Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study)

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March-April 2019 vs March-April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), the increase of a unit in the AAST score (+ 26%), surgery performed > 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registration number and date: Research Registry ID 5789, May 7th, 202

Single case of multiple right pulmonary nodules. Advanced cancer or resectable early stage tumor?

Despite ipermetabolic activity of the lesions and previous history of advanced laryngeal carcinoma, only one nodule was really neoplastic and not laryngeal metastatic, but pulmonary. Prognosis improved and chemotherapy was not necessary. This report suggests that in case of complicate oncologic history, PET-scan positivity could not be enough to diagnose relapse of the disease, and in dubious cases surgery is mandatory. Downloaded fro

Single case of multiple right pulmonary nodules : advanced cancer or resectable early stage tumor?

Abstract: we report the uncommon case of a patient with 3 right pulmonary nodules suspected for metastatic carcinoma. The aim of the paper is to focus the attention of surgeons on complicated cases that need to be managed outside the commonly accepted guides lines. Methods: a 52 years old man underwent in 2007 a laryngectomy for squamous carcinoma T2N2 and adjuvant chemo and radiotherapy . In September 2008 a CT scan showed a 1.2 cm sized nodule at the right upper pulmonary lobe. In December a control CT scan found the nodule slightly increased to 1.4 cm and detected two new smaller nodules of the middle and inferior lobes. A PET scan showed ipermetabolic activity of all nodules. A needle aspiration of the upper nodule was performed and malignant cells were found. Oncologists started a chemotherapy treatment based on the diagnosis of metastatic laryngeal carcinoma. After 3 cycles, CT/PET scan revealed a significant reduction in volume and activity of the inferior nodules but the upper was unchanged. That different behavior suggested a different histology of the upper an inferior nodules. Diagnostic thoracoscopy was planned. Intra-operative histology showed that the upper nodule was and adenocarcinoma and the lower nodules were inflammatory; therefore we performed an upper lobectomy and mediastinal limphoadenectomy. Results: at definitive histology upper nodule was confirmed pulmonary adenocarcinoma T1N0G2 and the inferiors diffuse pulmonary sarcoidosis. Conclusions: despite ipermetabolic activity of the lesions and previous history of advanced laryngeal carcinoma, only one nodule was really neoplastic and not laryngeal metastatic, but pulmonary. Prognosis improved and chemotherapy was not necessary. This report suggests that in case of complicate oncologic history, PET scan positivity could not be enough to diagnose relapse of the disease, and in dubious cases surgery is mandatory

Aortobisiliac Bypass Using a Venous Homograft Concomitant With Kidney Transplantation in a Patient With Severe Bilateral Iliac Occlusive Disease: A Case Report

Aortoiliac occlusive disease (AOD) is a great threat for kidney transplantation (KT). Here we report the case of an aortoiliac bypass, performed simultaneously with renal transplantation using venous grafts obtained from the deceased donor. The recipient was a 68-year-old woman with significant stenosis of the aortoiliac axis. We performed an aortobisiliac bypass using donor's femoral veins because presence of methicillin-resistant Staphylococcus aureus was detected on donor hemoculture and contraindicated a prosthetic implant on the recipient. KT was then carried out using standard technique. Operative time amounted to 330 minutes and cold ischemia time of the renal graft was 900 minutes. Delayed graft function was observed until postoperative day 12, but the patient showed a good urine output and a serum creatinine of 2.1 mg/dL at discharge. AOD is not an absolute contraindication to renal transplantation, and simultaneous surgical repair of aortoiliac lesions with KT seems feasible. The patient's return to function after initial delayed graft function suggests that such interventions may allow transplantation to be offered to those patients who otherwise may be excluded for severe vascular comorbidities. Homologous vascular grafts are an excellent choice because prosthetic vascular replacement during immunosuppression must be avoided as long as possible, especially in patients with coexisting infective risk