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1.
Plant J ; 108(3): 646-660, 2021 11.
Article in English | MEDLINE | ID: mdl-34427014

ABSTRACT

Food legumes are crucial for all agriculture-related societal challenges, including climate change mitigation, agrobiodiversity conservation, sustainable agriculture, food security and human health. The transition to plant-based diets, largely based on food legumes, could present major opportunities for adaptation and mitigation, generating significant co-benefits for human health. The characterization, maintenance and exploitation of food-legume genetic resources, to date largely unexploited, form the core development of both sustainable agriculture and a healthy food system. INCREASE will implement, on chickpea (Cicer arietinum), common bean (Phaseolus vulgaris), lentil (Lens culinaris) and lupin (Lupinus albus and L. mutabilis), a new approach to conserve, manage and characterize genetic resources. Intelligent Collections, consisting of nested core collections composed of single-seed descent-purified accessions (i.e., inbred lines), will be developed, exploiting germplasm available both from genebanks and on-farm and subjected to different levels of genotypic and phenotypic characterization. Phenotyping and gene discovery activities will meet, via a participatory approach, the needs of various actors, including breeders, scientists, farmers and agri-food and non-food industries, exploiting also the power of massive metabolomics and transcriptomics and of artificial intelligence and smart tools. Moreover, INCREASE will test, with a citizen science experiment, an innovative system of conservation and use of genetic resources based on a decentralized approach for data management and dynamic conservation. By promoting the use of food legumes, improving their quality, adaptation and yield and boosting the competitiveness of the agriculture and food sector, the INCREASE strategy will have a major impact on economy and society and represents a case study of integrative and participatory approaches towards conservation and exploitation of crop genetic resources.


Subject(s)
Crops, Agricultural/genetics , Fabaceae/genetics , Seed Bank , Databases, Genetic , Europe , Genotype , International Cooperation , Seeds/genetics
2.
J Vasc Surg ; 76(2): 326-334, 2022 08.
Article in English | MEDLINE | ID: mdl-35314297

ABSTRACT

OBJECTIVES: To assess the outcomes of Cook t-Branch off-the-shelf multibranched stent graft in the treatment of complex aortic aneurysms with narrow internal aortic lumen. METHODS: Between 2016 and 2020, 48 patients (mean age, 73 years) underwent elective or urgent or emergent Cook t-Branch implantation for thoracoabdominal or para/juxtarenal aortic aneurysms in two Italian vascular centers. Among these, 20 patients presented a paravisceral or pararenal luminal diameter of less than 25 mm. Major clinical and radiologic outcomes of patients with narrow aortic lumen were compared with patients with a larger lumen in a multicenter, nonrandomized, retrospective fashion. RESULTS: The in-hospital mortality was 10% (5% in the elective setting). Spinal cord ischemia occurred in 6% of the cases. During a mean follow-up of 18 months (range, 1-63 months), late t-Branch procedure-related mortality and the need for reintervention was 0% and 12%, respectively. Comparing the outcomes of patients with large internal aortic lumen (group 1) with patients with small lumen (group 2), no significant difference was found regarding fluoroscopy time (P = .3); technical success (P = 1); early (P = .4) and late (P = 1) mortality; spinal cord ischemia (P = .2); bowel ischemia (P = .5); renal (P = .7), cardiac (P = 1), and respiratory complications (P = 1); reintervention rate (P = 1); and primary patency rate of stented target vessels (P = 1). CONCLUSIONS: The use of the Cook t-Branch in our experience was safe and effective in the treatment of complex aortic aneurysms regardless the caliber of the aortic lumen. With all the limitations of a small sample size, this approach has demonstrated to be feasible when maneuverability is decreased, with low mortality and morbidity, and acceptable reintervention rates. Perioperative mortality remains closely related to clinical presentation. Large-scale studies are needed to confirm these results.


