Video-assisted thoracoscopic diagnosis of trapped lung in malignant pleural effusions

PURPOSE. The aim of this study is to present the role of video-assisted thoracoscopy to assess the ability of the lung to expand in malignant pleural effusions. METHODS. The survey was conducted for a 3-year period in 13 patients with histologically diagnosed malignant pleural effusion and trapped lung. In each of the patients video-assisted thoracoscopy was performed. RESULTS. Two reasons for trapped lung were identified. In 10 of the patients it was due to multiple metastatic nodules. In 3 cases the cause was a diffuse fibrotic involvement of the lung resulting from the metastatic process.CONCLUSIONS. Our research confirmed two causes of trapped lung in malignant pleural effusions: multiple metastases on the lung surface and diffuse lung fibrosis, induced by the metastatic process, with the increased role of multiple metastases on the lung surface

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

An analysis of 212 cases of rib fractures due to blunt thoracic trauma

PURPOSE. The aim of this retrospective study was to investigate the role of rib fractures for the outcome in blunt chest trauma, to examine the mortality rate and the need of hospitalization of patients underwent blunt thoracic trauma. METHODS. 212 patients with fractured ribs after blunt thoracic trauma were included in the study. The mechanism of trauma, the number of fractured ribs; the type of associated thoracic injuries and the mortality rate were analyzed. RESULTS. The patients were divided in two groups according to the number of fractured ribs-group 1-patients with up to two fractured ribs- 72 patients/33,9%/, and group 2- with three or more fractured ribs-140 patients /66,1%/. The number of associated chest injuries was significantly higher in the second group- in 133 patients/95%/.The mortality rate was 16,9% /36 patients/.The mortality rate was significantly higher for the group of patients at the age above 65 years and for the group of patients with multiple/≥3/ rib fractures. CONCLUSIONS. Our study confirms the role of rib fractures as a marker of severity in cases of blunt chest trauma patients

Mermaid syndrome associated with VACTERL-H syndrome

Mermaid syndrome or sirenomelia is an extremely rare congenital malformation with an incidence between 1.5 and 4.2 per 1,000,000 pregnancies. Association of mermaid syndrome with VACTERL-H syndrome is extremely rare, with only two cases reported so far in the literature. We present a new case of type I sirenomelia associated with VACTERL-H syndrome and review the relevant literature. A 15-year-old female patient was admitted to the Department of Pathological Pregnancy at St George University Hospital, Plovdiv with progredient abortion during her first pregnancy. She had low socioeconomic status, negative history of concomitant diseases and addictions. The patient avoided prophylactic intake of folic acid during her pregnancy. Prenatal ultrasound found a malformative fetus. Consequently, magnetic resonance imaging was performed which established the presence of hydrocephalus and defects in the lower part of the spine. These pathological findings indicated interruption of pregnancy at 20 weeks of gestation. The fetopathological examination found sirenomelia type I associated with myelomeningocele, hydrocephalus, anal imperforation, single umbilical artery, bilateral renal and ureteric agenesis, bladder agenesis, tracheo-esophageal fistula, agenesis of external genitals, monkey fold of the left palm of the hand, also known as VACTERL-H syndrome.Our case demonstrates that mermaid syndrome and VACTERL-H syndrome represent different manifestations of a single pathological process that results in disorders of the blastogenesis at different stages during embryonic development.&nbsp

Postsurgical Complications in Lung Cancers

Patients undergoing thoracotomy in cases of lung cancer are highly susceptible to early postoperative complications. They can be life-threatening. The aim of this study was to analyze the early postoperative inflammatory changes in lung cancer patients. 71 lung cancer patients, prior and following thoracotomy, were included in the study. They were admitted to the Second Surgical Clinic of the University Hospital `St. George`-Plovdiv in the period 2013-2015. The subjects were analyzed based on sex, age, volume of surgery and the incidence of early postoperative complications. The results showed that 60 (85%) of the surgically-treated patients were male and 11 (15%) - women. Out of all, 9 (13%) were aged 50 years, 56 (79%) - from 51 - 75, and 6 (8%) - older than 75. Atypical resection was performed in 8 patients (11%), lobectomy - in 22 (31%), pulmonectomy - in 1 (15%), exploratory thoracotomy - in 9 (13%) and others - VATS or combined operational approaches - in 21 patients (30%). The following complications were observed in 8 (11%) out of all surveyed: surgical wound suppuration (1), empyema (1), retained collection without evidence of suppuration (2), subcutaneous emphysema (1), hydropneumothorax (1), fever (1), partial pneumothorax (1). Seven out of all 8 complications were with inflammatory origin. In conclusion, the postoperative inflammatory complications occur more frequently in male patients. The surgical approach was most frequent one in the age group between 51 and 75 years. The most frequent surgical technique was lobectomy followed by pulmonectomy. The most often encountered postsurgical complications are with inflammatory nature and arise in patients after lobectomy and in patients with right lung location of the cancer