Vein wall thickness and severity of pulmonary involvement due to sars n-cov2 virus infection.

BACKGROUND: An observational study involving patients recovered from COVID-19 was conducted in order to evaluate the presence/absence of vein wall thickness increasing, according to the severity of pulmonary involvement quantified with a CT-scoring system. METHODS: The venous wall thickness (VWT) of 31 patients (23 males and 8 females) with COVID 19 previously admitted to Federico II University Hospital of Naples was evaluated through ultrasound measurement of the common femoral Vein 1 cm proximal to the saphenous-femoral junction and the popliteal Vein 1 cm distal to the confluence of gemellary veins. Measurements were taken with an automated tool to avoid human error. All patients were evaluated in the supine position. Patients were then stratified into two groups, VWT > 1 mm and VWT < 1 mm. Lung damage was assessed through thoracic High Resolution Computer Tomography and subsequently quantified using the scoring system set out by Chung et al. CEAP-C class was calculated for all patients. RESULTS: The mean value of COVID score in VWT > 1 mm group was 7.4 (S.D. 4.83), whilst the mean value of the COVID score in the VWT < 1 mm group was 3.82 (S.D 3.34). These findings were determined to be statistically significant in a two-tie Student-T test. The linear regression test between VWT and Covid score values demonstrated a direct relationship between the two variables. CONCLUSION: These results demonstrate a link between two different aspects of the pathological effects on the vessels during a SARS-COV 2 infection. As such a common primum movens can be hypothesized in both micro-thrombotic and inflammatory processes relating to COVID 19.

Minimally invasive ileocecal valve resection in ileocecal Crohn's disease.

AIM: Considering ileocolic resection as a surgical standard for the treatment of ileocecal valve Crohn's disease, we propose a limited resection of the terminal ileum and ileocecal valve with ileocecal anastomosis. MATERIAL OF STUDY: Three patiens between 20 and 37 years of age, diagnosed with Crohn's disease unresponsive to medical therapy, who have stenoses or fissures confined to the terminal ileum and ileocecal valve, seen during instrumental investigations. RESULTS: The proposed procedure allowed us to perform a minimal resection and reconstruction of a new ileocecal valve. Once the symptoms have resolved, at endoscopic follow ups, at 6 and 12 months after surgery, there were no changes in the mucosa of the ileocecal neo-anastomosis. DISCUSSION: Since Crohn's disease is a systemic disease with a chronic relapsing course complicated by a high rate of post-surgical relapses, it is essential to limit the extension of resections to the macroscopically involved tissues and reduce the anastomotic surfaces. The proposed surgical procedure allows to preserve the caecum and the colon with an optimal postoperative course. CONCLUSION: We believe that, with specific clinical and endoscopic conditions, the treatment we illustrated can be proposed to other patients as an alternative to the standard VL ileocolic resection. KEY WORDS: Crohn's Disease, Ileocaecal Valve, Ileocaecal Anastomosis.

Surgical treatment in late-stage gastric cancer. A retrospective analysis of 26 cases.

BACKGROUND: Gastric cancer represents the fourth most common form of cancer and the second most common cause of death in the world. It is also one of the most common cancers leading to mortality in Italy. Therefore, this study aimed to determine the survival rate of patients with advanced gastric cancer and its affecting factors in our experience at AOU Federico II. METHODS: 26 patients with late-stage T4N2M0 and T4N2M1 gastric cancer that were diagnosed and registered during 2008 to 2018 in Federico II Surgical department, were studied. All patients were followed to the end of 2019. Kaplan-Meier method was used to draw survival curves and to determine the effective factors on the survival rate of surveyed patients. Moreover, Log-rank test was used to evaluate whether or not survival curves for different patients, related to residual tumor, are statistically equivalent (p<0.05). RESULTS: The mean age of the study population was 49±29, and most of them were males (57,8% (15 patients). After diagnosis, the survival rates for 1, 2, 3 and 4 years, were 26,9%, 11,5 %, 3,8%, 19,2 %; 11,5% of patients with residual tumors survived 6 months respectively. Overall average survival was of 20.61 sd 17.52 months with a median of 12. No statistical difference was detected in terms of survival among M0 and M1 sub-groups. CONCLUSION: Based on the findings of the present study, T4 gastric cancer has a poor prognosis. Survival rate was decreased over time after diagnosis. Tumoral stage at the time of diagnosis is the most important factor affecting the survival of surveyed patients. This shows that there is a crucial need to diagnose the gastric cancer in early stages. KEY WORDS: Advanced gastric cancer, Surgical techniques, Therapy.

