
Key Questions in Thoracic Surgery
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- Key Questions in THORACIC SURGERY
- Title Page
- Copyright
- Contents
- Preface
- Foreword
- Acknowledgements
- Contributors
- Abbreviations
- Chapter 1: Thoracic anatomy
- 1 Describe the boundaries and compartments of the mediastinum
- 2 Describe the anatomical structures that are located on the thoracic plane
- 3 Describe the anatomy of the thymus
- 4 Describe the anatomy of the thoracic duct
- 5 Describe the anatomy of the trachea
- 6 Describe the blood supply, venous and lymphatic drainage, and innervation of the trachea
- 7 What are the important anatomical relations of the trachea?
- 8 Describe the anatomical course of the oesophagus
- 9 Describe the anatomical layers of the oesophagus
- 10 Describe the neural innervation of the oesophagus
- 11 Describe the anatomical relations of the oesophagus
- 12 Describe the blood and lymphatic supply of the oesophagus
- 13 Describe the anatomy of the phrenic nerve
- 14 Describe the anatomy of the vagus nerve
- 15 Describe the anatomy of the sympathetic chain
- 16 Describe the anatomy of the lungs
- 17 Describe the anatomy of the main bronchi
- 18 Describe the anatomy of the tracheobronchial tree
- 19 Describe the anatomy of the pulmonary vasculature
- 20 Describe the lymphatic drainage of the lung and mediastinum
- 21 Describe the anatomy of the ribs
- 22 Describe the anatomy of the sternum
- 23 Describe the anatomy of the thoracic inlet
- 24 Describe the anatomy of the intercostal space
- 25 Describe the major muscles of the chest wall
- 26 Describe the anatomy of the diaphragm
- 27 Describe the structures that pass through the openings in the diaphragm
- 28 Describe the anatomy of the pleura
- 29 Describe the embryological origins of the lung, oesophagus and diaphragm
- Acknowledgement
- Recommended reading
- Chapter 2: Lung physiology
- 1 What is pulmonary ventilation?
- 2 Describe the airway structures involved in ventilation
- 3 Describe the physiology of the pleural space
- 4 What is the function of the airways?
- 5 What factors influence airflow during breathing?
- 6 What is transpulmonary pressure?
- 7 What is lung compliance?
- 8 What is surfactant?
- 9 What are the functions of surfactant?
- 10 What is the definition of minute volume?
- 11 What is the mechanism of respiration?
- 12 What is the neurological control of respiration?
- 13 What is dead space?
- 14 What is the ventilation-perfusion ratio?
- 15 What is an intrapulmonary shunt?
- 16 What is ventilation-perfusion (V/Q) mismatch?
- 17 How does pulmonary gas exchange occur?
- 18 What is Fick's law of diffusion?
- 19 What is the pulmonary diffusion capacity?
- 20 What is the respiratory exchange ratio?
- 21 What are West zones?
- 22 What is the alveolar-arterial PO² gradient?
- 23 What are Starling forces of fluid movement?
- 24 What are the characteristic features of pulmonary oedema?
- 25 What are the principles of mechanical ventilation?
- 26 How is O² transported in blood?
- 27 Describe the O² dissociation curve
- 28 What is the Bohr effect?
- 29 What is the effect of carbon monoxide on O² transport?
- 30 How is CO² transported in blood?
- 31 Describe the CO² dissociation curve
- Recommended reading
- Chapter 3: Pharmacology
- 1 What are the pharmacological properties of salbutamol?
- 2 What are the pharmacological properties of ipratropium?
- 3 What are the pharmacological properties of theophylline?
- 4 What are the pharmacological properties of prednisolone?
- 5 What are the pharmacological properties of carbocysteine?
- 6 What are the pharmacological properties of DNAse?
- 7 What are the pharmacological properties of paracetamol (acetaminophen)?
- 8 What are the pharmacological properties of non-steroidal anti-inflammatory drugs (NSAIDs)?
- 9 What are the pharmacological properties of cyclooxygenase 2 (COX-2) inhibitors?
- 10 What are the pharmacological properties of opiates?
- 11 What are the pharmacological properties of lignocaine?
- 12 What are the pharmacological properties of cisplatin?
- 13 What are the pharmacological properties of vinorelbine?
- 14 What are the pharmacological properties of paclitaxel?
- 15 What are the pharmacological properties of pyridostigmine?
- 16 What are the pharmacological properties of low-molecular-weight heparin?
- 17 What are the pharmacological properties of tranexamic acid?
- 18 What are the pharmacological properties of proton pump inhibitors?
- 19 What are the pharmacological properties of ranitidine?
- 20 What are the pharmacological properties of Gaviscon®?
- 21 What are the pharmacological properties of metoclopramide?
- 22 What are the pharmacological properties of ondansetron?
- 23 What are the pharmacological properties of cyclizine?
- 24 What are the pharmacological properties of talc?
- 25 What are the pharmacological properties of amoxicillin?
- 26 What are the pharmacological properties of gentamicin?
- 27 What are the pharmacological properties of meropenem?
- 28 What are the pharmacological properties of cefuroxime?
- 29 What are the pharmacological properties of vancomycin?
- 30 What are the pharmacological properties of erythromycin?
- 31 What are the pharmacological properties of aztreonam?
- 32 What are the pharmacological properties of ciprofloxacin?
- 33 What are the pharmacological properties of trimethoprim?
- 34 What are the pharmacological properties of doxycycline?
- 35 What are the pharmacological properties of rifampicin?
- 36 What are the pharmacological properties of isoniazid?
- 37 What are the pharmacological properties of pyrazinamide?
- 38 What are the pharmacological properties of ethambutol?
- 39 What are the pharmacological properties of fluconazole?
- Chapter 4: Thoracic radiology
- 1 What are the principles of chest radiography?
- 2 What are the important technical features to assess on a chest radiograph?
- 3 What are the important anatomical features to assess on a frontal chest radiograph?
- 4 What are the important anatomical features to assess on a lateral chest radiograph?
- 5 What are the chest radiographic features of a pleural effusion?
- 6 What are the chest radiographic features of pulmonary oedema?
- 7 What are the chest radiographic features of a pneumothorax?
- 8 What are the chest radiographic features of pneumonia?
- 9 What are the chest radiographic features of atelectasis?
- 10 What are the chest radiographic features of acute respiratory distress syndrome?
- 11 What are the radiological features that differentiate ARDS from cardiogenic pulmonary oedema?
- 12 What are the principles of computed tomography (CT) scanning?
- 13 What are the important anatomical features to assess on a CT scan?
- 14 What are the CT radiological features of a solitary pulmonary nodule?
- 15 What are the CT radiological features of interstitial lung disease?
- 16 What are the CT radiological features of pleural empyema?
- 17 What are the CT radiological features of emphysema?
- 18 What are the principles of magnetic resonance imaging?
- 19 What are the indications and contraindications for thoracic MRI?
- 20 What are the principles of positron emission tomography (PET)?
- 21 What are the indications for thoracic PET?
- 22 What are the PET radiological features of lung cancer?
- 23 What are the important considerations of PET-CT for lung cancer staging?
- Acknowledgement
- Recommended reading
- Chapter 5: Pulmonary function tests
- 1 How can respiratory function be assessed?
- 2 What are the principles of lung function testing?
- 3 What is spirometry?
- 4 What is forced vital capacity?
- 5 What is forced expiratory volume in 1 second?
- 6 What is the FEV¹/FVC ratio?
- 7 What is forced expiratory flow?
- 8 What are the spirometry findings in a patient with obstructive lung disease?
- 9 What are the spirometry findings in a patient with restrictive lung disease?
- 10 What is a respiratory flow-volume loop?
- 11 What are the characteristic morphologies of normal and pathological respiratory flow-volume loops?
- 12 Define the lung volumes and capacities that can be assessed
- 13 What are the principles of static lung volume determination?
- 14 What are the static lung volume findings in a patient with obstructive or restrictive lung disease?
- 15 What is gas transfer?
- 16 How is gas transfer measured?
- 17 Why is carbon monoxide used to assess gas transfer?
- 18 What are the causes of a decreased DLCO?
- 19 What are causes of an increased DLCO?
- 20 How can postoperative lung function be predicted?
- 21 What are the principles of a cardiopulmonary exercise test?
- 22 What are the principles of a shuttle walk test?
- 23 What are the principles of a six-minute walk test?
- 24 What are the normal values for arterial blood gas analysis?
- 25 What are the arterial blood gas features of respiratory acidosis?
- 26 What are the causes and management of respiratory acidosis?
- 27 What are the arterial blood gas features of respiratory alkalosis?
- 28 What are the causes and management of respiratory alkalosis?
- 29 What are the causes of hypoxia?
- 30 What are the effects of hypercapnia?
- 31 What are the effects of hypocapnia?
- Recommended reading
- Chapter 6: Oesophageal function tests
- 1 Describe the anatomical course of the oesophagus
- 2 Describe the anatomical layers of the oesophagus
- 3 Describe the nerve supply of the oesophagus
- 4 Describe the physiological components of the oesophagus
- 5 Describe the stages of normal swallowing
- 6 What is peristalsis?
- 7 Describe the factors that control gastro-oesophageal competence
- 8 What are the principles of standard oesophageal manometry?
- 9 What are the principles of high-resolution oesophageal manometry?
