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3.
Surg Today ; 51(3): 447-451, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1453756

ABSTRACT

Accumulation of experience and advances in techniques and instruments have enabled surgeons to perform video-assisted thoracic surgery (VATS) safely for sublobar resection, including segmentectomy and wedge resection. A key to successful VATS sublobar resection is to have adequate resection margins and the appropriate use of articulated surgical staplers is essential for this purpose. The SigniaTM stapling system (Covidien Japan, Tokyo) has been used extensively in the fields of thoracic surgery. Its features include high maneuverability with fully powered articulation, rotation, clamping, and firing, which the surgeon can control with one hand. We introduce the "sliding technique" using the SigniaTM system, which allows for adjustment of the resection lines of the pulmonary parenchyma to optimize safe surgical margins with minimal stapler movement, and without repetitively moving the stapler in and out of the pleural cavity, during VATS sublobar resection.


Subject(s)
Lung Neoplasms/surgery , Lung/surgery , Margins of Excision , Pneumonectomy/instrumentation , Pneumonectomy/methods , Surgical Staplers , Surgical Stapling/instrumentation , Surgical Stapling/methods , Thoracic Surgery, Video-Assisted/instrumentation , Thoracic Surgery, Video-Assisted/methods , Humans , Safety
4.
Curr Med Imaging ; 18(4): 440-443, 2022.
Article in English | MEDLINE | ID: covidwho-1417027

ABSTRACT

BACKGROUND: Lung transplantation might be a viable alternative for patients with irreversible lung injury secondary to coronavirus disease 2019 (COVID-19). Here, we describe two patients with end-stage COVID-19 that received lung transplantations, the clinical-radiologic manifestations of postoperative complications, and the imaging features of allograft rejection. CASE PRESENTATION: In case 1, a 66-year-old woman presented severe hypoxia after lung transplantation. Chest imaging revealed diffuse homogeneous infiltration in the donor's lung. Dramatic resolution of the imaging abnormalities after intravenous administration of methylprednisolone favored a diagnosis of hyperacute rejection. The second is a 70-year-old man who was infected with bacterial postoperatively. During the empiric antibiotic therapy, chest CT showed newly developed groundglass opacities with septal thickening, suggesting a diagnosis of acute rejection. High-dose corticosteroids therapy was initiated, and the patient recovered gradually. CONCLUSION: This is the first report describing postoperative complications of lung transplantation in patients with advanced COVID-19. We presumed that imaging procedures could be a useful tool in early detecting lung transplant complications and selecting specific interventions for patients with COVID-19.


Subject(s)
COVID-19 , Lung Transplantation , Aged , COVID-19/diagnostic imaging , Female , Humans , Lung/diagnostic imaging , Lung/surgery , Male , Postoperative Complications/diagnostic imaging , SARS-CoV-2
5.
Cardiol Young ; 31(8): 1238-1240, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1397819

ABSTRACT

The growing unmet demand for suitable organ donors increases each year. Despite relative contraindications for thoracic organ donation after previous cardiac surgery, experienced programmes and surgeons can successfully utilise the lungs from select donors who have undergone prior cardiac surgery. This is the first reported case of double lung en bloc procurement from a donor who had a previous arterial switch operation as an infant.


Subject(s)
Arterial Switch Operation , Cardiac Surgical Procedures , Lung Transplantation , Tissue and Organ Procurement , Humans , Infant , Lung/diagnostic imaging , Lung/surgery , Tissue Donors
6.
J Med Case Rep ; 15(1): 377, 2021 Jul 13.
Article in English | MEDLINE | ID: covidwho-1309926

ABSTRACT

BACKGROUND: Cavities are frequent manifestations of a wide variety of pathological processes involving the lung. There has been a growing body of evidence of coronavirus disease 2019 leading to a cavitary pulmonary disease. CASE PRESENTATION: A healthy 29-year-old Filipino male presented to the hospital a couple of months after convalescence from coronavirus disease 2019 with severe pleuritic chest pain, fever, chills, and shortness of breath, and was found to have a cavitary lung lesion on chest computed tomography. While conservative management alone failed to improve the patient's condition, he ultimately underwent left lung video-assisted thoracoscopic surgery decortication. Even though the surgical pathology revealed only necrosis with dense acute inflammation and granulation tissue with no microorganisms, he gradually improved with medical therapy adjunct with surgical therapy. CONCLUSION: Documented cases of cavitary lung disease secondary to coronavirus disease 2019 have been mostly reported in the acute or subacute phase of the infection. However, clinicians should recognize this entity as a late complication of coronavirus disease 2019, even in previously healthy individuals.