Subject(s)
Aortic Aneurysm, Thoracic , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Spinal Cord Ischemia , Aged , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis/adverse effects , Blood Vessel Prosthesis Implantation/adverse effects , Endovascular Procedures/adverse effects , Humans , Postoperative Complications , Prosthesis Design , Retrospective Studies , Risk Factors , Spinal Cord Ischemia/etiology , Stents/adverse effects , Time Factors , Treatment Outcome
3.
Eur J Vasc Endovasc Surg ; 60(3): 395-401, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32665199

ABSTRACT

OBJECTIVE: The objective of this prospective single centre study was to assess whether branches and fenestrations have different outcomes on renal function in the early phase. METHODS: From March 2018 to June 2019, 67 patients who underwent elective fenestrated and branched endovascular aneurysm repair (F/BEVAR) procedures were enrolled in this study. The patients were divided into two groups according to the renal bridging component configuration (fenestration vs. branch). All of them underwent dynamic renal scintigraphy with 99mTc diethylenetriaminepentaacetic acid (DTPA), two weeks pre-operatively, and three months and one year post-operatively. The primary end points were peri-procedural technical success, 30 day major adverse events, differences in glomerular filtration rate (GFR) between the branch and fenestration configurations, and variations between the pre-operative and the post-operative dynamic renal scintigraphy. RESULTS: Overall, 135 kidneys were analysed: 63 in the 32 patients treated with fenestrations, and 72 in the 35 patients treated with branches; the mean GFR on baseline scintigraphy was 58.4 ± 30.9 mL/min in the fenestration group, and 65.1 ± 29.2 mL/min in the branch group. Only kidneys associated with a patent fenestration/branch were included in the split GFR final analysis. The mean total GFR at three month scintigraphy decreased by 6.0 ± 2.9 mL/min in the fenestration group and by 23.4 ± 6.4 mL/min in the branch group. The split GFR decreased by 3.5 ± 0.6 mL/min in the fenestration group, and by 15.4 ± 5.4 mL/min in the branch group. The GFR decrease remained stable at one year. CONCLUSION: In this study, the use of branches for renal arteries during F/BEVAR resulted in a greater decrease in the GFR than in those patients who were treated with fenestrations alone. The scintigraphic alterations were evident at an early phase.


Subject(s)
Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis , Endovascular Procedures/instrumentation , Kidney Diseases/diagnostic imaging , Radionuclide Imaging , Renal Artery/surgery , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/physiopathology , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/physiopathology , Blood Vessel Prosthesis Implantation/adverse effects , Endovascular Procedures/adverse effects , Female , Glomerular Filtration Rate , Humans , Kidney Diseases/etiology , Kidney Diseases/physiopathology , Male , Predictive Value of Tests , Prospective Studies , Prosthesis Design , Radiopharmaceuticals/administration & dosage , Renal Artery/diagnostic imaging , Renal Artery/physiopathology , Technetium Tc 99m Pentetate/administration & dosage , Time Factors , Treatment Outcome
4.
Ann Vasc Surg ; 69: 454.e7-454.e11, 2020 Nov.
Article in English | MEDLINE | ID: mdl-32768550

ABSTRACT

Small-sized vessels can represent a contraindication to standard endovascular aortic repair (EVAR), and more specifically, aortoiliac deformities resulting from poliomyelitis may add an adjunctive challenge for total endovascular repair. Herein we report a case of a 62-year-old man with a 55 mm abdominal aortic aneurysm (AAA) and a history of poliomyelitis. More specifically, a computed tomography angiogram (CTA) showed a very narrow infrarenal aortic neck, measuring 13 mm in maximum diameter, and severely atrophic external iliac and common femoral arteries. A total endovascular repair was planned and realized with a single aortic JOTEC iliac branch and contralateral VBX placement. All prosthetic materials were delivered from the nonatrophic side. At the 1-year CTA, the aneurysm was successfully excluded and both iliofemoral axes were patent.


Subject(s)
Aorta, Abdominal/surgery , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis , Endovascular Procedures/instrumentation , Iliac Artery/surgery , Poliomyelitis/complications , Stents , Aged , Aorta, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/diagnostic imaging , Atrophy , Humans , Iliac Artery/diagnostic imaging , Iliac Artery/pathology , Male , Poliomyelitis/diagnosis , Poliomyelitis/virology , Treatment Outcome
5.
J Vasc Surg ; 69(6): 1655-1663, 2019 Jun.
Article in English | MEDLINE | ID: mdl-30497866

