A diaphragmatic hernia is a protrusion of abdominal contents into the thoracic cavity. Although it is commonly congenital, diaphragmatic hernias can also be acquired. Blunt or penetrating trauma are among the most frequent causes, although spontaneous or iatrogenic cases have been reported. Recently, some case reports related to diaphragmatic hernia after debulking surgery for advanced ovarian cancer have been described. This is an exceedingly rare but life-threatening complication, being prompt recognition and surgical correction critical.We report a case of a delayed diaphragmatic hernia in a 19-year-old female resulting from cytoreductive surgery for advanced ovarian cancer. Rapid evolution from gastrointestinal symptoms to hypovolemic shock occurred, and intensive care admission was required. Immediate surgery was critical to improving the patient outcome. This case highlights this uncommon but life-threatening complication, the challenges of diagnosing and managing those patients, and the need for early recognition, support, and surgical correction.

Occam's razor, the principle that a single explanation is the most likely in medicine, assumes that when a patient has multiple symptoms the clinician seeks a single diagnosis rather than diagnosing multiple and different ones. However, as proposed by Hickam’s dictum, sometimes rare different diseases occurred in only one patient. We present a patient with a simultaneous diagnosis of two rare tumours, a cardiac hemangioma (primary cardiac tumour, often misdiagnosed as myxoma) and an appendiceal mucocele (a lesion of the appendix that can be neoplastic or not). A 71-year-old male presented with anorexia, asthenia, fever and weight loss for about one month. During the etiological investigation, a cardiac mass and an appendiceal lesion were detected and both lesions required surgical intervention. Cardiac and abdominal surgeries were uneventful and full recovery was achieved. The histological examination showed a cardiac hemangioma and a neoplastic appendiceal mucocele.

No abstract

Hospital acquired pneumonia (HAP) is a common discharge diagnosis in patients admitted both to surgical and medical wards, and it seems to be associated with increased mortality and morbidity. Recent epidemiological data points to an incidence roughly between 0.5 and 2%. Ventilator associated pneumonia accounts for about 1/3 of these episodes. Still, there is scarce information regarding HAP distribution, risk factors, the impact of age, differences between surgical and medical patients, strategies for prevention (outside the intensive care unit), and health costs, especially hospital length of stay and mortality. METHODS: Exploratory analysis of the Portuguese National Health Service (NHS) hospital discharge diagnosis database. All adult inpatients discharged between 2014 and 2017 with a new diagnosis of pneumonia ("not present on admission") were included. Demographic data, type of admission (either medical or surgical), the need for invasive ventilation, hospital length of stay and mortality were collected. This study was approved by the Central Administration of the National Health System.

No abstract