59 research outputs found
Un Aristofane per la scena. Notula di traduttore
No full textStarting from the experience of the author on a stage translation of Aristophanes’ Plutus (Plutocrazia. Un contrasto economico, un collasso dialettico of Archivio Zeta) this chapter examines four problems that a contemporary translator of Aristophanes has to deal with: the translation of onomastì komodein, all the cultural or material Realien, paratragedy and parody, bad words and scoptic language. Never forgetting that the goal is a translation not a rewriting of the comedy, this chapter focuses in particular on the importance of the text’s destination and of the contemporary audience
Minimal invasive extracorporeal circulation an alternative to ECMO in ventricular tachycardia ablation
No full textBackground: The advantages of mechanical assistance during ventricular tachycardia (VT) ablation have not been clinically demonstrated. We propose and discuss a technique, set up by us, that makes use of minimally invasive extra-corporeal circulation (MiECC) type III associated with a venous reservoir system, which allows complete cardiac flow support and blood oxygenation as well as hemodynamic stability during long-lasting procedures. Methods: We present a retrospective case series of ten patients with valvular heart disease and unresponsive Ventricular Tachycardia (VT) who underwent VT ablation with MiECC support. The mean age of the patients was 72 ± 8 years and the left ventricular ejection fraction was 36 ± 12%. All patients underwent a clinical evaluation to identify the cause of VT unresponsiveness (e.g., ischemic heart disease). Results: A total of 140 min, the following parameters were evaluated and recorded for 140 min. Central venous pressure (CVP) was used to evaluate excess volume. During the first 5 min, the mean was 15 mmHg, with a pump flow of 1.5 L/min and a mean systemic arterial pressure of 100 mmHg while setting up the circulation support. Following drainage in a volumetric bag of 1 L of blood, CVP was reduced to a value of 5 mmHg with a flow rate of 5 L/min and a mean systemic arterial pressure of 65 mmHg. In the case of small and low-weight patients our “1 L protocol” can be modified. Conclusions: In this preliminary retrospective case series, the MiECC type III system may represent the ideal support system during VT ablation, and further studies are needed to support this preliminary report
Effects, management and optimization of extracorporeal techniques and technologies in contemporary cardiac surgery
No full textThe techniques and approaches to extracorporeal circulation have a clinical impact in terms of organ protection, preservation from cerebrovascular damage and cognitive dysfunction. This thesis shows how integrating many aspects related to monitoring the selection of components can impact the post-operative outcome. Even the management of ECMO can be crucial we have introduced observations on the management and preservation of the long-term management of the oxygenator. Management of micro-embolic and embolic activity is crucial in cardiac surgery We have integrated the role of CO2 administration technique for post-operative cognitive disorders (POCD) prevention with the appearance and utility of cardiopulmonary bypass technologies and monitoring in the prevention of micro-embolic activity. The MiECC technique has been studied in detail on the aspects of the pharmacodynamics of Propofol in relation to the content of albumin, hemodilution and contact surface (the metabolic impact on frail patients has been investigated compared to the conventional CPB (and we have evaluated the benefits of the magnetic levitation pump on the reduction of hemolysis on short-term procedures. This thesis integrating the knowledge of cardiopulmonary bypass to the ECMO procedure and vice versa. In the world of research and development of new technologies, the key role of metabolic management is increasingly gaining scientific evidence, and the role of advanced techniques is increasingly crucial in reducing the adverse effects of conventional cardiopulmonary bypass. The holistic approach presented in this thesis represents an evolution of expedients on extracorporeal technologies aimed at the organic preservation of the patient by focusing on various aspects covered in the chapters of the thesis
Preconditioning before and during oxygenators use: “The Road to Extinction of High-pressure Excursion”
No full textPeripheral veno-arterial extracorporeal membrane oxygenation as a bridge to surgery in type A aortic dissection: a review on strategic approach to managing malperfusion syndrome