ABSTRACT

OBJECTIVE: Staged endovascular treatment of thoracoabdominal aortic aneurysms (TAAAs) with temporary perfusion of the sac through a branch left unstented or a dedicated branch is a strategy intended to reduce the risk of postoperative spinal cord ischemia (SCI). However, potential complications of this approach are aneurysm sac progression between stages, visceral embolism, and occlusion or displacement of components. We here present the "bare branch" technique, a safe adjunct to TAAA repair in terms of interstage complications. METHODS: In the first step, one branch, preferentially the one for the celiac trunk, is stented by a bare stent; in the second step, the bare branch is relined with a covered stent. There were 32 TAAAs (5 type I, 6 type II, 16 type III, 5 type IV) treated by this approach at our center from January 2015 to December 2017 (median follow-up, 13 months [range, 2-24 months]). Data were prospectively collected and retrospectively analyzed. Primary end points were aneurysm sac exclusion and freedom from major adverse events, which included SCI. Secondary end points were freedom from aneurysm growth between the stages and freedom from minor adverse events. RESULTS: Preoperative mean maximum diameter was 68.4 mm; 32 endografts (8 off-the-shelf and 24 custom-made devices) were used. The mean aortic coverage was 364 mm. The mean interval time between the two stages was 10.5 weeks (range, 7-20 weeks). In-hospital mortality was 0%. Type I or type III endoleak rate was 3.2%, whereas one type II endoleak was registered (3.2%). Two patients showed paraparesis, one after the first stage and one after the second stage, both noted at 4/5 on the Tarlov scale, and fully recovered so that the SCI rate was 6.4% with 0% permanent neurologic deficit. Interstage mean maximum diameter was 68.6 mm (P > .05). After the second step, there was an average of 4.7 spinal arteries (standard deviation, 1.4; P < .05) per patient with an increase in visibility and of diameter by 0.7 mm (standard deviation, 0.4 mm). CONCLUSIONS: This is a reproducible adjunct to staged TAAA endovascular repair. The use of a bare branch instead of a branch left completely open has the clear advantage of an easy catheterization in the second step. Furthermore, by having the target vessel stented with a bare stent, the risk of embolism is avoided. In this experience, there was no significant aneurysm sac growth in between the steps. Further comparative studies may determine whether there are different hemodynamic forces with this technique with respect to those already described in the literature.


Subject(s)
Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/methods , Endovascular Procedures/methods , Spinal Cord Ischemia/prevention & control , Aged , Aged, 80 and over , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/physiopathology , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Female , Humans , Male , Middle Aged , Progression-Free Survival , Prosthesis Design , Regional Blood Flow , Retrospective Studies , Risk Factors , Spinal Cord Ischemia/diagnosis , Spinal Cord Ischemia/etiology , Spinal Cord Ischemia/physiopathology , Stents , Time Factors
6.
Ann Vasc Surg ; 57: 266-271, 2019 May.
Article in English | MEDLINE | ID: mdl-30684615

ABSTRACT

BACKGROUND: The aim of this study is to report the Destino-guided branched endovascular aortic repair approach as a valid alternative to catheterization downward branches in complex aortic arch/descending thoracic anatomies. METHODS & RESULTS: A 53-year-old woman with Marfan syndrome underwent a thoracoabdominal aortic aneurysm (TAAA) repair for a type III dissecting aneurysm. A custom repair with an endograft having 3 fenestrations (for renal arteries and superior mesenteric artery) and 1 branch for the celiac trunk was planned. The right axillary artery was chronically occluded; the left subclavian artery (LSA) was aneurysmatic. The catheterization of the celiac trunk branch was demanding but ultimately a bare stent was used as a bridging component between the graft and the target vessel, for spinal cord preconditioning. At the 2-month computed tomography angiography, when planning the relining of the bare metal stent, a 1 cm increase in diameter of the LSA aneurysm was documented and therefore a Destino-guided branched endovascular aortic repair was planned. This approach consists of branch catheterization via femoral access using the Destino steerable guiding sheath inside which, after bending, a smaller Cook Flexor is placed to easily deliver the stent, while maintaining stability. CONCLUSIONS: The Destino-guided branched endovascular aortic repair is a reproducible and effective alternative to the classic catheterization of side branches via brachial/axillary access allowing their completion from a femoral access.


