Search

Background Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers. Method A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology. Results Given the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts’ opinion. Conclusions The aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment. We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient. The management of COVID-19 surgical patients is multidisciplinary. If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient.

Acute scrotum is characterized by intense acute scrotal pain, which may be associated with other symptoms and signs such as abdominal pain, inflammation, and fever. Many pathologic conditions can present in this way, most which involve the scrotal contents. Nonscrotal conditions, however, can rarely present clinically only as acute scrotum: among them, renal colic, aneurysm rupture or other causes of retroperitoneal hemorrhage, primary abdominal or pelvic tumors and metastases, pancreatitis, pelvic inflammation, and muscle injuries. The pathophysiologic characteristics of the clinical presentation, clues for diagnosis, and imaging features of a series of nonscrotal lesions presenting clinically with acute scrotal pain are herein reported and illustrated. In patients presenting with acute scrotal symptoms and normal scrotal ultrasound findings, nonscrotal causes of acute scrotal pain should be considered in the differential diagnosis. Therefore, an ultrasound investigation of the abdomen, groin, and thighs is indicated.

Journal of astronomical telescopes, instruments, and systems 8(01), 014007-1 (2022). doi:10.1117/1.JATIS.8.1.014007, The prototype Schwarzschild-Couder Telescope (pSCT) is a candidate for a medium-sized telescope in the Cherenkov Telescope Array. The pSCT is based on a novel dual mirror optics design which reduces the plate scale and allows for the use of silicon photomultipliers as photodetectors. The prototype pSCT camera currently has only the central sector instrumented with 25 camera modules (1600 pixels), providing a 2.68$^{\circ}$ field of view (FoV). The camera electronics are based on custom TARGET (TeV array readout with GSa/s sampling and event trigger) application specific integrated circuits. Field programmable gate arrays sample incoming signals at a gigasample per second. A single backplane provides camera-wide triggers. An upgrade of the pSCT camera is in progress, which will fully populate the focal plane. This will increase the number of pixels to 11,328, the number of backplanes to 9, and the FoV to 8.04$^{\circ}$. Here we give a detailed description of the pSCT camera, including the basic concept, mechanical design, detectors, electronics, current status and first light., Published by SPIE, [Bellingham, Wash.]

The Cherenkov Telescope Array (CTA) is the next-generation ground-based observatory for very-high-energy gamma rays. One candidate design for CTA's medium-sized telescopes consists of the Schwarzschild-Couder Telescope (SCT), featuring innovative dual-mirror optics. The SCT project has built and is currently operating a 9.7-m prototype SCT (pSCT) at the Fred Lawrence Whipple Observatory (FLWO); such optical design enables the use of a compact camera with state-of-the art silicon photomultiplier detectors. A partially-equipped camera has recently successfully detected the Crab Nebula with a statistical significance of 8.6 standard deviations. A funded upgrade of the pSCT focal plane sensors and electronics is currently ongoing, which will bring the total number of channels from 1600 to 11328 and the telescope field of view from about 2.7° to 8° . In this work, we will describe the technical and scientific performance of the pSCT.

BackgroundSince the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity. The World Society of Emergency Surgery (WSES) conceived this position paper with the purpose of providing recommendations for the management of surgical, infected and non-infected, patients in emergency setting under COVID-19 pandemic in the safety of the patient and health care workers based on available evidences and experienced surgeons’opinion.MethodA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P)through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology.ResultsGiven the limitation of the evidence, the current document represents an effort to provide a guide for emergency surgeons to perform safely surgery during this pandemic on the basis of evidence medicine and principles of mass casualty incident management to limit the diffusion of the infection among patients and health care workers. ConclusionsWe recommend screening for COVID-19 infection at emergency department, all surgical patients with clinical and epidemiologic features suspect for COVID-19 disease who are waiting for hospital admission and urgent surgery. The screening provides performing a RT-PCR naso-pharyngeal swab test and a baseline (non-contrast) chest CT or chest X-ray or lungs US, depending on skills and availability.The management of COVID-19 surgical patient is multidiplinary.If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every efforts to protect the operating room staff, in the safety of the patient . We recommend not being present during the intubation and extubation maneuvers (1A).To perform a safe surgical procedure, we recommend:-having a trained staff, wearing the necessary personal protective equipments, and an established protocol for the preoperative, peri-operative and postoperative management of the COVID-19 surgical patient;-being careful in the establishment and management of the artificial pneumoperitoneum, in the control of the hemostasis and of incisions to prevent any loss of biological fluids and contamination of the surgical staff;-using of all available devices to remove smoke and aerosol during the operation and a closed suction system for artificial pneumoperitoneum, especially if there is a risk of conversion to laparotomy.If it is not possible to perform surgery in a safe and protected environment, we recommend do not underestimating the highest risk of contamination and infection for health care workers and dissemination of the virus in the hospital and to consider transferring the patient in a COVID HUB hospital for the appropriate management.The administration of prophylactic anticoagulation with LMWH is recommended as soon as possible in COVID-19 patients to reduce thromboembolic risk related to the virus and sepsis, decreasing the mortality rate. We recommend to carefully administrating antibiotics in COVID-19 surgical patients for the high risk of selecting resistant bacteria, especially in patients admitted in ICU for mechanical ventilation. Early empirical antibiotic treatment should be targeted to results from cultures, with de-escalation of treatment as soon as possible. We recommend against empirical antifungal treatment in all surgical COVID-19 patients but to consider it in critically ill patients.

