Nellix endovascular aortic sealing endoprosthesis late explantation for concomitant type I endoleak and stent frames proximal caudal migration

Endovascular aneurysm sealing (EVAS) using the Nellix™ System was introduced in clinical practice with the aim of reducing the incidence of complications such as migration, endoleaks, and reinterventions after conventional endovascular aneurysm repair (EVAR). Although, initial efficacy data on this device have been encouraging, EVAS has also demonstrated to undergo adverse events. Herein, we report a case of Nellix graft explant due to endobags shrinkage after air bubble reabsorption leading to proximal type I A endoleak and stent migration. The focus of this article is on the importance of a more assiduous surveillance of this new device, in particular in those cases with air into the endobags immediately after the procedure; this surveillance should be aimed to timely identify complications which can otherwise lead to consequences that require open conversion

Single-center experience in the treatment of visceral artery aneurysms

Background: Visceral artery aneurysms (VAAs), although rare, represent a life-threatening disease with high mortality rates. With the more frequent use of diagnostic tests, there has been an incidental detection of these lesions which are mostly asymptomatic. It follows that surgeons are increasingly called to decide on the most appropriate management of VAAs between an open surgical or endovascular approach and among the different endovascular options currently available. The aim of this retrospective study was to evaluate the results of open surgery and interventional endovascular strategies of visceral artery aneurysms with respect to technical success, therapy-associated complications, and postinterventional follow-up in the elective and emergency situation. Methods: From January 1992 to January 2017, 125 open surgical or endovascular interventions for VAA were performed at our institution. Once the VAA was diagnosed and the indication for treatment was assessed, the preoperative diagnostic work-up consisted of contrast computed tomography (CT) or magnetic resonance imaging (MRI) and, in some patients, digital subtraction angiography. Follow-up included clinical and duplex ultrasound scan (DUS) and contrast-enhanced ultrasound to assess the treated vessel patency and organ perfusion after 1, 6, and 12 months, and yearly thereafter. CT or MRI controls were also performed at 1 year of follow-up and only when DUS was not diagnostic or showed a complication thereafter. After the first 5 years of follow-up, the status of the patient was obtained by a structured telephone survey. Results: The treatment option was endovascular in 56 of 125 cases (44.8%). Technical success was 98.3%. In one case, the procedure was interrupted for the extensive dissection of the afferent vessel. Twenty-six patients were treated by coil embolization while 29 with covered stenting. The endovascular approach was in emergency in two cases (3.6%). In the endovascular group, mortality was nil. Complications occurred in 5 cases (8.9%): 1 subacute intestinal ischemia caused by superior mesenteric artery dissection, 2 aneurysm reperfusion, 1 stent thrombosis, and 1 massive splenic hematoma. In 69 (55.2%) cases, surgical treatment was preferred, with 24 VAA resections and 45 arterial reconstructions. In 20 cases (29%), open surgery was performed in emergency conditions. In the surgical group, 8 emergency patients (40%) died intraoperatively. The mortality after elective surgical interventions was nil. Complications after surgery were 4 graft late thrombosis (5.8%): asymptomatic in three cases and requiring splenectomy in one. Conclusions: There is no overall consensus regarding the indications for treatment of VAA. Currently in emergent setting, the endovascular approach should be considered as the first choice because of its reduced invasiveness, faster way to access and bleeding control; this accounts for the lower morality of the interventional therapy than open surgery. Endovascular approach is effective for elective repair of VAAs, but procedure-related complications may occur in a not negligible number of patients. Given comparable mortality rates and low procedure-related complication rate, surgical approach still has space in the elective management of VAAs, especially for aneurysms unsuitable or challenging for the endovascular option in patients with low surgical risk. The size, location, and morphology of VAAs, systemic or local comorbidities, and specific anatomical situations such as previous abdominal surgery should dictate treatment choice

Commissioning of the ATLAS Pixel Detector with cosmic ray data

The ATLAS Pixel Detector performance during the calibration and commissioning with cosmic ray data in 2008 and 2009. Status and readiness for collisions

