The rare thoracic complication: perforation of gastric fundus ulcer: a case report.

BACKGROUND: Gastropleural fistula is an exceptionally rare condition, the incidence of which is currently unknown (Kunieda et al. in Intern Med 51(3):331, 2012,  https://doi.org/10.2169/internalmedicine.51.6823 , Iqbal et al. in Cureus 11(2):e4136, 2019, https://doi.org/10.7759/cureus.4136 , Kathayanatt et al. in Lung India 37(2):174-175, 2020, https://doi.org/10.4103/lungindia.lungindia_242_17 ). The etiology varies from traumatic or iatrogenic injury to perforation in a herniated stomach due to ischemia, ulceration, or malignancy. CASE PRESENTATION: A 27-year-old European male presented to our hospital with complaints of general weakness and shortness of breath. The patient had a single episode of hemoptysis before admission. A computed tomography scan demonstrated a left-sided pyopneumothorax, a defect in the left main bronchus, and signs of pneumonia in the lower sections of the right lung. Therefore, a rare complication of perforation of a gastric fundus ulcer with the formation of a subdiaphragmatic abscess, gastropleural fistula, gangrene of the left lung with circular necrosis of the left main bronchus and diastasis of its edges, and pleural empyema on the left is presented in this report. CONCLUSIONS: Although, a radical surgery may be preferable for this suspected malignancy; it should be weighed carefully against the risk of sepsis and the morbidity associated with a prolonged procedure in a sick patient. Damage-control surgery may be a viable option for a very sick patient, with more extensive resection reserved for later, provided the risk of infection and bleeding has been mitigated.

Comparative Morphological Characteristics of the Results of Implantation of Decellularized and Recellularized Porcine Skin Scaffolds.

The tissue reaction of pig skin to implantation of decellularized and recellularized dermal matrices on a formed wound defect was evaluated by histological methods on days 2, 5, 8, 16, and 20 after surgery. Differences in tissue response to different matrices were identified. In experimental wounds coated with decellularized dermal matrices, we observed the formation of a scar tissue, which required autodermoplasty on day 12 of the experiment. In wounds coated with recellularized dermal matrices, all layers of the skin completely recovered by day 20 after surgery with the formation of full dermal and epidermal layers. Our findings suggest that reparative morphological changes in the wound depend on the presence of fibroblasts in the implanted dermal matrix.

[TO THE PROTOCOL OF ANTIBIOTIC PROPHYLAXIS IN CARDIAC SURGERY.]

BACKGROUND: Guidelines recommend that duration of antibiotic prophylaxis in cardiac surgery should be no more than 48 h, but at the same time it has been suggested that a 24h or even a single dose may be sufficient. THE AIM: To define whether 24-hour antibiotic prophylaxis on the incidence of infectious complications in cardiac surgery compared to the 72-hour period. Materials andmethods. All 125 patients were operatedfrom 01.01.2014 till 01.10.2014. All preoperative, intra and postoperative data were analyzed. Group 1 (n = 56) - these patients were administered cefazolinfor 24 h antibiotic prophylaxis (3 g/day); group 2 (n = 69) -patients with cefazolin for 72 h antibiotic prophylaxis (1 g every 8 h). Pre and intraoperative characteristics were the same in both groups. RESULTS: Duration of stay in intensive care unit (ICU), postoperative hospitalization, sternomediastinitis frequency were also similar in both groups. The frequency of nosocomial pneumonia and rate ofprescription of antibiotics after antibiotic prophylaxis was significantly higher in group 1. CONCLUSION: 24-hour antibiotic prophylaxis does not increase the frequency of the surgical field's infection, but the frequency of postoperative pneumonia and change of antibiotic prophylaxis on antibiotic therapy was higher in group 1.