Left ventricular unloading during extracorporeal membrane oxygenation - Impella versus atrial septal defect: A simulation study.

BACKGROUND: Atrial septal defect and Impella have been proposed for left ventricular unloading in venoarterial extracorporeal membrane oxygenation patients. This work aims at evaluating the haemodynamic changes in venoarterial extracorporeal membrane oxygenation patients after Impella implantation or atrial septal defect realization by a simulation study. METHODS: A lumped parameter model of the cardiovascular system was adapted to this study. Atrial septal defect was modelled as a resistance between the two atria. Venoarterial extracorporeal membrane oxygenation and Impella were modelled starting from their pressure-flow characteristics. The baseline condition of a patient undergoing venoarterial extracorporeal membrane oxygenation was reproduced starting from haemodynamic and echocardiographic data. The effects of different atrial septal defect size, Impella and venoarterial extracorporeal membrane oxygenation support were simulated. RESULTS: Impella caused an increment of mean arterial pressure up to 67%, a decrement in mean pulmonary arterial pressure up to 8%, a decrement in left ventricular end systolic volume up to 11% with a reduction up to 97% of left ventricular cardiac output. Atrial septal defect reduces left atrial pressure (19%), increases right atrial pressure (22%), increases mean arterial pressure (18%), decreases left ventricular end systolic volume (11%), increases right ventricular volume (33%) and decreases left ventricular cardiac output (55%). CONCLUSION: Impella has a higher capability in left ventricular unloading during venoarterial extracorporeal membrane oxygenation in comparison to atrial septal defect with a lower right ventricular overload.

A Combined Approach of Field Data and Earth Observation for Coastal Risk Assessment.

The traditional approach for coastal monitoring consists in ground investigations that are burdensome both in terms of logistics and costs, on a national or even regional scale. Earth Observation (EO) techniques can represent a cost-effective alternative for a wide scale coastal monitoring. Thanks to the all-weather day/night radar imaging capability and to the nationwide acquisition plan named MapItaly, devised by the Italian Space Agency and active since 2010, COSMO-SkyMed (CSK) constellation is able to provide X-band images covering the Italian territory. However, any remote sensing approach must be accurately calibrated and corrected taking into account the marine conditions. Therefore, in situ data are essential for proper EO data selection, geocoding, tidal corrections and validation of EO products. A combined semi-automatic technique for coastal risk assessment and monitoring, named COSMO-Beach, is presented here, integrating ground truths with EO data, as well as its application on two different test sites in Apulia Region (South Italy). The research has shown that CSK data for coastal monitoring ensure a shoreline detection accuracy lower than image pixel resolution, and also providing several advantages: low-cost data, a short revisit period, operational continuity and a low computational time.

[Actual indications for day-surgery in the treatment of lung neoplasms]. / Attuali indicazioni per il trattamento delle affezioni neoplastiche del polmone in regime di day surgery.

AIM OF THE STUDY: To point out the actual possibilities to apply surgical treatments (diagnostic and therapeutics) for the cure of neoplastic disease of the lungs into an outpatient procedure. After a review of the recent literature, the authors show problems and limits of such a program. The analysis of the invasive diagnostic procedures (video-mediastinoscopy, anterior mediastinotomy, and thoracoscopy) shows that in most cases, a part from the kind of anesthesia, could be done in a short-term hospitalization. On the contrary, for pulmonary resection, all the experiences prove the practicability of the program, but only after careful selection of the patient, deep information of the patient and of his family and mostly, a proved integration between hospital and territory to warranty the continuation of the cures. CONCLUSION: The Authors believe that, mostly in their country, it is too early for a wide diffusion of new form of hospitalization different from the traditional one for the treatment of neoplastic disease of the lung.

Rapid progression of hepatocellular carcinoma after Radiofrequency Ablation.

AIM: To report the results of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) in cirrhotic patients and to describe the treatment related complications (mainly the rapid intrahepatic neoplastic progression). METHODS: Eighty-seven consecutive cirrhotic patients with 104 HCC (mean diameter 3.9 cm, 1.3 SD) were submitted to RFA between January 1998 and June 2003. In all cases RFA was performed with percutaneous approach under ultrasound guidance using expandable electrode needles. Treatment efficacy (necrosis and recurrence) was estimated with dual phase computed tomography (CT) and alpha-fetoprotein (AFP) level. RESULTS: Complete necrosis rate after single or multiple treatment was 100%, 87.7% and 57.1% in HCC smaller than 3 cm, between 3 and 5 cm and larger than 5 cm respectively (P=0.02). Seventeen lesions of 88(19.3%) developed local recurrence after complete necrosis during a mean follow up of 19.2 mo. There were no treatment-related deaths in 130 procedures and major complications occurred in 8 patients (6.1 %). In 4 patients, although complete local necrosis was achieved, we observed rapid intrahepatic neoplastic progression after treatment. Risk factors for rapid neoplastic progression were high preoperative AFP values and location of the tumor near segmental portal branches. CONCLUSION: RFA is an effective treatment for hepatocellular carcinoma smaller than 5 cm with complete necrosis in more than 80% of lesions. Patients with elevated AFP levels and tumors located near the main portal branch are at risk for rapid neoplastic progression after RFA. Further studies are necessary to evaluate the incidence and pathogenesis of this underestimated complication.