Case report of sequential bilateral spontaneous pneumothorax in a never-ventilated, lung-healthy COVID-19-patient.

INTRODUCTION: Patients with COVID-19 infection and severe lung parenchyma alterations may need mechanical ventilation with subsequent pneumothorax and eventually persistent air leak in case of pre-existing lung disease. PRESENTATION OF CASE: This report presents the case of a never-ventilated 58 years old male patient without pre-existing, underlying lung disease demonstrating severe lung parenchyma changes due to COVID-19-pneumonia. He suffered from recurrent bilateral spontaneous pneumothoraces, which were successfully treated with bilateral thoracoscopy and resections of the destroyed lung areas. Notably, he has already been under treatment with anticoagulation due to portal thrombosis 8 years ago. DISCUSSION: Although especially know from patients under mechanical ventilation, this patient suffered from spontaneous pneumothorax without ever been ventilated. Probably due to the severe vascular inflammatory changes and focal endothelitis like also seen in other organs of COVID-19 patients, the pneumothorax may lead to a prolonged air leak, which needs surgical therapy. The patients pre-existing anticoagulation therapy may prevented him from a mere severe course. CONCLUSION: Early surgical therapy may be considered in COVID-19 patients with persistent air leak, even if not mechanically ventilated. Simultaneously, the role of early anticoagulation needs further investigation.

[Group therapy following lung transplantation -- first experiences with a theme-centered "life management group"]. / Gruppentherapie nach Lungentransplantation -- erste Erfahrungen mit einer themenzentrierten "Life-Management-Gruppe".

Lung transplantation is a drastic life event that usually takes place in the preterminal phase of a lung disease. Although a lung transplantation increases the quality of life considerably, patients still face a range of physical and psychosocial strains. This article presents experiences made with a "Life Management Group" for lung transplantation patients. The aim of the eight group meetings was to encourage the sharing of experiences between patients and to support them in their active and competent realizations of desires and plans. Physical health, self-identity of lung transplant recipients, growing problems financing medical treatment and the forming of doctor-patient-relationships were the important issues. Patients were able to reach a higher level of self efficiency; they could use active coping strategies and develop their social networks. Positive experiences were made with the implementation of group therapy for lung transplantation patients. Lung transplant recipients have to deal with specific problems of identity. On the other hand, there are growing health-economic questions also from the patient's point of view.