A Review of the EUSO-Balloon Pathfinder for the JEM-EUSO Program.

EUSO-Balloon is a pathfinder for JEM-EUSO, the mission concept of a spaceborne observatory which is designed to observe Ultra-High Energy Cosmic Ray (UHECR)-induced Extensive Air Showers (EAS) by detecting their UltraViolet (UV) light tracks "from above." On August 25, 2014, EUSO-Balloon was launched from Timmins Stratospheric Balloon Base (Ontario, Canada) by the balloon division of the French Space Agency CNES. After reaching a floating altitude of 38 km, EUSO-Balloon imaged the UV light in the wavelength range ∼290-500 nm for more than 5 hours using the key technologies of JEM-EUSO. The flight allowed a good understanding of the performance of the detector to be developed, giving insights into possible improvements to be applied to future missions. A detailed measurement of the photoelectron counts in different atmospheric and ground conditions was achieved. By means of the simulation of the instrument response and by assuming atmospheric models, the absolute intensity of diffuse light was estimated. The instrument detected hundreds of laser tracks with similar characteristics to EASs shot by a helicopter flying underneath. These are the first recorded laser tracks measured from a fluorescence detector looking down on the atmosphere. The reconstruction of the direction of the laser tracks was performed. In this work, a review of the main results obtained by EUSO-Balloon is presented as well as implications for future space-based observations of UHECRs.

Unruptured ventricular septal wall dissection. A case report.

Dissection of the interventricular septum (IVS) is a rare condition, which can uncommonly complicate an acute myocardial infarction (AMI). We describe a case of unruptured IVS dissection observed 16 days after 2 close episodes of AMI. The diagnosis was made by transthoracic echocardiography. An echo-free space within the thickness of IVS, extended from the apex to the mid-portion, for a total length of about 30 mm was evident. The careful examination of the left ventricle did not reveal any discontinuity of the myocardial wall. The stable clinical condition, the absence of flow within the dissection, the demonstration of its favourable evolution during the hospitalisation and the characteristics of the underlying coronary disease (left anterior descending artery occlusion without myocardial viability) led to the decision of avoiding surgery. The predischarge contrast echocardiographic examination (Levovist) showed clearly the border of the infarcted zone and demonstrated an area reduction and echogenicity increase of the neocavitation, with partially organised thrombi. The patient recovered uneventfully and was discharged on medical therapy with a clinical and echocardiographic follow-up program. We believe that for IVS hemorrhagic dissection a nonsurgical option can be proposed; surgery should only be considered for myocardial revascularization when indicated. A close echocardiographic follow-up is mandatory.

Effects of adenosine and defibrotide adjunct to a standard crystalloid cardioplegic solution.

AIM: Adenosine has many actions potentially useful as adjunct to a cardioplegia. Defibrotide was recently shown to have protective effects during cardiac arrest. The aim of this study was to compare these 2 substances to delineate their profile of action in the setting of cardioplegic arrest. METHODS: A Langendorff model for isolated rat hearts was employed: 3 groups of 8 hearts each were used, respectively with plain St. Thomas cardioplegia as control (group C), and the same solution added with adenosine (group A) or defibrotide (group D). The hearts had a baseline perfusion for 30 minutes with Krebs-Henseleit solution at 37 degrees C, cardioplegia administration for 3 minutes, then 30 minutes of ischemia without any perfusion and finally 30 minutes of reperfusion with Krebs-Henseleit solution at 37 degrees C. RESULTS: The time to attain heart arrest was 20% shorter in group A, but this difference did not reach statistical significance (A: 13.6+/-1.5; D: 16.8+/-2.7; C: 17.3+/-2.2 s). The heart rate during reperfusion in group A was almost identical to baseline, while in both group C and D it was significantly lower (A: 101%, D: 93.4%, C: 82.4%, p<0.01).A and D decreased significantly the release of creatine phospokinase compared to group C (p=0.006). Lactate dehydrogenase release was lower in both treatment groups, although statistical significance was not reached. Peak positive dP/dT decreased more in controls during reperfusion (A: -23+/-6%, D: -17+/-5%, C: -31+/-5%, p=ns). Negative dP/dT was significantly worse in controls compared to both treatments (A: -19+/-6%, D: -12+/-5%, C: -34+/-7%, p=0.035). CONCLUSIONS: Both adenosine and defibrotide have protective effects in an isolated model of cardioplegic arrest. Adenosine is significantly more active on heart rate while defibrotide is more active on contractily. Further studies are justified in order to test the combination of these 2 drugs.

Serum cardiac troponin I after conventional and minimal invasive coronary artery bypass surgery.

