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

By Robert Kalimi MD, L. Penfield Faber MD

This distinctive case-based overview of thoracic surgical procedure bargains very good instruction for oral board examinations, which emphasize either basic wisdom and case administration. Written by means of well-known specialists, the ebook provides a number of circumstances masking the total spectrum of thoracic surgical illnesses. each one case starts with the medical presentation and proceeds to X-ray file, differential prognosis, CT experiment record, prognosis and advice, surgical technique, consequence, and dialogue. X-rays, CT scans, bronchoscopic images, and different appropriate illustrations accompany the textual content. a few circumstances comprise postoperative issues and dialogue of the motives, assessment, and administration of those complications.

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Sample text

Contraindications for lung transplantation include acute infection; malignancy; irreversible dysfunction of renal, hepatic, cardiac, or nervous system; and psychiatric conditions such as addiction or noncompliance. Relative contraindications to lung transplantation include ventilator dependency, prior thoracic surgery, and advanced age. In a candidate for single-lung transplantation, the side chosen to transplant is the one that has the worst function as measured by ventilation-perfusion mismatch.

These major strategies are in addition to appropriate fluid, pharmacologic, and nutritional management. Pathology Report The final pathologic study revealed an atypical carcinoid tumor based on the presence of coarse chromatin, hyperchromatism, and small nucleoli. There were also 3 to 4 mitoses per 10 HPFs. Tumor extended into the peribronchial lymph nodes. ■ Discussion Atypical carcinoids constitute about 10% of the carcinoids reported in most series. Because of the greater frequency of lymph node involvement and distal metastases, disease-free survival and overall survival rates are decreased in comparison to those of patients with typical carcinoids.

Needle biopsy is generally not necessary before removal. These tumors should be removed, even if asymptomatic, because of potential for airway compromise. Chest x-rays and CT scan are usually diagnostic, and additional evaluation is rarely necessary. Contrast used during CT scan provides iodine load and may produce thyrotoxicity. Nuclear scanning cannot be performed after contrast CT scan for several weeks. However, negative thyroid imaging, before iodinated contrast load, does not exclude the diagnosis of intrathoracic thyroid goiter.

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