Comparación en los resultados de pacientes con bronquiolitis manejados con dos diferentes métodos de administrar oxígeno. Informe preliminar de avance del Hospital General de Niños Dr. Pedro de Elizalde

Introducción: La oxigenoterapia en el tratamiento de niños con bronquiolitis puede ser administrada mediantes cánulas nasales con bajo o alto flujo (CNAF). Las CNAF podrían ser una alternativa a la ventilación no invasiva, requiriendo menos recursos que los cuidados intensivos (UCIP). Objetivo: Evaluar si existe diferencia en la proporción de sujetos hospitalizados por bronquiolitis que requiere UCIP o en la duración de su hospitalización, según oxigenoterapia (convencional o CNAF). Métodos: Estudio observacional incluyendo lactantes hospitalizados por bronquiolitis en los meses de junio a agosto de 2017. Los pacientes fueron tratados según el servicio donde se encontraban (las unidades 1, 2 y 3 con oxigenoterapia convencional, y las unidades 4 y 5 con CNAF), al que fueron asignados según disponibilidad de cama. Resultados: Se incluyeron 329 pacientes, con edad promedio de 7,2 meses, que permanecieron hospitalizados 5,9 días y recibieron 4,6 días de oxigenoterapia. Todos recibieron oxigenoterapia, 84 (25,5%) CNAF y 245 (74,5%) convencional. Sólo 10 (3,1%) requirieron UCIP. De los que ingresaron a UCIP 5/84 recibieron CNAF y 5/245 recibieron terapia convencional (OR: 3,1; IC 95%: 0,8-10,7; p=0,07). Los pacientes con CNAF permanecieron significativamente más tiempo hospitalizados (6,9 ± 3,9 días vs. 5,6 ±3,2; p=0,003), luego de controlar por edad, la etiología viral y requerimiento de UCIP. Conclusión: En la población analizada no se observó diferencia en la proporción de pacientes que requirieron UTIP según hubieran recibido oxigenoterapia por CNAF o en forma convencional.Background: Oxygen in bronchiolitis treatment can be delivered by nasal cannulas using low or high flow (HFNC). HFNC can be an alternative to non-invasive ventilation or intensive care (PICU). Objective: To evaluate PICU requirement and length of stay (LOS) according to oxygen delivery method in children hospitalized for bronchiolitis. Methods: Observational study including infants hospitalized for bronchiolitis from June to August 2017. Patients received oxygen based on to the unit in which they were hospitalized (units 1, 2 and 3 received conventional oxygen therapy, while units 4 and 5 received HFNC), assigned according to bed availability. Results: We included 329 patients, aged 7.2 months, with a LOS of 5.9 days, and receiving oxygen for 4.6 days. All of them received oxygen, 84 (25.5%) HFNC and 245 (74,5%) conventional therapy. Only 10 (3.1%) required PICU, 5 using HFNC and 5 on conventional therapy (OR: 3,1; 95%IC: 0.8-10.7; p=0.07). After controlling for age, viral etiology and PICU requirement, patients on HFNC showed a significantly longer LOS (6.9 ± 3.9 vs. 5.6 ± 3.2 days; p=0.003). Conclusion: Patients who received oxygen trough HFNC required PICU less frequently than those in conventional therapy but showed a longer length of stay.Fil: Potasnik, J.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Golubicki, A.. Ministerio de Salud de la Nación; ArgentinaFil: Fernandez, A.. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital General de Agudos Carlos Durand.; ArgentinaFil: Raiden, Silvina Claudia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Sosa, R.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Gonzalez, N.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Cairoli, H.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: De Lillo, L.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Sanluis Fenelli, G.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Planovsky, H.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Checacci, E.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Lopez, M.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Gigliotti, E.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Torres, F.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Ferrero, F.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentin

