Fundoplications

The Nissen fundoplication is total (360º)

but partial fundoplications, known as
   Belsey fundoplication (270º anterior transthoracic)
   Dor fundoplication (anterior 180-200º) and
   Toupet fundoplication (posterior 270º)
are also alternative procedures with somewhat different indications

trachea stent

Pancoast tumor resection

usually RUL/LUL lobectomy
" en bloc " with involved ribs
" plus " one rib above and one rib below the diseased ribs

tracheobronchial tree tumor

mucoepidermoid tumor:
    uncommon
    often distal to the carina but within mainstem and lobar bronchi
    salivary gland-like on histology
    further classified as low or high grade

To estimate residual lung function

DLco is the best predictor of pulmonary complications

right lung ventilation is 55%
                each lobe is 18.3%

left lung ventilation is 45%
               each lobe is 22.5%

800 ml and 35% of predicted FEV1 are the lower limits of resectability

70歲以上的年長者因肺癌接受肺葉切除

風險比較高
死亡率根據統計有 5% ~7%

FVC (forced vital capacity) reflects compliance of the lungs
FEV1 (forced expiratory volume in 1 sec) reflects obstructive disease
the two values together are used to diagnose restrictive lung disease

bronchoscopic exam

 Bronchus:the  left-side
            Main  bronchus:
                normal.
            Structure  of  bronchi  and  the  subdivisions:
                B1+2:normal.
                B3:normal.
                B4:normal.
                B5:normal.
                B6:normal.
                B8:normal.
                B9:normal.
                B10:normal.
 Bronchus:the  right-side
            Main  bronchus:
                normal.
            Structure  of  bronchi  and  the  subdivisions:
                B1:normal.
                B2:normal.
                B3:normal.
                B4:normal.
                B5:normal.
                B6:normal.
                B7:normal.
                B8:normal.
                B9:normal.
                B10:normal.

LLL collapse due to lung cancer

old TB on CT image

 

 

spirometry

Artery of Adamkiewicz

Artery of Adamkiewicz, a.k.a. AKA

In human anatomy, the Artery of Adamkiewicz is the largest anterior segmental medullary artery

It typically arises from a left posterior intercostal artery, which branches from the aorta, and supplies the lower two thirds of the spinal cord via the anterior spinal artery

Plummer-Vinson syndrome

Plummer–Vinson syndrome (PVS), also called Paterson–Brown–Kelly syndrome or sideropenic dysphagia presents as a triad of dysphagia (due to esophageal webs), glossitis, and iron deficiency anemia. It most usually occurs in postmenopausal women

胸壁纖維化 Fibrothorax

RLL pleural thickening

CT scan

patient turned out to be LUL lung cancer

the final diagnosis is     NSCLC, SCC
                                       T4 ( mediastinum, carina invasion )
                                       N3( supraclavicular LAP )
                                       M0
                                      stage IIIB

右側惡性肋膜積液 Right malignant pleural effusion

patient presented with right hydropneumothorax

3 days after pigtail drainage

10 days after pigtail drainage

the final diagnosis is NSCLC, adenocarcinoma
                                  T4N3M1a, stabe IV

RUL lung tumor 右上肺葉腫瘤

因為腫瘤已經很大了
壓迫到氣管和右支氣管
造成病患會喘,呼吸困難
還有右側的肺塌陷及肋膜積液

甚麼是 globus hystericus ?

簡單一句話
" 喉嚨有(一球的)異物感"

有時候,其實是因為本身有 Zenker's diverticulum

甚麼是 Mallory-Weiss syndrome ?

Mallory-Weiss syndrome
指的是食道和胃的交界處的黏膜破裂,併出血
所以也叫作 Gastro-esophageal laceration syndrome
是因為很厲害的乾嘔,咳嗽,或是嘔吐
導致的食道-胃交界"撕裂傷"
和 Boerhaave syndrome 的區別:
Mallory-Weiss 是"撕裂傷", 只傷到 mucosa and submucosa
Boerhaave 是"破裂", 除了 mucosa and submucosa, muscular layer 也破了 (whole layer break)

甚麼是 Boerhaave syndrome ?

簡單一句話
" 酒喝太多, 嘔吐得太用力, 導致食道破裂 "

多發生在食道下段, 左後側, 延伸數公分長
若不治療, 多會致命 !

南姐, 小心 !

topics

mediastinal tumor
lung cancer
solitary pulmonary nodule
lung volume reduction surgery
Zenker's diverticulum
lung transplantation
thymoma
MG
Barrett's esophagus
BAC
GERD
achalasia
pulmonary embolism
thyroglossal cyst

TE fistula