patients Deemed “Inoperable”

Newswise — ATS 2018, San Diego, CA – A new study demonstrates that awake video-assisted thoracoscopic surgery (AVATS) – a minimally invasive procedure that is done under local anesthesia and sedation – is a safe and effective alternative for patients with poor lung function and lung cancer who would normally be precluded from having surgery due to its risks.  The study was presented at the 2018 American Thoracic Society International Conference.

“Video-assisted thoracoscopic surgery (VATS) is a well established procedure, but patients with poor pulmonary function often cannot have it because it is risky for them to go under general anesthesia,” said study author, Ara Klijian, MD, of Sharp Grossmont Hospital, La Mesa, California and Scripps Mercy Hospital, San Diego.  “I extended the VATS procedure so that it is done under local anesthesia with sedation.  This enabled me to do a variety of procedures including lobectomies, esophageal surgeries, decortications and other types of thoracic surgery, with better outcomes.”

Over the last 5 years, Dr. Klijian has performed more than 500 AVATS procedures without significant mortality or morbidity. In the current study, 246 patients with lung cancer had the AVATS procedure.  Dr. Klijian demonstrated that patient safety was not compromised, that patients had a lower length of stay (1.6 days for patients who had a lobectomy, or removal of a lung) and better patient satisfaction.

Patients receiving the AVATS procedure typically have multiple chronic health conditions, as described in the abstract below, and poor lung function, which would typically increase the risk of surgical complications.

“By eliminating the need for endotracheal intubation and the comorbidity associated with general anesthesia, the AVATS procedure brings new, previously considered inoperable patients into the surgical arena,” Dr. Klijian said.  “My long-term data have shown that this approach has better outcomes than traditional lung surgery with this select group of patients.  It also reduces risks of hospital-acquired infection, as outpatient postoperative care minimizes the use of catheters.”

In the AVATS and VATS procedures, a tiny camera (thoracoscope) and surgical instruments are inserted into the chest through small incisions in the chest wall. The thoracoscope transmits images of the inside of the chest onto a video monitor, guiding the surgeon in performing the procedure.

The availability of the AVATS procedure is expected to increase, as Dr. Klijian has presented the technique and trained a number of other surgeons.   

Contact for Media: Ara Klijian, MD, Klijian@hotmail.com;

Sharp Grossmont Hospital PR Contact: Bruce Hartman, (619) 740-4053, Bruce.Hartman@Sharp.com

Abstract Number: 6958

Title:  Awake Video-Assisted Thoracic Surgery for Patients with Poor Pulmonary Function

Author:  A Klijian

Cardiothoracic  Surgery, Sharp & Scripps Hospitals, San Diego, United States

Patients with poor pulmonary function are often precluded from surgical therapy.  Awake video-assisted thoracic surgery (AVATS) done under local anesthesia and sedation allows for surgical resection of lung cancer previously deemed inoperable.  Wedge resection, segmentectomy and even lobectomy are feasible and have been performed with outcomes comparable or better than those done under general anesthesia. Over 500 AVATS cases have been performed without significant morbidity or mortality.  Lung resections for cancers done via AVATS have a length of stay for lobectomy of 1.6 days, even in patients with FEV1 under 0.6.  These patients have multiple comorbidities including diabetes, COPD, atrial fibrillation, hypertension and hepatic and/or renal dysfunction.  Of the patients undergoing resection, 203 of the 246 patients had FEV1 less than 0.8. Postoperative care of these patients has also been streamlined to minimize use of central lines, arterial, urinal and epidural catheters to minimize nosocomial infections.  AVATS is a safe option in select lung cancer patients, who previously would be classified inoperable, resulting in lower length of stay, better patient satisfaction and presumably lower costs.  

