Make an inventory of skin lesions during pregnancy and obtain visibility on healthcare pathway among these women in order to identify more precisely the role of the general practitioner (GP).
...Prospective, observational study, using a self-administered questionnaire among all women in immediate postpartum period between April 2021 and August 2021, relating to pre-existing skin lesions or rashes that appeared during pregnancy, and the description of the healthcare pathway among these women.
The questionnaire was collected in 377 women with a mean age of 30.6±3.7 years, 88.6% had fair skin and 14.6% were smokers. Among them, 35 (9.3%) declared skin diseases prior to pregnancy, of which 22 had a history of atopic eczema. During pregnancy, 136 women (36.1%) declared having skin lesions, the most frequent of which were stretch marks (63.2%) and hyperpigmentation (26.5%), and mainly during the 2
trimester (47.0%). Among these 136 women, only 59 (43.4%) referred it to a health care professional who was in 47.4% of cases (28/59) their GP and in 76.3% (45/59) of cases during a pregnancy follow-up appointment.
This study showed that skin lesions during pregnancy were frequent and that the majority of these women consulted their GP.
Background
Three-dimensional (3d) laparoscopy has been introduced to enhance depth perception and facilitate surgical operations. The aim of this study was to compare cognitive load during 3d and 2d ...laparoscopic procedures.
Methods
Two subjective questionnaires (the Simulator Sickness Questionnaire and the NASA task load index) were used to prospectively collect data regarding cognitive load in surgeons performing 2d and 3d laparoscopic colorectal resections. Moreover, the perioperative results of 3d and 2d laparoscopic operations were analyzed.
Results
A total of 313 patients were included: 82 in the 2d group and 231 in the 3d group. The NASA TLX results did not reveal significantly major cognitive load differences in the 3d group compared with the 2d group; the SSQ results were better in the 3d group than in the 2d group in terms of general discomfort, whereas difficulty concentrating, difficulty focusing, and fatigue were more frequent in 3d operations than in 2d operations (
p
= 0.001–0.038). The results of age, sex, and ASA score were comparable between the two groups (
p
= 0.299–0.374). The median operative time showed no statistically significant difference between the 3d and 2d groups (median, IQR, 2d 150 min 120–180—3d 160 min 130–190
p
= 0.611). There was no statistically significant difference in the risk of severe complications between patients in the 3d group and in the 2d group (2d 7 8.54% vs 3d 21 9.1%,
p
= 0.271). The median hospitalization time and the reoperation rate showed no difference between the 2d and 3d operations (
p
= 0.417–0.843).
Conclusion
The NASA TLX did not reveal a significant difference in cognitive load between the 2d and 3d groups, whereas data reported by the SSQ showed a mild risk of cognitive load in the 3d group. Furthermore, 3d laparoscopic surgery revealed the same postoperative results as 2d standard laparoscopy.
Introduction
Most thyroid nodules are benign, and treatment is primarily indicated for patients with symptoms or cosmetic concerns related to nodular volume. Recently, there has been growing interest ...in nonsurgical and minimally invasive techniques for the treatment of symptomatic benign thyroid nodules, including microwave ablation (MWA).
AIMS
This study aims to evaluate the effectiveness, efficacy, and safety of ultrasound-guided uncooled MWA in the treatment of benign symptomatic thyroid nodules, using a new ablation technique called the "fluid-motion technique."
Materials and methods
From April 2021 to February 2023, a total of 150 patients with benign thyroid nodules were treated using MWA at the Endocrine Surgery Unit of Pederzoli Hospital, Peschiera del Garda (Italy), with 102 of them being followed-up for at least 6 months.
Results
Before treatment, the mean major diameter was 38.4 ± 10.0 mm, and the mean volume was 13.6 ± 10.5 mL. At 1 month, the mean volume was 6.8 ± 6.2 mL, and at 3 months, it was 4.6 ± 4.1 mL. The mean Volume Reduction Rate (VRR) at 3 months was 61.1 ± 22.0%. Of the nodules, 17 (17%), 65 (66%), and 20 (19%) had volumes ≤ 10, 10.1–20, and ≥ 20.1 mL, respectively. For these nodules, the mean VRR at 3 and 6 months was 55.3 ± 16%, 63.4 ± 24.8%, 72 ± 26.9% and 68.0 ± 11.2%, 73.5 ± 18.3%, and 81.6 ± 15.8%, respectively.
Conclusion
Our study shows that ultrasound-guided MWA is an effective and safe minimally invasive treatment for benign thyroid nodules. The goal is to achieve a VRR that can reduce symptoms and improve cosmetic appearance.
•The analysis of the data regarding the use of emergency services during the 2020 Italian lockdown suggests a wrong use of these services in the pre-pandemic period in which many accesses were ...related to minor health problems.•During the first 3 weeks of Italian lockdown, it was observed almost 50% less ER activity than the same period of 2019.•National authorities have to develop new strategies for future pandemic response.•The strengthen of the territorial health services could reduce the ER overload and the hospital's waiting list.
