Transjugular Balloon-Assisted Retrograde Ethylene-Vinyl Alcohol Copolymer Embolization of a Main Pulmonary Artery Defect Discovered during Removal of a Malpositioned Dialytic Central Venous Catheter.

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Safety and Feasibility of Steerable Radiofrequency Ablation in Combination with Cementoplasty for the Treatment of Large Extraspinal Bone Metastases

Background: Radiofrequency ablation (RFA) and cementoplasty, individually and in concert, has been adopted as palliative interventional strategies to reduce pain caused by bone metastases and prevent skeletal related events. We aim to evaluate the feasibility and safety of a steerable RFA device with an articulating bipolar extensible electrode for the treatment of extraspinal bone metastases. Methods: All data were retrospectively reviewed. All the ablation procedures were performed using a steerable RFA device (STAR, Merit Medical Systems, Inc., South Jordan, UT, USA). The pain was assessed with a VAS score before treatment and at 1-week and 3-, 6-, and 12-month follow-up. The Functional Mobility Scale (FMS) was recorded preoperatively and 1 month after the treatment through a four-point scale (4, bedridden; 3, use of wheelchair; 2, limited painful ambulation; 1, normal ambulation). Technical success was defined as successful intraoperative ablation and cementoplasty without major complications. Results: A statistically significant reduction of the median VAS score before treatment and 1 week after RFA and cementoplasty was observed (p < 0.001). A total of 6/7 patients who used a wheelchair reported normal ambulation 1 month after treatment. All patients with limited painful ambulation reported normal ambulation after the RFA and cementoplasty (p = 0.003). Technical success was achieved in all the combined procedures. Two cement leakages were reported. No local recurrences were observed after 1 year. Conclusions: The combined treatment of RFA with a steerable device and cementoplasty is a safe, feasible, and promising clinical option for the management of painful bone metastases, challenging for morphology and location, resulting in an improvement of the quality of life of patients

Combined Trans-Arterial Embolization and Ablation for the Treatment of Large (>3 cm) Liver Metastases: Review of the Literature

Background: The aim of this review was to determine the state of clinical practice in the role of the combined approach of embolization and ablation in patients with secondary liver lesions greater than 3 cm who are not candidates for surgery, and to study its safety and efficacy. (2) Methods: Two reviewers conducted the literature search independently. Eight articles on the combined approach of embolization and ablation in secondary liver lesions were selected. (3) Results: The studies were published between 2009 and 2020. Two studies were prospective in design. The sample size was < 100 patients for all studies. All studies demonstrated the safety of the combined approach based on the low complication rate. Some studies lamented non-uniform systemic chemotherapy regimens and the variability in the sequence of embolization and ablation. (4) Conclusions: This review presents the combined approach of ablation and embolization in liver lesions greater than 3 cm as a safe therapeutic procedure with positive effects on patient survival. Prospective and multicentric studies are needed to further evaluate its efficacy

Epidemiology of Hypoalbuminemia in Hospitalized Patients: A Clinical Matter or an Emerging Public Health Problem?

Serum albumin levels are strongly associated with the morbidity, prognosis, and mortality rates of patients with hypoalbuminemia, which is a frequent problem during hospitalization. An observational retrospective study was carried out to analyze changes in albumin levels in hospitalized patients at the "Fondazione Policlinico Tor Vergata-PTV" in 2018. The prevalence of preexisting hypoalbuminemia at the time of discharge from hospital was investigated using a sample of 9428 patients. Information was collected from the discharge files recorded in the central informatics system of the hospital. Analysis of albumin levels at admission and at discharge was conducted by classes of albuminemia and then stratified by age. At the time of admission, hypoalbuminemia was found to be present in more than half of the sample, with no sex differences. The serum albumin level tended to decrease with age, with pathologic levels appearing from 50 years and progressive worsening thereafter. The condition of marked and mild hypoalbuminemia was more prevalent in patients over 65 years of age. Our findings suggest that hypoalbuminemia should be considered a dangerous condition in itself and a serious public health problem. We aimed to emphasize the role of albumin as useful marker of the in-hospital malnutrition and frailty, to be integrated in the routinely assessment of patients for reconsidering ad hoc healthcare pathways after discharge from hospital, especially when dealing with fragile populations

