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Introduction: Pneumothorax is a condition that usually occurs in thin, young people, especially in smokers. It is an unusual complication of COVID-19 disease that can be associated with worse results. This disease can occur without pre-existing lung disease or without mechanical ventilation. Materials and Methods: We present a monocentric comparative retrospective study of diagnostic and treatment analysis of two groups of patients diagnosed with COVID-19 and non-COVID-19 pneumothorax. All patients included in this study underwent surgery in a thoracic surgery department. The study was conducted over a period of 18 months. It included 34 patients with COVID-19 pneumothorax and 42 patients with non-COVID-19 pneumothorax. Results: The clinical symptoms were more intense in patients with COVID-19 pneumothorax. We found that the patients with COVID-19 had significantly more respiratory comorbidities. Diagnostic procedures include chest CT exam for both groups. Laboratory findings showed that increasing values for the analyzed data were consistent with the deterioration of the general condition and the appearance of pneumothorax in the COVID-19 group. The therapeutic attitude regarding the non-COVID-19 group was to eliminate the air from the pleural cavity and surgical approach to the lesion that determined the occurrence of pneumothorax. The group of patients with COVID-19 pneumothorax received systemic treatment, and only minimal pleurotomy was performed. The surgical approach did not alter patients’ survival. Conclusions: Careful monitoring of the patient’s clinic and laboratory tests evaluating the degradation of the lung parenchyma, correlated with the imaging examination (chest CT) is mandatory and reduces COVID-19 complications. Early imaging examination starts an effective diagnosis and treatment management. In severe COVID-19 pneumothorax cases, the pneumothorax did not influence the evolution of COVID-19 disease. When we found that the general condition worsened with the rapid progression of dyspnea and the deterioration of the general condition, and we found that it represented the progression or recurrence of pneumothorax.
Background: Spontaneous pneumothorax is a type of air collection in the pleural cavity that it develops in the absence of trauma or an iatrogenic cause. It may become an emergency in thoracic surgery. The anatomical substrate of spontaneous pneumothorax is represented by blisters. But we must not minimize the emphysema bubbles that appear in the lung parenchyma, which may also be a common cause of spontaneous pneumothorax. In order to appear the spontaneous pneumothorax, it is considered necessary to have an area of minimal resistance in the visceral pleura and also a triggering element. For decades, the therapeutic options are been discussed. Objectives: literature review and updating of scientific data Method: The management of conservative treatment is known, ambulatory air aspiration, drain tube installation, video-assisted thoracoscopic surgery The use of chemical pleurodesis-betadine versus talc and mechanical-pleural abrasion, resection of blisters or ligature at their base, apical pleurectomy, are therapeutic options that are custom applied for each case. The current diagnostic and treatment guidelines have been designed about 10 years ago and with a little change. Results: We support the use as a chemical agent of betadine to prevent recurrences with a similar effect to that of talc. We concluded that the introduction of betadine into the drain tube after minimal pleurotomy for symphysis, can sometimes lead to local pain, sometimes atrocious, unbearable, even simulating the myocardial infarction pain. Therefore, before applying the chemical, we recommend the systemic analgesics and local analgesic from the amide group. Video-assisted thoracic surgery is the main surgical technique for treating pneumothorax in order to prevent recurrences. Conclusions-We considered necessary a mini-revision of the literature in order to update the scientific data and the effective treatment methods with the mention of some own amendments regarding the therapeutic options.
Context: SARS-COV2 infection, the respiratory febrile disease firstly described in China in December 2019, which was declared a pandemic on March 11th, 2020, is associated with multiple air and fluid collections. Spontaneous hemopneumothorax in coronavirus disease 19 (COVID 19) patients is a rare clinical entity described as an unusual complication of severe COVID 19 pneumonia. Objective: The authors used the database of a single COVID 19 treatment center only. In our case series, we encountered a patient with particular hemopneumothorax features that we have decided to present. Method: A 51-year-old non-smoker male with fever and cough lasting for 7 days was admitted to the dedicated COVID 19 unit of "Dr. Carol Davila" Central University Military Hospital Bucharest. The patient developed hemopneumothorax on the 14 th day since the beginning of the symptoms. The thoracic surgeon performed pleural drainage through minimal pleurotomy allowing the evacuation of both air and fluid. Results: Post interventional computed tomography scan showed the remission of hemopneumothorax. The favorable evolution and the negative SARS COV2 screening throat swab test allowed the discharge of the patient on the 25th day after initial diagnosis. Conclusions: In certain situations, COVID 19 pneumopathy may lead to hemopneumothorax with unpredictable evolution, and only a fast therapeutic intervention can save the patient's life.
Background and Objectives: Malignant neoplasms are common causes of acute pleuropericardial effusion. Pleuropericarditis denotes poor patient prognosis, is associated with shortened average survival time, and represents a surgical emergency. Materials and Methods: We analyzed the impact of two minimally invasive surgical approaches, the type of cancer, and other clinical variables on the mortality of 338 patients with pleuropericarditis admitted to an emergency hospital in Romania between 2009 and 2020. All patients underwent minimally invasive surgeries to prevent the recurrence of the disease and to increase their life expectancy. Log-rank tests were used to check for survival probability differences by surgical approach. We also applied univariate and multivariate Cox proportional hazard models to assess the effect of each covariate. Results: No significant differences were found in the 2-year overall survival rate between patients who underwent the two types of surgery. The multivariate Cox proportional regression model adjusted for relevant covariates showed that age, having lung cancer, and a diagnosis of pericarditis and right pleural effusion increased the mortality risk. The surgical approach was not associated with mortality in these patients. Conclusion: These findings open up avenues for future research to advance the understanding of survival among patients with pleuropericarditis.
Introduction. Over the past decades, several definitions and classifications of cervico-mediastinal goiters have been proposed. We analyzed and discussed the clinical presentation, the diagnostic procedures and the surgical technique in relation to post-operative complications and long-term results in a case of a sixtysix years old obese, hypertensive female admitted in the Thoracic Surgery Department with respiratory distress (inspiratory dyspnea, stridor) progressively aggravating during the latest month. Methods. Cervico-thoracic CT scan revealed the existence of a cervico-mediastinal huge goiter which developed mostly intrathoracic (2/ 3 of the goiter). It determined a tracheal compression, reducing its caliber by two thirds, and its displacement to the right side. The proposed surgical procedure was total thyroidectomy and it involved a bipolar approach (transcervical and transsternal) through a partial upper cervico-sternotomy. Results. The complete removal of the goiter and the decompression of the trachea have been achieved. Postoperative results were very satisfactory, with the absence of the respiratory distress. The histological examination revealed a multinodular goiter with epithelium hyperplasia. Conclusion. The presence of a complicated cervico-mediastinal goiter with severe respiratory distress required a surgical excision as the main and immediate treatment option. The surgical procedure represented a milestone for both the anesthesiologist (difficult intubation, with a thin tracheal tube in the absence of the jet ventilation technology) and for the surgeon. The goiter's excision from the visceral mediastinum was very difficult because of its huge dimensions and close relations with trachea and great vessels (anterior) and esophagus, erector spinal muscles and the spine (posterior).
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