The authors here refer about the clinical case of a patient suffering from cirrhosis and hyperdyn... more The authors here refer about the clinical case of a patient suffering from cirrhosis and hyperdynamic circulatory state due to a giantism of the hepatic artery. The surgical ligature of the main hepatic artery determined the complete regression of the abdominal pain and melena: the high output cardiac failure also disappeared with surgical correction.
Human iliac arteries, obtained at surgery, were examined at SEM. The ultrastructural aspects has ... more Human iliac arteries, obtained at surgery, were examined at SEM. The ultrastructural aspects has evidenced pathological pictures, quite unexpected. The material observed resulted very adapt for scanning electron microscope.
The role of lumbar gangliectomy is examined by analysing cases of vascular interventions on the a... more The role of lumbar gangliectomy is examined by analysing cases of vascular interventions on the aorto-ilaco-femoral sector at the Department of Surgical Clinical Medicine II and at the Department of Surgical Anatomy and Surgery Studies of the University of Milan during the period 1966-1973. The steady, marked decrease in the incidence of operations on the Vegetative Nervous System, parallely with a notable rise in reconstructive operations is noted. The extension of indications to reconstructive operations alters the attitude to be assumed with regard to lumbar gangliectomy. Analysis of long-term results of indirect operations, however, confirms the validity of the method as a function of the restrictive attitude of present-day indications.
The second part of this in-depth clinical review focuses on drugs used in the prevention of AKI i... more The second part of this in-depth clinical review focuses on drugs used in the prevention of AKI in the patient at risk and/or in the management of the patient with incipient AKI. Among the drugs used to maintain a normal renal perfusion pressure, norepinephrine and vasopressin are most commonly used in hypotensive critically ill patients. The most recent RCT did not find a difference between low-dose vasopressin plus norepinephrine and norepinephrine alone in patients with septic shock, suggesting that either approach is reasonable. However, vasopressin may be beneficial in the less severe septic shock subgroup. Loop diuretics may convert an oliguric into a non-oliguric form of AKI that may allow easier fluid and/or nutritional support of the patient. Volume overload in AKI patients is common and diuretics may provide symptomatic benefit in that situation. However, loop diuretics are neither associated with improved survival, nor with better recovery of renal function in AKI. Among the renal vasodilating drugs, the routine administration of dopamine to patients for the prevention of AKI or incipient AKI is no longer justified. On the other hand, although additional studies may be warranted, fenoldopam may appear to be a likely candidate for the prevention of AKI, particularly in critically ill patients, if the positive results obtained in some recent studies are confirmed. Trials with natriuretic peptides were in general inconclusive but despite the fact that nesiritide is currently approved by the FDA only for the treatment of heart failure, this vasodilator may in the future play a role in the prevention of AKI, particularly in association with heart failure and cardiac surgery. The most recent trials seem to confirm a potential positive preventive effect of N-acetylcysteine (NAC), particularly in contrast-induced nephropathy (CIN), NAC alone should never take the place of IV hydration in patients at risk for CIN; fluids likely have a more substantiated benefit. At present, initiation of statin therapy for the prevention of CIN cannot be recommended, but these drugs should not be stopped before a radiological intervention in patients on chronic statin therapy. Rasburicase is very effective in the prevention of acute tumour lysis syndrome. Erythropoietin (EPO) has tissue-protective effects and prevents tissue damage during ischaemia and inflammation, and currently trials are performed with EPO in the prevention of AKI post-cardiac surgery, CIN and post-kidney transplantation. From this review it becomes clear that single-drug therapy will probably never be effective in the prevention of AKI and that multiple agents may be needed to improve outcomes. In addition, drugs should be administered early during the course of the disease
This document is the second deliverable produced within WP2 in the PLASTIC project. This delivera... more This document is the second deliverable produced within WP2 in the PLASTIC project. This deliverable describes the PLASTIC UML2 profile that concerns the starting point of the whole PLASTIC development process (described in PLASTIC Deliverable D2.1 – http://wwwc.inria.fr/plastic/deliverables/plastic-d2_1-finalpdf.pdf/download). It is a concrete implementation of the PLASTIC conceptual model (described in PLASTIC Deliverable D1.2 http://wwwc.inria.fr/plastic/deliverables/plastic-d1_2-finalpdf.pdf/download), which defines the modeling constructs that are used to build a PLASTIC service model. The reference modeling environment in which the profile is implemented is MagicDraw (http://www.magicdraw.com/). The PLASTIC UML2 profile allows the designer to build service models conforming the PLASTIC domain, i.e., context-aware and adaptable services over B3G networks. A service model is organized according to five views that reflect different aspects of the PLASTIC service's behavior. E...