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Air pollution hurts the poor disproportionately https://breathebettertolivebetter.com/2021/05/air-pollution-hurts-the-poor-disproportionately/?pk_campaign=feed&pk_kwd=air-pollution-hurts-the-poor-disproportionately https://breathebettertolivebetter.com/2021/05/air-pollution-hurts-the-poor-disproportionately/?pk_campaign=feed&pk_kwd=air-pollution-hurts-the-poor-disproportionately#respond Fri, 14 May 2021 14:01:10 +0000 https://breathebettertolivebetter.com/2021/05/air-pollution-hurts-the-poor-disproportionately/ ]]>

The photograph accom-panying an editorial in The Daily Star on April 21 spoke eloquently of the hazards facing the average citizen in Dhaka. The title “Steep rise in air pollution” raised the issue of air pollution in urban pockets, and the photo caption, “Pedestrians cover their noses as dust shrouds a dilapidated part of Rampura-Banasree Road,” graphically described the perils of breathing the dust-laden Dhaka air. In a more recent piece, The Daily Star reported that Dhaka’s air quality has been ranked as the third worst, behind New Delhi and Cairo, according to data compiled by the World Health Organisation (WHO) for megacities with a population of 14 million or more.

Air pollution affects our socio-economic groups differently. “Air pollution threatens us all, but the poorest and most marginalised people bear the brunt of the burden,” said Tedros Adhanom Ghebreyesus, WHO director-general. WHO’s measures of air pollution focus specifically on concentrations of fine particulate matter (PM2.5), which are linked with diseases including stroke, heart disease, lung cancer, COPD (chronic obstructive pulmonary diseases), and respiratory infections. Besides ambient (outdoor) air pollution, the new figures emphasised the problem of household air pollution from cooking with highly polluting fuels and stoves.

WHO data shows that there are 4.2 million deaths every year as a result of exposure to ambient (outdoor) air pollution, and that another 3.8 million die from faulty, smoke-emitting stoves. Around 91 percent of the world’s population lives in places where air quality levels exceed WHO limits. Statistics reveal that 50 percent of pneumonia deaths in children under five are due to household air pollution. Millions others face impaired lung function and asthma.

While ambient air pollution affects developed and developing countries alike, low- and middle-income countries shoulder the highest burden, particularly in the Western Pacific and South East Asia regions. Professor Anthony Frew, a respiratory medicine specialist at Royal Sussex County Hospital in UK, noted that the population in richer countries is largely spared the worst health effects of air pollution. He also noted the developing world is bearing the brunt of air pollution in part due to consumer demand from wealthier nations.

Professor Frew’s finding reminds me of an interesting dialogue that took place a quarter century ago. In 1991, Professor Lawrence Summers, my former boss at Harvard, had written an internal memo “tongue-in-cheek” to address a thorny issue debated then, i.e. environmental equity. Summers, who was the chief economist of the World Bank then, alluded to “proposals for more pollution in LDCs (Least Developed Countries)”, and weighed in on the option of “encouraging more migration of the dirty industries to the LDCs.” Many took Summers’ comments at face value and suggested that LDCs, which at that time had less pollution than the industrialised countries, could be compensated to take on the role of global “carbon sink”. Referring to developing countries, he continued, “Their air quality is probably vastly inefficiently low compared to Los Angeles or Mexico City. Only the lamentable facts that so much pollution is generated by non-tradable industries (transport, electrical generation) and that the unit transport costs of solid waste are so high prevent world-welfare-enhancing trade in air pollution and waste.” The WHO report only confirms that the hypothetical scenario conjured up in Summers’ memo has come true!

Air pollutants come in various shapes and sizes, and are broadly divided into three groups: criteria pollutants, air toxics, and biological pollutants. The major criteria pollutants that affect air quality are nitrogen dioxide, ozone, particles (PM10 and PM2.5), sulfur dioxide, carbon monoxide and lead. WHO Air quality guidelines offer global guidance on thresholds and limits for the first four. Air toxics, sometimes referred to as “hazardous air pollutants”, include “gaseous, aerosol or particulate pollutants that are present in the air in low concentrations” and come from motor vehicle emissions, solid fuel combustion, industrial emissions, and materials such as paints and adhesives in new buildings. Finally, biological pollutants “arise from sources such as microbiological contamination, e.g. moulds, the skin of animals and humans, and the remains and dropping of pests such as cockroaches.” Biological pollutants can be airborne and can have a significant impact on indoor air quality.

Coming back to the issue of equity, if the air quality of poorer countries currently is materially worse than that of the affluent ones, do we have an ipso facto stronger case to ask the developed countries for an equitable distribution of the burden of air pollution? Primarily, in the post-Paris Accord era, it is time for the developed countries to own up to their promise of a “global fund” which will allow developing countries to not only mitigate and adapt to climate change, but enable technology transfers for a smog-free urban environment.

