Management of hepatorenal syndrome and treatment-related adverse events.

Hepatorenal Syndrome is a critical complication of liver failure, mainly in cirrhotic patients and rarely in patients with acute liver disease. It is a complex spectrum of conditions that leads to renal dysfunction in the liver cirrhosis population; the pathophysiology is characterized by a specific triad: circulatory dysfunction, nitric oxide (NO) dysfunction and systemic inflammation but a specific kidney damage has never been demonstrated, in a clinicopathological study, kidney biopsies of patients with cirrhosis showed a wide spectrum of kidney damage. In addition, the absence of significant hematuria or proteinuria does not exclude renal damage.

Learning Curve Analysis of Robotic-Assisted Mitral Valve Repair with COVID-19 Exogenous Factor: A Single Center Experience.

Renewed interest in robot-assisted cardiac procedures has been demonstrated by several studies. However, concerns have been raised about the need for a long and complex learning curve. In addition, the COVID-19 pandemic in 2020 might have affected the learning curve of these procedures.

Evaluation of robotic-assisted mitral surgery in a contemporary experience.

Aims: To evaluate the safety/effectiveness of a recently established robotic-assisted mitral surgery program.

Methods: Cohort study with prospective collection of clinical data of 59 consecutive recipients (May 2019-August 2021) of robotic-assisted (fourth-generation platform, DaVinci X) mitral valve repair for degenerative disease, using a totally endoscopic technique. Patients' selection was based on defined anatomical and clinical criteria.

[Towards the age of computer-assisted surgery: how to establish a robotic-assisted mitral surgery program with a last-generation platform].

Mitral valve therapy is rapidly evolving. In this context, there is a clear evolution towards the diffusion of minimally invasive techniques for surgical mitral valve replacement or repair, namely in the context of primary mitral regurgitation. The robotic-assisted mitral surgery strategy allows the greatest reduction in surgical trauma to the patients, as well as improved ergonomics and video-assistance for performance of the mitral procedure.

Continued follow-up of the free margin running suture technique for mitral repair.

Objectives: The free margin running suture (FMRS) technique was recently proposed to treat complex degenerative mitral lesions. Limited follow-up data are available. We evaluated the midterm reliability of this technique and the associated mitral valve parameters using rest/stress echocardiography.

Versatility of endoaortic balloon occlusion device for less invasive management of complex and reoperative cardiac cases.

Heart Teams are increasingly confronted with decision-making in anatomically and clinically complex surgical candidates. Herein, we discuss the versatility of the endoaortic occlusion device (Intraclude; Edwards Lifesciences Inc) for the management of a various array of complex primary and reoperative cardiac cases. Three clinical scenarios are illustrated (ascending aortic pseudoaneurysm, mitral valve surgery after previous CABG, extensive thoracic aortic surgery with continuous visceral perfusion), suggesting the effectiveness of the patient-specific strategy to minimize operative morbidity.

Prolonged transesophageal echocardiography during percutaneous closure of the left atrial appendage without general anesthesia: the utility of the Janus mask.

Purpose: Left atrial appendage (LAA) closure is an interventional procedure increasingly used to prevent stroke in patients with permanent atrial fibrillation and contraindications to anticoagulation therapy. As this procedure requires a relatively immobile patient and performance of continuous and prolonged transesophageal echocardiography (TEE), it is usually performed under general anesthesia. In this case series, we describe the feasibility of prolonged TEE for percutaneous LAA closure using a new noninvasive ventilation device that can avoid the need for endotracheal intubation and general anesthesia.

Reducing mortality in acute kidney injury patients: systematic review and international web-based survey.

Objective: To identify all interventions that increase or reduce mortality in patients with acute kidney injury (AKI) and to establish the agreement between stated beliefs and actual practice in this setting.

Design And Setting: Systematic literature review and international web-based survey.

Participants: More than 300 physicians from 62 countries.

Anesthetic management for percutaneous aortic valve implantation: an overview of worldwide experiences.

Transcatheter aortic valve implantation is an emergent technique for high risk patients with aortic stenosis. Transcatheter aortic valve implantation poses significant challenges about its management, due to the procedure itself (i.e.

