A water-filled garment to protect astronauts during interplanetary missions tested on board the ISS

Abstract As manned spaceflights beyond low Earth orbit are in the agenda of Space Agencies, the concerns related to space radiation exposure of the crew are still without conclusive solutions. The risk of long-term detrimental health effects needs to be kept below acceptable limits, and emergency countermeasures must be planned to avoid the short-term consequences of exposure to high particle fluxes during hardly predictable solar events. Space habitat shielding cannot be the ultimate solution: the increasing complexity of future missions will require astronauts to protect themselves in low-shielded areas, e.g. during emergency operations. Personal radiation shielding is promising, particularly if using available resources for multi-functional shielding devices. In this work we report on all steps from the conception, design, manufacturing, to the final test on board the International Space Station (ISS) of the first prototype of a water-filled garment for emergency radiation shielding against solar particle events. The garment has a good shielding potential and comfort level. On-board water is used for filling and then recycled without waste. The successful outcome of this experiment represents an important breakthrough in space radiation shielding, opening to the development of similarly conceived devices and their use in interplanetary missions as the one to Mars

Unsuspected infrahepatic interruption of inferior vena cava associated with floppy mitral valve, mitral valve prolapse, and severe mitral regurgitation.

We describe a case of unsuspected infrahepatic interruption of the inferior vena cava with hemiazygos continuation in a 67-year-old man presenting with chest pain and evidence of mitral regurgitation. He had no persistent superior vena cava, with the hemiazygos draining directly into the right superior vena cava. Polysplenia and severe mitral prolapse were also present: the latter may represent more than an incidental finding in this condition. This malformation may deserve consideration in adults undergoing femoral right heart catheterization. Chest radiographic studies are the basic clue to the diagnosis

Use of Gianturco-Roubin stents for treating abrupt occlusion of unprotected left main stem during elective PTCA.

Abrupt occlusion of the left main during elective coronary angioplasty has a high mortality rate despite emergent surgery. Coronary stents are useful for managing abrupt occlusion during balloon angioplasty, but patients treated with bail-out stenting to obviate life-threatening occlusions are usually operated after stabilization. Two cases of multiple bail-out stenting of the left main as a stand-alone treatment and their long-term follow-up are reported

Coronary stenting after unsuccessful emergency angioplasty in acute myocardial infarction: results in a series of consecutive patients.

Nineteen consecutive procedures of coronary stenting were attempted in 70 consecutive patients (27\%) with evolving myocardial infarction due to threatened vessel reocclusion after primary (16 cases) or rescue (3 cases) angioplasty. Two patients were in cardiogenic shock. Stent delivery was successful in 18 patients, with a Thrombolysis in Myocardial infarction flow grade 3; residual diameter stenosis and minimum luminal diameter were 19\% +/- 11\% and 2.96 +/- 0.62 mm, respectively. After the procedure, heparin was continued for 4 days and 250 mg ticlopidine twice a day for 1 month. Acute stent occlusion occurred in one patient 1 hour after the procedure and was successfully treated with emergency repeat angioplasty. Subacute stent occlusion occurred 6 days after the procedure in one patient, with multivessel coronary disease and a suboptimal stent result. He had been referred for surgery, and emergent coronary artery bypass was performed. Coronary bypass surgery was performed in another patient before discharge because of severe multivessel disease. Persistent cardiogenic shock and new myocardial infarction in another location were the causes of death in two patients, 3 and 10 days after the procedure, respectively. Fifteen patients were discharged with a patient infarct vessel and without reinfarction or need for coronary bypass surgery. One patient had repeat angioplasty for intrastent restenosis at 3 months. The remaining 14 patients were free from new coronary events 4 +/- 2 months after the procedure. Although acute myocardial infarction is generally considered a contraindication to the use of coronary stents, stents may play a role in increasing the rates of successful infarct artery reperfusion

Concomitant myocardial infarction in identical twins with similar coronary lesions.