The COVID 19 pandemic was declared on the 9th of March 2020. The health crisis affected the whole world with a very high and unexpected number of infected people. The situation forced the declaration of lockdown and a worldwide health system reorganization. Surprisingly, the social distancing laws caused a reduction of urgent hospital activities not COVID 19 related. The aim of this manuscript is to analyze the reasons why fewer emergencies were described during the 2020 Italian lockdown. The Data reporting urgent Emergency Room (ER) activity, during the first three weeks of the Italian lockdown (Group 1), were analyzed and compared with the same period in 2019 (Group 2). During the study period in 2020, there was a 46,5% reduction in ER activity compared to that in 2019. Nevertheless, the hospitalization rate was higher in the 2020 then in 2019 (p<0.05). The present data showed that almost half of the basic ER activity araised from mild health problems that could be followed by territorial health services. The strengthening of territorial medical services would allow hospitals to handle critical situations more easily and to focus activity by reducing the waiting list.
Purpose
To report the author’s experience on a mini-invasive technique using bioprosthetic plug and a rectal wall flap advancement in the treatment of recurrent recto-urethral fistula.
Materials and ...methods
Between 2013 and 2015, seven patients with recurrent recto-urethral fistula were referred to the Pederzoli Hospital, Peschiera del Garda, Verona, Italy. Intraoperatively all patients were found to have a rectal wall lesion and were treated with urinary and fecal diversion. For the persistence of the fistula, all the patients underwent a mini-invasive treatment consisting on placement of a bioprosthetic plug in the fistula covered by an endorectal advancement flap through a trans-anal and trans-urethral combined technique.
Results
Median operative time was 48 min with a median blood loss of 30 ml. Median hospital stay was 3 days (IQR 1–3). No case of fistula recurrence or plug migration was described. None of the patients experienced fecal or urinary incontinence. All patients obtained complete fistula healing.
Conclusions
Recurrent recto-urethral fistula is a challenging postsurgical complication for surgeons and urologists, and its best treatment is still unknown. Our method seems to be feasible and effective for the treatment of complex recto-urethral fistula.
Recording the nycthemeral rhythm of sand flies allows the evaluation of the daily activity in different ecotypes, the period of greatest activity, and their degree of anthropophily. We investigated ...the fauna and the rhythm of sand fly activity in an ecotourism region in Mato Grosso do Sul (MS) state, Brazil. Sand flies were captured monthly, using a Shannon trap for 24 h periods between July 2012 and June 2014. We collected 1,815 sand flies, in which Lutzomyia whitmani (=Nyssomyia whitmani, sensu Galati) and Lutzomyia longipalpis were the most abundant species during the dry season, with activity from 5 p.m.–7 a.m. and 6 p.m.–5 a.m., respectively. Both species require particular attention as vectors of Leishmania (Viannia) braziliensis and Leishmania (Leishmania) infantum in several regions of Brazil, including MS. However, Lutzomyia dispar was more anthropophilic, and was most active between January and March, from 5 p.m. to 5 a.m. Lutzomyia misionensis (=Pintomyia misionensis, sensu Galati) was present throughout both years, active from 4 p.m. to 5 a.m. Other species were active from 5 p.m. to 6 a.m. Due to intense tourism in the months that coincide with a high number of vectors for leishmaniases in Piraputanga, it is essential to determine vector-monitoring strategies in the area by investigating sand fly rhythm while not neglecting other periods of the year when the insects are present.
Background
Hepatocellular carcinoma (HCC) has a high worldwide prevalence and mortality. While surgical resection and transplantation offers curative potential, donor availability and patient liver ...status and comorbidities may disallow either. Interventional radiological techniques such as radiofrequency ablation (RFA) may offer acceptable overall and disease-free survival rates.
Materials and Methods
Sixty-eight cirrhotic patients matched for age, sex, tumor size, and Child–Pugh grade with small (1–5 cm) unifocal HCC were studied retrospectively to find determinants of overall and disease-free survival in those treated with surgical resection and RFA between 1991 and 2003.
Results
Multivariate analysis using Cox proportional regression modeling showed that overall survival was related to tumor recurrence (
p
= 0.010), tumor diameter (
p
= 0.002), and treatment modality (
p
= 0.014); overall
p
= 0.008. Recurrence was independently related to the use of RFA over surgery (
p
= 0.023) on multivariate analysis; overall
p
= 0.034.
Conclusion
Surgical resection offers longer disease-free survival and potentially longer overall survival than RFA in patients with small unifocal HCC.
The study of some of the behavioral aspects of the main vector of Leishmania infantum chagasi Cunha & Chagas in the Americas, Lutzomyia longipalpis (Lutz & Neiva), such as dispersion, population ...size, and vector survival rates, is important for the elucidation of the mechanisms of visceral leishmaniasis transmission. These parameters were studied by means of capture-mark-release-recapture experiments in an urban area of Campo Grande municipality, an endemic area of visceral leishmaniasis, situated in Mato Grosso do Sul state, Brazil. Six capture-mark-release-recapture experiments were undertaken between November 2009 and November 2010 and once in January 2012 with a view to assessing the population size and survival rate of Lu. longipalpis. The insects were released in a peridomicile surrounded by 13 residences. The recaptures were undertaken with automatic light traps for four consecutive weeks after release in the surrounding area. In total, 3,354 sand flies were captured, marked, and released. The overall recapture rate during the capture-markrelease-recapture experiments was 4.23%, of which 92.45% were recaptured at the release site, indicating limited dispersal. The greatest distance recorded from the release site was 165 m for males and 241 m for females. The male daily survival rate, calculated on the basis of regressions from the numbers of marked recaptured insects during the 15 successive days after release was 0.897. The estimated male population size measured by the Lincoln Index was 10,947.127. Though Lu. longipalpis presented a limited dispersion the physical barriers typical of urban environments did not prevent the sand flies from flying long distances.
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