- 10 What are the main features of a normal manometry trace?
- 11 What are the characteristic standard manometry findings in a patient with an oesophageal motility disorder?
- 12 What are the characteristic features of achalasia on manometry?
- 13 What are the characteristic features of hypertensive LOS on manometry?
- 14 What are the characteristic features of nutcracker (hypertensive) oesophagus and jackhammer (hypercontractile) oesophagus on manometry?
- 15 What are the characteristic features of diffuse oesophageal spasm on manometery?
- 16 What are the characteristic features of ineffective oesophageal motility on manometry?
- 17 Describe the Chicago classification of oesophageal motility disorders
- 18 What are the principles of gastro-oesophageal pH studies?
- 19 What are the main features of a normal pH study?
- 20 What are the characteristic features of gastro-oesophageal reflux disease on a pH study?
- 21 What are the principles of multi-channel intraluminal impedance monitoring?
- 22 What are the principles of bile reflux monitoring?
- 23 What are the principles of a barium swallow?
- 24 What are the characteristic features of a normal barium swallow?
- 25 What are the characteristic features of a pharyngeal pouch on a barium swallow?
- 26 What are the characteristic features of achalasia on a barium swallow?
- 27 What are the characteristic features of diffuse oesophageal spasm on a barium swallow?
- Recommended reading
- Chapter 7: Pre-operative assessment of a thoracic surgical patient
- 1 How should a patient undergoing thoracic surgery be assessed?
- 2 What are the important factors that should be considered when taking a clinical history of a patient undergoing thoracic surgery?
- 3 How is performance status evaluated?
- 4 Describe the modified Medical Research Council (MRC) dyspnoea score
- 5 What are the important features of the clinical examination of a patient undergoing thoracic surgery?
- 6 Which blood tests should be used to investigate a patient undergoing thoracic surgery?
- 7 What imaging is required for patients undergoing thoracic surgery?
- 8 What investigations are used to evaluate pulmonary function?
- 9 How should lung function be assessed prior to consideration of pulmonary resection for NSCLC?
- 10 How can the risk of dyspnoea following pulmonary resection be reduced?
- 11 How is predicted postoperative lung function (ppo FEV¹ and ppo DLCO) calculated?
- 12 How is cardiovascular risk assessed in patients undergoing thoracic surgery?
- 13 What is the revised cardiac risk index?
- 14 How are patients with coronary artery disease managed prior to thoracic surgery?
- 15 How is the risk of mortality estimated in patients undergoing thoracic surgery?
- 16 What is the tripartite risk assessment model in patients undergoing radical lung cancer resection?
- 17 What interventions could be undertaken to decrease postoperative mortality and morbidity?
- Recommended reading
- Chapter 8: Thoracic anaesthesia
- 1 What are the important aspects of thoracic anatomy for an anaesthetist?
- 2 Which routine investigations are important to an anaesthetist prior to thoracic surgery?
- 3 Which lung function tests are important to an anaesthetist prior to thoracic surgery?
- 4 What are the important aspects of spirometry for an anaesthetist prior to thoracic surgery?
- 5 What are the important aspects of lung volume assessment for an anaesthetist prior to thoracic surgery?
- 6 How does functional residual capacity (FRC) change with position and anaesthesia?
- 7 How does anaesthesia alter the matching of ventilation and perfusion?
- 8 What are the principles of pre-operative anaesthetic assessment of a thoracic surgical patient?
- 9 What are the principles of anaesthetic optimisation for a thoracic surgical patient?
- 10 What are the principles of anaesthetic monitoring during thoracic surgery?
- 11 What is one-lung ventilation (OLV)?
- 12 What are the indications for OLV?
- 13 What are the principles of a double-lumen tube?
- 14 What are the principles of placing a bronchial blocker?
- 15 What are the advantages and disadvantages of the different methods available for one-lung ventilation?
- 16 What are the causes of hypoxia during one-lung ventilation?
- 17 How can ventilation be optimised to minimise hypoxia during OLV?
- 18 What is hypoxic pulmonary vasoconstriction (HPV)?
- 19 What analgesic techniques are appropriate for thoracic surgery?
- 20 What are the important anatomical landmarks when inserting an epidural catheter?
- 21 What are the complications of epidural analgesia?
- 22 What are the important anatomical landmarks for inserting a paravertebral catheter?
- 23 What are the complications of paravertebral analgesia?
- 24 What are the advantages and complications of multimodal systemic analgesia?
- 25 What are the advantages and limitations of intercostal blocks?
- 26 What are the advantages and complications of interpleural techniques?
- 27 What ventilation modes are commonly used during thoracic anaesthesia?
- 28 What are the principles of high frequency ventilation during thoracic surgery?
- 29 What ventilation techniques may be used for rigid bronchoscopy?
- 30 What are the criteria for extubation following thoracic surgery?
- 31 What are the principles of a thoracic surgery enhanced recovery programme?
- 32 What are the specific anaesthetic considerations for flexible bronchoscopy?
- 33 What are the specific anaesthetic considerations for rigid bronchoscopy, including interventional procedures?
- 34 What are the specific anaesthetic considerations for mediastinoscopy?
- 35 What are the specific anaesthetic considerations for a bronchopleural fistula?
- 36 What are the specific anaesthetic considerations for video-assisted thoracoscopic surgery (VATS)?
- Recommended reading
- Chapter 9: Thoracic surgical procedures
- 1 What are the principles of cervical mediastinoscopy?
- 2 What structures are at risk during a cervical mediastinoscopy?
- 3 What are the alternatives to mediastinoscopy for mediastinal lymph node sampling?
- 4 What are the principles of an anterior mediastinotomy?
- 5 What are the principles of a thymectomy?
- 6 Which structures are at risk during a thymectomy?
- 7 What are the important considerations prior to an open tracheostomy?
- 8 What are the principal steps in an open tracheostomy?
- 9 What are the important considerations prior to a rigid bronchoscopy?
- 10 What are the principles of rigid bronchoscopy?
- 11 Describe the important landmarks visualised at bronchoscopy
- 12 What techniques are available to debride an airway tumour?
- 13 What are the principles of tracheobronchial stenting?
- 14 What are the potential complications of airway stenting?
- 15 What approaches are available for tracheal resection?
- 16 What are the principles of tracheal resection?
- 17 Describe the different types of thoracotomy commonly performed
- 18 What are the principles of a posterolateral thoracotomy?
- 19 What are the principles of thoracic stapling?
- 20 What is an anatomical lung resection?
- 21 What are the principles of a pulmonary resection?
- 22 When should an intra-operative frozen section biopsy be performed?
- 23 Describe the anatomy of the left hilum
- 24 Describe the operative steps of a left pneumonectomy
- 25 Describe the operative steps of an anterior approach left upper lobectomy
- 26 Describe the operative steps of an anterior approach left lower lobectomy
- 27 How does the posterior approach to a left lower lobectomy differ from an anterior approach?
- 28 Describe the anatomy of the right hilum
- 29 Describe the operative steps of an anterior approach right upper lobectomy
- 30 Describe the operative steps of an anterior approach right middle lobectomy
- 31 Describe the operative steps of an anterior approach right lower lobectomy
- 32 What are the specific concerns with a right pneumonectomy?
- 33 What are important considerations when performing a bilobectomy?
- 34 What are the principles of resection for very proximal tumours?
- 35 What are the principles of a sleeve lobectomy?
- 36 Describe the operative steps involved in systematic lymph node dissection
- 37 What are the principles of an open decortication?
- 38 What are the principles of video-assisted thoracoscopic surgery?
- 39 Describe the port placement for video-assisted thoracoscopic surgery
- 40 What are the principles of a pleurectomy or pleural abrasion?
- 41 What are the principles of a VATS pleural biopsy?
- 42 What are the principles of a subxiphoid pericardial window?
- 43 What are the principles of chest wall reconstruction?
- 44 What are the principles of diaphragmatic plication?
- 45 What are the principles of an open pectus repair?
- 46 What the principles of the Nuss procedure?
- 47 What are the preparatory steps for oesophagogastroduodenoscopy?
- 48 What are the principles of oesophagogastroduodenoscopy?
- 49 What therapeutic interventions can be performed during oesophagogastroduodenoscopy?
- 50 What are the complications of oesophagogastroduodenoscopy?
- 51 What the principles of rigid oesophagoscopy?
- 52 What are the common surgical approaches to oesophagectomy?
- 53 What are the principles of an Ivor-Lewis gastro-oesophagectomy?
- 54 Which arteries need to be divided to mobilise the stomach during an oesophagectomy?
- 55 Which conduits are used for oesophageal reconstruction?
- 56 Should a pyloromyotomy be performed in conjunction with an oesophagectomy?
- 57 What are the principles of a laparoscopic Nissen's fundoplication?
- 58 What are the principles of a Belsey IV hiatus hernia repair?
- 59 What are the complications of laparoscopic anti-reflux surgery?
- 60 What are the principles of a laparoscopic Heller's cardiomyotomy?
- 61 What are the complications of surgical myotomy?
- 62 Should an anti-reflux procedure be performed at the same time as an oesophageal myotomy?
- 63 What is per oral endoscopic myotomy?
- Chapter 10: Thoracic surgical complications
- 1 Which cardiac arrhythmias occur following thoracic surgery?
