General Thoracic Surgery

correction factors may not be accurate .10 In summary, the past decade has witnessed an increase in the number of computerized spirometry systems that are easy to use but because of software problems may not have improved accuracy. Comprehensive spirometer testing and the ATS standard waveforms should enable the spirometer manufacturer to correct these problems with time. Although the results reported by Nelson et al may not represent the maximum errors the user can expect in a spirometer he may be using or is intending to purchase, they do represent the best available information. john L. Hankinson, Ph.D. Morgantown, WV Chief, Clinical Investigations Branch, National Institute for Occupational Safety and Health-ALOSH. Reprint requests: Dr. Hankinson, 944 Chestnut Ridge Road, Morgantown, W VA 26505-2888

REFERENCES 1 Morgan WKC. Committee recommendations: the assessment of ventilatory capacity: statement of the committees on environmental health and respiratory physiology. Chest 1975; 67:95-7 2 Gardner RM. American Thoracic Society statement: snowbird workshop on standardization of spirometry. Am Rev Respir Dis 1979; 119:831-38 3 Gardner RM, Hankinson JL, Clausen JL, Crapo RO, Johnson RL Jr, Epler GR. American Thoracic Society statement of spirometry-1987 update. Am Rev Respir Dis 1987; 136:128598 4 Association for the Advancement of Medical Instrumentation. Standards for spirometers (draft). Arlington, Va; AAMI; 1980. 5 FitzGerald MX, Smith AA, Gaensler EA. Evaluation of 'electronic' spirometers. N Engl J Med 1973; 289:1283-86 6 Gardner RM, Hankinson JL, West BJ. Evaluating commercially available spirometers. Am Rev Respir Dis 1980; 121:73-82 7 Gardner RM, Crapo RO, Billings RG, Shigeoka JW, Hankinson JL. Spirometry: what paper speed? Chest 1983; 84:161-65 8 Hankinson JL, Gardner RM. Standard waveforms for spirometer testing. Am Rev Respir Dis 1982; 126:362-64 9 Waveforms available from American Thoracic Society, New York, NY 10 Hankinson JL, Viola JO. Dynamic BTPS correction factors. J Appl Physiol1983; 55:1354-60

General Thoracic Surgery The Need for Excellence

in Training

The advent of general thoracic surgery (surgery of the lung, esophagus, mediastinum, diaphragm, trachea, and chest wall) began in 1904 when Sauerbruch, in Germany, published the principle of "operating on the lung under differential atmospheric pressure."1 This ultimately led to endotracheal intubation and the ability to safely operate on all structures within the chest. The dedicated training of the general thoracic surgeon ended with the development of cardiopulmonary bypass. Progress in cardiac surgery soon surpassed that in general thoracic surgery, and

there certainly was no glamour in taking care of empyemas or tuberculosis. 2 During the ensuing years, natural attrition over time gradually decreased the number of surgeons with expertise in general thoracic surgery, and there were few recruited to take their place. Despite the decrease in interest and education of the general thoracic surgeon, there has not been a concomitant decrease in the patients' need for their expertise. Lung cancer continues to increase annually and currently approaches 155,000 new cases a year to where it is now the most common cause of cancer deaths in both sexes. 3 Esophageal cancer persists at over 10,000 new cases annually. 3 Pulmonary transplantation has arrived and clearly requires the expertise of the general thoracic surgeon. Clearly, there remains a need for well-trained general thoracic surgeons. Such a surgeon requires more training than that currently provided in most thoracic and cardiovascular surgical residency programs. Ideally, 12 to 18 months should be dedicated to this specialty and a mechanism to acquire this training is urgently needed. 2 The Liaison Committee for Thoracic Surgery of the American Association for Thoracic Surgery is currently addressing these issues. The need for excellence in this speciality has always been present, now more than ever. EWer C. lbirolero, M.D., F.C.C.P.; VICtor F. 1rastek, M.D.; and W Spencer lbyne, M.D., F.C.C.P. Rochester, Minnesota Section of General Thoracic Surgery, Mayo Clinic and Mayo Foundation. Reprint requests: Dr. lbirolero, Mayo Clinic, Rochester; Minnesota 55905

REFERENCES 1 Sauerbruch F. On the ways and means of excluding the injurious effect of pneumothorax in intrathoracic operations. Centralbl fur Chirurgie 1904; 31:146 2 Orringer MD, Cooper JD, Magovem G, Mark J, McKneally M, Webb W. The continuing dilemma of general thoracic surgery: where to now? J Thorac Cardiovasc Surg 1989; 97:649 3 American Cancer Society. Estimated new cancer cases by sex for all sites- US, 1989. CA 1989; 38:12

Home Monitoring of the Transplanted Lung he fortunate patient who achieves the status of T "long-term survivor" (more than three months) of a heart-lung or lung transplantation still has a number of obstacles to face. A small but definite percentage of these will succumb to infection with a variety of viral and bacterial agents. 1 Of the rest, past series have reported a prevalence approaching 50 percent of obliterative bronchiolitis (OB), a term coined by the CHEST I 97 I 2 I FEBRUARY, 1990

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