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Fatigue and dyspnea are the most commonly reported long-term complaints in individuals previously infected with SARS-CoV-2. This study aimed to comprehensively evaluate diaphragm muscle function in post-COVID-19 patients and investigate whether potential diaphragm dysfunction contributes to physical functioning impairment. A total of 46 patients who qualified for pulmonary rehabilitation were examined. Diaphragm muscle function parameters were evaluated using ultrasonography, while the severity of dyspnea, aerobic capacity, and the amount of energy used by the body during physical activity were assessed using the six-minute walk test, mMRC scale, and Metabolic Equivalent Task (MET), respectively. We identified that 69.5% of patients had diaphragm atrophy and 6.5% had diaphragm paralysis. The percentage of atrophy was not related to age, gender, BMI, oxygen therapy usage during the COVID-19 infection course, and disease severity. Patients who experienced cough, fever, and no loss of smell during the COVID-19 course had significantly greater diaphragm inspiratory thickness values, while patients with cough and no smell disorders had a significantly lower percentage of diaphragm atrophy. Diaphragm functional parameters were strongly associated with selected variables of exercise tolerance, such as distance in the six-minute walk test, oxygen saturation levels, fatigue, and exertion on the Borg scale. In conclusion, diaphragm muscle dysfunction is a serious long-term post-COVID-19 consequence and can be viewed as a major contributing factor to prolonged functional impairments. [ABSTRACT FROM AUTHOR]

Simple Summary: Hepatocellular carcinoma (HCC) stands as a primary malignancy of the liver and represents a significant global health burden, particularly in regions where chronic hepatitis B and C infections prevail. Despite advancements in diagnostic techniques and therapeutic strategies, HCC continues to pose formidable challenges in clinical management due to its aggressive nature, frequent late-stage diagnosis, and metastasis to other organs. Although the incidence of metastasis to the diaphragm is low, this condition is one of few poor prognostic factors for HCC, making the early detection of diaphragm muscle involvement important in both primary and recurrent stages. The purpose of our study was to address two questions: (1) What symptoms or symptom clusters are reported among HCC patients with metastases to the diaphragm? (2) What risk factors for diaphragm muscle metastasis are present in HCC patients? Based on our findings, we conclude that the presence of hepatitis B and the localization of HCC cells in superior liver segments, particularly in the 8th liver segment, should be considered during the diagnostic process. Each patient in the reports presented with different symptoms, making it impossible to identify the leading symptom. The purpose of this study was to conduct a systematic review and meta-analysis of case reports presenting HCC spread to the diaphragm muscle and to determine possible risk factors for this condition. An extensive literature search was performed using the following electronic databases: MEDLINE, CINAHL, ScienceDirect, Google Scholar, and DOAJ. A total of 18 articles describing 27 hepatocellular carcinoma patients were included in this review. The presence of HCC cells in the superior liver segment is strongly associated with metastases to the diaphragm. Among the two types of diaphragm involvement by HCC cells, diaphragm infiltration occurs much more frequently than diaphragm adhesion. However, an HCC nodule in the 8th liver segment and a higher number of liver segments involved by HCC cells predispose patients to diaphragm adhesion. Hepatitis B is a risk factor for diaphragm metastases in recurrent HCC. The tumor diameter is not associated with HCC spread to the diaphragm muscle. We did not find specific symptoms reported by patients that could indicate HCC metastasis to the diaphragm muscle. The presence of hepatitis B and the localization of HCC cells in superior liver segments, especially in the 8th liver segment, should be take into consideration in the diagnostic process. [ABSTRACT FROM AUTHOR]

Spontaneous perforation of the esophagus (Boerhaave syndrome) is a rare disease that poses a serious surgical challenge. The analysis of literature concerning the Boerhaave syndrome reveled cases of recurrent spontaneous perforation of the esophagus. The incidental nature of this condition calls for more accurate assessment of all such cases. The authors made a detailed evaluation of the data obtained from eight reports of recurrent Boerhaave syndrome. The data is presented as a summary table comparing the clinical course and outcomes of patients with the primary Boerhaave syndrome as well as recurrent Boerhaave syndrome. [ABSTRACT FROM AUTHOR]

