RESUMO
OBJECTIVE: To demonstrate clinical features and outcomes in patients with cavitary lung lesions and COVID-19 associated pneumonia. MATERIAL AND METHODS: A retrospective analysis of electronic medical records of 8261 patients with COVID-19 was performed. We selected 40 patients meeting the inclusion criteria. Sex, age, hospital-stay, lung tissue lesion, comorbidities, treatment, methods of respiratory support, complications and outcomes were evaluated. RESULTS: Cavitary lung lesions were more common in men (67.5%). Age of patients ranged from 28 to 88 (mean 64.9±13.7) years. Hospital-stay in patients with cavitary lung lesions was 9-58 (median 27.5) days. There were 18 complications in 14 (35%) patients. Pneumothorax, isolated pneumomediastinum, pleural empyema, hemoptysis and sigmoid colon perforation were considered as complications of cavitary lung lesions. Nine (22.5%) patients died (5 of them with complications). Three patients died after surgical treatment. Long-term results were analyzed in 8 (25.8%) patients. Patients were followed-up for 3 months after discharge. Shrinkage of lesions occurred after 7-60 (mean 23) days, and complete obliteration of cavities came after 32 (range 14-90) days. CONCLUSION: Cavitary lung lesions are a rare complication of COVID-19 pneumonia. There was no significant correlation of complications with age, sex, therapy, volume of lung lesions and non-invasive ventilation (NIV). Despite more common fatal outcomes in older patients undergoing NIV, the last one was prescribed exclusively due to disease progression and respiratory failure. Further research on this problem is necessary to identify possible risk factors of cavitary lung lesions.
Assuntos
COVID-19 , Humanos , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/terapia , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso , SARS-CoV-2 , Pulmão/diagnóstico por imagem , Adulto , Tempo de Internação/estatística & dados numéricosAssuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomia Laparoscópica/efeitos adversos , Colecistite , Ducto Colédoco , Dilatação/métodos , Complicações Intraoperatórias/cirurgia , Implantação de Prótese , Adulto , Colecistectomia Laparoscópica/métodos , Colecistite/diagnóstico , Colecistite/etiologia , Colecistite/cirurgia , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/lesões , Ducto Colédoco/cirurgia , Feminino , Cálculos Biliares/complicações , Humanos , Doença Iatrogênica , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/fisiopatologia , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Reoperação/métodos , Stents , TerapêuticaAssuntos
Ascite , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colangiopancreatografia por Ressonância Magnética/métodos , Hidrotórax , Ductos Pancreáticos/diagnóstico por imagem , Fístula Pancreática , Pancreatite Necrosante Aguda/complicações , Amilases/análise , Ascite/diagnóstico , Ascite/etiologia , Ascite/fisiopatologia , Ascite/cirurgia , Feminino , Humanos , Hidrotórax/diagnóstico , Hidrotórax/etiologia , Hidrotórax/fisiopatologia , Hidrotórax/cirurgia , Pessoa de Meia-Idade , Fístula Pancreática/diagnóstico , Fístula Pancreática/etiologia , Fístula Pancreática/fisiopatologia , Fístula Pancreática/cirurgia , Paracentese/métodos , Radiografia Torácica/métodos , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Resultado do Tratamento , Ultrassonografia/métodosAssuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Isquemia Mesentérica , Oclusão Vascular Mesentérica , Veias Mesentéricas , Procedimentos Cirúrgicos Vasculares/métodos , Trombose Venosa/complicações , Humanos , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/etiologia , Isquemia Mesentérica/cirurgia , Oclusão Vascular Mesentérica/diagnóstico , Oclusão Vascular Mesentérica/etiologia , Oclusão Vascular Mesentérica/cirurgia , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/patologia , Tempo para o Tratamento , Resultado do TratamentoRESUMO
Retrospective analysis of treatment results was carried out in 37 patients that had been treated during 1984-2009 years. Mean age of the patients was 50.7 years; among them 94.6% were women. 8 (21.6%) patients had serous cystadenoma, 21 (56.8%) patients - mucinous cystadenoma, 7 (18,9%) patients - cystadenocarcinoma and 1 (2.7%) patient - intraductal papillary-mucinous tumor. Distal pancreatic resection was carried out to 19 patients, pancreatoduodenal resection - in 5 patients, enucleation - in 10 patients, midline resection - in 1 patient, pancreatectomy - in 2 patients. The frequency of complications amounted 35.1%; lethal outcomes were not observed. Pancreatitis (in 7 patients) and pancreatic fistula (in 4 patients) were the most common complications. Re-laparotomy was necessary for destructive pancreatitis in 2 observations. Other complications were treated conservatively. Long-term results were studied in 28 (76%) patients. Mean duration of the observation was 87,3 months (6-120 months). 5-year survival rate amounted 100% among patients with benign cystic tumors of the pancreas and 25% in patients with cystadenocarcinoma. It is drawn a conclusion that complete recovery is quite possible in patients with benign tumors whereas treatment of the patients with invasive cystadenocarcinoma demonstrate poor results in long-term period.
Assuntos
Pancreatectomia/métodos , Cisto Pancreático/diagnóstico , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cisto Pancreático/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia DopplerRESUMO
AIM: To inform the surgeons about specific morphologic criteria of pancreatic intraductal papillary mucinous neoplasm, features of diagnosis and surgical treatment of this pathology. RECENT LITERATURE DATA: This article review the foreign papers published in last five years, which are dedicated to the diagnostic, surgical strategy and long-term results. CONCLUSION: Feature of the intraductal papillary-mucinous neoplasm is growth along ductal system of the pancreas. Histological assessment of the resection's margin should be a gold rule. Long-term results of surgical treatment are better than those of the malignant intraductal papillary mucinous neoplasms.