How should i treat concomitant post - endarterectomy carotid pseudoaneurysm and contralateral symptomatyc stenosis?

Background: A 74-year-old male patient complaining of crescendo TIAs, hypertension and hyperlipidaemia. Investigation: Duplex ultrasound scan MR angiography. Diagnosis: Pseudoaneurysm stemming from the ICA. Treatment: An open or endovascular procedure for the right pECCA repair, or a left CEA or CAS

Emergency endovascular management of the common femoral artery rupture due to radiotherapy for scrotal carcinoma

We describe the case of a 72-year-old man with massive hemorrhage and shock resulting from rupture of the left common femoral artery as a complication of radiotherapy in the groin for cancer of the scrotum. This complication is extremely rare, presents dramatically, and is usually fatal. The patient was successfully treated with a stent graft deployment in order to achieve immediate hemostasis maintaining blood flow to the leg. Open surgery is not ideal in those cases especially when there is extensive tumor involvement of the groin causing altered anatomy and increasing the risk of re-bleeding

Single incision laparoscopic splenectomy, technical aspects and feasibility considerations

Minimally invasive techniques have been introduced to reduce morbidity related to standard laparoscopic procedures. One such approach is laparoendoscopic single-site surgery. The aim of the study was to present our initial clinical experience of using this technique for elective splenectomy. We carried out single access laparoscopic splenectomy (SALS) for an 8 cm cystic lesion of the spleen, involving the hilum, on a 38-year-old woman. The procedure was performed with a single-port device (4-channel) via a 2.5-cm umbilical incision. A flexible 5-mm optic and straight laparoscopic instruments were used. The operative time was 75 min. There was no blood loss. No complications were observed. The postoperative period was uneventful. Although substantial development of the instruments and skills is needed, this SALS technique appears to be feasible and safe. Nevertheless, further experience and observations are necessary

Intraoperative cell salvage in ruptured abdominal aortic aneurysms

Aim. The aim of this study was to evaluate the impact of intraoperative cell salvage (ICS) on the early outcome after open repair (OR) of ruptured abdominal aortic aneurysm (rAAA). Methods. This is a retrospective review of 73 consecutive patients who underwent emergency OR of infrarenal rAAA with ICS between 2005 and 2008 (Group I), compared to 51 repairs from 2002-2004 with no ICS (Group II). In addition, a transfusion protocol of platelets and fresh frozen plasma (FFP) administration on admission and during surgery was adopted in patients in Group I to maintain coagulation competence. Results. ICS reduced bank blood demand by 63.6% (from 11 to 4 units, P<0.001) compared to controls, and had a strong impact on rates of postoperative complications (P=0.05), or death (43.8% vs. 52.9%, P<0.05) or in-hospital LOS (P<0.07) in these patients. Patients surviving in Group I had significantly higher postoperative haemoglobin level (11.5 vs. 9.6 g/dL, P<0.05) and platelet count (267 vs. 95 x 109 L, P<0.001 ), a shorter APTT (31 s vs. 47 s, P<0.05) and a lower INR (1.3 vs. 2.1, P<0.01) than patients who died postoperatively. ICS volume was significantly higher in patients with suprarenal aortic clamping and in those who had bifurcated grafting reconstruction (P<0.05), but amount of red blood cells (RBC) collected did not influence outcome. Conclusion. These results suggest that intraoperative cell salvage, minimizing perioperative homologous blood transfusion, is an important determinant of outcome after rAAA repair. Combined administration of balanced blood components may contribute to improve the survival of the patient

Social capital in chronic disease: an ethnographic study

Chronically ill conditions are particularly difficult to manage because of their impact both on the social and on the corporal sphere to such an extent as to involve a series of problems that negatively alter the quality of life of affected patients. Chronicity has also a considerable ef-fect on social capital. In the current literature, it is known that social capital may contribute to a range of advantages to people health. Chronic Venous Disease (CVD) includes several pathologi-cal alterations of the venous system of the lower limbs that cause a wide range of symptoms and signs. The aim of this study is to explore, with a qualitative approach, the dynamics of social cap-ital within people's experience of CVD and describe the roles of family and friends and the health care system. The method used is based on face-to-face semistructured interviews was performed, following the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Six-teen patients were included: 11 women and 5 men. The results obtained are completely in line with the current literature, which shows a certain difficulty in terms of daily activities, pain management; work-related difficulties; non-coverage of healthcare costs for medications and drugs prescribed. In the context of social capital, the bonding social capital of the patients inter-viewed was more positively perceived in the role of CVD management than by the patients' fami-lies. Another interesting result concerns the total absence of knowledge of patient associations with CVD. Thus, alongside the biographical destruction that CVD entails, there is evidence of the scarce relevance and presence of health policies capable of improving the quality of life of these people not only from a social and medical point of view but also from an economic point of vie

