Intracardiac echocardiography to guide transseptal catheterization for radiofrequency catheter ablation of left-sided accessory pathways: two case reports

Intracardiac echocardiography (ICE) is a useful tool for guiding transseptal puncture during electrophysiological mapping and ablation procedures. Left-sided accessory pathways (LSAP) can be ablated by using two different modalities: retrograde approach through the aortic valve and transseptal approach with puncture of the fossa ovalis. We shall report two cases of LSAP where transcatheter radiofrequency ablation (TCRFA) was firstly attempted via transaortic approach with ineffective results. Subsequently, a transseptal approach under ICE guidance has been performed. During atrial septal puncture ICE was able to locate the needle tip position precisely and provided a clear visualization of the "tenting effect" on the fossa ovalis. ICE allowed a better mapping of the mitral ring and a more effective catheter ablation manipulation and tip contact which resulted in a persistent and complete ablation of the accessory pathway with a shorter time of fluoroscopic exposure. ICE-guided transseptal approach might be a promising modality for TCRFA of LSAP

Applicazione del World Class Manufacturing: il Caso Whirlpool Emea s.r.l.

La tesi è stata condotta presso l’azienda Whirlpool Emea s.r.l.a Comunanza ed ha riguardato l’analisi e l’ottimizzazione dei flussi di asservimento ad un impianto di assemblaggio gruppo oscillante attraverso l'applicazione degli strumenti del World Class Manufacturing (WCM). L’impianto realizza l’assemblaggio di vasche, flange e pulegge in un unico pezzo che viene poi inviato alle linee di montaggio. La tesi si sviluppa in tre fasi chiave: inizialmente, viene fornita un'esaustiva spiegazione del concetto di WCM, evidenziandone gli aspetti fondamentali e le applicazioni pratiche. Successivamente, il focus si sposta sulla realizzazione di un progetto di asservimento di componenti all'impianto, con particolare attenzione all'eliminazione di due carrellisti. Tale processo è stato implementato attraverso due diverse soluzioni: l'allungamento di scivoli gravitazionali e l'introduzione di due oppure quattro AGV. L'obiettivo principale della ricerca è quello di fornire una valutazione completa e approfondita delle soluzioni adottate, al fine di supportare decisioni future volte a ottimizzare l'efficienza del sistema logistico dell'impianto. I risultati ottenuti da ciascuna soluzione vengono dettagliatamente esaminati e confrontati, evidenziando i vantaggi e le sfide di ciascuna proposta. L’implementazione di quattro AGV si è dimostrata essere la soluzione più affidabile e dinamica per il miglioramento dell’efficienza operativ

Consensus Report by the Italian Academy of Osseointegration on the Use of Graft Materials in Postextraction Sites

Purpose: After tooth extraction, a modeling and remodeling phase of bone and soft tissues occurs. It has been fully demonstrated that bone resorption as high as 50% can take place regarding ridge width and a variable amount concerning ridge height, making it difficult to perform implant surgery. Materials and Methods: Active members of the Italian Academy of Osseointegration (IAO) participated in this Consensus Conference, and three systematic reviews were conducted before the meeting to provide guidelines on alveolar ridge preservation procedures. The systematic reviews covered the following topics: (1) What material best preserves the dimensions of the ridge horizontally and vertically?; (2) what material favors the formation of the highest quantity of new bone?; (3) which technique would best seal the socket?; and (4) what effect does alveolar ridge preservation have on soft tissues? Results: The main conclusions reached by the assembly were that alveolar ridge preservation is advisable after dental extraction, particularly in esthetic areas, in proximity of anatomical structures (ie, maxillary sinus, inferior alveolar nerve, and mental foramen), whenever the treatment plan requires delayed placement, and whenever patients ask to postpone implant insertion for various reasons. Socket debridement is advised before the use of a "regenerative material," and xenograft is considered the gold standard material to maintain ridge dimensions. Another indication is antibiotic therapy, which is recommended in the case of alveolar ridge preservation (amoxicillin 2 g 1 hour before the intervention and 1 g every 12 hours for 6 days). A membrane or autologous soft tissue should be used to seal the socket and protect the regenerative material, and the indicated reentry time (implant insertion) is 4 to 6 months. Conclusion: This Consensus Conference agreed that the adoption of alveolar ridge preservation can effectively prevent physiologic bone loss, especially in esthetic areas. It is recommended to cover the xenograft material with a membrane or autologous soft tissue, and antibiotic therapy is advisable