1,721,036 research outputs found
Long term central venous access in oncology: Who, why, when?
No full textLong Term Central Venous Catheters (LTCVC) are widely used for administration of chemotherapy, blood products, parenteral nutrition, analgesics, antibiotics. Nevertheless, indications for the placement of LTCVC are not well defined in cancer patients and specific guidelines are still missing, so that the need for placement of an LTCVC is often based on the lack of alternative routes for intravenous treatments secondary to the severe loss of peripheral veins by recurrent and/or prolonged infusion of toxic drugs, such as chemotherapy and parenteral nutrition. This approach is the main factor behind several local complications (phlebitis, extravasation of drugs with ulcers or necrosis, pain) as well as an unacceptable delay in the chemotherapy schedule. The need for an LTCVC has to be considered during the first patient assessment while defining the plan of therapy and placement has to be planned prior to therapy administration. The pre-therapy placement of LTCVC is mandatory if one of the following criteria is present: low availability of peripheral venous accesses, schedules of chemotherapy by continuous infusion or by bolus with vesicant drugs with possible local toxicity with or without extravasation, high-dose chemotherapy, multiple infusion requirements (i.e. chemotherapy plus high volumes of intravenous fluids plus blood products), total parenteral nutrition. Pre-therapy placement of LTCVC is suggested for adjuvant chemotherapy in patients at high risk for early tumour recurrence, low patient compliance to multiple venipunctures, domiciliary treatment. In all other conditions, pre-therapy placement of LTCVC is not indicated but infusion routes should be carefully evaluated during the course of therapy so that the need for an LTCVC may be detected before treatment has to be interrupted for lack of vascular access
Biomass district heating system in Italy: A comprehensive model-based method for the assessment of energy, economic and environmental performance
Full text linkIn the framework of the energy strategy toward 2050, district heating systems (DHS) offers a great flexibility in terms of heat generation technologies and renewable resources integration, resulting, in case of proper management and supply conditions, in fossil primary energy and greenhouse gases savings compared to conventional technologies. In Italy, only the 2.5% of the thermal final uses are satisfied by DHS and, although widely available over the territory, those fuelled by wooden biomass represent less than the half of the total. Many studies in this framework have highlighted the need of methods and tools for a better understanding of the operative conditions, of the potentialities and of the optimal evolution of biomass DHS. To that end, a proper simulation model has been developed and calibrated on a real case study operating in cogeneration, in an urban area of Northern Italy. After investigating the current performance of the real case, some criticalities have been described and new operating scenarios have been defined and simulated. The achieved results represent a support for the stakeholders involved in BDHS and for future energy policies, providing hints on possible challenging evolutive scenarios and on measures to enhance the energy performance and the economic appeal
Portal vein graft rectal evacuation after Whipple procedure. The Fabrizio's disease
No full textIn selected cases, pancreatic resections may be performed ''en bloc'' with arterial and/or venous segments, which have to be replaced with autologous or synthetic grafts. Rectal evacuation of portal vein graft following a Whipple procedure is described, being a late graft infection supposed to underlie this event. Portal vein graft rectal evacuation has not previously been reported in the literature and it is worth keeping if in consideration when performing a regional pancreatectomy
Liver resections in over-75-year-old patients: Surgical hazard or current practice?
No full textObjectives: To assess the safety of hepatic resections in the very old patient by comparing the outcome in patients younger and older than 75 years. Methods: Thirty-two resections in 31 patients >= 75 years (Over-75 Group) were compared with 164 resections in 162 patients <75 years (Control Group). Indications for resection, concomitant diseases, previous abdominal surgery, type of resection, associated surgical procedures, use/length of portal clamping, intra-operative blood losses and transfusions, and length of operation were preliminarily compared. The outcome was evaluated in terms of post-operative mortality, morbidity, transfusions, and postoperative hospitalization. Results: Mean age was 76.0 +/- 2.3 years (range 75-83) in the Over-75 Group and 58.4 +/- 10.7 years (range 23-74) in the Control Group. The over-75 group included more hepatomas (43.8% vs. 26.8%, P = 0.09), chronic liver disease (31.3% vs. 28.7%, P = 0.03) and concomitant diseases (62.5% vs. 32.9%, P = 0.002). The two groups were comparable (P = n.s.) when evaluated for all other variables. The 30-day mortality rate was 3.6% in the Control Group and none in the Over-75 Group. Postoperative surgical complications occurred in 37 patients (22.6%) in the Control Group and 1 patient (3.1%) in the Over-75 Group, with statistically significant differences (P = 0.01), and incidence of medical complications was 13.4% in the Control Group and 3.1% in the Over-75 Group. Median postoperative hospitalization and transfusions were not statistically different. Conclusions: Hepatic resections in over-75-year-old patients are not a surgical hazard and may be carried out relatively safely as long as an accurate selection of the patient is performed
Le dilatazioni cistiche congenite delle vie biliari: ruolo della risonanza magnetica colangio-pancreatografia nella diagnostica per immagini
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COMBINED SURGICAL-PERCUTANEOUS APPROACH FOR PLACEMENT OF ARTERIAL DEVICES FOR HEPATIC CHEMOTHERAPY
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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
District thermal systems: State of the art and promising evolutive scenarios. A focus on Italy and Switzerland
Full text linkIn the framework of the built environment enhancement towards energy strategy 2050, interesting debates have been developed at building and district scale. In relation to thermal energy end-uses, that are the most impacting in buildings, district thermal systems (DTS) offer a great flexibility in terms of heat generation technologies and renewable resources integration, resulting, in case of proper management and supply conditions, in primary energy and greenhouse gases savings compared to the most diffuse technologies operating at building scale. Recent progresses in DTS have followed over the years the development of technologies and energy policies resulting in different configurations and operative schemes. The present contribution reviews the different classifications of DTS provided in the technical literature. The European framework of DTS is then analysed, with particular insights to the Italian and Swiss operative context. Currently, DTS have a marginal role in these two countries and can mainly be classified as high-temperature or mid-generation systems. However, there are also innovative systems, on which the attention of the involved stakeholders is focusing. The technological features of DTS are discussed, in order to provide possible challenging evolutive scenarios to enhance their performance and economic appeal through the evaluation of successful recent examples
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