RESUMO
OBJECTIVE: In order to examine prospectively the characteristics of violence among psychiatric patients, a 5-year study was carried out in an acute psychiatric unit. METHOD: All assaultive behaviour occurred in the ward during the study period were assessed routinely using the Staff Observation Aggression scale (SOAS). RESULTS: Of 1534 patients admitted to the unit during the study period, 116 were responsible for 329 aggressive episodes (prevalence of violence=7.5%, 2.8 incidents/patient). Most violent patients had an ICD-9 diagnosis of schizophrenia and/or delusional syndromes (55.1%), a history of violence (80.7%) and previous psychiatric admissions (92%). Approximately half of the incidents had no specific cause, occurred during daytime and the first week of admission and, in most cases, were directed towards individuals (77.8%). CONCLUSION: Although confirming the low rate of violence among Italian psychiatric in-patients, the study indicates the need for more attention to the problem of aggression in general hospital psychiatric units.
Assuntos
Agressão/psicologia , Delusões/epidemiologia , Pacientes Internados/estatística & dados numéricos , Esquizofrenia/epidemiologia , Psicologia do Esquizofrênico , Violência/estatística & dados numéricos , Adulto , Delusões/diagnóstico , Delusões/psicologia , Feminino , Hospitais Gerais/estatística & dados numéricos , Humanos , Pacientes Internados/psicologia , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Fatores de Risco , Esquizofrenia/diagnóstico , Violência/psicologiaRESUMO
BACKGROUND: The detection of hibernating myocardium involved different imaging procedures, trying to predict the functional recovery of this tissue, which survives at a low metabolic rate in regions exposed to chronic ischemia. MATERIALS AND METHODS: A small group of patients with prior myocardial infarction and severe left ventricular dysfunction has been evaluated by echo-dobutamine and 99mTc-MIBI myocardial SPET. This radiopharmaceutical drug has been considered of low usefulness for the detection of viability. RESULTS AND CONCLUSIONS: By comparing scintigraphic and echographic results there seem to be a reduced probability of the presence of viable myocardium in regions with severe perfusional scintigraphic defect.
Assuntos
Isquemia Miocárdica/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Sestamibi , Idoso , Cardiotônicos , Dobutamina , Imagem do Acúmulo Cardíaco de Comporta , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Isquemia Miocárdica/fisiopatologia , Ultrassonografia , Função Ventricular EsquerdaRESUMO
The majority of patients with chronic heart failure (CHF) have a decreased exercise tolerance. It has not been well established if muscle fatigue is related to a peripheral myopathy with specific metabolic, histologic and biochemical abnormalities. CHF patients demonstrate depressed oxidative capacity and activation of anaerobic glycolysis, leading to a reduction in the energy substrates. In addition, the skeletal muscles of the lower limbs demonstrate a shift toward type IIb fibers. Many factors, such as prolonged immobilization, reduced blood flow and neuroendocrine activation, can be cited in order to explain the origin of this myopathy. Recent studies show that immobilization is not the only reason for modifications in skeletal muscle composition, since patients with disuse atrophy show an increased percentage in myosin heavy chain I, while IIb is decreased. The opposite pattern is observed in CHF. It would appear that several factors such as deconditioning, prolonged immobilization and reduced blood flow, may produce muscular atrophy. The reasons behind specific changes in fibre composition may be found in metabolic factors such as insulin resistance, TNF levels and dysfunction of the ergo-metabolo muscle receptors.
Assuntos
Insuficiência Cardíaca/complicações , Fadiga Muscular/fisiologia , Doença Crônica , HumanosRESUMO
We describe a new laparoscopic modification of parietal cell vagotomy. The laparoscopic anterior extended seromyotomy with posterior truncal vagotomy was performed in five pigs weighing 21 to 25 kg each. Congo-red and pH tests were undertaken 2 weeks later by open gastrotomy. The photographs of the stained gastric mucosa made at the 5-min interval after Congo-red administration were analyzed with a computer-driven area calculation program. Preoperative and postoperative weights were taken for all animals. The experimental parietal cell vagotomy group was compared with the sham group and showed a minimal amount of nondenervated parietal cell mass (0.9 +/- 0.4% versus 28.2 +/- 3.9%, p < 0.05). The pH values showed an inhibition of gastric acid secretion (7.8 +/- 0.7 versus 2.2 +/- 0.4, p < 0.05). During postoperative follow-up, no significant difference in the weight increase of the experimental and the sham control group was noticed (1.6 +/- 0.6 kg versus 2.0 +/- 0.1 kg, p < 0.27). The laparoscopic anterior extended seromyotomy with posterior truncal vagotomy efficiently suppresses gastric acid secretion, preserving the motility of the antrum and pylorus and diminishing the risk of residual areas of innervation. This procedure avoids dissection of the esophagus and can provide an easier but equally effective operative treatment of ulcer disease compared with other types of parietal cell vagotomy.
Assuntos
Laparoscopia , Vagotomia Gástrica Proximal/métodos , Vagotomia Troncular/métodos , Animais , SuínosRESUMO
We report on the prevalence of chronic heart failure (CHF) in a random sample of a population (aged 20-64 years) from the Veneto region in northern Italy. The relationship between CHF and hypertension and obesity was also investigated. These data were collected during an international research project coordinated by the World Health Organization. The overall prevalence of CHF was 2.0% both in the male and female population. The prevalence of CHF increased significantly with age and was positively correlated with body mass index in both sexes. Patients with borderline hypertension showed a 3.5-fold increased prevalence of CHF. The prevalence of CHF was 4.9-fold higher in hypertensive than in the normotensive subjects. Patients treated with hypotensive drugs had a significantly higher prevalence of CHF than untreated patients.
Assuntos
Insuficiência Cardíaca/epidemiologia , Adulto , Fatores Etários , Distribuição de Qui-Quadrado , Feminino , Humanos , Hipertensão/epidemiologia , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Prevalência , Distribuição Aleatória , Fatores SexuaisRESUMO
In the course of a general population survey in Mirano (Venice), Northern Italy, a random sample of 1,903 subjects (50.1% men) aged 20-59 was examined. Fifty-five were diabetic (fasting plasma glucose greater than or equal to 140 mg/dl or diagnosed by a physician) and 1,670 non-diabetic subjects (fasting plasma glucose below 110 mg/dl). In this paper an assessment was made on the more frequent occurrence of coronary risk factors (serum cholesterol and triglycerides, body mass index (BMI), systolic blood pressure, cigarette smoking) and, in particular, of their aggregation in diabetic patients as compared to non-diabetic controls. The occurrence of any one of the coronary risk factors studied was more frequent in diabetic subjects and significantly so for triglyceridemia in both sexes and for systolic blood pressure and BMI in men. The aggregation of two or more risk factors was also more frequent in diabetic subjects than controls. Finally, the combined score of coronary risk as calculated by multiple logistic function showed higher values for diabetic subjects. These results confirm the need for a systematic search for coronary risk factors in diabetic subjects in order to prevent cardiovascular complications.