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The prognosis for patients with mediastinal pathology has improved significantly in recent years as a result of better understanding of the impact of chemotherapy and radiotherapy on malignant mediastinal tumors. The signs and symptoms of mediastinal pathology range from trivial to life-threatening, and include airway compression, superior vena cava syndrome, compression of the right heart and pulmonary arteries, and dysphagia from esophageal compression. The surgical approach for diagnostic procedures of mediastinal surgery is via cervical mediastinoscopy or anterior mediastinotomy, while for tumor resection the usual approaches are via median sternotomy or lateral thoracotomy. Careful evaluation of the airway is necessary during pre-operative assessment for surgery within the mediastinum. Myasthenia gravis is commonly associated with other autoimmune disorders. In severe myasthenia, neuromuscular blocking drugs may be avoided completely, as the muscle-relaxing effect of volatile anesthetics is enhanced.
Patients presenting for pleurectomy often have associated lung diseases such as asthma, emphysema and cystic fibrosis. Appropriate pre-operative optimizing of their condition should occur. One-lung anesthesia is required to assist access for pleurectomy procedure during which the pleura is stripped where possible. Although the commonest association of bacterial infection of the pleural space is a concomitant pneumonia, other causes include trauma or surgery to the thorax; and extension of a suppurative process from either neck or abdomen. Over half of patients presenting with empyema have concomitant chronic disease (for example, diabetes mellitus; malignancy) or conditions that predispose to aspiration pneumonia. The commonest set of operations for acquired chest wall disorders are those requiring chest wall resection. Chest wall resection requires careful operative planning including the extent of resection, the options for chest wall stabilization and the method of tissue coverage to be employed, usually a muscle flap.
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