- 2 What are the principles of managing a patient with a postoperative cardiac arrhythmia?
- 3 What is postoperative atelectasis?
- 4 What are the principles of managing a patient with atelectasis?
- 5 What is the aetiology of postoperative respiratory failure?
- 6 What are the principles of management in a patient with postoperative respiratory failure?
- 7 What is acute respiratory distress syndrome?
- 8 What are the characteristic features of postoperative pulmonary oedema?
- 9 What are the characteristic features of postoperative pneumonia?
- 10 What are the principles of managing postoperative pain?
- 11 What is postpneumonectomy syndrome?
- 12 What are the characteristic features of bleeding following pulmonary resection?
- 13 What are the principles of management in a patient with significant bleeding following thoracic surgery?
- 14 What wound complications may occur following thoracic surgery?
- 15 What are the principles of management in a patient with a wound haematoma?
- 16 What are the principles of management in a patient with a wound seroma?
- 17 What are the principles of management in a patient with a wound infection?
- 18 What are the principles of management in a patient with a wound dehiscence?
- 19 What are the principles of management in a patient with lung herniation?
- 20 What are the characteristic features of cardiac herniation?
- 21 What are the characteristic features of lobar torsion?
- 22 What are the main principles in preventing lobar torsion?
- 23 What are the risk factors for a prolonged air leak following pulmonary surgery?
- 24 What are the principles of management in a patient with a prolonged air leak?
- 25 What are the principles of management in a patient with surgical emphysema?
- 26 What are the risk factors for early bronchopleural fistula formation?
- 27 What are the clinical features of an early bronchopleural fistula?
- 28 What are the chest radiographical features of an early bronchopleural fistula?
- 29 What are the principles of management in a patient with an early bronchopleural fistula?
- 30 What are the principles of surgery in a patient with an early bronchopleural fistula?
- 31 What are the characteristic features of a late bronchopleural fistula?
- 32 What are the principles of management in a patient with a late bronchopleural fistula?
- Recommended reading
- Chapter 11: Non-small cell lung cancer
- 1 What is non-small cell lung cancer?
- 2 Describe the revised lung adenocarcinoma sub-classification
- 3 How are the pathological subtypes of NSCLC distinguished?
- 4 What is the epidemiology of lung cancer?
- 5 What are the risk factors for NSCLC?
- 6 What is the pathogenesis of NSCLC?
- 7 Which genetic mutations are thought to be involved in the pathogenesis of NSCLC?
- 8 Which paraneoplastic syndromes are associated with NSCLC?
- 9 What are the symptoms of NSCLC?
- 10 What are the signs of NSCLC?
- 11 Which blood tests are used to investigate a patient with NSCLC?
- 12 What are the radiological features of NSCLC?
- 13 What accounts for the false-positive and false-negative rate associated with PET-CT?
- 14 What information from radiological investigation other than TNM staging influences prognosis?
- 15 What is the evidence for screening in NSCLC?
- 16 What did the NLST study show?
- 17 What are the changes to the TNM descriptors in the 7th edition of the TNM classification for NSCLC?
- 18 Describe the AJCC/UICC 7th edition of the TNM classification for NSCLC
- 19 Describe the lymph node stations according to the IASLC
- 20 What are the stage groupings according to the AJCC/UICC 7th edition of the TNM classification for NSCLC?
- 21 What are the TNM additional descriptors?
- 22 What techniques are used in the surgical staging of NSCLC?
- 23 What are the indications for invasive mediastinal staging in NSCLC?
- 24 Which lymph node stations are accessible at invasive mediastinal staging?
- 25 What are the roles of endoscopic and surgical procedures in mediastinal staging?
- 26 What are the principles of management in a patient with NSCLC?
- 27 What are the principles of management for Stage I or II disease in NSCLC?
- 28 What are the principles of management for Stage III disease in NSCLC?
- 29 What are the principles of management for Stage IV disease in NSCLC?
- 30 What are the principles of management for a Pancoast tumour?
- 31 What are the indications for surgery in a patient with NSCLC?
- 32 What are the principles of surgery for a patient with NSCLC?
- 33 Which lymph nodes should be resected at surgery with curative intent in NSCLC?
- 34 How is complete resection defined?
- 35 What are the principles of VATS lobectomy in the treatment of NSCLC?
- 36 What did the CALGB 39802 trial show?
- 37 What are the indications for radiation therapy in NSCLC?
- 38 What are the indications for chemotherapy in NSCLC?
- 39 What is the role of palliative surgery in advanced NSLCLC?
- 40 What are the management options of airway obstruction in NSCLC?
- 41 What are the limitations of stenting in patients with advanced NSCLC?
- 42 What follow-up is recommended for patients who have undergone resection of NSCLC?
- 43 What are the 5-year survival rates for patients with NSCLC?
- Recommended reading
- Acknowledgement
- Chapter 12: Small cell lung cancer
- 1 What is small cell lung cancer?
- 2 What are the differences between SCLC and non-small cell lung cancer?
- 3 What is the epidemiology of SCLC?
- 4 What are the risk factors for developing SCLC?
- 5 What is a paraneoplastic syndrome?
- 6 Which paraneoplastic syndromes are associated with SCLC?
- 7 What are the clinical features of SCLC?
- 8 What blood tests are used in the investigation of a patient with SCLC?
- 9 What are the radiological features of SCLC?
- 10 How is SCLC staged?
- 11 Describe the AJCC/UICC 7th edition of the TNM classification for SCLC
- 12 Describe the Veterans Administration Lung Study Group (VALSG) staging system of SCLC
- 13 What are the different options available to make a tissue diagnosis in SCLC?
- 14 What are the principles of managing a patient with SCLC?
- 15 What are the principles of surgery in a patient with SCLC?
- 16 What are the principles of chemotherapy in SCLC?
- 17 What are the principles of radiotherapy in SCLC?
- 18 What is the prognosis of patients with SCLC?
- Recommended reading
- Acknowledgement
- Chapter 13: Chemotherapy
- 1 Describe the cell cycle
- 2 What are the indications for chemotherapy?
- 3 What are the mechanisms of action of the chemotherapeutic agents used in the management of thoracic oncology?
- 4 What are first-line and second-line therapies?
- 5 What is maintenance chemotherapy?
- 6 How is the response to chemotherapy assessed?
- 7 What is targeted therapy?
- 8 What are the side effects of chemotherapy in general?
- 9 What are the side effects of the specific chemotherapeutic agents used in the management of thoracic oncology?
- 10 What are the indications for cessation of first-line chemotherapy?
- 11 What are the indications for chemotherapy in lung cancer?
- 12 What are the indications for adjuvant chemotherapy in completely resected NSCLC?
- 13 What adjuvant chemotherapeutic regime is recommended following complete resection of NSCLC?
- 14 What are the stage-specific benefits of adjuvant chemotherapy in patients with completely resected NSCLC?
- 15 What are the effects of the 7th edition of the AJCC/UICC TNM classification when considering adjuvant chemotherapy for patients with completely resected NSCLC?
- 16 What is the role for adjuvant chemotherapy in completely resected stage IA NSCLC?
- 17 What is the role for chemotherapy in Stage III NSCLC?
- 18 What factors influence the choice of regime in Stage IV disease?
- 19 What are the first-line chemotherapy treatment options for patients with Stage IV disease?
- 20 What are the optimal combination cytotoxic chemotherapeutic regimes for patients with Stage IV disease?
- 21 What are the advantages of neoadjuvant chemotherapy compared to adjuvant chemotherapy in early-stage operable NSCLC?
- 22 What factors influence the overall benefit of chemotherapy for NSCLC?
- 23 How does the histologic subtype of lung carcinoma affect the choice of chemotherapeutic agent?
- 24 How does performance status influence response to chemotherapy in Stage IIIB and IV disease?
- 25 What are the genetic mutations that offer the possibility to target chemotherapy in NSCLC?
- 26 How may EGFR be targeted in patients with advanced NSCLC?
- 27 What is the evidence for the use of bevacizumab in advanced NSCLC?
- 28 What is the evidence for concurrent chemoradiotherapy in locally advanced NSCLC?
- 29 Which chemotherapeutic agents are recommended for second-line chemotherapy in the treatment of NSCLC?
- 30 How does a VATS lobectomy influence uptake of adjuvant therapy?
- 31 What are the principles of chemotherapy in SCLC?
- 32 What is the role of chemotherapy in oesophageal cancer?
- 33 What is the role of chemotherapy in mesothelioma?
- 34 What is the role of chemotherapy in thymoma?
- 35 What did the LACE meta-analysis show?
- 36 What did the CALGB 9633 trial show?
- 37 What did the IPASS study show?
- 38 What did the FLEX study show?
- Recommended reading
- Chapter 14: Radiotherapy
- 1 What is radiotherapy?
- 2 How is radiotherapy classified?
- 3 How does radiation damage cells?
- 4 What are the potential side effects of thoracic radiotherapy?
- 5 What are the indications for radiotherapy?
- 6 What are the uses of radiotherapy in thoracic diseases?
- 7 Which patients are suitable for radiotherapy?
- 8 What are the different radiotherapy treatment regimens used for NSCLC?
- 9 What are the indications for radiation therapy in NSCLC?
- 10 What is the role of radiotherapy in SCLC?
- 11 What is the role of radiotherapy in the treatment of superior sulcus tumours?