Subject(s)
COVID-19 , Adult , Humans , Lung/diagnostic imaging , Lung/surgery , Male , SARS-CoV-2 , Thoracic Surgery, Video-Assisted , Tomography, X-Ray Computed
8.
Sci Transl Med ; 12(574)2020 12 16.
Article in English | MEDLINE | ID: covidwho-1207479

ABSTRACT

Lung transplantation can potentially be a life-saving treatment for patients with nonresolving COVID-19-associated respiratory failure. Concerns limiting lung transplantation include recurrence of SARS-CoV-2 infection in the allograft, technical challenges imposed by viral-mediated injury to the native lung, and the potential risk for allograft infection by pathogens causing ventilator-associated pneumonia in the native lung. Additionally, the native lung might recover, resulting in long-term outcomes preferable to those of transplant. Here, we report the results of lung transplantation in three patients with nonresolving COVID-19-associated respiratory failure. We performed single-molecule fluorescence in situ hybridization (smFISH) to detect both positive and negative strands of SARS-CoV-2 RNA in explanted lung tissue from the three patients and in additional control lung tissue samples. We conducted extracellular matrix imaging and single-cell RNA sequencing on explanted lung tissue from the three patients who underwent transplantation and on warm postmortem lung biopsies from two patients who had died from COVID-19-associated pneumonia. Lungs from these five patients with prolonged COVID-19 disease were free of SARS-CoV-2 as detected by smFISH, but pathology showed extensive evidence of injury and fibrosis that resembled end-stage pulmonary fibrosis. Using machine learning, we compared single-cell RNA sequencing data from the lungs of patients with late-stage COVID-19 to that from the lungs of patients with pulmonary fibrosis and identified similarities in gene expression across cell lineages. Our findings suggest that some patients with severe COVID-19 develop fibrotic lung disease for which lung transplantation is their only option for survival.


Subject(s)
COVID-19/surgery , Lung Transplantation , Lung/surgery , Pulmonary Fibrosis/surgery , Adult , Aged, 80 and over , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19/virology , COVID-19 Nucleic Acid Testing , Databases, Factual , Disease Progression , Female , Humans , In Situ Hybridization, Fluorescence , Lung/physiopathology , Lung/virology , Male , Middle Aged , Pulmonary Fibrosis/diagnosis , Pulmonary Fibrosis/physiopathology , Pulmonary Fibrosis/virology , RNA-Seq , Recovery of Function , Retrospective Studies , Severity of Illness Index , Single-Cell Analysis , Treatment Outcome
9.
Gen Thorac Cardiovasc Surg ; 69(7): 1159-1162, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1163151

ABSTRACT

A 65-year-old man with coronavirus disease 2019 (COVID-19) was admitted to our hospital. Computed tomography detected bilateral pneumonia with a lung nodule suspicious for lung cancer. Lobectomy was performed 3 months after the treatment for COVID-19 without any complications. The surgical specimen revealed fibrosis below the pleura with a small collection of lymphocytes and intravascular hemorrhagic thrombosis, and no residual RNA was detected. This is the first report describing a surgical specimen after recovery from COVID-19 pneumonia, and suggests that elective thoracic surgery can be performed safely, depending on the patient's respiratory function, without infectious risk.


