Khirurgii͡a
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Spontaneous pneumomediastinum (SPM) is an uncommon, benign, self-limited disorder that usually occurs in young adults without any apparent precipitating factor or disease. The purpose of this study was to review our experience in dealing with this entity and detail a reasonable course of assessment and management. A retrospective case series of 4 patients with SPM were diagnosed and treated in a Thoraci Surgery Department at Saint Sofia Pulmonary Hospital between 2000 and 2006. ⋯ Chest X-ray and CT scan should be always performed. Hospitalization and aggressive approach should be limited. SPM responds well to conservative treatment and follows a benign natural course.
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Fiberoptic bronchoscopy (FOB) has become a commonplace procedure in ICUs in patients after operation. We studied the outcomes of 35 FOBs performed in 26 patients (18 male and 8 female) during their stay in the ICU of "St. Ekaterina" University Hospital in Sofia after cardiac surgery with Cardiopulmonary Bypass. 33 (95%) of our patients were receiving mechanical ventilation at the time of the FOB. Bronchoalveolar lavage (BAL) was added to all procedures. 21 (60%) patients demonstrated an improvement after FOB. We defined improvement as either an increase of PaO2 with 10 or more mmHg in 6 hours after the procedure or better aeration on the follow-up chest radiograph (CXR). In 19 (54%) FOBs a great amount of secretions, plugging up bronchial lumens was seen. 14 (73%) of these patients were improved after the FOB. From the rest 16 patients, in whom such increased amount of secretions was not seen on FOB, only 7 (43%) demonstrated an improvement after the FOB. 16 procedures were performed on indications of atelectasis. 9 (56%) of them showed an improvement after the FOB. When atelectasis was not present on the CXR, an improvement was found in 12 (63%) cases. ⋯ 1. FOB is most effective in removing retained secretions. 2. Although not so effective in resolving atelectasis that is not caused by central plugging, FOB should not be neglected because of the additional benefit of BAL for clearing more distal airways.
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The trauma of the trachea and bronchi are extremely rare, in 0.6 to 3 per cent of the patients with chest trauma. Most common are the longitudinal lesions localized in the membranous part. Following are the transversal lesions localized between two cartilaginous rings and in 20 per cent of the cases total circular lesions with dislocation of the two ends are found. A review of the clinical signs, the complications, the diagnosis and the successful operative treatment of a patient with the latter particularly rare traumatic injury of the trachea is presented.
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A case of 23-year-old man with Pectus Excavatum (grade II) is reported on. The functional cardiorespiratory impairment was a leading symptom. ⋯ All procedure steps are described. Nine months after the operation cosmetic and functional results are considered excellent.
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Functional renal disorders commonly complicate cirrhosis and ascits, and in its terminal stage is known as hepatorenal syndrome (HRS). HRS is defined as the development of renal failure in patients with advanced liver failure (acute or chronic) in the absence of other identifiable causes of renal pathology. It is a syndrome characterized by oliguria, severe renal sodium retention, circulatory instability with marked systemic arterial vasodilatation and activation vasoactive systems. ⋯ Theoretically the ideal treatment for patients with HRS is liver transplantation. The prognosis for HRS is poor and treatment almost always unsatisfactory when liver transplantation is excluded. The best treatment of HRS is preventing precipitating factors.