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

Thromboembolic tendency (TE) in IBD (inflammatory bowel disease) patients

Background: The incidence of TE events in IBD patients is higher then in population control. The main reason of it, is the hypercoaugulable state. Our aim was to detect serum markers related to TE, that can assume preventing and prognostic meanings. Materials and Methods: We performed a 3 years study on 71 patients with IBD, evaluating hypercoaugulability, and then we compared the results with a 71 patients non IBD group control. We also investigated patients of both groups concerning TE events occurred already. Results: In IBD group we found out that 16 patients (22.5%) had history of TE versus >1% of group control. Nineteen of them, already had knowledge of their previous hypercoaugulating condition. 48 (67%) had increased markers value versus less then 6% detected in group control. In IBD group 43%,20% and 4.2% had respectively 1, 1-3 or > 3 markers higher levels then normal range. Among the markers investigated, we detected increased levels of plated in 33%, homocysteine in 26.7%, d-dimero 25.3%, c3 in 15.4%, apcr in 5.6%. Conclusions: From our study we detected highest incidence of TE events, and hypercoaugulating status in IBD group. In our previous investigations, plated, homocysteine, d-dimero, c3, and apcr, seems to be the TE markers with higher sensibility. It seems reasonable, according our experience, to propose a new TE risk score index for IBD patients: low, mild and high risk respectively for patients with 1, 1-3 and >3 markers with higher serum levels then normal range

Thromboembolic tendency (TE) in IBD (Inflammatory bowel disease) patients.

The acronym IBD identifies the ulcerative colitis (URC), Crohn's disease (CD) and the undeterminate colitis (UC) 7. Inflammatory bowel diseases are characterized by variegated etiopathogenesis, probably autoimmune. They have in common a histological damage of a granulomatous/ulcerative kind and also the same manifestations which includes the alternation of remissions and exacerbations 1. They have a remarkable familiarity (13.5%) although it is more evident in CD than in URC. The incidence of IBD varies according to different geographical areas but with a steady increasing trend above all in CD and the diffusion seems to be linked to genetic factors (association with HLA-A2 and B 18) and to geographical factors. Today the etiopathogenesis is still debated. The latest theories seem to confirm an autoimmune genesis. IBD show a remarkable tendency in developing secondary remote manifestations in a different location from the intestinal one: extraintestinal manifestations (EM). They can appear simultaneously with the primitive intestinal manifestation or they can precede or follow after years. According to the most reliable etiopathogenetic hypothesis, EM give rise to "metastasizations" of autoantibodies activated in the bowel from the "ideational intestinal brain"; once the autoantibodies are activated, they are able to attack any organ, tissue or system causing damage directly or mediated. In support of this theory there is the evidence that almost all EM regress with a cortison-based/immunosuppressant treatment. In literature we have descriptions of the extraintestinal remissions of symptoms after total proctolectomia and ileo-anal pouch. Among EM we find following manifestations: hepatobiliary, osteoarticular, muscular, dermatological, stomatological, ophthamological, gynaecological, urological, metabolic, perianal etc. Recently another manifestation has appeared which consists in a remarkable thromboembolic tendency (TE) in IBD patients. TE and IBD are an important field of research as TE occurs in young patients aggressively causing significant morbidity (stroke, retinal vascular occlusive thrombus deposition in cerebral, retinal and mesenteric vessels, massive pulmonary embolism). Several studies describe thrombosis in venous and arterial district in IBD patients as 4% but according to autopsy studies the percentage is more than 30% 2. Among the causes of the TE disease we have: thrombocytosis, increase of the coagulation factors, mutation of V factor of Laiden 8, hyperhomocysteinemia (due to the combined deficit of methylene-hydrofolate-tetra reductase (MTHFR), B12 vitamin and folate) observed mutation of MTHFR gene in some IBD patients. Finally, surgery determines an additional TE risk in these patients compared to non-IBD patients who have the same operation. Some studies describe mortality of 1-1,2% after restorative proctolectomia due to TE complications (pulmonary-cerebral and mesenteric district

Retroperitoneal dedifferentiated lipo-sarcoma (DDLS) with hyperglycemic activity: case report and literature review.

The authors describe a Retroperitoneal De Differentiated LipoSarcomas (DDLs), that for its clinical behavior shows peculiar characteristics and original aspects: typical is the recurrence due to local invasiveness, but absolutely original seems to be the surviving time, maybe correlated to its histological evolution (dedifferentiation from leiomyosarcoma to liposarcoma) and an interesting correlation from the tumor recurrence and the glycemic curve first and after the surgical treatments