Interposition of prosthetic material for arteriovenous communications became an indication for ac... more Interposition of prosthetic material for arteriovenous communications became an indication for access surgery if there are no possibilities to construct a direct arteriovenous fistula. This study will describe and analyse the results of 202 arteriovenous and graft fistulas out of a total experience of 684 vascular access procedures. The frequency of complications and the outcome of reoperations of homologous saphenous vein, bovine carotid and extended PTFE grafts are specially compared.
In a controlled trial the effects of two different methylprednisolone (MP) schedules were studied... more In a controlled trial the effects of two different methylprednisolone (MP) schedules were studied in 100 cadaver kidney adult recipients followed for 18-46 months. Group A patients were given 160 mg/day i.v. for 3 days, then oral MP (0.8 mg/kg/day), which was tapered by 4 mg/week to a maintenance dose of 16 mg/day up to the 6th month. Group B patients were given 80 mg/day i.v. for 3 days followed by 0.4 mg/kg/day oral MP; the dose was reduced by 2 mg/week to 16 mg/day. In both groups, the dose was further reduced bimonthly to a final dose of 8 mg/day. No significant differences were evidenced between the two groups in patients and kidney survival or in the incidence of complications. The number of patients with at least one rejection episode was significantly higher in the lower dose group.
Three-hundred sixty-eight grafts of 1701 KTs performed during a 25-year period showed major anato... more Three-hundred sixty-eight grafts of 1701 KTs performed during a 25-year period showed major anatomical anomalies: 358 kidneys presented an abnormal vascular supply, 8 organs had a double ureters, 2 were indivisible horseshoe kidneys. The outcome of these MKs is virtually identical (84%) to those obtained with transplant of normal grafts (85%). The advantages of ex vivo arterioplasty have been advocated.
Congresso Nazionale del Gruppo di Studio degli Accessi Vascolari della Società Italiana di Nefrologia, 2008
Trattamento degli aneurismi delle FAV emodialitiche Berardinelli L., Beretta C, Pozzoli E. Fondaz... more Trattamento degli aneurismi delle FAV emodialitiche Berardinelli L., Beretta C, Pozzoli E. Fondazione Ospedale Maggiore Policlinico, MARE Milano U.O. Chirurgia Generale e dei Trapianti di Rene Scopo del lavoro L\u2019aneurisma vero \ue8 una delle complicanze pi\uf9 rilevanti dell\u2019arterializzazione del circolo venoso nelle fistole emodialitiche; nelle FAV con vasi propri, pu\uf2 essere peri anastomotico o localizzarsi nel tratto di vena arterializzata quando la zona di venipuntura non venga frequentemente modificata. L\u2019aneurisma pu\uf2 localizzarsi anche sulle protesi con un\u2019incidenza maggiore nelle FAV confezionate con protesi biologiche. Per l\u2019eziologia si pu\uf2 invocare una intrinseca debolezza parietale come nelle protesi organiche, la frammentazione delle maglie delle protesi sintetiche, la perdita progressiva dell\u2019elasticit\ue0 parietale venosa conseguente alle venipunture o gli incrementi pressori nel lume della protesi come nell\u2019ipertensione venosa. Per tutti i tipi di accesso emodialitico l\u2019accuratezza del management \ue8 da considerare la miglior forma di prevenzione all\u2019insorgenza di aneurismi. Un adeguato trattamento permette di mantenere efficiente l\u2019accesso prolungandone la sopravvivenza. Il trattamento chirurgico degli aneurismi veri