We evaluated myocardial release of cardiac troponin I (cTnI) in patients treated with conventional coronary artery bypass grafting (CABG), which employs extracorporeal circulation, and different kinds of minimal invasive coronary artery bypass grafting (MICABG), a surgical technique where the operation is performed without extra-corporeal circulation. Furthermore, we evaluated the usefulness of serum cTnI measurement to detect perioperative myocardial infarction (PMI) after coronary artery bypass surgery. Thirty-one patients were included: sixteen underwent CABG, fifteen underwent different MICABG and five patients had PMI. Blood specimens for cTnI measurements were collected up to 72 hours after opening the graft. Aortic cross-clamping time was a minor determinant of myocardial damage; on the other side, the trauma during surgery correlated with the number of involved arteries and with the manoeuvre employed to obtain heart dislocation, and appeared a more important determinant of myocardial damage. In patients with PMI, the cumulative release of cTnI was higher than in patients free from PMI; however, only after 24-72 hours we observed significant differences in serum cTnI values, because the increased perioperative values of cTnI complicated the interpretation of the myocardial status and a single cut-off could not be used to exclude PMI.

Edge-to-edge repair of congenital familiar tricuspid regurgitation: case report.

We report a case of edge-to-edge (Alfieri's technique) repair of congenital familiar tricuspid regurgitation in a 49-year-old woman, who had severe tricuspid regurgitation, atrial septal defect with left-to-right shunt, and two stenoses in peripheral branches of the left pulmonary artery, of no clinical relevance. The repair was performed through a longitudinal inferior partial sternotomy. The atrial septal defect was closed by direct suture; the anterior and posterior leaflets of the tricuspid valve were sutured together. The chordae to the prolapsing medial part of the anterior leaflet were shortened by direct suture to the leaflet free edge. Annuloplasty was performed by means of a Carpentier ring. The final step was edge-to-edge approximation of the septal leaflet to the new antero-posterior position with two interrupted stitches. The hemodynamic result was excellent, and the patient eventually returned to full active life.

Improved acceptability of laparoscopic surgery and increasing rate of cholecystectomy implications for surgeon and patients.

BACKGROUND/AIMS: The aim of our study was to evaluate the impact of introduction of laparoscopic cholecystectomy (LC) and reasons for the increase in cholecystectomy rate, by a retrospective review of all admissions for gallbladder disease before and after the introduction of laparoscopic surgery in our department. METHODOLOGY: Chi-squared test was used for statistical analysis of the comparisons. RESULTS: Comparing the 2 periods, cholecystectomy rate increased by 35% (p<0.01) and patients aged 25-44 years were more likely to undergo LC (p<0.001); a 35% decrease in unjustified refusal (p<0.02) was also observed. The number of both longstanding disease patients and asymptomatic ones operated upon was not different (p=1; p=0.06), while a 46% increase (p=0.02) in cholecystectomy rate was shown in patients with low-grade symptoms or at 1st colic episode. CONCLUSIONS: An increase in the patient pool due to improved acceptability was responsible for the increase in cholecystectomy rate after introduction of laparoscopic surgery, rather than lowered surgical threshold, as previously suggested by other authors. Judiciousness is required to prevent the increased acceptability of LC from leading to its uncontrolled and unrestricted use, as alteration of the surgical threshold may occur without surgeon awareness, particularly when dealing with low grade symptomatic patients.

[Hartmann's operation in acute perforated diverticulitis]. / L'intervento di Hartmann nella diverticolite acuta perforata.

Acute perforated diverticulitis of the colon is still a serious clinical event that requires an emergency treatment which is based upon clinical staging and pathological characteristics. Surgical treatment, performed in Hinchey's stages III and IV, is correlated with the presence of infection in the peritoneal cavity: it is always necessary to remove the septic focus, but there are different reconstruction strategies. The resection of the diseased colonic segment can be performed with primary anastomosis or Hartmann's operation with reconstruction in a later time. In our experience, based on 97 patients (33 of which, Hinchey's III and IV, underwent emergency surgical treatment) we preferred Hartmann's operation which carries a low risk of mortality in seriously ill patients.

[Rare causes of serious digestive hemorrhages]. / Le gravi emorragie digestive da cause rare.

The rare causes of massive hemorrhage in the gastrointestinal tract are not completely classifiable. They are characterized by high variability, as shown in several isolated reports. In our experience of 17 cases, clinical and endoscopic features were sometimes typical of a rare pathology, others were referable to common pathologies and exactly diagnosed only by angiography or surgery. Our experience points out the difficulties in the surgical prescription and timing, when the endoscopic diagnosis was lacking or unsure, or when a massive haemorrhagic recurrence forced diagnostic laparatomy. The role of endoscopy and the advantages of intraoperative enteroscopy have been compellingly demonstrated. Diagnostic and therapeutic angiography has been the main method in vascular hemorrhage.

