Assessment of Operability and Resectability in Lung Cancer.

Lung cancer is a lethal disease, and chronic cigarette smoking is the most common cause. The selection of treatment is based on the histologic cell type, accurate staging, and adequacy of cardiopulmonary functional reserve. The risk for surgery is highest in patients over the age of 80 years.

The Lymphatic Spread of Lung Cancer: An Investigation of the Anatomy of the Lymphatic Drainage of the Lungs and Preoperative Mediastinal Staging.

The knowledge of lymphatic spread of lung cancer permitted the study of anatomy of lymphatic drainage of the lungs. The history of anatomy of lymphatic drainage of the lungs began in the 15th century. In the human, pulmonary lymph flows to the lymph nodes around the lobar bronchi and thence to extrapulmonary lymph nodes located around the main bronchi and trachea and its bifurcation (tracheobronchial lymph nodes). These send their efferents to a right and left mediastinal lymph trunks, which may join the thoracic duct, but usually drain opening directly into the brachiocephalic vein of their own side.

The History and Evolution of Surgical Instruments in Thoracic Surgery.

Surgery is as old as man, and its evolution has been moulded in every age by current technical and scientific advances, not forgetting the demands made upon it by social circumstances and religion. It is both an art and a science, while its practice largely depends on the human relations between doctor and patient. It is extremely difficult to define where surgery begins or ends, and its separation from medicine is largely based on the very different paths which the two disciplines took in ancient times.

Paraneoplastic Syndromes in Lung Cancers: Manifestations of Ectopic Endocrinological Syndromes and Neurologic Syndromes.

Paraneoplastic syndromes are clinical entities associated with cancers and often overlap with metabolic and endocrine syndromes. The cell types of lung cancer involved are frequently small cell, squamous cell, adenocarcinoma, large cell, and carcinoid tumor. A number of neurologic paraneoplastic syndromes have been described for which the tumor product remains unknown. These include peripheral neuropathies, a myasthenia-like syndrome, and subacute cerebellar degeneration. Although all of these syndromes may improve with successful treatment of the primary tumor, complete resolution is rare.

Delays in Managing Lung Cancer: The Importance of Fast-Tracking in the Clinical Care.

Early diagnosis in lung cancer is desirable, because surgical resection offers the only hope of cure. In the face of suggestive symptoms, a normal plain chest radiograph does not exclude the diagnosis, and investigation is essential. The various imaging changes seen on computerized tomography and PET scan provide strong suggestive evidence of lung cancer, but proof of diagnosis rests on histologic examination, material that may be obtained by one of the following diagnostic procedures: bronchoscopy, mediastinoscopy, fine needle aspiration biopsy, thoracentesis and pleural biopsy, lymph node biopsy, and exploratory thoracotomy.

Medical Audit to Improve the Quality of Patient Care in Thoracic Surgery.

The purpose and conduct of medical audit is a means of quality control for medical practice by which the profession shall regulate its activities with the intention of improving overall patient care. The quality assurance depends on patient and physician satisfaction. The medical profession needs to be educated about the structure, process, and outcome. The structure equates to resources found within the hospital. The outcome is when quality of care becomes preeminent.

Oligometastatic Lung Cancer Defined by Biology, Science, and Secondary Growths.

Breast cancer was the first malignant tumor for which TNM classification was proposed by the International Union Against Cancer. Volume and distribution of tumor burden were considered clinically important in this cancer. Lung cancer is caused by excessive cigarette smoking. Prognosis is worst in small cell lung cancer and in non-small cell lung cancer measuring over 3 cm in size and having regional lymphatic spread. Metastatic spread from lung cancer is favored by lymphatic spread to the locoregional lymph nodes and blood-borne spread to 5 sites-lung, brain, bone, liver, and adrenal-all of which are unfavorable prognostic indicators.

Ethics for Thoracic Surgeons in the Management of Lung Cancer.

Lung cancer is a terrible disease, with less than 20% of patients with a diagnosis of lung cancer able to have a resection but many relapsing, making it one of the most biologically aggressive cancers known. Thoracic surgeons do not see all the other 80% but are often consulted and have to make recommendations, and sometimes have to intervene. Thoracic surgeons should be well informed about the ethical framework and participate actively in the discussion. Ethics is an important aspect of surgical practice and has implications for patients, surgeons, and surgical teams, as well as for society.

