Skin diseases in geriatric patients: our experience from a public skin outpatient clinic in Siena.

AIM: With the progressive aging of the Italian population, geriatric health care has become a major issue for health authorities. However, little data is available regarding geriatric skin diseases. In order to provide rapid access to specialist help, in 2003 we created a dermatology clinic dedicated only to geriatric patients age 65 and older. METHODS: To determine the characteristic pattern and the prevalence of various skin disorders among the geriatric patients seen at the clinic, we performed a retrospective and descriptive study of all skin diseases in patients seen in our office from January 2003 to December 2009. We evaluated: age, proportion and gender for all skin disease categories. RESULTS: A total of 2100 geriatric patients were examined. The male to female ratio was 1.4 to 1. The most common disorder was pruritus "sine materia" (18.9%) followed by benign tumors (13.5%); 9.1% of our patients presented with actinic keratoses and 13.2% with malignant tumors. As reported by others, the quality of life in patients with skin cancer was better than patients with rashes as skin cancer patients tended to wait longer before seeking specialist care. To improve the assessment of skin diseases, we often worked closely with CONCLUSION: The prevalence of skin diseases in our patients emphasized the importance of educating the elderly about sun protection, the early detection of skin cancer, the use of emollients and proper skin care in general.

Recurrent Mondor's disease resolved after exeresis of abdominal lipoma.

BACKGROUND: Mondor's disease is a rare disorder characterized by superficial thrombophlebitis, classically of the thoracic-epigastric and/or lateral thoracic veins. The etiopathogenesis of the disease is not entirely clear. OBJECTIVE: We report the case of a patient who presented with recurrent Mondor's disease involving the left abdominal wall along the thoracoepigastric vein as far as the ipsilateral iliac fossa where a lipoma was observed. METHODS: Surgical removal of the lipoma showed a close anatomical relationship between the affected veins and the neoformation. RESULTS: Follow-up after 1 year did not reveal any signs of relapse of the thrombophlebitis. CONCLUSION: Since primary or secondary factors leading to hypercoagulability states were not detected in our patient, we speculate that the interference of venous flow by the abdominal lipoma was probably implicated in the etiopathogenesis of the disease.

[Effects of reduction of blood viscosity at constant hematocrit on the cerebral blood flow]. / Effetti della riduzione della viscosità ematica ad ematocrito costante sul flusso ematico cerebrale.

It is well established that cerebral blood flow (CBF) is low in patients with high hematocrit and is high in anemic patients. An inverse relationship between CBF and hematocrit has been found. Furthermore, if hematocrit is reduced, CBF increases. There is some debate as to whether these observations are due to viscosity or to oxygen carrying capacity of the blood. In order to further elucidate this problem, CBF, blood viscosity and hematocrit were measured in 4 patients with paraproteinemias before and after paraproteins had been removed by plasmapheresis without changes in hematocrit. After plasmapheresis, blood viscosity significantly decreases and CBF increases by a mean of 24.4 ml/100 g/min. Mean arterial blood pressure and hematocrit were not influenced by plasmapheresis. These results indicate that blood viscosity is an important factor in determining CBF. This does not exclude the role of oxygen transport as an associated factor, but it is evident that oxygen transport and blood viscosity are independent variables in the control of CBF.

A double-blind, interpatient comparison of plain and slow-release ketoprofen in osteoarthritis.

Eighty patients with osteoarthritis of various localization completed a double-blind, parallel-group trial of 2 weeks' duration comparing the efficacy and tolerance of ketoprofen slow-release capsules (150 mg) given either as a morning or a midday or an evening dose with that of ketoprofen conventional capsules (50 mg) 3X daily. All regimens were associated with a statistically significant improvement in pain at rest, pain on active motion, quality of sleep, and spine flexion, but there was no difference between treatments. The tolerance of ketoprofen was also similar in all groups. In view of the alleged better compliance of patients with once-daily medications, the new slow-release formulation of ketoprofen appears to be a useful alternative to the conventional capsules.

Effects of intravenous indoprofen on bleeding time and other haemostatic parameters.

The influence of i.v. administration of indoprofen on template bleeding time and other haemostatic parameters was investigated in ten elderly subjects with osteoarthritis. The drug was given first as a single dose (400 mg bolus) and then, after an appropriate interval, as a short-term treatment (200 mg bolus t.i.d. for 7 days). Platelet count, prothrombin time and partial thromboplastin time were never affected, whereas a significant, though moderate, lengthening of bleeding time and a parallel reduction of platelet aggregation were observed in both trials. In the acute one these changes were seen at the first hour following administration and waned in all patients within 96 hours. In the subacute test the bleeding time was steadily prolonged throughout the week of treatment, being slightly still above the baseline value 7 days later, at which time no residual effects were noticeable in platelet aggregation.

Indoprofen in rheumatic patients with acute episodes: a multicentre trial.

