Guidelines on the diagnosis, treatment and management of visceral and renal arteries aneurysms: a joint assessment by the Italian Societies of Vascular and Endovascular Surgery (SICVE) and Medical and Interventional Radiology (SIRM)

: The objective of these Guidelines is to provide recommendations for the classification, indication, treatment and management of patients suffering from aneurysmal pathology of the visceral and renal arteries. The methodology applied was the GRADE-SIGN version, and followed the instructions of the AGREE quality of reporting checklist. Clinical questions, structured according to the PICO (Population, Intervention, Comparator, Outcome) model, were formulated, and systematic literature reviews were carried out according to them. Selected articles were evaluated through specific methodological checklists. Considered Judgments were compiled for each clinical question in which the characteristics of the body of available evidence were evaluated in order to establish recommendations. Overall, 79 clinical practice recommendations were proposed. Indications for treatment and therapeutic options were discussed for each arterial district, as well as follow-up and medical management, in both candidate patients for conservative therapy and patients who underwent treatment. The recommendations provided by these guidelines simplify and improve decision-making processes and diagnostic-therapeutic pathways of patients with visceral and renal arteries aneurysms. Their widespread use is recommended

Thoracic endovascular repair for blunt traumatic thoracic aortic injury: Long-term results

Objective: This study aims to evaluate the endoprosthesis complications in patients undergoing TEVAR for blunt traumatic thoracic aortic injury, through long-term clinical and diagnostic follow-up. Methods: During the study interval (November 2000-October 2020), a total of 38 patients (63% male; average age 37.5 years) with thoracic aortic injury underwent thoracic endovascular aortic repair. Patients underwent routine follow-up with clinical examination and radiological evaluation (CT-angiography or MRI-angiography plus chest radiograph), scheduled at 1 month, at 6 months (only in the cases of thoracic aortic dissection), at 1 year after the procedure and every 1 year thereafter. Results: Technical success was achieved in 38 procedures (100%). The TEVAR-related mortality rate was 0%. No immediate major complications related to the endovascular procedure were observed. The median duration of diagnostic follow-up was 80 months. A total of four procedure-related complications (10.5%) were identified at the follow-up. Three (7.9%) distal infoldings and collapses of the thoracic endoprosthesis and one (2.6%) type Ia endoleak were observed. No thrombosis of the prosthesis, nor signs of aortic pseudocoarctation were identified. No further complications related to endograft (endoleaks, infections, rupture, partial or complete thrombosis) occurred. No changes in the native aorta, stenosis, or increases in the endograft's diameters were observed. A total of 20 patients (52.6%) underwent MRI-angiography examinations, while a total of 34 patients (89.5%) underwent chest radiographs at the follow-up. In all cases, CT-angiography examinations were performed at the follow-up. Conclusions: Procedure-related complications were observed within one year of TEVAR, limiting concerns related to the durability of the prosthesis. No morphological changes in the aorta were observed despite long-term follow-up. The consequences of lifelong surveillance in terms of radiation exposure deserve special consideration, especially in younger patients treated for TAI

Dual-phase CT for the assessment of acute vascular injuries in high-energy blunt trauma: The imaging findings and management implications

Acute vascular injuries are the second most common cause of fatalities in patients with multiple traumatic injuries; thus, prompt identification and management is essential for patient survival. Over the past few years, multidetector CT (MDCT) using dual-phase scanning protocol has become the imaging modality of choice in high-energy deceleration traumas. The objective of this article was to review the role of dual-phase MDCT in the identification and management of acute vascular injuries, particularly in the chest and abdomen following multiple traumatic injuries. In addition, this article will provide examples of MDCT features of acute vascular injuries with correlative surgical and interventional findings

Hypoxia and tumor angiogenesis in the era of hepatocellular carcinoma transarterial loco-regional treatments

This review focuses upon interactions and potential therapeutic targets in the 'vicious cycle' between hypoxia and neoangiogenesis following treatment of hepatocellular carcinoma with transarterial loco-regional therapies. Biomarkers correlated with angiogenesis have been studied by many authors as prognostic determinants following transarterial intrahepatic therapy. According to these results future therapies directed toward specific factors related to angiogenesis could play a significant role in preventing local tumor recurrence and remote metastasis

Gastroprotective and anti Helicobacter pylori activities of propolis

Helicobacter pylori (HP) determines the most common human infection overall. Important gastric diseases are associated with HP with percentage of correlation up to 90% (duodenal ulcer and gastric lymphoma). The complexity of the pathogenetic factors of HP has prompted research to identit/ "phytocomplexes" able to act on different mechanisms of HP pathogenesis [1]. Our group investigated propolis regarding its antibacterial activity and focusing the protection from oxidative stress and massive inflammatory response, key elements of the progression of HP gastric diseases related, scarcely considered in classic antibiotical therapies [21. We studied propolis marketed in ltaly: classic propolis dry extract, hydrodispersible propolis, water-soluble propolis and a new formulation of propolis (75% italian propolis dry extract, 15% green tea catechins, 10% grape seed procyanidins), 50% total polyphenols UV method standardized. The different chemical composition of samples determines different biological activity as evidenced by in vífro and in human cells assays [3,4,51. Propolis water solutions at different concentrations were tested. Results indicated that propolis has high radical scavenging capacity (lCso in DPPH test ranging from 8.2 to 65.4 ?g/mt) and protect cell membranes from oxidative stress. Antioxidant activitvity was directly proportional to the effectiveness against HP: the new propolis formulation MBC and MIC against HPcagt and HPcag is 0.250 mg/ mL Tests on human PBMC stimulated wíth LPS showed that all samples (conc. 200 pg/ml) exhibited anti-inflammatory activity respect to LPS group. This research clearly demonstrated that antioxidant properties of propolis preparatíons and effectively promote gastric protection acfing in different steps of HP pathogenesis. Keyvu,ords: Helicobacter pylori, propolis, anti-infl ammatory, antioxidant, gastroprotective References: [1] Molnar B, Galamb O, Sipos F, Leisztef K, Tulassay (2010) Z Dig Dis 28(4-5):604-608. [2] Calvino-Fernindez M, Pana-Cid T (2010) Rev Esp Enferm Dig 1O2:. 41-5O. [3] Biagi M, Miraldi E, Figura N, ciachetti D (2009) Nat Prod Commun 4(2):255-260. [4] Rapta P, Misík V, Srasko A, Vrébet I (1995) Free Radic Biol Med 18 (5):901-908. [5] Boyanova L, Gergova G, Nikolov R, Derejian S, Lazarova E, Katsarov N, Mitov l, I(rastev Z (2005) J Med Microbiol 54:481-483

Septic sacroiliitis: an uncommon septic arthritis

Septic sacroiliitis is an uncommon joint infection and the diagnosis is often delayed. We present the first case of a septic arthritis of the shoulder and of the sacroiliac joint in a woman affected by systemic sclerosis, and we reviewed the medical literature since 1997 to 2008 on septic sacroiliitis with a specific microbiological diagnosis other than Mycobacteria and Brucella species.Evidence shows that antibiotic therapy should be continued until full clinical and radiological resolution is achieved