Heart transplantation without informed consent: discussion of a case

OBJECTIVE: To discuss informed consent to heart transplantation in the case of an intensive care unit (ICU) patient: relatives' informed consent was refused by the patient himself whose cognitive ability appeared to be reasonable for the purpose. SETTING: ICU of a university teaching hospital. PATIENT: A 62-year-old man who underwent myocardial revascularization had in the immediate post-operative hemodynamic instability, continuous serious arrhythmias, ventilatory support, fentanyl infusion. Heart transplantation could be the only chance for his survival. INVENTION: Heart transplantation. RESULTS: Despite patient's refusal, we decided to hold the relative's consent as valid, and transplantation was accordingly performed, to the subsequent satisfaction of the patient. CONCLUSIONS: Our decision was based on two beliefs: (1) the severity of the patient's clinical condition may have impaired his cognitive abilities; (2) the very same conditions may mask impairment and certainly make reliable assessment of cognition and judgment impossible. This being so, the preservation of life assumes priority

FEA testing the pre-flight Ariel primary mirror

Ariel (Atmospheric Remote-sensing Infrared Exoplanet Large-survey) is an ESA M class mission aimed at the study of exoplanets. The satellite will orbit in the lagrangian point L2 and will survey a sample of 1000 exoplanets simultaneously in visible and infrared wavelengths. The challenging scientific goal of Ariel implies unprecedented engineering efforts to satisfy the severe requirements coming from the science in terms of accuracy. The most important specification – an all-Aluminum telescope – requires very accurate design of the primary mirror (M1), a novel, off-set paraboloid honeycomb mirror with ribs, edge, and reflective surface. To validate such a mirror, some tests were carried out on a prototype – namely Pathfinder Telescope Mirror (PTM) – built specifically for this purpose. These tests, carried out at the Centre Spatial de Liège in Belgium – revealed an unexpected deformation of the reflecting surface exceeding a peek-to-valley of 1µm. Consequently, the test had to be re-run, to identify systematic errors and correct the setting for future tests on the final prototype M1. To avoid the very expensive procedure of developing a new prototype and testing it both at room and cryogenic temperatures, it was decided to carry out some numerical simulations. These analyses allowed first to recognize and understand the reasoning behind the faults occurred during the testing phase, and later to apply the obtained knowledge to a new M1 design to set a defined guideline for future testing campaigns

Late angiographic changes of the left anterior descending coronary artery following removal of multiple occluded stents and on-lay patching with the left internal mammary artery

Abstract We present postoperative and midterm (3 years) angiographic changes after removal of five (of six) occluded stents from the left anterior descending (LAD) coronary artery and its reconstruction with a 9-cm-long on-lay patching done with the left internal mammary arter