Subject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Catheterization, Peripheral/instrumentation , Endovascular Procedures/instrumentation , Femoral Artery , Vascular Access Devices , Aortic Dissection/diagnostic imaging , Aortic Dissection/etiology , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/etiology , Aortography/methods , Blood Vessel Prosthesis , Computed Tomography Angiography , Equipment Design , Female , Femoral Artery/diagnostic imaging , Humans , Marfan Syndrome/complications , Marfan Syndrome/diagnosis , Middle Aged , Punctures , Treatment Outcome
7.
BMC Med Inform Decis Mak ; 18(1): 63, 2018 07 09.
Article in English | MEDLINE | ID: mdl-29986684

ABSTRACT

BACKGROUND: Recent scientific achievements and technological advances have brought forward a massive display of new or updated medical devices, enabled with highly-developed embedded-control functions and interactivity. From the final decade of the twentieth century, medical beds have particularly been affected by this surge, taking on new forms and functions, while accommodating to established properties that have become well-known for these devices. The past fifteen years have also brought forward changes to conceptual frameworks, concerning the product design and manufacturing processes (standards), as well as the patient (perspectives on patient-care environments and accessibility). This work presents a state-of-art survey on electric medical beds, representing what is defined as the time of "smart beds", as part of an increasingly comprehensive patient-care environment. METHODS: A survey and assessment of market trends, research efforts and standards related to smart medical beds was performed, covering a wide range of public records of intellectual property, models and related healthcare solutions, as well as relevant research efforts in the field between 2000 and 2016. Contextual topics, necessary for the understanding of this subject, on novel technologies, disability and the reach of healthcare systems, were also researched and interpreted. RESULTS: The new generation of electric medical beds is defined, with the final stage of the proposed timeline for these devices being covered. Functional, aesthetic and interactive features are presented, and the current global market for medical beds and related standards are also assessed. Finally, discussions concerning rising challenges and opportunities for these systems are explored, with the potential for adding further monitoring and assistive implementations into medical devices and environments being highlighted. CONCLUSIONS: Smart medical beds are integrated solutions for patient care, assistance and monitoring, based on a comprehensive, multidisciplinary design approach. Research in this field is critical in a context of global ageing, and powered by a surge in opportunities for accessibility solutions. Smart beds, seamlessly integrated into the healthcare system, have a unique opportunity in enabling more efficient efforts for caregivers, and more responsive environments for patients.


Subject(s)
Beds/trends , Electrical Equipment and Supplies/trends , Patient-Centered Care/trends , Health Services Research , Humans , Surveys and Questionnaires
8.
Ann Vasc Surg ; 42: 304.e11-304.e16, 2017 Jul.
Article in English | MEDLINE | ID: mdl-28389292

ABSTRACT

Type II endoleak is the most frequent procedure-related complication during endovascular aneurysm exclusion. Actually, there is little controversy in the management of type I and III endoleak, while type II endoleak still generates conflicting reports about their timing and type of treatment. Currently, the intervention is needed only in case of sac enlargement but not in case of persistent endoleak alone. We report the case of a 77-year-old man treated with a custom-made branched/fenestrated endograft for a type III thoracoabdominal aortic aneurysm. A low-flow type II endoleak was detected at the end of the intervention, and a conservative approach was adopted. The sixth month follow-up computed tomography scan demonstrated a 6-mm aneurysm sac growth that required the type II endoleak management. The endoleak nidus, situated between the inferior mesenteric artery (IMA) and left renal artery stent graft, was embolized through the IMA punctured laparoscopically. IMA origin laparoscopic clipping completed the intervention. To our knowledge, this is a unique case in the literature. Type II endoleak management should be reserved to selected patients. The combination of different techniques may offer safe and feasible treatment options in complex aneurysms treated with advanced endovascular materials.


Subject(s)
Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis , Embolization, Therapeutic/methods , Endoleak/surgery , Endovascular Procedures/instrumentation , Laparoscopy , Stents , Aged , Aortography/methods , Blood Vessel Prosthesis Implantation/adverse effects , Computed Tomography Angiography , Endoleak/diagnostic imaging , Endoleak/etiology , Endovascular Procedures/adverse effects , Humans , Male , Prosthesis Design , Treatment Outcome
9.
Ann Vasc Surg ; 32: 133.e7-10, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26806232

ABSTRACT

We report the case of a 77-year-old man treated with a custom-made fenestrated endograft for pararenal aortic aneurysm repair. Fenestrations for the superior mesenteric and both the renal arteries and augmented anterior valley and/or scallop for the celiac trunk were performed. The procedure was complicated by the superior mesenteric artery stent-graft entrapment from the endograft delivery system release wires and total dislodgement into the endograft main body. Superior mesenteric artery restenting and displaced stent-graft removal completed the intervention. Fenestrated-endograft deployment should be performed by a team familiar with the device, deployment system, and bail out solutions.