Post Penetrating Keratoplasty Ectasia: Incidence, Risk Factors, Clinical Features, and Treatment Options

BACKGROUND: Corneal transplantation in keratoconus (KC) patients is generally considered to be successful with a high grade of patient satisfaction. Long-term studies suggest a 6% to 11% probability of KC recurrence manifested by keratometric instability and progressive corneal ectasia. METHODS: We propose to review the frequency, risk factors for the development, and the surgical options for the correction of high irregular astigmatism due to late graft ectasia following penetrating keratoplasty (PK). RESULTS: Post-keratoplasty ectasia is characterized by increasing corneal steepening with myopic shift and high irregular astigmatism, developing years or decades after PK, mostly occurring in KC patients. Contact lenses may adequately improve the visual acuity; however, because these patients are often elderly and intolerant to hard contact lenses, ultimately a surgical correction is proposed to the patient. Compressive suture and corneal wedge resection may improve corneal astigmatism, but the outcomes are unpredictable and often temporary. For this reason, a larger PK graft is often proposed for surgical rehabilitation with the consequence of removing more of the recipient’s healthy endothelium and exposing the patient to a renewed immunogenic stimulus and short-term graft failure for endothelial decompensation. More recently, lamellar keratoplasty using various techniques has been proposed as an alternative to PK in order to maximize the visual outcomes and minimize the complications. CONCLUSIONS: Management of advanced corneal ectasia is a significant challenge for corneal surgeons. Many surgical approaches have been developed, so there is a large arsenal of surgical operations to correct post-PK ectasia. Among them, large-diameter anterior lamellar keratoplasty may be a viable, safer, and effective alternative to PK for the correction of post-keratoplasty ectasia

Bari Costa Sud - Concorso internazionale di idee per la riqualificazione della costa sud di Bari

Il concorso prevedeva la definizione di una strategia di riordino di una grande area urbana e periurbana di Bari che si estende per circa sei chilometri a sudest della citt\ue0 per una profondit\ue0 di circa due chilometri. L'obiettivo del concorso - in previsione di una serie di importanti interventi sulle infrastrutture viarie e ferroviarie - intendeva contribuire, con una ricognizione di idee, al reimpianto di quantit\ue0 edilizie gi\ue0 approvate e non ancora costruite oppure deteriorate da sostituire, nelle previsioni del nuovo Piano Urbanistico Generale attualmente allo studio. Il progetto \ue8 risultato vincitore del 2\ub0 premio, proponendo una nuova strategia di disegno urbano che superi la concezione dello zooning che ha caratterizzato lo sviluppo urbano dei quartieri periferici negli anni 80-90, che riporti in primo piano la necessit\ue0 delle citt\ue0 contemporanee di dotarsi di spazi pubblici qualificati e che definisca una chiara geometria e un ordine urbano in grado di includere elementi della citt\ue0 storica, edilizia pianificata, edilizia semi-spontanea, diritti volumetrici da far "atterrare", eccetera e farli dialogare con gli spazi naturali della costa marina e del retroterra agricolo.The competition provided for the definition of a reorganization strategy for a large urban and periurban area of \u200b\u200bBari that extends for about six kilometers southeast of the city for a depth of about two kilometers. The aim of the competition - in anticipation of a series of important interventions on road and railway infrastructures - intended to contribute, with a reconnaissance of ideas, to the replanting of building quantities already approved and not yet built or deteriorated to be replaced, in the forecasts of the new Plan General Urban Planning currently being studied. The project won the 2nd prize, proposing a new urban design strategy that overcomes the concept of zooning that characterized the urban development of the peripheral districts in the 80s and 90s, which brought to the fore the need for contemporary cities to equip themselves of qualified public spaces and defining a clear geometry and an urban order able to include elements of the historical city, planned building, semi-spontaneous construction, volumetric rights to be "landed", etc. and make them dialogue with the natural spaces of the marine coast and the agricultural background