- 12 What is the role of radiotherapy in the palliation of lung cancer?
- 13 What is the role of radiotherapy in malignant pleural mesothelioma?
- 14 What is the role of radiotherapy in oesophageal cancer?
- 15 What did the Intergroup 0139 trial show?
- 16 What did the CALGB 9781 trial show?
- Recommended reading
- Chapter 15: Carcinoid and benign pulmonary tumours
- 1 What are the causes of a benign pulmonary tumour?
- 2 What is a carcinoid tumour?
- 3 What is the epidemiology of bronchopulmonary carcinoid tumours?
- 4 What are the clinical features of a bronchopulmonary carcinoid tumour?
- 5 What is carcinoid syndrome?
- 6 What are the characteristic features of lung carcinoid-related Cushing's syndrome?
- 7 What are the characteristic features of ectopic growth hormone-releasing hormone syndrome?
- 8 What are the investigative findings in a patient with a bronchopulmonary carcinoid tumour?
- 9 What are the principles of management in a patient with a bronchopulmonary carcinoid tumour?
- 10 What are the principles of bronchoscopic resection in a patient with a bronchopulmonary carcinoid tumour?
- 11 What are the principles of surgery in a patient with a bronchopulmonary carcinoid tumour?
- 12 What are the characteristic features of a carcinoid tumourlet?
- 13 What are the characteristic features of a lung hamartoma?
- 14 What are the principles of management in a patient with a lung hamartoma?
- 15 What are the characteristic features of a sclerosing haemangioma?
- 16 What are the principles of management in a patient with a sclerosing haemangioma?
- 17 What are the characteristic features of a benign pulmonary inflammatory pseudotumour?
- 18 What are the principles of management in a patient with a benign pulmonary inflammatory pseudotumour?
- 19 What are the characteristic features of a pulmonary lipoma?
- 20 What are the characteristic features of a benign metastasising leiomyoma?
- 21 What are the characteristic features of a solitary fibrous tumour of the pleura?
- Recommended reading
- Chapter 16: Pulmonary metastases
- 1 Which tumours metastasise to the lung?
- 2 What is the role of the thoracic surgeon in the management of pulmonary metastases?
- 3 What is the rationale for pulmonary metastasectomy?
- 4 What are the indications for pulmonary metastasectomy?
- 5 How are pulmonary metastases detected?
- 6 What imaging is required prior to pulmonary metastasectomy?
- 7 Should all patients with a pulmonary metastasis undergo a pre-operative biopsy?
- 8 Should the mediastinum be staged prior to pulmonary metastasectomy?
- 9 What is the optimal surgical approach to a pulmonary metastasectomy?
- 10 What are the goals of pulmonary metastasectomy?
- 11 What is the evidence that pulmonary metastasectomy influences long-term survival?
- 12 What are the principles of managing a patient with pulmonary metastases in colorectal cancer?
- 13 Which factors are associated with a poor outcome following surgery for colorectal pulmonary metastases?
- 14 What are the results of pulmonary metastasectomy for sarcoma?
- 15 What are the results of pulmonary metastasectomy for renal cell carcinoma?
- 16 What are the results of pulmonary metastasectomy for malignant melanoma?
- 17 What are the results of pulmonary metastasectomy for germ cell tumours?
- Recommended reading
- Chapter 17: Solitary pulmonary nodule
- 1 What is a solitary pulmonary nodule?
- 2 What is the aetiology of an SPN?
- 3 What are the important features in the clinical history of a patient with an SPN?
- 4 What are the important features in the clinical examination of a patient with an SPN?
- 5 What are the important radiological characteristics of an SPN?
- 6 What is a ground-glass opacity?
- 7 What are the important features of an SPN on positron emission tomography (PET) scanning?
- 8 What blood test findings are useful in determining the aetiology of an SPN?
- 9 What are the principles of management in a patient with an SPN diagnosed on a chest radiograph?
- 10 What are the principles of management in a patient with a SPN smaller than 1cm?
- 11 What are the modalities for tissue diagnosis in a patient with SPN?
- 12 What are the principles of CT-guided biopsy in a patient with an SPN?
- 13 What are the principles of intra-operative frozen section histology in the management of an SPN?
- 14 What are the important features of an SPN in a patient with a coexisting or previously treated extrapulmonary malignancy?
- 15 What are the principles of managing a fit 84-year-old patient with an incidental 15mm SPN?
- 16 What are the principles of managing a fit 24-year-old patient with a low-risk 15mm SPN?
- 17 What are the principles of managing an undiagnosed spiculated lesion situated deep in the lobe, where a wedge biopsy and frozen section is difficult or unsafe?
- 18 What are the principles of managing a patient with a malignant SPN, who is unfit for surgery?
- Recommended reading
- Chapter 18: Chronic obstructive pulmonary disease
- 1 What is chronic obstructive pulmonary disease?
- 2 How is COPD classified?
- 3 What is the aetiology of COPD?
- 4 What is the pathophysiology of COPD?
- 5 What are the symptoms of a patient with COPD?
- 6 What are the clinical signs of a patient with COPD?
- 7 What is the prognosis of a patient with COPD?
- 8 What are the radiological features of a patient with COPD?
- 9 What are the findings on lung function testing of a patient with COPD?
- 10 What are the principles of managing a patient with COPD?
- 11 What are the surgical options for the treatment of giant bullae?
- 12 What are the indications for surgery on bullae?
- 13 What are the surgical approaches for bullectomy?
- 14 What are the principles of surgery for a VATS giant bullectomy?
- 15 What complications are common after bullectomy?
- 16 What are the indications for lung volume reduction surgery (LVRS)?
- 17 How are patients optimised before LVRS?
- 18 What are the surgical approaches for LVRS?
- 19 Is there a role for unilateral LVRS?
- 20 What are the principles of LVRS?
- 21 What are the complications of LVRS?
- 22 What techniques are available to reduce postoperative air leak?
- 23 Describe the endobronchial therapies used for the treatment of emphysema
- 24 Describe the concept of collateral ventilation
- 25 What are the principles of endobronchial valve insertion?
- 26 What are the complications of endobronchial valve insertion?
- 27 What did the NETT trial show?
- 28 What did the VENT trial show?
- Recommended reading
- Chapter 19: Lung infections
- 1 What is a respiratory tract infection?
- 2 What is the relationship between thoracic surgery and respiratory infections?
- 3 What is a lower respiratory tract infection?
- 4 What is community-acquired pneumonia?
- 5 What is hospital-acquired pneumonia (HAP)?
- 6 What is healthcare-associated pneumonia?
- 7 What is aspiration pneumonia?
- 8 What is opportunistic pneumonia?
- 9 What are the radiological features of pneumonia?
- 10 What are the principles of management in a patient with pneumonia?
- 11 What is the aetiology of viral pneumonia?
- 12 What are the characteristic features of viral pneumonia?
- 13 What are the principles of treatment of viral pneumonia?
- 14 What is the role of surgery in the management of respiratory infections?
- 15 What is bronchiectasis?
- 16 What is the epidemiology of bronchiectasis?
- 17 What is the pathophysiology of bronchiectasis?
- 18 What is the aetiology of bronchiectasis?
- 19 What are the clinical features of bronchiectasis?
- 20 What are the radiological findings of bronchiectasis?
- 21 What are the principles of management in a patient with bronchiectasis?
- 22 What are the principles of surgery for bronchiectasis?
- 23 What is cystic fibrosis?
- 24 What is the pathophysiology of cystic fibrosis?
- 25 What are the clinical features of cystic fibrosis?
- 26 What are the radiological features of cystic fibrosis?
- 27 What are the principles of treating a patient with cystic fibrosis?
- 28 What are the indications for thoracic surgery for cystic fibrosis?
- 29 What is a lung abscess?
- 30 What is the physiopathology of a lung abscess?
- 31 What are the causative organisms of lung abscess formation?
- 32 What are the clinical features of a lung abscess?
- 33 What are the investigative findings in a patient with a lung abscess?
- 34 What are the principles of management of a lung abscess?
- 35 What are the principles of surgery for a lung abscess?
- 36 What is the prognosis for a patient with a lung abscess?
- 37 What are mycobacteria?
- 38 What is the epidemiology of tuberculosis?
- 39 What is the pathophysiology of tuberculosis?
- 40 What are the clinical features of tuberculosis?
- 41 What are the radiological features of tuberculosis?
- 42 What are the principles of medical management of pulmonary tuberculosis?
- 43 What is the medical management of multidrug-resistant pulmonary tuberculosis?
- 44 What are the principles of surgery for pulmonary tuberculosis?
- 45 What are the characteristic features of pulmonary non-tuberculous mycobacteria?
- 46 What are the characteristic features of NTM hypersensitivity pneumonitis?
- 47 What are the characteristic features of NTM tuberculous-like pulmonary disease?
- 48 What are the characteristic features of disseminated non-tuberculous mycobacterial disease?
- 49 What is Aspergillus?
- 50 What are the characteristic features of allergic bronchopulmonary aspergillosis (ABPA)?
- 51 What are the characteristic features of an aspergilloma?
- 52 What are the characteristic features of chronic necrotising Aspergillus pneumonia?
- 53 What are the characteristic features of invasive aspergillosis?
- 54 What is the role of surgery in Aspergillus lung disease?
