Bilateral heterochronic spontaneous hemothorax caused by pulmonary arteriovenous malformation in a gravid: A case report

Bilateral heterochronic spontaneous hemothorax as a result of pulmonary ateriovenous malformation is a very rarely happened disease. A 34-year-old woman presented major symptoms with right-sided chest pain and shortness of breath. The following contrast-enhanced computed tomographic scan of the chest showed a large amount of fluid in the right thorax with mediastinal shift, but without major vessel injury and 2 small dense opacities in the apical segment of the right lower lobe and in the posterior aspect of the left lower lobe. The patient underwent local resection of the right lower lobe. The pulmonary ateriovenous malformation was further identified by pathological examination. One month after she was discharged home, the symptoms described above recurred. A follow-up computed tomographic scan of the chest showed a large amount of fluid in the left thorax. During the emergency operation, we found a bullous lesion in the left lower lobe and a small blood vessel overlying the lesion that was actively bleeding. As stated above, local resection of the left lower lobe was performed once more. Pathological result was the same as observed previously. There were no postoperative complications and she was discharged from the hospital after two weeks. Two months later, she successfully delivered a healthy female infant. Up to now, regular follow-up observation has shown her to be perfectly asymptomatic

Multi-scale investigation of uranium attenuation by arsenic at an abandoned uranium mine, South Terras

Detailed mineralogical analysis of soils from the UK’s historical key uranium mine, South Terras, was performed to elucidate the mechanisms of uranium degradation and migration in the 86 years since abandonment. Soils were sampled from the surface (0 – 2 cm) and near-surface (25 cm) in two distinct areas of ore processing activities. Bulk soil analysis revealed the presence of high concentrations of uranium (<1690 ppm), arsenic (1830 ppm) and beryllium (~250 ppm), suggesting pedogenic weathering of the country rock and ore extraction processes to be the mechanisms of uranium ore degradation. Micro-focus XRF analysis indicated the association of uranium with arsenic, phosphate and copper; µ-XRD data confirmed the presence of the uranyl-arsenate minerals metazeunerite (Cu(UO2)2(AsO4)2·8H2O) and metatorbernite (Cu(UO2)2(PO4)2·8H2O) to be ubiquitous. Our data are consistent with the solid solution of these two uranyl-mica minerals, not previously observed at uranium-contaminated sites. Crystallites of uranyl-mica minerals were observed to coat particles of jarosite and muscovite, suggesting that the mobility of uranium from degraded ores is attenuated by co-precipitation with arsenic and phosphate, which was not previously considered at this site

Shoulder hemiarthroplasty for fractures of the proximal humerus

Proximal humeral fractures were managed with primary hemiarthroplasty in 57 patients, 53 women (93%) and 4 men (7%) aged 51–87 years (mean 72.2). The mean follow-up period was 52 months (range 12–98), and the mean Constant score was 59.2 (range 38–76). Patients were very satisfied (n = 19); satisfied (n = 32) or dissatisfied with the outcome (n = 5). One patient required early revision surgery. Surgical treatment of three- and four-part fractures of the proximal humerus with hemiarthroplasty is a safe and effective approach, the outcome of which appears to be related to the quality of the anatomical reconstruction of the tuberosities

Severe hemoptysis from dilated systemic aberrant arteries supplying normal lung segments

Hemoptysis is an uncommon presentation in children. It can be caused by several systemic and pulmonary disorders. Bleeding from an anomalous arterial supply to normal lung segments with no underlying pulmonary or cardiovascular disorders was widely reported in adults but is extremely rare in the pediatric age group. Here we describe 4 previously normal children and one girl with chronic lung disease, secondary to bronchopumonary dysplasia, with acute and significant hemoptysis of variable severity. Extensive clinical and laboratory investigations did not identify any reasonable causes for their symptoms. Cardiac catheterization showed dilated anomalous systemic arteries that supplied a pulmonary arteriovenous malformation in one case and normal basal lung segments in the other 4 cases. Embolization of the anomalous arterial collaterals led to occlusion of these arteries and the cessation of further hemoptysis. © 2004 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/35323/1/20115_ftp.pd

Quali strumenti giuridici statali e regionali per le comunit\ue0 patrimoniali?

