RezumatIntroducere: Fistula esotraheală postintubaţie este o complicaţie severă, apărută în anumite condiţii la pacienţii care necesită ventilaţie mecanică pentru o perioadă îndelungată de timp. Material şi metodă: Articolul prezintă o serie de 11 pacienţi cu fistula esotraheală postintubaţie operaţi în clinica noastră în perioada 2005 -2015. Abordul anterior cu rezecţie de trahee a fost preferat la 10 dintre aceşti pacienţi, într-un caz cu o fistulă de dimensiuni mari preferând să efectuăm o intervenţie chirurgicală atipică. Trei dintre pacienţii seriei au fost operaţi înainte de sevrarea de ventilator în încercarea de a ajuta la desprinderea de ventilaţia mecanică. Două cazuri au fost operate în urma recidivei fistulei după tentative de închidere în alte servicii chirurgicale. Rezultate: Doi pacienţi (ambii din grupul celor care nu au fost sevraţi de ventilator) au decedat în urma unor complicaţii specifice intubaţiei continuate după rezecţia traheală (dehiscenţă anastomotică cu mediastinită şi fistulă traheo-vasculară în trunchiul arterial brahiocefalic). Restul de 9 pacienţi ai seriei au avut o evoluţie bună, cu restaurarea căii aeriene şi deglutiţie normală. Concluzii: Abordarea chirurgicală a acestei patologii are succes în servicii specializate în chirurgie traheală şi esofagiană. Alegerea momentului operator este de mare importanţă pentru obţinerea unor rezultate bune.Cuvinte cheie: fistula esotraheală, stenoză trahee, rezecţie traheală The anterior approach with tracheal resection was performed in 10 of these patients, while an atypical surgical technique was preferred in a case involving a large-sized fistula. Three of these patients were subject to surgery while still on the ventilator, in order to help weaning them from mechanical ventilation. Two patients were operated following a relapse of the fistula, after attempts of closing it in other surgical units. Results: Two patients (of those who were still on mechanical ventilation) died from intubation-related complications that persisted after tracheal resection (anastomotic dehiscence with mediastinitis and tracheoarterial fistula in the brachiocephalic arterial trunk). The nine remaining patients improved, with their airways restored and having regained normal deglutition. Conclusions: The surgical approach of this pathology is successful in surgical units that are specialised in tracheal and oesophageal surgery. Adequately timing the surgery is crucial for a good outcome.

Gastric pull-up is the most commonly used procedure for esophageal replacement in both malignant and benign conditions. In our article we compare the differences in mortality and morbidity between thoracic anastomosis and cervical anastomosis during gastric pull-up. The study group comprised of 126 patients - 58 patients (56%) with cervical anastomosis and 68 patients (64%) with thoracic anastomosis. The overall mortality in the study group was 5.55% (7 patients), while the overall morbidity was higher at 28%. There were no significant differences between the two subgroups regarding mortality and morbidity, although the rate of anastomotic leakage was higher in the cervical subgroup (13.8% vs 1.5%). We recommend performing thoracic anastomosis during gastric pull-up whenever the location of the lesion allows it, since the procedure is safe, relatively easy to master and it shortens operating time by excluding the cervical approach.

Lateral thoracotomy is a versatile approach with many variations and is currently the most widely used incision in thoracic surgery. In the current article we are presenting the muscle-sparing lateral thoracotomy in the lateral decubitus position which we consider to be the "standard" for lateral thoracotomies.Indications, surgical technique and pitfalls are described alongside our experience with thoracic drainage.Although there is no consensus regarding the name of this incision, some authors call it "axillary thoracotomy" while others call it a "modified lateral thoracotomy", they all agree on one aspect -the importance of muscle sparingwhich makes it the go-to thoracotomy for both small and large procedures involving the lung.Lateral muscle sparing thoracotomy allows for good exposure of the pulmonary hilum, fissures, apex and diaphragm. The approach is easy and quick to perform while at the same time ensuring faster postoperative recovery by sparing the latissimus dorsi muscle, better cosmetics and lower postoperative pain score when compared to the posterolateral or classical lateral thoracotomies.Acne conglobata is a rare, severe form of acne vulgaris characterized by the presence of comedones, papules, pustules, nodules and sometimes hematic or meliceric crusts, located on the face, trunk, neck, arms and buttocks.Mihai Dumitrescu et al. 61

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