Intraoperative continuous neural monitoring (C-IONM) during thyroid surgery has been recognized as a useful tool to identify and confirm recurrent laryngeal nerve integrity. The aim of the present study is to analyze electromyographic features and thresholds for normal vocal fold function in our initial experience with C-IONM in thyroid surgery. C-IONM was utilized in 57 patients who underwent thyroid surgery between July 2012 and December 2015. EMG parameters were analyzed looking for potential predictors of postoperative vocal fold dismotility. There were 54 females (94.7%) and 3 males (5.3%) with a mean age of 46.7 ± 11.6 years. C-IONM was successfully registered in 89 of 107 nerves at risk (83.1%). Mean basal amplitude was 727.31 ± 471.25 μV and mean final amplitude was 650.27 ± 526.87 μV (P = 0.095, CI 95% 13.83-167.91). Mean basal latency was 5.23 ± 1.42 mS and mean final latency was 5.18 ± 1.50 mS (P = 0.594, CI 95% 0.39-0.24). Four patients had transient postoperative vocal fold paresis. None of these four patients had loss of signal (LOS), three had transient decrease in amplitude, and one had a normal registry throughout the operation. C-IONM is a useful tool to identify patients in whom intraoperative RLN is at risk during surgery. Final amplitude above 500 μV and no LOS is associated with RLN integrity and normal postoperative vocal fold function.

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Objectives The appearance of characteristic pulmonary lesions has been noted after COVID-19, being described as post-COVID-19 pneumo-hematocele. The aim of this study is to describe the clinical, histopathologic, and imaging features of pneumo-hematocele and to suggest a treatment algorithm for these patients. Methods A retrospective study was performed in patients admitted with a diagnosis of SARS-CoV2 infection from March 2020 to September 2021 who presented a pneumo-hematocele on imaging studies. Clinical and demographic variables were recorded, and CT scans were analyzed. A secondary analysis was performed to estimate the risk provided by the pneumo-hematocele diameter of developing pneumothorax. Results 37 patients were diagnosed with pneumo-hematoceles, 97.3% were males with a median age of 41 ± 13 years and 51% were smokers. The mean diameter of the pneumatocele was 6.3 ± 2.8 cm; they were more common on the subpleural surface and in the inferior lobe. Thirty patients had ruptured pneumo-hematoceles and developed pneumothorax (81.1%); a total of 26 patients required surgery (70.3%). Lesions measuring 5 cm had a high risk of rupture (OR 6.8, CI 95% 1.1–42); those measuring 3 cm were prone to this complication. For each centimeter that the pneumo-hematocele diameter increases, the OR for rupture increases 1.5. Conclusions It appears that post-COVID-19 pneumo-hematocele occurs secondary to encapsulation of blood accumulation inside the lung, as a result of micro-capillary bleeding, with partial reabsorption of blood and subsequent air filling. We recommend surgery for patients with pneumo-hematoceles of 5 cm and those with persistent lesions of 3 cm. Trial registration Clinical Trial Registration: NCT05067881.

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Laparoscopic cholecystectomy (LC) is the gold standard technique for the treatment of gallbladder disease. However, in some cases, conversion to open surgery is still necessary. Identification of patients with high risk of conversion is of great importance to prepare the surgical scenario and to anticipate the convalescence. The objective of this study is to identify the factors that may predict a conversion to an open procedure. A total of 1386 LC were performed in Dr. Manuel Gea González General Hospital, from January 2009 to May 2013. A retrospective analysis of 41 parameters in these patients was performed, including demographic variables, clinical history, laboratory studies, ultrasound results and intraoperative findings. Subsequently, a multivariate logistic regression analysis was used to determine the predictive variables for conversion. Fourteen patients required conversion (1%). The multivariate analysis revealed that the factor that was most associated with conversion was emergency surgery (OR 4.9, CI 95% 2.3-2.4), as well as dilatation > 6 mm of the common bile duct in ultrasound (OR 1.8, CI 95% 1.1-1.7), hepatomegaly (OR 1.3, CI 95% 0.3-4.9), diagnosis of chronic cholecystitis associated to previous biliary colics (OR 2.8, CI 95% 1.0-21) and elevated alanine aminotransaminase (OR 1.2, CI 95% 1.0-2.1). Patients with acute symptoms, with dilatation of the bile duct, cholestasis history and hepatomegaly have a higher risk of a conversion surgery. These factors may warn both the patient and the surgeon for a complex surgery and possible complications.