Subject(s)
Aortic Aneurysm/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis , Endovascular Procedures/instrumentation , Stents , Aged , Aortic Aneurysm/diagnosis , Aortography/methods , Blood Vessel Prosthesis Implantation/adverse effects , Computed Tomography Angiography , Endovascular Procedures/adverse effects , Humans , Male , Mesenteric Artery, Superior/surgery , Prosthesis Design , Renal Artery/surgery , Treatment Outcome
10.
Ann Vasc Surg ; 30: 277-85, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26370748

ABSTRACT

BACKGROUND: Endovascular treatment is now considered the first-line therapy for the aortoiliac occlusive disease (AIOD). We report our experience with the total endovascular treatment of infrarenal and pararenal aortoiliac occlusions and the 7-year approach evolution. METHODS: A total of 22 patients underwent total endovascular treatment of AIOD from January 2008 to September 2014. Bare metal stents in kissing configuration were deployed in 9 cases, covered stents in kissing configuration in 9 patients and the aortic bifurcation reconstruction with the Y-guidewire configuration technique was performed in the last 4 patients. RESULTS: Technical success was 100%. Perioperative mortality rate was 4.5%. ankle-brachial index improved from 0.49 ± 0.19 to 0.96 ± 0.05 at the right side and from 0.53 ± 0.17 0.98 ± 0.04 at the left side (P < 0.01). Mean follow-up was 39.5 months (range, 5-80 months). The primary patency rate was 95.2% at 1 year and 90.5% at 3 years, and the secondary patency rate was 95.2% at 1 year and 100% at 3 years. CONCLUSIONS: Different stent types and configurations used for the aortoiliac endovascular treatment offer all the benefits of these materials for treatment on a case-by-case basis. The Y-guidewire configuration technique for the aortic bifurcation reconstruction may render the procedure more feasible. More cases and longer follow-up are necessary before the widespread use of this technique.


Subject(s)
Aortic Diseases/surgery , Arterial Occlusive Diseases/surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Iliac Artery , Aged , Aged, 80 and over , Aortic Diseases/diagnosis , Aortic Diseases/mortality , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/mortality , Female , Humans , Male , Middle Aged , Retrospective Studies , Stents , Time Factors , Treatment Outcome , Vascular Patency
11.
Ann Vasc Surg ; 29(1): 126.e15-9, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25304906

ABSTRACT

We report the case of a 76-year-old man presented with three saccular aneurysms at the aortic arch and descending thoracic aorta. A two-staged hybrid approach was performed. A left common carotid-to-left subclavian artery bypass and a custom-made fenestrated endograft were used for the two proximal aneurysms. The endograft deployment was complicated by the unadverted coverage of the left common carotid artery ostium, promptly corrected with the chimney technique. The endovascular treatment was completed with the third endovascular aneurysm exclusion 5 months after the first procedure to reduce the risk of spinal cord ischemia. Yearly follow-up computed tomography scan confirmed aortic arch and descending thoracic aorta aneurysms exclusion with supra-aortic vessels, bypass, and stent patency. Endovascular repair of the aortic arch aneurysm with a fenestrated endograft is safe and feasible in selected patients. Complications may be solved with total endovascular approach. Long term follow-up remains mandatory.