- Recommended reading
- Chapter 20: Interstitial lung disease
- 1 What is interstitial lung disease?
- 2 What is the pathophysiology of interstitial lung disease?
- 3 What is the classification of interstitial lung diseases?
- 4 What is the aetiology of interstitial lung disease of 'known' cause?
- 5 What is the epidemiology of interstitial lung disease?
- 6 What are the symptoms of interstitial lung disease?
- 7 What are the signs of interstitial lung disease?
- 8 Which blood tests are useful in the diagnosis of interstitial lung disease?
- 9 What are the radiological features of a patient with interstitial lung disease?
- 10 What are the pulmonary function test findings in a patient with interstitial lung disease?
- 11 What are the principles of management of a patient with radiological features of interstitial lung disease?
- 12 What are the options for obtaining a lung biopsy in a patient with interstitial lung disease?
- 13 What are the principles of a surgical lung biopsy?
- 14 What are the histological features of a lung biopsy in a patient with interstitial lung disease?
- 15 What are the principles of management in a patient diagnosed with interstitial lung disease?
- 16 What are the treatment options for a patient with interstitial lung disease?
- 17 What are the principles of pharmacological treatment in a patient with interstitial lung disease?
- 18 What are the indications for lung transplantation in a patient with interstitial lung disease?
- 19 What are the surgical options for lung transplantation in a patient with interstitial lung disease?
- 20 What is the prognosis for patients with interstitial lung disease?
- Recommended reading
- Chapter 21: Pulmonary transplantation
- 1 Describe the history of pulmonary transplantation
- 2 What are the indications for lung transplantation?
- 3 What are the indications for lung transplantation in a patient with chronic obstructive pulmonary disease (COPD) or emphysema?
- 4 What are the indications for lung transplantation in a patient with interstitial lung disease?
- 5 What are the indications for lung transplantation in a patient with cystic fibrosis or other causes of suppurative lung disease?
- 6 What are the indications for lung transplantation in a patient with pulmonary arterial hypertension?
- 7 What are the absolute contraindications for lung transplantation?
- 8 What are the relative contraindications for lung transplantation?
- 9 Should patients requiring ventilator or extracorporeal membrane oxygenation support undergo transplantation?
- 10 Which patients are suitable for organ donation?
- 11 What are the principles of donor lung procurement?
- 12 What ischaemic times are acceptable for lung implantation?
- 13 Which factors influence donor-recipient matching?
- 14 What are the important considerations in donor-recipient size matching?
- 15 What are the indications for the different surgical options for lung transplantation?
- 16 What are the operative steps during single-lung transplantation?
- 17 What are the operative steps during bilateral-lung transplantation?
- 18 What are the indications for cardiopulmonary bypass during lung transplantation?
- 19 Describe the immunosuppression regime used for lung transplantation patients.
- 20 What are the complications of lung transplantation?
- 21 What are the risk factors for primary graft dysfunction?
- 22 Describe the classification of post-transplantation organ rejection
- 23 Describe the follow-up regime for patients following lung transplantation
- 24 What are the results of lung transplantation?
- 25 What are the indications for retransplantation?
- Recommended reading
- Chapter 22: Haemoptysis
- 1 What is haemoptysis?
- 2 How is haemoptysis classified?
- 3 What is the aetiology of haemoptysis?
- 4 What is the epidemiology of haemoptysis?
- 5 What is the source of the bleeding in haemoptysis?
- 6 What are the clinical features of a patient with haemoptysis?
- 7 What are the differential diagnoses of haemoptysis?
- 8 What are the chest radiological (CXR) features of a patient with haemoptysis?
- 9 What are the computed tomography (CT) features of a patient with haemoptysis?
- 10 What are the radiological features of haemoptysis on bronchial artery angiography?
- 11 What are the principles of management in a patient with minor haemoptysis?
- 12 What are the principles of management in a patient with moderate haemoptysis?
- 13 What are the principles of management in a patient with massive or exsanguinating haemoptysis?
- 14 What are the therapeutic options for a patient with massive or exsanguinating haemoptysis?
- 15 What is the role of bronchoscopy in the management of a patient with haemoptysis?
- 16 What is the role of flexible bronchoscopy in the management of a patient with haemoptysis?
- 17 What is the role of rigid bronchoscopy in the management of a patient with haemoptysis?
- 18 What are the principles of endobronchial interventions in the management of a patient with haemoptysis?
- 19 What is the role of endotracheal intubation in the management of a patient with haemoptysis?
- 20 What are the principles of bronchial artery embolisation?
- 21 What are the principles of surgery in a patient with massive or exsanguinating haemoptysis?
- 22 What is the mortality of a patient with massive haemoptysis?
- Recommended reading
- Chapter 23: Tracheal lesions
- 1 What is the trachea?
- 2 Describe the embryology of the trachea
- 3 Describe the anatomical characteristics of the trachea
- 4 What are the arterial supply, venous and lymphatic drainage, and innervation of the trachea?
- 5 Describe the anatomical characteristics of the main carina
- 6 What are important anatomical relations of the trachea?
- 7 Describe the physiological characteristics of the trachea
- 8 What are the factors that influence airways resistance?
- 9 What are the common causes of tracheal lesions?
- 10 What are the common symptoms of tracheal lesions?
- 11 Describe the characteristic features of congenital tracheomalacia
- 12 Describe the characteristic features of congenital tracheal stenosis
- 13 Describe the characteristic features of a tracheo-oesophageal fistula
- 14 Describe the characteristic features of vascular anomalies and rings
- 15 Describe the characteristic features of inflammatory tracheal lesions
- 16 Describe the characteristic features of traumatic tracheal lesions
- 17 Describe the characteristic features of malignant tracheal tumours
- 18 Describe the characteristic features of benign tracheal tumours
- 19 Which important investigations are used in the diagnosis of tracheal lesions?
- 20 Describe the grading systems used to classify the severity of tracheal stenosis
- 21 What are the treatment options for a patient with a tracheal lesion?
- 22 What surgical approaches can be used for tracheal surgery?
- 23 What are the principles of ventilation during tracheal surgery?
- 24 What are the principles of surgery for tracheal lesions?
- 25 What are release procedures?
- 26 What are the complications of tracheal surgery?
- 27 What are the principles of managing a patient with congenital tracheomalacia?
- 28 What are the principles of managing a patient with congenital tracheal stenosis?
- 29 What are the principles of managing a patient with a congenital tracheo-oesophageal fistula (TOF)?
- 30 What are the principles of managing a patient with a congenital vascular ring?
- 31 What are the principles of managing a patient with a traumatic tracheal lesion?
- 32 What are the principles of managing a patient with an inflammatory (autoimmune) tracheal lesion?
- 33 What are the principles of managing a patient with a neoplastic tracheal lesion?
- 34 What are the indications for a tracheostomy?
- 35 What are the complications of a tracheostomy?
- Recommended reading
- Chapter 24: Mesothelioma
- 1 What is mesothelioma?
- 2 What is the pathogenesis for mesothelioma?
- 3 Describe the pathological classification of mesothelioma
- 4 What is the epidemiology of mesothelioma?
- 5 What is the pathophysiology of mesothelioma?
- 6 Describe the clinical presentation of a patient with mesothelioma
- 7 What are the chest radiological findings in a patient with mesothelioma?
- 8 What are the computed tomography findings in a patient with mesothelioma?
- 9 What are the magnetic resonance imaging and ultrasound scan findings in a patient with mesothelioma?
- 10 What is the role of positron emission tomography in a patient with mesothelioma?
- 11 What are the staging systems used for mesothelioma?
- 12 What are the principles of the Butchart's staging system?
- 13 What are the principles of the UICC staging system?
- 14 What are the principles of the International Mesothelioma Interest Group (IMIG) staging system?
- 15 What are the principles of the Brigham and Women's Hospital (BWH)/Dana Farber Cancer Institute staging system?
- 16 What are the principles of management in a patient with mesothelioma?
- 17 What are the therapeutic options for a patient with mesothelioma?
- 18 What are the surgical options for a patient with mesothelioma?
- 19 What are the indications for radical surgery in a patient with mesothelioma?
- 20 What are the complications following extrapleural pneumonectomy?
- 21 What are the indications for chemotherapy in a patient with mesothelioma?
- 22 What are the principles of chemotherapy in a patient with mesothelioma?
- 23 What are the indications for radiotherapy?
- 24 What are the principles of radiotherapy for a patient with mesothelioma?
- 25 What is the prognosis for patients with mesothelioma?
- 26 What are the poor prognostic factors in mesothelioma?
- 27 What did the MARS trial show?
- 28 What did the MS01 trial show?
- Recommended reading
- Chapter 25: Pleural effusion
- 1 Describe the anatomy of the pleural space
- 2 Describe the surface anatomy of the pleura
- 3 Describe the blood supply and lymphatic drainage of the pleura
- 4 What is the composition of pleural fluid?
- 5 What is the mechanism of pleural fluid turnover?
- 6 What is a pleural effusion?
- 7 What are the types of fluid that may accumulate within the pleural space?
- 8 What are the presenting symptoms of a patient with a pleural effusion?
- 9 What are the signs of a pleural effusion?
- 10 How are pleural effusions classified?
- 11 What are Light's criteria?
- 12 What are the causes of a transudate?
- 13 What are the causes of an exudate?
