Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Bony landmarks of the medial orbital wall: An anatomical study of ethmoidal foramina

The study determines the distribution patterns of ethmoidal foramina (EF) evaluate how they are affected by gender or bilateral asymmetry, and highlights the surgical implications on the anatomical landmarks of the orbit. Two hundred and forty-nine dry orbits were assessed. The number and pattern of EF were determined and distances between the anterior lacrimal crest (ALC), anterior (AEF) middle (MEF), posterior (PEF) ethmoidal foramina and between PEF and the optic canal (OC) were measured. The patterns of EF were classified as type I (single foramen) in 4 orbits (1.6%), type II (double foramina) in 152 (61%), type III (triple foramina) in 71 (28.5%), and type IV (multiple foramina) in 22 orbits (16.4%). Two orbits were found with five EF and a single orbit with six EF. A significant gender difference was observed for ALC-AEF distance (P ≤ 0.03), in males 23.53 ± 2.86 (20.67-26.39) versus females 22.51 ± 3.72 (18.79-26.23) mm. Bilateral asymmetry was observed for ALC-AEF distance (P ≤ 0.01). The distances ALC-AEF and ALC-PEF varied significantly according to EF classification (P ≤ 0.03 and P ≤ 0.02). The navigation ratio from ALC-AEF, AEF-PEF, and PEF-OC, in Greek population was "23-10-4 mm". A variation in the number of EF was found, ranging from 1 to 6, with the first report of sextuple EF. Although measures were generally consistent across genders and side, there are significant differences across ethnicities. These findings suggest that surgeons must consider population differences in determining the anatomical landmarks and navigation points of the orbit. © 2013 Wiley Periodicals, Inc

Aortic Wall Inflammation in the Pathogenesis, Diagnosis and Treatment of Aortic Aneurysms

The role of inflammation in the development of aortic aneurysms is emerging, along with the potential diagnostic and therapeutical potential of this correlation. Abdominal aorta aneurysms have a strong inflammatory substrate since atherosclerosis, which is undoubtedly linked to inflammation, is also a predisposing factor to their formation. Yet, data have emerged that the development of thoracic aorta aneurysms involves several inflammatory pathways, although they were previously referred to as a non-inflammatory disease. Since aortic aneurysms are mainly asymptomatic during their clinical course until their complications—which may be lethal—serum biomarkers for their early diagnosis are a necessity. Studies highlight that inflammation molecules may have a critical role in that direction. In addition, imaging techniques that trace aortic wall inflammation are developed in order to predict aneurysm growth rates and sites vulnerable of rupture. Several anti-inflammatory agents have been also studied in animal models and clinical trials for the treatment of aortic aneurysms. This review highlights the role of inflammation in pathogenesis, diagnosis and treatment of aortic aneurysms. © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature

Horseshoe kidney: A review of anatomy and pathology

Horseshoe kidney (HSK) is the most common renal fusion, which is characterized by three anatomic anomalies: ectopia, malrotation and vascular changes. Patients with HSK are prone to a variety of complications, genitourinary and non-genitourinary. In this paper, the anatomy of HSK is delineated with a great emphasis on its blood supply. After reviewing the literature, the arterial supply patterns found by each author were categorized according to the classification system proposed by Graves. The majority of HSKs were found to be supplied by renal arteries derived from the abdominal aorta below the isthmus or by vessels originating from the common iliac arteries. In addition, the abnormalities associated with HSK are highlighted and classified in anatomical variations, congenital anomalies as well as in pathologic conditions related to HSK. © 2013 Springer-Verlag

The ossified pterygoalar ligament: An anatomical study with pathological and surgical implications

Mandibular nerve entrapment has great significance, as it may be responsible for the appearance of several neurological pathologies, such as chewing disorders, taste loss, facial or tongue paraesthesia and neuralgia. The ossified pterygoalar (Pta) bar is the result of calcification and/or ossification of the ligament extending from the pterygospinous process of the lateral pterygoid lamina to the infratemporal surface of the sphenoid bone. The ossified bar may act as the cause for this entrapment. One hundred and forty-five Greek adult dry skulls were examined for the existence of a complete or incomplete Pta bar and a relative foramen. The Pta bar appeared in 31.7% of the skulls, in total, in 4.1% completely and in 27.6% incompletely ossified. The mean sagittal and transverse diameters of Pta foramen were 3.21 ± 1.70 and 4.79 ± 1.39 mm, respectively. There was no statistical significant difference between the presence of Pta bar and the side or gender. Apart from the neurological interest, this study highlights the importance of the existence of Pta bar in neurosurgery, anaesthesiology, oral and maxillofacial surgery. The passage of the needle through the foramen ovale for the injection of anaesthetics, as a treatment for trigeminal neuralgia may not be achieved due to this anatomical obstacle. In this case, intra- or postoperative radiologic investigation may be helpful. © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved

Short-term risk prediction after major lower limb amputation: PERCEIVE study

This multicentre cohort study of 537 patients evaluated the accuracy of preoperative predictions of outcomes by healthcare professionals and several relevant risk prediction tools. Surgeons and anaesthetists predicted 30-day outcomes after major lower limb amputation more accurately than most risk prediction tools. The best performing method of predicting mortality was a tool that incorporated healthcare professional estimation of risk.Background The accuracy with which healthcare professionals (HCPs) and risk prediction tools predict outcomes after major lower limb amputation (MLLA) is uncertain. The aim of this study was to evaluate the accuracy of predicting short-term (30 days after MLLA) mortality, morbidity, and revisional surgery. Methods The PERCEIVE (PrEdiction of Risk and Communication of outcomE following major lower limb amputation: a collaboratIVE) study was launched on 1 October 2020. It was an international multicentre study, including adults undergoing MLLA for complications of peripheral arterial disease and/or diabetes. Preoperative predictions of 30-day mortality, morbidity, and MLLA revision by surgeons and anaesthetists were recorded. Probabilities from relevant risk prediction tools were calculated. Evaluation of accuracy included measures of discrimination, calibration, and overall performance. Results Some 537 patients were included. HCPs had acceptable discrimination in predicting mortality (931 predictions; C-statistic 0.758) and MLLA revision (565 predictions; C-statistic 0.756), but were poor at predicting morbidity (980 predictions; C-statistic 0.616). They overpredicted the risk of all outcomes. All except three risk prediction tools had worse discrimination than HCPs for predicting mortality (C-statistics 0.789, 0.774, and 0.773); two of these significantly overestimated the risk compared with HCPs. SORT version 2 (the only tool incorporating HCP predictions) demonstrated better calibration and overall performance (Brier score 0.082) than HCPs. Tools predicting morbidity and MLLA revision had poor discrimination (C-statistics 0.520 and 0.679). Conclusion Clinicians predicted mortality and MLLA revision well, but predicted morbidity poorly. They overestimated the risk of mortality, morbidity, and MLLA revision. Most short-term risk prediction tools had poorer discrimination or calibration than HCPs. The best method of predicting mortality was a statistical tool that incorporated HCP estimation

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic