Clinical Scenarios in Thoracic Surgery by Robert Kalimi MD, L. Penfield Faber MD

By Robert Kalimi MD, L. Penfield Faber MD

This special case-based evaluate of thoracic surgical procedure bargains very good instruction for oral board examinations, which emphasize either normal wisdom and case administration. Written via well-known specialists, the e-book provides quite a few instances protecting the entire spectrum of thoracic surgical ailments. each one case starts with the medical presentation and proceeds to X-ray record, differential analysis, CT experiment document, analysis and advice, surgical technique, final result, and dialogue. X-rays, CT scans, bronchoscopic pictures, and different appropriate illustrations accompany the textual content. a few instances contain postoperative issues and dialogue of the motives, review, and administration of those complications.

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More remotely, signs of hypothyroidism and hypoparathyroidism should be monitored. Case Continued The patient is taken to the operating room where a collar incision is performed. The strap muscles are retracted laterally, the thyroid is identified, and the middle 35 36 Clinical Scenarios in Thoracic Surgery thyroid vein is ligated. After identification of the parathyroid and recurrent laryngeal nerve, an attempt is made to deliver the substernal portion of the thyroid through the neck incision; however, this is unsuccessful.

However, the use of routine mediastinoscopy in patients with lung cancer remains controversial. Most surgeons use mediastinoscopy selectively in patients with enlarged lymph nodes (larger than 10 mm), T3 tumors, and central cancers. Anterior mediastinotomy has been used when the subaortic and lateral aortic area nodes are enlarged in a patient with lung cancer. When bronchoscopy and needle biopsy are not diagnostic, video-assisted thoracic surgery (VATS) can be used to excise peripheral nodules.

Most patients are asymptomatic in the early stages. Generally, the disease is advanced if significant symptoms are present. The initial symptoms are usually cough, hemoptysis, wheezing, stridor, dyspnea, or recurrent infections. Extrapulmonary signs and symptoms such as hoarseness, chest pain, dysphagia, pleural effusion, Horner’s syndrome, Pancoast’s syndrome, and superior vena cava syndrome are present in more advanced disease. Paraneoplastic syndromes can be the first sign of disease. Hypercalcemia, the syndrome of inappropriate antidiuretic hormone (SIADH), and Cushing’s syndrome are the most common.

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