[Ectopic neuroglial tissue associated with intrapulmonary congenital cystic adenomatoid malformation]. / Ectopia neurogliale associata a malformazione adenomatoide cistica polmonare.

BACKGROUND: Few cases of ectopic neurological tissue have been reported in the lung. The aim of the present study was to give a brief overview of these cases and to examine an additional case of intrapulmonary neuroglial heterotopia. We have identified only sixteen similar cases in the literature. CASE DESCRIPTION: The object of our study was a male fetus of Asian parents at the 23rd week of gestation, in which ultrasound tests revealed the presence of anterior encephalocele. Routine postmortem examination of lung samples showed neuroglial tissue and a congenital adenomatoid cystic malformation of type II. The lesion was made up of multiple small cysts lined with columnar or ciliated cuboidal epithelium. A possible link between adenomatoid malformation and intrapulmonary neurological tissue has not so far been reported in the literature. Immunohistochemical analysis showed the presence in the pulmonary parenchyma of neuronal cells (neuron-specific enolase positive), astrocytes (glial fibrillary acidic protein positive) and intra-alveolar squamous cells (citokeratines positive), indicative of fetal aspiration of amniotic fluid. CONCLUSIONS: There are several possible explanations for the presence of intrapulmonary neuroglial heterotopia: fetal aspiration, neural crest migration defects or vascular embolization with implantation. However, in the view of the microscopic findings and at the same time recognizing the intrapulmonary aspiration of amniotic fluid, the authors maintain that the most likely explanation for the heterotopia is that of consequential multiple malformations. Moreover neuroglial ectopy and cystic adenomatoid congenital malformation of the lung could have appeared simultaneously, due to embryologic insult between the 4th and the 20th week of gestation.

Recurrence of acute colonic pseudo-obstruction in selective adrenergic dysautonomia associated with infectious toxoplasmosis.

BACKGROUND: Acute colonic pseudo-obstruction is a life-threatening condition associated with several pathologic conditions, whose pathophysiology is still uncertain. CASE: Autonomic function in a young patient operated on for acute colonic pseudo-obstruction was carefully evaluated; none of the common clinical conditions described in the literature was found to have caused the syndrome. Selective adrenergic failure was suggested by the presence of severe orthostatic hypotension, low basal plasma catecholamine level, and absence of the expected increase on standing and by the findings of provocation tests, cardiovascular tests, and acetylcholine sweat spot test. Biopsy specimens from the colon and small-bowel wall did not show any morphologic or immunohistochemical alteration either in muscle layers or in the autonomic plexus, testifying to the possible occurrence of extrinsic denervation in the presence of an intact plexus. Infectious toxoplasmosis was proved through indirect and direct hemagglutination assays, enzyme-linked immunosorbent assay IgG, IgM, and IgA, immunosorbent agglutination IgM assay, and the protozoa were demonstrated in a biopsy specimen from the rectus abdominis muscle. CONCLUSIONS: Selective adrenergic denervation of the gut resulted in recurrent episodes of colonic pseudo-obstruction, probably by direct toxicity or a cross-reaction between the immune process and a toxoplasmic antigen, stressing the importance of sympathetic inhibitory modulation on colon motor activity.

[Hyperplastic polyposis of a gastrojejunal anastomosis]. / Poliposi iperplastica dell'anastomosi gastro-digiunale.

Only two cases of hyperplastic polyposis of the gastrojejunal anastomosis are reported in the literature. Reference is made to a personal case with singular clinical and diagnostic features, stress being laid on the endoscopic appearance of the multiple polyps encircling the anastomotic line. The risk of malignancy is negligible and endoscopic excision is the rational step. If histobiotic definition is impossible, destructive surgery should follow.

[Criteria of evaluation of hemorrhagic portal hypertension and surgical indications]. / Criteri di valutazione nell'iperteso portale emorragico e indicazioni chirurgiche

Massive, active bleeding of the oesophageal varices in cirrhotics requires immediate, comprehensive and continuing appraisal of determining risk parameters (liver function and morphology, hyperdynamic syndrome, renal function, dynamic angiography of the splanchnic circulation). When survival is linked with stopping the haemorrhage, indications must not be looked at restrictively and operation has to be fast. Minor surgical measures aimed at temporary control of the haemorrhage are not satisfactory. Side-to-side portacaval anastomosis is effective in terms of reducing portal pressure and controlling the haemorrhage. Mesenterico-caval shunt with H-dacron graft interposition is sufficient dynamically and has less effect on porto-hepatic flow. Long-term results with this technique requires further study.