Subject(s)
COVID-19 , Pneumonia , Aged , Elective Surgical Procedures , Humans , Lung/diagnostic imaging , Lung/surgery , Male , SARS-CoV-2
10.
Am J Clin Pathol ; 155(4): 506-514, 2021 Mar 15.
Article in English | MEDLINE | ID: covidwho-975195

ABSTRACT

OBJECTIVES: Current knowledge of the pulmonary pathology of coronavirus disease 2019 (COVID-19) is based largely on postmortem studies. In most, the interval between disease onset and death is relatively short (<1 month). Information regarding lung pathology in patients who survive for longer periods is scant. We describe the pathology in three patients with severe COVID-19 who underwent antemortem examination of lung tissue at least 8 weeks after initial diagnosis. METHODS: We conducted a retrospective case series. RESULTS: The first patient developed acute respiratory failure and was started on extracorporeal membrane oxygenation (ECMO) on day 21, with subsequent hemothorax. Debridement (day 38) showed extensive lung infarction with diffuse alveolar damage and Candida overgrowth. The second patient developed acute respiratory failure requiring mechanical ventilation that did not improve despite ECMO. Surgical lung biopsy on day 74 showed diffuse interstitial fibrosis with focal microscopic honeycomb change. The third patient also required ECMO and underwent bilateral lung transplantation on day 126. The explanted lungs showed diffuse interstitial fibrosis with focal microscopic honeycomb change. CONCLUSIONS: This series provides histologic confirmation that complications of COVID-19 after 8 weeks to 4 months of severe disease include lung infarction and diffuse interstitial fibrosis.


Subject(s)
COVID-19 Testing/methods , COVID-19/pathology , Lung/pathology , Severity of Illness Index , Biopsy , COVID-19/diagnosis , COVID-19/therapy , Disease Progression , Female , Humans , Lung/surgery , Lung Transplantation , Male , Middle Aged , Time Factors
11.
Ann Thorac Surg ; 111(4): e241-e243, 2021 04.
Article in English | MEDLINE | ID: covidwho-956092

ABSTRACT

We report a case of necrotizing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia complicated by a bronchopleural fistula and treated by decortication and salvage lobectomy. Owing to the unknown characteristics of the underlying SARS-CoV-2 infection, treatment of the abscess and bronchopleural fistula was delayed. This may have resulted in further deterioration of the patient, with ensuing multiple organ dysfunction. Complications of SARS-CoV-2 pneumonia, such as a bacterial abscess and a bronchopleural fistula, should be treated as if the patient were not infected with SARS-CoV-2.


Subject(s)
Bronchial Fistula/surgery , COVID-19/complications , Lung/diagnostic imaging , Pleural Diseases/surgery , Pneumonectomy/methods , Pneumonia, Viral/complications , Adult , Bronchial Fistula/diagnosis , Bronchial Fistula/etiology , COVID-19/diagnosis , COVID-19/epidemiology , Female , Humans , Lung/surgery , Pleural Diseases/diagnosis , Pleural Diseases/etiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/surgery , Tomography, X-Ray Computed
12.
J Thorac Cardiovasc Surg ; 163(1): 336-337, 2022 01.
Article in English | MEDLINE | ID: covidwho-938234
13.
Infect Disord Drug Targets ; 21(6): e170721187877, 2021.
Article in English | MEDLINE | ID: covidwho-922760

ABSTRACT

BACKGROUND: The recent outbreak of the coronavirus disease (COVID-19) in China has rapidly spread throughout the world and there are many reports of symptoms ranging from malaise to acute respiratory distress syndrome (ARDS) caused by this infection. However, few reports have been discussed surgical outcomes in COVID-19 patients. CASE PRESENTATION: In this report, we described a case of an elderly female developed with postoperative pulmonary complications after uneventful elective minor surgery. The patient was asymptomatic before the operation with no history of cough or fever. After surgery, the patient developed respiratory distress and chest radiological imaging revealed bilateral ground-glass opacities. It seems any type of surgeries requiring local anesthesia or general anesthesia may contribute to worsening outcomes in patients with covid19.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Aged , Female , Humans , Lung/diagnostic imaging , Lung/surgery , Respiratory Distress Syndrome/etiology , SARS-CoV-2 , Tomography, X-Ray Computed
14.
Ann Thorac Surg ; 111(3): e183-e184, 2021 03.
Article in English | MEDLINE | ID: covidwho-797517

