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A new title in the Romanian medical literature: Preoperative medical preparation of patients with respiratory diseases

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The book, published in October 2017, and edited by Anca Macri, MD, is one of the exceptional successes of one of the most prestigious publishing houses in the medical field - the “Carol Davila” University Publishing House.

The rationale is various, from the title and the quality of the authors to the conceiving of each chapter and the clarity in expressing the content. The topic is novel but needed; it is absent from the medical literature - even internationally - at least regarding the unitary manner in which the respiratory pathology is approached in a patient proposed for surgery.

The readers – pulmonologists, cardiologists, anesthesiologists, surgeons, and not only these - will understand that the patient with respiratory diseases who ends up in the operating room is at the end of a chain of consultations and investigations that begin with the general practitioner, the pulmonologist, possibly the oncologist, the cardiologist, and possibly also physicians of other specialties, depending on co-morbidities.

The preoperative respiratory functional exploration (Diana Ioniță, MD), as well as the cardiologic exploration (Ștefania Magda, MD, and Tudor Constantinescu, MD) are two distinct chapters that make a clear and easy-to-understand synthesis of these two essential preoperative investigations.In another chapter, Tudor Toma, MD from King’s College London, presents the role of bronchoscopy in the pre- and perioperative management of cases, also bringing into discussion modern investigations that are part of the working algorithm of physicians from England.

The readers will find out from the chapter written by the physicians Cristina and Cristian Popa the indications for surgery in pulmonary tuberculosis, the types of practiced operations, the risk of transmission of the TB infection, etc.; this information cannot be found with such clarity in no other chapter and indeed in no other specialty book. Readers will be surprised to learn that tuberculosis patients are qualified for almost any type of surgery and the reasons for postponing them or to contraindicate them are only of a subjective nature.

Adriana Hristea, MD et al. bring us all the rationale of the physicians specialized in infectious diseases regarding the fact that preoperative prophylaxis of infections should be performed according to the modern guidelines and protocols from this area; thus the risks of septic complications can be controlled and decreased.

Other chapters of the book approach common pathologies from the pulmonology practice that may raise complex perioperative issues for the pulmonologists, anesthesiologists, and surgeons: morbid obesity (Ștefan Dumitrache Rujinski, MD), sleep apnea syndrome, and obstructive pulmonary diseases in advanced stages (Anca Macri, MD), interstitial fibroses and pleural empyemas (Irina Strâmbu, MD), critical patients Radu Stoica, MD). Each chapter analyses and presents the risks and benefits related to surgery, as well as the treatment optimization modalities in order to decrease the risks.

In the chapter dedicated to the indications, selection and preparing the patients for lung transplant, Claudia Toma, M.D., together with Petronela Fildan, M.D. and Cristian Oancea, M.D., clarify why is it that such patients should be evaluated in hospitals and departments with tradition in pulmonology and thoracic surgery and with personnel with capabilities acquired in prestigious European clinics in this area.

The chapter written by Felix Dobrițoiu, MD, presents the evaluation of the surgeon based on the magnitude and the difficulties of the surgery. The various types of surgery that can be performed on patients with bronchopulmonary neoplasm, their indications and their risks are presented briefly and in a manner that can be understood by physicians of other specialties than thoracic surgery.

The pre-anesthetic consultation and the determination of the anesthetical and surgical risk, chapter written by one of the most experienced anesthesiologist in this area, Radu Stoica, MD, is actually at the end of the chain of consultations and investigations.

Alina Croitoru, MD, pulmonologist with experience in the area of respiratory rehabilitation, explains the inestimable benefits obtained with this intervention that should be initiated many days before the scheduled surgery and should be then continued in the postoperative period.

The book is also accessible for people who have no experience in this area yet. It is unusual due to the fact that it reaches the objective of bringing a valuable medical education by the uniform and coherent association of authors of extremely different medical specialties.

Despite the fact that an ample collective of authors contributed to the writing of the book, the volume is remarkable that it has a uniform style and a balanced editing; therefore its reading is enjoyable and clear. There is almost no medical specialty involved in the care of patients with respiratory pathology that is not addressed by this book. Another value that recommends this book is the bibliography, which is rich, recent and is selected based on value.

The publishing of a book of such high value is not an ordinary matter but an event that should be appreciated. Certainly the readers will be the ones who will appreciate the information contained in this book and will benefit of it.

 

Prof. dr. Ioan Paul Stoicescu

Vice President of the Internal Medicine Section of the Academy of Medical Sciences

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