Conventional and digital pleural drainage systems - advantages and disadvantages.

INTRODUCTION: Pleural cavity drainage is a crucial component of the surgical management of patients with various chest diseases. Digital drainage systems are increasingly used in contemporary thoracic surgical procedure, which is likely a result of their effectiveness in achieving early postoperative ambulation, cutting down on hospital stays and lowering costs. The vast majority of thoracic surgeons worldwide prefer digital drainage systems to traditional ones. The advantages of the former, however, are disputed by some researchers.

Surgical Innovations in Tracheal Reconstruction: A Review on Synthetic Material Fabrication.

Background and Objectives: The aim of this review is to explore the recent surgical innovations in tracheal reconstruction by evaluating the uses of synthetic material fabrication when dealing with tracheomalacia or stenotic pathologies, then discussing the challenges holding back these innovations. Materials and Methods: A targeted non-systematic review of published literature relating to tracheal reconstruction was performed within the PubMed database to help identify how synthetic materials are utilised to innovate tracheal reconstruction. Results: The advancements in 3D printing to aid synthetic material fabrication have unveiled promising alternatives to conventional approaches. Achieving successful tracheal reconstruction through this technology demands that the 3D models exhibit biocompatibility with neighbouring tracheal elements by encompassing vasculature, chondral foundation, and immunocompatibility. Tracheal reconstruction has employed grafts and scaffolds, showing a promising beginning in vivo. Concurrently, the integration of resorbable models and stem cell therapy serves to underscore their viability and application in the context of tracheal pathologies. Despite this, certain barriers hinder its advancement in surgery. The intricate tracheal structure has posed a challenge for researchers seeking novel approaches to support its growth and regeneration. Conclusions: The potential of synthetic material fabrication has shown promising outcomes in initial studies involving smaller animals. Yet, to fully realise the applicability of these innovative developments, research must progress toward clinical trials. These trials would ascertain the anatomical and physiological effects on the human body, enabling a thorough evaluation of post-operative outcomes and any potential complications linked to the materials or cells implanted in the trachea.

Spontaneous pneumothorax associated with COVID-19 pneumonia: a single-centre retrospective study.

Spontaneous pneumothorax (SP) is a rare complication of COVID-19 pneumonia; it affects both intubated and non-intubated patients. The pathogenesis includes barotrauma and pneumatocele formation. In the following article, we present case series of 18 patients with COVID-19 associated pneumothorax - a detailed demographic and clinical analysis were performed. The study revealed that men were more affected than women, especially above the age of 55 years; whilst, the distribution of intubated patients and those with spontaneous breathing were equal. Importantly, tube thoracostomy was the preferred method of treatment. The lethal outcome was observed in all patients on mechanical ventilation, due to the severe course of the underlying disease. The occurrence of pneumothorax in patients with COVID-19 is associated with poorer outcome of the disease, especially in those placed on mechanical ventilation.

Surgical treatment of pneumothorax in patients with COVID-19 - results and management.

INTRODUCTION: The new coronavirus, SARS-CoV-2, provokes infection with different clinical presentation. It involves an asymptomatic condition, mild variants with fever and dry cough to severe pneumonia, adynamia and respiratory failure with lethal outcome. The fibrotic lung tissue after the inflammatory process is a background for development of a secondary pneumothorax. Although it rarely causes lethal outcomes in COVID-19 patients, pneumothorax requires early diagnosis and adequate treatment to prevent any complications and decrease mortality rate. AIM: The aim of this study was to analyse the results of surgical treatment of hospitalized COVID-19 patients with pneumothorax in terms of demographic data, concomitant diseases, complications, and outcome. MATERIALS AND METHODS: Longitudinal prospective study was carried out with 26 patients with pneumothorax as a result of SARS-CoV-2 infection. They were treated at the Intensive Care Unit of the Infectious Disease Clinic and at the Second Clinic of Surgery, St George University Hospital in Plovdiv over a 6-month period from September 2020 to February 2021. RESULTS: Seventeen of the patients were men and nine - women. Twenty-four of all patients underwent thoracentesis and two of them had a video-assisted thoracoscopy. The mean age of the studied patients with pneumothorax and COVID-19 was 66.77±12.61 years, which shows that it is the patients of advanced age with concomitant diseases that are at a higher risk of serious complications and adverse outcome. Of the hospitalized 1245 patients with COVID-19, 385 (30.92%) passed away. Of all hospitalized patients with SARS-CoV-2, 26 (2.08%) developed pneumothorax. Sixteen of them (62%) passed away. The possibility of a lethal outcome for intubated patients increased more than twice. CONCLUSIONS: The pneumothorax as a complication of COVID-19 carries high mortality and severely worsens the prognosis for these patients.

Size of tumour as a risk factor for malignancy in patients with peripheral pulmonary nodules.