Climate funds would not only support adaptation and mitigation efforts to combat the effects of past CO2 emissions, but simultaneously allow newly emerging nations to explore cleaner fuel options and embrace “sustainable development”. This appeal for resource transfer is complementary to the traditional argument for “climate change” funds.

Pending the availability of the promised “climate funds”, Bangladesh needs to gear up on its own with attention to fuel efficiency, vehicle inspections, conversion of brick kilns, inspection of construction sites, and adoption of best practices in municipal waste management, among others. For example, tariffs on imported motor vehicles could be lower for electric and hybrid, and based on MPG. All major automakers, including Toyota, VW and GM, have embraced fuel efficiency standards in response to consumer demands and government regulations. Bangladesh may proactively embrace fuel efficiency standards similar to India to improve the average fuel economy of cars and light trucks (trucks, vans and sport utility vehicles) imported or produced for sale in Bangladesh. In a public-private partnership, environmental groups may also be brought in to help develop clean transport strategies that improve the efficiency of vehicles by promoting deployment of cleaner fuels, improved vehicular emission standards, and standards for fuel economy performance.

Admittedly, Bangladesh is caught in a bind. Projections show that if demand for electricity grows at 7-10 percent rate a year, the power sector will need to more than double power generation to over 30,000 megawatts by 2030. If our future economic growth is based on fossil fuels, we need to address policy areas such as geographical location of industries, costs and benefits of ultra-supercritical turbines for power plants, and a regulatory framework to ensure a “clean coal” chain. In this respect, we might learn a lesson or two from China as it pulled back from the brink of ecological disaster.

To quote The Daily Star editorial, “Policies and investments supporting cleaner transport, energy-efficient housing, power generation, industry and better municipal waste management can effectively reduce key sources of ambient air pollution” and also lead to improved indoor air quality.

Dr Abdullah Shibli is an economist, and Senior Research Fellow at the International Sustainable Development Institute (ISDI), a think-tank in Boston, USA. His new book Economic Crosscurrents will be published later this year.

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“The LHIN can provide equipment under certain circumstances on a short-term basis to patients receiving LHIN home care services,” the LHIN said. “Eligible patients must be receiving, or have been referred to, at least one professional service, such as nursing, physiotherapy or occupational therapy.”

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New Technology Could Increase Supply of Usable Donor Lungs https://breathebettertolivebetter.com/2021/05/new-technology-could-increase-supply-of-usable-donor-lungs/?pk_campaign=feed&pk_kwd=new-technology-could-increase-supply-of-usable-donor-lungs https://breathebettertolivebetter.com/2021/05/new-technology-could-increase-supply-of-usable-donor-lungs/?pk_campaign=feed&pk_kwd=new-technology-could-increase-supply-of-usable-donor-lungs#respond Fri, 14 May 2021 14:01:10 +0000 https://breathebettertolivebetter.com/2021/05/new-technology-could-increase-supply-of-usable-donor-lungs/ ]]>

(HealthNewsDigest.com) – MAYWOOD, IL –  As many as 80 percent of lungs from organ donors are not used, either because they are not in good enough condition to transplant, or there are doubts about their quality and there is no way to verify their condition.

“Because transplant physicians do not want to risk using lungs that won’t work well, they tend to be very conservative in what donor lungs they will accept for transplant,” said Daniel Dilling, MD, Loyola Medicine’s medical director of lung transplantation.

An investigational technology called ex vivo lung perfusion (EVLP) potentially could increase the organ supply by providing a more informed evaluation of lungs that otherwise would be deemed ineligible for transplant.

Loyola Medicine recently performed its first transplant using a lung that was assessed with the EVLP system. The patient is Bob Falat, of Lockport, Illinois.

“All of the doctors, nurses and staff genuinely care, and they all did everything they could to make sure my transplant worked,” Mr. Falat said. “Loyola is a special type of hospital.”

Mr. Falat’s transplant was performed by Mamdouh Bakhos, MD, one of the nation’s most experienced lung transplant surgeons, and Syed Ali, MD.