The results are reported of an open multicentre trial in 228 rheumatic patients with flare-ups. Fourteen centres adopting the same investigational protocol collaborated in the study. Indoprofen was administered for 1 week at a daily dosage of 1000 mg according to a treatment schedule used with success in acute gouty arthritis: a 400 mg i.v. bolus was followed by 200 mg (1 tablet) t.i.d. Subjective (pain) and objective variables were used for reliable assessment of activity. Marked reduction of pain intensity was already noticeable on day 1 of treatment and was followed by progressive improvement in subjective and objective variables for all the diagnoses considered. According to the patients' own overall assessments, results were good or very good in more than 50% of cases. The best outcomes were obtained in low back pain, acute gout and psoriatic arthritis. At the end of treatment only 7.4% of patients experienced no change or deterioration of symptoms. Adverse reactions, consisting mostly of mild and reversible gastrointestinal disturbances, were reported by 9.2% of patients, but only in 1.8% was treatment discontinued. Indoprofen administered according to the above schedule is an appropriate treatment for acute episodes of rheumatic diseases.

Familial lead poisoning from contaminated wine.

Three members of a family were found be suffering from lead poisoning of nonindustrial origin, the causative agent being the home-produced wine left to ferment in a glazed earthenware vat. The clinical and neurophysiological features are discussed in the light of similar cases in the literature. Correct diagnosis and early treatment of nonindustrial lead polyneuropathy are often extremely difficult because of the elusive nature of the exposure.

[Clinical study of a preparation with bronchomucotropic activity: guacetisal]. / Studio clinico di un preparato ad attività broncomucotropica: il guacetisal.

An open clinical study has been carried out on 40 patients of both sexes suffering from prevalently chronic bronchopneumopathy, with a suspension of guacetisal for adults. The drug is a new bronchomucotropic synthesized by the Bayer Italia S.p.A. Research Laboratories. The improvement in the clinical picture was very evident in 55% of cases and is in favour of an overall positive opinion of the drug's activity bearing in mind that the pathology considered would not in any case have permitted the achievement of complete resolution. The drug was very well tolerated and presented marked mucopoietic and anti-inflammatory properties at a dose of 1 spoonful (10 ml) 2-3 times a day.

A double-blind evaluation of oral indoprofen versus ASA in osteoarthritic patients: influence on haemostatic parameters and clinical effects.

Indoprofen, a non-steroidal anti-inflammatory agent, was investigated in a double-blind, randomized study in 44 osteoarthritic patients for its influence on haemostatic parameters and therapeutic effects. Twenty-two patients received indoprofen orally, 600 mg daily, and a similar group took acetylsalicylic acid 3 g daily for 21 days. Platelet count, partial thromboplastin time and prothrombin time showed no variations. Bleeding time wa prolonged and platelet aggregation reduced by both drugs. The effects of ASA, however, were significantly greater. Indoprofen, unlike ASA, showed almost no residual effect seven days after stopping medication. The therapeutic responses to indoprofen and ASA were comparable. However, adverse reactions (pyrosis and gastric pain) were much more frequent in the ASA group (15 patients) than in the indoprofen group (2 patients).

Antihypertensive effect of oxprenolol and chlorthalidone in fixed combination, given once daily.

In a multicentre, single-blind, within-patient study, the effectiveness and tolerability of the fixed combination oxprenolol 80 mg + chlorthalidone 10 mg per tablet given once daily, compared to the well established b.i.d. schedule, has been investigated in forty out-patients with mild to moderate hypertension. After a two-weeks placebo wash-out, twenty patients were given 1 tablet b.i.d. of the fixed combination for 4 weeks and thereafter 2 tablets once-daily for a further 4 weeks; the remaining twenty patients were given the fixed combination in the reverse order. There was no significant difference in clinical response between the two treatment regimes, which were equally effective and well tolerated. However, patient compliance might be considerably improved with the once-daily dosage schedule of the fixed combination.

[A new standardized method for determination of the bleeding time]. / Un nuovo metodo standardizzato per la determinazione del tempo di sanguinamento

The standardized bleeding time is considered a valuable measure of the platelet role in haemostasis. It is particularly useful for the evaluation of drugs that affect platelet functions. Measurements of the bleeding time were performed using a new system which was designed following the instructions of Mielke and co-workers with some variations of the described method. The standardized bleeding time proved to be a high reproducible and sensitive technique.

[Anti-platelet aggregating drugs in the prevention of thromboembolic diseases]. / I farmaci antiaggreganti piastrinici nella prevenzione delle malattie tromboemboliche

The treatment and prevention of arterial thrombosis have been improved in recent years by the use of drugs acting on certain platelet characteristics, such as clumping capacity, adhesivity, release of factors 3 & 4, and survival. Many substances have been proposed for clinical employment. Mechanisms of action are discussed on the basis of personal experience, particularly with dipyrimadol and beta-blocking drugs. It would seem that the best results are obtainable with drugs whose effect on platelet clumping comes from stablisation of the membrane, such as the non-steroid anti-inflammatory preparations, in association with drugs than enhance intraplatelet cyclic AMP.