Subject(s)
Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/methods , Endovascular Procedures/methods , Aged , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/physiopathology , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/physiopathology , Aortography/methods , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/instrumentation , Endovascular Procedures/instrumentation , Humans , Male , Prosthesis Design , Stents , Time Factors , Tomography, X-Ray Computed , Treatment Outcome , Vascular Patency
12.
Ann Vasc Surg ; 29(8): 1662.e1-5, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26315792

ABSTRACT

The use of extra-anatomic bypasses for the hybrid repair of thoracic aortic pathologies should consider the risk of vascular graft infection. Graft infections at cervical level are extremely rare and are associated with high mortality and morbidity rates. We report 2 cases of infected extra-anatomic bypasses for supra-aortic vessels debranching treated with a hybrid approach: re-extra-anatomical bypass with the Viabahn Open Revascularization Technique (VORTEC) in the first patient and the EndoVAC approach in the second case. Endovascular techniques may offer bail-out solutions in a hybrid fashion to treat vascular graft infection in patients considered unfeasible for the conventional surgical repair, associated with appropriate antibiotic therapy.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis/adverse effects , Endovascular Procedures , Prosthesis-Related Infections/therapy , Staphylococcal Infections/therapy , Adult , Aged , Blood Vessel Prosthesis Implantation , Humans , Male , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/etiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/etiology
13.
Ann Vasc Surg ; 28(7): 1795.e7-1795.e10, 2014 Oct.
Article in English | MEDLINE | ID: mdl-24858588

ABSTRACT

Total chronic occlusion of the common carotid artery with patent internal and external carotid arteries can induce cerebral embolism and hypoperfusion. We report a hybrid approach that was used to treat 2 patients presented with symptomatic chronic occlusion of the common carotid artery and ipsilateral internal carotid stenosis. Antegrade recanalization and retrograde stenting of the common carotid artery was performed in both patients associated to carotid bulb endarterectomy. Fresh thrombus observed in the distal common carotid stump was responsible for the embolic cerebral lesions and patients' previous symptoms. Patients remain asymptomatic at the 23rd- and 18th-month follow-up, respectively.


Subject(s)
Carotid Stenosis/surgery , Aged , Anticoagulants/therapeutic use , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/methods , Carotid Stenosis/complications , Carotid Stenosis/diagnosis , Chronic Disease , Diagnostic Imaging , Endarterectomy, Carotid , Female , Humans , Intracranial Embolism/etiology , Stents
14.
Ann Vasc Surg ; 28(7): 1789.e19-23, 2014 Oct.
Article in English | MEDLINE | ID: mdl-24530715

ABSTRACT

An 81-year-old man presented with rapid enlargement of a 2-year known abdominal aortic and common iliac aneurysms. A hybrid approach to preserve both hypogastric arteries (HAs) was planned: a bifurcated endograft for the right aortoiliac axis, right femoral-to-left femoral artery bypass, and left external-to-internal iliac artery stent graft placement. Urethral stenosis requiring an epicystostomy rendered this approach not feasible. After left HA embolization, a bifurcated endograft was deployed for the abdominal aortic aneurysm exclusion. The endograft right limb was extended using a second bifurcated endograft for the ipsilateral aortoiliac axis. Surgical femoral accesses were used for the 2 bifurcated endografts and left HA embolization. Through the left brachial access, 2 stent grafts were used to preserve the right hypogastric artery revascularization. The 5-year follow-up computed tomography scan demonstrated complete aneurysm exclusion and HA patency.


Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation/methods , Diagnostic Imaging , Iliac Aneurysm/surgery , Stomach/blood supply , Aged, 80 and over , Aortic Aneurysm, Abdominal/diagnosis , Blood Vessel Prosthesis , Contrast Media , Humans , Iliac Aneurysm/diagnosis , Male , Prosthesis Design , Stents
15.
Ann Med Surg (Lond) ; 86(5): 2684-2687, 2024 May.
Article in English | MEDLINE | ID: mdl-38694363

ABSTRACT

Objectives: To assess the quality of the meta-analyses that review the WHO surgical safety checklist. Methods: A systematic review of meta-analysis studies was undertaken using the search terms "World Health Organization Surgical Safety Checklist" in PubMed, Embase, and Lilacs databases. The selected meta-analyses were rated using the AMSTAR 2 assessment tool. Results: In the three meta-analyses evaluated, the checklist was associated with a decrease in the rates of complications and mortality. Overall confidence in the results of the evaluated meta-analysis was critically low. Conclusions: The meta-analysis coincides with obtaining lower complications and mortality rates with the WHO surgical safety checklist. However, the studies included in the meta-analyses were mostly observational, with potential biases, and according to the AMSTAR 2 tool, the overall confidence in the results of the evaluated studies was critically low.

