The web of clinical data, bioengineering, augmented reality and robotic in vascular surgery

The new protocol for information distribution amongst scientists within the CERN, once slightly refined and publicly announced as the Worldwide Web in the August of 1991, has led to impressive achievements beyond the starting plan

Angiosarcoma of the breast: a new therapeutic approach?

Introduction Angiosarcomas are highly malignant endothelial cell tumors with poor prognosis. These can be due to breast cancer itself or to subsequent therapeutic modalities. No evidence-based guidelines exist concerning the ideal treatment of angiosarcomas. Presentation of the case We report the case of a 76-year-old woman who developed an exuberant and aggressive post radiation angiosarcoma of the breast and discuss different aspects of therapy for this disease. A total left mastectomy was performed, followed by a right mastectomy. The lesions into the chest wall, and multiple abdominal skin nodules were treated with local Electrochemotherapy (ECT) with intravenous bleomicin. Discussion No evidence-based guidelines exist concerning the ideal treatment of angiosarcomas. Electrochemotherapy (ECT) is an efficient palliative treatment of cutaneous and subcutaneous tumor nodules. It consists of the combination of a cytotoxic drug and electroporation, using appropriate electrical parameters; destabilization of the membrane is reversible, ensuring a high survival of permeabilized cells and the delivery of non-permeant molecules inside the cell. Conclusion Due to the rarity of the disease, prospective studies concerning adjuvant or neoadjuvant therapy are limited and no evidence-based guidelines exist. The response to chemotherapy seems to be poor. Treatment with ECT in addition to systemic chemotherapy achieves a complete response in all the lesions and improving patient body image perception

Incidental extravascular findings in computed tomographic angiography for planning or monitoring endovascular aortic aneurysm repair: Smoker patients, increased lung cancer prevalence?

AIMTo validate the feasibility of high resolution computed tomography (HRCT) of the lung prior to computed tomography angiography (CTA) in assessing incidental thoracic findings during endovascular aortic aneurysm repair (EVAR) planning or follow-up.METHODSWe conducted a retrospective study among 181 patients (143 men, mean age 71 years, range 50-94) referred to our centre for CTA EVAR planning or follow-up. HRCT and CTA were performed before or after 1 or 12 mo respectively to EVAR in all patients. All HRCT examinations were reviewed by two radiologists with 15 and 8 years' experience in thoracic imaging. The results were compared with histology, bronchoscopy or follow-up HRCT in 12, 8 and 82 nodules respectively.RESULTSThere were a total of 102 suspected nodules in 92 HRCT examinations, with a mean of 1.79 nodules per patient and an average diameter of 9.2 mm (range 4-56 mm). Eighty-nine out of 181 HRCTs resulted negative for the presence of suspected nodules with a mean smoking history of 10 pack-years (p-y, range 5-18 p-y). Eighty-two out of 102 (76.4%) of the nodules met criteria for computed tomography follow-up, to exclude the malignant evolution. Of the remaining 20 nodules, 10 out of 20 (50%) nodules, suspected for malignancy, underwent biopsy and then surgical intervention that confirmed the neoplastic nature: 4 (20%) adenocarcinomas, 4 (20%) squamous cell carcinomas, 1 (5%) small cell lung cancer and 1 (5%) breast cancer metastasis); 8 out of 20 (40%) underwent bronchoscopy (8 pneumonia) and 2 out of 20 (10%) underwent biopsy with the diagnosis of sarcoidosis.CONCLUSIONHRCT in EVAR planning and follow-up allows to correctly identify patients requiring additional treatments, especially in case of lung cancer

Acute deep vein thrombosis and pulmonary embolism: is the thromboaspiration device an appropriate choice?

Nowadays patients affected by deep vein thrombosis (DVT) and pulmonary embolism (PE) are studied widely but the challenge for physicians is when and how they are to be treated. Most patients present serious comorbidities that can potentially make treatment difficult. An increasing cohort of patients cannot be treated with systemic fibrinolysis but fortunately today, physicians can utilize a number of different instruments to resolve acute DVT and PE

Focusing on diabetic ulcers

Foot ulcers associated with Diabetes mellitus require immediate attention due to risk of amputation if left untreated. Herein we focus on the mitigating risk factors and physiopathology of the diabetic foot, recounting our own surgical approach and revascularization procedures

Prospective validation of the CLIP score: a new prognostic system for patient with cirrhosis and hepatocellular carcinoma