Un sistema esperto per scavi archeologici in aree urbane

L’articolo descrive un sistema esperto (Archeo) rivolto alla progettazione preliminare di scavi archeologici in rocce sciolte. Il sistema, sviluppato dal Dipartimento di Ingegneria Geotecnica dell’Ateneo Federico II nell’ambito di una convenzione con il CO.RI.S.T.A., può essere eseguito su di un personal computer di media potenza. La sua architettura è basata sulla distinzione tra parti di conoscenza geotecnica di validità generale e parti strettamente dipendenti dalla situazione in cui si opera. Per la raccolta delle informazioni, Archeo utilizza un’interfaccia utente semplice ed immediata, dotata di funzioni di controllo e d’aiuto in linea. Il sistema simula il processo logico seguito da un esperto costruendo uno scenario di riferimento per lo scavo da eseguire, progettando una campagna d’indagini geotecniche, organizzando i dati acquisiti e selezionando le possibili soluzioni per il sostegno dello scavo. Alla fine del processo Archeo propone una o più soluzioni ritenute valide per il caso di studio ed esegue un dimensionamento di massima delle opere di sostegno dei fronti di scavo, per consentire all’utente una stima dell’impegno economico delle stesse. Nell’articolo sono presentati e discussi i principali elementi sopra indicati ed esemplificati alcuni casi di studio. L’accento è posto sulle relazioni esistenti tra qualità dei risultati, rappresentazione della conoscenza e qualità e quantità delle informazioni introdotte

Lavinium III. Saggi di scavo presso la rimessa agricola della tenuta Borghese (1985-1986)

Con questo volume riprende la pubblicazione delle monografie dell’Università di Roma La Sapienza dedicate a Pratica di Mare, l’antica Lavinium. Si tratta dell’edizione dello scavo e dei materiali venuti in luce nel corso dei sondaggi intrapresi nell’area urbana negli anni 1985-1986, presso la rimessa agricola della tenuta Borghese. Nell’ambito di alcuni sondaggi, in uno degli ambienti iden-tificati, fu messa in luce una significativa quantità di materiale riconducibile alla media Repubblica, costituito anche di numerosi esemplari integri. Il contesto ceramico, degno di nota per la sua composizione e tipologia, sarebbe riconducibile alla dotazione di una dispensa, forse la culina di un santuario o, comunque, interpretabile come un set utilizzato nell’ambito di attività comunitarie periodiche

Cervical artery dissection: presentation and treatment

Cervical artery dissection (CeAD) is a rare condition whereby a tear occurs in the intimal layer of the artery wall. This condition can determine stroke, peripheral symptoms or can be asymptomatic. Vascular surgeons are often involved in the treatment of this pathology and the present paper aims to overview the actual knowledge on this topic. Clinical studies and randomized trials were screened and analyzed through PubMed to report the incidence, the clinical manifestations and the treatment options of CeAD. CeAD involving extracranial internal carotid artery is most frequently involved (80%) rather than vertebral artery (15%) or carotid artery in association with vertebral artery (5%). Internal carotid dissection occurs in all age group and it is responsible for 2.5% of all strokes, and 40% of stroke in patients older than 50 years. Carotid artery dissection typically begins with local symptoms, such as a sudden onset of unilateral and constant headache or an ipsilateral neck pain or a partial Horner’s syndrome, followed by retinal or cerebral ischemia. Stroke associated with CeAD are present in 50-60% of symptomatic cases, even if many of CeAD are asymptomatic and therefore the real incidence of stroke associated with CeAD is difficult to establish. The risk of recurrent stroke after carotid artery dissection is less than 3%. Anticoagulant or antiplatelet therapy are both associated with low-rate of symptoms recurrence (1-3%) at the follow-up. Surgical or endovascular therapy can be considered for patients with symptoms recurrence without benefit from medical therapy. CeAD is a possible cause of stroke, and it should be carefully investigated, particularly in young patients, in order to deliver an adequate therapeutic approach

Intracranial Hemorrhage After Endovascular Repair of Thoracoabdominal Aortic Aneurysm

Background: Intracranial hemorrhage (ICH) is a rare but devastating complication of thoracoabdominal aortic aneurysm (TAAA) repair with fenestrated/branched endograft (f/bEVAR). The cerebrospinal fluid drainage (CSFD) is considered one of the leading causes; however, other possible concomitant factors have not been individualized yet. The aim of the present work was to evaluate the pattern of ICH events after f/bEVAR for TAAA and to identify possible associated factors. Materials and Methods: All f/bEVAR procedures for TAAA performed in a single academic center from 2012 to 2020 were evaluated. ICH was assessed by cerebral computed tomography if neurological symptoms arose. Pre-, intra-, and postoperative characteristics were analyzed in order to identify possible factors associated. Results: A total of 135 f/bEVAR were performed for 72 (53%) type I, II, III and 63 (47%) type IV TAAA; 74 (55%) were staged procedures, 101 (73%) required CSFD, and 24 (18%) were performed urgently. The overall 30-day mortality was 8% (5% in elective cases); spinal-cord ischemia occurred in 11(8%) and ICH in 8 (6%) patients. All ICH occurred in patients with CSFD. ICH occurred intraoperatively in 1 case, inter-stage in 4 and after F/BEVAR completion in 3, after a median of 6 days the completion stage. Three (38%) of 8 patients with ICH died at 30 days and ICH was associated with 30-day mortality: odds ratio (OR) 13.2, 95% confidence interval (CI): 2.3–76, p=0.01. The analysis of the perioperative characteristics identified platelet reduction >60% (OR 11, 95% CI 1.6–77, p=0.03), chronic kidney disease (16% vs 0%, p=0.002), and total volume of liquor drained >50 mL (OR 8.1, 95% CI 1.1–69, p=0.03) as associated with ICH. Conclusions: Current findings may suggest that ICH is a potential lethal complication of the endovascular treatment for TAAAs and it mainly occurs in patients with CSFD. High-volume liquor drainage, platelet reduction, and chronic kidney disease seems increase significantly the risk of ICH and should be considered during the perioperative period and for further studies

