Intrapericardial teratomas are rare but potentially fatal. With prenatal ultrasound, early diagnosis and decision for treatment can be accomplished. However, the decision becomes to treat prenatally vs. waiting until the neonatal period for definitive surgical management. The most common sequelae of intrapericardial teratomas are pericardial effusion and often progression to hydrops. It is these sequelae that tend to guide management. Presented here is a case report of the diagnosis and management of a twin fetus with an intrapericardial teratoma, as well as a review of the literature.

Background Large studies comparing totally minimally invasive oesophagectomy (TMIE) with laparoscopically assisted (hybrid) oesophagectomy are lacking. Although randomized trials have compared TMIE invasive with open oesophagectomy, daily clinical practice does not always resemble the results reported in such trials. The aim of the present study was to compare complications after totally minimally invasive, hybrid and open Ivor Lewis oesophagectomy in patients with oesophageal cancer. Methods The study was performed using data from the International Esodata Study Group registered between February 2015 and December 2019. The primary outcome was pneumonia, and secondary outcomes included the incidence and severity of anastomotic leakage, (major) complications, duration of hospital stay, escalation of care, and 90-day mortality. Data were analysed using multivariable multilevel models. Results Some 8640 patients were included between 2015 and 2019. Patients undergoing TMIE had a lower incidence of pneumonia than those having hybrid (10.9 versus 16.3 per cent; odds ratio (OR) 0.56, 95 per cent c.i. 0.40 to 0.80) or open (10.9 versus 17.4 per cent; OR 0.60, 0.42 to 0.84) oesophagectomy, and had a shorter hospital stay (median 10 (i.q.r. 8–16) days versus 14 (11–19) days (P = 0.041) and 11 (9–16) days (P = 0.027) respectively). The rate of anastomotic leakage was higher after TMIE than hybrid (15.1 versus 10.7 per cent; OR 1.47, 1.01 to 2.13) or open (15.1 versus 7.3 per cent; OR 1.73, 1.26 to 2.38) procedures. Conclusion Compared with hybrid and open Ivor Lewis oesophagectomy, TMIE resulted in a lower pneumonia rate, a shorter duration of hospital stay, but higher anastomotic leakage rates. Therefore, no clear advantage was seen for either TMIE, hybrid or open Ivor Lewis oesophagectomy when performed in daily clinical practice.

Patients with anastomotic leaks had increased variance in their preoperative oral and gastric flora. Microbiome analysis could help identify patients at higher risk for leak after esophagectomy.

Rationale: Chronic obstructive pulmonary disease (COPD) hospitalizations increase short and long-term mortality; multiple COPD hospitalizations track with even higher mortality. While comorbidities such as coronary artery disease (CAD) and congestive heart failure (CHF) are common in COPD, their contribution to mortality risk after a sentinel COPD hospitalization is unknown. Purpose: Assess the effect on mortality of comorbid conditions prompting rehospitalization following COPD exacerbation hospitalization. Methods: We performed a retrospective cohort analysis of patients hospitalized for COPD exacerbations in Pennsylvania from 1990-2010 using the Pennsylvania Health Care Cost Containment Council (PHC4) database. We included patients > 40 years old hospitalized for an acute exacerbation of COPD (AECOPD; International Classification of Diseases-Ninth Edition, [ICD-9] #491, 492, 496) by discharge diagnosis. Thirty-day mortality in patients with COPD hospitalization for acute exacerbation who were rehospitalized for COPD < 30days post-discharge was compared to those primarily readmitted for comorbid conditions. Relative risk of death after readmission was determined by diagnosis. Primary end-point was mortality 30 days post-readmission for 14 most common non-COPD diagnoses, including heart failure, pneumonia, pulmonary embolus (PE), and myocardial infarction. Results: Patients were nearly 2 times more likely to die within 30 days when readmitted for pneumonia (p<0.0001) or myocardial infarction (p<0.0001) rather than COPD. Septicemia conferred the highest mortality. Conclusions: COPD patients rehospitalized for comorbid conditions such as myocardial infarction, pneumonia, septicemia or pulmonary heart disease (includes PE) were significantly more likely to die within 30 days than patients readmitted for COPD. Great emphasis is already placed on preventing COPD rehospitalization; however, more attention should focus on preemptive risk reduction for comorbidities in COPD patients.

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