Prognosis of patients with cirrhosis and hepatocellular carcinoma (HCC) depends on both residual liver function and tumor extension. The CLIP score includes Child-Pugh stage, tumor morphology and extension, serum alfa-fetoprotein (AFP) levels, and portal vein thrombosis. We externally validated the CLIP score and compared its discriminatory ability and predictive power with that of the Okuda staging system in 196 patients with cirrhosis and HCC prospectively enrolled in a randomized trial. No significant associations were found between the CLIP score and the age, sex, and pattern of viral infection. There was a strong correlation between the CLIP score and the Okuda stage, As of June 1999, 150 patients (76.5%) had died. Median survival time was 11 months, overall, and it was 36, 22, 9, 7, and 3 months for CLIP categories 0, 1, 2, 3, and 4 to 6, respectively. In multivariate analysis, the CLIP score had additional explanatory power above that of the Okuda stage. This was true for both patients treated with locoregional therapy or not. A quantitative estimation of 2-year survival predictive power showed that the CLIP score explained 37% of survival variability, compared with 21% explained by Okuda stage. In conclusion, the CLIP score, compared with the Okuda staging system, gives more accurate prognostic information, is statistically more efficient, and has a greater survival predictive power. It could be useful in treatment planning by improving baseline prognostic evaluation of patients with RCC, and could be used in prospective therapeutic trials as a stratification variable, reducing the variability of results owing to patient selection

Book of abstracts Chimici per le Biotecnologie 2023

The increased consumer demand for natural body care products has driven academic and industrial research towards the development of innovative products from raw materials made available by nature. In this perspective, Erbagil srl (Telese Terme, BN, Italy) has developed innovative medical devices based on OZOILE®. OZOILE® is a pool of molecules obtained by a patented ozonation process, in which ozone binds to the olefinic bonds of extra virgin olive oil +Oil® forming stable ozonides. In this process, ozone is produced from medical oxygen and olive oil obtained from native Sannio (Benevento, Italy) olive cultivars grown organically and treated with Ozogea®, a corroborant also produced by Erbagil srl and based on ozonated +Oil®, an enhancer of the plants' natural defences, for a circular process in which nature cures nature. This generates a product, OZOILE®, that includes the relevant properties of the unsaponifiable portion of extra virgin olive oil, in particular the polyphenolic fraction, not involved in the ozonation process, in addition to the beneficial effects of ozone, already widely recognised by the scientific world. The first advantage is the availability of a fairly stable form of ozone that lends itself to a wide range of medicinal applications, not only in hospitals but especially “at home”. Although OZOILE® and OZOILE®-based products already have extensive scientific documentation attesting to their various curative properties, other formulations with specific carriers are being studied to broaden their possible applications in the clinical field. Natural and biodegradable polymers with pH-sensitive properties, such as alginate and chitosan, are widely used in drug delivery applications, especially in the form of biocompatible microspheres, and thermo-reactive poly(N-isopropyl- acrylamide) (PNIPAM) is frequently used in biomedical delivery systems. In this work, hydrogel multi-responsive microspheres (MRM) based on alginate, chitosan and PNIPAM were fabricated by extrusion dripping and used as an OZOILE® carrier system. Chemical composition by Fourier transform infrared (FTIR) spectroscopy, thermo-reactive properties by differential scanning calorimetry (DSC), swelling and degradation behaviour were analysed. Tests performed on MRM/OZOILE® unveiled the influence of the chitosan coating in delaying the release of OZOILE®. Thus, the results in terms of thermo-pH-responsive behaviour, swelling and degradation reveal the potential use of MRM for the therapeutic release of OZOILE®at specific inflammatory sites

Device selection for carotid stenting: reviewing the evidence

Introduction: Carotid artery stenting (CAS) has recently changed the status in the treatment of the extracranial carotid atheromasic disease. In recent years, evolution in both stents and protection devices as well as in carotid stenting techniques, has resulted in an important reduction in the rate of stroke in patients undergoing CAS procedures. Areas covered: The purpose of this article is reviewing the literature and summarizing the current evidence of the new available materials to underline the importance of the correct choice of the devices during the procedure. Expert commentary: Certainly a key issue in order to limit the periprocedural events to the lowest possible, is to select the appropriate device for the appropriate patient anatomy and clinical syndrome, the so called â\u80\u98tailored approachâ\u80\u99