pu\uf2 variare in rapporto alle loro dimensioni, al numero e alla comparsa su vasi propri o su protesi. Materiali e metodi Della nostra esperienza pluriennale, sono stati presi in considerazione 2506 accessi emodialitici (1503 in vasi propri e 1003 con interposizione protesica) con un adeguato follow up. Abbiamo ricercato la comparsa di aneurisma in relazione al tipo di accesso, alla localizzazione anatomica e al momento di insorgenza. Viene descritto il trattamento attuato e calcolato l\u2019incremento di sopravvivenza. Risultati Sono stati rilevati 127 aneurismi (5.1%). Di questi, 74 sono comparsi su fav in vasi propri e 53 su FAV in protesi. Con un\u2019insorgenza in media a 97 mesi dopo il confezionamento per le prime e a 42,3 mesi per le FAV in protesi (p<0.00001). In 27 casi, l\u2019aneurisma singolo \ue8 stato trattato con aneurismectomia e un\u2019angioplastica in protesi. In 9 casi di aneurismi delle vene efferenti da FAV con vasi propri \ue8 stata eseguita l\u2019aneurismectomia e un\u2019anastomosi T-T dei monconi venosi. In 85 casi pi\uf9 favorevoli, in cui la parete protesica si presentava aneurismatica ma senza lesioni degenerative, abbiamo eseguito la recentazione a losanga della parete anteriore del segmento interessato e la sutura dell\u2019arteriotomia a sopraggitto in modo da ottenersi un calibro interno simile al resto della protesi. Recentemente abbiamo messo a punto una tecnica che prevede l\u2019utilizzazione delle suturatrici meccaniche a punti vascolari per eseguire contemporaneamente l\u2019aneurismectomia e la ricostruzion e della continuit\ue0 parietale. Conclusioni Il trattamento chirurgico degli aneurismi ha permesso di prolungare la funzione delle FAV emodialitiche, scongiurando le complicanze da rottura e da infezione, e di aumentare la sopravvivenza globale a 5 anni degli accessi che \ue8 passata nella nostra esperienza dal 24.3% al 78.7%
The authors here refer about the clinical case of a patient suffering from cirrhosis and hyperdyn... more The authors here refer about the clinical case of a patient suffering from cirrhosis and hyperdynamic circulatory state due to a giantism of the hepatic artery. The surgical ligature of the main hepatic artery determined the complete regression of the abdominal pain and melena: the high output cardiac failure also disappeared with surgical correction.
Human iliac arteries, obtained at surgery, were examined at SEM. The ultrastructural aspects has ... more Human iliac arteries, obtained at surgery, were examined at SEM. The ultrastructural aspects has evidenced pathological pictures, quite unexpected. The material observed resulted very adapt for scanning electron microscope.
The role of lumbar gangliectomy is examined by analysing cases of vascular interventions on the a... more The role of lumbar gangliectomy is examined by analysing cases of vascular interventions on the aorto-ilaco-femoral sector at the Department of Surgical Clinical Medicine II and at the Department of Surgical Anatomy and Surgery Studies of the University of Milan during the period 1966-1973. The steady, marked decrease in the incidence of operations on the Vegetative Nervous System, parallely with a notable rise in reconstructive operations is noted. The extension of indications to reconstructive operations alters the attitude to be assumed with regard to lumbar gangliectomy. Analysis of long-term results of indirect operations, however, confirms the validity of the method as a function of the restrictive attitude of present-day indications.
