Ruptured abdominal aortic aneurysm: Endovascular treatment

Abstract Aim The elective endovascular treatment of abdominal aortic aneurysm (AAA) is nowadays a daily routine practice in selected patients. The traditional treatment of ruptured abdominal aortic aneurysm (rAAA) has a peri-operative mortality of 40–50% that has not changed in the last 20 years. Nowadays, the endovascular repair may reduce mortality, hospitalization and sanitary costs. Methods The study included 14 patients affected by AAA who came to the Emergency Department because of hemodynamic shock (nine patients) or back pain (five patients). All patients underwent a CT angiography before surgery. Forty-two percent of the patients presented with shock (systolic pressure ≤70 mm Hg) in the operating room, and they underwent an endovascular aortic repair (EVAR) as an emergency procedure. Five bifurcated endoprotesis and nine uniliac protesis making a femoro-femoral bypass to revascularize the excluded limb were made. Patients underwent a follow up with CT angiography one month and then six months after surgery and if no problems were detected, patients underwent a follow-up every year. Results Two cases were immediately converted to open surgery because of failed EVAR. Four patients (28%) died after surgery because of multi-organ failure (MOF). The mean hospitalization was 12 days (range 3–21 days). We observed only one case of first-type endoleak at the 1-month follow up and we successfully treated it with a proximal cuff. Conclusion In our experience, the intention-to-treat protocol for rAAA offered acceptable results in terms of mortality rates. Multicenter studies are necessary to establish the role of endovascular treatment in patients with rAAA

Epoxy composite dusts with and without carbon nanotubes cause similar pulmonary responses, but differences in liver histology in mice following pulmonary deposition

Inorganic chemical composition given as elemental weight% measured by standardless WDXRF. The three epoxy materials were measured as solid disks (4 cm in diameter, 1 cm high). For comparison, the results for CNT powder, previously published in [25], were added to the figure. Displayed axis 99.7 – 100 %. (PPTX 71 kb

ITS-NANO - Prioritising nanosafety research to develop a stakeholder driven intelligent testing strategy

Background To assess the risk of all nanomaterials (NMs) on a case-by-case basis is challenging in terms of financial, ethical and time resources. Instead a more intelligent approach to knowledge gain and risk assessment is required. Methods A framework of future research priorities was developed from the accorded opinion of experts covering all major stake holder groups (government, industry, academia, funders and NGOs). It recognises and stresses the major topics of physicochemical characterisation, exposure identification, hazard identification and modelling approaches as key components of the current and future risk assessment of NMs. Results The framework for future research has been developed from the opinions of over 80 stakeholders, that describes the research priorities for effective development of an intelligent testing strategy (ITS) to allow risk evaluation of NMs. In this context, an ITS is a process that allows the risks of NMs to be assessed accurately, effectively and efficiently, thereby reducing the need to test NMs on a case-by-case basis. For each of the major topics of physicochemical characterisation, exposure identification, hazard identification and modelling, key-priority research areas are described via a series of stepping stones, or hexagon diagrams structured into a time perspective. Importantly, this framework is flexible, allowing individual stakeholders to identify where their own activities and expertise are positioned within the prioritisation pathway and furthermore to identify how they can effectively contribute and structure their work accordingly. In other words, the prioritisation hexagon diagrams provide a tool that individual stakeholders can adapt to meet their own particular needs and to deliver an ITS for NMs risk assessment. Such an approach would, over time, reduce the need for testing by increasing the reliability and sophistication of in silico approaches. The manuscript includes an appraisal of how this framework relates to the current risk assessment approaches and how future risk assessment could adapt to accommodate these new approaches. A full report is available in electronic format (pdf) at http://www.nano.hw.ac.uk/research-projects/itsnano.html webcite. Conclusion ITS-NANO has delivered a detailed, stakeholder driven and flexible research prioritisation (or strategy) tool, which identifies specific research needs, suggests connections between areas, and frames this in a time-perspective

Acoustic radiation force impulse (ARFI) imaging in the pre-operative liver function evaluation in patients candidate to liver resection

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Quantum Dots: Proteomics characterization of the impact on biological systems

