Prevalence of varicose veins in an Italian elderly population.

The prevalence of varicose veins (VV) in the elderly population of the Campania Region, in Southern Italy, was estimated. A random sample of the people aged more than 65 years was drawn by means of a stratified multistage sampling design warranting that observed percentages were direct estimates of population percentages. The investigation covered 1319 subjects, 560 (42.5%) men and 759 (57.5%) women, their ages ranging from 66 to 96 years with an average value of 74.2 years, who were interviewed and visited by trained physicians. VV were defined as any reticular or truncal visible varicosities of the lower limbs, and investigated symptoms were heaviness, pain, nightly cramps, edema, eczema, hyperpigmentation, and ulceration. Some variables were studied as risk factors: age, sex, lifetime occupation, smoking, alcohol, hypertension, diabetes, and obesity; previous treatment and use of elastic stockings were also studied. Statistical associations were evaluated by Chi-square test, a two-tailed P value of 0.05 being assumed as significance level. In total, 391 (29.6%) subjects were reported to be affected by VV, but the clinical examination was positive in only 362 (27.4%) with a good correspondence between answers and clinical findings. Prevalence was greatly affected by sex, the percentage being two times higher in women (35.2%) than in men (17%). VV developed after a pregnancy in 40.5% of women, but a high percentage of women (38.2%) also reported menopause as a time starting point. No significant association between reported risk factors and VV was found among men, whereas obesity was strongly related to VV in women. One or more symptoms were reported in 92.1% of persons affected by VV, but no previous therapy was reported by 58.9% of subjects. Only 16.9% of patients used elastic stockings with a significant difference between men (7.4%) and women (20.2%).

[Closure of the residual pancreatic stump after pancreatoduodenectomy using a mechanical stapler]. / La chiusura del moncone pancreatico residuo a DCP con suturatrice meccanica.

An important technical problem during pancreatoduodenectomy is the treatment of the pancreatic stump. The Authors describe their recent experience in five cases of pancreatoduodenectomy, in which the pancreatic stump, including the Wirsung, was closed using a linear stapler. An outflow of clear pancreatic juice through the drainage tubes was registered postoperatively, in all patients. The flow of the fistula was very limited in 4 cases and the healing occurred within two weeks; only in one case the drainage was initially more than 200 ml/die, but a spontaneous healing occurred after 28 days.