Male breast cancer: an update.

PURPOSE: To summarize and compare the most recent data from the literature to clarify the management of male breast cancer. METHODS: A review article. RESULTS: Diagnosis and Treatment of Male Breast Cancer have been derivative for years. Nowadays MBC is a nosological entity in its own right with biological, molecular and clinical features that require a multidisciplinary approach and the involvement of specific skills. Multimodal treatment involves surgery, radiotherapy and chemotherapy. It is evident that the outcome of the MBC is worse than the female one. MBC is often diagnosed in advanced stages. Screening programs in the male population need to be strengthened to obtain an earlier diagnosis. It is necessary to know even more in depth the endocrine-metabolic and behavioral risk factors related to the neoplasm. Finally in the coming years it is reasonable to expect an improvement in multigenic tests: the sensitivity of these methods could predict the risk of recurrence even more precisely. This could lead to substantial changes in the choice and duration of treatment with results that could be surprising. KEY WORDS: Male breast cancer, Management, Review, Update.

Outpatient vascular clinic management in COVID-19 pandemic.

INTRODUCTION: The recent Sars-CoV2 pandemic has dramatically slowed patients' access to our clinic for vascular pathology when the contagion curve peaked. The need to restore the assistance activity has led us to adopt new individual prophylaxis and hygiene measures. METHODS: Doctors and staff must wear dedicated clothes. Mask and gloves are mandatory for patients. A visit is scheduled every 60 minutes to allow the sanitation of the rooms. The day before the visit patients are contacted by telephone for the Covid-19 risk triage. In the presence of symptoms the visit is postponed. In the presence of other risk factors a IgG/IgM Rapid Test for Covid-19 is performed on admission to the clinic. In the presence of fever, if an extraordinary rapid test cannot be performed, the visit must be postponed. Rapid test positive patients cannot be visited: they are placed in solitary confinement at their home waiting for a nasopharyngeal swab for Covid-19. When the rapid test is positive, immediate room sanitation also occurs. The rooms dedicated to the outpatient clinic as well as medical and not medical instruments are disinfected. CONCLUSION: The one adopted can be a useful management model for any type of care activity in order to guarantee the safety of patients and all the staff. KEY WORDS: COVID-19, Management, vascular, Outpatient clinic.

CGF Treatment of Leg Ulcers: a Randomized Controlled Trial.

BACKGROUND: Concentrated Growth Factors (CGF) is a concentration of second generation autologous growth factors compared to platelet rich plasma (PRP) and represents a multifactorial stimulation system that can be used for the management and treatment of chronic skin ulcers. AIM: The aim of this work is to evaluate the additional benefits of the CGF compared to the standard of dressing and its effects on the dynamics of the healing process. METHODS: Autologous CGFs were obtained from 100 patients with chronic mixed ulcers (venous ulcers in patients with II stage claudication) of the lower limbs in a multicentric controlled randomized study. RESULTS: The results showed a significant advantage in the use of CGF in association with cleansing and selective compression in the healing time and stabilization of mixed ulcers of the lower extremities. CONCLUSIONS: These results support the CGF's clinical use for improving clinical outcomes in mixed ulcers of the legs.

Surgical Versus Sequential Hybrid Treatment of Carotid Body Tumors.

Carotid body tumor (CBT) are slow-growing tumors that develop in the cervical region at the carotid bifurcation. . In a randomized study, 33 patients were treated for CBT excision: 10 patients performed preoperative embolization (PE) and 23 were treated only by isolated traditional surgery (N-PE). The first group includes patients undergoing preoperative embolization. The second group of patients (N-PE) included 11 males and 12 females. Intraoperative complications were lower in patients treated with a hybrid procedure (PE): sections of the cranial nerves were recorded in 7% of cases compared to 12% of the surgical procedure (P-value = 0.72); while the reversible nerve lesions (P value = 0.21) and the permanent ones (P value = 0.46), were instead similar in both procedures. The comparative blood loss during the operative procedure shows a P-value of 0.02. Operating times, reversible damage of the cranial nerves , incidence of stroke (0% vs1%, P value> 0.99) and post-operative hospital stay (4.1 vs. 4.2 days, P value = 0.91) did not show differences in the two groups of patients. The analysis of the results detects pre-operative embolization of CBT in reducing intraoperative blood loss and resection of the cranial nerves..