- 14 What investigations are used to diagnose the presence of a pleural effusion and determine its aetiology?
- 15 What investigations can be performed on pleural fluid to determine its aetiology?
- 16 What are the principles of obtaining pleural fluid or a pleural biopsy?
- 17 What are the principles of thoracocentesis?
- 18 What are the complications of thoracocentesis?
- 19 What are the principles of management in a patient with a malignant pleural effusion?
- 20 What are the therapeutic options for a patient with a malignant pleural effusion?
- 21 What are the principles of management in a patient with a benign pleural effusion?
- 22 What are the principles of chemical pleurodesis?
- 23 Which chemicals can be used to induce pleurodesis?
- 24 What is the best agent to achieve chemical pleurodesis?
- Recommended reading
- Acknowledgement
- Chapter 26: Pneumothorax
- 1 What is a pneumothorax?
- 2 How are pneumothoraces classified?
- 3 What is the aetiology of a pneumothorax?
- 4 What is the epidemiology of a pneumothorax?
- 5 What is the pathophysiology of a pneumothorax?
- 6 What are the complications of a pneumothorax?
- 7 What is the natural history of a pneumothorax?
- 8 What are the symptoms of a pneumothorax?
- 9 What are the signs of a pneumothorax?
- 10 What are the chest radiological features of a pneumothorax?
- 11 What are the computed tomography (CT) features of a pneumothorax?
- 12 What are the ultrasound features of a pneumothorax?
- 13 What are the principles of managing a patient with a pneumothorax?
- 14 What are the therapeutic options for a patient with a pneumothorax?
- 15 What are the indications for non-surgical management of a patient with a pneumothorax?
- 16 What are the indications for surgery in a patient with a spontaneous pneumothorax?
- 17 What are the surgical incisions used for a patient with a pneumothorax?
- 18 What are the principles of surgery in a patient with a pneumothorax?
- 19 What are the complications following surgery in a patient with a pneumothorax?
- 20 What are the principles of managing a patient with a tension pneumothorax?
- 21 What is pneumomediastinum?
- 22 What are the clinical features of a patient with pneumomediastinum?
- 23 What are the radiological features of a patient with pneumomediastinum?
- 24 What are the principles of managing a patient with a pneumomediastinum?
- Recommended reading
- Acknowledgement
- Chapter 27: Haemothorax
- 1 What is a haemothorax?
- 2 What is the aetiology of a haemothorax?
- 3 What is the natural history of a haemothorax?
- 4 What are the symptoms of a haemothorax?
- 5 What are the signs of a haemothorax?
- 6 What are the chest radiographical features of a haemothorax?
- 7 What are the ultrasound features of a haemothorax?
- 8 What are the computed tomography features of a haemothorax?
- 9 What are the principles of management in a patient with a haemothorax?
- 10 What are the therapeutic options for a patient with a haemothorax?
- 11 What are the principles of non-surgical management in a patient with a haemothorax?
- 12 What are the indications for surgery in a patient with a traumatic haemothorax?
- 13 What are the principles of chest drain insertion for the treatment of a haemothorax?
- 14 What are the surgical approaches used for a patient with a haemothorax?
- 15 What are the principles of surgery in a patient with a haemothorax?
- 16 What are the principles of a VATS evacuation of a haemothorax?
- 17 What are the complications following surgery on a patient with a haemothorax?
- 18 What is a retained haemothorax?
- Recommended reading
- Acknowledgement
- Chapter 28: Chylothorax
- 1 What is chylothorax?
- 2 How is chylothorax classified?
- 3 What are the non-traumatic causes of chylothorax?
- 4 What are the traumatic causes of chylothorax?
- 5 What is the composition of chyle?
- 6 What is the normal lymphatic drainage volume?
- 7 Describe the lymphatic drainage system
- 8 Describe the anatomical course of the thoracic duct
- 9 What is the difference between a chylothorax and a cholesterol effusion?
- 10 What are the symptoms of a patient with a chylothorax?
- 11 What are the signs of a chylothorax?
- 12 What laboratory tests are used to investigate chylothorax?
- 13 What are the radiological findings in a patient with chylothorax?
- 14 What are the principles of management of chylothorax?
- 15 What are the principles of conservative management of chylothorax?
- 16 What are the principles of interventional management of chylothorax?
- 17 What are the principles of surgical management of chylothorax?
- Recommended reading
- Acknowledgement
- Chapter 29: Pleural empyema
- 1 What is a pleural empyema?
- 2 What is the difference between a pleural empyema and a lung abscess?
- 3 What is the aetiology of an empyema?
- 4 What are the most common organisms associated with empyema?
- 5 What is the pathophysiology of an empyema?
- 6 What is the epidemiology of parapneumonic effusions and empyema?
- 7 What are the clinical features of an empyema?
- 8 What are the complications of an empyema?
- 9 What are the haematological and microbiological features of a parapneumonic effusion or empyema?
- 10 What are the chest radiological features of a parapneumonic effusion and empyema?
- 11 What are the ultrasound scan features of a parapneumonic effusion and empyema?
- 12 What are the computed tomography features of a parapneumonic effusion and empyema?
- 13 What are the principles of managing a patient with a parapneumonic effusion?
- 14 What are the principles of antibiotic management in a patient with an empyema?
- 15 What are the principles of chest drain insertion in parapneumonic effusion and empyema?
- 16 What is the evidence for intrapleural fibrinolytic therapy in parapneumonic effusion and empyema?
- 17 What is the role of early surgery in complicated parapneumonic effusion?
- 18 What are the indications for surgery in a patient with an empyema?
- 19 What are the principles of surgery in a patient with an empyema?
- 20 What are the principles of VATS decortication?
- 21 What are the principles of open decortication?
- 22 What are the principles of open drainage of the pleural space?
- 23 What are the principles of management in a patient with post-pneumonectomy empyema?
- 24 What is the mortality rate from empyema?
- 25 How does empyema differ between adults and children?
- 26 What did the MIST1 study show?
- Recommended reading
- Chapter 30: Pectus deformities
- 1 What are the causes of anterior chest wall deformities?
- 2 What is the pathophysiology of pectus excavatum?
- 3 What is the epidemiology of pectus excavatum?
- 4 What is the aetiology of pectus excavatum?
- 5 What are the effects of pectus excavatum on respiratory function?
- 6 What is the effect of pectus excavatum on cardiac function?
- 7 What are the symptoms associated with pectus excavatum?
- 8 What are the signs associated with pectus excavatum?
- 9 What are the radiological features of pectus excavatum?
- 10 What is the Haller index?
- 11 What are the principles of management in a patient with pectus excavatum?
- 12 What are the principles of a modified Ravitch procedure?
- 13 What are the principles of a Nuss procedure?
- 14 What are the complications of the Nuss procedure?
- 15 What is pectus carinatum?
- 16 What is the epidemiology of pectus carinatum?
- 17 What are the clinical features of pectus carinatum?
- 18 What are the principles of management in a patient with pectus carinatum?
- 19 What is Pouter pigeon breast?
- Recommended reading
- Chapter 31: Chest wall tumours
- 1 What is a chest wall tumour?
- 2 Describe the classification of chest wall tumours
- 3 What are the clinical features of a chest wall tumour?
- 4 What are the principles of investigation in a patient with a chest wall tumour?
- 5 What are the principles of management in a patient with a chest wall tumour?
- 6 What are the characteristic features of a cutaneous naevus?
- 7 What are the characteristic features of a lipoma?
- 8 What are the characteristic features of a haemangioma?
- 9 What are the characteristic features of a lymphangioma?
- 10 What are the characteristic features of a neurofibroma?
- 11 What are the characteristic features of a fibroma?
- 12 What are the characteristic features of a desmoid tumour?
- 13 What are the characteristic features of a rhabdomyoma?
- 14 What are the characteristic features of a malignant fibrous histiocytoma?
- 15 What are the characteristic features of a liposarcoma?
- 16 What are the characteristic features of a neurofibrosarcoma?
- 17 What are the characteristic features of a rhabdomyosarcoma?
- 18 What are the characteristic features of fibrous dysplasia?
- 19 What are the characteristic features of an osteochondroma?
- 20 What are the characteristic features of a chondroma?
- 21 What are the characteristic features of Langerhans cell histiocytosis?
- 22 What are the characteristic features of a chondrosarcoma?
- 23 What are the characteristic features of an osteosarcoma?
- 24 What are the characteristic features of a Ewing's sarcoma?
- 25 What are the characteristic features of a plasmacytoma?
- 26 What are the important considerations prior to resection of a primary lung carcinoma that invades the chest wall?
- 27 What are the important considerations prior to resection of a metastatic chest wall tumour?
- 28 What are the important considerations prior to resection of a primary chest wall tumour?
- 29 What are the principles of surgery for resection of a chest wall tumour?
- 30 What are the indications for chest wall reconstruction?
- 31 Which prosthetic materials can be used for chest wall reconstruction?
- 32 What are the options available for soft-tissue coverage of chest wall defects?
- Recommended reading
- Acknowledgement
- Chapter 32: Barrett's oesophagus and oesophageal tumours
- 1 What is Barrett's oesophagus?
- 2 What is the epidemiology of Barrett's oesophagus?
- 3 What are the principles of diagnosing Barrett's oesophagus?
- 4 What are the predictors of progression from Barrett's oesophagus to adenocarcinoma?
