The role of grade of injury in non-operative management of blunt hepatic and splenic trauma. Case series from a multicenter experience

This retrospective study shows the results of a 2 years application of a clinical pathway concerning the indications to NOM based on the patient's hemodynamic answer instead of on the injury grade of the lesions.We conducted a retrospective study applied on a patient's cohort, admitted in "Azienda Ospedaliero-Universitaria Ospedali Riuniti of Ancona" and in the Digestive and Emergency Surgery Department of the Santa Maria of Terni hospital between September 2015 and December 2017, all affected by blunt abdominal trauma, involving liver, spleen or both of them managed conservatively. Patients were divided into 3 main groups according to their hemodynamic response to a fluid administration: stable (group A), transient responder (group B) and unstable (group C). Management of patients was performed according to specific institutional pathway, and only patients from category A and B were treated conservatively regardless of the injury grade of lesions.From October 2015 to December 2017, a total amount of 111 trauma patients were treated with NOM. Each patient underwent CT scan at his admission. No contrast pooling was found in 50 pts. (45.04%). Contrast pooling was found in 61 patients (54.95%). The NOM overall outcome resulted in success in 107 patients (96.4%). NOM was successful in 100% of cases of liver trauma patients and was successful in 94.7% of splenic trauma patients (72/76). NOM failure occurred in 4 patients (5.3%) treated for spleen injuries. All these patients received splenectomy: in 1 case to treat pseudoaneurysm, (AAST, American Association for the Surgery of Trauma, grade of injury II), in 2 cases because of re-bleeding (AAST grade of injury IV) and in the remaining case was necessary to stop monitoring spleen because the patient should undergo to orthopedic procedure to treat pelvis fracture (AAST grade of injury II).Non-operative management for blunt hepatic and splenic lesions in stable or stabilizable patients seems to be the choice of treatment regardless of the grade of lesions according to the AAST Organ Injury Scale

The use of renal biopsy in the kidney tumor management: A retrospective analysis of consecutive cases in a referral center

Introduction: Ultrasound-guided renal masses biopsy (RMB) is a useful and underestimated tool to evaluate suspected renal tumors. This study aimed to assess the safety and feasibility of this technique. Materials and Methods: Data of 80 patients with suspected primary or secondary kidney tumors who underwent RMB between January 2012 and December 2020 were included in this retrospective study. Twelve patients were excluded due to incomplete data. Biopsy outcomes were collected through our electronic medical records system and then compared with definitive pathology. Results: RMB was performed in 68 cases. Pathological examination reported 43 (63%) malignant cases, while RMB was negative in 15 (22%) samples. On the other hand, a benign lesion was present in 8 (12%) cases, and 2 (3%) biopsies were non diagnostic. One major and one minor post-procedure complication were reported among the patients. A total of 31 patients underwent renal surgery including 19 partial and 12 radical nephrectomies. Out of them, 4 patients had a negative biopsy, but radiological imaging strongly suggested malignancy. The concordance between biopsy and definitive pathology occurred in 22 out of 31 (71%) cases, with a higher rate among the masses greater than 4 cm, 9/11 (82%) compared to smaller ones 13/20 (65%). Pathologic examination of the 4 cases with negative biopsy showed 3 renal cell and a translocation renal cell carcinoma. Conclusions: Ultrasound-guided biopsy for renal masses is a safe and effective procedure. Its ability to identify malignancy is evident, especially for primary renal tumors. However, low concordance between biopsy and definitive pathology in cases with negative biopsies, especially for tumors < 4 cm, does not reliably guarantee the absence of tumor and, therefore, strict follow-up or repeat biopsy may be indicated

Vertical Greening Systems and Urban Heat Island related aspects: outcomes of a research project

Vegetation in architecture can be assumed as a proper design strategy aimed at improving climate in cities and towns. Vertical Greening Systems (VGSs) and green roof are both building systems introduced extensively in recent times in architecture design. The interest about such systems is remarkable and it is often due to both their physics and environmental performances. A variety of ecological benefits can be ascribed to VGSs, i.e. heat island effect mitigation, noise abatement, heating and cooling energy demand reduction, absorption of particulate matters as well as of VOC, enhancement of biodiversity. Furthermore a noteworthy contribution is given towards those aspects related to extreme weather events affecting nowadays European cities, such as heat-waves and urban flooding. Within an industrial research project, focused on the design, manufacture and performance assessment of a VGS, a number of environmental issues were tackled in. The study was aimed, on one hand, identifying a methodology to select materials to be used in the module assembly and, on the other hand, at testing its performance during actual operating use. In this paper results are presented concerning the aspects related to UHI at the mere building envelope scale, as the assessment of the CO2 equivalent emissions due to manufacturing processes, the analysis of VGS thermal behavior and of its potential in reducing the wall external surface temperatures. These experimental results will constitute the starting point for a research activity aimed at evaluating, through the use of simulation tools, the UHI mitigation at building and urban scal

