Association between asymptomatic carotid atherosclerosis and degenerative aortic stenosis.

OBJECTIVE: Degenerative aortic stenosis shows similarities with atherosclerosis. To confirm the hypothesis that aortic stenosis is an "atherosclerosis-like" disease, we investigated the association between degenerative aortic stenosis and atherosclerosis of carotid arteries. METHODS: We studied 270 consecutive patients, 135 with degenerative aortic stenosis (trans-aortic peak velocity ≥ 2 m/sec) and other 135 subjects without aortic valve disease. All patients underwent echocardiography and ultrasound scan of the supra-aortic trunks to assess the presence of plaque and/or intima-media thickening (IMT). RESULTS: Atherosclerosis of carotid arteries (IMT and plaque) was significantly more frequent in patients with aortic stenosis than in controls (95.5% vs. 66.6%, p < 0.0001). The same result was confirmed as concerns carotid plaques (69.6% vs. 42.2%, p < 0.0001). In addition, there was a significant association between aortic stenosis and degenerative carotid plaque (OR = 3.13; 95% C.I. = 1.90-5.17). Thus the presence of a linear correlation between the trans-aortic peak velocity of the cases and the thickness of the plaques and IMT was evaluated by calculating the coefficient of correlation (R = 0.15 for plaque and R = 0.53 for IMT). CONCLUSIONS: The presence of carotid atherosclerosis is associated with degenerative aortic stenosis and the severity of aortic stenosis corresponds to an increase of the thickness of plaque and IMT. This relationship is quite new. Our result strengthens the pathogenetic hypothesis "atherosclerosis-like" of degenerative aortic stenosis and suggest the ultrasound scan as a non invasive method for risk stratification in patient with aortic stenosis, with therapeutic implications especially for higher risk subgroups

Incarcerated hernia in a trocar site following laparoscopic gastric bypass

This paper reports a case of small bowel occlusion due to the herniation of an ileal ansa at the site of the insertion of a 12-mm trocar. A 28-year-old obese female patient underwent laparoscopic surgery for gastric bypass, the skin incisions of the trocar insertion sites were closed with absorbable sutures. Small bowel occlusion occurred on post-operative day 6 and the patient again underwent laparoscopic surgery. Laparoscopic exploration confirmed the suspected presence of the incarcerated hernia of an ileal ansa at the site of the trocar insertion which was freed without any need for bowel resection. The fascial defect was successfully closed under direct vision with the use of a special system of fascial sutures

Quality interoperability within digital libraries: the DL.org perspective

Quality is the most dynamic aspect of DLs, and becomes even more complex with respect to interoperability. This paper formalizes the research motivations and hypotheses on quality interoperability conducted by the Quality Working Group within the EU-funded project DL.org (&lt;a href="http://www.dlorg.eu"&gt;http://www.dlorg.eu/&lt;/a&gt;). After providing a multi-level interoperability framework – adopted by DL.org - the authors illustrate key-research points and approaches on the way to the interoperability of DLs quality, grounding them in the DELOS Reference Model. By applying the DELOS Reference Model Quality Concept Map to their interoperability motivating scenario, the authors subsequently present the two main research outcomes of their investigation - the Quality Core Model and the Quality Interoperability Survey

The PFO anatomy evaluation as possible tool to stratify the associated risks and the benefits arising from the closure

According to the current guidelines, the patent foramen ovale (PFO) is still considered a qualitative factor and, as a consequence, its closure is recommended just on the basis of its 'presence'. Methods and results In the year 2008, we evaluated 25 patients (mean age 62.7) with acute cerebrovascular event and 92 patients (mean age 27.3) suffering from migraine with aura. No PFO was reported in 79 patients. A venous-to-arterial circulation shunt had been shown in 38 patients (29 subjects with migraine and 9 subjects with prior stroke). According to the number of microbubbles arrived during the Valsava manoeuvre, we found: 25 small PFO, 6 moderate PFO, and 6 severe PFO. In the baseline population with migraine (n = 92), 32 (n = 29) had a PFO. A 'large' foramen was reported in ∼9 of the migraine subjects. In the population with prior stroke (n=25), 9 patients (36) had a PFO. A 'large' foramen was reported in 45 of the patients with ischaemic stroke. We found embryonic recesses in 13 (n = 4) of the patients with migraine and PFO (n=29) vs. 66 (n=6) of the patients with ischaemic stroke and PFO (P= 0.01). Conclusion It is possible to suppose that not all PFO have the same prognostic value. The evaluation of two anatomical characteristics can allow to identify those foramina at higher risk and, as a consequence, the patients who could have a major benefit from the closur

Radiological and clinical results following high-dose intensity-modulated radiotherapy in recurrent craniopharyngioma: A case report

none9noCraniopharyngiomas (CPs) are rare benign suprasellar tumors. The standard treatment for CP is complete surgical resection or partial resection followed by adjuvant radiotherapy (RT). Adjuvant RT is typically administered at a total dose of 54 Gy with 1.8 Gy/fraction. The current study reported the case of a young patient affected by recurrent craniopharyngioma, who was treated with irradiation subsequent to several surgical resections. Image fusion and intensity‑modulated radiation therapy techniques were employed to deliver a high total dose (63 Gy with 2.1 Gy/fraction) with no severe acute toxicities recorded. At the 6‑year follow‑up, no radiological or clinical signs of disease progression or late sequelae were observed.mixedPierro, Antonio; Cilla, Savino; Picardi, Vincenzo; Ferro, Marica; Macchia, Gabriella; Deodato, Francesco; Buwenge, Milly; Sallustio, Giuseppina; Morganti, Alessio G.Pierro, Antonio; Cilla, Savino; Picardi, Vincenzo; Ferro, Marica; Macchia, Gabriella; Deodato, Francesco; Buwenge, Milly; Sallustio, Giuseppina; Morganti, Alessio G

On the cutting edge of intensity modulated radiotherapy and simultaneous integrated boost (IMRT-SIB): The case of a patient with 8 brain metastases

Background: Patients with multiple brain metastases, especially those with more than 3 lesions, usually undergo to palliative whole brain (WB) radiotherapy (RT). Methods: A breast cancer patient with 8 brain metastases was treated on the brain by a radical RT regimen. Prescription doses were according to the simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) technique with all lesions as well brain irradiated simultaneously in 20 daily fractions. Doses of 40.0 Gy (2.0 Gy/fraction) and 50.0 Gy (2.5 Gy/fraction) were prescribed to the whole brain and to eight individual metastases, respectively. Results: Mean volume of the eight metastases was 8.1 cc (range: 3.8-10.1 cc). For all lesions, the volume receiving 95% of prescribed dose was 100% and dose homogeneity was within 3%. Moreover, maximum doses were less than 105% of prescribed dose, while average mean dose to lesions was 50.6. Gy (range: 49.7-51.5 Gy). Whole brain mean dose was 45.2 Gy. Maximum doses to brainstem and optic chiasma were limited to 44.5 Gy and 42.9 Gy, respectively, while maximum doses to eyes, lens and optic nerves were limited to 9.2 Gy, 4.9 Gy and 41.0 Gy, respectively. From a clinical point of view, subsequent MRI brain controls showed a complete clinical response. Forty months after treatment the patient is disease free and shows no late brain and skin toxicities. Conclusion: This case demonstrates the technical feasibility of a SIB-IMRT treatment in patients with more than 3 brain metastases