1,721,017 research outputs found
LATE LEAKAGE OF THE AORTIC STUMP AFTER REMOVAL OF AN INFECTED GRAFT :SUCCESSFUL SURGICAL TREATMENT
No full textAppearance and rapid evolution of thoraco-abdominal intramural hematoma after TEVAR
No full textSome studies consider the different physical properties of the stent graft when compared with the blood vessel on the basis of vascular lesions that may require further intervention. We present a case in which a patient developed an intramural hematoma at the distal landing of previous thoracic endovascular aortic repair (TEVAR) that required the relining with a flared prosthesis. During follow-up, we observed the appearance of more caudal hematoma. We decided to observe this lesion with close radiological controls. In order to prevent serious complication after the induction of TEVAR, accurate planning of the procedure is very important to study the impact of the prosthesis implanted in the cardiovascular system. In particular, oversize, radial forces and length of coverage have been taken into account. The adherence to follow-up is very important to precociously detect the lesions to avoid the onset of complication
Hybrid Gore® Vascular Graft: A New Tool for the Hybrid Treatment of Thoraco- Abdominal Aneurysms
No full textThe Hybrid procedure, first performed in 1999 by Quinones-
Baldrich and colleagues [1], has been proposed for thoracoabdominal
aneurysms (TAAA) repair as a less invasive technique than the
traditional open surgery (avoiding both thoracophreno-laparotomy
and aortic cross-clamping): in our Institute, the Hybrid technique has
been performed since 2005 [2]. Since then, Literature showed several
disadvantages: the overall duration of the procedure due to extensive
dissections to prepare each visceral vessel and to make 5 to 7
anastomoses and the length of end-organ ischemia during the
execution of each anastomosis (15 to 30 minutes) can cause critical
rates of post-operative organ failure, morbidity and mortality [3].
Furthermore, nowadays total endovascular techniques make the
Hybrid repair less attractive, but it can still be useful when you don’t
have enough time (at least 3-4 weeks) to develop customized
endovascular prosthesis. The new Gore® Hybrid Vascular Graft (HVG)
can be a useful tool because it allows performing a “sutureless
anastomosis” in a few minutes, and minimizes both the ischemia time
of the target organ and the overall length of the operation. Effectively,
this device is an ePTFE heparin bonded vascular prosthesis which has
a section reinforced with nitinol. This part is partially constrained into
a tubular shape to allow for easy insertion and deployment into a
vessel. Gore® HVGs Instruction for Use (IFU) presents the device as a
vascular prosthesis for replacement or bypass of diseased vessels in
patients suffering occlusive or aneurysmal disease, for dialysis access,
and in each patient requiring vascular replacement
MULTIPLE ENDOVASCULAR TREATMENTS OF AORTIC RUPTURE SECONDARY TO AN ACUTE AORTIC B
No full textRuptures of the thoracic aorta in acute type B dissections are currently treated with Endoprosthesis at the proximal tear level. On the other hand, problems occur when one or more visceral vessels arise from the false lumen, because the bleeding through the ostium of the vessel in the lamella of dissection can continue. Eventually, the simple exclusion of proximal tear might not preserve the patient from the next progression to an aneurysm. This case shows both complications
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Rectus muscle diastasis in Italian women: determinants of disease severity, and associated disorders
No full textPurpose Diastasis of rectus abdominis (DRA) refers to a separation of the rectus abdominis from the linea alba, which is common in the female population during pregnancy and in the postpartum period. The present study aimed at investigating DRA severity, risk factors and associated disorders. Methods In the present cross-sectional study, a web-based questionnaire was addressed to the 23,000 members of the Women's Diastasis Association. The questionnaire comprised three parts, dedicated respectively to diastasis characteristics, possible risk factors, and related disorders. Faecal and urinary incontinences were assessed using the Wexner and ICIQ-SF score, respectively. Risk factors for diastasis severity (<3, 3-5, >5 cm) were evaluated by a multinomial regression model. Results Four thousand six hundred twenty-nine women with a mean age (SD) of 39.8 (6.5) years and a median BMI of 23.7 kg/m(2) (range 16.0-40.0) responded to the questionnaire. Proportion of DRA >5 cm increased from 22.8% in