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Investigation of the respiratory system Pulmonary function tests (PFTs) are useful in determining the functional capacity of the patient and the severity of pulmonary disease, and in predicting the response to various treatments. The tests range from simple ...

LUNG TRANSPLANTATION (see Chapter 92 ) Lung transplantation is an established therapy for those with end-stage parenchymal or pulmonary vascular disease; it is limited by the number of donor lungs available.

Learning objectives To understand: The anatomy and physiology of the thorax • Investigation of chest pathology • The role of surgery in pleural disease •

Lung abscess The causes of lung abscess are shown in Table 60.8 . The chest radiograph shows a cavity with a fluid level or in mycetoma a fungal ball. Most acute abscesses resolve with appropriate antibiotic therapy and postural drainage. Surgery is avoided. S...

MAJOR THORACIC SURGERY The British Thoracic Society (BTS) recommends a tripartite risk assessment model for patients undergoing lung resection, considering the risk of operative mortality , risk of perioperative myocardial events and risk of postoperative dy...

MEDICAL CONDITIONS FOR WHICH SURGERY MA Y BE REQUIRED Bronchiectasis Bronchiectasis is chronic irreversible dilatation of the medium- sized bronchi, which may occur following a suppurative pneumonia or bronchial obstruction. It is the pathological end stage o...

Mechanics of breathing The intercostal muscles contract, causing the ribs to move upwards and outwards, thereby increasing the transverse and anteroposterior dimensions of the chest wall. Along with - the diaphragm, which contracts simultaneously and flattens,...

NEOPLASMS OF THE LUNG

Other conditions of the mediastinum Many of the primary tumours such as neurogenic tumours and germ cell tumours can present as cysts or have a cystic quality . In addition, the mediastinum can contain other cysts, often with an embryological aetiology . Thym...

Other diseases of the chest wall Congenital abnormalities are often incidental findings on chest radiography (e.g. bifid rib), but there are some important exceptions. Cervical rib and thoracic outlet syndrome This rib is usually represented by a fibrous band or...

Pleural effusion Pleural e ff usion can be readily understood with reference to the physiological mechanisms governing the flux of pleural fluid given above. Pleural e ff usions are divided into exudates and transudates, depending on protein content (more [exudat...

Primary lung cancer Lung cancer is one of the most common cancers throughout the world. In the UK, there are approximately 45 /uni00A0 000 new cases a year. From the time of diagnosis, 60% of patients are dead within 1 year and only 15% survive 5 years, mak...

Primary tumours of the mediastinum Thymoma, neurogenic tumours, germ cell tumours and lymphoma are the usual primary tumours of the mediastinum. /uni25CF Thymoma . This is the most common mediastinal tumour, accounting for 25% of the total, and is derived fr...

Pulmonary sequestration This describes a section of non-functional lung separated from the normal bronchial connection with other abnormalities of development, which often include a direct systemic arterial supply from the aorta. V enous return is to the pulm...

Risk of operative mortality The Thoracic Surgery Scoring System (Thoracoscore) is the most widely used model to assess the risk of operative mortality in thoracic patients. Risk is calculated based on nine variables – age, sex, American Society of Anesthesio...

Risk of perioperative myocardial event History , physical examination and resting electrocardiogram (ECG) form the basics of assessing perioperative cardiovas - - cular risk. Patients who are found to have an active cardiac condition should be evaluated by a ...

Risk of postoperative dyspnoea Any patient undergoing general anaesthesia requires some assessment of respiratory function. This may be a clinical appraisal of fitness, but more detail is necessary for patients who are undergoing lung resection.

Surgical approach to lung cancer resection Thoracotomy Although the most frequent indication for thoracotomy is lung cancer, all surgeons dealing with trauma should be able to perform a thoracotomy if required. The standard route into the thoracic cavity is th...