Acute acalculous cholecystitis on a COVID-19 patient: a case report.

INTRODUCTION: We report an extremely rare case of acute acalculous cholecystitis on a COVID-19 patient. In our knowledge, this is the first report of laparoscopic cholecystectomy performed on a COVID-19 patient. PRESENTATION OF CASE: A COVID-19 patient was diagnosed with acute acalculous cholecystitis and a multidisciplinary team decided to perform a percutaneous transhepatic biliary drainage (PTBD) as the first treatment. SARS-CoV-2 RNA was not found in the bile fluid. Because of deterioration of the patient's clinical conditions, laparoscopic cholecystectomy had to be performed and since the gallbladder was gangrenous, the severe inflammation made surgery difficult to perform. DISCUSSION: Acalculous cholecystitis was related with mechanical ventilation and prolonged total parenteral nutrition, in this case the gangrenous histopathology pattern and the gallbladder wall ischemia was probably caused by vascular insufficiency secondary to severe acute respiratory distress syndrome of COVID-19 pneumonia. The percutaneous transhepatic gallbladder drainage (PTBD) was performed according to Tokyo Guidelines because of high surgical risk. Laparoscopic cholecystectomy was next performed due to no clinical improvement. The absence of viral RNA in the bile highlights that SARS-CoV-2 is not eliminated with the bile while it probably infects small intestinal enterocytes which is responsible of gastrointestinal symptoms such as anorexia, nausea, vomiting, and diarrhoea. CONCLUSIONS: Although the lack of evidence and guidelines about the management of patient with acute cholecystitis during COVID-19 pandemic, laparoscopic cholecystectomy, at most preceded by PTGBD on high surgical risk patients, remains the gold standard for the treatment of acute cholecystitis on COVID-19 patients.

[Methylene blue test for the determination of viability of free larvae of Trichinella spiralis]. / Coloración de azul de metileno como alternativa para determinar la viabilidad de larvas libres de Trichinella spiralis.

The present research was carried out with the purpose of determining whether or not the methylene blue test could also evidence viability of free larvae of Trichinella spiralis, taking into account its usefulness in the determination of viability of protoscolices in Echinococcus granulosus. To this end, three T. spiralis larval suspensions (M1, M2 and M3) were used, each containing 500 free larval stages. A hundred microl of methylene blue solution 1:10000 in distilled water were added to 100 microl of the larval suspension. Larvae were observed under optical microscopy to evaluate motility. M1 was exposed to -30 degrees C and could be observed on day 70, M2 was exposed to 80 degrees C during 5 minutes and it was immediately observed under optical microscopy, and M3 was maintained at 4 degrees C during the experiment as a 100% viability testing. Our results indicated that when T. spiralis larvae took up 100% of the methylene blue stain (M1 and M2), their inner structures appeared not only retracted but also stained blue, whereas in the M3 suspension test, larvae remained unstained and 100% of them showed their typical spiral-like movement.

Laparoscopic resection of an abdominal wall desmoid using a modified suture traction technique: the "marionette trick".

Desmoids are rare mesenchimal tumors that may originate also inside the abdomen or in the abdominal wall. These tumors are biologically characterized by a tendency to local growth, and only rarely are they able to develop distant metastases. Surgical excision usually is the best treatment with a chance of a cure. In the few reports on intraabdominal or abdominal wall desmoids, open surgery always was performed. The first case of successful laparoscopic resection of a symptomatic anterior wall desmoid tumor with intraabdominal growth is reported. During the procedure, it was difficult to mobilize and grasp the mass using the common laparoscopic instruments, but with the help of the "marionette trick," modified suture traction technique, the tumor could be removed easily using only three trocars. With four traction sutures minimizing the wall trauma, the trick made it possible to mobilize the mass in at least, seven directions, according to the principles of physical forces and vectors. This simple trick can be helpful for other common laparoscopic procedures, avoiding the insertion of sometimes ineffective instruments through more traumatic trocars.

Extravascular migration of the catheter. A rare complication of the totally implantable venous device.

Since the first report of TIVD implantation, many authors have published immediate and post-operative complications. The Authors report the first case in which the catheter, implanted via the cephalic vein by cutdown technique, has migrated completely out of the vein. In order to avoid extravascular migration, during the surgical procedure, the catheter should be fixed at the vein with nonabsorbable sutures, taking care to avoid narrowing the catheter lumen. This case report discusses the possibility of catheter migration when a TIVD fails to function properly and considers how to avoid more disastrous effects.

[Cystic lymphangioma of the pancreas: clinical case and review of the literature]. / Linfangioma cistico del pancreas: caso clinico e revisione della letteratura.