Vestibulo-Ocular Reflex Modification after Virtual Environment Exposure

Immersion in an illusory world is possible by means of virtual reality (VR), where environmental perception is modi bff c1c ed by artificial sensorial stimulation. The application of VR for the assessment and rehabilitation of pathologies affecting the vestibular system, in terms of both diagnosis and care, could represent an interesting new line of research. Our perception of reality is in fact based on static and dynamic spatial information perceived by our senses. During head movements in a virtual environment the images on the display and the labyrinthine information relative to the head angular accelerations differ and therefore a visuo-vestibular conflict is present. It is known that mismatches between visual and labyrinthine information may modify the vestibulo-oculomotor reflex (VOR) gain. We studied the post-immersion modifications in 20 healthy subjects (mean age 25 years) exposed to a virtual environment for 20 min by wearing a head-mounted display. VOR gain and phase were measured by means of harmonic sinusoidal stimulation in the dark before, at the end of and 30 min after VR exposure. A VOR gain reduction was observed in all subjects at the end of VR exposure which disappeared after 30 min. Our data show that exposure to a virtual environment can induce a temporary modi bff c1c cation of the VOR gain. This bff c1c nding can be employed to enable an artificial, instrumental modification of the VOR gain and therefore opens up new perspectives in the assessment and rehabilitation of vestibular diseases

Evaluation of municipal waste incineration impact on environmental noise

The EU Directive 2002/49/EC or Environmental Noise Directive (END) aims to define a common approach intended to avoid, prevent or reduce the harmful effects, including annoyance, due to exposure to environmental noise. Under this Directive, member states are obliged to produce the noise maps of the major roads, railways airports, large agglomerations and industrial activity sites. The first maps had to be produced for the main agglomerations by July 2007 and the first action plans should be activated no lather than July 2008. In this work we consider the industrial noise produced by municipal waste incineration; the study was developed to provide data of the sound power level along the facades buildings and contours of this site that can be used to produce strategic noise maps. To characterize the impact of the waste incineration plant, measurements of the noise emissions were performed in situ. The distribution of sound power and sound input levels have been calculated by SoundPLAN\uae computer model. The results of this work can provide a re-applicable method for the production of noise levels due to industrial noise sources. The results are suitable to be included in noise maps for agglomerations, in line with the END expectatio

Chagas disease at the crossroad of international migration and public health policies: why a national screening might not be enough

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Indium(111) pentetreotide single photon emission computed tomography (In-111 pentetreotide SPECT): a new technique to evaluate somatostatin receptors in chordomas

Chordomas are rare neoplasms originating along the neuraxis. Although they do not usually show cytological atypia, metastases have been reported in 30 per cent of cases. Survival rates in cases of skull base locations are low, and local recurrence is common after local excision. Radiation therapy is used in post-operative treatment and proton radiation therapy as the primary treatment. In the present paper we present the case of a 50-year-old Caucasian man affected by chordoma of the clivus, with liver and chest metastases, relapsed after several surgical local excisions, to discuss improvements in therapeutic and imaging techniques. Indium(III) (In-III) pentetreotide single photon emission computed tomography (SPECT) was employed to assess the presence of somatostatin receptors and to treat the tumour with radiolabelled Y-90-DOTA-lanreotide. Imaging, performed 2 months afterwards, showed stable disease in the lungs but a local progression in the metastases, in comparison with pre-treatment uptake. These data suggest the usefulness of radiolabelled somatostatin analogues in the diagnosis and therapy of chordomas

Rain evaporation rate estimates from dual-wavelength lidar measurements and intercomparison against a model analytical solution

Rain evaporation, while significantly contributing to moisture and heat cloud budgets, is a still poorly understood process with few measurements presently available. Multiwavelength lidars, widely employed in aerosols and clouds studies, can also provide useful information on the microphysical characteristics of light precipitation, for example, drizzle and virga. In this paper, lidar measurements of the median volume raindrop diameter and rain evaporation rate profiles are compared with a model analytical solution. The intercomparison reveals good agreement between the model and observations, with a correlation between the profiles up to 65% and a root-mean-square error up to 22% with a 5% bias. Larger discrepancies are due to radiosonde soundings different air masses and model assumptions no more valid along the profile as nonsteady atmosphere and/or appearance of collision–coalescence processes. Nevertheless, this study shares valuable information to better characterize the rain evaporation processes