Repair of a Pulmonary Hernia after Thoracotomy with an Intrapleural Mesh: a Case Report.

Pulmonary hernias are rare. They can be congenital, but mostly are acquired. Usually asymptomatic, they are diagnosed on physical examination or, incidentally, on imaging exams. Surgical treatment is required for large, increasing, or symptomatic hernias, and incarcerated or strangulated ones. This is a clinical case of a symptomatic postoperative pulmonary hernia. It occurred two years after a posterolateral thoracotomy for the resection of an intercostal myxolipoma. The tumor was resected en bloc with a partial segment of the 10th left rib and immediate reconstruction was made with an onlay polypropylene mesh. The postoperative hernia was successfully treated with a double-faced mesh of polypropylene and ePTFE. This surgery provided a functional and aesthetic enhancement for the patient, greatly improving his quality of life. This approach is, therefore, considered safe and effective.

A subxiphoid uniportal approach for a surgical biopsy.

The following case report demonstrates a surgical biopsy performed through a subxiphoid uniportal video-assisted thoracoscopic surgery approach. The patient was a 35-year-old male, non-smoker, obese, with a history of arterial hypertension. He was referred for a thoracic surgery consultation because nonspecific interstitial pneumonia was suspected. The histological analysis confirmed the nonspecific interstitial pneumonia. We describe the procedure step by step. The postoperative course was uneventful. The subxiphoid approach is associated with less postoperative pain than the transthoracic approaches and could be an alternative, even for patients who have to undergo major lung resection surgery.

When benign leiomyomas metastasize to the lungs - a case report.

Benign metastasizing leiomyoma is a rare disease that primarily affects premenopausal women who have a history of uterine leiomyoma, which is characterized by pulmonary metastases. The pathogenesis of this condition is unknown. Patients are usually asymptomatic or have vague symptoms. Pathological examination in conjunction with immunohistochemistry is required for diagno-sis. Treatment is determined by the patient's age, hormonal status, symptoms, and the extent of the lesions (number, size, and location of nodules), with surgical resection being the most effective. We present the case of a 72-year-old woman who had a total hysterec-tomy 30 years earlier due to myomas and developed a persistent dry cough. Her computed tomography of the chest revealed several small nodules in the pulmonary parenchyma. Because of the nod-ules' small size and difficult accessibility, a surgical biopsy was per-formed for histopathological examination and immunohistochemi-cal staining, which revealed metastasizing leiomyoma. Letrozole treatment was started and was well tolerated.

Role of the Plastic Surgeon in Tuberculosis Treatment.

Background: Tuberculous empyema is rare. Its treatment requires oral antituberculous drugs, empyema drainage, and in severe cases, decortication and pneumectomy. In the presence of tuberculosis, lung resection has a high risk of postoperative bronchopleural fistula (BPF) and empyema. Treatment includes drainage, fistula occlusion, dead space obliteration, and infection control. Muscle flap transfer allows BPF occlusion and dead space obliteration. Methods: This report presents a case of a 63-year-old man with tuberculosis and postoperative BPF with empyema after pleural decortication and left lower lobe resection. The empyema was drained, and antituberculous drugs were started. The BPF was occluded with a latissimus dorsi and serratus anterior chimeric muscle flap, and the remaining thoracic dead space and chest wall defect were reconstructed with a pedicled pectoralis major myocutaneous flap. Results: Healing occurred uneventfully, and the patient was discharged from the hospital after 2 weeks. Conclusions: This type of thoracic defect is rare nowadays, especially in the setting of tuberculous infections. Although workhorse flaps like latissimus dorsi or pectoralis major flaps have been progressively surpassed by more elegant solutions like fasciocutaneous pedicled flaps and free flaps, they must still be considerations in the decision-making process of a reconstructive surgeon, and flap choice must be made on a case-by-case basis.

Cutaneous endocannabinoid system: Does it have a role on skin wound healing bearing fibrosis?

INTRODUCTION: Recently, the endocannabinoid system has been identified in skin and it has been linked with the formation of skin fibrosis and wound healing. We aimed to find and analyse reported data on compounds acting in the endocannabinoid system with significant effect in skin fibrosis. METHODS: A literature search on PUBMED was conducted for studies published in English until February 2020 on cannabinoids and skin fibrosis. The initial search was performed with terms: "cannabinoid" AND "skin". This search retrieved 296 publications from which 18 directly related to skin fibrosis or wound healing process were included in this review. RESULTS: CB1 receptor inactivation and CB2 receptor activation show anti-fibrotic effects on cellular and animal experimental models of cutaneous fibrosis. CB2 receptor activation also promotes re-epithelization. Other cannabinoid related receptors, like adenosine A2A receptors and PPAR-γ, are also involved. Their activation lead to a pro-fibrotic and anti-fibrotic effect, respectively. CONCLUSION: Several molecular drug targets for endocannabinoid system were identified in skin. It may be a promising approach for the treatment of excessive skin fibrosis disorders.