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1. Lung cancer continues to be a highly lethal and extremely common cancer, with 5-year survival of 15%. Lung cancer incidence is second only to the incidence of prostate cancer in men and breast cancer in women. Squamous cell carcinoma and adenocarcinoma of the lung are the most common subtypes and are rarely found in the absence of a smoking history. Nonsmokers who live with smokers have a 24% increased risk of lung cancer compared to nonsmokers who do not live with smokers.

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2. Endoscopic bronchial ultrasound is a valuable new tool that can enhance the accuracy and safety of transbronchial biopsies of both the primary tumor (when it abuts the central airways) and the mediastinal lymph nodes and should become part of the surgeon’s armamentarium for the diagnosis and treatment of lung cancer.

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3. The assessment of patient risk before thoracic resection is based on clinical judgment and data.

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4. Impaired exchange of carbon monoxide is associated with a significant increase in the risk of postoperative pulmonary complications, independent of the patient’s smoking history. In patients undergoing pulmonary resection, the risk of any pulmonary complication increases by 42% for every 10% decline in the percent carbon monoxide diffusion capacity (%Dlco), and this measure may be a useful parameter in risk stratification of patients for surgery.

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5. Maximum oxygen consumption (V̇o2max) values provide important additional information in those patients with severely impaired Dlco and forced expiratory volume in 1 second. Values of <10 mL/kg per minute generally prohibit any major pulmonary resection, because the mortality in patients with these levels is 26% compared with only 8.3% in patients whose V̇o2max is ⩾10 mL/kg per minute; values of >15 mL/kg per minute generally indicate the patient’s ability to tolerate pneumonectomy.

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6. Major changes in the tumor, node, and metastasis (TNM) staging system for lung cancer have been proposed. Tumor stage will be further subdivided into T1a and T1b, T2a and T2b, T3, and T4. Satellite nodules in the same lobe will be considered T3 and malignant pleural and pericardial effusions will be considered metastatic disease rather than T4 disease.

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7. Increasing evidence suggests a significant role for gastroesophageal reflux disease in the pathogenesis of chronic lung diseases such as bronchiectasis and idiopathic pulmonary fibrosis, and it may also contribute to bronchiolitis obliterans syndrome in lung transplant patients.

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8. Multidrug-resistant tuberculosis (MDRTB) organisms are present in approximately 10% of new tuberculosis cases and 40% of recurrent cases. Another rare disease variant termed extensively drug-resistant tuberculosis has also been identified. The causative organisms are resistant not only to isoniazid and rifampin, as are the MDRTB organisms, but also to at least one of the injectable second-line drugs such as capreomycin, amikacin, and kanamycin.

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9. Treatment of pulmonary aspergilloma is individualized. Asymptomatic patients can be observed without any additional therapy. Similarly, mild hemoptysis, which is not life-threatening, can be managed with medical therapy, including antifungals and cough suppressant. Amphotericin B is the drug of choice, although voriconazole ...

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