Does a decannulation protocol exist in COVID-19 patients? The importance of working in a multiprofessional team.

As a Covid Hub in Emilia Romagna, we have experienced an increasing number of tracheostomized patients, prompting us to develop a standardized decannulation protocol for COVID-19 ARDS patients. Currently, there are no guidelines or protocols for decannulation in this population, and few studies have investigated the early outcomes of tracheostomy in COVID-19 patients, with no detailed analysis of the decannulation process. We recognized the importance of mutual reliance among our team members and the significant achievements we made compared to previous decannulation methods. Through the optimization of the decannulation process, we identified a clear, safe, and repeatable method based on clinical best practice and literature evidence. We decided to implement an existing standardized decannulation protocol, which was originally designed for severe brain-damaged patients, due to the growing number of COVID-19 patients with tracheostomy. This protocol was designed for daily practice and aimed to provide a uniform approach to using devices like fenestrated cannulas, speaking valves, and capping. The results of our implementation include:expanding the applicability of the protocol beyond severe brain-damaged patients to different populations and settings (in this case, patients subjected to a long period of sedation and invasive ventilation)early activation of speech therapy to facilitate weaning from the cannula and recovery of physiological swallowing and phonationearly activation of otolaryngologist evaluation to identify organic problems related to prolonged intubation, tracheostomy, and ventilation and address proper speech therapy treatmentactivation of more fluid and effective management paths for decannulation with a multiprofessional team.

Prognostic correlations of operable carcinoma of the rectum.

Various histologic factors correlated to survival were studied in 124 patients radically operated on for rectal carcinoma in order to establish valid prognostic criteria. The total survival rate after five years was 63 percent, while in stage B1 it was 89 percent, in B2, 61 percent, and in C1, 47 percent (P less than 0.05). With regard to histotype, the survival was 83 percent in the papillary subtype of adenocarcinoma, while in the tubular subtype it was 62 percent, and 29 percent in the mucinous type (P = not significant). Vascular invasion negatively affected survival (41 percent); however, when there was no invasion, the prognosis was better (71 percent) (P less than 0.01). In evaluating histologic grading and lymphoglandular reactivity, the difference in survival rates was not statistically significant. The marked peri- and intratumoral lymphocytic infiltration gave a very good prognosis (92 percent) contrary to when reactivity was moderate (59 percent) or even absent (51 percent) (P less than 0.01). Finally, the expanding type tumor, with reference to Ming's classification of gastric carcinoma, had a much better prognosis (75 per cent) than the infiltrative type (40 percent) (P less than 0.01).

[Cystic dilatation of intrahepatic bile ducts (Caroli's disease)]. / Dilatazione cistica delle vie biliari intraepatiche (morbo di Caroli).

The AA, report two cases of congenital cystic dilation of intrahepatic biliary ducts. They consider the difficulties in diagnosis and show the ways to follow to demonstrate the pathology. They discuss the therapy and point out that resections are necessary, whereas bilio-digestive bypasses are ineffective.