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Background Thyroidectomy is a common and safe surgical procedure which is typically associated with low morbidity. Pneumomediastinum and pneumothorax following cervical emphysema after thyroidectomy have been rarely mentioned, and the mechanism implicated in these two conditions is uncertain.

This paper describes an uncommon case of acute respiratory failure in a patient who presented with low a haemoglobin rate and metabolic acidosis but with normal vital signs. He had a history of persistent atrial fibrillation, long-term therapy with coumarin anticoagulants and amiodarone, diabetes mellitus, and hypothyroidism. The patient was intubated due to severe acidosis, accumulation of lactic acid, and severe tachypnoea. During the investigation, and based on CT findings, it was thought that the patient had an upper gastrointestinal tumour. However, the results of the endoscopy were surprising. This paper outlines our comments, concerns and thoughts for an uncommon case which can present a potentially life-threatening situation for a patient. It also indicates the appropriate clinical and imaging investigation. Moreover, recommendations are given to enable a physician to offer the best possible services to a critically ill patient.

Spontaneous hepatic rupture with hemoperitoneum is an uncommon but devastating complication of hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. Although the syndrome has been considered a variant of preeclampsia/eclampsia, its pathogenesis is not completely understood. Hepatic rupture increases the perinatal and maternal morbidity and mortality. This report describes 3 cases of extensive spontaneous hepatic rupture in pregnant women with HELLP syndrome. Early diagnosis and adequate tertiary management of this rare but life-threatening condition reduce the high maternal and newborn mortality.

Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring in a patient after intubation with an endotracheal tube or tracheostomy tube lasting for 48 hours or more. We describe a case of 75-year-old male who initially presented with pneumonia of the right basis with accompanying plevritis. The patient was intubated and his condition was complicated with a VAP infection while he developed a lung abscess. The antibiotic therapy was based on susceptibility bronchial secretions isolated acinetobacter baumannii and klebsiella pneumoniae; these pathogens were also isolated from the drained abscess. The patient was discharged in good health. The interest of this case is recommended in the existence of two responsible pathogens, the paucity of the development of lung abscess in a patient with VAP, and the successful treatment of the patient with the combination of controlled drainage of the abscess and appropriate antibiotic therapy.

Takotsubo cardiomyopathy (TCM) is an underrecognized transient left ventricular dysfunction that mimics clinically an acute coronary syndrome. It has been linked to emotional stress and several clinical entities that provoke a catecholamine surge in the blood stream. We investigated the case of a young female patient who was admitted to the intensive care unit after a significant blood loss due to miscarriage. The patient was fully monitored and was treated for the hypovolemia. A dramatic aggravation of her clinical status was directly linked to the appearance of TCM 1 hour after her admission. This study sought to assess the appearance of TCM in a hypovolemic patient. We found no reports in the literature linking these 2 clinical entities. The blood loss and the pathophysiology of hypovolemia, especially through the excess of catecholamines that are released in the blood stream, seem to provoke the appearance of a subclinical form of TCM. As a result, TCM worsened further the general condition of the patient. There is a high possibility that TCM and hypovolemia can be closely related, and therefore, the treatment of hypovolemia can be adjusted to new standards. Because it has already been proved that TCM can be induced by emotional stress and various pathological entities, further investigations are necessary.

Introduction Despite the warnings of health hazards of cigarette smoking, still one third of the population in industrial countries smoke. This review was conducted with the aim of exploring the effects of preoperative tobacco smoking on the risk of intra- and postoperative complications and to identify the value of preoperative smoking cessation. Methods The databases that were searched included The Cochrane Library Database, Medline, and EMBASE. Articles were also identified through a general internet search using the Google search engine. The incidence or risk of different types of intra- and postoperative complications were used as outcome measures. Results Tobacco smoking has a negative effect on surgical outcome, as has been found to be a risk factor for the development of complications during and after many types of surgery, even in the absence of chronic lung disease. Furthermore, the long-term health hazards of smoking reduce health-related quality of life and premature death. Conclusion It is widely documented that stopping smoking before surgery has substantial health benefits in the longer term and should be recommended to every smoker in order for them to gain maximum benefit from their treatment. However, identification of the optimal period of preoperative smoking cessation on postoperative complications cannot be determined.