Scenes from the past: the Medici Project: radiographic survey.

The remains of 12 members of the grand ducal (junior) branch of the Florentine Medici family were exhumed in 2003 as part of the Medici Project, a multidisciplinary study whose aim was to investigate the lifestyles, health status, and possible causes of death of members of one of the richest, most powerful families of the Italian Renaissance. Digital radiography and orthopantomography were performed on the skeletal remains of individuals who lived between 1562 and 1666. The observed bone malformations, deformities, and changes (degenerative, metabolic, and dental) challenge traditional views, based on portraits and historical accounts, about the appearance and lifestyle of some family members.

Rheumatoid arthritis, Klippel-Feil syndrome and Pott's disease in Cardinal Carlo de' Medici (1595-1666).

Objective: A paleopathological study was carried out on the she skeletal remains of Cardinal Carlo de' Medici (1595-1666), son of the Grand Duke Ferdinando I (1549-1609) and Cristina from Lorraine (1565-1636), to investigate the articular pathology described in the archival sources.

Methods: The skeletal remains of Carlo, buried in the Basilica of San Lorenzo in Florence, have been exhumed and submitted to macroscopic and radiological examination.

Results: The skeleton of Carlo revealed a concentration of different severe pathologies.

Osteochondritis dissecans of the patella in a XVII century player of the Florentine historic kickball.

We report a case of osteochondritis dissecans in the patella of Francesco de' Medici, Prince of Capistrano, who lived from 1594 to 1614. He was known to play Florentine kick ball, a precursor of Rugby and American football, and speculate that trauma from this activity may have led to the lesion.

Diffuse idiopathic skeletal hyperostosis in the Medici, Grand Dukes of Florence (XVI century).

Diffuse idiopathic skeletal hyperostosis (DISH) is a common systemic disorder characterised by the ossification of the anterior longitudinal spinal ligament involving at least three contiguous vertebrae and by diffuse extraspinal enthesopathies. The condition is associated with the male sex and with advanced age; its aetiology is uncertain, but seems to be related to obesity and diabetes. The most recent studies in archaeological series demonstrated a relation between high social status and the incidence of DISH.

Transient hepatic attenuation differences and focal liver lesions: sump effect due to primary arterial hyperperfusion.

Objective: To analyze at computed tomography (CT) examination the "sump effect," a particular type of transient hepatic attenuation differences, related primarily to an increase in arterial flow without any accompanying decrease in portal flow.

Methods: We retrospectively evaluated all biphasic upper abdomen CT examinations (1283 in 807 patients) performed from the year 2003 to the year 2006 and selected and organized those with at least 1 transient hepatic attenuation differences. Of these, we enrolled patients with lobar/multisegmental arterializations surrounding focal lesion(s), without CT portal hypoperfusion signs, in the study group.

The 'gout' of the Medici, Grand Dukes of Florence: a palaeopathological study.

Objective: According to the written sources several members of the famous Medici family of Renaissance Florence suffered from an arthritic disease, called 'gout' by contemporary physicians; a palaeopathological study allowed verification of the true nature of the 'gout of the Medici' referred by archive document data.

Methods: The skeletal remains of the Grand Dukes and their families, buried in the Basilica of San Lorenzo in Florence, were examined macroscopically and submitted to X-ray investigation.

Results: Out of 15 investigated individuals, two cases of diffuse idiopathic skeletal hyperostosis (DISH), with ossification of the anterior longitudinal ligament and massive hyperostotic changes of the extra-spinal ligaments, were detected in the skeletons of the Grand Dukes Cosimo I (1519-74) and his son Ferdinand I (1549-1609).

CT colonography after incomplete colonoscopy in subjects with positive faecal occult blood test.

Aim: To report our experience with computed tomography colonography (CTC) systematically performed in subjects with positive faecal occult blood test (FOBT) and an incomplete colonoscopy in the setting of a population-based screening for colorectal cancer (CRC).

Methods: From April 2006 to April 2007, 43290 individuals (age range 50-70) who adhered to the regional screening program for the prevention of CRC underwent immunochemical FOBT. FOBT was positive in 1882 subjects (4.

