Clinics in chest medicine
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Clinics in chest medicine · Mar 1992
Review Comparative StudyEvaluation and management of solitary and multiple pulmonary nodules.
The evaluation and management of a patient with an SPN is guided by principles that were derived from earlier surgical studies. Stability or no growth for at least 2 years, the presence of calcium in characteristic patterns, and age less than 35 years without any associated risk factors are reliable indicators of a benign process. Fluoroscopy and localized tomography are helpful in evaluation of an SPN. ⋯ Multiple pulmonary nodules are most commonly encountered in patients with metastatic disease to the lungs. Other less commonly encountered diseases that present as multiple pulmonary nodules include infections, arteriovenous malformations, Wegener's granulomatosis, and lymphoma. The evaluation and management of the patient with multiple pulmonary nodules are usually guided by the history, physical examination, and laboratory findings.
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Pulmonary complications represent the leading cause of postoperative morbidity. Thoracic surgical procedures carry the highest risk of such complications. Prevention of pulmonary morbidity in thoracic surgical patients depends on an understanding of expected pulmonary pathophysiologic changes, preoperative assessment of patient risk, and specific interventions aimed at minimizing the incidence and severity of these complications. This article reviews these strategies and gives recommendations concerning the use of preoperative evaluation and postoperative lung expansion techniques.
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Although tracheostomy is performed most commonly for ventilator-dependent patients who have had prolonged periods of endotracheal intubation, it is still necessary and used for other airway problems. Patient management as it relates to indications, timing, various surgical techniques, types of tubes, and complications of tracheostomy and other forms of airway maintenance and control are discussed and evaluated.
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A synopsis of both blunt and penetrating thoracic trauma, this article outlines an approach to management for injuries to the lung, heart, esophagus, tracheobronchial tree, diaphragm, and major thoracic vessels. Also outlined are the management of rib fractures, scapula fractures, sternal fractures, and, in particular, flail chest with associated pulmonary contusion.