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Schwartz's Principles of Surgery There is a significant role in the pathogenesis of chronic

Chapter 19: Chest Wall, Lung, Mediastinum, and Pleura lung diseases (bronchiectasis and idiopathic pulmonary
fibrosis)
KEY POINTS It may also contribute to Bronchiolitis Obliterans Syndrome
1) Lung Cancer in lung transplant patients.
Highly lethal and extremely common cancer 8) Multidrug-resistant tuberculosis (MDRTB) organisms
5-year survival of 15% Present in approximately 10% of new tuberculosis cases
Incidence is second only to the incidence of prostate and 40% of recurrent cases.
cancer in men and breast cancer in women. Extensively Drug-Resistant Tuberculosis
Most common subtypes Another rare disease varian
a) Squamous cell carcinoma Causative organisms are resistant not only to
b) Adenocarcinoma of the lung Isoniazid and Rifampin, as are the MDRTB
Rarely found in the absence of a smoking history organisms, but also to at least one of the injectable
Nonsmokers who live with smokers have a 24% increased second-line drugs such as Capreomycin, Amikacin,
risk of lung cancer compared to non-smokers who do not and Kanamycin.
live with smokers. 9) Pulmonary Aspergilloma
2) Endoscopic Bronchial Ultrasound Treatment of is individualized.
Can enhance the accuracy and safety of transbronchial Asymptomatic patients can be observed without any
biopsies of both the primary tumor (abuts central airways) additional therapy.
and the mediastinal lymph nodes Mild hemoptysis, which is not life-threatening, can be
Should become part of the surgeon's armamentarium for managed with medical therapy, including antifungals and
the diagnosis and treatment of lung cancer. cough suppressant.
3) Assessment of patient risk before thoracic resection is based on Amphotericin B is the drug of choice
clinical judgment and data. Voriconazole has recently been used for treatment of
4) Impaired exchange of carbon monoxide Aspergillosis
Associated with a significant increase in the risk of Fewer side effects and equivalent efficacy.
postoperative pulmonary complications, independent of the 10) Massive Hemoptysis
patient's smoking history. Traditionally been an indication for urgent or emergent
Patients undergoing pulmonary resection, the risk of any
operative intervention.
pulmonary complication increases by 42% for every 10% With the advancement of endovascular techniques,
decline in the percent carbon monoxide diffusion capacity
Bronchial Artery Embolization has been effective.
(%DLCO)
11) Candidal Infection
This measure may be a useful parameter in risk Demonstrated efficacy is similar to that of other classes of
stratification of patients for surgery. antifungal drugs, the Triazoles and Echinocandins
5) Maximum Oxygen Consumption ( O2max)
Fewer side effects and better tolerated than these
Provide important additional information in those patients
other drug classes.
with severely impaired DLCO and forced expiratory volume
12) Malignant pleural effusion, poor expansion of the lung
in 1 second.
(entrapment by tumor or adhesions) generally predicts a poor
Values of <10 mL/kg per minute generally prohibit any
result with Pleurodesis
major pulmonary resection Primary indication for placement of indwelling pleural
Mortality is 26% compared with only 8.3% in patients catheters.
whose O2 patient's ability to tolerate pneumonectomy. Substantially shorten the amount of time patients spend in
6) Tumor stage will be further subdivided into T1a and T1b, T2a the hospital during their final weeks of life.
and T2b, T3, and T4.
Satellite nodules in the same lobe will be considered T3 TRACHEA
Malignant pleural and pericardial effusions will be Anatomy
considered metastatic disease rather than T4 disease. composed of cartilaginous and
7) Gastroesophageal reflux disease