Telemedicine During COVID-19 Pandemic: Lesson Learned from the Lazio Region Infectious Diseases and Emergency Department Network.

Telemedicine and teleconsultation can be powerful and useful tools for patients to hamper the physical barriers to access to health care services during COVID-19 pandemic. We describe the teleconsultation (TC) model in the Lazio Region. It uses a hub-and-spoke network system on geographic regional basis using a web based digital platform, termed ADVICE with the aim to connect regional Emergency Departments (EDs) and Infectious Diseases (ID) acute and critical care settings for patients with acute ID syndrome.

[Access to the Emergency Department in the time of COVID-19: an analysis of the first three months in the Lazio Region (Central Italy)].

Objectives: to evaluate the impact of the SARS-CoV-2 epidemic on the access to the emergency services of the Lazio Region (Central Italy) for time-dependent pathologies, for suspected SARS-CoV-2 symptoms, and for potentially inappropriate conditions.

Design: observational study.

Setting And Participants: accesses to the emergency departments (EDs) of Lazio Region hospitals in the first three months of 2017, 2018, 2019, and 2020.

Major trauma critical pathway: preliminary results from the monitoring system in the regional network and in a hub center in Rome metropolitan area.

Objective: The aim of this study is to collect the two years' data regarding the Integrated Trauma Management System (SIAT) by capturing the activity of its three Hubs in the Italian Lazio Region and test the performance of one of the Hubs' (Fondazione Policlinico Universitario A. Gemelli - IRCCS, FPG -IRCCS) Major Trauma Clinical Pathway's (MTCP) monitoring system, introducing the preliminary results through volume, process and outcome indicators.

Materials And Methods: A retrospective analysis on SIAT was conducted on years 2016 to 2018, by collecting outcome and timeliness indicators through the Lazio Informative System whereas the MTCP was monitored through set of indicators from the FPG - IRCCS Informative System belonging to randomly selected clinical records of the established period.

Learning on animal models: a 16-year experience with the theoretical-practical course on surgery of polytrauma.

The aim of this paper was to highlight, the important features of this course: - an update on the pathophysiology of the trauma patient, on the common maneuvers of damage control surgery and their indications, on surgical techniques and their rationale in the various regions of the body, and indications and modalities of non-operative treatment (NOM); - participants test their knowledge and skills through an interactive approach, considering the resources of the hospitals of origin; - an extremely realistic approach to trauma surgery and likewise a possibility to observe and test, "in the field", products such as topical hemostatic agents, which are frequently used in this kind of surgery. KEY WORDS: Animal models, Training simulation.

International consensus conference on open abdomen in trauma.

Background: A part of damage-control laparotomy is to leave the fascial edges and the skin open to avoid abdominal compartment syndrome and allow further explorations. This condition, known as open abdomen (OA), although effective, is associated with severe complications. Our aim was to develop evidence-based recommendations to define indications for OA, techniques for temporary abdominal closure, management of enteric fistulas, and methods of definitive wall closure.

Management of hemodynamically unstable pelvic trauma: results of the first Italian consensus conference (cooperative guidelines of the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology -Section of Vascular and Interventional Radiology- and the World Society of Emergency Surgery).

Hemodynamically Unstable Pelvic Trauma is a major problem in blunt traumatic injury. No cosensus has been reached in literature on the optimal treatment of this condition. We present the results of the First Italian Consensus Conference on Pelvic Trauma which took place in Bergamo on April 13 2013.

Comparison of quality control for trauma management between Western and Eastern European trauma center.

Background: Quality control of trauma care is essential to define the effectiveness of trauma center and trauma system. To identify the troublesome issues of the system is the first step for validation of the focused customized solutions. This is a comparative study of two level I trauma centers in Italy and Romania and it has been designed to give an overview of the entire trauma care program adopted in these two countries.

[The continuing medical education in the management of trauma (corrected)].

Background: The continuous medical education constitutes a great institutional project for the improvement of the relief quality in which he is affirming a variety of formative methodologies. Particularly must be uses specific systems for the adult education.

Materials And Methods: The project that is introduced it concerns a post-university formative run on the trauma with courses of target multidisciplinare or specialistic that answers to the need of specific knowledges on the whole run of clinical continuity of the patient.

[The education of the trauma surgeon: the "trauma surgery course" as advanced didactic tool].

Background: The consequences of low incidence of penetrating injuries in Europe and of the increasing in nonoperative management of blunt trauma are a decrease in surgeons' confidence for managing traumatic injuries. The Corso Teorico Pratico di Chirurgia del Politrauma was developed as model for teaching operative trauma techniques. The aim of this retrospective study is to evaluate the effectiveness of the course and compare it with other similar courses.

Initial evaluation of the "Trauma surgery course".