Mr. Falat’s transplant was performed as part of a multi-center clinical trial sponsored by Lung Bioengineering Inc. In the trial, if a donor’s lungs appear to need further evaluation, they are flown to Lung Bioengineering’s lung assessment center in Silver Spring, MD. After spending three to six hours functioning on the EVLP machine, the lungs are tested and examined. If they are found suitable for transplant, the lungs are flown to a participating center. Mr. Falat received the donor’s right lung, while the left lung went to a patient at another center.

The clinical trial is comparing 66 lung transplant patients such as Mr. Falat who receive EVLP lungs with 66 patients who receive standard lungs that qualified for transplant without undergoing EVLP. Loyola is the only Illinois center participating in the study.

Most donor lungs are not suitable for transplant because the organs are compromised by trauma (such as car and motorcycle accidents); pre-existing lung diseases; medical treatments such as extended mechanical ventilation; pneumonia; or the dying process. Depending on the injury, donor lungs can become bruised, swollen or waterlogged.

Ex vivo lung perfusion is performed after lungs are removed from the donor. (Ex vivo means outside the body). The lungs are inflated with a ventilator and the blood vessels are perfused with a solution of proteins and nutrients. The perfusion is done at body temperature to mimic normal physiological conditions. The condition of the lungs is monitored with tests such as X-rays, bronchoscopies and oxygen level analyses. Donor blood remaining in the lungs, including medications, is diluted and filtered away. Also removed are blood clots. Antibiotics and anti-inflammatory drugs are administered as a precaution.

During the EVLP process involving Mr. Falat’s lung, Loyola’s lung transplantation team remained in close communication with the EVLP center. After reviewing test results, they determined that the lung – which would not have been deemed usable based on normally available information – was suitable for transplant based on the additional evaluation provided by the EVLP process.

“The lung is working very well, and Mr. Falat’s prognosis is excellent, thanks to the life-giving generosity of his donor,” Dr. Dilling said.

For years prior to his transplant, Mr. Falat suffered from a progressive lung condition called chronic obstructive pulmonary disease (COPD). By the time of his transplant, he was breathing supplemental oxygen 24/7, and even minor exertions such as tying his shoes left him winded.

“Unless you have the disease, you can’t understand what it does to your life,” he said. “If you can’t breathe, you can’t do anything.”

Before he got sick, Mr. Falat, 72, was quite active. And now that he has the chance to breathe more normally again, he hopes to resume activities such as golfing, doing household repairs and taking his grandchildren fishing.

“I am forever grateful to Loyola, Dr. Dilling and all the staff who took care of me,” Mr. Falat said.

For 30 years, Loyola has operated the largest and most successful lung transplant program in Illinois. Loyola has performed more than 900 transplants – more than all other Illinois centers combined. Loyola’s multidisciplinary team regularly evaluates and successfully performs transplants in patients who have been turned down by other centers in Illinois and surrounding states. Despite taking on more challenging cases, Loyola consistently records outstanding outcomes.

The clinical trial Mr. Falat is participating in is titled: “Phase 2, Multicenter, Open-label Study to Measure the Safety of Extending Preservation and Assessment Time of Donor Lungs Using Normothermic Ex Vivo Lung Perfusion and Ventilation (EVLP) as Administered by the SPONSOR Using the Toronto EVLP System™.”

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Asthma attacks plummeted among Black and Hispanic/Latinx individuals during the COVID-19 pandemic https://breathebettertolivebetter.com/2021/05/asthma-attacks-plummeted-among-black-and-hispanic-latinx-individuals-during-the-covid-19-pandemic/?pk_campaign=feed&pk_kwd=asthma-attacks-plummeted-among-black-and-hispanic-latinx-individuals-during-the-covid-19-pandemic https://breathebettertolivebetter.com/2021/05/asthma-attacks-plummeted-among-black-and-hispanic-latinx-individuals-during-the-covid-19-pandemic/?pk_campaign=feed&pk_kwd=asthma-attacks-plummeted-among-black-and-hispanic-latinx-individuals-during-the-covid-19-pandemic#respond Thu, 06 May 2021 18:22:00 +0000 https://breathebettertolivebetter.com/2021/05/asthma-attacks-plummeted-among-black-and-hispanic-latinx-individuals-during-the-covid-19-pandemic/ ]]> In a report of data collected as part of a trial in Black and Hispanic/Latinx patients with asthma that began before COVID-19 hit the U.S., researchers found total asthma attacks decreased by greater than 40 percent with the onset of the pandemic.

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