Can Biologic Aggressiveness and Metastatic Potential of Primary Lung Cancer Be Predicted from Clinical Staging Alone?

The future biologic aggressiveness and metastatic potential of lung cancer, as in other cancers, cannot be predetermined from the current clinical information, imaging studies, and pathologic examination whose purpose is to provide diagnosis and mutation studies and molecular drivers only in making decision for treatment. There is a need for better understanding of the biologic characteristics and aggressiveness of lung cancer. The most that is achieved from clinical staging and pathologic staging is in the planning of treatment of lung cancer and predicting prognosis. Aggressive biologic behavior to come is not within the domain of clinical staging or pathologic staging.

Fundamentals of Standard Sleeve Resection.

Standard sleeve resection refers to the circumferential removal of a segment of the main bronchus in continuity with a lobectomy in order to avoid pneumonectomy. By doing so, surgery can be carried out in patients with compromised pulmonary function while also benefiting those with more normal function. It is most often indicated for malignant tumors located at the origin of the right upper lobe bronchus. Operative mortality is low and in the range of 2% to 3%, and quality of life and long-term survival are better than what is observed after pneumonectomy.

A curious lobe.

A case of azygos lobe is presented. An azygos lobe is an accessory lobe of the lung that may occasionally be confused with a pathological process such as a bulla, lung abscess or neoplasm. Its pathogenesis is discussed, as are the characteristic x-ray features that enable an accurate diagnosis.

Pure red cell aplasia and associated thymoma.

Pure red cell aplasia is a rare cause of anemia, caused by an absence of red blood cell precursors in the bone marrow. It is usually a paraneoplastic syndrome, associated most commonly with large-cell granular lymphocyte leukemia but also thymoma. For patients who present both pure red cell aplasia and thymoma, thymectomy leads to an initial remission of the aplasia in 30% of cases. However, sustained remission may require the addition of medications such as corticosteroids, cyclosporine, or cyclophosphamide. We present a case of pure red cell aplasia associated with a thymoma in an otherwise healthy 80 year-old woman.

A patient with an aberrant pulmonary blood supply and recurrent infection.

A case of intralobar pulmonary sequestration presenting with recurrent episodes of infection is reported. Pulmonary sequestration is a rare congenital malformation characterized by accessory lung tissue with no direct connection to the tracheobronchial tree and is supplied by an aberrant systemic artery. The aberrant artery is key to both diagnosis and treatment. The correct diagnosis may be suspected on clinical grounds and should be confirmed by identifying the lesion and aberrant artery on imaging studies. Surgical resection is curative, taking particular care not to injure the aberrant artery, which may result in devastating intraoperative hemorrhage.

Solitary fibrous tumour of the pleura: A case report.

Solitary fibrous tumours of the pleura are rare pleural neoplasms that are distinct from mesothelioma. Most of them are benign, although some behave aggressively; morphological and pathological features are important in distinguishing them from mesothelioma and in predicting clinical behaviour. Solitary fibrous tumours often grow to a large size before causing symptoms, and are characteristically associated with hypertrophic pulmonary osteoarthropathy in up to 20% of cases. In cases of benign lesions, complete resection is usually curative. A case involving a 62-year-old woman who underwent surgical resection of a solitary fibrous tumour of the pleura measuring 25 cm in size is described.

Postural control during laparoscopic surgical tasks.

BACKGROUND: Balance control during standing is essential while performing surgery. The postural sway must be controlled to enhance movement accuracy. Postural control was compared between novices and experts during standardized laparoscopic tasks. METHODS: Seven novices with limited exposition to laparoscopy were compared with 7 expert surgeons. The subjects were requested to perform 4 laproscopic tasks on the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) and a quiet standing task while standing on 2 force platforms. An analysis of variance (ANOVA) with repeated measures was performed to compare groups and the different conditions. Significant level was set at P < .05. RESULTS: The technical requirements of the laparoscopic tasks impacted on postural sway in both anteroposterior and mediolateral directions. Furthermore, results indicate that the experts have a significantly better postural balance for all tasks compared to novices. CONCLUSION: Postural sway increases with the technical requirements of minimally invasive surgery. This study showed that postural control performance while standing improves with laparoscopic expertise.