Journal of thoracic disease
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Intubated general anesthesia with one-lung ventilation was traditionally considered necessary for thoracoscopic major pulmonary resections. However, non-intubated thoracoscopic lobectomy can be performed by using conventional and uniportal video-assisted thoracoscopic surgery (VATS). These non-intubated procedures try to minimize the adverse effects of tracheal intubation and general anesthesia but these procedures must only be performed by experienced anesthesiologists and skilled thoracoscopic surgeons. Here we present a video of a uniportal VATS left upper lobectomy in a non-intubated patient, maintaining the spontaneous ventilation.
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We present an extremely rare case of a giant pulmonary hamartoma (PH) coexisting with an anomalous common pulmonary venous trunk (ACPVT). An asymptomatic 39-year-old man was referred for evaluation of a giant pulmonary lesion in his left thorax detected on chest X-ray during a routine medical examination. After clinical work-up, the patient underwent left exploratory thoracotomy. ⋯ Histology revealed a blend of pieces of rounded cartilage separated by fibrous bands in which mature adipose tissue and cleft-like structures lined. The features were consistent with those of a chondromatous hamartoma. The patient made a satisfactory recovery and 10 months after the operation was asymptomatic.
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Postoperative pain is a very important issue for several patients. Indifferent of the surgery type or method, pain management is very necessary. The relief from suffering leads to early mobilization, less hospital stay, reduced hospital costs, and increased patient satisfaction. ⋯ The major goal in the management of postoperative pain is minimizing the dose of medications to lessen side effects while still providing adequate analgesia. Again a multidisciplinary team approach should be pursued planning and formulating a plan for pain relief, particularly in complicated patients, such as those who have medical comorbidities. These patients might appear increase for analgesia-related complications or side effects.
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Recently, many researchers paid more attentions to the association between air pollution and chronic obstructive pulmonary disease (COPD). Haze, a severe form of outdoor air pollution, affected most parts of northern and eastern China in the past winter. In China, studies have been performed to evaluate the impact of outdoor air pollution and biomass smoke exposure on COPD; and most studies have focused on the role of air pollution in acutely triggering symptoms and exacerbations. ⋯ Cross-sectional studies showed biomass smoke exposure is a risk factor for COPD. A long-term retrospective study and a long-term prospective cohort study showed that biomass smoke exposure reductions were associated with a reduced decline in forced expiratory volume in 1 second (FEV1) and with a decreased risk of COPD. To fully understand the effect of air pollution on COPD, we recommend future studies with longer follow-up periods, more standardized definitions of COPD and more refined and source-specific exposure assessments.
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Air pollution in many Chinese cities has been so severe in recent years that a special terminology, the "Chinese haze", was created to describe China's air quality problem. Historically, the problem of Chinese haze has developed several decades after Western high-income countries have significantly improved their air quality from the smog-laden days in the early- and mid-20(th) century. Hence it is important to provide a global and historical perspective to help China combat the current air pollution problems. In this regard, this article addresses the followings specific questions: (I) What is the Chinese haze in comparison with the sulfurous (London-type) smog and the photochemical (Los Angeles-type) smog? (II) How does Chinese haze fit into the current trend of global air pollution transition? (III) What are the major mitigation measures that have improved air quality in Western countries? and (IV) What specific recommendations for China can be derived from lessons and experiences from Western countries?