Monocentric case-series of mesenteric vascular disease occurred in the first month of the COVID-19 pandemic

Objectives: we describe Coronavirus Disease (COVID-19) patients also manifesting gastro-intestinal symptoms. Methods: five women, between the ages of 32 and 82 years old, were admitted for acute abdomen, and received a nasopharyngeal swab for COVID-19 screening, lab test analysis, and contrast thoraco-abdominal CT-scan. All presented leukocytosis, different localizations of visceral vessels thrombosis and ischemia, and COVID-19. Results: emergency laparotomy was accepted by all but 1, who died after 5 days. Postoperatively, 1 died of multi-organ failure, 3 were discharged home after 14, 8 and 10 days respectively, under anti-platelet and anticoagulation treatment. Conclusions: in COVID-19 patients with acute abdomen, abdominal contrast CT-scans should be systematically extended to the thorax to detect visceral COVID-19 initial pulmonary signs. Emergency laparotomy and visceral arteries thrombectomy could be necessary

A cross-sectional study evaluating hospitalization rates for chronic limb-threatening ischemia during the COVID-19 outbreak in Campania, Italy

The expansion of coronavirus disease 2019 (COVID-19) prompted measures of disease containment by the Italian government with a national lockdown on March 9, 2020. The purpose of this study is to evaluate the rate of hospitalization and mode of in-hospital treatment of patients with chronic limb-threatening ischemia (CLTI) before and during lockdown in the Campania region of Italy. The study population includes all patients with CLTI hospitalized in Campania over a 10-week period: 5 weeks before and 5 weeks during lockdown (n = 453). Patients were treated medically and/or underwent urgent revascularization and/or major amputation of the lower extremities. Mean age was 69.2 +/- 10.6 years and 27.6% of the patients were women. During hospitalization, 21.9% of patients were treated medically, 78.1% underwent revascularization, and 17.4% required amputations. In the weeks during the lockdown, a reduced rate of hospitalization for CLTI was observed compared with the weeks before lockdown (25 vs 74/100,000 inhabitants/year; incidence rate ratio: 0.34, 95% CI 0.32-0.37). This effect persisted to the end of the study period. An increased amputation rate in the weeks during lockdown was observed (29.3% vs 13.4%; p < 0.001). This study reports a reduced rate of CLTI-related hospitalization and an increased in-hospital amputation rate during lockdown in Campania. Ensuring appropriate treatment for patients with CLTI should be prioritized, even during disease containment measures due to the COVID-19 pandemic or other similar conditions

How the First Year of the COVID-19 Pandemic Impacted Patients’ Hospital Admission and Care in the Vascular Surgery Divisions of the Southern Regions of the Italian Peninsula

Background: To investigate the effects of the COVID-19 lockdowns on the vasculopathic population. Methods: The Divisions of Vascular Surgery of the southern Italian peninsula joined this multicenter retrospective study. Each received a 13-point questionnaire investigating the hospitalization rate of vascular patients in the first 11 months of the COVID-19 pandemic and in the preceding 11 months. Results: 27 out of 29 Centers were enrolled. April-December 2020 (7092 patients) vs. 2019 (9161 patients): post-EVAR surveillance, hospitalization for Rutherford category 3 peripheral arterial disease, and asymptomatic carotid stenosis revascularization significantly decreased (1484 (16.2%) vs. 1014 (14.3%), p = 0.0009; 1401 (15.29%) vs. 959 (13.52%), p = 0.0006; and 1558 (17.01%) vs. 934 (13.17%), p < 0.0001, respectively), while admissions for revascularization or major amputations for chronic limb-threatening ischemia and urgent revascularization for symptomatic carotid stenosis significantly increased (1204 (16.98%) vs. 1245 (13.59%), p < 0.0001; 355 (5.01%) vs. 358 (3.91%), p = 0.0007; and 153 (2.16%) vs. 140 (1.53%), p = 0.0009, respectively). Conclusions: The suspension of elective procedures during the COVID-19 pandemic caused a significant reduction in post-EVAR surveillance, and in the hospitalization of asymptomatic carotid stenosis revascularization and Rutherford 3 peripheral arterial disease. Consequentially, we observed a significant increase in admissions for urgent revascularization for symptomatic carotid stenosis, as well as for revascularization or major amputations for chronic limb-threatening ischemia

