Realizzazione di un simulatore biomeccanico del sistema ventricolo-aorta e studio della contropulsazione passiva

La sinergia tra diverse aree scientifiche svolge oggi un ruolo preminente nella risoluzione di problematiche molto complesse: in ambito medico, un massiccio intervento delle scienze fisico-matematiche ha portato, grazie alla ricerca sulle proprietà subatomiche (NMR), sulla funzione elettromeccanica tissutale (pace-makers) e sulla biocompatibilità di materiali innovativi, ad un completo rinnovamento e miglioramento delle terapie tradizionali, delineando nuove strategie terapeutiche. In questo quadro di attiva collaborazione si colloca la ricerca in ambito biomeccanico cardiovascolare che, approfondendo la funzionalità del cuore e dei vasi in condizioni normali e patologiche, propone soluzioni terapeutiche alternative all'approccio farmacologico, impensabili fino a pochi anni fa. Uno di questi ambiti è l'insufficienza cardiaca: al ventricolo incapace di produrre l'energia necessaria alla perfusione ematica viene associato un sistema di pulsazione meccanica che riduce il carico durante l'eiezione ed aumenta la perfusione coronarica in diastole. Tuttavia, benché l'efficacia della contropulsazione intra-aortica sia riconosciuta da decenni, alcune problematiche rimangono irrisolte: l'inapplicabilità su pazienti aritmici, l'eccessiva sollecitazione meccanica in pazienti vasculopatici, la complessità e l'alto costo dell'apparecchiatura. Questo lavoro affronta la validazione e la caratterizzazione di una soluzione terapeutica alternativa, di tipo completamente passivo, il cui effetto non è basato sulla somministrazione di energia meccanica dall'esterno, attraverso la pulsazione, ma sull'adattamento di impedenza biomeccanica tra la sorgente elastica pulsatile (il ventricolo) ed il carico (l'aorta). Per verificare l'ipotesi funzionale è stato realizzato un sistema contrattile che simulasse diversi livelli di insufficienza ventricolare ed un sistema vascolare con resistenza idraulica ed elastanza variabili. Sono stati rilevati i parametri fisiologici (pressioni, flusso, potenza ed efficienza) nelle diverse condizioni di accoppiamento biomeccanico e si sono ripetuti i rilievi inserendo il dispositivo di contropulsazione passiva. La validazione sperimentale ha prodotto risultati coerenti con quanto atteso ed è stata indispensabile per l'ottenimento, da parte del Comitato Etico, dell'autorizzazione per la sperimentazione clinica del sistema in oggetto.

[Right-sided lower abdominal pain and diarrhea of a young diabetic woman]

We report the case of a 24-years old diabetic women hospitalised because of right-sided lower abdominal pain and diarrhea. She fulminantly developed shock before appendectomy could be performed and was transferred to intensive care unit. Hypotension remained and laparoscopy revealed primary peritonitis and toxic shock syndrome by Group A Streptococcus which was cultivated in blood and ascites. Therapy with penicilline and clindamycine resolved symptoms. During hospitalisation Clostridium difficile colitis occurred. This complication leaded to prolonged hospitalisation.

Compartment pressure of the rectus sheath accurately reflects intra-abdominal pressure in a porcine model

To investigate whether the compartment pressure of the rectus sheath (CPRS) reflects the intra-abdominal pressure (IAP) under various conditions of intra-abdominal hypertension (IAH) in a pig model.

Splanchnic vasoregulation after major abdominal surgery in pigs

Unrecognized reduction of blood supply to intestinal organs is associated with significant postoperative morbidity in abdominal surgery. The aim of this study was to determine whether--in the absence of hypovolemia--intestinal hypoperfusion as a result of blood flow redistribution occurs after abdominal surgery.

A 5-year follow-up of patients discharged with non-specific abdominal pain: out of sight, out of mind?

Acute non-specific abdominal pain (NSAP) is prevalent in 6-25% of the general population and is a common cause of admission to the emergency department (ED). Despite involvement of substantial financial and human resources, there are few data on long-term outcome after initial diagnosis. The aim of this study was to evaluate long-term outcome of patients initially admitted with NSAP to an ED.

Gender, age and ethnic aspects of analgesia in acute abdominal pain: is analgesia even across the groups?

Numerous studies have shown differences in pain perception between men and women, which may affect pain management strategies.

Increasing abdominal pressure with and without PEEP: effects on intra-peritoneal, intra-organ and intra-vascular pressures

Intra-organ and intra-vascular pressures can be used to estimate intra-abdominal pressure. The aim of this prospective, interventional study was to assess the effect of PEEP on the accuracy of pressure estimation at different measurement sites in a model of increased abdominal pressure.

Early fish oil supplementation and organ failure in patients with septic shock from abdominal infections: a propensity-matched cohort study

Fish oil (FO) has immunomodulating effects and may improve organ function and outcome in critically ill patients. This retrospective, propensity-matched cohort study investigates the effects of early intravenous FO supplementation on organ failure in patients with septic shock from abdominal infection.

Prevention of rupture of abdominal aortic aneurysm

Two thirds of patients with an abdominal aortic aneurysm (AAA) have relevant coronary artery disease (CAD). AAAs are prevalent in up to 16% of smokers with CAD. General screening of AAA is controversial. Aim was to assess the potential of finding AAA prior to rupture among patients with known CAD. Main endpoint was whether AAA could have been found during follow-up by sonography or at other time of cardiovascular evaluation.

An unusual cause of hemoptysis--aberrant origin of the left pulmonary artery from the ascending aorta in the adult

Aberrant origin of a pulmonary artery from the ascending aorta is an uncommon congenital vascular malformation with poor survival without surgery. In this case report, we describe the unusual late diagnosis of this congenital malformation in an otherwise asymptomatic young man presenting with mild hemoptysis. We review the natural and modified history of this defect and the relevant aspects of follow-up in adult life.

Iterative Reconstruction Algorithm for Abdominal Multidetector CT at Different Tube Voltages: Assessment of Diagnostic Accuracy, Image Quality, and Radiation Dose in a Phantom Study

To assess the diagnostic accuracy, image quality, and radiation dose of an iterative reconstruction algorithm compared with a filtered back projection (FBP) algorithm for abdominal computed tomography (CT) at different tube voltages.

Low-tube-voltage, high-tube-current multidetector abdominal CT: improved image quality and decreased radiation dose with adaptive statistical iterative reconstruction algorithm--initial clinical experience

To investigate whether an adaptive statistical iterative reconstruction (ASIR) algorithm improves the image quality at low-tube-voltage (80-kVp), high-tube-current (675-mA) multidetector abdominal computed tomography (CT) during the late hepatic arterial phase.

The Influence of Abdominal Pressure on Lower Extremity Venous Pressure and Hemodynamics: A Human In-vivo Model Simulating the Effect of Abdominal Obesity

To demonstrate that abdominal pressure impacts venous flow and pressure characteristics.