Background: The consequence of the low rate of penetrating injuries in Europe and the increase in non-operative management of blunt trauma is a decrease in surgeons' confidence in managing traumatic injuries has led to the need for new didactic tools. The aim of this retrospective study was to present the Corso di Chirurgia del Politrauma (Trauma Surgery Course), developed as a model for teaching operative trauma techniques, and assess its efficacy.

Method: the two-day course consisted of theoretical lectures and practical experience on large-sized swine.

[Abdominal compartment syndrome: patophysiologic and clinic remarks].

The abdominal compartment syndrome is a high grade abdominal hypertension with clinical evidence of multiorgan failure (MOF). It is more and more frequently observed in intensive-care units as a complication in critical patients, but especially in traumatology and surgery. The incidence is highly variable according to the different trials but the severity of scores is the common factor.

[Abdominal "packing": indications and method].

Abdominal packing is a lifesaving technique for temporary control of severe injury and it is used in damage control surgery schedule. Technically bleeding from abdominal cavity can generally be achieved by applying pressure with several large abdominal packs. Its possible too applying packs in organ-specific techniques (early abdominal packing).

[Packing: current concepts of "life-saving" surgery].

Abdominal packing is a lifesaving technique for temporary control of severe injury and it is used in Damage Control Surgery schedule. Technically bleeding from abdominal cavity can generally be achieved by applying pressure with several large abdominal packs. It's possible too applying packs in organ-specific techniques (early abdominal packing).

[Superior vena cava syndrome].

Superior vena cava syndrome is due to an intrinsic or extrinsic caval obstruction that evolves in acute or subacute way with distinctive clinical feature such as respiratory symptoms and venous stasis. Since 1998 we have treated three cases of spontaneous superior vena cava thrombosis in neoplastic patients who underwent several infusion of chemotherapy, respectively for a breast, uterine and rectum cancer. All patients was female, 52, 58 and 70 years old.

[Surgical management of trauma: from the "golden hour" to the "Golden Day"].

The treatment of the "trauma" has individualized objective therapeutic to reach in the first phase of clinical management defined by Mattox in the concept of the Golden Hour, that consist to transport the patient to the fittest hospital and to recognize and to treat the priorities "ABCDE", identifies in ATLS Guideline. The evolution of the organization for the treatment of the trauma has developed the concept of Trauma System to whose apex there are of the structures devoted define Trauma Center, with specificity of structures and functions, personal devoted fully grown with a specific run. In the Trauma Center is possible to get a therapeutic planning according to the priorities of the case in few times so that to not only achieve the objective to treat in emergency the vital lesions, but to do the necessary treatments precociously to prevent the compliances of the patient, that is checked in environment then multidisciplinary intensive care.

[Damage control surgery: the technique].

Abdominal packing and planned reoperation is a lifesaving technique for temporary control of haemorrhage in severely injured patients. Morbidity and mortality, however, remain significant. The purpose of this study is to evaluate all surgical technique and our results during 31 years of trauma surgery.

Intramural mesenteric venulitis. A new cause of intestinal ischaemia.

Venous damage is an uncommon cause of intestinal ischaemia. We report on a 44-year-old woman who presented signs and symptoms of acute intestinal ischaemia requiring surgical treatment. Histological examination of the resected right colon showed features of an intramural lymphocytic venulitis with no other demonstrable causes of ischaemic injury of the bowel.

[Kidney failure during acute pancreatitis. A unique aspect of multiple organ failure].

Eighty-two patients with acute pancreatis observed in the last seven years were included in prospective trial of monitoring protocol comprising: multiple organ failure and non invasive imaging of pancreatic lesion. One organ failure noted in the 60.9%, M.

[Surgical treatment of pancreatic pseudocyst].

The review of diagnosis and treatment of 18 pancreatic pseudocysts has led to some conclusions about controversial aspects of the surgical management. The accuracy of imaging techniques in the early detection of the pseudocyst is high and plays a major role in the demonstration of its spontaneous resolution and evolution. The optimal surgical treatment of uncomplicated pseudocysts is the internal drainage, most rarely their resection.

[Primary resection in occlusions caused by cancer of the left colon].

Based on a survey of 47 cases of left colonic occlusive cancer operated on at the Emergency Surgery Department-University of Rome "La Sapienza", the authors concluded that in such condition, when the patient is not seriously ill, the Hartmann procedure is a valid alternative to the anastomosis-resection because: a) it solves intestinal obstruction in a short time with consequent improvement of general conditions; b) it allows to perform the second oncologically radical operation early with less risk of neoplastic spread. The latter procedure, therefore, is carried out under better conditions, relative to the stage of the disease and the status of the patient.

Somatostatin infused during acute pancreatitis retains its biological activity.

Somatostatin (SST) is used in the treatment of acute pancreatitis (AP) to inhibit pancreatic exocrine secretion, which represents one of the goals of medical treatment in this disease. Its therapeutic efficacy, however, is poor. One hypothesis, which has not yet been investigated, is that i.