Over the past few years, Quantum Dots have been tested in most biotechnologicalapplications that use fluorescence, including DNA array technology, immunofluorescenceassays, cell and animal biology. Quantum Dots tend to be brighter than conventional dyes,because of the compounded effects of extinction coefficients that are an order of magnitudelarger than those of most dyes. Their main advantage resides in their resistance to bleachingover long periods of time (minutes to hours), allowing the acquisition of images that are crispand well contrasted. This increased photostability is especially useful for three-dimensional(3D) optical sectioning, where a major issue is bleaching of fluorophores during acquisition ofsuccessive z-sections, which compromises the correct reconstruction of 3D structures. Thelong-term stability and brightness of Quantum Dots make them ideal candidates also for liveanimal targeting and imaging. The vast majority of the papers published to date have shown norelevant effects on cells viability at the concentration used for imaging applications; higherconcentrations, however, caused some issues on embryonic development. Adverse effects aredue to be caused by the release of cadmium, as surface PEGylation of the Quantum Dotsreduces these issues. A recently published paper shows evidences of an epigenetic effect ofQuantum Dots treatment, with general histones hypoacetylation, and a translocation to thenucleus of p53. In this study, mice treated with Quantum Dots for imaging purposes wereanalyzed to investigate the impact on protein expression and networking. Differential monoandbidimensional electrophoresis assays were performed, with the individuation ofdifferentially expressed proteins after intravenous injection and imaging analysis; further, asseveral authors indicate an increase in reactive oxygen species as a possible mean of damagedue to the Quantum Dots treatment, we investigated the signalling pathway of APE1/Ref1, aprotein involved in the response to oxidative stress. Our results, although preliminary, suggestseveral interesting point of discussion on Quantum Dots imaging for in vivo diagnosticapplication, but also for a new therapeutic approach

Trattamento della prima lussazione di spalla. Ruolo del tipo di immobilizzazione nella prevenzione della recidiva.

Il trattamento della prima lussazione scapolo—omerale in pazienti in età giovanile e media e ancora motive di discussione. Lo scopo del nostro studio e di stabilire 1 importanza che il tipo e la durata della immobilizzazione possono avere riguardo alia recidiva in pazienti con lussazione traumatica anteriore. Sono stati studiati 128 pazienti trattati per una prima lussazione di spalla tra il 1986 ed il 1990 la I Clinica Ortopedica dell' Università "La Sapienza" di Roma (Gruppo A) e la Clinica Ortopedica della Università di Trieste (Gruppo B). II gruppo A comprendeva 70 pazienti, 59 maschi e 11 femmine di 16 — 42 anni (media 28,2 anni), trattati con fasciatura alla Desault per 16 — 22 giorni (media 20 giorni), Nel gruppo B erano compresi 58 pazienti, 47 maschi e 11 femmine di 16 -49 anni (media 29,4 anni); questi pazienti sono stati immobilizzati in apparecchio gessato toraco—brachiale per 30 — 42 giorni (media 36 giorni) dopo un'immobilizzazione di 3 — 5 giorni in Desault o Gillchrist, I pazienti sono stati controllati dopo 3-6 anni dalla lussazione media 4,2 anni) Nel gruppo A la percentuale di recidiva e stata del 78,8 %, mentre nel gruppo B solo il 18 % dei pazienti ha avuto una recidiva della lussazione. i1 tipo di immobilizzazione dopo una lussazione scapolo—omerale an traumatica sembra avere una considerevole importanza nella prevenzione della recidiva

A rare case of incidental pancreatic arteriovenous malformation correctly diagnosed with MDCT

Pancreatic arteriovenous malformations are a rare entity that can be incidentally discovered during MDCT examinations

Autoimmune pancreatitis: Multimodality non-invasive imaging diagnosis

Autoimmune pancreatitis (AIP) is characterized by obstructive jaundice, a dramatic clinical response to steroids and pathologically by a lymphoplasmacytic infiltrate, with or without a pancreatic mass. Type 1 AIP is the pancreatic manifestation of an IgG4-related systemic disease and is characterized by elevated IgG4 serum levels, infiltration of IgG4-positive plasma cells and extrapancreatic lesions. Type 2 AIP usually has none or very few IgG4-positive plasma cells, no serum IgG4 elevation and appears to be a pancreas-specific disorder without extrapancreatic involvement. AIP is diagnosed in approximately 2%-6% of patients that undergo pancreatic resection for suspected pancreatic cancer. There are three patterns of autoimmune pancreatitis: diffuse disease is the most common type, with a diffuse, "sausage-like" pancreatic enlargement with sharp margins and loss of the lobular contours; focal disease is less common and manifests as a focal mass, often within the pancreatic head, mimicking a pancreatic malignancy. Multifocal involvement can also occur. In this paper we describe the features of AIP at ultrasonography, computed tomography, magnetic resonance and positron emission tomography/computed tomography imaging, focusing on diagnosis and differential diagnosis with pancreatic ductal adenocarcinoma. It is of utmost importance to make an early correct differential diagnosis between these two diseases in order to identify the optimal therapeutic strategy and to avoid unnecessary laparotomy or pancreatic resection in AIP patients. Non-invasive imaging plays also an important role in therapy monitoring, in follow-up and in early identification of disease recurrence

Acoustic radiation force impulse with shear wave speed quantification of pancreatic masses: A prospective study

Acoustic Radiation Force Impulse (ARFI) is a new ultrasound technique that evaluates mechanical properties of tissues. To evaluate the use of ARFI with shear waves speed quantification for pancreatic masses characterization during the ultrasound examination