[One hundred years of the Association of Surgeons in the Netherlands. IV. Thoracic surgery]

In the Netherlands, two disciplines are involved, in thoracic surgery. Firstly, general surgeons, since thoracic surgery initially consisted of surgical treatment for pulmonary tuberculosis, bronchiectasis and empyema. Once tuberculostatics became available, surgical treatment of pulmonary tuberculosis became less important and lung/thoracic operations were carried out primarily for lung cancer. Secondly, cardio-pulmonary surgeons (now known as 'cardiothoracic surgeons') also play a role in thoracic surgery. This discipline is also allowed to carry out heart surgery. Surgery for stage-I and -II lung cancer is the mainstay of the practice of general thoracic surgeons. Surgery after induction chemotherapy for stage-III tumours is under investigation to find out whether this will improve treatment results. Video-assisted thoracic surgery (VATS) is a most interesting development, and has led to the revival of volume-reduction surgery for lung emphysema. Education is of paramount importance in ensuring the quality of surgery. In the near future there will be a need for qualified thoracic surgeons in the Netherlands and organisational and financial measures should be taken to prevent a shortage.

[Bernardino Ramazzini. Ante litteram epidemiologist]

Bernardino Ramazzini, born in Carpi in 1633 and deceased in Padua in 1714, is universally renowned father and founder of occupational health. This paper will present Bernardino Ramazzini under a different perspective, and will show that during his scientific career he continuously maintained the attitude of a modern epidemiologist. Reviewing all his scientific papers, and many papers commenting his activity, we present four major areas in which Ramazzini expressed in a direct and convincing way his epidemiologic culture: the epidemiologic constitutions and the work done mainly on physical subjects while he was in Modena; the general architecture of his most important book (De Morbis Artificum Diatriba); the first full description of an episode of environmental pollution which occurred in Finale Emilia in 1689 (in his book this episode is reported in the chapter describing the diseases of chemicals); the opening lectures of some academic years he gave while he was teaching, mainly, in Padua. To our knowledge the epidemiological attitude of Bernardino Ramazzini is not recognized yet in epidemiology textbooks.

The history of lung transplantation

Experimental lung transplantation began in the former Soviet Union in 1946. Experiments in the 1950s sought to understand the physiology and to master the technique of reimplantation. Study of the immunology of allografting in the 1960s lead to the first lung transplantation in a human in 1963 in the United States. Palliative lung transplantation was first reported from Canada in 1986 after the advent of effective and tolerable immunosuppressive regimens. Lung transplantation in centers of excellence is now an effective palliative method for more than 80% of carefully selected recipients. Widespread transplantation to treat end stage pulmonary dysfunction is impossible because of too few organ donors and imperfect management of rejection and infection.

Vignettes of a pulmonary rehabilitation team

A successful comprehensive pulmonary rehabilitation program depends on these key pieces: thorough planning, an experienced coordinator who is a patient advocate, a dedicated and supportive medical director, enthusiastic and committed team members, the use of program graduates as volunteers, and providing the essential components of pulmonary rehabilitation, which consist of assessment, patient training, exercise, psychosocial intervention, and follow-up. The patients are the most important members of the team. Their courage, dedication, and determination to make their quality of life the best it can be is truly an inspiration to all of us.