16.
Breast Dis ; 43(1): 65-69, 2024.
Article in English | MEDLINE | ID: mdl-38607745

ABSTRACT

BACKGROUND: Sentinel lymph node biopsy in breast cancer is considered the standard of staging in cases of clinically negative lymph nodes. Its omission in favor of axillary dissection generates significant morbidity. OBJECTIVE: To determine the total number of sentinel node biopsy procedures in breast cancer in Colombia from 2017 through 2020, model and analyze them as if they were performed only in stage I breast cancer patients, and integrate their results into the concepts of quality of medical care. METHODS: Search in a database of the Ministry of Health and Social Protection of Colombia with sentinel lymph node biopsy codes, and filters of breast cancer and year. Their results are contrasted with the number of cases in stage I of breast cancer. RESULTS: Breast cancer TNM staging was reported in 22154 cases, 3648 stage I. In the same time frame, the number of sentinel lymph node biopsies for breast cancer in Colombia was 1045, 28.64% of the total cases reported in stage I. CONCLUSIONS: Colombia is far from complying with the standard indicator of sentinel lymph node biopsy. It is recommended to concentrate breast cancer cases in hospitals that provide the conditions for its performance.


Subject(s)
Breast Neoplasms , Sentinel Lymph Node , Humans , Female , Breast Neoplasms/epidemiology , Breast Neoplasms/therapy , Colombia/epidemiology , Sentinel Lymph Node Biopsy , Breast
17.
Int J Cardiol ; 400: 131694, 2024 Apr 01.
Article in English | MEDLINE | ID: mdl-38160911

ABSTRACT

Pulmonary embolism (PE) is a potentially life-threatening condition that remains a major global health concern. Noteworthy, patients with high- and intermediate-high-risk PE pose unique challenges because they often display clinical and hemodynamic instability, thus requiring rapid intervention to mitigate the risk of clinical deterioration and death. Importantly, recovery from PE is associated with long-term complications such as recurrences, bleeding with oral anticoagulant treatment, pulmonary hypertension, and psychological distress. Several novel strategies to improve risk factor characterization and management of patients with PE have recently been introduced. Accordingly, this position paper of the Working Group of Interventional Cardiology of the Italian Society of Cardiology deals with the landscape of high- and intermediate-high risk PE, with a focus on bridging the gap between the evolving standards of care and the current clinical practice. Specifically, the growing importance of catheter-directed therapies as part of the therapeutic armamentarium is highlighted. These interventions have been shown to be effective strategies in unstable patients since they offer, as compared with thrombolysis, faster and more effective restoration of hemodynamic stability with a consistent reduction in the risk of bleeding. Evolving standards of care underscore the need for continuous re-assessment of patient risk stratification. To this end, a multidisciplinary approach is paramount in refining selection criteria to deliver the most effective treatment to patients with unstable hemodynamics. In conclusion, the current management of unstable patients with PE should prioritize tailored treatment in a patient-oriented approach in which transcatheter therapies play a central role.


Subject(s)
Cardiology , Pulmonary Embolism , Humans , Thrombolytic Therapy/adverse effects , Pulmonary Embolism/therapy , Pulmonary Embolism/drug therapy , Thrombectomy , Hemorrhage/chemically induced , Treatment Outcome , Italy/epidemiology , Fibrinolytic Agents/therapeutic use
18.
Rev Bras Ginecol Obstet ; 45(12): e775-e779, 2023 Dec.
Article in English | MEDLINE | ID: mdl-38141598

ABSTRACT

OBJECTIVE: To calculate and analyze the mortality rates from breast cancer in women under 50 years of age in Colombia and to compare them with those of other countries in the region. METHODS: Based on data from the registry of deaths in 2018 and the results of the National Population and Housing Census of Colombia for the same year, specific mortality rates in women with breast cancer, specific mortality according to age group, standardized by age, proportional mortality, potential years of life lost, and years of life expectancy lost in women under 50 years of age who died from breast cancer were calculated. The mortality rate of regional countries was consulted on the Global Cancer Observatory webpage. RESULTS: In the group from 20 to 49 years, the specific mortality rate was higher in the age range from 45 to 49 years, with a rate of 23.42 × 100,000, a value that was above the specific mortality rate due to breast cancer in women in Colombia, 15.17 × 100.000. In the age range of 45 to 49 years, the potential years of life lost were 42.16. Of the 0.275 years of life expectancy lost by the population due to this neoplasia, women under 50 years of age represented 0.091 (33%). Colombia is the fifth in the rank of mortality in Latin American countries in this age group. CONCLUSION: Breast cancer in patients from 30 to 59 years is the number one cause for the decrease in life expectancy of women in Colombia. Women under 50 years of age represent one third of this decrease. This neoplasm is also the leading cause of mortality in women younger than 50 years in South America.


