The Zuckerkandl tubercle

Identification and preservation of the recurrent laryngeal nerve is a major concern during thyroidectomies. The Zuckerkandl tubercle is an anatomic landmark that can be used for this purpose. It is generally found in 63% to 80% of patients undergoing thyroidectomy and is located between the superior and inferior lobes and points toward the tracheoesophageal groove. It is classified into three grades according to size: I <.5 cm, II .5 to 1 cm, III >1 cm. A grade III tubercle, present in 45% of patients, is sometimes associated with significant pressure symptoms in otherwise small-sized goiters.     

Application of neuroendoscopy to intraventricular lesions

We present an overview of the history, development, technological advancements, current application, and future trends of cranial endoscopy. Neuroendoscopy provides a safe and effective management modality for the treatment of a variety of intracranial disorders, either tumoral or non-tumoral, congenital, developmental, and degenerative, and its knowledge, indications, and limits are fundamental for the armamentarium of the modern neurosurgeon.     

Methicillin-Resistant Superinfection of the Wound After Body-Contouring Abdominal Surgery

BACKGROUND: This report presents the case of a patient who underwent abdominal body-contouring surgery, then later experienced a severe deep infection and a methicillin-resistant (MRSA) superinfection. CASE REPORT: A 56-year-old female ex-smoker presented, after massive weight loss, with skin excesses on the abdomen and flanks. She underwent an abdominoplasty with muscle plication and flank liposuction. On postoperative day 14, the woman presented with a deep wound infection, then 1 week later with MRSA superinfection. Since then, two surgical debridements and specific intravenous antibiotics have been necessary for a cure and to avoid septicemic complications. Complete wound closure was achieved only after 3 months of therapy, but a massive retractile and painful scar remained. CONCLUSION: Concomitant risk factors for wound infections (obesity, smoking, flap undermining) determined a rare but potentially fatal wound complication after body-contouring abdominoplasty. This complication was presented to alert plastic and general surgeons to such postoperative infections and to the possibility of a nonconservative approach.     

Third dose of SARS-CoV2 mRNA vaccination produces robust persistent cellular and humoral immune responses in liver transplant recipients

Weaker responses have been described after two doses of anti-SARS-CoV2 vaccination in liver transplant recipients (LTRs). At the Italian National Institute for Infectious Diseases, 122 LTRs (84% males, median age 64 years) were tested for humoral and cell-mediated immune response after a third doses of anti-SARS-CoV2 mRNA vaccines. Humoral response was measured by quantifying anti-receptor binding domain and neutralizing antibodies; cell-mediated response was measured by quantifying IFN-γ after stimulation of T cells with SARS-CoV-2-specific peptides. Humoral and cellular responses improved significantly compared to the second vaccine dose; 86.4% of previous non-responders to the first 2 vaccine doses (N = 22) became responders. Mycophenolate mofetil-containing regimens were not associated with lower response rates to a third vaccine; shorter time since transplantation (<6 years) was associated with lower humoral and cellular responses to third vaccine. Protective antibodies against Omicron variant were detected in 60% of patients 12 weeks after third vaccine dose.     

“Real world” efficacy of bulevirtide in HBV/HDV-related cirrhosis including people living with HIV: Results from the compassionate use programme at INMI Spallanzani in Rome,Italy

Objectives

We describe the preliminary results of bulevirtide compassionate use in patients with hepatitis B and delta virus (HBV/HDV)-related cirrhosis and clinically significant portal hypertension, including those living with HIV.

Methods

We conducted a prospective observational study of consecutive patients. Clinical evaluation, liver function tests, bile acid levels, HDV-RNA, HBV-DNA, hepatitis B surface antigen, and liver and spleen stiffness were assessed at baseline and after treatment months 1, 2, 3, 4, 6, 9, and 12. HIV-RNA and CD4+/CD8+ count were assessed in people living with HIV. The first drug injection was administered under nurse supervision, and counselling was provided and adherence reviewed at each visit.

Results

In total, 13 patients (61.5% migrants) were enrolled. The median treatment duration was 11 months. At month 6, mean alanine aminotransferase (ALT) levels fell by 64.5% and mean liver and spleen stiffness decreased by 8.6 and 0.9 kPa, respectively. The mean baseline HDV-RNA was 3.34 log IU/mL and 5.10 log IU/mL in people without and with HIV (n = 5) (p = 0.28), respectively. A similar mean decline was observed in both groups: −2.06 log IU/mL and −1.93 log IU/mL, respectively (p = 0.87). A combined response (undetectable HDV RNA or ≥ −2 log IU/mL decline vs. baseline, with ALT normalization) was achieved in 66% of subjects without and in 60% of patients with HIV. Patients with HIV showed persistently undetectable HIV-RNA and a progressive increase in CD4+/CD8+ cells during treatment. No patient discontinued bulevirtide because of adverse effects.

Conclusions

Preliminary results suggest that bulevirtide is feasible and well-tolerated in populations with difficult-to-treat conditions, such as those with HIV/HBV/HDV co-infection and migrants, when special attention is given to patient education. HDV-RNA decline during treatment was similar in people living with and without HIV.