Advanced stage empyemas in community-acquired pneumonia: how hospital re-organization during the Covid-19 pandemic affected the increase in surgically treated cases.

The cause of pleural empyema is bacterial pneumonia and three stages has been described in the evolution of this disease: exudative, fibrino-purulent and organizational phases. The first therapeutic intervention is the antibiotic therapy; where pharmacological therapy alone is not sufficient to eradicate the infection, it is also necessary a surgical treatment. Since the province of Piacenza having been in the epicenter area during the first Sars-Cov 2 pandemic wave in March 2020 and the number of patients with Covid-related pneumonia required invasive and non-invasive respiratory support, had a considerable organizational impact on pulmonology and respiratory unit, hindering an optimal treatment of the bacterial pneumonia both in community as well as in the hospital. Among the many "collateral" damages of the epidemiological wave of the infection with Sars Cov-2, we have been able to observe in our Hospital, also an increase of pulmonary empyemas diagnosed at an advanced stage for what we believe to be organizational and social causes directly related to the pandemic: in order to cope with the emergency the Unit of Pneumology has been since March nearly uninterruptedly dedicated to the exclusive treatment of covid patients so the pneumologist has been removed due to the need from outpatient and residential management of general pneumology.

Left diaphragmatic rupture in vehicle trauma: Report of surgical treatment and complications of two consecutive cases.

BACKGROUND AND AIMS: Diaphragmatic ruptures are associated with blunt abdominal or thoracic trauma and often occur in car and motorbike accident with a high energy impact. CASE PRESENTATION: We report two cases of patients victims of car and motorbike accidents that were referred to the Emergency Department of our Hospital in August and September 2017 for a politrauma. The patients were both diagnosed with a left diaphragmatic rupture with herniation of the stomach in the chest, and decomposed fractures of the ribs. One of the two patients reported a large abdominal wound with loss of substance in the site of the impact. Both patients underwent to open emergency surgery with primary repair of the phrenic rupture. The post-operative course was characterized by the occurrence of complications such as respiratory distress and emothorax for one of the patients. CONCLUSION: Traumatic rupture of the diaphragm can be associated to blunt or penetrating abdominal trauma in car and motorbike accident with a prevalence of the left-sided lesions. In patients with politrauma an associate rupture of the diaphragm should be always suspected especially in motor accident where high energy impact can generate a traumatic laceration of the respiratory muscle. The treatment of associate thoracic wall fractures to prevent weaning and respiratory distress in intubated patient should be discussed.

Serum ferritin levels in inflammation: a retrospective comparative analysis between COVID-19 and emergency surgical non-COVID-19 patients.

BACKGROUND: SARS-CoV-2 infection has spread worldwide, and the pathogenic mechanism is still under investigation. The presence of a huge inflammatory response, defined as "cytokine storm," is being studied in order to understand what might be the prognostic factors implicated in the progression of the infection, with ferritin being one of such markers. The role of ferritin as a marker of inflammation is already known, and whether it changes differently between COVID and non-COVID patients still remains unclear. The aim of this retrospective analysis is to understand whether the inflammatory process in these two types is different. METHODS: In this retrospective analysis, we compared 17 patients affected by SARS-CoV-2, who had been admitted between February and April 2020 (group A) along with 30 patients admitted for acute surgical disease with SARS-CoV-2 negative swab (group B). A further subgroup of Covid negative patients with leukocytosis was compared to group A. RESULTS: In group A, the median (interquartile range) serum ferritin was 674 (1284) ng/mL, and it was double the cutoff (300 ng/mL) in 9 out of 17 (52%). The median (IQR) value of ferritin level in the total blood samples of group B was 231, and in the subgroup with leucocytosis, 149 (145). Group A showed a significantly higher ferritin median level compared to the entire group B (two-tailed Mann-Whitney test, p < 0.0001) as well as to the subgroup with leucocytosis (p < 0.0014). CONCLUSIONS: The role of iron metabolism appears to be directly involved in COVID infection. On the other hand, in the acute inflammation of patients admitted for surgery, and probably in other common phlogistic processes, iron modifications appear to be self-limited. However, our finding suggests the use of ferritin as a marker for COVID infection.

Ladd's band in the adult, an unusual case of occlusion: Case report and review of the literature.

INTRODUCTION: Malrotation of gut is a congenital anomaly of foetal intestinal rotation and it is mostly discovered in early childhood as acute intestinal obstruction. This condition is very rare and often silent in adults. PRESENTATION OF CASE: We present a case of 44-year-old woman admitted with acute abdominal pain. The abdominal CT scan showed ileal conglomerate loops with thickened walls filled of liquid in the right iliac side. Laparotomic Ladd's procedure was performed successfully with division of Ladd's band, adhesiolysis, reconstruction of Treitz's ligament, small bowel resection and Merckel's diverticulum removal. The patient made an unremarkable recovery. DISCUSSION: We discuss the rarity of intestinal malrotation in adulthood and made a literature review comparison of the therapeutic options available. CONCLUSION: Intestinal malrotation is a rare entity and adult presentation is even rarer. Some cases are asymptomatic, but when symptomatic a volvulus should be promptly suspected to avoid complications such as bowel ischemia.

Small interventions in outpatient surgery: Project of Advanced Nursing Skills.

The research analyzes data on the impact of the introduction of the figure nursing with advanced skills, "Advanced Skills" , in diagnostic and therapeutic surgical clinics within the Hospital of Piacenza. This is the application of the testing on the Project of Nursing "Skills"on advanced minor surgery "Minor Surgery", an outpatient procedure. They were given the satisfaction questionnaires to users and to the medical and nursing staff of the USL in Piacenza. The aim of the study was to verify the contention of the literature about the usefulness of an increased use of nursing skills within an ambulatory surgery to improve the quality of care and consequently to a higher user satisfaction. In light of the findings of the research, the ' impact of the implementation of the Project Advanced Nursing Skills has been positive, both among users is that health care providers. For a functional and effective management of the surgery may be useful to train a new nursing characterized by the possession of "Advanced Skills" whose "mission" is to develop more knowledge, share knowledge, as well as to foster innovation organizational and management to meet the demands of public health.