Evolution of pulmonary resection techniques and review of the bronchus-first method.

The dissection technique of pulmonary resection evolved in the period 1930 to 1950. Surgeons had to cope with the location of disease, bronchiectasis, tuberculosis, and lung cancer, as well as associated bronchial secretions, hilar pathology, and the status of anesthesiology. Two basic hilar dissection methods emerged, the anterior vessel-first sequence and the posterior bronchus-first method. The bronchus-first method is particularly suitable for pneumonectomy, right upper lobectomy, and posterior-apical segmentectomy of this lobe as well as ease of lymph node removal. This technique, as a primary method of lung resection, does not appear to be emphasized in teaching curricula and supporting atlases or texts.

Postsegmentectomy pseudotumor of the lung.

After an apicoposterior staple segmental resection for squamous cell carcinoma of the left upper lobe, a "new" mass developed in the remaining upper lobe, 8 months postoperatively. Upon removal, this proved to be an ischemic infarction in the anterior segment. Residual lung rotation may have compounded local lung ischemia secondary to the staple technique of resection. One clue to this pseudotumor development appears to be prolonged postoperative "haziness" on chest roentgenograms.

Prognostic factors in patients with surgically resected stages I and II non-small cell lung cancer.

BACKGROUND: About one-third to one-half of patients with early stages of non-small cell lung cancer (NSCLC) succumb to their disease. In this study, we attempted to identify prognostic factors that predict outcome in patients with stages I and II NSCLC. METHODS: A retrospective evaluation of 454 patients with surgically resected stages I and II NSCLC was performed to determine the impact of various clinical, laboratory, and pathological factors on patient outcome such as overall survival (OS) and event-free survival (EFS). RESULTS: Patients older than 65 years had shorter EFS and OS than younger patients (p = 0.002). Patients with preoperative hemoglobin less than or equal to 10 g% had shorter EFS and OS compared to patients with a hemoglobin greater than 10 g% (p = 0.001). Expectedly, OS and EFS were shorter in patients with stage II as compared to stage I patients (p < 0.001). In a multivariate analysis, age, hemoglobin level, and stage remain significant predictors for EFS and OS. CONCLUSIONS: Older age, anemia, and higher stage are important prognostic factors in patients with surgically resected stage I and II NSCLC.

Field study of ventilation in volunteer scuba divers during head-out immersion.

Seven subjects had spirometric studies during head-out immersion before and after working at depth in coral research. Under the variable environmental conditions of a field study the seven subjects demonstrated changes in the spirometric variables consistent with those found in wet laboratories. Exercise at depth did not change the variables from preexercise levels. This suggests either that the body reestablishes preexercise head-out immersion equilibrium rapidly or that subtle changes were beyond the sensitivity of the instrument. On head-out immersion, one subject with abnormal control values of FEV1/FVC% and FEF25-75 had a rise rather than a fall in these values, which was the opposite of that of the other six subjects and the expected result.

Self-directed learning: the Wizard of Oz syndrome.

Every adult who embarks on a new project undergoes some self-directed learning. During the search for solutions, individuals may react in varied ways; yet, a basic syndrome of behavioral activities underlies these individual reactions. We have named this the "Wizard of Oz" syndrome because of the similarity it bears to the events in that classic fantasy. When developing interactive programs, producers should be cognizant of this behavior which characterizes the adult learner.