Severe blunt renal injury after motorcycle accident: failure of the conservative management.

We report the case of a patient who presented after a motorcycle accident a grade IV kidney lesion primarily treated with a NOM, which failed. We discuss the possibility at admission to select a subgroup of patients with a high grade (IV and V) kidney trauma in whom NOM might fail. KEY WORDS: Kidney Trauma, High grade renal trauma, Non operative management.

Idiopathic spontaneous liver hemorrhage A report of two cases and a review of the literature.

Spontaneous liver hemorrhage (SLH) is a serious, extremely rare, and life-threatening occurrence requiring a multidisciplinary approach. Since diagnosis might be difficult, a high mortality rate is reported. Survival depends on a prompt diagnosis followed by an appropriate management. If left untreated, SLH progresses, in fact, to a hemorrhagic shock and death. SLH is rarely idiopathic, whereas more commonly is secondary to severe preeclampsia and HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) syndrome, hepatocellular carcinoma (HCC), adenoma, focal nodular hyperplasia or hemangioma, and connective tissue diseases. We report two patients presenting with an idiopathic SLH successfully treated with angioembolization, and the results of an extensive literature review. KEY WORDS: Intrahepatic hematoma, Spontaneous liver hemorrhage, Spontaneous liver rupture.

Is Lung Ultrasound Imaging a Worthwhile Procedure for Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia Detection?

OBJECTIVES: We compared 2 imaging modalities in patients suspected of having coronavirus disease 2019 (COVID-19) pneumonia. Blinded to the results of real-time reverse transcriptase polymerase chain reaction (rRT-PCR) testing, lung ultrasound (LUS) examinations and chest computed tomography (CT) were performed, and the specific characteristics of these imaging studies were assessed. METHODS: From March 15, 2020, to April 15, 2020, 63 consecutive patients were enrolled in this prospective pilot study. All patients underwent hematochemical tests, LUS examinations, chest CT, and confirmatory rRT-PCR. The diagnostic performance of LUS and chest CT was calculated with rRT-PCR as a reference. The interobserver agreement of radiologists and ultrasound examiners was calculated. Ultrasound and CT features were compared to assess the sensitivity, specificity, positive predictive value, and negative predictive value. Positive and negative likelihood ratios measured the diagnostic accuracy. RESULTS: Nineteen (30%) patients were COVID-19 negative, and 44 (70%) were positive. No differences in demographics and clinical data at presentation were observed among positive and negative patients. Interobserver agreement for CT had a κ value of 0.877, whereas for LUS, it was 0.714. The sensitivity, specificity, positive predictive value, and negative predictive value of chest CT for COVID-19 pneumonia were 93%, 90%, 85%, and 95%, respectively; whereas for LUS, they were 68%, 79%, 88%, and 52%. On receiver operating characteristic curves, area under the curve values were 0.834 (95% confidence interval, 0.711-0.958) and 0.745 (95% confidence interval, 0.606-0.884) for chest CT and LUS. CONCLUSIONS: Lung ultrasound had good reliability compared to chest CT. Therefore, our results indicate that LUS may be used to assess patients suspected of having COVID-19 pneumonia.

When Less Invasive Causes Major Sequelae: A Dramatic Evolution of an Infected Common Femoral Artery Patch.

Endarterectomy of the common and profunda femoris is currently performed for treatment of atherosclerotic lesions involving femoral bifurcation. Misperception of surgical risk in terms of morbidity and mortality has induced the trend to extend the indication for treatment to patients with mild symptoms at presentation, at the cost of unnecessary increased complication rate and mortality risk, which persists even after patient discharge. We report the case of a giant infected femoral pseudoaneurysm occurring in a 74-year-old patient, previously treated with femoral artery endarterectomy with prosthetic patch closure because of mild claudication. Surgically managed with en block resection and autologous vein reconstruction, his postoperatory course was further complicated by fatal sepsis. Complications for femoral artery endarterectomy, including infectious and fatal events, need a close follow-up of these patients to promptly diagnose and treat any event which may occur, preventing its evolution to more challenging and potentially life-threatening clinical scenario.

Intraoperative ultrasound and 5-ALA: the two faces of the same medal?

BACKGROUND: High Grade Gliomas (HGG) still remain the most demanding neuro-oncological challenge. Several studies have confirmed that the extent of resection (EOR) correlates with increased survival in patients with HGGs. The Gross Total Resection (GTR) of HGGs can be difficult and challenging. For this reason, technologies to improve EOR have been of interest. The aim of this paper is to analyze advantages and limitations of both intra-operative fluorescence and intra-operative ultrasound (IOUS) resection techniques. METHODS: Our work deals with the comparison of one group of 15 patients treated with both tools (study group) with a control group of 15 patients in where only fluorescence was used. Post operative outcome are valued using Karnofsky Performance Status scale (KPS) while EOR are valued with MRI within 24 h after surgery. RESULTS: The difference between the postoperative KPS and between EOR in the 2 groups resulted not statistically significant considering p<0.05. In our experience 5-ALA has a limited sensitivity before starting resection while shows it's central role in identifying the tumor remnants after its removal. Conversely, IOUS is very useful in identifying the tumor before starting resection. After the tumor removal, the sensitivity of the ultrasound in identifying tumor remnants in the margins of the cavity decreased significantly. However, in one case, at the end of resection, we have not visualized any fluorescent tissue but we detect a residual of tumor using the IOUS. CONCLUSIONS: In our preliminary experience we observe that there are no significative advantages using IOUS plus 5-ALA. However we feel that IOUS is useful in first step of resection and fluorescence in the latest steps of operation. Therefore these two technologies could be considered the two faces of the same medal because they can help the surgeon to detect the tumor in all step of tumor removal.