The influence of diffusion- and relaxation-related factors on signal intensity: an introductive guide to magnetic resonance diffusion-weighted imaging studies.

In magnetic resonance diffusion-weighted imaging, signal intensity is influenced simultaneously by temperature, diffusivity, b value, pseudodiffusion, macroscopic motion, and T2-weighted intensity value. The purpose of this pictorial essay is to discuss and exemplify the influence that such factors and the related modifications have on signal intensity. Apparent diffusion coefficient, shine-through and pseudodiffusion will also be examined to show how T2-weighted signal intensity value and nondiffusional intravoxel incoherent motion can affect the diffusion-weighted imaging.

Bronchial artery embolization with detachable coils for the treatment of haemoptysis. Preliminary experience.

Purpose: This paper reports our early experience in the treatment of haemoptysis with embolization of the bronchial arteries using detachable coils.

Materials And Methods: Ten patients (mean age 45 years, range 23-83) with haemoptysis due to bronchoscopic biopsy of indeterminate lung nodules, lung cancer, tubercular bronchiectasis, cystic bronchiectasis or sarcoidosis underwent embolization of the bronchial arteries responsible for the bleeding using detachable coils. Patients were followed-up for a median of 14 months.

The Medici Project first anthropological and paleopathological results of the exploration of the Medici tombs in Florence.

Within the framework of the Medici Project, a paleopathological team of experts from the University of Pisa, the University of Florence and the Superintendence for Florentine Museums, is carrying out a study on 49 tombs of some of the Medici family members (16th-18th centuries) housed in the so-called Basilica of San Lorenzo in Florence. The project involves disciplines such as paleopathology, funerary archeology, physical anthropology, paleonutrition, parasitology, histology, histochemistry, immuno-histochemistry, electron microscopy, molecular biology, and identification of ancient pathogens. The most recent biomedical imaging technologies have been employed to obtain as much information as possible about the genetic make-up, eating habits, life styles and diseases of these important rulers of Renaissance Florence.

3-D segmentation algorithm of small lung nodules in spiral CT images.

Computed tomography (CT) is the most sensitive imaging technique for detecting lung nodules, and is now being evaluated as a screening tool for lung cancer in several large samples studies all over the world. In this report, we describe a semiautomatic method for 3-D segmentation of lung nodules in CT images for subsequent volume assessment. The distinguishing features of our algorithm are the following.

Bodies of stone: Girolamo Segato (1792-1836).

The life, activity and specimens of Girolamo Segato (Sospirolo 1792--Firenze 1836), as well as the mystery still surrounding his petrifaction method are outlined in this paper with the aim of shedding some light on one of the most controversial naturalists of the 19th century. Even if after his death many preparations became scattered or even destroyed, the greatest nucleus of them is now collected and exhibited in the Museum of the Department of Anatomy in Florence. Special attention has been given to the description of one of the most famous "pieces", a female head, recently added to the collection, coming from Museo Civico of Belluno.

Whole-brain histogram and voxel-based analyses of apparent diffusion coefficient and magnetization transfer ratio in celiac disease, epilepsy, and cerebral calcifications syndrome.

Background And Purpose: Diffusion and magnetization transfer (MT) techniques have been applied to the investigation with MR of epilepsy and have revealed changes in patients with or without abnormalities on MR imaging. We hypothesized that also in the coeliac disease (CD), epilepsy and cerebral calcifications (CEC) syndrome diffusion and MT techniques could reveal brain abnormalities undetected by MR imaging and tentatively correlated to epilepsy.

Materials And Methods: Diffusion and MT weighted images were obtained in 10 patients with CEC, 8 patients with CD without epilepsy and 17 healthy volunteers.

Subcortical damage and cortical functional changes in men and women with Fabry disease: a multifaceted MR study.

Purpose: To prospectively compare brain magnetic resonance (MR) imaging and hydrogen 1 (1H) MR spectroscopy findings and to use functional MR imaging to explore the patterns of brain activation in men and women with Fabry disease (FD).

Materials And Methods: Eight men and eight women with FD (mean age, 38.8 years +/- 13.