Desmoid-type fibromatosis (DF), also known as aggressive fibromatosis, is a locally aggressive benign fibroblastic neoplasm that can infiltrate or recur but cannot metastasize. It is rare, with an estimated annual incidence of two to four new cases per million people. Most DFs occur sporadically, but it may also be associated with the hereditary syndrome familial adenomatous polyposis. Treatment is necessary when the disease is symptomatic, especially in case of compression of critical structures. When possible, surgical resection is the treatment of choice; however, recurrence is common. Due to the high rate of recurrence, imaging plays an important role not only in diagnosis, but also in the management of DF. Although there are a number of studies describing CT and MRI findings of DF, there is no description of contrast-enhanced ultrasound findings.

The Acute Abdomen Decision Making course® (AADM®) was developed by the World Society of Emergency Surgeons (WSES) members with the purpose to teach a systematic and concise method for approaching acute abdomen patient. It was first introduced in 2016. The course explains step by step the clinical reasoning to follow for immediate managing of the acute abdomen in emergency department with a safe and reliable method. We developed this original decision making model AADM following the Advanced Trauma Life Support (ATLS) philosophy in evaluating non-traumatic abdominal pain patient. The A-B-C-D-E-F management of non-traumatic acute abdominal pain is conceived by WSES to make easy and systematic the evaluation of patients in Emergency Department. AADM course teaches how to assess an acute abdomen patient’s diagnosis and determine the therapeutic approach to reduce unnecessary exams and hospitalizations.

Patients with acute abdominal pain due to acute colonic diverticulitis are a frequent cause of hospital admission. Diverticuar disease increases with age. In Western populations, diverticular disease is diagnosed in 50% individuals over 70 years and 80% over 85 years of age. The identification of patients with acute diverticulitis is a considerable challenge, since numerous other acute abdominal conditions mimic its clinical characteristics. Another problem is the atypical presentation in older patients. A high index of suspicion in the setting of a compatible history and physical examination serves as the cornerstone of early diagnosis. The purpose of this review is to underline the importance of an intimately integrate multidisciplinary approach between emergency physicians, radiologists and surgeons.

OBJECTIVE: To investigate the role of strain elastography using calculated strain ratio and visual elastography score in differentiating nonneoplastic, benign, and malignant neoplastic intratesticular lesions. MATERIALS AND METHODS: The study was approved by the hospital review board as a retrospective review of 86 patients examined with gray scale, color Doppler ultrasonography and strain elastography (visual elastography score and strain ratio). Sensitivity, specificity, and positive and negative likelihood ratio of color Doppler and stain elastography were documented. Receiver operator characteristic curves assessed the diagnostic accuracy of strain elastography to discriminate nonneoplastic, benign, and malignant neoplasms. Histology or follow-up ultrasonography determined lesion character. RESULTS: Thirty-one of 86 (36.0%) intratesticular malignant neoplasms, 17 of 86 (19.8%) benign neoplasms, and 38 of 86 (44.2%) nonneoplastic lesions were confirmed with histology (n = 52) or follow-up sonography (n = 34); 89.5% of intratesticular lesions were heterogeneous or hypoechoic on gray scale, with no difference between benign and malignant. Sensitivity, specificity, positive and negative likelihood ratio for nonneoplasm versus neoplasm were documented: color Doppler: 68.8%, 97.4%, 26.5, 0.32; visual elastography score: 81.3%, 57.9%, 1.93, 0.32; strain ratio: 68.8%, 81.6%, 3.73, 0.38. Neoplastic lesions showed a higher strain ratio than nonneoplastic lesions (P

On cross-sectional imaging studies performed for other indications, incidental discovery of renal lesions is not uncommon. In daily use, grey-scale ultrasonography (US) and conventional Doppler modes are often the modality of choice for the initial assessment. While simple cysts are fully characterized with US, other lesions require further characterization, which is traditionally obtained by multiphase imaging, such as contrast-enhanced CT and MRI. Contrast-enhanced ultrasound (CEUS) has become a powerful additional tool for imaging renal lesions. With its lack of nephrotoxicity, the absence of ionizing radiation, and the ability to evaluate the enhancement pattern of renal lesions quickly and in real- time, CEUS has unique advantages over traditional modes. Established applications are differentiation between solid tumours, pseudolesions, and complex cysts; characterization of complex cysts with different malignant potential, and evaluation of tumor ablation. Microbubble contrast agents are safe. Adverse reactions are rare. This article provides an overview of the current clinical applications of CEUS in characterizing renal masses, discussing advantages and limitations. The aim is to provide the framework for sonologists to make informed decisions regarding this emerging imaging test in appropriate circumstances.

