The expansion of coronavirus disease 2019 (COVID-19) prompted measures of disease containment by the Italian government with a national lockdown on March 9, 2020. The purpose of this study is to evaluate the rate of hospitalization and mode of in-hospital treatment of patients with chronic limb-threatening ischemia (CLTI) before and during lockdown in the Campania region of Italy. The study population includes all patients with CLTI hospitalized in Campania over a 10-week period: 5 weeks before and 5 weeks during lockdown ( n = 453). Patients were treated medically and/or underwent urgent revascularization and/or major amputation of the lower extremities. Mean age was 69.2 ± 10.6 years and 27.6% of the patients were women. During hospitalization, 21.9% of patients were treated medically, 78.1% underwent revascularization, and 17.4% required amputations. In the weeks during the lockdown, a reduced rate of hospitalization for CLTI was observed compared with the weeks before lockdown (25 vs 74/100,000 inhabitants/year; incidence rate ratio: 0.34, 95% CI 0.32–0.37). This effect persisted to the end of the study period. An increased amputation rate in the weeks during lockdown was observed (29.3% vs 13.4%; p < 0.001). This study reports a reduced rate of CLTI-related hospitalization and an increased in-hospital amputation rate during lockdown in Campania. Ensuring appropriate treatment for patients with CLTI should be prioritized, even during disease containment measures due to the COVID-19 pandemic or other similar conditions.

Ultrasound (US) is highly accurate in the diagnosis of small bowel obstruction (SBO). Because the indications for and timing of surgical intervention for SBO have changed over the past several decades, there is a widespread assumption that the majority of patients with simple SBO may be conservatively managed; in this scenario, staging SBO is crucial. This study evaluated the association between morphological and functional US signs in the diagnosis and staging (simple, decompensated and complicated), and the associations and prevalence of US signs correlated with clinical or surgical outcome. The US signs were divided into diagnostic (dilated bowel loops and altered kinesis) and staging criteria (extraluminal free fluid, parietal and villi alterations). We performed a retrospective, single-center cohort, observational study examining the prevalence of morphologic and functional US signs in the staging of simple, decompensated and complicated SBO. The most significant US signs were dilated bowel loops (100%), hypokinesis (90.46%), thickened walls (82.54%) and free fluid (74.60%). By linear regression, free fluid was positively correlated to US staging in both univariate and multivariate analysis; that is, the more advanced the stage of SBO, the more probable the presence of free fluid between the bowel loops. In univariate analysis only, we found a positive correlation between US staging/thickened walls and the prominence of valvulae conniventes. Additionally, the multivariate analysis indicated that parietal stratification and bowel jump kinesis were negative predictors for US staging in comparison to other US signs. In addition, we found significant associations between conservative treatment or surgery and hypokinesis (p = 0.0326), akinesis (p = 0.0326), free fluid (p = 0.0013) and prominence of valvulae conniventes (p = 0.011). Free fluid in particular was significantly less present in patients that were conservatively treated (p = 0.040). We conclude that the US staging of SBO may be crucial, with a valuable role in the initial diagnosis and staging of the pathology, saving time and reducing total radiation exposure to the patient.

No abstract

Aim of our study was to evaluate the prevalence of aberrant origin of the branches of the external carotid artery (ECA) in 97 patients by computed tomography (CTA) and magnetic resonance angiography (MRA) and to compare the accuracy of these two techniques in the visualization of the ECA system. All patients underwent CTA and MRA examination of the head and neck. Multiplanar and volumetric reformations were obtained in all cases. For each set of images, the presence of aberrant origin of the branches of the external carotid artery was investigated. MRA and CTA images of each patient were compared to define their information content. Anatomical anomalies were found in 88 heminecks, with a prevalence of 53.3%. In the 61 patients in whom the CTA was performed before the MRA, the latter method showed only 92% of abnormalities detected at the first examination; in the 36 patients in whom MRA was performed first, CTA identified all of the anomalies highlighted by the former, adding 12 new. Knowledge of the anomalies of origin of the ECA branches is essential for the head and neck surgeon; the high prevalence of anomalies found in our series as in the previous studies indicates the opportunity to perform a CTA or a MRA of the head and neck before any surgical or interventional procedure. CTA is the method of choice in the evaluation of anomalies of origin of the branches of the ECA and in the definition of their course.