The Thorax - Part A: Physiology (In Three Parts) PDF

PREFACE TO THE FIRST EDITION

It is only somewhat belatedly that chest physicians have begun to focus their attention on the chest wall. Physiologists have continued their interest since at least the time of Hippocrates, but physicians have mostly avoided the role of the chest wall except when it was obviously involved in diseases such as flail chest, kyphoscoliosis, or neuromuscular disorders.

However, just as hypertension can lead to congestive heart failure, the chest wall can also malfunction due to disorders that are external to it. Lung disease can put such a load on the chest wall muscles and low cardiac output states can sufficiently impair their supply, that they may fail to develop the respiratory pressure swings required for normal alveolar ventilation. It is this growing awareness that is leading chest physicians to become more interested in the chest wall aspect of respiratory disease. Furthermore, chest wall disorders offer new possibilities for treatment, even though the external disorders cannot be effectively reversed. Indeed, a substantial number of chest physicians think that the most crippling aspects of respiratory disease, namely, shortness of breath and hypercapnic respiratory failure, arise from disordered chest wall function and not from the lung.

Thus this book attempts to gather the essence of this timely topic: the function and dysfunction of the chest wall. It is meant to provide a comprehensive view of the physiology and pathophysiology of the chest wall with an overview of the various therapeutic modalities presently available. In its own right, this book is not simply a resume of current information, but contains several chapters of original scientific contribution. Our aim is not only to describe the burgeoning wealth of information which has accumulated, but also to emphasize what remains unsolved, thereby stimulating further research in this domain.

We are also attempting, as implied by the title, to restore the original meaning of the word "thorax." Most chest physicians equate "thorax" with rib cage. As one of us points out, this is not in accord with its original meaning in ancient Greek. At that time, "thorax" meant "chest wall" and this is how we use the term in this book. We hope our readers will also restore the original meaning to the word "thorax."

During the period needed to produce this book, the infusion of new knowledge continued unabated and new concepts evolved, rendering this work an editorial challenge, but also, we hope, a gratifying scientific contribution.

Author: Charis Roussos