The Framework Convention on the Value of Cultural Heritage for Society (Faro Convention, 2005) recognizes a central role to heritage communities in the process of identification, study, interpretation, protection, conservation and presentation of the cultural heritage. As a signatory State of the Convention (signed on 27th February 2013, still waiting for ratification), Italy has in any case to ensure its contribution to the safeguarding of the tangible and intangible cultural heritage by adequate policies. Currently, a State law providing a general regulation of the participation of civil society to the protection and the enhancement of cultural heritage in the Italian legal system has not been adopted yet. Nevertheless, communities, groups and individuals have a wide range of instruments available, which can be drawn by an accurate interpretation of the Constitution and of many State and regional laws. In the long run, the persistent lack of common rules on this subject may be a source of uncertainty, capable of weakening, instead of strengthening, the role of heritage communities, in contrast with the principles of the Faro Convention

Citizens of Europe

Il titolo della collana esprime la volont\ue0 di approfondire i profili legati al processo di integrazione europeo, non ignorandone i risvolti pi\uf9 discutibili e burocratici ma sapendo guardare al di l\ue0 di essi, nella logica che traspare dal gioco di assonanze indicato dal titolo. In questo terzo volume Citizens of Europe, dedicato ai temi delle identit\ue0 e della cittadinanza culturale, viene in rilievo la tensione tra i limiti delle politiche, culturali e di cittadinanza, perseguite dalla UE e l\u2019imporsi progressivo \u2013 malgrado le cupe ombre proiettate dalla drammatica attualit\ue0 \u2013 di una pi\uf9 ampia nozione di \u2018cittadinanza d\u2019Europa\u2019, scandita in particolare da quei recenti strumenti giuridici del Consiglio d\u2019Europa attraverso i quali l\u2019afflato europeo, non imprigionato nelle pastoie dei meccanismi della EU citizenship, si sviluppa pi\uf9 significativamente

Changes in Telepsychiatry Regulations during the COVID-19 Pandemic: 17 Countries and Regions' Approaches to an Evolving Healthcare Landscape

Background: During the COVID-19 pandemic, the use of telemedicine as a way to reduce COVID-19 infections was noted and consequently deregulated. However, the degree of telemedicine regulation varies from country to country, which may alter the widespread use of telemediine. This study aimed to clarify the telepsychiatry regulations for each collaborating country/region before and during the COVID-19 pandemic. Methods: We used snowball sampling within a global network of international telepsychiatry experts. Thirty collaborators from 17 different countries/regions responded to a questionnaire on barriers to the use and implementation of telepsychiatric care, including policy factors such as regulations and reimbursement at the end of 2019 and as of May 2020. Results: Thirteen of 17 regions reported a relaxation of regulations due to the pandemic; consequently, all regions surveyed stated that telepsychiatry was now possible within their public healthcare systems. In some regions, restrictions on prescription medications allowed via telepsychiatry were eased, but in 11 of the 17 regions, there were still restrictions on prescribing medications via telepsychiatry. Lower insurance reimbursement amounts for telepsychiatry consultations versus in-person consultations were reevaluated in 4 regions, and consequently, in 15 regions telepsychiatry services were reimbursed at the same rate (or higher) than in-person consultations during the COVID-19 pandemic. Conclusions: Our results confirm that, due to COVID-19, the majority of countries surveyed are altering telemedicine regulations that had previously restricted the spread of telemedicine. These findings provide information that could guide future policy and regulatory decisions, that facilitate greater scale and spread of telepsychiatry globally

Poor Identification of Emergency Department Acute Recreational Drug Toxicity Presentations Using Routine Hospital Coding Systems: the Experience in Denmark, Switzerland and the UK

Understanding emergency department and healthcare utilisation related to acute recreational drug toxicity (ARDT) generally relies on nationally collated data based on ICD-10 coding. Previous UK studies have shown this poorly captures the true ARDT burden. The aim of this study was to investigate whether this is also the case elsewhere in Europe.; The Euro-DEN Plus database was interrogated for all presentations 1st July to 31st December 2015 to the EDs in (i) St Thomas' Hospital, London, UK; (ii) Universitätsspital Basel, Basel, Switzerland; and (iii) Zealand University Hospital, Roskilde, Denmark. Comparison of the drug(s) involved in the presentation with the ICD-10 codes applied to those presentations was undertaken to determine the proportion of cases where the primary/subsequent ICD-10 code(s) were ARDT related.; There were 619 presentations over the 6-month period. Two hundred thirteen (34.4%) of those presentations were coded; 89.7% had a primary/subsequent ARDT-related ICD-10 code. One hundred percent of presentations to Roskilde had a primary ARDT ICD-10 code compared to 9.6% and 18.9% in Basel and London respectively. Overall, only 8.5% of the coded presentations had codes that captured all of the drugs that were involved in that presentation.; While the majority of primary and secondary codes applied related to ARDT, often they did not identify the actual drug(s) involved. This was due to both inconsistencies in the ICD-10 codes applied and lack of ICD-10 codes for the drugs/NPS. Further work and education is needed to improve consistency of use of current ICD-10 and future potential ICD-11 coding systems