BackgroundFenestrations or divisions of the vascular lumen into separate channels appear to be common anatomical variations in patients with intracranial aneurysms. The most frequent sites of occurrence are the anterior communicating artery (ACom), followed by vertebrobasilar and middle cerebral artery (MCA) locations.Case presentationA 61-year-old female was brought to the emergency department after experiencing severe headache with abrupt onset, nausea, and vomiting. Clinical examination on arrival showed a drowsy patient (GCS 14), with neck stiffness, but no cranial nerve palsies or other neurological deficits (Hunt-Hess 2). Non-contrast head CT and CT angiography revealed subarachnoid and intraventricular hemorrhage (modified Fisher 4) and two saccular aneurysms, one located on the right supraclinoid ICA with peripheral calcifications, measuring 20 × 12 mm, the second on the left MCA bifurcation, 6 × 4 mm. 3D rotational angiography revealed a right ICA fenestration located between the ophthalmic (OA) and posterior communicating artery (PCom). The proximal part of the fenestration harbored a large saccular aneurysm projecting superiorly with the neck engulfing the origin of the fenestration; due to the favorable neck and geometry of the aneurysm, endovascular coil occlusion was chosen as a treatment option without balloon or stent assistance. The decision was taken to clip the MCA aneurysm.ConclusionSupraclinoid ICA fenestrations are rare anatomical variations. Endovascular treatment of supraclinoid ICA fenestration-related aneurysms is feasible and safe, with the notable concern of perforators originating from the limbs.

The circular economy (CE) is currently a very widespread paradigm aimed at addressing the climate crisis. However, its notions seem often to be only focused on technical, industrial and economic growth-centric goals, without practically addressing social problems such as inequality and social exclusion. In this context, type B social cooperation (SC-B) emerges in the Italian context as a type of organisation explicitly aiming at addressing social issues. It has historically fulfilled this mandate by pioneering, among others, “circular” processes in the field of waste management. In doing so, it has consolidated a high level of organizational and management capacity, which has made it an exemplary model capable of innovating the CE discourse and including marginalized people while delivering high-quality environmental services. Through evidence gathered integrating different methods and sources (interviews with social cooperatives, literature review, case study research on filed actions), this paper aims to offer a reading of SC-B as a driver for promoting a social turn of CE and local development. Moving beyond waste management and towards waste reuse, SC-B could play an active role in creating local and regional waste transformation and upcycling chains, capable of creating new employment and inclusion opportunities as well as reducing environmental impacts by processing wastes directly in the territory, shortening their treatment chain.

Radial forearm fl aps. Experience in ten patientsBackground: Radial forearm fl ap is extraordinarily versatile thanks to its irrigation by the radial artery and its minor pedicles. It provides assorted alternatives for the reconstruction of proximal or distal defects of the arm and can be used as a free fl ap in head, neck, posterior trunk region, lower limb, esophagus and penis. It allows the incorporation of bone, tendons, nerves and muscle for complex lesion repair. Aim: To report our experience with radial forearm fl ap. Patients and Methods: Ten patients aged 20 to 65 years (four women) are reported. The lesions repaired were traumatic in four, infectious in three, secondary to tumors in two (a squamous intra oral adenocarcinoma in both patients) and vascular in one patient. Results: No patient had a partial or total loss of the fl ap. Five patients required complementary dermo epidermic grafts in a second intervention. Mean hospital stay was 30 days. All patients reported a favorable degree of satisfaction with the procedure. Conclusions: Radial forearm fl aps are a good alternative for the repair of a great variety of lesions.

Internal carotid artery (ICA) anatomical variations are relatively rare occurrences during diagnostic imaging procedures. Their presence can have important prognostic consequences in the evaluation of vascular neurological diseases. It is therefore important to have a good knowledge about these variations, in order to avoid unwarranted medical interventions. We present the case of a patient harboring a right ICA fenestration in the cervical segment, misdiagnosed as a dissection on computed tomography angiography, admitted in the Department of Neurology and treated accordingly. The possible pathological and embryological origins of arterial fenestrations are discussed, and a brief review of the literature related to ICA fenestrations is presented.

A 56-year-old man presented to the emergency department with pain, swelling, and restricted mobility of the left lower limb and shortness of breath on exertion in the previous 3 days. Seven months prior to this presentation, he had been diagnosed with adult-onset Still’s disease based on the Yamuguchi criteria, after excluding the presence of any other disease. The patient had been treated with prednisolone and methotrexate. Subsequent investigations revealed that he developed bilateral deep venous thrombosis and bilateral pulmonary emboli. This case emphasizes that adult-onset Still’s disease can be a rare but life-threatening cause of venous thromboembolism.