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Cancer Biology and Implications for the Perioperative Period

Introduction In spite of the evident cytoreductive, potentially curative advantages of surgery, there has long been a suspicion that resecting primary tumors carries an intrinsic, paradoxical risk with respect to disease progression. , Anecdotal evidence prompted surgeons in the second half of the 19th century to draw comparisons between operative dissemination of cancer and of tuberculosis, seeking to understand how an apparently benign neoplasm might become…

Global Cancer Surgery—The Lancet Commission

Introduction Since 1991, the global burden of disease has shifted from communicable to noncommunicable disease (NCDs), primarily due to prevention, mitigation, and treatment of infectious disease in low- and middle-income countries (LMICs). This epidemiological shift has impacted global mortality rates and other important health indicators, and there has been a simultaneous increase in disability and death primarily due to cancer. The increase in cancer has especially…

Cancer Epidemiology, Prevention, and Survivorship

Introduction Cancer epidemiology provides the tools and methods to understand the cancer problem in any given population, from the local level up to the global level. Incidence, prevalence, and mortality are the most commonly used measures to assess the cancer burden. Examining temporal trends in these measures or comparison of these measures between states, regions, or countries can uncover important causes of cancer. The study of…

Mathematical functions relevant to respiratory physiology

This book contains many examples of mathematical statements which relate respiratory variables under specified conditions. Appendix E is intended to refresh the memory of those readers whose knowledge of mathematics has been attenuated under the relentless pressure of new information acquired in the course of study of the biological sciences. The most basic study of respiratory physiology requires familiarity with at least four types of mathematical…

Physical quantities and units of measurement

International system of units A clean transition from the old to the new metric units failed to occur. The old system was based on the centimetre-gram-second (CGS), and was supplemented with many noncoherent derived units such as the millimetre of mercury (mmHg) for pressure and the calorie for work, which could not be related to the basic units by factors, which were powers of ten. The…

The history of respiratory physiology

Key points That breathing was essential for life was clear to the ancient Egyptian civilizations 5000 years ago, but the reasons for this were unknown. Early explanations for the function of breathing involved the air drawn into the lungs fuelling combustion in the heart and removing ‘sooty and fuliginous spirits’ from the body. In the Renaissance, advances in knowledge of anatomy led to the discovery of…

The atmosphere

Key points The mass of the Earth and its distance from the sun provide optimal conditions of gravity and temperature for the long-term existence of liquid surface water and the retention in its atmosphere of oxygen, nitrogen and carbon dioxide. Primitive life-forms generated energy by photosynthetic reactions, producing oxygen and so facilitating the development of an oxygen-containing atmosphere and aerobic organisms. Carbon dioxide was initially the…

Pulmonary surgery

Key points Surgical resection of lung tissue via thoracotomy is a routine procedure, used mostly for treating lung cancer, which requires careful assessment of the patient’s physiological reserve. Less invasive surgical techniques such as video-assisted thoracic surgery are increasing rapidly and associated with less physiological disturbance and clinical complications. One-lung ventilation is required for many pulmonary surgery procedures, and understanding of the physiology involved is vital…

Respiratory support and artificial ventilation

Key points Noninvasive ventilation may be used to increase airway pressure and support a failing respiratory system without the need for tracheal intubation or tracheostomy. Intermittent positive pressure ventilation can be delivered by a variety of different techniques, many of which are coordinated with the patient’s own respiratory efforts. Positive end-expiratory pressure increases the functional residual capacity, reduces airway resistance and may prevent or reverse lung…

Acute lung injury

Key points Acute lung injury is lung inflammation that develops in response to a variety of both pulmonary and generalized acute diseases. The clinical features of acute lung injury vary from mild, self-limiting dyspnoea to rapidly progressive and fatal respiratory failure. Widespread pulmonary inflammation causes increased permeability of the alveolar capillary membrane, leading to flooding and collapse of alveoli and severely impaired gas exchange. Artificial ventilation…

Diseases of the lung parenchyma and pleura

Key points Lung collapse occurs either from compression of lung tissue or by absorption of gas from lung units with occluded or severely narrowed airways. Many forms of interstitial lung disease exist, varying from purely inflammatory conditions (alveolitis) to those involving progressive fibrosis with minimal lung inflammation. Lung fibrosis arises from an imbalance between the cellular systems responsible for inflammation and tissue repair. Lung cancer is…

Pulmonary vascular disease

Key points Pulmonary oedema occurs when increases in pulmonary capillary pressure or the permeability of the alveolar/capillary membrane cause fluid to accumulate in the interstitial space and alveoli. Pulmonary embolism, with either thrombus or air, partially occludes the pulmonary circulation, causing an increase in alveolar dead space and pulmonary arterial hypertension. Pulmonary hypertension most commonly results from long-term hypoxia or elevated left atrial pressure and involves…

Airways disease

Key points Whatever the cause, airway narrowing leads to expiratory flow limitation, gas trapping and hyperinflation of the lung, which manifests itself as breathlessness. Asthma involves intermittent, reversible airway obstruction caused by airway inflammation and bronchial smooth muscle contraction, both as a result of mediators released from mast cells and eosinophils. Chronic obstructive pulmonary disease is progressive, with a poorly reversible airway narrowing caused by airway…

Ventilatory failure

Key points Ventilatory failure occurs when alveolar ventilation becomes too low to maintain normal arterial blood gas partial pressures. There are many causes, involving the respiratory centre, the respiratory muscles or their nerve supply and abnormalities of the chest wall, lung or airways. Modest increases in the inspired oxygen concentration will correct hypoxia because of ventilatory failure but may worsen hypercapnia. Definitions Respiratory failure is defined…

Comparative respiratory physiology

Key points The animal kingdom contains a myriad of solutions to the challenge of respiratory gas exchange, such as integument respiration, external or internal gills in water or a tracheae system or lung for breathing air. Factors affecting respiratory system design include the breathing medium (water or air), body temperature and activity level (metabolic rate), with homeothermic (warm-blooded) animals requiring more efficient systems and air to…

Oxygen toxicity and hyperoxia

Key points Breathing oxygen at increased atmospheric pressure achieves very high arterial P o 2 values, but venous P o 2 , and therefore minimum tissue P o 2 , only increases at 3 atm absolute pressure. Normal metabolic processes, particularly in the mitochondria, produce a range of powerful oxidizing derivatives of oxygen, some of which are referred to as reactive oxygen species. The harmful effects…