Venous thromboembolism in critically ill patients affected by ARDS related to COVID-19 in Northern-West Italy.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. An association between increased venous thromboembolism in patients with pneumonia-related to COVID-19 has not yet been well described. PATIENTS AND METHODS: We aimed to illustrate cases of pulmonary thromboembolism in patients with acute respiratory distress syndrome related to COVID-19 treated in our intensive care unit. The medical records of patients affected by COVID-19 with acute respiratory distress syndrome in our institute from 1/3/2020 to 31/3/2020 were retrospectively reviewed. RESULTS: Our center registered a high prevalence of thromboembolic events among 62 patients affected by acute respiratory distress syndrome related to COVID-19 despite a regular antithrombotic prophylaxis. Out of these, 32 patients were transferred to other hospitals, and 30 were treated in our center. Venous thromboembolism was registered in 12 (19.3%) cases. In particular, 11 diagnoses of pulmonary embolism and 1 diagnosis of deep vein thrombosis were formulated. We described a case series of venous thromboembolism in nine patients treated in our Intensive Care Unit (ICU). Main pulmonary arteries were always involved in these patients. None of them died. CONCLUSIONS: In conclusion, critically ill patients with ARDS related to COVID-19 may have an increased risk of VTE that could be a leading cause of mortality. These patients require a high index of clinical suspicion and an accurate diagnostic approach, in order to immediately start an appropriate anticoagulant treatment.

Type III dissection according to DeBakey. Comments on 45 cases treated.

BACKGROUND: There is uncertainty regarding the most suitable form of treatment for both chronic and even more so the acute forms of DeBakey's type III aortic dissections. This retrospective study analyses the indications and methods used in 20 acute cases and 25 chronic cases of type III dissection. METHOD: The 45 patients included in this study presented a high index of operability given that they were selected from more than one coronary unit and referred to our service for this purpose. This study also confirmed a clear indication for medical treatment in uncomplicated acute forms, whereas it is necessary to opt for surgery in the case of ongoing or threatened complications. In chronic forms aorta diameter and/or thrombosis of the false lumen are a valid parameter. RESULTS: The incidence of mortality was 33.3% in the 12 acute forms undergoing surgery, with 4 deaths; in the case of chronic forms undergoing surgery, the incidence was 15% with 3 deaths. Of the 8 patients with acute pathology who were not operated, 87.5% died; whereas of the 5 non-operated chronic patients, 60% died (3 cases). During the post-operative period rethoracotomy was only necessary in 1 case following hemothorax on day 5, whereas at a respiratory level only 50% of patients were extubated within 48 hours, and in 12 cases it was necessary to continue until day 5-7, whereas tracheostomy was performed in 5 cases. CONCLUSIONS: The modern tendency in the treatment of DeBakey's type III acute dissections is to opt for surgery not only in the presence of manifest complications, but also when faced with threatened complications or the failure of medical treatment. Chronic forms present the two key indications for surgery, namely aneurysmatic evolution of the wall (> 5-6 cm) and absent thrombosis of the false lumen.

The dacron aorta.

Total aorta replacement is a major and increasingly successful surgical procedure. The paper describes a patient whose progressive aneursymatic disease spread from the ascending segment to the bifurcation over a three-years period during which time after three separate operations, the aorta was totally replaced. The paper describes the diagnostic and surgical procedures deployed and shows the results of angiographic and CT scans. Credit for the success of the replacement is also given to the highly skilled anaesthetists and nurses involved.

[Surgery of the descending thoracic and thoraco-abdominal arteries. Report of 105 cases]. / La chirurgia dell'aorta toracica discendente e toraco-addominale. A proposito di 105 casi.

The Authors show their casistic of about 105 cases of thoracic descending and thoraco-abdominal aorta pathologies between 1.1.1993 and 30.12.1995. After a short introduction about the improvements in anesthesia and reanimation of these pathologies as well as the good reliability of diagnostic and currently available instruments, mortality and mobility parameters are taken into account, the last one referring to paraplegia and ARF. The casistic is evaluated splitting the cases into 2 groups, urgent surgery and election surgery, and differentiating the aneurysm type from the dissection type. Besides, the mortality and mobility are reported for any pathology, with a discussion of the parameters which drove the choice of the most suitable methodology to be adopted (ECC femoro-subclavian shunt, simple clamping). The results achieved show a mortality of 40% in urgency, between 5 and 15% in election, with a rate of paraplegia around 8-10% and a ARF between 5 and 15%. These data match the literature statistics and support the quality of the adopted methodologies.

[The superior vena cava occlusion syndrome. A case of neoplastic thrombosis due to hepatocarcinoma and cirrhosis]. / Sindrome da occlusione della vena cava superiore. Su di un caso di trombosi neoplastica da epatocarcinoma su cirrosi.

The authors report their experience with 11 patients, surgically treated since 1990, affected with superior vena cava syndrome. A peculiar case of neoplastic thrombosis in hepatocarcinoma is stressed. In fact a similar case hadn't been reported in the last ten-year literature, although hepatocarcinoma may spread in different organs. A subject review and a discussion are presented.

Surgical treatment of carotid kinking.

