JLB: a flexible and effective device in critical patients. Review of clinical cases

JLB catheter (Deltamed Inc) is an alternative way to manage difficult venous access; it is placed under US-guidance in large bore veins, with an easy-sterile approach. Internal jugular vein (IJV) is the first choice for cannulation, followed by subclavian or deep upper-arm veins. The catheter is available in different lengths and gauges, it allows high flow rates and can be left in place up to 30 days. From June 2015 to March 2017, JLB has been positioned in 409 patients: in 354 as primary access in IJV, brachial or subclavian vein; in 55 cases JLB became an introducing line for the Seldinger guidewire and further CVC positioning. All clinical cases were reviewed selecting those with greater clinical relevance. We report 8 cases in which JLB resulted determinant for the patient treatment: a 16 years old obese girl born with perinatal distress, a 78 years old obese woman with hemorrhagic shock caused by gastrointestinal bleeding, a 40 years old man with severe hypokalemia, a 30 years old man with severe sepsis, a 40 years old man with Becker’s muscular dystrophy and severe sepsis, a 40 years old man with multiple myeloma who had to carry out cycles of chemotherapy, a 76 years old man with CMV pancolitis and myelofibrosis who needed parenteral nutrition, antiviral therapy and frequent blood and platelets transfusion. Moreover, it has been useful in elderly patients who needed to carry out palliative care for seniority or cancer lasting up to 30 days . In our experience the JLB catheter is safe, easy to place, quick and cost –effective. It is a valid solution either in unstable patients requiring an immediate access in emergency and stable patients with difficult venous access, in which invasive devices can be considered an over-treatment

EFFECT OF ASSISTED REPRODUCTIVE CONCEPTION AND ART TYPE ON PERINATAL OUTCOME IN A POPULATION OF 897 TWIN PREGNANCIES

Introduction: Twin births are at greater risk of adverse perinatal outcome than singletons. However, there is still no consensus about whether the worse outcome associated with twin pregnancies achieved via assisted reproductive tecnique (ART) differ from those caused by twinning itself. Materials and Methods: We conducted a retrospective cohort study between January 2003 and December 2013 at the San Pietro FBF Hospital of Rome, a tertiary obstetrical care center. The study aimed to compare obstetrical and neonatal outcome of 376 twin pregnancies conceived with different types of ART procedures (318 FIVET/ICSI; 32 ovulation induction with or without artificial insemination; 24 egg donation) and 521 naturally conceived twin pregnancies. The effect of ART was evaluated using logistic regression for dicothomus outcomes and linear regression for continous ones. The predictor effect on the obstetrical outcome was adjusted for maternal age, parity, pre-existing systemic diseases (diabetes,

A case of splenic artery pseudoaneurysm rupture in a bulimic patient with gastric ulcer

Splenic artery pseudoaneurysm is a rarely described condition and it is even more rarely considered as a complication of peptic disease. The most common etiologies are pancreatitis, both chronic and acute, and trauma. Diagnosis can be challenging, including ultrasonography, computed tomography scan and angiography, the latter being useful also for therapy (embolization). Given her history of bulimia nervosa and the stress related to hospitalization, our patient was particularly predisposed to peptic ulcer