Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

What's new in laparoscopic left hemicolectomy?

Whath's new in laparoscopic left hemicolectomy

Filtrazione ascitica cutanea come complicanza del posizionamento di un sistema totalmente impiantabile arterioso

Gli Autori riportano il caso di un paziente con epatopatia croni - ca affetto da colangiocarcinoma intraepatico in cui era stato posizio - nato un sistema totalmente impiantabile (STI) per effettuare chemioterapia loco-regionale. Nel post-operatorio il paziente ha avuto come complicanza il drenaggio di liquido ascitico dalla ferita cutanea della tasca alla base del torace in cui era posizionato il STI. Dopo aver discusso la probabile etiopatogenesi, gli Autori propongono gli accorgi - menti per la soluzione della problematica

Importanza del nursing nella prevenzione delle complicanze dei sistemi totalmente impiantabili

to riportato il caso clinico di un paziente sottoposto a chemioterapia in cui si è verificata una complicanza da non corret - to nursing. Il paziente, a cui era stato inserito un sistema totalmente ed impiantabile venoso ed era sottoposto a terapia antiblastica, durante un ciclo di chemioterapia ha accusato la sintomatologia dovuta allo stravaso di farmaci antiblastici. I sintomi sono regrediti rapidamente interrompendo l’infusione e non si è verificata alcuna complicanza a distanza. Gli Autori, dopo aver illustrato gli effetti collaterali dei vari far - maci antiblastici e le relative terapie, concludono puntualizzando la necessita di un corretto nursing al fine di prevenire le complicanze e di non aggravare quindi lo stato psicologico del paziente affetto da cancro

Preoperative basal computed tomography.

<p>The involvement of the psoas muscle and retroperitoneum from the Morrison's pouch up to the right iliac fossa and to the iliac region is evident (I, II). The same CT scan shows the involvement of the right thigh with the cysts localized deeply and behind the muscular aponeurotic plane of the femoral quadriceps and abductor muscles up to the knee (III, IV).</p

Postoperative computed tomography showing the outcome of the treatment.

<p>The psoas muscle has been spared despite the resection of the cysts (I, II); the right thigh is free of cysts with the conservation of the muscular structures (III, IV).</p