Pneumonectomy: Procedure, Indications, Surgical Technique, Risks, Recovery, and Postoperative Care

Pneumonectomy: Procedure, Indications, Surgical Technique, Risks, Recovery, and Postoperative Care

pediagenosis    July 30, 2026    Comment   

PNEUMONECTOMY

Pneumonectomy was first successfully performed in 1933 by Evarts Graham. The procedure was carried out for bronchogenic carcinoma in a fellow physician, James Gilmore, who eventually outlived his surgeon. The event is a milestone in surgical history. The technique of pneumonectomy has been improved and standardized in the intervening years, and the results are quite gratifying when the operation is carefully performed in appropriately selected cases. Current indications are chiefly as an operation for cure for lung cancer (usually centrally located) or for a destroyed lung as a result of infection or trauma. Palliative pneumonectomy is generally not warranted unless it is directed at alleviation of sepsis or control of recurrent hemorrhage. Before embarking upon resection of an entire lung, the surgeon must have a histologic diagnosis and a full assessment of the patient’s cardiopulmonary reserve; little is gained if the pneumonectomized patient survives but has severe respiratory disability.

Video-Assisted Thoracoscopic Surgery (VATS): Procedure, Benefits, Indications, Risks, Recovery & Surgical Technique

Video-Assisted Thoracoscopic Surgery (VATS): Procedure, Benefits, Indications, Risks, Recovery & Surgical Technique

pediagenosis    July 30, 2026    Comment   

VIDEO-ASSISTED THORACOSCOPIC SURGERY

Video-assisted thoracoscopic surgery (VATS) has become a common tool for thoracic surgeons. It is useful in the evaluation and management of patients with pleural disease, benign and malignant pulmonary parenchymal neoplasms or diseases, mediastinal masses or adenopathy, and esophageal pathology and for resection of posterior mediastinal neurogenic tumors or conditions responsive to sympathectomy. A VATS operation is defined by use of two or more port incisions and video display of the involved hemithorax on operating room monitors, and it does not involve rib spreading. Most standard thoracic surgical instruments have been modified for thoracoscopic surgery.

Extracorporeal Shock Wave Lithotripsy (ESWL): Procedure, Indications, Risks, Recovery & Success Rate

Extracorporeal Shock Wave Lithotripsy (ESWL): Procedure, Indications, Risks, Recovery & Success Rate

pediagenosis    July 28, 2026    Comment   

Plate 10-12

EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

Extracorporeal shock wave lithotripsy (ESWL) is a noninvasive procedure for the treatment of nephrolithiasis. In this procedure, acoustic shock waves are generated external to the patient and focused on the renal stones, which are fragmented into small pieces that can be spontaneously passed in the urine. The skin and surrounding renal parenchyma receive a much smaller dose of energy and therefore remain largely unharmed.

Lung Volume Reduction Surgery (LVRS): Procedure, Benefits, Risks, Recovery, and NETT Trial Explained

Lung Volume Reduction Surgery (LVRS): Procedure, Benefits, Risks, Recovery, and NETT Trial Explained

pediagenosis    July 28, 2026    Comment   

LUNG VOLUME REDUCTION SURGERY

The goal of lung volume reduction surgery (LVRS) is to safely palliate dyspnea in patients with emphysema. Successful LVRS demands attention to the details of patient selection, preoperative preparation, intraoperative anesthetic and surgical technique, and multidisciplinary postoperative care. Expertise and effective communication among pulmonary medicine, thoracic surgery, thoracic anesthesia, pain management services, critical care medicine, respiratory therapy, and rehabilitation medicine departments are vital components to any LVRS program. In experienced centers, bilateral approaches yield nearly twice the physiologic benefit to unilateral LVRS without adversely affecting operative morbidity or mortality. Current practice favors stapled bilateral resection over plication or laser ablation to achieve lung volume reduction.

Lung Transplantation: Types, Procedure, Risks, Recovery, and Long-Term Survival

Lung Transplantation: Types, Procedure, Risks, Recovery, and Long-Term Survival

pediagenosis    July 28, 2026    Comment   

LUNG TRANSPLANTATION

Clinical lung transplantation was first attempted in the 1960s, but little success was achieved until the availability of more effective immunosuppressive drugs (cyclosporine) and improved surgical techniques in the early 1980s. The annual number of lung transplant procedures has increased steadily from fewer than 100 per year in the 1980s to more than 2700 transplants reported by 150 worldwide transplant centers in 2007. Lung transplantation is now an accepted therapy for all forms of advanced lung disease.

Carney Complex: Symptoms, Causes, Diagnosis, Genetics, Treatment, and Long-Term Management

Carney Complex: Symptoms, Causes, Diagnosis, Genetics, Treatment, and Long-Term Management

pediagenosis    July 21, 2026    Comment   

CARNEY COMPLEX

Carney complex, also known as NAME syndrome (nevi, atrial myxomas, myxoid neurofibromas, ephelides) or LAMB syndrome (lentigines, atrial myxomas, mucocutaneous myxomas, blue nevi), is an autosomal dominantly inherited disorder that affects the integumentary, endocrine, cardiovascular, and central nervous systems. This rare disorder is primarily caused by a genetic mutation in the tumor suppressor gene, PRKAR1A. Approximately 20% of patients have defects in an undescribed gene located at 2p16. Various genotypes and phenotypes exist, and the diagnosis is based on a complex list of major, supplemental, and minor criteria.