Two 42-year-old male twins were referred to our hospital for coronary angiography within 3 months. Despite some gross similarities in the aspect of the coronary tree, the coronary dominance pattern was not the same in these twins, but coronary lesions involved almost the same sites. Genetically determined local factors, such as the rheologic profile in some sections of the coronary tree, or the susceptibility to lipid deposition in some spots, may be important in the development of atheromatous lesions in special sites

Elective coronary angioplasty with and without surgical standby: clinical and angiographic criteria for the selection of patients.

The cardiac catheterization laboratory (CCL) of our hospital is the only facility for invasive cardiology in a large district. No cardiac surgery is carried out in our hospital at present, the nearest facility being approximately 50 miles away.Over a period of 2 years we recommended percutaneous transluminal coronary angioplasty (PTCA) with surgical standby for 164 cases, who were referred to CCLs with on-site surgical standby, and PTCA without surgical standby for 232 cases, 199 of whom underwent PTCA in our CCL. Criteria used in the selection of patients for PTCA without surgical standby were the following: (a) either limited extent or severely impaired function of the ventricular segment in jeopardy; (b) normal or near-normal function of the uninvolved myocardial segments; (c) absence of lesions of the left main or left anterior descending coronary arteries when the target stenosis was in the left coronary artery; (d) non-applicability and high risk-benefit ratio of emergency surgical revascularization in the individual patient. Clinical and angiographic characteristics of patients assigned to PTCA with and without surgical standby are compared.An initial success was achieved in 186 cases (93\%) in our CCL. In 12 cases (6\%), PTCA was not successful, and in two cases (1\%) it was complicated by myocardial infarction. None of the patients died, or had to undergo further coronary interventions within 1 month. Coronary stents were implanted in 24 cases.For many PTCA candidates, emergency coronary surgery is not an option in case of occlusive complications. Our data suggest that PTCA can be performed with minor complications in these patients in the absence of surgical standby, provided strict criteria are used in the selection of cases

Percutaneous transluminal angioplasty of right and left internal mammary artery grafts

Four patients with recurrent severe angina and evidence of myocardial ischemia two to six months after surgical coronary revascularization have been submitted to percutaneous transluminal angioplasty of the distal insertion of internal mammary artery grafts or of the recipient vessel distal to it. These cases illustrate the feasibility and safety of transluminal angioplasty of right and left internal mammary artery grafts, using the mammary artery as a way of access

Angiographic follow-up after coronary implantation of the Multilink stent: a prospective observation.

A growing variety of coronary stents is becoming available on the market. Results of randomized trials may be difficult to apply to less selected patients, and experience with every device cannot be obtained in every center. Detailed information about the immediate and long-term results achieved with one device can be a helpful reference for interventional cardiologists. The aim of this study was to test the applicability and the clinical and angiographic results, both immediate and at 6 months, of the Multilink coronary stent in a cohort of unselected patients undergoing coronary angioplasty.From March 1997 to June 1998 coronary angioplasty was performed in 391 patients in our center, with the use of stents in 339 patients.Three hundred and seventeen Multilink stents were successfully implanted in 295 lesions in 277 patients; an acute coronary syndrome was present in 209 cases (75\%), and lesion types B2 and C accounted for 30\% of lesions. In 7 cases (2.4\%) the Multilink stent did not cross the lesion, and another device was implanted. Subacute stent occlusion occurred in 1 patient (0.36\%) after primary angioplasty. After 6 months from the procedure, clinical follow-up data were available for 252 out of 254 patients: none had died, and angina or myocardial ischemia occurred in 25 patients (9.9\%). A control angiogram was performed in 239 out of 254 patients (94\%) at 178 +/- 34 days. Restenosis occurred in 44/239 patients (18.4\%) and in 48/247 lesions (19.4\%). In patients with vs without restenosis the original lesion was longer (p = 0.009), and diabetes mellitus was more frequent (p = 0.002), as was the use of multiple stents (p = 0.005). In single 15, 25 and 35 mm long stents restenosis occurred in 13.9, 15.5 and 46.2\% of cases, respectively (p = NS).The Multilink stent showed a low rate of subacute occlusion (0.36\%) and could be used safely also in patients with acute coronary syndromes. The use of a single, 15 or 25 mm long Multilink stent was associated with a low angiographic recurrence rate (14-16\%)