Ultrasound (US) is recognized as a useful first-line imaging modality, being esteemed its characteristics such as real-time scanning, no radiation, easy performance, and cost-effectiveness. However, it is regarded inferior to computed tomography and magnetic resonance because of its low ability to depict organ vascularization especially for tumor characterization.

Scrotum is a superficial anatomical structure and it can be easily assessed with clinical examination. Ultrasonography (US) is the initial imaging modality for evaluating pathologic conditions of the scrotum. However, magnetic resonance (MR) imaging is useful in case of equivocal sonographic findings.

Purpose Defining the site of recurrent disease early after definitive treatment for a localized prostate cancer is a critical issue as it may greatly influence the subsequent therapeutic strategy or patient management.

Scrotal cystic lesions are common incidental findings at ultrasonography. Most of them are located in the epididymis, but the testis and the cord are also involved. Testicular, albugineal, and epidermoid cysts; cystic dysplasia of the rete testis; cysts of the spermatic cord; and cystic appendages are easily detected at ultrasonography, which is the modality of choice to differentiate benign cysts from cystic tumors. Other imaging modalities such as CEUS and MR imaging may have a role for characterization of complex cystic lesions.

Penile traumas can result from penetrating or non-penetrating injuries. Diagnosis of albugineal disruption must be obtained as soon as possible since early surgical repair reduces significantly the rate of posttraumatic curvature and fibrosis. MR imaging is the modality of choice to investigate the integrity of the tunica albuginea. In expert hands, however, ultrasonography can be as informative as MR. It is able to detect the exact site of the tear as an interruption of the thin echogenic line of the tunica albuginea.

Ultrasound features of solid scrotal tumors are often nonspecific, and most of them have no special character to help identification of their nature. Ultrasonography, however, identifies lesions in virtually all cases. Moreover, it allows differentiation between intratesticular and extratesticular masses and gives an accurate estimate of their local extent and of the relationship with adjacent tissues.

Contrast-enhanced ultrasound (CEUS) is a new technique that employs microbubble contrast agents and complementary harmonic pulse sequences to demonstrate parenchymal perfusion.

In the clinical practice, there is an increasing incidence of small, non-palpable testicular lesions identified with an ultrasonographic investigation performed for other purposes. Many of these lesions are benign tumours or non-neoplastic conditions. In this context, the old axiom that every testicular mass should be considered a malignant tumour and the testis must be removed is no longer valid. Lesions can either undergo active surveillance or testis-sparing surgery, which allows maximal preservation of testicular parenchyma and its vasculature. To provide for the possibility of testis-sparing surgery for non-palpable nodules, precise intraoperative ultrasonographic localisation of the lesion is necessary. Our technique includes ultrasonographic localisation of the nodule within the exposed testicle and placement of a localising needle while the patient is on the operating table.

The increased use of ultrasound in patients with urological and andrological symptoms has given an higher detection of intra-testicular nodules. Most of these lesions are hypoechoic and their interpretation is often equivocal. Recently, new ultrasound techniques have been developed alongside of B-mode and color-Doppler ultrasound. Although not completely standardized, contrast-enhanced ultrasound (CEUS) and tissue elastography (TE), added to traditional ultrasonography, can provide useful information about the correct interpretation of incidentally detected non-palpable testicular nodules. The purpose of this review article is to illustrate these new techniques in the patient management.

Objective Chest auscultation and chest x-ray commonly are used to detect postoperative abnormalities and complications in patients admitted to intensive care after cardiac surgery. The aim of the study was to evaluate whether chest ultrasound represents an effective alternative to bedside chest x-ray to identify early postoperative abnormalities. Design Diagnostic accuracy of chest auscultation and chest ultrasound were compared in identifying individual abnormalities detected by chest x-ray, considered the reference method. Setting Cardiac surgery intensive care unit. Participants One hundred fifty-one consecutive adult patients undergoing cardiac surgery. Interventions All patients included were studied by chest auscultation, ultrasound, and x-ray upon admission to intensive care after cardiac surgery. Measurements and Main Results Six lung pathologic changes and endotracheal tube malposition were found. There was a highly significant correlation between abnormalities detected by chest ultrasound and x-ray (k = 0.90), but a poor correlation between chest auscultation and x-ray abnormalities (k = 0.15). Conclusions Chest auscultation may help identify endotracheal tube misplacement and tension pneumothorax but it may miss most major abnormalities. Chest ultrasound represents a valid alternative to chest x-ray to detect most postoperative abnormalities and misplacements.