No full textBackground: Acute Type A aortic dissection (ATAAD) is a critical cardiovascular emergency characterized by high mortality rates and complex management challenges. The presence of a tear in the ascending aorta often extends into the aortic arch and descending thoracic aorta, leading to malperfusion syndrome, a severe condition resulting from obstructed blood flow to vital organs. Despite the high risks associated with ATAAD, the use of Peripheral Veno-Arterial (VA), Extracorporeal Membrane Oxygenation (ECMO) remains controversial. This intervention aims to maintain systemic circulation and organ perfusion, potentially stabilizing patients prior to surgical repair. Materials and methods: A narrative review of the literature was conducted through a comprehensive search of PubMed and Embase databases, covering the period from January 2000 to March 2025. Keywords included “ECMO”, “Type A Aortic Dissection”, “malperfusion”, and “bridge to surgery”, among others. Although this is a narrative review, the methodology was guided by the PRISMA guidelines to ensure transparency and reproducibility in the selection and reporting of the included studies. Results: Ten relevant articles were identified, including observational studies, case series, and reviews. This narrative review presents the role of peripheral VA ECMO in managing ATAAD, focusing on the timing of ECMO initiation and its implications for patient outcomes. The approach emphasizes rapid deployment following confirmation that the iliac and femoral arteries are free from dissection involvement, ensuring safe cannulation and effective circulatory support. The discussion also explores ECMO’s role as a bridge to surgery, detailing its impact on preventing malperfusion to critical organs such as the brain, kidneys, and splanchnic organs. Conclusion: While VA ECMO offers a potential lifeline for patients with severe ATAAD, its application must be carefully considered within an integrated treatment strategy. The ongoing debate and emerging research underscore the need for further studies to define clear guidelines and optimize ECMO’s use in this high-risk patient population. The balance between preventing malperfusion and managing increased myocardial workload presents a complex clinical challenge, necessitating continued investigation and dialogue within the medical community
Water Condensation and Gas Exchange Correlation in Different Models and Fibers of Blood Oxygenators: “How Can We Improve Performance?”
No full textCreation of water condensation in blood oxygenators is a phenomenon that is constantly present during cardiopulmonary bypass and in medium- to long-term extracorporeal life support. Clinical observation of condensation at the oxygenator exit is still a common event normally associated with sudden cooling of the gas flow proximal to the outlet cover (after exiting the fiber bundle), where the warming effect of blood is no longer present. Condensation could progressively obstruct a certain number of fibers, reducing the efficiency of gaseous exchange in the membrane of the oxygenator surface. The study included 48 patients divided into four oxygenator groups of 12 each: group 1 used an Inspire 6 F oxygenator from Livanova; group 2, an Affinity Fusion from Medtronic; group 3, an Alone from Eurosets, and group 4, an ECMO Alone from Eurosets; while the last group used an ECMO Alone oxygenator from Eurosets with polymethylpentene fiber. Each group of oxygenators comprising 12 patients were divided into two groups, namely, A and B, with six patients in each group. Group A used mild hypothermia during the procedure, and group B of six patients used normothermia; Groups A and B were further subdivided into four subgroups: A1, A2, B1, and B2, each consists of three patients; subgroups A1 and B1 used negative aspiration (−8 mmHg) measuring humidity (%) and temperature (°C) in the gas oxygenator output; consequently, a measurement system was necessary to be created; Subgroups A2 and B2 did not use negative aspiration in the oxygenator outlet. No statistically significant difference for PaO2 and humidity values was found in polypropylene and polymethylpentene oxygenators with mild hypothermia management with vacuum and without vacuum in the gas outlet in the first 60 minutes and 60 minutes later during cardiopulmonary bypass. In normothermia, a statistically significant difference in the PaO2–humidity relationship was observed with polypropylene and polymethylpentene fiber models. Results of this study show an inversely proportional correlation between gas exchange and condensation in statistically significant values during the use of normothermia and a reduction in oxygenation performance, in polypropylene and polymethylpentene fiber oxygenators
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