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Lobectomy or Pneumonectomy


Presentation

  • Articles in this outstanding issue include: Pathology of neuroendocrine tumors, Clinical and radiological presentation of neuroendocrine tumors of the lung, Neuroendocrine tumors and endocrine syndromes, The significance of histology: typical and atypical[books.google.com]
  • This study presents a single-institution retrospective audit of the surgical management of 23 patients with multidrug-resistant tuberculosis.[ncbi.nlm.nih.gov]
  • Finley, MD, MPH, will be presenting the results of this research at the 95th AATS Annual Meeting in Seattle, WA on April 28, 2015. For patients in the early stages of NSCLC, lung surgery is associated with the best long-term survival.[sciencedaily.com]
Asymptomatic
  • Perioperative risk reduction strategies: The patient should be taken in optimal condition with no or minimal airway inflammation and PEF (Peak Expiratory Flow) 80 % of patient’s asymptomatic baseline.[cancertherapyadvisor.com]
  • A follow-up of integrated positron emission tomography/computed tomography after curative resection of non-small-cell lung cancer in asymptomatic patients. J Thorac Cardiovasc Surg. 2010; 139(6): 1447-51. 14) IARC.[haigan.gr.jp]
Cushingoid
  • Examining a lung transplant: Inspection: Clamshell incision (transverse thoracosternotomy scar), median sternotomy scar, lateral thoracotomy scar, Cushingoid (steroids), gum hypertrophy (cyclosporin), hypertrichosis (cyclosporin).[ptpaces.wordpress.com]
Dyspnea
  • Incidence 2% o Mortality 30-70% o Causes: § Necrosis of bronchial stump § Dehiscence of suture line o More common on the right o Increased risk in association with § Residual carcinoma § Preoperative radiation § Diabetes o Clinical § Sudden onset of dyspnea[learningradiology.com]
  • Signs that a stump has ruptured include dyspnea, change in mental status, and expectoration of serosanguineous fluid.[medical-dictionary.thefreedictionary.com]
  • BronCHopleural fisTula • It implies breakdown of the bronchial stump and it occcurs around the 10 th postoperative day ,if small it may not be noticed untill much later • It is recognised by dyspnea ,an irritating cough and possible expectoration of dark[slideshare.net]
  • Patients with evidence of interstitial lung disease on radiological tests or dyspnea on exertion should also have DLCO measured even with adequate FEV 1.[cancertherapyadvisor.com]
Myopathy
  • Stay current on the latest anesthetic implications in regards to coexisting diseases, procedures, drugs, and alternative and complementary therapies, including coverage of mitochondrial myopathy, atrial fibrillation ablation, awake craniotomy, stereotactic[books.google.com]
Delayed Wound Healing
  • Endocrine: Poorly controlled diabetes is associated with increased incidence of surgical site infections and delayed wound healing. Adequate blood glucose control may provide benefit.[cancertherapyadvisor.com]
Neurologic Manifestation
  • Certain paraneoplastic syndromes of lung malignancies have neurologic manifestations. The most common are central and peripheral neuropathies caused by autoantibodies and manifested by weakness and neurological disability.[cancertherapyadvisor.com]

Workup

  • If the patient meets the following criteria, no further workup is necessary: FEV1 2 liters FEV1/FVC 50% MVV 50% of predicted RV/TLC If these criteria were met and the patient were to have pneumonectomy, he would be left with at least 1 liter of FEV1 in[lumen.luc.edu]
Mediastinal Shift
  • CT The lung is absent at the side of surgery, with resultant mediastinal shift and compensatory hyperinflation of the contralateral lung. Promoted articles (advertising)[radiopaedia.org]
  • A fistula between the bronchus and pleura sometimes occurs, leading to subcutaneous emphysema and mediastinal shift caused by a massive air leak.[medical-dictionary.thefreedictionary.com]
  • Second point, there may be no sign to suggest mediastinal shift in lobectomy ( central trachea) but in penumonectomy, you are expected to find signs suggesting mediastinal shift ( based on your tracheal position or apex beat).[passpaces.com]
  • Post-pneumonectomy syndrome This syndrome results from the extrinsic compression of the distal trachea and main-stem bronchus due to mediastinal shifting and compensatory hyperinflation that occurs in the remaining lung.[quizlet.com]
  • Because of constant volume in the PPS and exhalation in the contralateral lung on expiration, a contralateral mediastinal shift of up to 3.5 cm on expiration is considered normal.[cancerjournal.net]
Hyponatremia
  • It is useful to rule out metabolic derangements such as hyponatremia, and to determine the presence of antibodies. Carotid ultrasound is the screening test of choice for carotid artery disease.[cancertherapyadvisor.com]
Pleural Adhesions
  • If the specimen is a pneumonectomy, determine which lobes are involved by tumor and whether the tumor causes pleural adhesion between lobes.[essentialpathology.info]

