8 research outputs found
The Use of a Handheld Ultrasound Device to Guide the Axillary Vein Access during Pacemaker and Cardioverter-Defibrillator Implantation. A Feasibility Study
No full textBackground: Although ultrasound guidance for axillary vein (AV) access (USGAVA) has been described as a reliable technique for cardiac implantable electronic device (CIED) implantation, no data is available on the use of handheld ultrasound devices (HUD) in such a setting. Objective: We investigated the feasibility of using a HUD for USGAVA in patients referred to our Institution for CIED implantation. Methods: The procedure details of 80 consecutive patients undergoing USGAVA (Group-1) from June 2020 to June 2021 were prospectively collected and compared to those of an age and sex-matched cohort of 91 patients (Group-2) who had undergone AV access with the traditional venipuncture guided by fluoroscopic landmarks. Results: The two groups were comparable for the success rate of venous access (92.5% versus 93.4%, p = 0.82), complication rate (1.3% versus 0.9%, p = 1.0), and procedure time (71 ± 32 min versus 70 ± 29 min, p = 0.9). However, Group-2 had a longer X-ray exposure time (7.6 ± 8.4 min versus 5.7 ± 7.3 min, p = 0.03). In Group-1, the univariate logistic regression analysis demonstrated that the AV diameter was associated with successful USGAVA (odds ratio = 3.34, 95% confidence interval 1.47–7.59, p < 0.01), with a 3-fold increase of probability of success per each 1 mm increase in the AV diameter. Conclusions: USGAVA using a HUD for CIED implantation is a feasible, effective, and safe technique; moreover, it saves X-ray exposure time without lengthening the implant procedure time
Feasibility of Ultrasound-Guided Axillary Vein Puncture under Valsalva Maneuver for Diagnostic and Cardiovascular Interventional Purposes: Pacemaker and Cardioverter-Defibrillator Implantation
No full textAbstract: Although ultrasound-guided axillary vein access (USGAVA) has proven to be a highly
effective and safe method for cardiac electronic implantable device (CIED) lead placement, the
collapsibility of the axillary vein (AV) during tidal breathing can lead to narrowing or complete
collapse, posing a challenge for successful vein puncture and cannulation. We investigated the
potential of the Valsalva maneuver (Vm) as a facilitating technique for USGAVA in this context.
Out of 148 patients undergoing CIED implantation via USGAVA, 41 were asked to perform the
Vm, because they were considered unsuitable for venipuncture due to a narrower AV diameter, as
assessed by ultrasound (2.7 1.7 mm vs. 9.1 3.3 mm, p < 0.0001). Among them, 37 patients
were able to perform the Vm correctly. Overall, the Vm resulted in an average increase in the AV
diameter of 4.9 3.4mm(p < 0.001). USGAVA performed during the Vm was successful in 30 patients
(81%), and no Vm-related complications were observed during the 30-day follow-up. In patients with
unsuccessful USGAVA, the Vm resulted in a notably smaller increase in AV diameter (0.5 0.3 mm vs.
6.0 2.8 mm, p < 0.0001) compared to patients who achieved successful USGAVA, while performing
the Vm. Therefore, the Vm is a feasible maneuver to enhance AV diameter and the success rate of
USGAVA in most patients undergoing CIED implantation while maintaining safety
Handheld ultrasound device-guided axillary vein access for pacemaker and defibrillator implantation
No full textWhile ultrasound assistance for accessing the axillary vein has been established as a reliable method for cardiac pacemaker and cardioverter-defibrillator leads implantation, there is a lack of information regarding the utilization of portable handheld ultrasound devices within this context. We describe our experience with the systematic use of a pocket-sized handheld ultrasound device during the implantation of transvenous cardiovascular implantable electronic devices
Travels with a medieval queen
No full textThe author retraces the many paths of Constance of Hauteville, who traveled from Germany south to reclaim her father's throne
St Joseph's Day in Kerala
No full textActing on a chance comment by an Indian visitor, the author travels to Southern India to see how the Christian community of Kerala celebrates St. Joseph’s Day, expecting to find something similar to the elaborately decorated altars erected in Sicily to honor this saint. Feeding the poor in St. Joseph’s honor has taken quite a different direction in Kerala, however. The author is taken to visit churches where preparations are underway for a ritual meal that will be served to hundreds of parishioners, ensuring them the saint’s blessing for the year that follows. The meal includes payasam, aviyal, and other traditional dishes that she later learns have been borrowed from Hindu rituals. She also participates in a very simple yet moving ceremony in a private home, in which three of the poor representing the Holy Family are fed and given new clothes.</jats:p
CMR Predictors of Favorable Outcome in Myocarditis: A Single-Center Experience
