Case report: Self-expanding transcatheter valve implantation (Acurate Neo 2) in a very small native aortic annulus

Transcatheter aortic valve replacement (TAVR) is a treatment of choice in patients with symptomatic severe aortic valve stenosis (AS) and intermediate-to-high surgical risk. The presence of a small aortic annulus (SAA) has been associated with a higher incidence of prosthesis–patient mismatch (PPM) when surgical aortic valve replacement (sAVR) is performed. TAVR might be a treatment option offering better hemodynamics with a lower incidence of PPM. When a severe AS with a SAA is treated, TAVR-related risk as the coronary obstruction and the annulus rupture, must be also prevented. We present a case of a TAVR in a very small aortic annulus; to our knowledge, this is the smallest native aortic annulus treated percutaneously in a tricuspid stenotic aortic valve with a Self-Expanding Transcatheter Heart Valve (THV) Acurate Neo 2

Aspetti medico-legali e giuridico-deontologici del trattamento sanitario obbligatorio

Health treatments usually need a consenting patient but in cases as infective diseases, industrial accidents or mental diseases physicians can apply to MT (Mandatory Treatment). In Italy the first laws concerning obligatory treatment of psychiatric diseases date back to the beginning of 20th century and have been recently modified to have more guarantees of patient’s life and health. In order to allow a MT we need 3 conditions: an emergency situation caused by a health diseases, a non-consenting patient, impossibility to begin an adequate therapy outside hospitals. Any physician can “suggest” a MT to his patient describing briefly the disease and his clinical conditions. The “proposal” must be sent to the Mayor and has to be approved by another doctor working in the ASL (local public health unit). Then the Mayor has 48 hours to send everything to a judge who will validate or not the MT. Health treatment is carried out by Police. MT cannot last longer than 7 days

Utilizzo degli acciai ferritici a bassa attivazione come materiale strutturale per la prima parete di un reattore a fusione

Un problema basilare per l'ingegneria dei reattori a fusione consiste nella selezione .dei materiali più adatti a costituirne la prima parte, ovvero quella par­ te di struttura direttamente esposta al plasma; essa costituisce una delle componenti più critiche, essen­do sottoposta ad una serie di interazioni e di sollecita­zioni che vanno dallo stress termico, al bombarda­mento di particelle, alla fatica. Fra gli altri aspetti, uno dei più importanti è il feno­meno della radioattività indotta da interazione neutronic

Wunderlich's syndrome and hemorrhagic shock

We report a case of Wunderlich's syndrome in an obese woman associated with massive retroperitoneal hemorrhage. Stable hemodynamic patient condition was obtained by selective arterial embolization. Since the first embolization of a renal angiomyolipoma in 1976 by Moorhead et al., highly selective renal arterial embolization of angiomyolipoma with rupture has become a procedure that offers greater efficacy, particularly in life-threatening cases

Retrograde pedal artery access for below-the-knee percutaneous revascularisation

[No abstract available

Congenital hypothyroidism due to defects of thyroid development and mild increase of TSH at screening: data from the Italian National Registry of infants with congenital hypothyroidism.

CONTEXT: Over the years lower TSH cutoffs have been adopted in some screening programs for congenital hypothyroidism (CH) worldwide. This has resulted in a progressive increase in detecting additional mild forms of the disease, essentially with normally located and shaped thyroid. However, the question of whether such additional mild CH cases can benefit from detection by newborn screening and early thyroid hormone treatment is still open. OBJECTIVE: The aim of this study was to estimate the frequency of cases with mild increase of TSH at screening in the Italian population of babies with permanent CH and to characterize these babies in terms of diagnosis classification and neonatal features. METHODS: Data recorded in the Italian National Registry of infants with CH were analyzed. RESULTS: Between 2000 and 2006, 17 of the 25 Italian screening centers adopted a TSH cutoff at screening of <15.0 μU/mL. It was found that 21.6% of babies with permanent CH had TSH at screening of 15.0 μU/mL or less, whereas this percentage was 54% in infants with transient hypothyroidism. Among the babies with permanent CH and mild increase of TSH at screening (≤15 μU/mL), 19.6% had thyroid dysgenesis with serum TSH levels at confirmation of the diagnosis ranging from 9.9 to 708 μU/mL. These babies would have been missed at screening if the cutoff had been higher. CONCLUSIONS: Lowering TSH cutoff in our country has enabled us to detect additional cases of permanent CH, a number of which had defects of thyroid development and severe hypothyroidism at confirmation of the diagnosis