Treatment

  • RESULTS: Stay in the intensive treatment unit was 2.9 days (range 1-17 days) and hospital stay, 8.6 days (range 5-45 days).[ncbi.nlm.nih.gov]
  • […] of advanced thoracic neuroendocrine tumors, Radiometabolic treatment of advanced neuroendocrine tumors, Biological and clinical prognostic factors in thoracic neuroendocrine tumors, and more![books.google.com]
  • Sepsis /septic shock from any cause until treatment has started and there has been adequate resuscitation. Untreated DVT and/or hemodynamically significant PE until extension assessed and treatment started. It may require IVC filter placement. 3.[cancertherapyadvisor.com]
  • This successful case led to the modern treatment of lung cancer. In fact, pneumonectomy was the treatment of choice until 1962, when results show that pneumonectomy increased complications but did not improve survival compared to a lobectomy.[coursera.org]
  • […] with the treatment of MDR TB.[omicsonline.org]

Prognosis

  • Early age of onset (before 16) and intermittent asthma were associated and had a more favourable prognosis, while the childhood bronchitic had a better outlook than the adult bronchitic. Intermittent and continuous asthma have been compared.[books.google.ro]
  • The prognosis following a pneumonectomy depends on many factors.[verywell.com]
  • Step 3: If the patient has predicted post-operative FEV1 value is less than 800 ml, and if the surgeon still feels that he has a resectable lesion with a good prognosis, the next evaluation would be to occlude the pulmonary artery and measure the pulmonary[lumen.luc.edu]
  • Surgery has a greater roll in the management of 'NSCLC' rather than small-cell carcinoma' which has poorer prognosis and is almost always unsuitable for surgical intervention by the time of presentation.[quizlet.com]
  • Prognosis of synchronous and metachronous multiple primary lung cancers: systematic review and meta-analysis. Lung Cancer. 2015;87(3):303–10. CrossRef PubMed Google Scholar 8. Ha D, Choi H, Chevalier C, Zell K, Wang X-F, Mazzone PJ.[link.springer.com]

Etiology

  • This is applicable as well as in cases of unresponsive hemodynamic instability of unclear etiology. c.[cancertherapyadvisor.com]

Epidemiology

  • Didactic material will cover epidemiology, screening and diagnosis, staging, imaging, radiation therapy, systemic therapy, surgery, psychiatry, and patient support topics.[coursera.org]
  • Temporal trends in outcomes following sublobar and lobar resections for small( 2cm)non-small cell lung cancers--a Surveillance Epidemiology End Results database analysis.[haigan.gr.jp]
Sex distribution
Age distribution

Pathophysiology

  • Lung injury after one-lung ventilation: a review of the pathophysiologic mechanisms affecting the ventilated and the collapsed lung. Anesth Analg. 2015;121(2):302–18.[link.springer.com]
  • Pathophysiology and management of one-lung ventilation. ThoracSurgClin. 2005;15(1):85-103. [PubMed][apicareonline.com]

Prevention

  • To help prevent this, we usually interpose a muscle flap in between the airway and the pulmonary artery to prevent this.[coursera.org]
  • It is recommended that patients undergoing a pneumonectomy be monitored for symptoms of pneumonia and also take steps to prevent the illness.[news.cancerconnect.com]
  • Postoperative chest physiotherapy • Clear the lung field • Reexpansion of the lung • Prevent circulatory complication • Prevent wound complication • Regain the arm and trunk movement • Maintain the good posture • Conditioning exercise Dr.Tarpan Shah 23[slideshare.net]
  • Even if you have to stay in bed, it’s important to keep up regular leg movements to help your circulation and prevent blood clots.[macmillan.org.uk]
  • This is to prevent strain on your chest muscles and the cut.[hopkinsmedicine.org]

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