No full textBackground: Cardiovascular magnetic resonance (CMR) has emerged as the most accurate, non-invasive method to support the diagnosis of clinically suspected myocarditis and as a risk-stratification tool in patients with cardiomyopathies. We aim to assess the diagnostic and prognostic role of CMR at diagnosis in patients with myocarditis. Methods: We enrolled consecutive single-center patients with 2013 ESC consensus-based endomyocardial biopsy (EMB)-proven or clinically suspected myocarditis undergoing CMR at diagnosis. The pre-specified outcome was defined as NYHA class > I and echocardiographic left ventricular ejection fraction (LVEF) < 50% at follow-up. Results: We included 207 patients (74% male, median age 36 years; 25% EMB-proven). CMR showed the highest sensitivity in myocarditis with infarct-like presentation. Patients with EMB-proven myocarditis were more likely to have diffuse LGE and right ventricular LGE (p < 0.001), which was also more common among patients with arrhythmic presentation (p = 0.001). The outcome was met in 17 patients at any follow-up time point, more commonly in those with larger biventricular volumes (p < 0.001), CMR-based diagnosis of dilated cardiomyopathy (p < 0.001), and ischemic LGE (p = 0.005). Higher biventricular systolic function (p < 0.001) and greater LGE extent (p = 0.033) at diagnosis had a protective effect. Conclusions: In our single-center cohort of rigorously defined myocarditis patients, higher biventricular systolic function and greater LGE extent on CMR at diagnosis identified patients with better functional class and higher left ventricular ejection fraction at follow-up. Conversely, larger biventricular volumes, CMR-based DCM features, and the presence of an ischemic LGE pattern at diagnosis were predictors of worse functional class and LV systolic dysfunction at follow-up. Larger prospective studies are warranted to extend our findings to multi-center cohorts
Il disegno per la salvaguardia dell’architettura: la Centrale Termoelettrica di Giuseppe Samonà a Trapani
No full textRiflessioni grafiche per salvaguardare l’architettura. Nella Centrale Termoelettrica di Giuseppe Samonà, costruita a Trapani negli anni ’60, il concetto di spazio non inteso come mero luogo di lavoro, le relazioni armoniche che il manufatto instaura con il paesaggio, il linguaggio come esito del dualismo tra involucro e struttura e la lezione dei maestri del ‘900 sono tutti caratteri estrinsecabili attraverso il ridisegno critico. Un atto ermeneutico che tenta di definire il valore dell’edificio e diffonderne la conoscenza, al fine di scongiurarne l’oblio o, ancor peggio, la distruzione.Graphic reflections to safeguard the architecture. In the Thermoelectric Power Plant of Giuseppe Samonà, built in Trapani in the 60s, the concept of space not intended simply as a workplace, the harmonic relationships that the building establishes with the landscape, language as the outcome of the dualism between the envelope and structure and the lesson of the masters of the ‘900 are all characters extrinsectable through the critical redesign. A hermeneutical act that tries to define the value of the building and spread its knowledge, in order to avoid its oblivion or, even worse, its destruction
New Moral Economies in Western Sicily: Fair-trade and Organic Agriculture Between Change and Constraint
No full textThis thesis addresses the dialectic between the values of capitalism and those of moral economy, and the implications of that dialectic for how people who are engaged in alternative economic practices in Palermo and western Sicily experience their agency. It examines in particular the local commodity network created by people who practised ethical consumption and who worked in fair-trade retail and organic farming. It is based upon fifteen months of fieldwork in the city of Palermo, Sicily’s capital, and its rural province, among predominantly lower-middle-class citizens.
In contrast to abstract views of the market logic as the dominant one in industrialised societies, the people of Palermo and western Sicily drew upon numerous values from outside a capitalist belief system to conceptualise the economy as a moral construct. However, the ways in which they did so were mobile, contested and ambiguous, and varied along the lines of production, exchange and consumption. The thesis explores how notions of value, normativity and motivations to behave ethically in economic processes all had to be negotiated through the demands of daily life. It therefore argues that the economic, political, and cultural constraints faced by people striving to build alternative economies cannot be overlooked, thus interrogating ethnographically the central anthropological issue of how and if economies are embedded in social relations.
The thesis begins with an outline of the three main groups of actors—consumers, fair-traders and farmers—and how they embody the recent historical transformations that have taken place in Sicily. It then looks in detail at each group, analysing how agency is played out both at the symbolic and practical level. The final chapter highlights the commonalities and contradictions shown by this local moral economy
