Mediterranean jellyfish sting-induced Tako-Tsubo cardiomyopathy.

We report a case of a 53-year-old woman swimming in the southern Mediterranean Sea on the Calabrian coast that was suddenly stung on her right forearm by a mauve-pink jellyfish. She got extremely scared and while swimming back to the shore, she accused fatigue and an intense itch sensation. She lost consciousness on the beach as a consequence of a condition of pulseless electrical activity

ANMCO/SIC/SICI-GISE/SICCH Executive Summary of Consensus Document on Risk Stratification in elderly patients with aortic stenosis before surgery or transcatheter aortic valve replacement

Aortic stenosis is one of the most frequent valvular diseases in developed countries, and its impact on public health resources and assistance is increasing. A substantial proportion of elderly people with severe aortic stenosis is not eligible to surgery because of the advanced age, frailty, and multiple co-morbidities. Transcatheter aortic valve implantation (TAVI) enables the treatment of very elderly patients at high or prohibitive surgical risk considered ineligible for surgery and with an acceptable life expectancy. However, a significant percentage of patients die or show no improvement in quality of life (QOL) in the follow-up. In the decision-making process, it is important to determine: (i) whether and how much frailty of the patient influences the risk of procedures; (ii) how the QOL and the individual patient's survival are influenced by aortic valve disease or from other associated conditions; and (iii) whether a geriatric specialist intervention to evaluate and correct frailty or other diseases with their potential or already manifest disabilities can improve the outcome of surgery or TAVI. Consequently, in addition to risk stratification with conventional tools, a number of factors including multi-morbidity, disability, frailty, and cognitive function should be considered, in order to assess the expected benefit of both surgery and TAVI. The pre-operative optimization through a multidisciplinary approach with a Heart Team can counteract the multiple damage (cardiac, neurological, muscular, respiratory, and kidney) that can potentially aggravate the reduced physiological reserves characteristic of frailty. The systematic application in clinical practice of multidimensional assessment instruments of frailty and cognitive function in the screening and the adoption of specific care pathways should facilitate this task

Left main and saphenous vein graft spasm: an unusual association

We present a case of left main spasm which was associated with spasm of a saphenous vein graft. This case emphasizes the importance of excluding an excessive vasoconstrictory response in patients treated with percutaneous coronary interventions. (c) 2004 Elsevier Ireland Ltd. All rights reserved

Damping of package resonances in microwave integrated circuits: a FDTD analysis

In this paper, a graded mesh FDTD code running on the massive parallel computer DEC 12000 with 4K processors has been applied to analyzed various MMIC discontinuities enclosed in a metal package and fed by coaxial transitions. Observe that, in the present approach, the circuit and the package are analyzed as a whole. Moreover, also the effects of the feeding connectors have been thoroughly modeled. Since the package introduces resonances several different possibilities to choke off these resonances have been investigated. It is shown that the common practice of inserting a damping layer just below the lid is often not effective. In particular, the importance of placing damping layers also on the side walls is demonstrated

A case of very late thrombosis of bare metal stent successfully treated with excimer laser coronary angioplasty

Late thrombosis occurring after bare metal stent (BMS) implantation is a rare complication. However, it is often associated with poor outcome. Mechanisms underlying BMS thrombosis may differ from those underlying drug eluting stent thrombosis. In particular, severe instent restenosis may trigger thrombus formation. This case report describes a very late thrombosis of BMS occurring on an in-stent restenosis. After failure of manual thrombectomy, the case was successfully faced by Excimer Laser Coronary Angioplasty (ELCA). Cases like this may be successfully treated by devices like ELCA combining debulking and thrombus removal capabilities