Why should you stay one night? Prospective observational study of enhanced recovery in elderly patients.

BACKGROUND: Delirium is a severe condition that can arise in many contexts during hospitalization. The aim of this research was to measure the incidence of postoperative delirium in patients aged 75 years or older, with the exclusion of those with preexisting neurocognitive disorders (NCD), who underwent fast-track, moderate surgery. METHODS: We conducted a prospective cohort study with patients ≥ 75 years of age who were eligible for fast-track, moderate surgery, without severe dementia, with a planned hospitalization of 24 h and with a physical status varying from very fit to vulnerable. The 4-item confusion assessment method (CAM4) was used to measure delirium. RESULTS: Of the 209 eligible patients, 195 subjects were enrolled in the study. The percentage of the population with a CAM4 score above 0 before surgery was 2.56%; after surgery, the percentage was 10.25%; and on the following day, the percentage was 4.61%. There was a statistically significant difference in the CAM4 scores between immediately after surgery and at 24 h after surgery (p = 0.0172). CONCLUSION: The data from this study support an enhanced recovery approach for elderly patients, in which after a minor surgical procedure with anaesthesia, a recovery period of one night in the hospital can contribute to normalizing the CAM4 score and reducing the incidence of delirium.

[The Breast Unit in the European and national policy documents: similarities and differences]. / La Breast Unit nei documenti di indirizzo europei e nazionali: analogie e differenze.

Aim of this study is to assess differences and similarities in official European and Italian Ministry of Health policy documents referring to the subject "Breast Unit". The T-Lab software package for textual analysis was used to analyze the documents. This instrument permits the identification of the most frequent used words and the semantic network associated with "Breast Unit". Results show that the European document gives more emphasis to the concept of "integrated care", delivered by a multi-professional team that meets the clinical, psychological and informational needs of the patient. The Italian document gives more prominence to themes related to the clinical content of the interventions and managerial aspects through the use of clinical guidelines.

Cranial nerve involvement as presenting sign of multifocal motor neuropathy.

Multifocal motor neuropathy (MMN) is characterized by slowly progressive, predominantly distal, asymmetric limb weakness and partial conduction blocks (CB) of motor axons. Cranial nerve involvement and respiratory failure are uncommon. We report two patients who exhibited unilateral hypoglossal and abducens palsy as presenting signs. Other remarkable features were autonomic instability and respiratory failure due to bilateral phrenic nerve involvement. Treatment with intravenous (IV) immunoglobulin (Ig) resulted in an improvement. Patient 2, who showed IgM reactivity against ganglioside GM1, has been receiving maintenance therapy with IVIg for 7 years. We speculate that cranial weakness of our patients could be due to CB similar to those detected in the motor nerves of the extremities.

The vegetative state: a report of two cases with a long-term follow-up.

OBJECTIVES: To demonstrate that patients with Prolonged Vegetative State (PVS) can show signs of improvements and important changes and, consequently, to strengthen the necessity to evaluate them with long-term serial follow-ups. SETTING: Rehabilitation of patients with severe traumatic brain injury (TBI). PARTICIPANTS: Two people with severe TBI discharged after a long period of inpatient rehabilitation in a condition of PVS. RESULTS: After 5 years some important changes happened and the initial prognosis was proved to be wrong. CONCLUSION: Sometimes patients declared to be in PVS have the possibility to recover, especially when initial clinical conditions are particularly severe and do not allow the emergence of the state of consciousness. It is important to conduct regular follow-ups to better evaluate changes and, if it is necessary, to re-adjust the rehabilitation accordingly.