- 5 What are the principles of management of Barrett's oesophagus?
- 6 What are the principles of the surveillance programme for Barrett's oesophagus?
- 7 What are the principles of medical management for Barrett's oesophagus?
- 8 What are the principles of non-medical management for Barrett's oesophagus?
- 9 What is oesophageal carcinoma?
- 10 What is the epidemiology of oesophageal carcinoma?
- 11 What are the pathological features of oesophageal carcinoma?
- 12 What are the predisposing risk factors for the development of oesophageal carcinoma?
- 13 What are the clinical features of oesophageal carcinoma?
- 14 Which tests are used to investigate a patient with oesophageal carcinoma?
- 15 What are the barium swallow features of oesophageal carcinoma?
- 16 What are the oesophagogastroduodenoscopy features of oesophageal carcinoma?
- 17 What are the endoscopic ultrasound features of oesophageal carcinoma?
- 18 What are the computed tomography features of oesophageal carcinoma?
- 19 What are the positron emission tomography features of oesophageal carcinoma?
- 20 What are the principles of minimally invasive staging?
- 21 Describe the important changes to the TNM classification for oesophageal carcinoma in the updated 7th edition
- 22 Describe the TNM stage groupings for oesophageal carcinoma
- 23 What is the importance of lymph node status in the staging and survival of patients with oesophageal cancer?
- 24 What are the principles of management in a patient with oesophageal carcinoma?
- 25 What are the treatment options for patients medically unfit for surgical treatment?
- 26 What are the palliative procedures available for a patient with oesophageal carcinoma?
- 27 What are the principles of non-surgical treatment?
- 28 What are the principles of surgery for oesophageal carcinoma?
- 29 What are the indications for surgery for oesophageal carcinoma?
- 30 What are the common surgical approaches to oesophagectomy?
- 31 What are the principles of an Ivor-Lewis gastro-oesophagectomy?
- 32 Which conduits can be used for oesophageal reconstruction?
- 33 What are the options for location of the oesophageal anastomosis?
- 34 What are the principles of postoperative management in a patient following oesophageal resection surgery?
- 35 What are the postoperative complications of an Ivor-Lewis gastro-oesophagectomy?
- 36 What are the principles of minimally invasive oesophagectomy?
- 37 What are the principles of endoscopic mucosal resection?
- 38 What are the principles of radiotherapy in oesophageal carcinoma?
- 39 What are the principles of chemotherapy in oesophageal carcinoma?
- 40 What did the MAGIC trial show?
- 41 What did the CROSS trial show?
- 42 What are the principles of oesophageal stents?
- 43 What are the complications of oesophageal stents?
- 44 What are the treatment options for tumour in-growth?
- 45 What are the principles of photodynamic therapy?
- 46 What are the benign tumours of the oesophagus?
- 47 What are the characteristic features of an oesophageal leiomyoma?
- 48 What are the principles of management in a patient with an oesophageal leiomyoma?
- 49 What are the characteristic features of an intraluminal polyp?
- 50 Describe the Siewert classification of gastro-oesophageal tumours
- Recommended reading
- Chapter 33: Gastro-oesophageal reflux disease and hiatus hernia
- 1 What is gastro-oesophageal reflux disease?
- 2 What is the epidemiology of GORD?
- 3 What is the pathophysiology of GORD?
- 4 What are the risk factors for developing GORD?
- 5 What are the complications of GORD?
- 6 What are the symptoms of GORD?
- 7 What are the investigative findings of a patient with GORD?
- 8 What are the treatment options for a patient with GORD?
- 9 What is reflux oesophagitis?
- 10 How is reflux oesophagitis classified?
- 11 What is an oesophageal stricture?
- 12 What are the principles of managing an oesophageal stricture?
- 13 What is Barrett's oesophagus?
- 14 What are the principles of management in a patient with Barrett's oesophagus?
- 15 What are the indications for anti-reflux surgery?
- 16 What are the contraindications to anti-reflux surgery?
- 17 What are the relative contraindications to surgery?
- 18 What are the principles of anti-reflux surgery?
- 19 What are the surgical approaches to anti-reflux surgery?
- 20 What are the operative steps of a laparoscopic Nissen's fundoplication?
- 21 What are the complications of anti-reflux surgery?
- 22 What are the side effects of anti-reflux surgery?
- 23 What new techniques are available for the treatment of gastro-oesophageal reflux?
- 24 What is a hiatus hernia?
- 25 How are hiatus hernias classified?
- 26 What is the significance of a hiatus hernia?
- 27 What are the indications for surgery of a paraoesophageal hernia?
- 28 What are the principles of surgery for a paraoesophageal hernia?
- Recommended reading
- Acknowledgement
- Chapter 34: Dysphagia, oesophageal motility disorders and oesophagopharyngeal diverticula
- 1 What is dysphagia?
- 2 What are the common causes of oropharyngeal dysphagia?
- 3 What are the common causes of oesophageal dysphagia?
- 4 Which diagnostic tests are performed to investigate a patient with dysphagia?
- 5 What are the principles of management in a patient with dysphagia?
- 6 How are oesophageal motility disorders classified?
- 7 What is achalasia?
- 8 What are the clinical features of achalasia?
- 9 What are the investigative findings of a patient with achalasia?
- 10 What are the principles of managing a patient with achalasia?
- 11 What are the principles of endoscopic balloon dilation in a patient with achalasia?
- 12 What are the principles of endoscopic botulinum toxin injection in a patient with achalasia?
- 13 What are the principles of surgery in a patient with achalasia?
- 14 What are the characteristic features of diffuse oesophageal spasm?
- 15 What are the characteristic features of nutcracker oesophagus?
- 16 What are the characteristic features of hypertensive LOS?
- 17 What are the characteristic features of ineffective oesophageal motility?
- 18 How are oesophageal diverticula classified?
- 19 What is a Zenker's diverticulum?
- 20 What are the clinical features of a patient with a Zenker's diverticulum?
- 21 What are the principles of management of a Zenker's diverticulum?
- 22 What is an epiphrenic diverticulum?
- 23 What are the clinical features of an epiphrenic diverticulum?
- 24 What are the principles of management of an epiphrenic diverticulum?
- 25 What is a mid-oesophageal diverticulum?
- 26 What are the clinical features of a mid-oesophageal diverticulum?
- 27 What are the principles of management of a mid-oesophageal diverticulum?
- 28 What are the characteristic features of an oesophageal intramural pseudodiverticulum?
- 29 What are the characteristic features of an oesophageal ring?
- Recommended reading
- Acknowledgement
- Chapter 35: Mediastinal lesions
- 1 Describe the anatomy of the mediastinum
- 2 What are the contents of the mediastinal compartments?
- 3 What are the commonest causes of a mediastinal mass in each compartment in adults?
- 4 What are the clinical features of a patient with a mediastinal mass?
- 5 Which investigations should be performed in a patient with a mediastinal mass?
- 6 What is lymphoma?
- 7 What are the clinical features of mediastinal lymphoma?
- 8 Which investigations are performed in the diagnosis of mediastinal lymphoma?
- 9 How is lymphoma staged?
- 10 What are the principles of management in a patient with mediastinal lymphoma?
- 11 What are germ cell tumours?
- 12 Describe the characteristic features of a teratoma
- 13 Describe the characteristic features of malignant germ cell tumours
- 14 What are the clinical features of germ cell tumours?
- 15 Which investigations are performed in the diagnosis of germ cell tumours?
- 16 What are the principles of managing a patient with a germ cell tumour?
- 17 What is the prognosis of malignant extragonadal germ cell tumours?
- 18 What is mediastinal or retrosternal goitre?
- 19 What is the pathophysiology of retrosternal goitre?
- 20 What are the clinical features of a patient with a retrosternal goitre?
- 21 Which investigations should be performed in a patient with a retrosternal goitre?
- 22 What are the principles of surgery in a patient with a retrosternal goitre?
- 23 Describe the characteristic features of a parathyroid mediastinal mass
- 24 Describe the most common mediastinal cysts
- 25 What are the characteristic features of a pleuropericardial cyst?
- 26 What are the characteristic features of a bronchogenic cyst?
- 27 What are the characteristic features of an enteric cyst?
- 28 What are mediastinal neurogenic tumours?
- 29 What are the clinical features of mediastinal neurogenic tumours?
- 30 What are the radiological findings of a mediastinal neurogenic tumour?
- 31 What are the principles of management in a patient with a mediastinal neurogenic tumour?
- 32 What are the principles of surgery in a patient with a mediastinal neurogenic tumour?
- Recommended reading
- Acknowledgement
- Chapter 36: Thymic lesions
- 1 What is the thymus?
- 2 Describe the embryological development of the thymus
- 3 Describe the anatomy of the thymus
- 4 Describe the anatomical structure of the thymus
- 5 What is the blood supply of the thymus?
- 6 What is the lymphatic drainage of the thymus?
- 7 What is the nerve supply of the thymus?
- 8 Which cell types are found in the thymus?
- 9 Describe the physiology of the thymus
- 10 What are the principal imaging modalities for the thymus?
- 11 Describe the pathological classification of thymic tumours
- 12 What is the epidemiology of thymomas?
- 13 What are the histological features of a thymoma?
- 14 Describe the WHO classification (2004) of thymomas and thymic carcinomas
- 15 What is the prevalence of the histological types of thymomas?