Adrenocortical carcinoma: What the surgeon needs to know. Case report and literature review

AbstractAdrenocortical carcinoma is a rare and aggressive cancer and its prognosis is frequently unsatisfactory. Due to its rarity there's a lack of prospective randomized studies. Without experience in the approach of this kind of tumor, managing becomes challenging and, moreover, we have only few recommendations, based on weak evidence. We report a case that has some peculiarities and is an excellent food for thought. Then we deal with a literature review to highlight and summarize most significant aspects of epidemiology, clinic, diagnosis, therapy and prognosis in an exquisitely surgical point of view

A chronology of sinkholes related to artificial cavities in the hydrographic district of the Southern Apennines of Italy

Occurrence of sinkholes related to presence of artificial cavities is a very common hazard in many towns and villages of Italy, and is not limited to karst settings. Actually, the use of underground by humans involved a large part of the Italian territory, due to its very long historical and cultural history. At some locations, such a use has been so extensive that, in the historical part of towns, it is very difficult to find areas without subterranean voids. In the recent years, a chronological catalogue of sinkholes (of both natural and anthropogenic origin) in Italy has been published, based upon the classification of artificial cavities developed by the specific Commission of the Italian Speleological Society (Galeazzi, 2013), later on adopted at the international level by the Com-mission on Artificial Cavities of the International Union of Speleology (Parise et al., 2013). In this contribution we intend to extract and discuss the sinkholes evolution in time, related to artificial cavities. The study area covers one of the largest hydrographic districts of Europe, that is the Hydrographic District of Southern Apennines in Italy. It includes five entire Regions (Puglia, Calabria, Campania, Basilicata, Molise) and a portion of Lazio and Abruzzo Regions. Even though the catalogue is inevitably affected by inhomogeneity, due to the variety of sources used to fill the database, and the possible incompleteness of data, it offers a first analyses on the effect that sinkholes related to artificial cavities may produce on the society and infrastructures. A good knowledge of the cavity genesis and timing of sinkhole phenomena occurred in the past is the first step to be reached in order to improve the societal resiliency toward natural and anthropogenic hazards; this is particularly true in complex geological settings such as the territory of the Italian Hydrographic District of Southern Apennines

The hidden world of artificial cavities in the hydrographic district of the Southern Apennines of Italy: findings, architectural variability and risk assessment

The present paper presents the preliminary results of a study project launched on the territory of one of the largest hydrographic districts in Italy, the Hydrographic District of Southern Apennine (Autorità di Bacino Distrettuale dell’Appennino Meridionale), in southern Italy, in collaboration with the Earth and Environmental Sciences Department at the University of Bari Aldo Moro and the Engineering Department of the University of Campania L. Vanvitelli. The objective of the research is the acquisition of all available information on the presence of cavities of anthropic origin in the subsoil of the District territory, in order to provide guidelines for the analysis and characterization of artificial cavities. An accurate research was conducted of all the documentary sources that provided information on the presence of cavities. The great heterogeneity of the data acquired made it necessary to identify a homogenization and cataloging system to be connected to the classification provided by the National Commission on Artificial Cavities of the Italian Speleological Society, and which takes into account the construction typologies and those structural elements susceptible to trigger phenomena of sinkholes. Since the municipalities included in the District are 1632, a “top-down” approach was chosen for the identification of the presence of possible anthropic cavities, starting from the analysis of the Lithological Map of Italy and selecting those lithologies potentially affected by mining activities. This has reduced the number of administrative areas to check. Although the work is still preliminary, it will constitute a single document in Italy and will allow for the definition of procedures for preliminary evaluation of the stability conditions of artificial cavities