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Introduction/Objective. Chronic obstructive pulmonary disease (COPD) is a primary lung disease. Today, pulmonary rehabilitation (PR) is the basis for non-pharmacological treatment of these patients, with numerous confirmed effects on the most significant symptoms of the disease and the quality of life (QoL). The aim of this study was to determine the relationship between certain risk factors and the outcome of PR, as well as to determine the percentage of respondents who had a positive outcome of PR. Methods. The study included 500 patients with COPD, determined according to the Global Initiative for Chronic Obstructive Lung Disease guidelines, all stages (I?IV), in the stable phase of the disease, who completed the outpatient PR program. Disease stage, comorbidities, forced expiratory volume in the first second, six-minute walk test (6MWT), COPD Assessment Test (CAT), and Medical Research Council dyspnea scale, body mass index, airflow obstruction, dyspnea and exercise capacity (BODE) index, were measured before and after the program. The last four parameters have been observed as risk factors that affect the outcome of PR, but also as parameters by which we monitor the outcome of PR. Results. A successful outcome of PR was achieved by as many as 452 (90.4%) patients. The following were determined as independent predictors of a positive outcome of PR: lower number of comorbidities, absence of heart failure, higher BMI, and CAT ? 10. Conclusions. PR in our group of patients leads to statistically significant improvements in most of the examined subjective and objective parameters, in patients in all stages of the disease.

Introduction Over the last few months the coronavirus disease 2019 (COVID-19) pandemic has created overwhelming challenges for physicians around the world. While much has been described in the literature about lung infiltrates and respiratory failure associated with infection of coronavirus 2 (SARSCoV-2), pneumothorax is reported as a rare (a rate of 1%) but a life-threatening complication of COVID-19 pneumonia. Late bilateral spontaneous pneumothorax has been described in few cases. The aim of the report is to consider pneumothorax as a possible complication of COVID-19 pneumonia, which is also one of the causes of respiratory deterioration and potentially fatal outcome in these patients. Case оutline This article describes the clinical course of the patient who tested positive for SARS-CoV-2 on reverse-transcriptase polymerase chain reaction (RT-PCR) testing of nasopharyngeal and oropharyngeal swab specimens and who presented with COVID-19 pneumonia complicated by bilateral, spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema. He had no underlying lung disease nor risk factors for pneumothorax, except administered non-invasive ventilation/continuous positive airway pressure during first hospitalization. The patient was successfully treated with surgical (chest drainage, thoracoscopy and pleural abrasion) and non-surgical methods (by application of drugs and other supportive therapies). Conclusion This review demonstrates that the possibility of a late pneumothorax should be kept in mind in patients with, or recovering from, COVID-19 disease with progressive dyspnea. The timely diagnosis and management of pneumothorax will reduce COVID-19 associated mortality. © 2021, Serbia Medical Society. All rights reserved.

Introduction. Exogenous lipoid pneumonia (ELP) is caused by inhalation or aspiration of different oily substances of animal, vegetable, or mineral origin. It can be in acute or chronic form. Herein, we report a case of ELP in its chronic form, confirmed in surgical lung biopsy. Case outline. A 47-year-old male locomotive engineer, former smoker, without clinical symptoms, with a history of pneumonia two years previously, was referred to our institution. The operating diagnosis of multifocal subpleural tumors was made based on the chest computed tomography. A surgical lung biopsy confirmed a diagnosis of ELP. Conclusion. Diagnosis of ELP is frequently made after surgical biopsy performed for suspected neoplasm, because of neglecting profesional exposure to mineral oils.

Introduction. Solitary fibrous tumor is a neoplasm that arises most commonly from the pleura, but can occur at other sites. Intrapulmonary solitary fibrous tumor has been rarely reported and therefore is not well recognized. Case outline. We report a case of an asymptomatic 63-year-old woman in whom a large, well-circumscribed mass was incidentally revealed on chest X-ray during preparation for ergometric cardiac testing. Chest computed tomography revealed an abnormal nodule in the lower right lung lobe. Mediastinal and hilar lymphadenopathy was not detected. After transthoracic fine needle aspiration, cytology showed a finding suspicious for spindle cell tumor. Consequently, right anterolateral thoracotomy with right lower lobectomy was performed. On gross examination, the lower right lobe was almost completely replaced with abnormal, white-yellow, well-demarcated solid nodule measuring 13.5 cm in its largest diameter surrounded by a pseudocapsule. After histological examination and applied immunohistochemical analysis, a diagnosis of intrapulmonary solitary fibrous tumor of low malignant potential was set. Due to the presence of unfavorable prognostic parameters (tumor size, as well as the presence of hypercellularity), more frequent follow-up check-ups were recommended. Eighteen months after surgery, the patient remained uneventful, with no evidence of tumor recurrence. Conclusion. Intrapulmonary solitary fibrous tumor is a rare entity challenging for diagnosis, because variegated histology and variability of its growth patterns can resemble other soft tissue tumors. The treatment of choice is complete excision with clear surgical margins, but since morphology cannot be a reliable predictor of clinical behavior, the patients need a long-term follow-up.