UNLABELLED: Peripheral pulmonary tumours are often quite difficult to diagnose and treat. Their detection brings immediately the problem of whether clinicians should just wait and observe or operate the patients. The aim of this study was to determine if there is a direct correlation between tumour size and the risk for malignancy and whether the tumor size should be considered a risk factor for malignancy. PATIENTS AND METHODS: Between 1997 and 2009, 145 patients with peripheral pulmonary tumours of less than 3 cm in diameter underwent video-assisted thoracoscopic (VATS) resection for the purpose of histologic examination of the tumor. RESULTS: The mean age of the patients was 62.60 +/- 0.95 years. The youngest patient was 17 years old and the oldest--82. The study sample included 61 women and 84 men; the men were statistically significantly more than the women (57.3% and 42.07%, respectively) (t = 2.74, P < 0.01). The total number of patients we operated were 145 with 198 resected tumours. The diameter of the lesions ranged between 0.30 cm and 3 cm (mean 1.41 +/- 0.06 cm). We found that 108 (54.55%) of the tumours were malignant, and 90 (45.45%) were benign, the difference between them failing to reach statistical significance (t = 1.82, P > 0.05). The mean size of malignant lesions was statistically significantly greater than that of benign tumours (1.62 +/- 0.08 cm vs 1.15 +/- 0.06 cm). CONCLUSION: The results of this study suggest that the bigger the diameter of the nodule, the greater the percentage share of malignant tumours, which means that the size of the tumour is an important risk factor for malignancy.

Primary pulmonary paraganglioma.

We report a case of primary pulmonary paraganglioma (PPP) in a 19-year-old female. The patient was admitted to the Clinic with high fever, cough, right chest pain, severe fatigue and elevated WBC count. Antibiotic treatment was ineffective. A control chest X-ray showed a 5 x 6-cm tumor formation in the right thoracic cavity which required surgical treatment. Tumorectomy with partial resection of the lobe was performed. The postoperative period was uneventful and the patient was discharged in good general condition, afebrile, with no complaints. Histological and immunohistochemical studies revealed nests of oval cells positive for chromogranin A, surrounded by elongated cells positive for S-100 protein, which was accepted as a definitive trait for PPP. At the control examination six months later the patient was in good general condition and had no complaints. The presented case of PPP (the first ever in the Bulgarian medical literature) is reported because it is exceedingly rare and difficult to diagnose.

Estrogen receptors--known and unknown biological functions.

The present literature review includes the data available from 1995 to 2005 about the biological functions of estrogen receptors (ERs) and their role in tumorigenesis. The domain organisation,and cell and tissue localization of two estrogen receptors are described. The article reviews the well known function of these receptors as transcription factors and their less familiar extracellular "non-genome" effects. Because of their stimulating effect on cell proliferation estrogens are supposed to actively participate in the genesis and development of some malignant conditions. We draw particular attention to the significance these estrogen receptors have for the onset and development of tumors outside the reproductive system. Knowledge of the receptor mechanisms of estrogenic action may enhance the diagnostic and therapeutic opportunities to treat a wide range of neoplastic lesions.

Enteral nutrition in sepsis patients.

Sepsis, with its associated complications, is a leading cause of death in intensive care units. It is a major public health problem world-wide. The altered metabolism, severe condition and specific organ failure in sepsis patients get entangled in a vicious circle. Their treatment should invariably include nutritional support. The present survey summarizes the sepsis-induced metabolic changes so that they can be adequately compensated by nutritional support using specialized enteral formulas. We argue the necessity of introducing new efficient formulas as part of the so called immunonutrition. The basic requirements these formulas should meet are: 1. to provide sufficient amount of protein and energy substrate that can preserve the muscle function; 2. to be a source of substances that stimulate and protect enterocytes with restriction of bacterial translocation; 3. to help keep the liver function normal; 4. by including various substances with immunomodulating features to prevent and compensate the disturbances in the immune response.

Low-grade pulmonary myxoid liposarcoma.

Primary pulmonary liposarcoma is extremely rare. There are only 12 cases reported in the literature. We presented a case of low-grade primary pulmonary myxoid liposarcoma, which was diagnosed and underwent surgery in our clinic. The diagnosis was established after imaging investigations (X-ray and CT), histologic and immunohistochemical examinations. The patient was followed up one year after the operation.

Small bowel obstruction by the silicone tube of the gastric band.

A wide range of operations are used today for morbid obesity. Adjustable gastric banding (AGB) is one of the most widespread. Numerous complications after AGB are known, namely gastric perforation, band slippage, penetration of the band into stomach, port disconnection, port-site infection, etc. The authors present a case of small bowel obstruction caused by the intra-abdominal silicone tube of the gastric band in a woman with AGB performed 9 years before, with a very good result and considerable weight loss. She was operated as an emergency, and part of the terminal ileum was found incarcerated around and between the silicone tube and the anterior abdominal wall. Bowel resection for intestinal necrosis, with terminal ileostomy, was performed, followed 1 month later by an end-to-end ileo-ileal anastomosis. The patient recovered without sequelae.