The second part of this in-depth clinical review focuses on drugs used in the prevention of AKI i... more The second part of this in-depth clinical review focuses on drugs used in the prevention of AKI in the patient at risk and/or in the management of the patient with incipient AKI. Among the drugs used to maintain a normal renal perfusion pressure, norepinephrine and vasopressin are most commonly used in hypotensive critically ill patients. The most recent RCT did not find a difference between low-dose vasopressin plus norepinephrine and norepinephrine alone in patients with septic shock, suggesting that either approach is reasonable. However, vasopressin may be beneficial in the less severe septic shock subgroup. Loop diuretics may convert an oliguric into a non-oliguric form of AKI that may allow easier fluid and/or nutritional support of the patient. Volume overload in AKI patients is common and diuretics may provide symptomatic benefit in that situation. However, loop diuretics are neither associated with improved survival, nor with better recovery of renal function in AKI. Among the renal vasodilating drugs, the routine administration of dopamine to patients for the prevention of AKI or incipient AKI is no longer justified. On the other hand, although additional studies may be warranted, fenoldopam may appear to be a likely candidate for the prevention of AKI, particularly in critically ill patients, if the positive results obtained in some recent studies are confirmed. Trials with natriuretic peptides were in general inconclusive but despite the fact that nesiritide is currently approved by the FDA only for the treatment of heart failure, this vasodilator may in the future play a role in the prevention of AKI, particularly in association with heart failure and cardiac surgery. The most recent trials seem to confirm a potential positive preventive effect of N-acetylcysteine (NAC), particularly in contrast-induced nephropathy (CIN), NAC alone should never take the place of IV hydration in patients at risk for CIN; fluids likely have a more substantiated benefit. At present, initiation of statin therapy for the prevention of CIN cannot be recommended, but these drugs should not be stopped before a radiological intervention in patients on chronic statin therapy. Rasburicase is very effective in the prevention of acute tumour lysis syndrome. Erythropoietin (EPO) has tissue-protective effects and prevents tissue damage during ischaemia and inflammation, and currently trials are performed with EPO in the prevention of AKI post-cardiac surgery, CIN and post-kidney transplantation. From this review it becomes clear that single-drug therapy will probably never be effective in the prevention of AKI and that multiple agents may be needed to improve outcomes. In addition, drugs should be administered early during the course of the disease
This document is the second deliverable produced within WP2 in the PLASTIC project. This delivera... more This document is the second deliverable produced within WP2 in the PLASTIC project. This deliverable describes the PLASTIC UML2 profile that concerns the starting point of the whole PLASTIC development process (described in PLASTIC Deliverable D2.1 – http://wwwc.inria.fr/plastic/deliverables/plastic-d2_1-finalpdf.pdf/download). It is a concrete implementation of the PLASTIC conceptual model (described in PLASTIC Deliverable D1.2 http://wwwc.inria.fr/plastic/deliverables/plastic-d1_2-finalpdf.pdf/download), which defines the modeling constructs that are used to build a PLASTIC service model. The reference modeling environment in which the profile is implemented is MagicDraw (http://www.magicdraw.com/). The PLASTIC UML2 profile allows the designer to build service models conforming the PLASTIC domain, i.e., context-aware and adaptable services over B3G networks. A service model is organized according to five views that reflect different aspects of the PLASTIC service's behavior. E...
Interposition of prosthetic material for arteriovenous communications became an indication for ac... more Interposition of prosthetic material for arteriovenous communications became an indication for access surgery if there are no possibilities to construct a direct arteriovenous fistula. This study will describe and analyse the results of 202 arteriovenous and graft fistulas out of a total experience of 684 vascular access procedures. The frequency of complications and the outcome of reoperations of homologous saphenous vein, bovine carotid and extended PTFE grafts are specially compared.
In a controlled trial the effects of two different methylprednisolone (MP) schedules were studied... more In a controlled trial the effects of two different methylprednisolone (MP) schedules were studied in 100 cadaver kidney adult recipients followed for 18-46 months. Group A patients were given 160 mg/day i.v. for 3 days, then oral MP (0.8 mg/kg/day), which was tapered by 4 mg/week to a maintenance dose of 16 mg/day up to the 6th month. Group B patients were given 80 mg/day i.v. for 3 days followed by 0.4 mg/kg/day oral MP; the dose was reduced by 2 mg/week to 16 mg/day. In both groups, the dose was further reduced bimonthly to a final dose of 8 mg/day. No significant differences were evidenced between the two groups in patients and kidney survival or in the incidence of complications. The number of patients with at least one rejection episode was significantly higher in the lower dose group.