Case Report: “Spontaneous Descemet Membrane Detachment”

Introduction: We report a case and discuss the clinical characteristics and treatment of spontaneous Descemet membrane detachment (DMD). Case description: We describe a rare case of spontaneous DMD in a patient with prior anterior uveitis and provide a review of the current literature. A 20-year-old woman with a prior history of anterior uveitis presented with vision loss in the left eye. The slit-lamp examination showed corneal edema secondary to DMD, confirmed by anterior segment optical coherence tomography (AS-OCT). The patient underwent an intracameral injection of 20% sulphur hexafluoride (SF6) with complete resolution of the DMD. Although rare, several cases of spontaneous DMD have been reported in the literature, mostly occurring after intraocular surgery. We searched the Pubmed database (1949–2021) for peer-reviewed publications relevant to the topic of spontaneous DMD. Discussion: The pathogenesis of spontaneous DMD is complex and depends on several factors. It can occur due to anatomical anomalies, inflammatory disease, trauma, chemical injuries, and surgical or laser procedures. In most cases, early diagnosis and appropriate management led to resolution

Progetto per Bari Costasud

La citt\ue0 ci \ue8 giunta slabbrata, lacunosa ed episodica nelle porzioni di crescita che corrispondono al secondo Novecento. Gli anni che seguiranno richiedono un impegno etico e culturale per rispondere a mezzo secolo di consumazione di risorse ambientali, territoriali e paesaggistiche e per rimediarvi attraverso la ricerca di un nuovo ordine urbano che renda nuovamente leggibile il disegno della citt\ue0. La nostra proposta si basa su cinque azioni fondamentali: 1. Eliminare la strada costiera per naturalizzare la costa, 2. Aprire dei varchi di paesaggio naturale tra i volumi sparsi, 3. Cercare nell\u2019attuale ibrido citt\ue0/campagna, le tracce di un ritmo urbano, 4. Elevare a dignit\ue0 di luogo urbano l\u2019asse viario, 5. Definire i margini urbani in modo chiaro

One step minilaparotomy-assisted transmesenteric portal vein recanalization combined with transjugular intrahepatic portosystemic shunt placement: A novel surgical proposal in pediatrics

Transjugular intrahepatic portosystemic shunt (TIPS) placement is a standard procedure for the treatment of portal hypertension complications. When this conventional approach is not feasible, alternative procedures for systemic diversion of portal blood have been proposed. A one-step interventional approach, combining minilaparotomy-assisted transmesenteric (MAT) antegrade portal recanalization and TIPS, is described in an adolescent with recurrent esophageal varice bleeding and portal cavernoma (PC). A 16-year-old girl was admitted to our Unit because of repeated bleeding episodes over a short period of time due to esophageal varices in the context of a PC. A portal vein recanalization through an ileocolic vein isolation with the MAT approach followed by TIPS during the same session was performed. In the case of failed portal recanalization, this approach, would also be useful for varice endovascular embolization. Postoperative recovery was uneventful. Treatment consisting of propanolol, enoxaparin and a proton pump inhibitor was prescribed after the procedure. One month post-op, contrast enhanced computed tomography confirmed the patency of the portal and intrahepatic stent grafts. No residual peritoneal fluid was detected nor opacification of the large varices. Endoscopy showed good improvement of the varices. Doppler ultrasound confirmed the accelerated flow in the portal stent and hepatopetal flow inside the intrahepatic portal branches. Three months post-op, TIPS maintained its hourglass shape despite a slight expansion. Portal hypertension and life threatening conditions related to PC would benefit from one-step portal recanalization. MAT-TIPS is feasible and safe for the treatment of PC even in children. This minimally invasive procedure avoids or delays surgical treatment or re-transplantation when necessary in pediatric patients