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Surgical management of pleural effusions and infections Thoracoscopy or video-assisted thoracoscopic surgery (VATS) The direct-vision thoracoscope has been used for many years, but its use was limited mainly to performing biopsies. Since the advent of video-a...

Surgical management of pneumothorax Pleurectomy and pleurodesis Surgery for pneumothorax can be performed by video-assisted thoracoscopic surgery (V ATS) or as an open procedure (thora cotomy). The object of the exercise is threefold: /uni25CF to deal with an...

THE DIAPHRAGM The diaphragm is the fibromuscular structure separating the thorax from the abdomen.

THE MEDIASTINUM The mediastinum refers to the central area in the chest between the thoracic inlet and the diaphragm, between the right and left pleural surfaces, and which extends from the inner aspect of the sternum to the vertebral column. It contains the ...

Treatment Removal of the bronchiectatic part of the lung for bleeding, recurrent infection or copious symptoms can be very e ff ective when the disease is localised. y ,

Tuberculosis Surgery is rarely indicated for tuberculosis in resource-rich countries but, when it is, it must be combined with adequate antitubercular chemotherapy or the benefit of surgery will be lost. Summary box 60.5 Tuberculosis: indications for surgery /...

AMPUTATION General Amputation should be considered when part of a limb is dead, deadly or a dead loss. A limb is dead when arterial occlusive disease is severe enough to cause infarction of macroscopic portions of tissue, i.e. gangrene. The occlusion may be ...

ANEURYSM General Dilatations of localised segments of the arterial system are called aneurysms when there is a ≥ 50% increase in the diam - eter of the vessel; below 50% they are termed ectatic. They can either be true aneurysms, containing the three layers...

ARTERIAL STENOSIS AND OCCLUSION Cause and effect Peripheral arterial stenosis or occlusion is predominantly caused by atherosclerosis and/or thromboembolic disease, but may also occur as a result of trauma. Stenosis or occlusion produces symptoms and signs th...

ARTERIOVENOUS FISTULA Communication between an artery and a vein may be either a congenital malformation or the result of trauma. Arteriovenous fistulae for haemodialysis access are also created surgically . All arteriovenous communications have a structural a...

ARTERITIS AND VASOSPASTIC CONDITIONS Thromboangiitis obliterans (Buerger’s disease) This is characterised by occlusive disease of small and medium-sized limb arteries, thrombophlebitis of superficial or deep veins and Raynaud’s syndrome; it usually occurs in ...

Abdominal aortic aneurysm Abdominal aortic aneurysm is by far the most common type of large-vessel aneurysm and is found in 2% of the population at autopsy; 95% have associated atheromatous degeneration and 95% occur below the renal arteries. Most remain asym...

Acrocyanosis Acrocyanosis may be confused with Raynaud’s disease but it is painless and not episodic. It tends to a ff ect young women and the mottled cyanosis of the fingers and/or toes may be accompanied by paraesthesia and chilblains.

Acute limb ischaemia ALI is an emergency that requires rapid, accurate clinical assessment and emergency surgical treatment. ALI typically - occurs as a result of embolic arterial occlusion or trauma, but less common causes, including thrombosed popliteal art...

Acute mesenteric ischaemia Acute mesenteric occlusion may be either thrombotic (follow - ing atheromatous narrowing) or embolic. Embolic occlusion results in sudden, severe abdominal pain, with bowel emptying (vomiting and diarrhoea) and a source of emboli pr...

Clinical features The majority of arterial aneurysms are asymptomatic at the time of identification and are often identified during routine health checks or investigations for other pathologies. Aneurysms measuring twice the size of the corresponding normal v...

Cystic myxomatous degeneration This is typified by an accumulation of clear jelly (like a synovial ganglion) in the outer layers of a main artery , especially the popliteal artery . The lesion may narrow the vessel, causing claudication. Duplex scan is the in...

Distal and transmetatarsal amputation In patients with small-vessel disease, typically caused by DM, gangrene of the toes may occur with relatively good blood supply to the surrounding tissues. In such circumstances local amputation of the digits can result ...