Three-hundred sixty-eight grafts of 1701 KTs performed during a 25-year period showed major anato... more Three-hundred sixty-eight grafts of 1701 KTs performed during a 25-year period showed major anatomical anomalies: 358 kidneys presented an abnormal vascular supply, 8 organs had a double ureters, 2 were indivisible horseshoe kidneys. The outcome of these MKs is virtually identical (84%) to those obtained with transplant of normal grafts (85%). The advantages of ex vivo arterioplasty have been advocated.
Congresso Nazionale del Gruppo di Studio degli Accessi Vascolari della Società Italiana di Nefrologia, 2008
Trattamento degli aneurismi delle FAV emodialitiche Berardinelli L., Beretta C, Pozzoli E. Fondaz... more Trattamento degli aneurismi delle FAV emodialitiche Berardinelli L., Beretta C, Pozzoli E. Fondazione Ospedale Maggiore Policlinico, MARE Milano U.O. Chirurgia Generale e dei Trapianti di Rene Scopo del lavoro L\u2019aneurisma vero \ue8 una delle complicanze pi\uf9 rilevanti dell\u2019arterializzazione del circolo venoso nelle fistole emodialitiche; nelle FAV con vasi propri, pu\uf2 essere peri anastomotico o localizzarsi nel tratto di vena arterializzata quando la zona di venipuntura non venga frequentemente modificata. L\u2019aneurisma pu\uf2 localizzarsi anche sulle protesi con un\u2019incidenza maggiore nelle FAV confezionate con protesi biologiche. Per l\u2019eziologia si pu\uf2 invocare una intrinseca debolezza parietale come nelle protesi organiche, la frammentazione delle maglie delle protesi sintetiche, la perdita progressiva dell\u2019elasticit\ue0 parietale venosa conseguente alle venipunture o gli incrementi pressori nel lume della protesi come nell\u2019ipertensione venosa. Per tutti i tipi di accesso emodialitico l\u2019accuratezza del management \ue8 da considerare la miglior forma di prevenzione all\u2019insorgenza di aneurismi. Un adeguato trattamento permette di mantenere efficiente l\u2019accesso prolungandone la sopravvivenza. Il trattamento chirurgico degli aneurismi veri pu\uf2 variare in rapporto alle loro dimensioni, al numero e alla comparsa su vasi propri o su protesi. Materiali e metodi Della nostra esperienza pluriennale, sono stati presi in considerazione 2506 accessi emodialitici (1503 in vasi propri e 1003 con interposizione protesica) con un adeguato follow up. Abbiamo ricercato la comparsa di aneurisma in relazione al tipo di accesso, alla localizzazione anatomica e al momento di insorgenza. Viene descritto il trattamento attuato e calcolato l\u2019incremento di sopravvivenza. Risultati Sono stati rilevati 127 aneurismi (5.1%). Di questi, 74 sono comparsi su fav in vasi propri e 53 su FAV in protesi. Con un\u2019insorgenza in media a 97 mesi dopo il confezionamento per le prime e a 42,3 mesi per le FAV in protesi (p<0.00001). In 27 casi, l\u2019aneurisma singolo \ue8 stato trattato con aneurismectomia e un\u2019angioplastica in protesi. In 9 casi di aneurismi delle vene efferenti da FAV con vasi propri \ue8 stata eseguita l\u2019aneurismectomia e un\u2019anastomosi T-T dei monconi venosi. In 85 casi pi\uf9 favorevoli, in cui la parete protesica si presentava aneurismatica ma senza lesioni degenerative, abbiamo eseguito la recentazione a losanga della parete anteriore del segmento interessato e la sutura dell\u2019arteriotomia a sopraggitto in modo da ottenersi un calibro interno simile al resto della protesi. Recentemente abbiamo messo a punto una tecnica che prevede l\u2019utilizzazione delle suturatrici meccaniche a punti vascolari per eseguire contemporaneamente l\u2019aneurismectomia e la ricostruzion e della continuit\ue0 parietale. Conclusioni Il trattamento chirurgico degli aneurismi ha permesso di prolungare la funzione delle FAV emodialitiche, scongiurando le complicanze da rottura e da infezione, e di aumentare la sopravvivenza globale a 5 anni degli accessi che \ue8 passata nella nostra esperienza dal 24.3% al 78.7%
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