Introduction. Lung carcinoids are considered a rare and uncommon group of lung tumors, making about 1% of all primary lung tumors. Atypical carcinoids are more aggressive than typical ones, with higher metastatic potential and worse prognosis and a 10-year survival rate of less than 60%. Case outline. In 2012, a 61-year-old male underwent the right lower lobectomy and the histopathological finding was an atypical lung carcinoid tumor. At the beginning of 2016, radiological and bronchoscopic progression of the disease was reported. Magnetic resonance imaging revealed enhanced nodular lesions compatible with liver metastases. The patient received endoluminal brachytherapy. Subsequently, the first line chemotherapy according to the cisplatin/etoposide (PE) protocol was applied. In August 2016, the somatostatin receptor scintigraphy (SRS) revealed secondary deposits with somatostatin receptor (SR) expression in the liver and lungs. The treatment with lanreotide injections was initiated. After five treatment courses, progression of the disease in the bronchial tree was verified and electro-cauterization and argon plasma cauterization of the tumor in the right main bronchus were performed. In September 2017, progression of the disease was verified again. The Oncology Board introduced the third line therapy with everolimus. Conclusion. The evidence supporting optimal treatment strategies for an atypical lung carcinoid tumor is lacking, but some recent publications indicate that multimodal treatment is associated with prolonged survival.

Introduction. Fibrous dysplasia is a noninherited benign skeletal disorder associated with abnormal bone development. Single bone involvement, the monostotic form, accounts for 70 ? 80% of cases, while the polyostotic form, with multiple bone involvement, accounts for 20 ? 30% of cases. Cystic degeneration and occasional aneurysmal bone cyst formation may be found in fibrous dysplasia lesions, particularly in the costal lesions. Case Report. A 51-year-old man presented with acute shortness of breath after sustaining simple chest wall injury. Chest computed tomography showed multiple massive osteolytic rib lesions, as well as a massive left-sided pleural effusion with compression atelectasis of the lung parenchyma. Osteolytic lesions of the anterior 2nd and 7th thoracic vertebral body were found, along with a well defined osteolytic lesion in the body of the sternum. Video-assisted thoracoscopy of the left pleural space was performed and frozen sections, collected using endoscopic biopsy forceps of the cystic wall and solid parts of the tumors, were sent for ex tempore histopathological analysis. Results showed fibrous dysplasia with suspected malignancy. Talc pleurodesis was performed based on the obtained results. At present, the patient is asymptomatic with his daily routine uninterrupted by his medical condition. Conclusion. Treatment of pleural effusion caused by a cyst rupture of unresectable degenerated polyostotic fibrous dysplasia of the ribs represents a surgical challenge. Surgical drainage of the cysts followed by chemical pleurodesis seems to be a reasonable solution in cases where pulmonary functions are impacted by combined effects of pleural effusion and cystic compression.

Introduction. Tracheobronchial disruption is a rare disorder, usually accompanied by a severe blunt chest trauma that quite rarely appears as an isolated event. Case Report. This is a case report of a right main bronchus disruption, due to an injury to the right hemithorax, caused by a falling tree trunk. The disruption was accompanied by mediastinal emphysema, fractures of the 4th and 5th ribs on the right side and compound sternal fracture. The patient was operated in general anesthesia, through right thoracotomy approach, followed by successful right main bronchus reconstruction by interrupted suture technique, without anatomic resection of the lung parenchyma. Conclusion. Although this injury is rare, with suspicion of bronchial rupture, bronchoscopy confirms the diagnosis and leads to better prognosis.

Pulmonary inflammatory myofibroblastic tumor encompasses a heterogeneous spectrum of reactive, infectious, and neoplastic entities. It is composed of spindle-shaped myofibroblastic cells in a background of inflammatory cells and collagen fibres. Actinomycosis is a bacterial infection. It infects the lower respiratory tracts by inhalation or aspiration of oropharyngeal or upper gastrointestinal materials. Only eight cases of pulmonary IMT associated with actinomycosis have been reported in the literature so far. This is the ninth case reported.

Background The clear cell “sugar“ tumor of the lung is an extremely rare benign mesenchymal tumor. Aim: To report a case of the sugar tumor and discuss diagnostic differentiation of the tumor.

Primary hyperhidrosis affects approximately 3% of the world’s population, particularly young female adults. It is defined as excessive, profuse sweating of the palms, soles, armpits and face. Conservative treament includes diverse modalities, however, surgical treatment has shown the best long-term results. The objective of this study was to assess some disease-specific epidemiological characteristics in a pre-selected group of patients seeking surgical therapy, as well as outcomes of thoracoscopic sympathectomy. The severity and impact of hypehidrosis was assessed, using Hyperhidrosis Disease Severity Scale (HDSS: patients rate the serverity of symptoms on a scale from 1 to 4). Thoracoscopic sympathectomy was performed using a double lumen endotracheal tube, via bilateral 5 mm dual port videothoracoscopic camera 0°, and an endoscopic ultrasound activated harmonic scalpel. The sympathetic chain was resected on both sides at the level of the second and the third thoracic ganglion (T2 and T3), using an ultrasound knife. The extirpated chain was also at the level T3-T4 and sent forex temporeanalysis.There were 162 patients undergoing thoracoscopic sympathectomy: 39.51% were males and 60.49% females; at presentation their mean age (± SD) was 30.5 (±8.3), range 16 - 58 years. Axillary hyperhidrosis occurs later than palmar-axillary-plantar (pIn conclusion, nowadays videothoracoscopic sympathectomy is a standard treatment for primary hyperhidrosis with a high success rate.