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

By Robert Kalimi MD, L. Penfield Faber MD

This certain case-based evaluation of thoracic surgical procedure bargains first-class training for oral board examinations, which emphasize either common wisdom and case administration. Written by way of well-known specialists, the e-book provides quite a few instances protecting the complete spectrum of thoracic surgical ailments. every one case starts off with the scientific presentation and proceeds to X-ray document, differential analysis, CT test document, prognosis and suggestion, surgical process, consequence, and dialogue. X-rays, CT scans, bronchoscopic pictures, and different suitable illustrations accompany the textual content. a few circumstances contain postoperative issues and dialogue of the motives, evaluate, and administration of those complications.

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Sample text

Hormones that can be increased include adrenocorticotropic hormone (ACTH), inappropriate antidiuretic hormone (IADH), and melanophorestimulating hormone (MSH). Patients with the carcinoid syndrome may have elevated levels of serotonin and 5-hydroxyindoleacetic acid in the blood and urine. This syndrome is rarely seen in patients with tracheobronchial carcinoid. Bronchoscopy identifies the tumor in 75% of patients. Frozen section should not be obtained because the tumor has similarities to small cell carcinomas.

Because of the size and location of the tumor and a positive hilar lymph node, bilobectomy and mediastinal lymph node dissection are performed. There is minimal intraoperative blood loss, and the patient is extubated in the operating room. The patient is transferred to the pediatric intensive care unit for postoperative monitoring. Overnight, the patient’s vital signs are stable, but during the first postoperative day, he begins to complain of respiratory distress with decreasing oxygen saturation.

Broad-spectrum antibiotics should be administered. A right thoracostomy tube is placed that yields serous fluid. The patient should be returned to the operating room for neck exploration. Discussion Morbidity associated with surgery for Zenker’s diverticulum includes vocal cord paralysis, wound infection, suture line leak, and recurrence of the diverticulum. A suspected leak from the hypopharynx or esophagus requires urgent diagnosis and management. In this patient, endoscopy and contrast esophagram are not necessary because there is already a region of high suspicion for leak based on the findings during the initial operation.

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