Pneumothorax/pneumomediastinum and pre-existing lung pathology in ventilated COVID-19 patients: a cohort study.

Background: There is an increasing number of reports on developing pneumothorax/pneumomediastinum among severe acute respiratory syndrome coronavirus disease 2019 (SARS-COVID-19) patients. The aim of our study was whether pre-existing diffuse lung pathology increases visceral pleural vulnerability resulting in pneumomediastinum and pneumothorax among mechanically ventilated COVID-19 patients? Methods: A total of 138 consecutive COVID-19 patients admitted to the Intensive Care Unit of Petz Aladár University Teaching Hospital between 1st March 2020 and 1st February 2021 were included. Sixty/138 (43.48%) patients had one or more computer tomography scans of the chest. Analysis was focused on the image defined lung conditions during artificial ventilation. Results: Thirteen out of 60 ventilated patients developed pneumothorax or pneumomediastinum proven by computer tomography (9.42%). Three/13 patients suffered from pre-existing lung parenchyma pathology, while 10/13 had only COVID-19 infection-related image abnormality. Forty-three/60 patient had healthy lung pre-COVID. Kruskal-Wallis test, Spearman correlation and Cox regression calculations did not reveal any statistically significant result proving increased vulnerability during pressure support therapy and visceral pleural breakdown in patients with pre-existing lung pathologies. Conclusions: Pre-existing lung pathology does not increase the risk of onset of pneumothorax or pneumomediastinum in comparation with previously healthy lungs of ventilated COVID-19 patients.

[The complex intensive care and rehabilitation of a quadriplegic patient using a diaphragm pacemaker]. / Magas nyaki gerincvelôsérült beteg komplex intenzív ellátása, rehabilitációja rekeszi pacemaker alkalmazásával.

A 21 year female polytraumatized patient was admitted to our unit after a serious motorbike accident. We carried out CT imaging, which confirmed the fracture of the C-II vertebra and compression of spinal cord. Futhermore, the diagnostic investigations detected the compound and comminuted fracture of the left humerus and femur; the sacrum and the pubic bones were broken as well. After the stabilization of the cervical vertebra, a tracheotomy and the fixation of her limbs were performed. She spent 1.5 years in our unit. Meanwhile we tried to fix all the medical problems related to tetraplegia and respiratory insufficiency. As part of this process she underwent an electrophysiological examination in Uppsala (Sweden) and a diaphragm pacemaker was implanted. Our main goal was to reach the fully available quality of life. It is worth making this case familiar in a wider range of public as it could be an excellent example for the close collaboration of medical and non-medical fields.

Lengthening temporalis myoplasty versus hypoglossal-facial nerve coaptation in the surgical rehabilitation of facial palsy: evaluation by medical and nonmedical juries and patient-assessed quality of life.

BACKGROUND: To compare the results of 2 techniques of facial rehabilitation, lengthening temporalis myoplasty and 2 types of hypoglossal-facial (XII-VII) coaptation as evaluated by medical and nonmedical teams and patient self-assessment of quality of life (QOL). MATERIALS AND METHODS: Videos of 42 consecutive patients with complete facial palsy who underwent surgery from 1998 to 2005 were reviewed. Facial rehabilitation was by temporalis myoplasty (n = 10) or by XII-VII coaptation (n = 32) either end-to-end (n = 16) or end-to-side with a jump interpositional graft (n = 16). Evaluation was by (i) a medical jury using 4 facial nerve grading systems and 3 other measurements for the face at rest and during voluntary and emotional motions, (ii) a nonmedical jury using the 3 measures described above, and (iii) patient self-assessment of QOL by questionnaires. RESULTS: Whatever the grading systems used, the medical jury rated facial rehabilitation with XII-VII coaptation better than myoplasty. Scores did not differ between the 2 types of coaptation: synkinesis was severe with end-to-end and almost absent with end-to-side coaptation. However, muscle tone was stronger in the end-to-end than end-to-side coaptation. The nonmedical jury considered that XII-VII coaptation, whatever the type, led to better results than myoplasty. Patients in all groups considered their QOL improved by surgery, whatever the format, with no significant differences between the groups. CONCLUSION: This study revealed XII-VII coaptation with better results than myoplasty. End-to-end coaptation should be restricted to patients with a strong emotional expression or those with a long-standing facial palsy because it provides a strong muscle tone but significant synkinesis.

Successful treatment of mediastinal pancreatic pseudocyst by pancreatic head resection.

CONTEXT: A mediastinal pseudocyst is an unusual and rare complication of acute and chronic pancreatitis. CASE REPORT: The authors report the case of a 41-year-old male patient with a documented history of chronic pancreatitis who developed a pancreaticomediastinal fistula with mediastinal pseudocyst, which was successfully treated by pancreatic head resection (Frey). CONCLUSION: Though the choice of treatment is still controversial, the main goal of surgical treatment is to ensure the adequate flow of pancreatic juice from the pseudocyst and the pancreas.

[Early jejunal nutrition with combined pre- and probiotics in acute pancreatitis--prospective, randomized, double-blind investigations]. / Korai jejunális táplálás pre- és probiotikummal történó kombinálása akut pancreatitisben--prospektív, randomizált, kettós-vak vizsgálatsorozat.

BACKGROUND: Development of infection of pancreatic tissue in patients with severe acute pancreatitis dramatically increases morbidity and mortality. Colonisation of the lower gastrointestinal tract and oropharynx, mostly with gram-negative but sometimes also gram-positive bacteria is known to precede the contamination of the pancreatic tissue by a few days. A few specific lactic acid bacteria such as Lactobacillus plantarum 299 were effective in preventing colonisation of the gut by potential pathogens, to reduce endotoxemia and to stimulate the gut-associated lymphatic system (GALT) and the immune system. METHODS: Patients with acute pancreatitis, arriving within 48 hours after onset of disease showing typical clinical picture and laboratory signs of pancreatitis (plasma amylase > 200 U/l, CRP > 150 mg/l and an Imrie-score = or > 3) were randomised into two groups During the first week the treatment group received a freeze-dried preparation containing 10(9) live Lactobacillus plantarum 299 together with an oat fibre substrate. The control group received a similar preparation, but the Lactobacillus plantarum 299 had been inactivated by heat. For seven days the treatment was repeated twice every day. The preparations were delivered to the hospital in sachets so the content was unknown to the investigators, staff and patients. RESULTS: Forty five patients completed the study before there was indication that one group differed from the other in a statistically significant way, at which time the study was discontinued and the code broken. At this time 22 patients had received treatment with live and 23 patients with heat-killed Lactobacillus plantarum 299. Infected necrosis and abscesses occurred in 1/22 (4.5%) in the treatment group vs. 7/23 (30%) (p = 0.023) in the control group. The length of stay was 13.7 days in the treatment group vs. 21.4 days in the control group (not statistically significant). CONCLUSIONS: Supplementing Lactobacillus plantarum 299 is an effective tool to prevent pancreatic sepsis, to reduce the number of operations and length of stay. The only patient who developed sepsis in the treatment group did so eight days after the treatment had been discontinued. One week treatment, as in the present study, is too short. It should be provided for at least 2 weeks, or more appropriately, as long as the patients are treated with antibiotics or have signs of GI colonisation.