Minimally invasive laparoscopic and robot-assisted emergency treatment of strangulated giant hiatal hernias: report of five cases and literature review

Background Giant hiatal hernia (GHH) is a condition where one-third of the stomach migrates into the thorax. Nowadays, laparoscopic treatment gives excellent postoperative outcomes. Strangulated GHH is rare, and its emergent repair is associated with significant morbidity and mortality rates. We report a series of five cases of strangulated GHH treated by a minimally invasive laparoscopic and robot-assisted approach, together with a systematic review of the literature. Methods During 10 years (December 2009–December 2019), 31 patients affected by GHH were treated by robot-assisted or conventional laparoscopic surgical approach. Among them, five cases were treated in an emergency setting. We performed a PubMed MEDLINE search about the minimally invasive emergent treatment of GHH, selecting 18 articles for review. Results The five cases were male patients with a mean age of 70 ± 18 years. All patients referred to the emergency service complaining of severe abdominal and thoracic pain, nausea and vomiting. CT scan and endoscopy were the main diagnostic tools. All patients showed stable hemodynamic conditions so that they could undergo a minimally invasive attempt. The surgical approach was robotic-assisted in three patients (60%) and laparoscopic in two (40%). Patients reported no complications or recurrences. Conclusion Reviewing current literature, no general recommendations are available about the emergent treatment of strangulated hiatal hernia. Acute mechanical outlet obstruction, ischemia of gastric wall or perforation and severe bleeding are the reasons for an emergent surgical indication. In stable conditions, a minimally invasive approach is often feasible. Moreover, the robot-assisted approach, allowing a stable 3D view and using articulated instruments, represents a reasonable option in challenging situations

Modeling the contribution of male testosterone levels to the duration of positive COVID testing among hospitalized male COVID-19 patients

Background: A growing body of evidence is emerging suggesting testosterone can affect all cells involved in the immune response to both bacterial and viral infections, and the testosterone effect on the immune response could explain the greater susceptibility of men to infections including COVID-19. We aimed to explore the predictive role of male serum total testosterone (TT) levels on the time till viral negativity testing among hospitalized COVID-19 patients. Methods: The univariate effect of risk factors for the duration of COVID-19 viral positivity was evaluated using the log-rank test and Kaplan-Meier estimates. A multivariable Cox regression model was developed to test the role of TT levels and the subsequent odds for shorter viral positivity intervals. Results: Increasing serum TT levels and the need for an oxygen administration strategy were independently predictive for respectively reduced and increased days to negativization (Hazard Ratio [HR]: 1.39, 95% CI: 0.95-2.03 and HR: 0.19, 95% CI: 0.03-1.18). Conclusion: Baseline higher TT levels for male COVID-19 patients at hospital admission are associated with shorter durations of positive COVID-19 testing and thus viral clearance. Our preliminary findings might play a relevant to help pandemic control strategies if these will be verified in future larger multicentric and possibly randomized trials

Parathyroid Retrospective Analysis of Neoplasms Incidence (pTRANI Study): An Italian Multicenter Study on Parathyroid Carcinoma and Atypical Parathyroid Tumour

Background: Parathyroid cancer (PC) is a rare sporadic or hereditary malignancy whose histologic features were redefined with the 2022 WHO classification. A total of 24 Italian institutions designed this multicenter study to specify PC incidence, describe its clinical, functional, and imaging characteristics and improve its differentiation from the atypical parathyroid tumour (APT). Methods: All relevant information was collected about PC and APT patients treated between 2009 and 2021. Results: Among 8361 parathyroidectomies, 351 patients (mean age 59.0 ± 14.5; F = 210, 59.8%) were divided into the APT (n = 226, 2.8%) and PC group (n = 125, 1.5%). PC showed significantly higher rates (p < 0.05) of bone involvement, abdominal, and neurological symptoms than APT (48.8% vs. 35.0%, 17.6% vs. 7.1%, 13.6% vs. 5.3%, respectively). Ultrasound (US) diameter >3 cm (30.9% vs. 19.3%, p = 0.049) was significantly more common in the PC. A significantly higher frequency of local recurrences was observed in the PC (8.0% vs. 2.7%, p = 0.022). Mortality due to consequences of cancer or uncontrolled hyperparathyroidism was 3.3%. Conclusions: Symptomatic hyperparathyroidism, high PTH and albumin-corrected serum calcium values, and a US diameter >3 cm may be considered features differentiating PC from APT. 2022 WHO criteria did not impact the diagnosis

High Risk of Secondary Infections Following Thrombotic Complications in Patients With COVID-19

