Urgent need to clarify the definition of chronic critical limb ischemia - a position paper from the European Society for Vascular Medicine

Chronic critical lower limb ischemia (CLI) has been defined as ischemia that endangers the leg. An attempt was made to give a precise definition of CLI, based on clinical and hemodynamic data (Second European Consensus). CLI may be easily defined from a clinical point of view as rest pain of the distal foot or gangrene or ulceration. It is probably useful to add leg ulcers of other origin which do not heal because of severe ischemia, and to consider the impact of frailty on adverse outcome. From a hemodynamic viewpoint there is no consensus and most of the existing classifications are not based upon evidence. We should thus propose a definition and then validate it in a prospective cohort in order to define the patients at major risk of amputation, and also to define the categories of patients whose prognosis is improved by revascularisation. From today\u27s available data, it seems clear that the patients with a systolic toe pressure (STP) below 30 mmHg must be revascularised whenever possible. However other patients with clinically suspected CLI and STP above 30 mmHg must be evaluated and treated in specialised vascular units and revascularisation has to be discussed on a case by case basis, taking into account other data such as the WiFi classification for ulcers.In conclusion, many useful but at times contradictory definitions of CLI have been suggested. Only a few have taken into account evidence, and none have been validated prospectively. This paper aims to address this and to give notice that a CLI registry within Europe will be set up to prospectively validate, or not, the previous and suggested definitions of CLI

Ultrasonography of the reticulum in 30 healthy Saanen goats

Background: The reticulum plays a crucial role in the ruminant digestive tract because the primary cycle of rumen motility always starts with a reticular contraction. In contrast to cattle, there are only few results on the ultrasonographic examination of the reticulum in goats. Therefore, it was the goal of the present study, to describe the results of ultrasonography of the reticulum of 30 healthy Saanen goats. Methods: Ultrasonography was carried out on standing, non-sedated animals using a 5.0 MHz linear transducer. The shape, contour and motility of the reticulum were investigated. A nine-minute video recording of the reticulum was made for each goat and the frequency, duration and amplitude of reticular contractions were calculated as described for cattle. Results: The reticulum appeared as a crescent-shaped structure with a smooth contour located immediately adjacent to the diaphragm. 0.8 to 2.1 (1.41 ± 0.31) reticular contractions were seen per minute. In all goats, biphasic reticular contractions were observed. 90% of the goats also had monophasic reticular contractions, and two had triphasic contractions. During the nine-minute observation periods, there were 0 to 6 monophasic reticular contractions and 6 to 15 biphasic contractions per goat. The duration of the biphasic contractions was 6.56 ± 0.74 s, which was significantly longer than the monophasic contractions at 4.31 ± 0.81 s. The average interval between two reticular contractions was 45.06 ± 12.57 s. Conclusion: Ultrasonography of the reticulum in goats is a valuable tool to characterise the appearance and motility of this organ. In addition to the biphasic motility pattern seen in cattle the reticular motility of goats is characterized by monophasic reticular contractions. The results of the present study are an important contribution for better understanding of the reticular motility in goats

A multidisciplinary approach to cardiovascular diseases

It is a great honor for me to present a selection of papers discussed on the occasion of the 1st Congress organized by the Multinational Chapter of the International Union of Angiology (IUA) in conjunction with the XXIV Congress of the Mediterranean League of Angiology and Vascular Surgery (MLAVS), that was held on October 2-5, 2014 at the Didactic Centre of the Campus of the University of Palermo, with the aim of being an opportunity for scientific dialogue and communication at the highest levels.The subtitle of the meeting “A multidisciplinary approach to cardiovascular diseases” is in agreement with the mission of the IUA and MLAVS, both characterized by a multidisciplinary approach, aiming to provide a unique forum for discussing critical issues concerning the management and care of all vascular patients, that is focused on two main issues: to bring together all types of vascular specialists and support their interdisciplinary cooperation, that is neces-sary for a good clinical practice at present, and to support young vascular specialists and give them an educational opportunity and the possibility to be scientifically active. During the Congress the most recent experiences and researches in the field of cardiovascular diseases were pre-sented and debated among angiologists, cardiologists, diabetologists, specialists in internal medicine and geriatrics, hematologists, radiologists, vascular surgeons, biologists and genetists, as well as young post-graduate doctors in these disciplines, in a multiform and attractive scientific programme.Salvatore NovoChairman of the Congres