Early Lung Ultrasound Findings in Patients With COVID-19 Pneumonia: A Retrospective Multicenter Study of 479 Patients.

OBJECTIVES: Lung ultrasound (LUS) holds the promise of an accurate, radiation-free, and affordable diagnostic and monitoring tool in coronavirus disease 2019 (COVID-19) pneumonia. We sought to evaluate the usefulness of LUS in the diagnosis of patients with respiratory distress and suspicion of interstitial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, in comparison to other imaging modalities. METHODS: This was a multicenter, retrospective study. LUS was performed, on Emergency Department (ED) arrival of patients presenting for possible COVID-19 evaluation, by trained emergency physicians, before undergoing conventional radiologic examination or while waiting for the report. Scans were performed using longitudinal transducer orientation of the lung regions. CXR was interpreted by radiologists staffing ED radiology. Subjects were divided into two group based on molecular test results. LUS findings were compared to COVID test results, nonlaboratory data, and other imaging for each patient. Categorical variables were expressed as percentages and continuous variables as median ± standard error. RESULTS: A total of 479 patients were enrolled, 87% diagnosed with SARS-CoV-2 by molecular testing. COVID positive and COVID negative patients differed with respect to sex, presence of fever, and white blood cells count. Most common findings on lung point of care ultrasound (POCUS) for COVID-positive patients were B-lines, irregular pleural lines, and small consolidation. Normal chest X-ray was found in 17.89% of cases. CONCLUSIONS: This 479 patient cohort, with COVID-19, found LUS to be noninferior to chest X-ray (CXR) for diagnostic accuracy. In this study, COVID-positive patients are most likely to show B lines and sub-pleural consolidations on LUS examination.

Extended Lymphadenectomy in Locally Advanced Rectal Cancers: A Systematic Review.

PURPOSE: The surgical treatment of advanced low rectal cancer remains controversial. Extended lymphadenectomy (EL) is the preferred option in the East, especially in Japan, while neoadjuvant radiotherapy is the treatment of choice in the West. This review was undertaken to review available evidence supporting each of the therapies. METHODS: All studies looking at EL were included in this review. A comprehensive search was conducted as per PRISMA guidelines. Primary outcome was defined as 5-year overall survival, with secondary outcomes including 3-year overall survival, 3- and 5-year disease-free survival, length of operation, and number of complications. RESULTS: Thirty-one studies met the inclusion criteria. There was no significant publication bias. There was statistically significant difference in 5-year survival for patient who underwent EL (odds ratio, 1.34; 95 confidence interval, 0.09-0.5; P=0.006). There were no differences noted in secondary outcomes except for length of the operations. CONCLUSION: There is evidence supporting EL in rectal cancer; however, it is difficult to interpret and not easily transferable to a Western population. Further research is necessary on this important topic.

Right Colectomy for Cancer: A Matched Comparison of Three Different Surgical Approaches.

PURPOSE: The standard approach to right colon cancer resection is still a matter of debate and includes laparoscopy, open midline incision, or open transverse incision. We aimed this study to compare the short- and long-term results of laparoscopic right-colectomy with those provided by the open approaches. METHODS: Of the 176 patients who underwent right-colectomy at our Department for nonmetastatic colon cancer, 40 patients treated by laparoscopy, 40 treated by transverse incisions, and 40 treated by midline incisions were selected and matched using the propensity score method. Short-term results included: operating time, morbidity rate, number of lymph-nodes harvested (LNH), patients' recovery features, and costs. Long-term results included: disease-specific survivals and the rate of incisional hernias. The sub-groups were compared using t-test and Chi-square tests, whereas the Kaplan-Meier method was used to assess survivals. RESULTS: Laparoscopies were the longer procedures, providing similar morbidity rates and LNH in comparison with the open approaches. Laparoscopy provided a faster return to oral intake and a shorter use of analgesics comparing with the midline approach; however, it showed only a minor consumption of analgesics in comparison with transverse laparotomy. There were no differences in the hospital stay and the long-term results were comparable between sub-groups. Costs analysis documented minor but not significant surgical expenses for the transverse approach. CONCLUSIONS: Laparoscopy was documented safe, with similar morbidity rates and long-term results comparing with open surgery. Laparoscopy provided better functional short-term results comparing with the midline approach, but only small differences with respect to the transverse incision approach.

Synchronous gastric adenocarcinoma and pancreatic ductal adenocarcinoma.

BACKGROUND: The association between gastric and pancreatic carcinoma is a relatively rare condition. In gastric carcinoma patients, the prevalence of second tumors varies 2.8% to 6.8% according to the reported statistics. Gastric cancer associated with pancreatic cancer is uncommon. METHODS: We report a case of a 73-year-old patient hospitalized for vomiting and weight loss. Esophagogastroduodenoscopy demonstrated an ulcerative lesion of the gastric antrum. Computed tomography and magnetic resonance showed a gastric thickening in the antral and pyloric portion and a nodular mass (3 X 1.7 cm) in the uncinate portion of the pancreas. RESULTS: The patient underwent pancreaticoduodenectomy according to Whipple regional type I Fortner. Histological examination of the specimen demonstrated a moderately differentiated adenocarcinoma of the stomach and a poorly differentiated ductal adenocarcinoma of the pancreas. CONCLUSIONS: Long survival is rare in patients with associated gastric and pancreatic cancer. Surgical resection remains the only potentially curative treatment.

Triple synchronous tumours of the urinary system with different histologies: a case report.

We present the case report of a male patient with a diagnosis of synchronous kidney, bladder and prostate tumours with different histologies: renal oncocytoma, urothelial carcinoma of the bladder, and adenocarcinoma of the prostate. This is the first case report described in the literature in which a complete surgical resection of triple tumours has been performed with surgery in a single session. Recent advances in the field of genetics enable the surgeon to hypothesise new strategies in the early treatment of synchronous tumours, particularly when a number of common tumour markers are positive. One such marker recently identified is the prostate-specific membrane antigen (PSMA), present with high expression in carcinoma of the prostate and in the vascular endothelium of solid tumours; only overexpression of PSMA is to be regarded as diagnostic, inasmuch as this antigen is normally expressed in the renal tubular epithelium. Recent knowledge in the field of genetics has led to new strategies for the early treatment of synchronous tumours, but clinical data and instrumental diagnostics are still of fundamental importance, in that they may enable the surgeon to diagnose the presence of synchronous tumours at an early stage. The execution of prompt surgical treatment remains of basic importance for the purposes of guaranteeing oncological radicality also of synchronous tumours, in association with more sensitive and accurate instrumental diagnostics.

A rare case of aggressive squamous-cell carcinoma of the breast skin: Marjolin's ulcer. A case report.

Marjolin's ulcer is an epidermoid carcinoma arising in a scar or chronic wound and is characterised by an aggressive course. We present a clinical case of ulcerated skin carcinoma of the breast arising in an 80-year-old woman, who at history taking reported a burn occurring 30 years earlier on the breast skin, with subsequent chronic ulcerative scar formation. The definitive histological examination identified a "squamous-cell carcinoma of the breast skin". We have assessed this case and reviewed the literature on Marjolin's ulcer. The patient presented a metastatic relapse of local disease after aggressive surgical treatment. In the clinical history of patients with chronic ulcers it is important to analyse the morphological changes with biopsies and subsequently with the most appropriate diagnostic techniques for the purposes of early initiation of a therapeutic program, since, in the advanced stages, even an aggressive surgical treatment may prove inadequate.