- 16 What are the radiological features of a thymoma?
- 17 Describe the staging system for thymoma
- 18 What are the Masaoka stage-specific treatment options for patients with thymoma?
- 19 What is the prognosis of a patient with a thymoma or thymic carcinoma?
- 20 What factors affect the prognosis of a thymoma?
- 21 Which medical conditions are associated with thymomas (parathymic syndromes)?
- 22 What is myasthenia gravis?
- 23 What are the indications for thymic surgery?
- 24 What is the role for thymectomy in a patient with myasthenia gravis?
- 25 What are the surgical approaches for thymic resection?
- 26 What factors should be considered when determining the surgical approach?
- 27 What are the benefits of minimally invasive surgery for thymectomy?
- 28 What are the disadvantages of a minimally invasive technique for thymectomy?
- 29 What are the principles of a VATS thymectomy?
- 30 What are the complications of thymectomy?
- 31 What is the classification of outcomes for patients with myasthenia gravis following thymic surgery?
- Recommended reading
- Chapter 37: Diaphragmatic disorders
- 1 What is the diaphragm?
- 2 How does the diaphragm develop embryologically?
- 3 What are the origins and insertions of the diaphragm?
- 4 What are the anatomical components of the diaphragm?
- 5 Describe the structures that pass through the openings in the diaphragm
- 6 What is the blood supply and innervation of the diaphragm?
- 7 What is the course of the phrenic nerve?
- 8 What is the physiological function of the diaphragm?
- 9 What are the landmarks of the diaphragm on a normal chest X-ray?
- 10 What are the causes of diaphragmatic paralysis?
- 11 What is the pathophysiology of diaphragmatic paralysis?
- 12 What are the symptoms and signs of diaphragmatic paralysis?
- 13 What are the investigative findings of a patient with diaphragmatic paralysis?
- 14 What are the factors that determine whether spontaneous recovery will occur in a patient with diaphragmatic paralysis?
- 15 What are the therapeutic options for a patient with diaphragmatic paralysis?
- 16 What are the principles of diaphragmatic plication?
- 17 What is diaphragmatic eventration?
- 18 What are the investigative findings of a patient with diaphragmatic eventration?
- 19 What are the principles of management in a patient with diaphragmatic eventration?
- 20 What are the causes of diaphragmatic hernias?
- 21 How are hiatus hernias classified?
- 22 What are the radiological features of a diaphragmatic hernia?
- 23 What are the complications of a diaphragmatic hernia?
- 24 What are the indications for surgical repair of a diaphragmatic hernia?
- 25 What are the surgical approaches for hiatus hernia repair?
- 26 What are the complications following surgical repair of a diaphragmatic hernia?
- 27 What is the aetiology of diaphragmatic rupture?
- 28 What are the clinical features of diaphragmatic rupture?
- 29 What investigations are available to diagnose diaphragmatic rupture?
- 30 What are the principles of managing a patient with diaphragmatic rupture?
- 31 What are the complications of a delayed diagnosis of a ruptured diaphragm?
- 32 What are the causes of cystic lesions on the diaphragm?
- 33 What is the differential diagnosis of a mass arising from the diaphragm?
- 34 How are diaphragmatic tumours classified?
- 35 What are the clinical features of primary diaphragmatic tumours?
- 36 What are the principles of management of malignant diaphragmatic tumours?
- 37 Describe the pathology of diaphragmatic pleural plaques
- 38 Describe the role of the diaphragm in the development of a catamenial pneumothorax
- Recommended reading
- Chapter 38: Hyperhidrosis and superior vena cava obstruction
- 1 What is hyperhidrosis?
- 2 What is the anatomy of the sympathetic chain?
- 3 What is the physiology of sweating?
- 4 How is hyperhidrosis classified?
- 5 What is the aetiology of hyperhidrosis?
- 6 What is the epidemiology of hyperhidrosis?
- 7 What are the clinical features of hyperhidrosis?
- 8 What is Harlequin syndrome?
- 9 What is Frey's syndrome?
- 10 What are the investigative findings of a patient with hyperhidrosis?
- 11 What are the therapeutic options for a patient with hyperhidrosis?
- 12 What are the principles of management of a patient with hyperhidrosis?
- 13 What are the principles of a thoracic sympathectomy for a patient with hyperhidrosis?
- 14 What are the complications of a thoracic sympathectomy?
- 15 What are the long-term results following thoracic sympathectomy?
- 16 What is superior vena cava obstruction?
- 17 What is the anatomy of the superior vena cava?
- 18 What is the pathophysiology of superior vena cava obstruction?
- 19 What are the causes of superior vena cava obstruction?
- 20 What is the epidemiology of patients presenting with superior vena cava obstruction?
- 21 What are the symptoms of superior vena cava obstruction?
- 22 What are the signs of superior vena cava obstruction?
- 23 What is Pemberton's sign?
- 24 What are the radiological features of a patient with superior vena cava obstruction?
- 25 What are the principles of management in a patient with superior vena cava obstruction?
- 26 What are the therapeutic options for a patient with superior vena cava obstruction?
- 27 What is the prognosis of superior vena cava obstruction?
- Recommended reading
- Chapter 39: Thoracic outlet syndrome
- 1 What is thoracic outlet syndrome?
- 2 Describe the anatomy of the thoracic outlet
- 3 What is the pathophysiology of thoracic outlet syndrome?
- 4 What is the classification of thoracic outlet syndrome?
- 5 What is the epidemiology of thoracic outlet syndrome?
- 6 What are the characteristic features of neurogenic thoracic outlet syndrome?
- 7 What are the characteristic features of venous thoracic outlet syndrome?
- 8 What are the characteristic features of arterial thoracic outlet syndrome?
- 9 What are the compression and release phenomena?
- 10 Which provocative clinical tests are used to aid the diagnosis of thoracic outlet syndrome?
- 11 What are the differential diagnoses of thoracic outlet syndrome?
- 12 Describe the radiographical findings in a patient with suspected thoracic outlet syndrome
- 13 Which investigations are used in the diagnosis of neurogenic thoracic outlet syndrome?
- 14 Which investigations are used in the diagnosis of venous thoracic outlet syndrome?
- 15 Which investigations are used in the diagnosis of arterial thoracic outlet syndrome?
- 16 What are the principles of management in a patient with neurogenic thoracic outlet syndrome?
- 17 What are the principles of managing a patient with arterial or venous thoracic outlet syndrome?
- 18 What are the surgical approaches for the operative management of thoracic outlet syndrome?
- 19 Describe the transaxillary surgical approach for excision of the 1st rib
- 20 What are the complications following surgery on a patient with thoracic outlet syndrome?
- 21 What is the success rate of the surgery?
- Recommended reading
- Chapter 40: Thoracic trauma
- 1 What are the main causes of cardiothoracic trauma?
- 2 What is the incidence of major cardiothoracic trauma?
- 3 What are the main physiological causes of death following thoracic trauma?
- 4 What are the principles of managing a patient with thoracic trauma?
- 5 What are the principles of the primary survey?
- 6 What are the important differences when managing a paediatric patient, elderly patient and pregnant woman following thoracic trauma?
- 7 What are the important thoracic injuries that should be identified during the primary survey?
- 8 What are the characteristic features of a tension pneumothorax?
- 9 What are the characteristic features of an open pneumothorax or 'sucking' chest wound?
- 10 What are the characteristic features of a flail chest?
- 11 What are the characteristic features of a massive haemothorax?
- 12 What are the important thoracic injuries that should be identified during the secondary survey?
- 13 What are the important features of a post-traumatic simple pneumothorax or simple haemothorax?
- 14 What are the characteristic features of pulmonary contusion?
- 15 What are the characteristic features of a tracheobronchial injury?
- 16 What are the characteristic features of traumatic diaphragmatic injury?
- 17 What are the characteristic features of traumatic oesophageal injury?
- 18 What are the characteristic features of traumatic rib fractures?
- 19 What are the characteristic features of a traumatic sternal fracture?
- 20 What are the characteristic features of traumatic asphyxia?
- 21 What are the indications for an emergency department thoracotomy?
- 22 What is FAST scanning?
- Acknowledgement
- Recommended reading
- Appendix I: Anatomical structures on frontal and lateral chest radiographs (CXR)
- Appendix II: Anatomical structures on axial computed tomography (CT) scans (mediastinal and lung windows)
- Appendix III: Bronchopulmonary segments
- Appendix IV: Bronchoscopy
- Appendix V: Lung volumes and capacities
- Appendix VI: Respiratory flow-volume loops
- Appendix VII: Pleural effusion differential diagnosis
- Appendix VIII: TNM classification (2010) for non-small cell lung cancer (NSCLC)
- Appendix IX: TNM staging (2010) for non-small cell lung cancer (NSCLC)
- Appendix X: International Association for the Study of Lung Cancer (IASLC) lymph node station map
- Appendix XI: TNM classification (2010) for oesophageal carcinoma
- Appendix XII: TNM staging (2010) for oesophageal carcinoma (adenocarcinoma and squamous cell carcinoma)
- Appendix XIII: Endoscopic ultrasound (EUS) assessment of the layers of the oesophageal wall
- Appendix XIV: International Mesothelioma Interest Group (IMIG) classification for mesothelioma
- Index
- Back Cover
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