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Healthy Life: Fixing Leaky Lungs

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BACKGROUND: Although lung surgery can treat several conditions, it is most often associated with lung cancer, which the Centers for Disease Control and Prevention says kills more people than any other type of cancer. Most lung surgeries are performed to take a closer look at a mass inside of the lungs, remove a mass, or treat conditions like collapsed lung or fluid around the lungs. A lung collapses when the wall of the lung is thin or ruptured and air leaks into the pleural space. Fluid accumulates in the lungs often as a result of an infection. Lung surgery can either be performed directly in a procedure known as thoracotomy, or with a camera in a procedure called thoracoscopy. Early stage lung cancer can often be treated through thoracoscopy. To treat non-small cancers, surgeons often perform a lobectomy, or removal of part of a lung. Sometimes, they need to remove an entire lung in a procedure called pneumonectomy. Patients who undergo lung surgery generally have to stay in the hospital seven to 10 days following surgery, and reach full recovery after one to three months.

AIR LEAKS: Because all lung surgeries require insertion of a chest tube, most patients develop air leaks after surgery. This happens when air from lung tissue leaks out into the chest cavity. If pressure from this air becomes too great, it can cause lung tissue to collapse. Most air leaks stop after three to five days, but when they last longer, they become prolonged air leaks -- the most common complication associated with lung surgery. "About half of the patients have an air leak after surgery, and approximately 10 to 15 percent of the patients end up having an air leak more than seven days," Farid Gharagozloo, M.D., surgeon-in-chief at the Washington Institute of Thoracic and Cardiovascular Surgery in Washington, D.C., told Ivanhoe.

PREVENTING AIR LEAKS: Evicel is a fibrin glue derived from human plasma. This glue is sprayed or dripped on small blood vessels to stop bleeding during surgery. It stops bleeding by combining the proteins fibrinogen and thrombin. Doctors have recently found a new use for the sealant. In experimental surgeries, they have applied it over sutures or staples to prevent air from escaping into the chest cavity. Johnson and Johnson markets this product to be used as, "an adjunct to hemostasis for use in patients undergoing surgery, when control of bleeding by standard surgical techniques is ineffective or impractical." Although this product is FDA-approved to stop bleeding in vascular and liver surgeries, its use for stopping air leaks is still in the experimental stage. Although Evicel has produced no side effects as a lung sealant so far, it is not recommended for those with severe allergies to human blood products. While the drug comes from donors who've been screened and tested for blood transmitted infections, it still poses a risk of carrying infections agents like viruses.

Farid Gharagozloo, MD
Washington Institute of Thoracic & Cardiovascular Surgery
Washington, D.C.
(202) 775-8600

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