Publications by authors named "Francesco Cafarelli"

The purpose of this study is to anatomically evaluate the impact on the patient intra vitam of an endocranial condition on a late 20th century skull housed in the Section of Legal Medicine of the University of Foggia (Foggia, Apulia, Italy). After performing a retrospective diagnosis, the condition is framed in the broader context of studies on this pathology. An anthropological and radiological analysis (X-ray and CT scan imaging) made it possible to confirm the preliminary information and to detail the osteological diagnosis of HFI.

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Article Synopsis
  • The study focuses on a new aggressive treatment method for acute type A aortic dissection using the frozen elephant trunk (FET) technique, which extends repair to the aortic arch and proximal descending thoracic aorta.
  • A total of 66 patients (average age ~63 years, mostly men) underwent emergency surgery between December 2017 and January 2022, with researchers assessing 30-day mortality, in-hospital mortality, and postoperative complications.
  • Results showed a 30-day mortality rate of 10.6% and in-hospital mortality of 13.6%, with key predictors for long-term survival identified, including left ventricular ejection fraction and presence of peripheral vascular disease
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The frozen elephant trunk (FET) technique is an increasingly common procedure to treat complex extensive aortic disease both in elective and emergency setting. In a contemporary era, several prostheses are available to be used by surgeons performing such procedures, merging the advantages of endovascular and conventional surgery and preparing a more useful landing zone for second-stage downstream endovascular or open repair. Thoraflex hybrid (Terumo Aortic, Scotland) is a largely used hybrid vascular device merging a conventional surgical vascular graft made of gelatin-sealed woven polyester graft with a nitinol self-expanding stent graft.

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During the last years, post-mortem imaging has gradually been assumed within research in the field of forensic pathology. This role appears to be clearly and simply applied in the trauma field with the use of conventional radiography or Post Mortem Computed Tomography (PMCT). Recently, particular attention was paid to cardiovascular imaging using Post Mortem Magnetic Resonance Imaging (PMMRI).

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Article Synopsis
  • The study evaluates early clinical outcomes of the frozen elephant trunk (FET) technique for treating complex aortic diseases, transitioning from traditional methods.
  • A total of 70 patients were treated, with a 100% technical success rate; however, in-hospital mortality was 14.2% with some occurrences of major strokes and spinal cord injury.
  • The FET technique showed promising results in a real-world context, suggesting good feasibility and outcomes, particularly in neurological complications, but further refinement and protocols for safety are needed.
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Acute type A aortic dissection (ATAAD) is an indisputable emergency with very poor outcomes without surgical treatment. Although the aortic arch is often involved in the aortic dissection, its optimal management during surgical therapy remains uncertain. A conservative tear-oriented approach has traditionally been adopted, limiting the procedure to the ascending aorta (or hemiarch) replacement.

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  • Phosphaturic mesenchymal tumors (PMTs) are rare tumors found in soft tissue or bones, associated with a condition called tumor-induced osteomalacia that affects phosphate levels in the body.
  • These tumors can be difficult to diagnose due to their varied appearances in imaging and histological studies, which often resemble other similar tumors.
  • The paper discusses the imaging characteristics of PMTs and offers a suggested diagnostic approach based on a review of existing literature.
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We report a unique case of a Starr-Edwards prosthesis (model 6310, cloth covered) implanted in the mitral position by Christian Barnard that was successfully explanted and replaced after 50 years, the longest period free from valve dysfunction ever reported. Reoperation also included replacement of the native aortic valve combined with tricuspid valve annuloplasty. ().

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Osteoporosis, a disease characterized by low bone mass and alterations of bone microarchitecture, leading to an increased risk for fragility fractures and, eventually, to fracture; is associated with an excess of mortality, a decrease in quality of life, and co-morbidities. Bone mineral density (BMD), measured by dual X-ray absorptiometry (DXA), has been the gold standard for the diagnosis of osteoporosis. Trabecular bone score (TBS), a textural analysis of the lumbar spine DXA images, is an index of bone microarchitecture.