Reinterventions after fenestrated and branched endografting for degenerative aortic aneurysms

Objective: Fenestrated/branched endovascular abdominal aortic aneurysm repair (F/B-EVAR) is widely accepted technique to treat juxta/pararenal abdominal aortic aneurysms (J/P-AAAs) and thoracoabdominal aortic aneurysms (TAAAs) for patients at high-surgical risk. However, the follow-up results should be carefully evaluated, especially in terms of the reintervention rate. The aim of the present study was, therefore, to evaluate the early and mid-term reinterventions after FB-EVAR for J/P-AAAs and TAAAs and their effects on follow-up survival. Methods: From 2006 to 2019, all consecutive patients who had undergone F/B-EVAR for J/P-AAAs or TAAAs were prospectively enrolled. Cases requiring reinterventions were retrospectively analyzed. Patients with aortic dissection were excluded from the present analysis. Reinterventions were classified as follows: access related, aortoiliac related, or target visceral vessel (TVV) related. Freedom from reintervention and survival were assessed using the Kaplan-Meier method, and univariate and multivariate analyses were used to determine the risk factors. Results: Overall, 221 F/B-EVAR procedures were performed for 111 J/P-AAAs (50.3%) and 110 TAAAs (49.7%) in an elective (182; 82%) or urgent (39; 18%) setting. The median follow-up was 27 months (interquartile range, 13 months). Overall, 41 patients had undergone 52 reinterventions (single, 30 [14%]; multiple, 11 [5%]; access related, 17 [33%]; aortoiliac related, 6 [12%]; TVV related, 29 [55%]). Of the 52 reinterventions, 32 (62%) and 20 (38%) had occurred within and after 30 days, respectively. Eight reinterventions (15%) had been were performed in an urgent setting. Endovascular and open reinterventions were performed in 32 (62%) and 20 (38%) cases, respectively. Open reinterventions were frequently access related (access, 16; no access, 4; P ≤ .001). Technical success was 95% (39 patients); failures consisted of one splenic artery rupture and one renal artery loss. Patients undergoing reintervention had more frequently undergone a primary urgent F/B-EVAR (urgent, 12 of 39 [31%]; elective, 29 of 182 [16%]; P < .001) and had had TAAAs (TAAAs, 34 of 41 [83%]; J/P-AAAs, 7 of 41 [17%]; P < .001). The patients with TAAAs had had a greater incidence of TVV-related reintervention (TAAAs, 26 of 28 [93%]; J/P-AAAs, 2 of 28 [7%]; P < .001) and multiple reinterventions (TAAAs, 9 of 11 [82%]; J/P-AAAs, 2 of 11 [18%]; P = .03) compared with those with J/P-AAAs. Survival at 3 years was 75%. Freedom from reintervention was 81% at 3 years. Patients who had undergone reinterventions had lower 3-year survival (reintervention, 61%; no reintervention, 77%; P = .02). Preoperative chronic renal failure (hazard ratio [HR], 2.0; 95% confidence interval [CI], 1.1-3.6; P = .02), TAAAs (HR, 2.3; 95% CI, 1.1-4.8; P = .03), and urgent primary F/B-EVAR procedures (HR, 2.5; 95% CI, 1.2-4.9; P = .01) were independent predictors of late mortality. Conclusions: Reinterventions after F/B-EVAR are not uncommon and were related to TVVs in only one half of cases. Most of them can be performed in an elective setting using endovascular techniques. The technical success rate was excellent. Reinterventions were more frequent after TAAAs and urgent F/B-EVAR procedures and had a significant effect on overall survival in these situations