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Ann Thorac Surg 1997;63:312-319
© 1997 The Society of Thoracic Surgeons
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
| The first 300 words of the full text of this article appear below. |
I was sent a humorous greeting card by one of our lung transplant recipients some time ago. On the cover it shows one of life's couch potatoes complaining about her lot in life, with the text, "Life is so hard." On the inside the text reads "It's breathe, breathe, breathe all the time." Well, considering who is on the cover of the card, it is rather humorous. However, there are many for whom its not funny. I am referring to patients suffering from end-stage lung disease, tethered to an oxygen tank, whose life is centered around a wheelchair, for whom each breath is a struggle. It has been exciting that in the last 10 to 12 years there are some new surgical procedures that have brought hope and relief to this group of patients. Today I would like to review with you the evolution of surgical procedures for chronic obstructive pulmonary disease.
The anatomic changes associated with emphysema were described two centuries ago. Even earlier, veterinary descriptions of the lungs, in what was termed "broken winded" horses, depicted the changes of emphysema.
In a text by Baillie in 1793, there is included a description of emphysematous lungs at autopsy. He noted that "in opening into the chest it is not unusual to find that the lungs do not collapse but that they fill up the cavity completely on each side of the heart. When examined their cells appear full of air so that there is seen upon the surface a prodigious number of small white vesicles" [1]. In his accompanying atlas, Baillie illustrated his autopsy findings. This particular drawing (Fig 1
) is of the lungs of Dr Samuel Johnson, whose autopsy was performed by Dr Baillie.
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