Cushing's Syndrome vs Cushing's Disease: Symptoms, Causes, Diagnosis & Treatment Guide

Cushing's Syndrome vs Cushing's Disease: Symptoms, Causes, Diagnosis & Treatment Guide

pediagenosis    July 21, 2026    Comment   

CUSHING’S SYNDROME AND CUSHING’S DISEASE

Cushing’s syndrome is caused by excessive secretion of endogenous glucocorticoids or, more frequently, by intake of excessive exogenous glucocorticoids. The latter type is typically iatrogenic in nature. The excessive glucocorticoid levels lead to the many cutaneous and systemic signs and symptoms of Cushing’s syndrome and Cushing’s disease. Endogenous glucocorticoids are made and secreted by the adrenal glands, and benign adrenal adenomas are the most frequently implicated adrenal tumors causing Cushing’s syndrome. Cushing’s disease is caused by excessive secretion from the anterior pituitary of adrenocorticotropic hormone (ACTH, corticotropin) as the result of a basophilic or chromophobe adenoma. The increased amount of ACTH causes the adrenal glands to hypertrophy and boost their production of cortisol, eventually leading to a state of hypercortisolism. Excessive release of corticotropin-releasing hormone (CRH) from the para- ventricular nucleus of the hypothalamus can also cause the syndrome. Any tumor that has the ability to produce ACTH also has the potential to cause Cushing’s syndrome. The most frequently reported such tumor is the small cell tumor of the lung, which is able to produce many neuroendocrine hormones including ACTH in large amounts.

Cushing's Syndrome Pathophysiology: Causes, Symptoms, Hormonal Mechanisms & Diagnosis

Cushing's Syndrome Pathophysiology: Causes, Symptoms, Hormonal Mechanisms & Diagnosis

pediagenosis    July 21, 2026    Comment   

CUSHING’S SYNDROME: PATHOPHYSIOLOGY

Cushing’s syndrome is directly caused by excessive amounts of glucocorticoids and their effects on numerous organ systems. Cortisol is strikingly elevated in all cases of Cushing’s syndrome. In some cases, levels of 17-ketosteroids and aldosterone are slightly elevated, and this plays a role in the clinical manifestations of the disease. There are numerous disease states that can cause hypercortisolemia, including excessive secretion of adrenocorticotropic hormone (ACTH, corticotropin), adenoma and hyperplasia of the adrenal gland, carcinoma of the adrenal gland, primary pigmented nodular adrenocortical disease (PPNAD), and exogenous cortisol use. In all cases, it is the marked elevation of cortisol that ultimately is the cause of the disease.

Down Syndrome (Trisomy 21): Symptoms, Causes, Diagnosis, Skin Signs & Treatment Guide

Down Syndrome (Trisomy 21): Symptoms, Causes, Diagnosis, Skin Signs & Treatment Guide

pediagenosis    July 21, 2026    Comment   

DOWN SYNDROME

Down syndrome is a genetic disorder caused by trisomy of chromosome 21. Trisomy 21 occurs in approximately 1 of every 1000 births. Chromosome 21 is an acrocentric chromosome, and trisomy 21 is the most common form of chromosomal trisomy. Trisomy 21 most often occurs as the result of nondisjunction of meiosis, which leads to an extra copy of chromosome 21. Some patients with Down syndrome have a Robertsonian translocation to chromosome 14 or chromosome 22, which are two other acrocentric chromosomes. In these cases, the number of total chromosomes is normal at 46, but the extra chromosome 21 material is translocated to another chromosome. This, in effect, causes an extra chromosome 21. All or part of chromosome 21 may be trans-located, leading to variations in phenotype. Mosaicism is a rare cause of trisomy 21 in partial cell lines, and the clinical phenotype depends on how early the genetic defect occurred during embryogenesis.

SYPHILIS

SYPHILIS

pediagenosis    July 19, 2026   

SYPHILIS

The scrotal skin is not an uncommon site for a primary syphilitic lesion. The primary stage of syphilis is marked by the appearance of a single sore (chancre), approximately 21 days after exposure. The chancre is usually firm, round, small, and painless, lasts 3 to 6 weeks, and heals without treatment. Regardless of location, the syphilitic chancre is grossly the same (see Plate 2-23). It may occur at the penoscrotal junction with barrier contraceptives. Lesions of the scrotum, however, are much more common in later forms of syphilis, especially during early and late relapses. They appear during relapse within the first 2 years but have been observed many years later as well. Anogenital cutaneous relapse occurs in 40% of cases and scrotal lesions occur in 25% of relapsing cases.