Neumomediastino en paciente con COVID-19 / Pneumomediastinum in a patient with COVID-19

El neumomediastino es una entidad poco frecuente que se puede presentar en patología respiratorias causado por la infección del virus SARS COV2. El signo que observamos en los pacientes fue de enfisema subcutáneo. El diagnóstico fue mediante el examen físico y la tomografía de tórax (en la mayoría de casos entre el séptimo y décimo día de diagnóstico de neumonía por SARS COV 2). A continuación presentamos una serie de 3 casos con esta manifestaciónclínica y el tipo de tratamiento que se instauró en cada paciente. (AU)

Pneumomediastinum is a rare entity that can occur in respiratory diseases caused by infection with the SARS COV2 virus. The sign we observed in the patients was subcutaneous emphysema. The diagnosis was made by physical examination and chest tomography (in most cases between the seventh and tenth day of diagnosis of SARS COV 2 pneumonia). Below we present a series of 3 cases with this clinical manifestation and the type of treatment that was established in each patient. (AU)

[Subclavian steal syndrome. Clinical aspects and therapeutic problems]. / Sindrome da furto della succlavia. Aspetti clinici e problemi terapeutici.

Cerebrovascular disease is a leading cause of morbidity and mortality in Italy. Although atherosclerotic involvement of the carotid artery is more prevalent, some patients suffer from stenosis of the subclavian artery, usually proximal to the origin of the vertebral artery. Neurological symptoms result from reversed flow in the vertebral artery, so-called "subclavian-steal". This collateral pathway may rob the posterior circulation of perfusion to the degree of producing episodes of vertebrobasilar insufficiency. The authors have therefore reviewed their experience with this disease and present their findings, therapeutic procedures and short-term results. During 1990 four patients affected by "subclavian-steal syndrome" were observed at the Surgical Department of Montecchio Maggiore Hospital (VI). Two patients were operated on and axillo-axillary bypass operations were performed (with a 5 mm Gore-tex graft). The goal of surgical treatment is to alleviate cerebrovascular symptomatology by restoring flow to the subclavian artery distal to the occlusion. Axillo-axillary bypass offers distinct advantages over the alternative methods such as transthoracic procedures or carotid-subclavian bypass. Axillo-axillary bypass is a technically simple procedure with very good results and minimal complications. It avoids sternotomy, thoracotomy and clavicular resections: the carotid artery is not involved in the procedure. The authors conclude that axillo-axillary bypass is a cheap, safe and effective treatment for symptomatic subclavian artery insufficiency.