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  • Short-term mechanical circulatory support (MCS) devices aid patients in severe cardiac situations, providing hemodynamic stability during high-risk surgeries, heart failure, and other critical conditions.
  • Electrical storm is a dangerous complication in cardiac patients, characterized by multiple episodes of ventricular fibrillation in a day, with a very high mortality rate of 80-90%.
  • The case study details a 38-year-old man with severe coronary artery disease and heart dysfunction who faced an electrical storm after emergency CABG surgery but was successfully treated with a combination of biventricular MCS using extracorporeal life support and devices like Impella CP and ProtekDuo.
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Reimplantation of the supra-aortic vessels can be challenging with Thoraflex Hybrid. A device modification made the vessel lengths more appropriate and the position of the neo-vessels in the chest avoided malpositioning and kinking and facilitated sternum closure; this may improve operating times as well as allowing complete and continuous cerebral trivascular perfusion and corrects positioning of the intrathoracic vessels.

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The human spine is a highly specialized structure that protects the neuraxis and supports the body during movement, but its complex structure is a challenge for imaging. Radiographs can provide fine bony detail, but lack soft tissue definition and can be complicated by overlying structures. MR imaging allow(s) excellent soft tissue contrast, but some bony abnormalities can be difficult to discern.

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Introduction: The relationship between post-menopausal osteoporosis and obesity has been mainly investigated using bone mineral density (BMD) as marker of bone health. Since BMD does not reflect bone microarchitecture, another analytical tool, the Trabecular Bone Score (TBS), has been recently developed for this purpose. In this study, we intended to investigate the validity of TBS as marker of bone quality in obese post-menopausal women.

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Postmortem imaging is a fascinating field of forensic radiology that has seen extraordinary growth in the last 10 years. Indeed, if autopsy represents the sole reliable method of determining the definitive cause of death, imaging may provide an efficient guide to supplement conventional autopsy. This is particularly true because of several techniques that are currently available, such as postmortem computed tomography, multiphase postmortem computed tomography angiography, and postmortem magnetic resonance imaging.

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Objectives: Bone mineral density (BMD) is associated with muscle mass and quality, but little research has been done on functional muscle-bone unit and back muscle density in patients with lumbar vertebral fracture. This study used the "modified functional muscle-bone unit" concept and measured back muscle density to investigate muscle-bone interaction difference between the fracture and control group.

Methods: This was a case-control study.

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Type 1 neurofibromatosis (NF 1), a rare genetic disease with autosomal dominant transmission, has typical dermatologic manifestations with pathognomonic Lisch nodules, and is rarely known for vascular alterations. Among these, aneurysmal dilatation is the most common form. We report a fatal case of massive hemothorax due to a spontaneous rupture of the left pulmonary artery branch micro-aneurysm in a NF 1 patient.

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Aims: To evaluate the relationship between an incremental model including cardiovascular risk factors, carotid disease, and inflammatory biomarkers to predict the presence of obstructive coronary artery disease (CAD).

Methods And Results: A total of 134 consecutive and asymptomatic intermediate-risk patients (mean age 61 ± 9 years, 52% men) were enrolled. Each subject underwent circulating levels assessment of interleukin (IL)-2r, IL-6, IL-8, IL-10, high-sensitivity C-reactive protein (hs-CRP) and carotid and coronary artery evaluation using carotid ultrasound and coronary computed tomography angiography (CCTA), respectively.

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Nutritional status is the results of nutrients intake, absorption and utilization, able to influence physiological and pathological conditions. Nutritional status can be measured for individuals with different techniques, such as CT Body Composition, quantitative Magnetic Resonance Imaging, Ultrasound, Dual-Energy X-Ray Absorptiometry and Bioimpendance. Because obesity is becoming a worldwide epidemic, there is an increasing interest in the study of body composition to monitor conditions and delay in development of obesity-related diseases.

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Wernicke's encephalopathy is an acute neuropsychiatric condition due to thiamine deficiency frequently associated with chronic alcohol abuse. We describe 2 cases of patients who experienced acute Wernicke's encephalopathy after allogeneic stem cell transplantation associated with the use of commercial total parental nutrition. Early diagnosis with magnetic resonance imaging and timely treatment with thiamine resulted in rapid resolution of clinical and radiological signs.

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