Background. This study’s primary aim was to evaluate the impact of thrombotic complications on the development of secondary infections. The secondary aim was to compare the etiology of secondary infections in patients with and without thrombotic complications. Methods. This was a cohort study (NCT04318366) of coronavirus disease 2019 (COVID-19) patients hospitalized at IRCCS San Raffaele Hospital between February 25 and June 30, 2020. Incidence rates (IRs) were calculated by univariable Poisson regression as the number of cases per 1000 person-days of follow-up (PDFU) with 95% confidence intervals. The cumulative incidence functions of secondary infections according to thrombotic complications were compared with Gray’s method accounting for competing risk of death. A multivariable Fine-Gray model was applied to assess factors associated with risk of secondary infections. Results. Overall, 109/904 patients had 176 secondary infections (IR, 10.0; 95% CI, 8.8–11.5; per 1000-PDFU). The IRs of secondary infections among patients with or without thrombotic complications were 15.0 (95% CI, 10.7–21.0) and 9.3 (95% CI, 7.9–11.0) per 1000-PDFU, respectively (P = .017). At multivariable analysis, thrombotic complications were associated with the development of secondary infections (subdistribution hazard ratio, 1.788; 95% CI, 1.018–3.140; P = .043). The etiology of secondary infections was similar in patients with and without thrombotic complications. Conclusions. In patients with COVID-19, thrombotic complications were associated with a high risk of secondary infections

Nascita e sviluppo dell'ingegneria elettrica

La tesi riporta la storia dell'ingegneria elettrica tra la seconda metà del 1800 ed i primi anni del 1900

Irrigation during Laparoscopic Appendectomy for Complicated Appendicitis: Time to Review Current Guidelines

It could be asserted that the advent of evidencebased medicine and minimally invasive approaches are among the most remarkable revolutions that general surgeons had to face with during the second half of the 20th century. Still being one of the most common diseases leading to emergency surgery procedures, with a lifetime risk of 8.6% for males and 6.7% for females [1], acute appendicitis (AA) seems to be a paradigm of the challenging changes of current surgical practice. A recent meta-analysis [2] could not demonstrate the superiority of laparoscopic appendectomy (LA) compared with open appendectomy for what concerns the incidence of intra-abdominal abscess (IAA) (odds ratio (OR) 0.79; 95% confidence interval (CI) 0.45–1.37)

Statistical and Fractal Approaches on Long Time-Series to Surface-Water/Groundwater Relationship Assessment: A Central Italy Alluvial Plain Case Study

In this research, univariate and bivariate statistical methods were applied to rainfall, river and piezometric level datasets belonging to 24-year time series (1986–2009). These methods, which often are used to understand the effects of precipitation on rivers and karstic springs discharge, have been used to assess piezometric level response to rainfall and river level fluctuations in a porous aquifer. A rain gauge, a river level gauge and three wells, located in Central Italy along the lower Pescara River valley in correspondence of its important alluvial aquifer, provided the data. Statistical analysis has been used within a known hydrogeological framework, which has been refined by mean of a photo-interpretation and a GPS survey. Water–groundwater relationships were identified following the autocorrelation and cross-correlation analyses. Spectral analysis and mono-fractal features of time series were assessed to provide information on multi-year variability, data distributions, their fractal dimension and the distribution return time within the historical time series. The statistical–mathematical results were interpreted through fieldwork that identified distinct groundwater flowpaths within the aquifer and enabled the implementation of a conceptual model, improving the knowledge on water resources management tools

Experiences of Italian surgical residents in low-income countries: an analysis from the Italian Polyspecialistic Society of Young Surgeons (SPIGC)

BACKGROUND: Surgery is a developing sector of global health; the insufficient number of surgeons seems to be the primary problem in low-income countries. International experiences in low-income countries are advocated from students and residents, lack of tutoring and different kind of surgeries represent obstacles for the training. The Italian Polyspecialistic Society of Young Surgeons (SPIGC) administered a survey to young surgeons and surgical residents, to examine the reasons they become involved in global surgery during residency and the impact of their experiences on the surgical training. METHODS: A 23-item, anonymous electronic questionnaire was administered to Italian surgical residents and young surgeons (≤40 years of age), coming from any surgical specialty. The study was conducted during January 2020. The study design guaranteed anonymity. RESULTS: All respondents (100%) recommended the experience in the low-income country, and none recommended spending time during the residency in a different way. Moreover, 83% of respondents judged their training as improved. CONCLUSIONS: This is the first Italian survey regarding global surgery experiences in relation to surgical residency. Our results show how Italian medical doctors who travelled in low-income countries during residency recommend this experience to improve knowledge. Surgical residents’ experience in low-income countries should grow, Italian residents are satisfied, and the training should be standardized