ABSTRACT

Patients with severe coronavirus disease 2019 from infection with severe acute respiratory syndrome coronavirus 2 mount a profound inflammatory response and are predisposed to thrombotic complications. Pulmonary vein thrombosis is a rare disease process resulting in pulmonary congestion, infarction, and potential mortality. This report describes a patient with coronavirus disease 2019 requiring venovenous extracorporeal membrane oxygenation for hypoxic respiratory failure who developed hemorrhagic infarction of the right lower lobe. During emergency exploration the patient was found to have a right inferior vein thrombosis and marked lobar hemorrhage mandating lobectomy.


Subject(s)
COVID-19/complications , Hemoptysis/surgery , Infarction/surgery , Lung/blood supply , Pneumonectomy/methods , Adult , COVID-19/epidemiology , Hemoptysis/etiology , Humans , Infarction/etiology , Lung/surgery , Male , Pandemics
15.
Medicine (Baltimore) ; 99(28): e21046, 2020 Jul 10.
Article in English | MEDLINE | ID: covidwho-646088

ABSTRACT

RATIONALE: Although there have been several studies describing clinical and radiographic features about the novel coronavirus (COVID-19) infection, there is a lack of pathologic data conducted on biopsies or autopsies. PATIENT CONCERNS: A 56-year-old and a 70-year-old men with fever, cough, and respiratory fatigue were admitted to the intensive care unit and intubated for respiratory distress. DIAGNOSIS: The nasopharyngeal swab was positive for COVID-19 and the chest Computed Tomography (CT) scan showed the presence of peripheral and bilateral ground-glass opacities. INTERVENTIONS: Both patients developed pneumothoraces after intubation and was managed with chest tube. Due to persistent air leak, thoracoscopies with blebs resection and pleurectomies were performed on 23rd and 16th days from symptoms onset. OUTCOMES: The procedures were successful with no evidence of postoperative air-leak, with respiratory improvement. Pathological specimens were analyzed with evidence of diffuse alveolar septum disruption, interstitium thickness, and infiltration of inflammatory cells with diffuse endothelial dysfunction and hemorrhagic thrombosis. LESSONS: Despite well-known pulmonary damages induced by the COVID-19, the late-phase histological changes include diffused peripheral vessels endothelial hyperplasia, in toto muscular wall thickening, and intravascular hemorrhagic thrombosis.


Subject(s)
Coronavirus Infections/pathology , Endothelium, Vascular/pathology , Lung , Pandemics , Pleura , Pneumonia, Viral/pathology , Thrombosis/pathology , Thrombosis/parasitology , Aged , Betacoronavirus/isolation & purification , Biopsy/methods , COVID-19 , COVID-19 Testing , Chest Tubes/adverse effects , Clinical Laboratory Techniques/methods , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Humans , Lung/blood supply , Lung/diagnostic imaging , Lung/pathology , Lung/surgery , Male , Middle Aged , Pleura/pathology , Pleura/surgery , Pneumonia, Viral/complications , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Pneumothorax/etiology , Pneumothorax/therapy , Respiration, Artificial/methods , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , SARS-CoV-2 , Thoracoscopy/methods , Tomography, X-Ray Computed/methods , Treatment Outcome
17.
J Thorac Oncol ; 15(6): 1065-1072, 2020 06.
Article in English | MEDLINE | ID: covidwho-208942

