An unusual case of repeated splenectomy: traumatic rupture of an accessory spleen in a previously splenectomized patient

The traumatic rupture of an accessory spleen is a very rare condition and only few cases have been reported in the literature. We describe the case of a 51-year-old man undergone splenectomy for trauma several years before, who developed hemoperitoneum due to a laceration of a voluminous accessory spleen, following an accidental two-meter fall. As a conservative management of the injury was not possible, an accessory splenectomy was then required. Thus, a briefly review of the literature about this uncommon topic was perfomed

A Rapid Antigen Detection Test to Diagnose SARS-CoV-2 Infection Using Exhaled Breath Condensate by A Modified Inflammacheck® Device

Background: The standard test that identifies the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is based on reverse transcriptase-polymerase chain reaction (RT-PCR) from nasopharyngeal (NP) swab specimens. We compared the accuracy of a rapid antigen detection test using exhaled breath condensate by a modified Inflammacheck® device with the standard RT-PCR to diagnose SARS-CoV-2 infection. Methods: We performed a manufacturer-independent, cross-sectional, diagnostic accuracy study involving two Italian hospitals. Sensitivity, specificity, positive (PLR) and negative likelihood ratio (NLR), positive (PPV) and negative predictive value (NPV) and diagnostic accuracy with 95% confidence intervals (95% CI) of Inflammacheck® were calculated using the RT-PCR results as the standard. Further RT-PCR tests were conducted on NP specimens from test positive subjects to obtain the Ct (cycle threshold) values as indicative evidence of the viral load. Results: A total of 105 individuals (41 females, 39.0%; 64 males, 61.0%; mean age: 58.4 years) were included in the final analysis, with the RT-PCR being positive in 13 (12.4%) and negative in 92 (87.6%). The agreement between the two methods was 98.1%, with a Cohen’s κ score of 0.91 (95% CI: 0.79–1.00). The overall sensitivity and specificity of the Inflammacheck® were 92.3% (95% CI: 64.0%–99.8%) and 98.9% (95% CI: 94.1%–100%), respectively, with a PLR of 84.9 (95% CI: 12.0–600.3) and a NLR of 0.08 (95% CI: 0.01–0.51). Considering a 12.4% disease prevalence in the study cohort, the PPV was 92.3% (95% CI: 62.9%–98.8%) and the NPV was 98.9% (95% CI: 93.3%–99.8%), with an overall accuracy of 98.1% (95% CI: 93.3%–99.8%). The Fagan’s nomogram substantially confirmed the clinical applicability of the test in a realistic scenario with a pre-test probability set at 4%. Ct values obtained for the positive test subjects by means of the RT-PCR were normally distributed between 26 and 38 cycles, corresponding to viral loads from light (38 cycles) to high (26 cycles). The single false negative record had a Ct value of 33, which was close to the mean of the cohort (32.5 cycles). Conclusions: The modified Inflammacheck® device may be a rapid, non-demanding and cost-effective method for SARS-CoV-2 detection. This device may be used for routine practice in different healthcare settings (community, hospital, rehabilitation)

Age, BMI and severity of acute diverticulitis: myths or facts?

Introduction: Although it is commonly believed that patients presenting with severe acute diverticulitis are more often obese and elderly, only few evidences are reported in literature about these clinical observations.1,2 In this study, we tried to determine if body mass index (BMI) and old age are associated with a higher incidence of complicated acute diverticulitis. Material and Methods: A retrospective review of patients hospitalized with acute diverticulitis between 2013 and 2015 was conducted. Severity of Acute Diverticulitis was graded in according to modified Hinchey’s classification.3 The mean BMI and mean age for each group of patients were calculated. Statistical analysis was performed by one way anova test with significance set at P<0.05. Results: Charts of 90 patients hospitalized with acute diverticulitis were reviewed. Five groups were identified: 32 patients (36%) were admitted with Hinchey’s stage Ia; 21 (23%) with stage Ib; 20 (22%) with stage II; 12 (13%) with stage III and 5 (6%) with stage IV. Mean BMI and mean age were respectively: 25,45 Kg/m2 (range 40,40-19,10) and 58 years (range 35-87) in group 1; 26,78 Kg/m2 (range 3,33-20,23) and 58 years (range 34-83) in group 2; 26,14 Kg/m2 (range 30,48-22,73) and 63 years (range 49-83) in group 3; 26,68 Kg/m2 (range 34,28-21,25) and 58 years (range 38-87) in group 4; 24,44 Kg/m2 (range 28,3-18,13) and 66 years (range 26-90) in group 5. There was no significant difference among these groups by either age (P=0.762) or BMI (P=0.334). Discussion: Numerous studies have shown a correlation between acute diverticulitis and obesity, particularly in people of advanced age. This retrospective study was undertaken to identify a possible link between BMI, age and complicated acute diverticulitis. No significant differences were recognized, among the groups with different grades of acute diverticulitis, in terms of BMI and age. Despite this result, the aetiological relationship between obesity, old age and diverticular complications still remain unclear

Exercise related ventilation dynamics and clinical correlates in patients with fibrotic idiopathic interstitial pneumonias

Assessment of exercise performance is a key component in the management of interstitial lung diseases, as its limitation may occur very early. Aim of the present study was to assess ventilation dynamics in combination with pulse-oximetry changes in 54 clinically stable patients affected by idiopathic pulmonary fibrosis or idiopathic fibrotic nonspecific interstitial pneumonia. Testing was successfully performed with the Spiropalm 6-MWT Hand-held spirometer by the majority of cases (94%). End test oxygen saturation (SpO2) values <88% were common in most of patients (76%), with a mean distance walked of 403 meters. Ventilation significantly increased due to the contribution of the tidal volume and the respiratory frequency (RF). This finding was associated with a decrease of the end of test respiratory reserve (RR), that was <20% in 9 cases (17.6%). Lung function was inversely related to the end of test RF, while a positive correlation occurred with the end of test RR and the estimated maximal voluntary ventilation (MVV). RR was also a predictive factor of declining forced vital capacity and lung diffusion capacity for carbon monoxide (DLCO) over a 6-month period. Further factors of DLCO impairment were low SpO2 and MVV. Comparison with the cardio-pulmonary exercise test (CPET) showed that the 6-MWT end of test RR was inversely related to the CPET-derived peak RF and VE/VCO2 suggesting RR as pivotal in exercise limitation assessment. Our results open challenging perspectives in an unexplored field. Future research will include management of latent respiratory failure and monitoring of disease progression and therapy response