A new approach in the treatment of high flow native AV fistula: the open-pore external scaffolding prosthesis

Objective: The vascular access steal syndrome is a complication occurring in 1-6% after native arterio-venous (AV) fistulas, often due to huge diameter of the vein. This results in very high flow, which could also be responsible for cardiac overload. The aim of this study is to evaluate the efficiency of a new approach in the treatment of this pathology using open-pore external scaffolding prosthesis.Methods: This a retrospective review of all patients presenting symptomatic high flow after native AV fistula between January 2007 and December 2009 in 3 vascular centers. Pre-operative duplex exam confirmed the diagnosis of high flow. The operation consisted in preparation of the whole fistula, measurement of the flow and section on the venous side. The vein was wrapped with this 6 to 8 mm open-pore external scaffolding prosthesis (ProVena, BBraun, Germany) according to its diameter and to the flow and then sutured. Measurement of the flow was repeated. Patients were followed by duplex exam at 1 week and at 1, 3, 6 and 12 months. Procedural success was defined as complete implantation of the prosthesis and reduction of the flow. Primary outcomes were reduction of the flow and recovery of the symptoms and secondary endpoint was patency of the fistula.Results: During the study period, 14 patients, with a mean age of 65・8 years old, have been operated with this technique.There were 2 native forearmfistulas and 12 on the armwith a mean pre-operative flow of 2600 ml/min (1800-3800). The mode of presentation was pain in 6 patients, neurological disorders in 10 and necrosis in 4. Moreover, 3 patients had cardiac insufficiency due to high flow in the fistula. The procedure was technically successful in 100% of cases. Re-intervention was necessary in 2 patients due to hematoma. Recovery of the initial symptoms occurred in 13 patients (93%). The mean flow reduction was 1200 ml/min (600-2000). In 1 patient, a persistent steal syndrome despite flow reduction to 1400 ml/min resulted in fistula closure 2 months later. At a mean follow-up of 22 months (4-35), all remaining patients (13/14) presented a patent fistula without recurrence.Conclusion: This new approach seems to be safe and effective in the treatment of symptomatic high flow native AV fistulas by significantly reducing the flow and avoiding closure of the vascular access. Longer follow-up with more patients are necessary to evaluate the risk of recurrence.

Les endocardites dues aux germes du groupe HACEK. A propos d'un cas d'endocardite native a Kingella kingae. [Endocarditis due to HACEK bacteria. A case report of endocarditis due to Kingella kingae]

Endocarditis is a common disease in hospital practice. Identification of the microorganism responsible for the valvular damage is essential to establish the prognosis and to determine the optimal antibiotic treatment. In some cases of endocarditis the diagnosis is laborious, especially when the responsible microorganism is difficult to detect using standard culture techniques. Here we report a case of native aortic valve endocarditis due to Kingella kingae, a Gram negative organism of the HACEK group. In addition we review 6 other cases of endocarditis caused by organism belonging to this group, treated in our hospital between 1983 and 1999. Epidemiological studies show that less than 5% of all cases of endocarditis are caused by organisms of the HACEK group. The diagnosis is often delayed because their slow growth on a standard culture medium. We describe clinical and microbiological characteristics of this group of endocarditis.

Il laudario dei battisti di Modena... : Con una tavola fuori testo / pubblicato a cura di Giulio Bertoni...

Collection : Beihefte zur Zeitschrift für romanische Philologie ; 20

Tasso di omocisteina e diminuzione del rischio cardiovascolare: nessun effetto delle vitamine B: revisione Cochrane per il medico di famiglia.

Questo articolo presenta i risultati della rivista sistematica: Martí-Carvajal AJ, Solà I, Lathyris D, Salanti G. Homocysteine lowering interventions for preventing cardiovascular events. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD006612. DOI: 10.1002/14651858.CD006612.pub2. PMID: 19821378.

Emissioni atmosferiche da discariche di rifiuti in Lombardia: stato attuale e scenari tecnologici di riduzione

Lo studio ha valutato le emissioni atmosferiche in Regione Lombardia dallo smaltimento di rifiuti solidi in discariche controllate nell'anno 2001, proiettandone i quantitativi attesi a medio e lungo termine sulla base degli scenari di evoluzione più attendibili per le caratteristiche qualitative dei fifiuti, le modalità di smaltimento e le tecnologie adottabili per il controllo delle emissioni stesse. La valutazione è stata condotta acquisendo i dati base degli impianti attualmente presenti sul territorio lombardo per quanto riguarda i rifiuti smaltiti e le modalità di captazione e di combustione del biogas. Sono stati quindi definiti alcuni scenari alternativi ragionevolmente ipotizzabili nel medio e lungo periodo per lo smaltimento dei rifiuti, sulla base dell'evoluzione imposta dalla normativa nazionale e dagli strumenti della pianificazione regionale. L'individuazione delle migliori tecnologie applicabili per la captazione ed il trattamento del gas prodotto e per il controllo delle corrispondenti emissioni atmosferiche ha permesso di stimare l'evoluzione temporale, in corrispondenza dei diversi scenari, della produzione di gas e delle emissioni dei principali inquinanti di interesse. I risultati mostrano la possibilità di ottenere una consistente riduzione delle emissioni di metano, tale da comportare a scala regionale una corrispondente diminuzione del 2% delle emissioni complessive di C02 equivalente. [Autore]

Interference of Native Language in English Language Acquisition in Santa Cruz and Calheta Secondary schools

This study analyzes the interference of native language when students are learning a foreign language, in this case English. According to this study, interferences from the native language such as lexical-semantic and phonological are not infrequent. It is one of the main barriers that create difficulties when learning English. The outcome of this study is presented at the end of the Monografia: to provide English-language teachers and students the most significant linguistic interferences that occur during the learning process of English language. Furthermore, some teaching strategies are discussed to avoid the biases that appear due to the interferences of the native language. As a result of this study, I hope to contribute to the learning success among English-language students.