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Background: Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) infection is associated with hypercoagulability caused by direct invasion of endothelial cells and\or proinflammatory cytokine release. Thromboprophylaxis with enoxaparin is recommended by current guidelines, but evidence is still weak. The aim of this study was to assess the impact of thromboprophylaxis with enoxaparin on hospital mortality in patients admitted for Coronavirus disease 2019 (COVID-19). The effects of enoxaparin on intensive care admission and hospital length-of-stay were evaluated as secondary outcomes., Methods: Observational cohort study, with data collected from patients admitted to Poliambulanza Foundation with positive real time reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 from 20th February to 10th May 2020. Multivariate logistic regression with overlap weight propensity score was used to model hospital mortality and intensive care admission, hospital length-of-stay was analyzed with a multivariate Poisson regression. Seven hundred and ninety nine (57%) patients who received enoxaparin at least once during the hospitalization were included in the enoxaparin cohort, 604 (43%) patients who did not were included in the control cohort., Findings: At the adjusted analysis enoxaparin was associated with lower in-hospital mortality (Odds Ratio 0·53, 95% C.I. 0·40-0·70) compared with no enoxaparin treatment. Hospital length-of-stay was longer for patients treated with enoxaparin (Incidence Rate Ratios 1·45, 95% C.I. 1·36-1·54). Enoxaparin treatment was associated with reduced risk of intensive care admission at the adjusted analysis (Odds Ratio 0·48, 95% C.I. 0·32-0·69)., Interpretation: This study shows that treatment with enoxaparin during hospital stay is associated with a lower death rate and, while results from randomized clinical trials are still pending, this study supports the use of thromboprophylaxis with enoxaparin in all patients admitted for COVID-19. Moreover, when enoxaparin is used on the wards, it reduces the risk of Intensive Care Unit admission., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 The Author(s).)

We analyzed ventilation-induced changes in arterial blood pressure and photoplethysmography from waveforms obtained by monitoring 57 patients in the operating room and intensive care unit. Analysis of systolic and pulse pressure variations during positive pressure ventilation, DeltaUp, DeltaDown, and changes in the preejection period on both arterial and photoplethysmographic waveforms were possible in 49 (86%) patients. The pulse pressure variation and preejection period were similar when calculated using both arterial blood pressure and photoplethysmography, whereas the other variables were different. Photoplethysmographic pulse variation >9% identified patients with arterial pulse pressure variation >13% (area under ROC curve = 0.85) or DeltaDown >5 mm Hg (area under ROC curve = 0.85). In hypotensive patients, photoplethysmographic pulse variation >9% remained the best threshold value (pulse pressure variation >13%: area under ROC curve = 0.90; DeltaDown >5 mm Hg: area under ROC curve = 0.93) for predicting fluid responsiveness. In conclusion, this study showed that pulse variations observed in the arterial pressure waveform and photoplethysmogram are similiar in response to positive pressure ventilation. Furthermore, photoplethysmographic pulse variation > 9% identifies patients with ventilation-induced arterial blood pressure variation that is likely to respond to fluid administration.

Background: The ProSeal laryngeal mask airway (PLMA) may have advantages over the laryngeal mask airway (LMA) in obese patients. We tested this hypothesis in a clinical setting., Methods: Sixty obese patients (BMI >30) were randomized to receive mechanical ventilation (tidal volume 7 ml kg(-1), PEEP 10 cm H(2)O), through either the PLMA or the LMA. A gastric tube was used in all patients. Cuff pressure was set at 60 cm H(2)O and increased progressively until excessive leak occurred. The incidence of sore throat was assessed at recovery and after 1 week., Results: The mean leak fraction was 6.1 (SD 2.9)% with the LMA and 6.4 (3.5)% with the PLMA (P=0.721). With the PLMA, with no sign of ventilation problems, the drainage tube was not patent in three patients. The cuff pressure was >100 cm H(2)O in 38% of the LMA group and 7% of the PLMA group (P=0.05). The incidence of sore throat was similar in both groups and it was similarly scored in the recovery room and 1 week after surgery., Conclusions: Both the PLMA and the LMA can be used for mechanical ventilation of obese patients. The patency of the PLMA drainage tube needs to be checked constantly even when an optimal airtight seal is present. In obese patients the LMA requires a greater cuff pressure than the PLMA, but sore throat is not related to the cuff pressure. Sore throat assessment in the recovery room appears as reliable as assessment later.

Background: The tracheal tube (TT) produces reversible bronchoconstriction and increases pulmonary airway resistance compared to the laryngeal mask airway (LMA). The possible persistence of this effect in the postoperative period has not been studied. The aim of this study was to compare the early postoperative pulmonary function in healthy patients undergoing minor surgical procedures with the LMA or with the TT., Methods: Sixty patients scheduled for saphenous vein stripping under general anaesthesia were randomised to receive the LMA or the TT. Before anaesthesia and 20 min after LMA or TT removal, pulse oxymetry values (SpO(2)) were recorded and patients performed forced spirometry in the supine position., Results: Preoperative pulmonary function was normal in both groups. There were no differences between groups in the preoperative respiratory function test and SpO(2). Following surgery SpO(2), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC) and peak expiratory flow (PEF) decreased in both groups. The FEV1/FVC did not change in either of the groups. In the TT group, compared to patients using the LMA, there was a greater relative decrease of SpO(2) (2.7 +/- 2.7% vs. 1.3 +/- 2.2%, P=0.017), FEV1 (17.6 +/- 12.2% vs. 8 +/- 17.4%, P=0.008), FVC (15.8 +/- 12.4% vs. 9 +/- 13.4%, P=0.023) and PEF (20.6% +/- 15.3% vs. 8.1 +/- 33.3%, P=0.033)., Conclusions: This study demonstrates greater early postoperative respiratory restrictive syndrome and lower arterial oxygen saturation following tracheal intubation compared to LMA use in patients without respiratory disease.

Aneurysms of the profunda femoris artery rarely occur as an isolated lesion because of anatomical position and characteristics of wall tissue. The case of a 79-year-old man admitted to the hospital because of acute pain and swelling of the right leg with pulsating tumor in the groin is reported. Duplex scanning and angiography, performed in order to establish the diagnosis and to plan the operation, demonstrated a right large aneurysm of the deep femoral artery (8 x 12 cm). At operation, the aneurysm was resected associated to a PTFE Stretch graft replacement because the autogenous saphenous vein was not available. A review of the literature on the clinical manifestation and management in emergency or elective surgery of the isolated true atherosclerotic aneurysm of the deep femoral artery, is presented.

The infected aneurysms of the aorta represent the 0.65% of all the aneurysms and they are associated with high morbidity and mortality. The vascular infections from Salmonella are not particularly frequent, even if in the last years their reports are more numerous. The authors report their experience in the surgical treatment of one case of aneurysm of the abdominal aorta infected by group C Salmonella, making a review of the Literature on this matter.

The aneurysms of the celiac trunk are the rarest aneurysms of the visceral arteries. From 1958 only 69 cases have been reported in the international literature. They are frequently asymptomatic and their discovery is more often occasional. They can rupture in 15-20% of the cases with a mortality approaching 80% of the cases. This explains the need of a surgical treatment even in the asymptomatic cases. Personal experience in the surgical treatment of a case of aneurysm of the celiac trunk is reported and a survey of the literature on this matter is made.