Interventional Radiology's Osteoid Osteoma Management: Percutaneous Thermal Ablation

Osteoid osteoma (OO) is one of the most common benign bone tumors with specific clinical and radiological characteristics. Analgesic therapy and surgical treatment have been considered the only therapy for a long time. Recently, safe and effective new therapeutic options have been introduced, among which percutaneous thermal ablation techniques. This review aims to describe the recent updates in the field of percutaneous thermal ablation techniques in the treatment of OO, assessing the outcomes in terms of efficacy, complications, and recurrence rate

Radiological response and inflammation scores predict tumour recurrence in patients treated with transarterial chemoembolization before liver transplantation

To investigate the prognostic value of the radiological response after transarterial chemoembolization (TACE) and inflammatory markers in patients affected by hepatocellular carcinoma (HCC) awaiting liver transplantation (LT)

A novel vertical greenery module system for building envelopes: The results and outcomes of a multidisciplinary research project

Vegetation in architecture can be considered a proper design strategy that is aimed at improving not only the performances of buildings, but also the outdoor climate. Different technological solutions have been proposed over the years to cover buildings with vegetation, i.e. green roofs, green walls and green balconies. A particular typology of green wall, which has recently been gaining high consensus among designers, is the vertical greenery modular system (VGMS). The positive impact of this type of technology on the performance of buildings is related to several factors, such as the façade orientation, the use of the building, climatic conditions, the type of plants, the substrates and wall assemblies, as well as mechanical and technological issues. A multidisciplinary approach is therefore needed, and different skills have to be joined together right from the early design phase in order to optimize and balance all the aspects that are involved. In this framework, a research project has been carried out in Turin (North West Italy), with the aim of developing a novel VGMS, constituted by a modular box covered with vegetation, made up of recycled/natural and highly performing materials from the energy/environmental point of view. After the design phase, the actual performance of the VGMS was assessed, through laboratory and long-term in field monitoring, and at the same time, the technological issues, biometric parameters, and the acoustic, thermal and mechanical aspects were investigated

Doxorubicin-eluting bead vs conventional transcatheter arterial chemoembolization for hepatocellular carcinoma before liver transplantation

To assess the possible effect of two different types of preoperative transcatheter arterial chemoembolization (TACE) on recurrence-free survival after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) and to analyze the effects of TACE on tumor histology

Role of Bronchial Artery Embolization as Early Treatment Option in Stable Cystic Fibrosis Patients with Sub-Massive Hemoptysis: Personal Experience and Literature Review

(1) Background: We describe our experience with cystic fibrosis (CF) patients treated with bronchial artery embolization (BAE) for sub-massive hemoptysis to understand if early treatment of sub-massive hemoptysis can reduce the volume of any subsequent bleedings. (2) Materials: We performed a retrospective study including CF patients who underwent angiographic procedures for BAE following sub-massive hemoptysis, from March 2016 to December 2021. All patients underwent an initial chest angio-CT study. BAE was realized with microspheres or coils. (3) Results: Thirteen patients were included, subjected to at least one BAE after sub-massive hemoptysis, for a total of 19 procedures. Technical success was 94.7%; in a single case, the catheterization of the bronchial arterial feeder was not achievable and the procedure was repeated. Primary clinical success was 92.3%; secondary clinical success was 69.2%. Relative clinical success was 85%. A higher incidence of recurrent hemoptysis following treatment with coils was observed (100% of cases) compared to treatment with microspheres (54.5% of cases) χ2 = 5.43 (p < 0.05). (4) Conclusions: BAE is a safe and effective method for the treatment of hemoptysis in CF patients; it should be practiced not only after massive or recurrent hemoptysis but also in patients with sub-massive bleeding to improve their life expectancy and quality of life