Subject(s)
Breast Neoplasms , Humans , Female , Middle Aged , Colombia/epidemiology , Life Expectancy , Global Health
19.
J Cardiovasc Echogr ; 33(4): 199-201, 2023.
Article in English | MEDLINE | ID: mdl-38486687

ABSTRACT

Heart metastatic tumors are more frequent than primary heart tumors. Cardiac metastasis is a rare phenomenon, occurring mainly by direct spread, especially from lung cancer. Cardiac metastases may be asymptomatic or cause arrhythmias, nonspecific electrocardiographic alterations, or mimic a myocardial infarction. In this case report, we illustrate a rare case of pulmonary adenocarcinoma, which through the bloodstream developed a stalactite-shaped metastasis within the right ventricle of conspicuous size (20 mm × 34 mm × 12 mm). In addition, the tumor compressed the right pulmonary trunk, causing pulmonary hypertension. It is essential to characterize metastasis with multimodality imaging. Such lesions within the right cavities can cause massive pulmonary embolism, as in our case, leading to the patient's death, thrombolytic therapy not being effective.

20.
Rev Bras Ginecol Obstet ; 44(8): 785-789, 2022 Aug.
Article in English | MEDLINE | ID: mdl-35724685

ABSTRACT

OBJECTIVE: To assess the quality of recent meta-analyses reviewing the diagnostic utility of sentinel node biopsy in endometrial cancer. METHODS: With the MeSH terms endometrial neoplasms and sentinel lymph node biopsy, PubMed and Embase databases were searched on October 21, 2020, and again on November 10, 2021, with meta-analysis and publication date filters set to since 2015. The articles included were classified with the A Measurement Tool to Assess Systematic Reviews (AMSTAR 2) assessment tool. RESULTS: The database searches found 17, 7 of which, after the screening, were selected for full review by the author, finally extracting six meta-analyzes for quality analysis. The rating with the AMSTAR 2 assessment tool found that overall confidence in their results was critically low. CONCLUSION: This study found that the quality of recent meta-analyses on the utility of the staging of endometrial cancer with sentinel node biopsy, evaluated by the AMSTAR 2 assessment tool, is classified as critically low, and, therefore, these meta-analyses are not reliable in the summary of their studies.


OBJETIVO: Avaliar a qualidade de meta-análises recentes que revisaram a utilidade diagnóstica da biópsia do linfonodo sentinela no câncer de endométrio. MéTODOS: Com os termos MeSH endometrial neoplasms e =biópsia do linfonodo sentinela, as bases de dados PubMed e Embase foram pesquisadas em 21 de outubro de 2020 e novamente em 10 de novembro de 2021, com filtros de meta-análise e data de publicação configurados para desde 2015. Os artigos incluídos foram classificados com o instrumento de avaliação A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). RESULTADOS: As pesquisas de banco de dados encontraram 17 artigos, sete dos quais, após a triagem, foram selecionados para revisão completa pelo autor, extraindo finalmente 6 meta-análises para análise de qualidade. A classificação com a ferramenta de avaliação AMSTAR 2 descobriu que a confiança geral em seus resultados era criticamente baixa. CONCLUSãO: Este estudo constatou que a qualidade de meta-análises recentes sobre a utilidade do estadiamento do câncer de endométrio com biópsia do linfonodo sentinela, avaliada pela ferramenta de avaliação AMSTAR 2, é classificada como criticamente baixa e, portanto, essas meta-análises não são confiáveis no resumo de seus estudos.


Subject(s)
Endometrial Neoplasms , Sentinel Lymph Node Biopsy , Endometrial Neoplasms/diagnosis , Endometrial Neoplasms/pathology , Female , Humans , Lymph Node Excision , Lymph Nodes/pathology , Sentinel Lymph Node Biopsy/methods
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