ABSTRACT

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, People's Republic of China, and has subsequently spread worldwide. Clinical information on patients who contracted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the perioperative period is limited. Here, we report seven cases with confirmed SARS-CoV-2 infection in the perioperative period of lung resection. Retrospective analysis suggested that one patient had been infected with the SARS-CoV-2 infection before the surgery and the other six patients contracted the infection after the lung resection. Fever, lymphopenia, and ground-glass opacities revealed on computed tomography are the most common clinical manifestations of the patients who contracted COVID-19 after the lung resection. Pathologic studies of the specimens of these seven patients were performed. Pathologic examination of patient 1, who was infected with the SARS-CoV-2 infection before the surgery, revealed that apart from the tumor, there was a wide range of interstitial inflammation with plasma cell and macrophage infiltration. High density of macrophages and foam cells in the alveolar cavities, but no obvious proliferation of pneumocyte, was found. Three of seven patients died from COVID-19 pneumonia, suggesting lung resection surgery might be a risk factor for death in patients with COVID-19 in the perioperative period.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Lung Neoplasms/complications , Lung/diagnostic imaging , Pneumonectomy , Pneumonia, Viral/complications , Surgicenters , Thoracic Surgery , Aged , Biopsy , COVID-19 , China/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Female , Humans , Incidence , Lung/surgery , Lung Neoplasms/epidemiology , Lung Neoplasms/surgery , Male , Middle Aged , Pandemics , Perioperative Period , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Tomography, X-Ray Computed
18.
Virchows Arch ; 477(5): 743-748, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-143976

ABSTRACT

Despite the current pandemic season, reports on pathologic features of coronavirus disease 19 (Covid-19) are exceedingly rare at the present time. Here we describe the pathologic features of early lung involvement by Covid-19 in a surgical sample resected for carcinoma from a patient who developed SARS-CoV-2 infection soon after surgery. The main histologic findings observed were pneumocyte damage, alveolar hemorrhages with clustering of macrophages, prominent and diffuse neutrophilic margination within septal vessels, and interstitial inflammatory infiltrates, mainly represented by CD8+ T lymphocytes. These features are similar to those previously described in SARS-CoV-1 infection. Subtle histologic changes suggestive pulmonary involvement by Covid-19 may be accidentally encountered in routine pathology practice, especially when extensive sampling is performed for histology. These findings should be carefully interpreted in light of the clinical context of the patient and could prompt a pharyngeal swab PCR test to rule out the possibility of SARS-CoV-2 infection in asymptomatic patients.


Subject(s)
Adenocarcinoma/surgery , Betacoronavirus , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Lung Neoplasms/surgery , Lung/pathology , Pneumonia, Viral/diagnosis , Postoperative Complications/diagnosis , Adenocarcinoma/pathology , Adenocarcinoma/virology , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , Coronavirus Infections/etiology , Coronavirus Infections/pathology , Humans , Lung/surgery , Lung/virology , Lung Neoplasms/pathology , Lung Neoplasms/virology , Male , Middle Aged , Pandemics , Pneumonectomy , Pneumonia, Viral/etiology , Pneumonia, Viral/pathology , Postoperative Complications/pathology , Postoperative Complications/virology , SARS-CoV-2
20.
J Thorac Oncol ; 15(5): 700-704, 2020 05.
Article in English | MEDLINE | ID: covidwho-2529

ABSTRACT

There is currently a lack of pathologic data on the novel coronavirus (severe acute respiratory syndrome coronavirus 2) pneumonia, or coronavirus disease 2019 (COVID-19), from autopsy or biopsy. Two patients who recently underwent lung lobectomies for adenocarcinoma were retrospectively found to have had COVID-19 at the time of the operation. These two cases thus provide important first opportunities to study the pathology of COVID-19. Pathologic examinations revealed that apart from the tumors, the lungs of both patients exhibited edema, proteinaceous exudate, focal reactive hyperplasia of pneumocytes with patchy inflammatory cellular infiltration, and multinucleated giant cells. Hyaline membranes were not prominent. Because both patients did not exhibit symptoms of pneumonia at the time of operation, these changes likely represent an early phase of the lung pathology of COVID-19 pneumonia.


Subject(s)
Adenocarcinoma/surgery , Coronavirus Infections/complications , Lung Neoplasms/surgery , Lung/pathology , Pneumonia, Viral/complications , Adenocarcinoma/complications , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Female , Humans , Lung/diagnostic imaging , Lung/surgery , Lung Neoplasms/complications , Male , Pandemics , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed
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