A high-urgency stroke code reduces in-hospital delays in acute ischemic stroke: a single-centre experience.

Timely treatment is essential in acute ischemic stroke as the chances of recovery diminish over time, so efforts are necessary to streamline in-hospital pathways and reduce delays. Here, we analyse the interventions to reduce door-to-needle time in stroke patients suitable for intravenous thrombolysis at the Emergency Department of San Carlo Borromeo Hospital, Milan, Italy. All stroke patients consecutively treated with intravenous thrombolysis at our centre from January 1, 2013 to December 31, 2015 were included in this analysis. The main interventions adopted were (1) continuous education of personnel, (2) reconsideration of blood tests and identify the ones really affecting treatment decision, (3) approval of a new high-urgency Stroke Code activated as soon as the triage nurse comes to know of a potential thrombolysis candidate. Median door-to-needle time progressively decreased from 103 min (iqr 78-120) in 2013, to 92 min (iqr 72-112) in 2014, and to 37 min (iqr 27-58) with the new Stroke Code (p < 0.001) in 2015. Simultaneously, median onset-to-treatment time decreased from 177 min (iqr 142-188) in 2013, to 155 min (iqr 141-198) in 2014, and to 114 min (iqr 86-160) with the new Stroke Code (p < 0.001 and p 0.005, respectively). We did not observe any significant difference in bleeding risks or deaths, whereas the likelihood of favourable outcome (mRS 0-2) increased. Streamlining in-hospital pathways with progressive interventions significantly decreases door-to-needle time and onset-to-treatment time and may contribute to improve stroke outcomes.

[Comparison among perineometric, radiologic and electromyographic parameters in patients with urinary stress incontinence]. / Confronto tra parametri perineometrici, radiologici ed elettromiografici nelle pazienti affette da incontinenza urinaria da sforzo.

In order to increase our knowledge of the physiopathology of urinary stress incontinence related to pelvic relaxation, the Authors examined 20 women suffering from SUI (Stress Urinary Incontinence) almost always characterized by concomitant slight or moderate urethrocystocele and 20 women without urological problems. They analyzed and compared the measurement of perineal descent with radiological and electromyographic parameters in order to detect if a suffering of some fibers of the pudendal plexus can be related to the pathology of SUI. They pointed out that patients affected by SUI show a perineal position, either at rest and under switch, below the ischial tuberosities plane. Furthermore the anterior angle at rest is always more than 30 degrees and electromyographic records are pathological in 90% of cases.

[Perineometry and stress incontinence]. / Perineometria e incontinenza urinaria da sforzo.

The authors have examined 20 patients with genuine stress incontinence and urogenital prolapse and 20 control subjects searching a difference between static and dynamic condition of the pelvic floor. They used a simple device to study the mean position of the perineal plane both at rest and under switch. In incontinent patients the perineal plane is always below the bituberal plane (+1.17 cm at rest and +1.32 cm straining). These values are on a higher plane in the control subject (-0.64 cm at rest and +0.48 cm upon straining). These differences have an highly significant statistical value (P = 0.0002 and P = 0.001).

[Clinical results of the modified Marshall-Marchetti procedure in female urinary incontinence]. / Risultati clinici della Marshall Marchetti modificata nell'incontinenza urinaria femminile.

We considered 49 patients suffering from urinary stress incontinence, operated from January 1984 to December 1989 by Marshall-Marchetti modified after Symmonds procedure. 13 patients had one or more previous surgical procedures. We made urodynamic preoperative tests and a stress test (after Ferrari) in all our cases. We obtained: complete recovery in 80% of our cases, improvement in 14% and failure in 6%; particularly the recovery percentage in our patients operated for the first time was the 97.2%; in the recurrences we had complete success in 46%, an improvement in 38.5% and surgical failure in 15.5%. Complications were observed in 1 patient affected by pubic osteitis, treated with medical therapy. Only 3 patients had an incomplete bladder emptying one year after the surgical operation, with value of the post micturitional residual volume of about 1/3 of the maximal cystometric capacity.