Acute mental stress assessment via short term HRV analysis in healthy adults : a systematic review with meta-analysis

Mental stress reduces performances, on the work place and in daily life, and is one of the first causes of cognitive dysfunctions, cardiovascular disorders and depression. This study systematically reviewed existing literature investigating, in healthy subjects, the associations between acute mental stress and short term Heart Rate Variability (HRV) measures in time, frequency and non-linear domain. The goal of this study was to provide reliable information about the trends and the pivot values of HRV measures during mental stress. A systematic review and meta-analysis of the evidence was conducted, performing an exhaustive research of electronic repositories and linear researching references of papers responding to the inclusion criteria. After removing duplicates and not pertinent papers, journal papers describing well-designed studies that analyzed rigorously HRV were included if analyzed the same population of healthy subjects at rest and during mental stress. 12 papers were shortlisted, enrolling overall 758 volunteers and investigating 22 different HRV measures, 9 of which reported by at least 2 studies and therefore meta-analyzed in this review. Four measures in time and non-linear domains, associated with a normal degree of HRV variations resulted significantly depressed during stress. The power of HRV fluctuations at high frequencies was significantly depressed during stress, while the ratio between low and high frequency resulted significantly increased, suggesting a sympathetic activation and a parasympathetic withdrawal during acute mental stress. Finally, among the 15 non-linear measures extracted, only 2 were reported by at least 2 studies, therefore pooled, and only one resulted significantly depressed, suggesting a reduced chaotic behaviour during mental stress. HRV resulted significantly depressed during mental stress, showing a reduced variability and less chaotic behaviour. The pooled frequency domain measures demonstrated a significant autonomic balance shift during acute mental stress towards the sympathetic activation and the parasympathetic withdrawal. Pivot values for the pooled mean differences of HRV measures are provided. Further studies investigating HRV non-linear measures during mental stress are still required. However, the method proposed to transform and then meta-analyze the HRV measures can be applied to other fields where HRV proved to be clinically significant

What the young physician should know about May-Thurner syndrome

May-Thurner syndrome (MTS) is an anatomically variable condition resulting in compression of the left common iliac vein between the right common iliac artery and the underlying spine with subsequent development of a left deep vein thrombosis (DVT). Although this syndrome is rare, its true prevalence is likely underestimated. Mainly, clinical symptoms and signs include, but are not limited to, pain, swelling, venous stasis ulcers, skin pigmentation changes and post-thrombotic syndrome. Correct treatment is not well established and is based on clinical presentation. Staged thrombolysis with/without prophylactic retrievable inferior vena cava filter placement followed by angioplasty/stenting of the left iliac vein appears to be the best option in MTS patients with extensive DVT. The aim of this review is to present in a simple and didactic form all variable clinical presentations of MTS and to outline possible management within the current guidelines

Early stage Healthcare Technology Assessment

This chapter presents an overview of HTA methods aiming to inform the research and development of new medical devices, here defined as early stage HTA methods. First, standard HTA methods are briefly introduced and their limits and weaknesses are discussed, with specific regards to medical devices assessment, particularly during research and development phases. Finally, three methods for early stage HTA are introduced: four stages Markov Models, which aims to estimate the cost-effectiveness of new technology when very limited evidence is available; the Headroom, which aims to predict the max reimbursable cost for a medical devices, at least in the best case; the Analytic Hierarchic Process (AHP), which aims to estimate how an innovative healthcare technology meets the main user needs in specific scenarios

Retrospective Observational Study on Microbial Contamination of Ulcerative Foot Lesions in Diabetic Patients

According to recent studies, there are almost 435 million people worldwide with diabetes mellitus. It is estimated that of these 148 million will develop Diabetic foot ulcers (DFUs) during their lifetime, of which 35 to 50% will be infected. In this scenario, the presence and frequency of pathogenic microorganisms and their level of susceptibility to the most frequent classes of antibiotics used to treat this pathological condition from patients with DFUs admitted to the outpatient clinic of vascular surgery of the Federico II University Hospital of Naples from January 2019 to March 2021 were investigated. Furthermore, the diabetic population characteristics under study (i.e., general, clinical, and comorbidities) and the pathogenic bacteria isolated from lesions were also considered. Bacterial strains poorly susceptible to antibiotics were more frequent in polymicrobial infections than in monomicrobial infections. β-Lactams showed the highest levels of resistance, followed by fluoroquinolones, aminoglycosides, and finally macrolides. The main findings of the study demonstrated that the occurrence of resistant microorganisms is the dominant factor in ulcer healing; thus it is essential to investigate the antibiotics’ susceptibility before setting antibiotic therapy to avoid inappropriate prescriptions that would affect the treatment and increase the development and spread of antibiotic resistanc