In the present article, we present the experimental results concerning the fine-tuning and optimization of superconducting quantum interference device (SQUID) parameters by thermal annealing. This treatment allows for the modification of the parameters in order to meet a specific application or to adjust the device parameters to prevent the increase of magnetic field noise and work instability conditions due to a different critical current with respect to the design value. In particular, we report the sensor critical current, the voltage&ndash, flux (V&ndash, &Phi, ) characteristics and the spectral density of the magnetic field of SQUID magnetometers for different annealing temperatures. The measurements demonstrate that it is possible to achieve a fine control of the most important device parameters. In particular, we show that thermal annealing allows for the reduction of SQUID noise by more than a factor of 5 and makes the device working operations very stable. These results are very useful in view of quantum technology applications related to superconducting quantum computing where the correct functioning of the quantum bit depends on the fine control of the superconducting quantum device parameters and selectable annealing is possible by using a suitable laser as a thermal source.

Branchial cleft cysts are benign lesions caused by anomalous development of the brachial cleft. This report describes a 20-year-old girl with swelling on the right lateral aspect of the neck, which expanded slowly but progressively. The clinical suspicion was that of a branchial cleft cyst. Sonography revealed a homogeneously hypo- to anechoic mass with well-defined margins and no intralesional septa. Color Doppler reviewed no internal vascularization. The ultrasound examination confirmed the clinical diagnosis of a second branchial cleft cyst, demonstrating the cystic nature of the mass and excluding the presence of complications. For superficial lesions like these, ultrasound is the first-level imaging study of choice because it is non-invasive, rapid, low-cost, and does not involve exposure to ionizing radiation.Le cisti branchiali sono lesioni benigne dovute ad anomalie di sviluppo degli archi branchiali. Viene presentato il caso di una Paziente, 20 anni, con tumefazione laterocervicale a lenta e progressiva crescita, sospetta clinicamente per cisti branchiale. Ecograficamente la lesione mostrava struttura omogenea ipo- anecogena, con margini ben definiti, priva di setti intralesionali e di patologica vascolarizzazione alla valutazione color-Doppler. L’ecografia confermava quindi il sospetto clinico di cisti del II arco branchiale, dimostrando la sua natura cistica ed escludendo possibili complicanze. Trattandosi di lesioni superficiali l’ecografia rappresenta la metodica di imaging di primo livello essendo non invasiva, di rapida esecuzione, poco costosa, non esponendo il paziente a radiazioni ionizzanti.

Introduction Differentiation among the many clinical situations that can present with acute scrotal pain is a significant diagnostic problem in clinical practice. A firm diagnosis is often difficult based on clinical history and physical examinations alone, and imaging is usually requested for this purpose. However, imagingfindings alonemaynot clarify the diagnosis as imaging studies have to be interpreted in close correlation with clinical information and with knowledge of the possible pathologic situations underlying the clinical presentation of the specific patient. In this article we describe and discuss the most common problems encountered when performing diagnostic studies for acute scrotal symptoms and the solutions for, possibly, avoiding them.

Digital radiography technology has replaced conventional screen-film systems in many hospitals. Despite the different characteristics of new detector materials, frequently, the same radiological protocols previously optimised for screen film are still used with digital equipment without any critical review. This study addressed optimisation of exposure settings for chest examinations with digital systems, considering both image quality and patient dose. Images acquired with direct digital radiography equipment and a computed radiography system were analysed with specially developed commercial software with a four-alternative forced-choice method: the most promising protocols were then scored by two senior radiologists. Digital technology offers a wide dynamic range and the ability to postprocess images, allowing use of lower tube potentials in chest examinations. The computed radiography system showed both better image quality and lower dose at lower energies (85 kVp and 95 kVp) than those currently used (125 kVp). Direct digital radiography equipment confirmed both its superior image quality and lower dose requirements compared with the storage phosphor plate system. Generally, lowering tube potentials in chest examinations seems to allow better image quality/effective dose ratio when using digital equipment.

We present the case of an 80-year-old man with two renal solid masses found at sonography, which were imaged by contrast-enhanced ultrasound, CT, and MRI and confirmed histologically. Contrast-enhanced ultrasound findings suggested a benign mass and a CT-guided biopsy yielded a diagnosis of extramedullary hematopoiesis.