Total aortic arch replacement with a branched graft and limited circulatory arrest of the brain

AbstractBackgroundTotal replacement of the aortic arch is commonly performed with either antegrade perfusion of the brachiocephalic arteries by means of direct cannulation or with an interval of hypothermic circulatory arrest of at least 30 to 40 minutes. We present a technique with a branched graft that uses antegrade brain perfusion without the need for direct cannulation of the brachiocephalic arteries or a separate perfusion circuit, with only a brief period of circulatory arrest of the brain.MethodsTwelve patients underwent resection of the aortic arch through either a midline sternotomy (4 patients) or a bilateral anterior thoracotomy (8 patients). The right axillary artery was used for arterial return and for brain perfusion. After establishing hypothermic circulatory arrest, the brachiocephalic arteries were detached from the aorta, flushed, and occluded with clamps. Hypothermic perfusion of the brain was established through the right axillary artery, and the brachiocephalic arteries were sequentially attached to the limbs of a branched aortic graft. Flow to the brain was then established in the antegrade direction through the axillary artery.ResultsThe mean duration of circulatory arrest of the brain at a mean nasopharyngeal temperature of 16°C was 8.8 minutes (range, 6-13 minutes). The subsequent period of hypothermic (20°C-22°C) brain perfusion, during which the 3 branches of the graft were attached to the brachiocephalic arteries, averaged 35 minutes (range, 23-44 minutes). All the patients survived the procedure and were discharged from the hospital. No patient sustained a permanent neurologic deficit. One patient had lethargy for 2 days, with full recovery. Nine of the 12 patients were extubated within 72 hours.ConclusionsThis technique obviates the need for direct cannulation of the brachiocephalic arteries and for a separate perfusion circuit and requires only a brief period of circulatory arrest of the brain

Synchronous Bilateral Paget's Disease of the Nipple Associated with Bilateral Breast Carcinoma

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Caratterizzazione dell’ambiente marino dei Campi Flegrei. Risultati preliminari della campagna oceanografica RICAMAR 2013

The caldera of the Phlegraean Fields (also known as Campi Flegrei) is one of the most dangerous and populated volcanic area in the world, covering an area that comprises the western part of Naples and the Gulf of Pozzuoli. The main peculiarity of current volcanic activity is the gradual and periodic lift (positive or negative) of part of the Earth\u27s surface (bradyseism) combined, only during the positive phase, with a strong sismicity and surficial hydrotermal activity. Deformative models, calibrated using land-based measurements, highlighted the Gulf of Pozzuoli as the area with the largest deformation. Although the network of monitoring sensors on land is well developed and structured, there is a lack of sensing systems for the marine deformation. The activities of RIlievi per la Caratterizzazione dell’Ambiente MARino nel Golfo di Pozzuoli 2013 (RICAMAR2013) project - sinergically conducted by the Italian Navy\u27s Survey Vessel Ammiraglio Magnaghi , the Italian Hydrographic Office (IIM) and the Istituto Nazionale di Geofisica e Vulcanologia (INGV)- were targeted to fulfill this gap. In fact, the creation of marine observatories about the caldera\u27s phenomena will be based on the data collected during these bathymetric, magnetometric, stratigrafic and hydrologic surveys

The Highly Energetic Expansion of SN2010bh Associated with GRB 100316D

We present the spectroscopic and photometric evolution of the nearby (z = 0.059) spectroscopically confirmed type Ic supernova, SN 2010bh, associated with the soft, long-duration gamma-ray burst (X-ray flash) GRB 100316D. Intensive follow-up observations of SN 2010bh were performed at the ESO Very Large Telescope (VLT) using the X-shooter and FORS2 instruments. Owing to the detailed temporal coverage and the extended wavelength range (3000--24800 A), we obtained an unprecedentedly rich spectral sequence among the hypernovae, making SN 2010bh one of the best studied representatives of this SN class. We find that SN 2010bh has a more rapid rise to maximum brightness (8.0 +/- 1.0 rest-frame days) and a fainter absolute peak luminosity (L_bol~3e42 erg/s) than previously observed SN events associated with GRBs. Our estimate of the ejected (56)Ni mass is 0.12 +/- 0.02 Msun. From the broad spectral features we measure expansion velocities up to 47,000 km/s, higher than those of SNe 1998bw (GRB 980425) and 2006aj (GRB 060218). Helium absorption lines He I lambda5876 and He I 1.083 microm, blueshifted by ~20,000--30,000 km/s and ~28,000--38,000 km/s, respectively, may be present in the optical spectra. However, the lack of coverage of the He I 2.058 microm line prevents us from confirming such identifications. The nebular spectrum, taken at ~186 days after the explosion, shows a broad but faint [O I] emission at 6340 A. The light-curve shape and photospheric expansion velocities of SN 2010bh suggest that we witnessed a highly energetic explosion with a small ejected mass (E_k ~ 1e52 erg and M_ej ~ 3 Msun). The observed properties of SN 2010bh further extend the heterogeneity of the class of GRB supernovae.Comment: 37 pages and 12 figures (one-column pre-print format), accepted for publication in Ap

