Observational study of clinico-radiological follow-up of COVID-19 pneumonia: a district general hospital experience in the UK.

BACKGROUND: The British Thoracic Society (BTS) recommends that all patients admitted with COVID-19 pneumonia should have a chest X-ray (CXR) and clinical follow-up at 6 or 12 weeks, depending on the disease severity. Little data is available on long-term CXR follow-up for moderate and severe COVID-19 pneumonia. This study aims to evaluate compliance with clinico-radiological follow-up of patients recovering from COVID-19 pneumonia at a local hospital in the UK, as per the BTS guidance, and to analyse radiological changes at clinical follow-up at 12 weeks, in order to risk-stratify and improve patient outcomes. METHODS: This is a single-centre retrospective audit of 255 consecutive COVID-19 positive patients admitted to a local hospital in the UK over 5 months between May and October 2020. All CXRs and clinic follow-up at 12 ± 8 weeks were checked on an electronic database. RESULTS: Over one in two (131/255) patients had CXR evidence of COVID-19 pneumonia during the initial hospital admission. Half of the patients (60/131) died before CXR or clinic follow-up. Fifty-eight percent (41/71) of the surviving patients had a follow-up CXR, and only two developed respiratory complications- one had residual lung fibrosis, another a pulmonary embolism. Eighty-eight percent (36/41) of the patients had either resolution or improved radiological changes at follow-up. Most patients who had abnormal follow-up CXR were symptomatic (6/8), and many asymptomatic patients at follow-up had a normal CXR (10/12). CONCLUSIONS: Although there were concerns about interstitial lung disease (ILD) incidence in patients with COVID-19 pneumonia, most of our patients with COVID-19 pneumonia had no pulmonary complications at follow-up with CXR. This emphasises that CXR, a cost-effective investigation, can be used to risk-stratify patients for long term pulmonary complications following their COVID-19 pneumonia. However, we acknowledge the limitations of a low CXR and clinic follow-up rate in our cohort.

Hypothermic machine preservation facilitates successful transplantation of "orphan" extended criteria donor livers.

Hypothermic machine preservation (HMP) remains investigational in clinical liver transplantation. It is widely used to preserve kidneys for transplantation with improved results over static cold storage (SCS). At our center, we have used HMP in 31 adults receiving extended criteria donor (ECD) livers declined by the originating United Network for Organ Sharing region ("orphan livers"). These cases were compared to ECD SCS cases in a matched cohort study design. Livers were matched for donor age, recipient age, cold ischemic time, donor risk index and Model for End-Stage Liver Disease (MELD) score. HMP was performed for 3-7 h at 4-8 °C using our previously published protocol. Early allograft dysfunction rates were 19% in the HMP group versus 30% in the control group (p = 0.384). One-year patient survival was 84% in the HMP group versus 80% in the SCS group (p = NS). Post hoc analysis revealed significantly less biliary complications in the HMP group versus the SCS group (4 vs. 13, p = 0.016). Mean hospital stay was significantly shorter in the HMP group (13.64 ± 10.9 vs. 20.14 ± 11.12 days in the SCS group, p = 0.001). HMP provided safe and reliable preservation in orphan livers transplanted at our center.

[Recto-vesical and recto-vesico-vaginal fistulae caused by radiotherapy for carcinoma of the uterine cervix. Surgical treatment]. / Fistulele recto-vezicale si recto-vezico-vaginale postradice dupa neoplasm al colului uterin. Tratament chirurgical.

The authors present a study based on 4 cases of fistulous communication between the terminal digestive tube and the genitourinary tract, which appeared after surgery and radiation therapy for carcinoma of the uterine cervix. The diagnosis criteria (symptoms, clinical and imagistic findings), the objectives of the surgical treatment (external digestive derivation, treatment of the fistula and reconstruction of the digestive tube), the steps of the operation and the early and late postoperative evolution are pointed out. The conclusions are shown at the end.

[Gastrojejunocolic fistula after transmesocolic gastrojejunostomy for stenotic duodenal ulcer]. / Fistula gastro-jejuno-colica dupa gastro-jejunostomie transmezocolica pentru ulcer bulbar stenozant.

The authors are presenting the case of a 53 year-old patient, suffering from type II diabetes mellitus and ankylosing spondylitis, admitted in our clinic in July 1997 for gastrojejunocolic fistula, 5 years after a transmesocolic gastrojejunostomy for obstructive chronic duodenal ulcer. The severe metabolic disorders and the radiologic aspects which led to the diagnosis, as well as the morphopathologic lesions found and the ways to approach the fistula, the stenotic duodenal ulcer and the reconstruction of the digestive continuity in a single surgical procedure are further discussed. The conclusions are shown at the end.