Correlative anatomy for thoracic inlet; glottis and subglottis; trachea, carina, and main bronchi; lobes, fissures, and segments; hilum and pulmonary vascular system; bronchial arteries and lymphatics.

Because it is relatively inexpensive and universally available, standard radiographs of the thorax should still be viewed as the primary screening technique to look at the anatomy of intrathoracic structures and to investigate airway or pulmonary disorders. Modern trained thoracic surgeons must be able to correlate surgical anatomy with what is seen on more advanced imaging techniques, however, such as CT or MRI. More importantly, they must be able to recognize the indications, capabilities, limitations, and pitfalls of these imaging methods.

Lobes, fissures, and bronchopulmonary segments.

The clinical practice of thoracic surgery requires the surgeon to have intimate knowledge of pulmonary anatomy and of its variations. Attempts to perform thoracic procedures without this knowledge can only result in incomplete operations or technical mishaps. Proper understanding of the anatomy of the pulmonary lobes, segments, and fissures allows the surgeon to correlate imaging, pathologic processes, and possible resectional procedures, thus insuring that each patient gets the best possible operation.

Anatomy of the neck and cervicothoracic junction.

All thoracic surgeons must have an extensive knowledge of the anatomy of the neck, because cervical approaches are used on an almost daily basis to access the cervical trachea, upper esophagus, and superior mediastinum. In addition to basic and scholarly knowledge of anatomy, they also must understand the anatomic relationships among the neck, the mediastinum, and both pleural spaces. Indeed, such knowledge forms the basis for the diagnosis and management of many aspects of pulmonary, mediastinal, and esophageal pathologies.

Correlative anatomy for the sternum and ribs, costovertebral angle, chest wall muscles and intercostal spaces, thoracic outlet.

The structures of the chest wall and thoracic outlet are complex. A working knowledge of their anatomy and of its variations is essential to any thoracic surgeon working in the area. Correlating imaging with anatomy is just as important if one wants to recognize surgical indications, and potential operating difficulties.

Surgery for small cell lung cancer.

Operative management of small cell lung cancer generally yields little benefit because these tumors are known for their propensity to disseminate early to regional lymph nodes and distant sites. Primary surgery followed by chemotherapy is however indicated in very early stage tumors where survival approximates that of resected non small cell lung tumors. Surgery as an adjuvant to combination chemotherapy is also advocated by some authors to downstage the tumor and render it resectable.

Management of bullous disease.

Although emphysema is a "medical disease", the removal of large bullae may be beneficial to some patients. Selection for surgery should be based on careful clinical, anatomic, and functional evaluations. Unfortunately, no single preoperative test is considered to be an accurate predictor of improvement.

Indications, risks, and results of completion pneumonectomy.

Completion pneumonectomy refers to an operation intended to remove what is left of a lung partially resected during a previous operation. The procedure is seldom indicated and, according to current medical literature, it carries a higher risk of operative mortality and morbidity than does standard pneumonectomy, especially when done for benign disease. Over the past 20 years, 60 consecutive patients aged 17 to 70 years and having a diagnosis of recurrent lung cancer (n = 28), new primary lung cancer (n = 13), or benign pleuropulmonary disease (n = 19) underwent completion pneumonectomy.

[Evaluation of the extent of intra-thoracic lymph nodes. Role of mediastinoscopy].

Mediastinoscopy is a technique which enables palpation, inspection and biopsy of superior mediastinal glands. When this examination is done routinely in patients suffering from lung cancer which is presumed to be operable, 25-30% are found to have a positive gland and the greater part of these individuals become inoperable on account of significant invasion. The specificity of mediastinoscopy is 100% and this specificity ensures that no potentially operable patient would be refused a surgical cure.

[Evaluation of intrathoracic lymphatic involvement: the role of mediastinoscopy].

Mediastinoscopy is a technique that allows palpating, inspecting and puncturing the lymph nodes of the upper mediastinum. When this examination is performed as a routine in patients with a supposedly operable lung cancer, the positiveness rate is 25-30% and most subjects become inoperable because of the extent of invasion. The specificity of mediastinoscopy is of 100%, and it ensures that no potentially operable patient shall be refused for curative surgery.

Clinical spectrum of bronchogenic cysts of the mediastinum and lung in the adult.

Bronchogenic cysts are closed sacs considered to be the result of an abnormal budding of the respiratory system. They are lined by ciliated epithelium and have focal areas of hyaline cartilage, smooth muscle, and bronchial glands within their walls. They are seldom seen in the adult, and most are thought to be asymptomatic and free of complications.