Cystic lymphangioma is a rare benign tumor that occurs more often in children with different localizations. Abdominal localization and its development may produce symptoms and clinical features of acute abdomen leading to problems in the differential diagnosis. The Authors report a rare case of pancreatic lymphangioma in a nine years old child resolved by surgical treatment. A review of the literature concerning problems of diagnosis and treatment is also presented.

Effectiveness of porto-intracaval shunt to reduce the negative effects of portal and caval clamping in the rabbit.

In performing experimental liver surgery, it is difficult to prolong anhepatic time because the animals do not tolerate prolonged portal and caval clamping. To counteract prolonged venous stasis, the authors previously developed a simple porto-intracaval shunt. The shunt consists of a self-constructed inverted Y silicone tube. The effectiveness of this shunt was studied comparing two groups of 10 rabbits with shunt (S) versus those with clamped portal and inferior caval vein (C). In the group of rabbits that underwent porto-intracaval shunt, the results concerning intraoperative mortality, intraoperative increase in distal portal vein pressure, and incidence of the histologic signs of gut damage were clearly improved. The proposed porto-intracaval shunt was therefore effective in reducing some principal negative effects of portal and caval clamping. This type of porto-intracaval shunt can be therefore useful allowing improvement of experimental models concerning liver surgery in little animals.

[Migration of the catheter of a totally implantable venous system. A rare mechanical complication]. / Migrazione del catetere di un sistema totalmente impiantabile. Una rara complicanza meccanica.

Catheter migration, represents a rare, mechanical complication following the use of totally implantable venous devices. A case, in which the catheter was inserted into the right internal jugular vein by percutaneous route, without radiological control, is described. Following the chemotherapy infusion drugs, the patient developed a catheter displacement and subcutaneous extravasation. Etiological hypotheses and modalities of prevention are discussed.

[Evolution of the technique and indications of mini-invasive surgery of cholelithiasis]. / L'evoluzione della tecnica e delle indicazioni nella chirurgia mininvasiva della colelitiasi.

BACKGROUND: A review of the experience with laparoscopic cholecystectomy to evaluate the impact of the efficacy, safety, and complications on the learning curve. STUDY DESIGN: Retrospective study. METHODS: Between 1993 and 1998, 415 patients, 123 males and 292 females, median age 52.1 years (range 23-96 years), with symptomatic cholelithiasis, underwent laparoscopic cholecystectomy. On the basis of different selection criteria and surgical techniques adopted, our experience was divided into two periods (93-95 and 96-98). RESULTS: The success rate was 89.4% (371 patients) with a conversion rate of 10.6% (44 patients). Overall complications rate was 2.9% (12 patients): 7 major complications (2 biliary tract injuries, 2 hemorrhages, 1 sub-phrenic abscess, 1 gastric perforation and 1 choleperitoneum) and 3 minor complications (1 biliary leakage and 2 wound infections) with 2 long-term sequela (umbilical site eventration). Median hospital stay was 3.3 days, 2.2 days for uncomplicated cases and 5.6 in those converted or complicated. Comparison between the two groups showed a conversion rate of 10.6 vs 10.4% (23 vs 21 patients), with a complication rate of 4.2% vs 2.2%. CONCLUSIONS: Laparoscopic cholecystectomy can be considered a safe and effective procedure for the treatment of simple or complicated cholelithiasis. French surgical technique seems to be easier in the management of acute cholecystitis or lithiasis occurring after acute pancreatitis. Specific training in laparoscopy surgery is mandatory to avoid major complications.

Ventricle morphology in pelagic elasmobranch fishes.

Ventricle weights of the warm-bodied great white shark, Atlantic shortfin mako, and the common thresher shark (the latter presumed to be warm-bodied) are similar to those of ectothermic blue sharks, sandbar sharks, dusky sharks, tiger sharks and scalloped hammerhead sharks. Ventricle muscularity, as estimated by the ratio of cortical to spongy layer thickness, is almost twice as great in the former three species than in the latter elasmobranchs. Measurements of ventricular volumes suggest that the ventricles of the great white, Atlantic shortfin mako and common thresher sharks are better adapted to respond to demands for increases in cardiac output via increased heartbeat frequency in comparison with ectothermic species of shark.

[A study of arterial pressure, pulse rate and capnogram during exhaustive muscular work performed by healthy subjects while breathing air or 100% oxygen (author's transl)]. / Andamento della pressione arteriosa, della frequenza del polso e del capnogramma durante lavoro muscolare esauriente eseguito in respirazione d'aria ambiente o di ossigeno puro

Eight untrained healthy young men were submitted to exhaustive physical exercise, performed on a bicycle ergometer while breathing either air or 100% oxygen, Arterial pressures, pulse rate and, in some instances, capnogram too were recorded during exercise and at the end of it. In the majority of subjects, 100% oxygen breathing was found to improve in some way work performance, in comparison with air breathing. However, the differences in the parameters examined appeared to be subjective and inconstant and to change according to work load levels.