norm weight women to 44.0% in severely obese women, and from 10.0% in nulliparous women to 39.3% in women with >3 pregnancies. These associations were confirmed in multivariable analysis. DRA severity was associated with the risk of abdominal hernia and pelvic prolapse, whose prevalence more than doubled from women with DRA <3 cm (31.6% and 9.7%, respectively) to women with DRA >5 cm (68.2% and 20.2%). In addition, most patients reported postural pain and urinary incontinence, whose frequency increased with DRA severity. Conclusion The present study confirmed that DRA severity increases with increasing BMI and number of pregnancies. Larger separation between rectal muscles was associated with increased risk of pain/discomfort, urinary incontinence, abdominal hernia and pelvic prolapse. Prospective studies are needed to better evaluate risk factors
Pain control in laparoscopic surgery: a case-control study between transversus abdominis plane-block and trocar-site anesthesia
No full textLocal anesthesia in laparoscopic operations is gaining increasing consensus. To standardize analgesia, a prospective case-control study was created over a 1-year period, in collaboration with the anesthesiology service in our community hospital. Starting from February 2016, we prospectively enrolled adult patients (more than 16 years old) undergoing laparoscopic appendectomy or cholecystectomy, either in emergency or elective setting. Patients were preoperatively assigned (based on the chart-admission number) either to transversus abdominis plane (TAP) block treatment (Group 1-experimental arm) or trocar-site anesthesia (TSA) (Group 2-experimental arm), and then compared with group of patients not submitted to treatment (Group 3-control arm). Demographic and clinical characteristics of each patient were recorded. Post-operative pain level (primary outcome) was assessed with visual analog scale (VAS) score; analgesic use and length of stay in hospital were defined as secondary outcomes. Forty-two patients were assigned to TAP block treatment (Group 1), fifty-two to TSA (Group 2), and thirty-nine underwent no pre-incisional treatment (Group 3). In the comparison between patients undergoing TAP block or TSA with the control arm, a significance difference in reported pain was recorded in every scheduled time (p < 0.05 at 0, 6, 12, 18, 24, and 48 h from awakening). Both local anesthesia groups share a benefit in terms of primary outcome. The use of pre-incisional TSA for all the patients undergoing laparoscopic cholecystectomy and appendectomy could become a routine practice to reduce post-operative pain both in the elective and emergency setting
Nationwide analysis of laparoscopic groin hernia repair in Italy from 2015 to 2020
Full text linkSince its introduction, the minimally invasive treatment of groin hernias has become widely accepted as a viable alternative to open surgery. Still, the rates and reasons for its adoption vary highly among countries and the regions within a country. After almost thirty years since its introduction, its spread is still limited. The present study, conducted under the auspices of AGENAS (Italian National Agency for Regional Services), aims at giving a snapshot of the spreading of minimally invasive and robotic techniques for the treatment of groin hernia in Italy. This study is retrospective, with data covering the period from 1st January 2015 to 31st December 2020. AGENAS provided data using the operation and diagnosis codes used at discharge and reported in the International Classification of Diseases 9th revision (ICD9 2002 version). Admissions performed on an outpatient basis, i.e., without an overnight stay of at least one night in hospital, were excluded. A total of 33,925 laparoscopic hernia repairs were performed during the considered period. Overall, a slight increase in the number of procedures performed was observed from 2015 to 2019, with a mean annual change of 8.60% (CI: 6.46–10.74; p < 0.0001). The number of laparoscopic procedures dropped in 2020, and when considering the whole period, the mean annual change was − 0.98% (CI: − 7.41–5.45; p < 0.0001). Urgent procedures ranged from 335 in 2015 to 508 in 2020 referring to absolute frequencies, and from 0.87% to 9.8% in relative frequencies of overall procedures in 2017 and 2020, respectively (mean = 4.51%; CI = 3.02%–6%; p < 0.001). The most relevant observation that could be made according to our analysis was that the adoption of the laparoscopic approach knew a slow but steady increase from 2015 onward. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13304-022-01374-7
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