The authors take in exam 34 anatomical variation in the extracranial internal carotid artery (compared with more than 450 operated carotid artery), 15 of which involved kinking in patients with overt neurological symptoms, underwent corrective surgical treatment, and test the most useful and appropriate techniques in any case.

[Malignant fibrohistiocytoma arising at a femoral dacron vascular prosthesis. Case report and review of the literature]. / Fibroistiocitoma maligno comparso in sede di protesi vascolare di dacron a livello femorale. Case report e rassegna della letteratura.

In a recent publication, reporting the sixth case of aortic angiosarcoma, probably induced by the implantation of a dacron vascular prosthesis, Weiss et al. have done a literature review concerning the association between the presence of vascular prostheses and the onset of mesenchymal neoplasms. Although they consider the incidence of this association very low, they also point out the hypothesis, largely supported by experimental studies, that vascular prostheses can play the role of aetiological co-factor or factor in the onset of these tumors. We consider useful to report a case of malignant fibro histiocytoma arising around a femoral vascular prosthesis in a patient operated on for aneurysm of the femoral artery.

[Buerger disease. Report of an case, unusual for its site and clinical manifestations]. / Malattia di Buerger. Descrizione di un caso inusuale per sede e manifestazioni cliniche.

The diagnosis of Buerger's disease, like that of all arteritis, especially in the onset phase, can be difficult. The general criteria proposed by several authors, with the aim of codifying the verification of the disease, are sometimes too schematic and this collides with the existence of very variegated and polymorphous clinical situations, as well as totally atypical and unusual clinical patterns. On this subject we consider useful to report a case of Buerger's disease that presented some peculiar characteristics, the most important of which was the existence of an aneurysm of the left superficial temporal artery.

[Intraoperative microbiological monitoring in abdominal aortic aneurysms in elective surgery. A review of the literature and the authors' personal experience]. / Il monitoraggio microbiologico intraoperatorio negli aneurismi dell'aorta addominale operati in elezione. Revisione della letteratura ed esperienza personale.

Thirty-one patients, ranging in age from 57 to 78 years (mean 66), with the exclusion of cases with doubtful possible results, underwent abdominal aortic aneurysmectomy for asymptomatic AAA and had cultures from the aneurysmal wall and endovascular thrombus to identify possible microbiological source of future graft infection; 5 (16%) of 31 cultures yielded bacterial growth and the most common organism isolated was staphylococcus epidermidis. During an average follow-up of 15.4 months no graft infection was noted in patients with positive or negative aortic cultured. A literature review stresses the same disparity between positive cultures obtained at the aneurysmectomy and subsequent low graft-infection rate. It is concluded that the aneurysm wall itself does not represent an important source of early or late graft infection and it's suggested that the bacterial presence both in the wall and thrombus could be explained by an exogenous contamination at the operation time.

[The clinical and socioeconomic aspects of cerebrovascular diseases in Europe (a study in Turin on patients during 12 years of hospitalization)]. / Consideraciones clínicas y socioeconómicas sobre las enfermedades cerebrovasculares en Europa (estudio en Torino efectuado en enfermos durante 12 años de hospitalización).

During the period 1976-1987, 295,718 patients affected by vascular diseases have been admitted into all the public and private hospitals of Piemonte (Italy): 172,483 patients were affected by arteriopathies. 95,231 (55.2%) have been admitted because of cerebrovascular diseases: 73,511 (42.6%) were affected by diffuse form (T), 18,258 (26.5%) by TIA and 3,462 (2%) by precerebral stenosis and occlusions. (TSA). These data have been compared to the incidence of cerebrovascular disease in Europe and risk factors, sex, age, department of hospitalizations, kind of therapy and results have been investigated. In Piemonte cerebrovascular diseases show not only the highest incidence among all the vascular diseases, but they seem to be the highest cause of morbidity among all the patients admitted into the hospitals.

[Incidence of aortic aneurysms in Piedmont]. / Incidenza degli aneurismi aortici in Piemonte.

A retrospective clinico-epidemiological study of the incidence of all arteriopathy hospitalization in the Region of Piemonte over a twelve year period (1976-1987) has been performed: among all the cases, patients affected by aortic aneurysm show an average of hospitalization of 0.8 cases per 24 hours. The prevalence of the sex has been pointed out for males (75.5% versus 24.3% of females): the men showed a higher rate independently from the age. The most involved age groups are for population between 70 and 74 years, but, from 1976 up to 1987 we have observed a more homogeneous distribution than in the first considered cases when it was mainly for patients aged more than 70 years. We have to stress a curious and not under standable datum regarding the kind of therapy: patients were treated medically in 69.4% of cases, while surgery was carried out only in 27.9%, but, fortunately, since 1976, we have noticed a continuous increase of surgery up to 40% in 1987. Hospitalizations have regarded the wards of Internal medicine in 24% of cases, while both General Surgery and Vascular Surgery showed rates of 23% and 25%. The average hospitalization time has been lower if compared to that of all the arteriopathies: 14.4 days versus 22.5. Furthermore we have to point out a decrease in average days of hospitalization for aneurysms of the aorta and a decrease in the costs for this pathology. Mortality is still high, also if referred to the non-operated patients: in fact the mean is 25.5% with a low rate of necropsies (mean 29%).