Angiocatheter Decompression on a Covid-19 Patient with severe Pneumonia, Pneumothorax, and Subcutaneous Emphysema.

BACKGROUND: A novel coronavirus, currently known as Severe Acute Respiratory Syndrome Coronavirus 2, causes Coronavirus disease 2019 (Covid-19). Its most significant complication is a kind of pneumonia known as of 2019 New Coronavirus-Infected Pneumonia (NCIP). Covid-19 pneumonia can have unusual complications that affect both lungs in a widespread manner. Acute lung damage and Acute Respiratory Distress Syndrome (ARDS) are typical in severe Covid-19 cases. Several potential risk factors cause the pneumonia associated with this disease, such as age over 65, diabetes, hypertension, chronic obstructive pulmonary disease, immunosuppression, and pregnancy. Furthermore, various laboratory markers like high levels of C-reactive protein (CRP), D-dimers, ferritin, interleukin-6 (IL-6), and LDH, as well as a low lymphocyte and thrombocyte count, have been linked to increased disease severity and a poor prognosis. METHODS: In this study, we present a case of a 45-year-old patient with a rare evolution of the disease, who made a full recovery against all odds. We highlight the atypical presentation of Covid-19 in this patient, who developed some unusual complications, such as pneumonia, pneumothorax, pneumomediastinum, and subcutaneous emphysema. RESULTS: There is a scarcity of information on patient-related variables linked to pneumothorax in severely sick Covid-19 patients. This study adds to the existing research, reinforcing that spontaneous pneumothorax can be caused by the infection itself, in addition to ventilator-induced trauma in mechanically ventilated patients. CONCLUSIONS: We conclude that patients with Covid-19 pneumonia may develop a more robust and systemic illness characterized by acute lung injury, acute respiratory distress syndrome (ARDS), shock, coagulopathy, and nu¬merous organ dysfunctions, all of which are linked with a high risk of death.

[Therapeutic approach for patients with positive resection line (R1) after gastrectomy for gastric cancer]. / Atitudinea terapeutica la pacientii cu transa de rezectie pozitiva (R1) dupa gastrectomii pentru cancer gastric.

INTRODUCTION: The radical treatment of the gastric cancer consist in large gastric resections and lymphadenectomy. Resection line involvement at microscopic histopathological examination (R1) could change prognostic unfavorable. MATERIAL AND METHODS: They were 135 patients with gastric cancer operated between 2006-2007, with radical gastric resections and lymphadenectomy. In 3 patients with early gastric cancer and 23 patients with different stages of cancers, histopathological examination showed resection line involvement. From this study were eliminated the patients with stage IV cancers in whom resections were palliative. RESULTS: Incidence of positive resection line involvement was 19,25%. 88,46% of the tumors were staged pT2 and pT3 and the majority was poorly differentiated or undifferentiated (G3 and G4). Lymphatic involvement (pN1 or pN2) was demonstrated in 18 (69,23%0 patients with R1. Perioperative complications were encountered in 15,38% of this patients, with 7,69% mortality. CONCLUSIONS: Presence of tumoral tissue at resection line level could decrease survival in this patients. Therapeutic protocol in patients with resection line involvement (re-laparotomy with re-resection or surveillance) must be establish in accordance with several factors: T and N category, risks of another surgical interventions, patients acceptance.