Mid- and Long-Term Results of Endovascular Treatment in Thoracic Aorta Blunt Trauma

Study Aim. Evaluation of results in blunt injury of the thoracic aorta (BAI) endovascular treatment. Materials and Methods. Sixteen patients were treated for BAI. Thirteen patients had associated polytrauma, 4 of these had a serious hypotensive status and 4 had an hemothorax. In the remaining 3, two had a post-traumatic false aneurysm of the isthmus and 1 had a segmental dissection. In those 13 patients a periaortic hematoma was associated to hemothorax in 4. All patients were submitted to an endovascular treatment, in two cases the subclavian artery ostium was intentionally covered. Results. One patient died for disseminated intravascular coagulation. No paraplegia was recorded. No ischemic complications were observed. A type I endoleak was treated by an adjunctive cuff. During the followup (1–9 years) 3 patients were lost. A good patency and no endoleaks were observed in all cases. One infolding and 1 migration of the endografts were corrected by an adjunctive cuff. Conclusion. The medium and long term results of the endovascular treatment of BAI are encouraging with a low incidence rate of mortality and complications. More suitable endo-suite and endografts could be a crucial point for the further improvement of these results

Violenza assistita e maltrattamenti in famiglia: le modifiche introdotte dal c.d. codice rosso

La crescente attenzione riservata, non solo in ambito giuridico, al fenomeno della violenza assistita si è tradotta in un suo esplicito riconoscimento normativo da parte del legislatore penale, prima con la l. n. 119 del 2013 (legge sulla violenza di genere) e poi con la l. n. 69 del 2019 (c.d. codice rosso). La legge del 2019, in particolare, è intervenuta sulla formulazione dell’art. 572 c.p. Lo scopo è chiaramente quello di razionalizzare il quadro normativo di riferimento, anche se la nuova versione dell’art. 572 c.p. non manca di suscitare perplessità sul piano ricostruttivo-sistematico

DALLO PSICHIATRA "MEDICO-TERAPEUTA" ALLO PSICHIATRA "MEDICO-DIRETTORE". FORME E MODELLI DI RESPONSABILITA' PENALE NEL NUOVO VOLTO DELLE REMS

Il processo di “definitivo superamento” degli OPG impone di chiarire le possibili ripercussioni della riforma sul piano della responsabilità penale del medico-psichiatra. L’attribuzione, infatti, della “gestione interna” delle REMS all’operatore di salute mentale, sembrerebbe attribuire al medico-psichiatra compiti non più (e non solo) terapeutico-riabilitativi ma anche, e soprattutto, di tipo penitenziario-custodiale. L’omesso impedimento del reato, infatti, potrebbe essere invocato dapprima a fronte dell’incapacità dello psichiatra “medico-direttore” di azzerare, attraverso la propria attività di compliance, i rischi di commissione di reati all’interno della propria struttura; poi, e parallelamente, per la “erronea terapia” somministrata in qualità di “medico-terapeuta”

Eco-color-Doppler

Libri di patologia vascolare ed endovascolare per studenti, specializzandi e cultori della materi

Carotid stenting and transcranial Doppler monitorino (DTC): our experience

Objective: The aim of the study was to assess the role of Transcranial Doppler (TCD) in detecting the embolic events during carotid angioplasty and/or stenting and to identify which steps of this procedure are at higher risk in mobilizing debris from the atherosclerothic plaque that could develop brain damage. Methods: From January 1999 to September 2005, eighty-four patients, mean age 69 years, were submitted to endovascular treatment of carotid stenosis: 63 (75.0%) were asymptomatic and 21 (25.0%) symptomatic. In 65 cases (77.4%) the ICA lesions was primitive while in the remaining 19 (22.6%) a restenosis was present. In 61 cases (72.6%), a primary stenting of the ICA was performed; 18 patients (21.4%) were submitted to a predilatation followed by stent deployement and in other 4 (4.8%) a simple angioplasty was carried out. In the last patient (1.2%) the procedure was stopped after selective carotid angiography due to the onset of controlateral iposthenia of the superior arm and worsening confusion. All the carotid stenosis were haemodinamically significative as assessed by Duplex scanning; all the treated plaques were smooth and mainly fibrous with low morphologic embolic aspects. Before the procedure, a TCD monitoring was performed under basal conditions (at least 20–30 min) and digital compression of common carotid artery was performed to detect micromembolic signals and to evaluate the cerebral haemodynamic tolerance. In all treated patients a TCD monitoring was maintained for 30 min after the procedure. A spiral-CT scan or MR angiography was performed also in 73 cases (86.9%) to evaluate the cerebral vessels origin and calcification. Results: Two main neurological complications: a TIA during the selective catheterization of the CCA with TCD detection of only bubbles signals and a controlateral RIND occurred at the end of the procedure related to particulate microemboli in rapid succession. The mortality was nihil. In all patients TCD recorded bubbles signals during selective catheterization and angiography. In 96% of cases corpuscolate but isolated microemboli were detected during predilatation, positioning of the filter through the lesions, stent deployement and ballooning. All these MES were asymptomatic. Conclusion: Despite the high incidence of MES during the procedure, the neurological complications are related to TCD detection of corpuscolate signals in rapid succession. Even if no reduction of the overall incidence rate of MES was observed, a decrease in the number of corpuscolate emboli were recorded when a cerebral protection was use