Introduction: Lung cancer is one of the most prevalent cancers worldwide. Dickkopf-1 (DKK-1) and -2 (DKK-2) are important proteins for the regulated Wnt signalling pathway. Alternations in the Wnt pathway are associated with tumour progression. The aim of the study was to analyse the concentration of DKK-1 and DKK-2 in tumour and matched non-tumour (NT) samples of 65 patients with non-small cell lung cancer (NSCLC), including 3 subtypes: adenocarcinoma (AC), squamous cell carcinoma (SCC), and large cell carcinoma (LCC)., Material and Methods: The protein concentration was measured by enzyme-linked immunosorbent assay (ELISA) in homogenates., Results: The difference between the level of DKK-1 in tumour and NT specimens was not significant for the whole NSCLC group and SCC and LCC subtype, while in AC samples they were significantly higher ( p = 0.028). The highest concentration of DKK-1 was found in the advanced NSCLC samples, with the T4 parameter as well as stage III. Significantly decreased DKK-2 concentrations were detected in all NSCLC subtypes ( p < 0.05). Moreover, the DKK-2 level was higher in non-smokers than in smokers. The results indicate that concentrations of DKKs were different in relation to subtypes as well as clinical and socio-demographic parameters. The concentration of DKKs could be associated with the progression of NSCLC., Conclusions: We suggest that DKK-1 could play an oncogenic role in AC, while DKK-2 could be a tumour suppressor in all NSCLC subtypes. Dickkopf-1 and DKK-2 proteins could have differential roles in the Wnt signalling pathway, which is important in many cellular processes, such as proliferation and apoptosis., Competing Interests: None., (Copyright © 2024 Termedia.)

Tietze's syndrome is a benign, self-limiting arthropathy, without purulent character. The disease most often involves articulations: sternocostal, sternoclavicular, or costochondral joints. The characteristic symptoms are tenderness, pain and edema involving one of the aforementioned joints on one side. Diagnosis of Tietze's syndrome is based on physical examination (increase of palpation tenderness in the affected joint), laboratory tests (increase of inflammatory parameters) and imaging studies (USG, MRI). Differential diagnosis of Tietze's syndrome is based on exclusion of costal cartilage inflammation, coronary syndrome and inflammatory changes in the lung and pleura. Most commonly the treatment is conservative, in resistant cases surgical.

Spontaneous perforation of the esophagus (Boerhaave syndrome) is a rare disease that poses a serious surgical challenge. The analysis of literature concerning the Boerhaave syndrome reveled cases of recurrent spontaneous perforation of the esophagus. The incidental nature of this condition calls for more accurate assessment of all such cases. The authors made a detailed evaluation of the data obtained from eight reports of recurrent Boerhaave syndrome. The data is presented as a summary table comparing the clinical course and outcomes of patients with the primary Boerhaave syndrome as well as recurrent Boerhaave syndrome.

The authors of the present report review the etiology and clinical symptoms of malignant pleural mesothelioma (MPM) as well as diagnostic techniques (both radiological and biomarkers) used for its detection. Subsequently, they present methods of multimodal treatment (surgery, chemotherapy, and radiotherapy) recommended by the International Mesothelioma Interest Group (IMIG). Finally, they discuss complications and long-term results associated with these methods of MPM treatment.

The synchronous primary lung tumors is a rare condition and presented patient is the first reported case of simultaneous two distinct neuroendocrine lung cancer lesions in the same lobe. We present the case of a 55-year-old woman with synchronous two distinct neuroendocrine lung cancer lesions in the right upper lobe. Initially she showed no signs or symptoms related to lung lesions and was admitted to Thoracic Surgery Ward for the investigation of two oval, solitary pulmonary nodules (11 and 19 mm in diameter) detected on a chest X-ray performed three months earlier. The radiological imaging showed a variability of growth of both lesions (smaller tumor has enlarged while the larger one remained unchanged). After the CT-guided lung biopsy, patient underwent right upper lobectomy. Histological examination revealed a small cell carcinoma in one of the tumors and a large cell neuroendocrine carcinoma in the other one. The patient was discharged in good condition and lung inflation in chest X-ray and qualified for adjuvant chemotherapy with a combination of cisplatin and etoposide and the prophylactic cranial irradiation. Very important issues, having impact on outcome of patients with multiple lung tumours is differentiation whether the lesions are metastases or synchronous primary lung tumors and the optimal management of these patients.