Purpose COVID-19 has become a pandemic with significant consequences worldwide. About 3.2% of patients with COVID-19 will require intubation and invasive ventilation. Moreover, there will be an increase in the number of critically ill patients, hospitalized and intubated due to unrelated acute pathology, who will present underlying asymptomatic or mild forms of COVID-19. Tracheostomy is one of the procedures associated with an increased production of aerosols and higher risk of transmission of the virus to the health personnel. The aim of this paper is to describe indications and recommended technique of tracheostomy in COVID-19 patients, emphasizing the safety of the patient but also the medical team involved. Materials and methods A multidisciplinary group made up of surgeons with privileges to perform tracheostomies, intensive care physicians, infectious diseases specialists and intensive pulmonologists was created to update previous knowledge on performing a tracheostomy in critically ill adult patients (>18 years) amidst the SARS-CoV-2 pandemic in a high-volume referral center. Published evidence was collected using a systematic search and review of published studies. Results A guideline comprising indications, surgical technique, ventilator settings, personal protective equipment and timing of tracheostomy in COVID-19 patients was developed. Conclusions A safe approach to performing percutaneous dilational bedside tracheostomy with bronchoscopic guidance is feasible in COVID-19 patients of appropriate security measures are taken and a strict protocol is followed. Instruction of all the health care personnel involves is key to ensure their safety and the patient's favorable recovery.

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Introducción: El cáncer de pulmón es la principal causa de mortalidad relacionada con el cáncer en todo el mundo. Aunque el cáncer de pulmón se observa predominantemente en fumadores, los pacientes no fumadores representan el 20% de los casos en todo el mundo.    Objetivo: En este artículo, debatimos sobre un caso de adenocarcinoma de pulmón que se originó a partir de una cicatriz postoperatoria. Presentamos a un paciente masculino de 62 años que, mientras se estudiaba por diagnóstico de enfermedad ósea de Paget, presentaba un nódulo pulmonar de 1,5 cm (SUV 1.6) como un hallazgo de imagen en el segmento posterior del pulmón izquierdo. Se sometió a una segmentectomía pulmonar superior izquierda.   Materiales y métodos: Articulo de tipo caso clínico. Se obtuvieron los datos de manera retrospectiva a partir de la historia clínica del paciente bajo normas del comité de ética.   Resultados: Durante el seguimiento de rutina de su enfermedad subyacente, 12 años después de la cirugía original, se encontró un nódulo pulmonar. La particularidad de la muestra se basa en la observación macroscópica de la pieza tumoral donde se muestra el desarrollo de la masa neoplásica en la sutura mecánica de la cirugía previa realizada hace 12 años.   Conclusión: Describimos un mecanismo de desarrollo oncológico poco frecuente en la práctica clínica, a partir de la inflamación crónica postoperatoria debido a la sutura mecanica

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The most frequent sites of distant metastasis of colorectal cancer (CRC) are primarily liver and lung, followed by brain and bone metastases. Infrequently, metastases are found in the adrenal glands. They usually have a metachronous and homolateral character. We present a case of contralateral synchronic adrenal metastasis of CRC and its surgical resolution.