Diaphragm Season

As surgeons or physicians, we ignore the diaphragm at our peril. Yet despite our best intentions, we do not always grasp its workings as exasperated respiratory physiologists have long recognized.[1] The few who truly understand diaphragm function try to explain that “bellows” is an incomplete description and attempt to capture our interest in pointing to multiple interrelated respiratory muscles in health and elaborate compensation in failure. The main reason for indifference may then be the infrequent occurrence of overt disease or malfunction: the diaphragm, in general, works reliably well and even if it does not, compensatory mechanisms prevent respiratory failure in most patients. There remains a subset of patients whose failure to compensate is humbling enough to return us to the library.

In this issue of The Thoracic and Cardiovascular Surgeon, you will find three invited reviews and two original contributions on various diaphragmatic topics. Natalie Baldes and Joachim Schirren succinctly summarize the tumors of the diaphragm. Eitan Podgaetz and his co-authors Ilitch Diaz and Rafael Andrade explain in detail the options for diaphragmatic plication, while Carlos Rombola and his co-authors add their institutional experience to the general exposition. Cristian Rapicetta and his co-authors, in contrast, examine the price on diaphragmatic function exacted by surgical intervention. A summary of the perioperative causes of diaphragmatic impairment by Susan Wilcox and myself concludes the issue. We all hope you use the season to stock up on diaphragm reading.

• Reference

• 1 Macklem PT. Muscular weakness and respiratory function. N Engl J Med 1986; 314 (12) 775-776