COVID-19-related end stage lung disease: two distinct phenotypes

In COVID-19 related end stage lung disease, there are two distinct phenotypes. The first phenotype is the COVID-19 related acute respiratory distress syndrome (CARDS) showing a classical histopathological pattern of fibrotic diffuse alveolar damage (DAD). The second phenotype is the post-COVID pulmonary fibrosis (PCPF), in which the diagnosis is based on the combined clinical, radiological and (if available) pathological information. Both phenotypes have different clinical features, risk factors, biomarkers and pathophysiology. The exact prognosis in these two phenotypes as well as optimal treatment needs further studies. Key messages Two different phenotypes exist for COVID-19 related pulmonary fibrosis. The CARDS phenotype has a worse prognosis compared to the PCPF phenotype, which requires longer-term follow-up and evolves without ARDS picture. The best treatment options for the two different phenotypes, such as anti-fibrotic drugs or lung transplantation, still needs to be defined in future studies

Transthoracic versus transabdominal surgical approach for echinococcal cysts located over the superoposterior aspect of the right lobe of the liver

A retrospective study of 80 patients operated on for hydatid cysts located on the superoposterior aspect of the right lobe of the liver (segments VI, VII, VIII) is presented. Right thoracotomy was performed in 30 patients, and 50 patients were operated on through bilateral subcostal incisions. The two approaches were compared in terms of radicality and morbidity. The transabdominal approach produced superior results and fewer postoperative complications, resulting in a shorter hospital stay (11 +/- 5 vs. 18 +/- 8 days). Total cystopericystectomy was feasible in 30% of patients operated on transabdominally and in 6% of those approached transthoracically. The rest of the patients were offered partial pericystectomy, except three in the thoracotomy group who underwent simple drainage of the cavity. We recommend that the transabdominal approach be the first choice for treatment of liver hydatid cysts irrespective of their location and size. We abandoned the transthoracic approach for cysts located on the superoposterior aspect of the right liver lobe in 1996. The transabdominal approach enables the surgeon to treat liver hydatidosis in a more radical, safer manner than does the transthoracic approach