Management of Nutritional Needs in Pediatric Oncology: A Consensus Statement

Simple Summary Nutritional management is an underestimated issue in treating pediatric cancer, since a systematic approach is currently lacking. In this consensus statement, a cohort of 12 experts selected from four different tertiary pediatric oncology centers formulated 21 clinical questions regarding the identification and treatment of nutritional issues in children with cancer. These questions were discussed, and practical recommendations were provided. With this paper, we aimed to give consensus-based guidance for addressing the nutritional needs of children with cancer, filling a gap in the field. Malnutrition, intended as both overnutrition and undernutrition, is a common problem in children with cancer, impacting quality of life as well as survival. In addition, nutritional imbalances during childhood can significantly affect proper growth. Nevertheless, there is currently a lack of a systematic approach to this issue in the pediatric oncology population. To fill this gap, we aimed to provide practice recommendations for the uniform management of nutritional needs in children with cancer. Twenty-one clinical questions addressing evaluation and treatment of nutritional problems in children with cancer were formulated by selected members from four Italian Association of Pediatric Hematology and Oncology (AIEOP) centers and from the Survivorship Care and Nutritional Support Working Group of Alliance Against Cancer. A literature search in PubMed was performed; during two consensus meetings, all recommendations were discussed and finalized using the nominal group technique. Members representing every institution voted on each recommendation. Finally, recommendations were approved by all authors

A harmonized and efficient clinical research environment would benefit patients and enhance European competitiveness

Background. Implementation of the EU Regulation No. 536/2014 through national guidelines is a great opportunity to make sponsors reconsider Europe as a prime location for clinical trials. Methods. In November 2014, a Panel of clinical researchers and representatives of the pharmaceutical industry, patient organisations and Italian regulatory agency discussed potential advances fostering Italian competitiveness in terms of clinical research. As a case study, this analysis of the Italian situation can be representative of the average European situation. Results. Features characterising Italian clinical research patterns were analysed. Considerable engagement and cooperation by all stakeholders is required in addition to a well-structured interaction between National Authorities and ethical committees to comply with the strict timeframes mandated by the new Regulation. Conclusions. In the Panel’s view, harmonisation of the approval process and strengthening of clinical site performance are mandatory to provide a good return on investment in Europe for the pharmaceutical industry, access for patients to innovative treatments and new resources for clinical sites.                                                                                                                                                                 

Outcome of relapsed/refractory acute promyelocytic leukaemia in children, adolescents and young adult patients — a 25‐year Italian experience

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Early onset lactating adenoma and the role of breast MRI: a case report

<p>Abstract</p> <p>Introduction</p> <p>Lactating adenoma is a benign condition, representing the most prevalent breast lesion in pregnant women and during puerperium; in this paper, a case of a woman with lactating adenoma occurring during the first trimester of pregnancy is reported. There have been no reports in the literature, according to our search, focusing on magnetic resonance imaging findings in cases of lactating adenomas. Also the early onset of the lesion during the first trimester of pregnancy is quite unusual and possibly unique.</p> <p>Case presentation</p> <p>We report the case of a primiparous 30-year-old Caucasian woman, who noted an asymptomatic lump within her left breast during the 9^thweek of gestation, slightly increasing in size over the next few weeks. Ultrasound demonstrated a hypoecoic solid mass, hypervascularized and measuring 4 cm. On magnetic resonance imaging, performed in the first month after delivery, the lesion appeared as an ovoidal homogeneous mass, with regular margins and a significant contrast enhancement indicative of a giant adenoma.</p> <p>Conclusion</p> <p>Magnetic resonance imaging could play an important role in the differential diagnosis of pregnancy-related breast lumps, particularly during puerperium, thus avoiding unnecessary surgical biopsies.</p