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Thoracic surgery

Thoracic surgery. Thoracic Surgery Department Regional Hospital for Lung Diseases Szczecin Zdunowo, Poland. Long time ago. Much later. Main carcinogenic factors. Chemicals Asbestos Benzidine methyl eter Vinyl chloride Aromatic hydrocarbons CIGARETTE SMOKING. Occupational exposure

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Thoracic surgery

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  1. Thoracic surgery Thoracic Surgery Department Regional Hospital for Lung Diseases Szczecin Zdunowo, Poland

  2. Long time ago

  3. Much later

  4. Main carcinogenic factors • Chemicals • Asbestos • Benzidine • methyl eter • Vinyl chloride • Aromatic hydrocarbons CIGARETTE SMOKING • Occupational exposure • Coal gasification • Hematite and uranium mining • Contact with arsene, nickel, beryl, chrome

  5. So called early lung cancer symptoms • Cough • Hemoptysis • Intrathoracic pain • Recurrent pneumonias • Are those symptoms really early?

  6. Paraneoplasmatic symptoms • Cushing syndrome • Hipercalcemia • Gynaecomastia • Polymyosistis • Peripheral neuropathy • Myasthenia • Proliferatic osteoarthropathy • Lupus erythematosus • Acanthosis nigricans • Anaemia, leucopenia • Thrombocytopaenia • Thrombophlebitis migrans • Aseptic endocarditis

  7. Histology

  8. Diagnosis • Radiology: X-ray, CT, NMR, USG, scintigraphy • Pathology: sputum cytology, endoscopy, FNAB mediastinoscopy, VATS, explorative thoracotomy • Genetics: p53, k-ras, CEA, cyfra 21-1, myc

  9. Contraindications for surgery • Dissemination • Horner`s syndrome • Vena cava syndrome • Vocal cord paresis • Pancoast syndrome • WHO>2

  10. Surgical approach • Antero- and anterolateral • Posterolateral • Sternotomy • Clamshell • Paulson • Mixed

  11. Anterior thoracotomy

  12. Posterolateral thoracotomy

  13. Sternotomy

  14. Clamshell

  15. Paulson

  16. Mixed

  17. Types of surgery • Pneumonectomy • Lobectomy (incl. sleeve) • Segmentectomy • Wedge or marginal resection • VATS

  18. Long term survival rates

  19. Combined treatment

  20. Pneumothorax • Close • Open • Tension

  21. Treatment • Bed rest • Drainage • Pleurectomy

  22. Drainage

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