Introduction: Hydatidosis is one of the most critical parasitic zoonotic diseases worldwide. Lungs are the second most common site of the disease. Aim: This study aimed to evaluate the clinical presentation, diagnosis, radiological findings, surgical treatment and post-operative complications of pulmonary hydatid cyst in patients referred to the Second Surgery Clinic at St George University Hospital in Plovdiv, Bulgaria. Materials and methods: From January 2014 to December 2022, 69 patients were operated on due to pulmonary hydatidosis in the Clinic of Thoracic and Abdominal Surgery at St George University Hospital in Plovdiv, Bulgaria. Demographic data of the patients were collected including clinical symptoms, laboratory studies, radiological findings, location of the lung involvement, and surgical procedures and post-operative complications were recorded. Results: Pulmonary hydatidosis was confirmed for 69 (46 male and 23 female) patients. The average age of the study group was 31.59±19.49 years. In 29 of the tested patients, specific antibodies of the IgG class to Echinococcus granulosus were positive, and 23 patients showed negative results. The leading symptom was non-productive cough followed by shortness of breath, chest pain, fever, productive cough; rash was reported in one patient. 91.3% of the cases presented with a typical X-ray image and in 8.7% it was atypical. It turned out that 66.7% of patients with an atypical X-ray findings developed complications in the postoperative period. Right lung was affected in 50.7% of the cases. The average size of the echinococcal cyst was 7.43±3.23 cm. Statistical analysis revealed a correlation between the size of the hydatid cyst and the length of the postoperative period. Dissemination in other organs was found in 16 of the patients. No statistically significant differences were reported in the patients with dissemination, regarding the size of the primary hydatid cyst, complications and duration of the postoperative period. The preferred methods of approach were thoracotomy and VATS. The most commonly performed surgical technique was echinococcectomy and capitonnage a modo Delbet followed by two lobectomies and one wedge resection. The mean postoperative period was 7.00±2.81 days. In 12 of the analyzed patients, complications occurred in the postoperative period, and mortality was reported in one patient. Conclusion: Pulmonary echinococcosis remains a significant health issue in many countries worldwide including Bulgaria. With a prolonged silent period, it is usually diagnosed when clinical symptoms as cough, dyspnea, chest pain and fever start manifesting. Plain chest radiography remains the basic imaging method for initial diagnosis while ELISA test has limited diagnostic accuracy in cases of pulmonary hydatidosis. Irrelevant to surgical approach, Delbet’s capitonnage procedure is associated with good postoperative results and low complication rates.

Introduction: Descending necrotizing mediastinitis is one of the most lethal forms of acute mediastinitis. It originates from an odontogenic or deep neck infection, which descends to the mediastinum through the fascial planes. It is a rare condition, but mortality rates remain high, especially in the presence of comorbidities or predisposing factors. Delay in diagnosis has been shown to be one of the most important factors for the disease outcome. Therefore, early diagnosis and treatment by a multidisciplinary team are of utmost importance. Case series: Four healthy young males with descending necrotizing mediastinitis were treated at our institution. None of them had any comorbidities, but all of them waited between 3 and 4 days before seeking medical help. Upon their arrival at the hospital, in addition to the presence of a severe neck infection, the presence of mediastinitis was also found. Despite the timely surgical treatment of both the source of the infection and the mediastinitis, three of the four cases had a fatal outcome. Conclusion: We believe that the time factor is of greater importance for the outcome of acute descending mediastinitis than the factors of age and presence of accompanying diseases. Proper and rapid treatment by a multidisciplinary team is essential, even for young and healthy people.

Introduction: Pleural cavity drainage is a crucial component of the surgical management of patients with various chest diseases. Digital drainage systems are increasingly used in contemporary thoracic surgical procedure, which is likely a result of their effectiveness in achieving early postoperative ambulation, cutting down on hospital stays and lowering costs. The vast majority of thoracic surgeons worldwide prefer digital drainage systems to traditional ones. The advantages of the former, however, are disputed by some researchers. Aim: The objective of this study was to compare the two types of pleural drainage mechanisms, conventional and digital, in terms of duration of pleural drainage in days, financial cost, and postoperative air leak duration. Materials and methods: The study focused on 80 patients who underwent various thoracic surgical interventions in the Clinic of Thoracic and Abdominal Surgery at St George University Hospital in Plovdiv. They were divided into two groups: group 1 consisted of 42 patients who were postoperatively attached to a conventional non-mobile pleural drainage system, and group 2 consisted of 38 patients in whom a mobile digital pleural drainage system was used. The main analyzed data were duration of pleural drainage, duration of postoperative air leak, hospital stay, and financial costs. Results: The average duration of pleural drainage, regardless of surgery and type of drainage system applied was 4.86±0.8 days. The average duration of pleural drainage in patients attached to the mobile digital drainage system was shorter than that in patients with a conventional pleural non-mobile drainage system, regardless of the type of surgery done. This difference was statistically significant in favor of the digital pleural drainage system. The study also found a statistically significant difference in terms of financial costs in favor of digital draining system. The average cost of a hospital stay for patients attached to a mobile digital drainage system was BGN 119.40±7.15, whereas the average cost of a hospital stay for patients connected to a traditional pleural drainage system (PDS) was BGN 159±10.50. Regarding the duration of postoperative air leak, the difference between the types of pleural drainage mechanism used was not convincing. Conclusions: Digital pleural drainage systems provide clinicians with an opportunity to assess the postoperative air leak more precisely, track its dynamics, shorten hospital stays, reduce postoperative costs, and optimize the time to remove the chest drain. Based on these features, they will undoubtedly continue to enter everyday surgical practice.