Prevalence of Polysubstance Abuse and Dual Diagnosis in Patients Admitted to Alcohol Rehabilitation Units for Alcohol-Related Problems in Italy: Changes in 15 Years.

AIMS: Alcohol abuse has long been known as a disease with social and economic burden to society. Given the complex nature of alcohol treatment, it is worthwhile to examine the change over time of patients admitted to residential alcohol abuse rehabilitation units. METHODS: The data were collected from two Italian projects on alcoholics performed in the mid-1990s (ASSALT) and in 2009 (CORRAL), respectively. Categorical variables were considered in terms of absolute and relative frequencies. Comparisons of relative frequencies between groups were assessed by means of Fisher's exact test. Mixed logistic regression models were fitted to CORRAL data to identify the predictors of the probability of being a polysubstance abuser or having a dual diagnosis. The association estimates were reported as adjusted odds ratios and relative 95% confidence intervals. RESULTS: Compared to the mid-1990s, in 2009 patients were older (P= 0.0003), with a higher level of education (P= 0.0204), with fewer comorbidities (liver disease except cirrhosis, P < 0.0001; polyneuropathy, P= 0.0001), more frequently polysubstance abusers (P < 0.0001), affected by dual diagnosis (P < 0.0001). In 2009, the probability of being a polysubstance abuser was higher in younger and in patients with dual psychiatric diagnosis. Female gender and polysubstance abuse were positively associated to the probability of being affected by dual psychiatric diagnosis. CONCLUSIONS: The increment of patients admitted to residential programs for alcohol dependence with polysubstance abuse and/or dual psychiatric diagnoses suggests the need to pay more attention to both psychological/psychiatric interventions and internal medicine/physical rehabilitation. SHORT SUMMARY: The results of this study suggest that further research is needed to identify the best treatment strategy that is safe and effective for the new population of alcoholics.

[Alcohol-addiction inpatient: characteristics of patients and rehabilitation program]. / La residenzialità alcologica ospedaliera: caratteristiche dei pazienti e dei percorsi terapeutici/riabilitativi.

AIM: The treatment of alcohol addiction in Italy has had a progressive evolution of therapeutic structures for in-and outpatients. During the last 20 years there had been a crescent presence of short residential treatment facilities (1-6 months) characterized by a high level of medical and psychotherapeutic intervention. About two years ago 12 of them jointed together in an association called CORRAL (COordinamento of Residenzialità Riabilitive Alcologiche). The aim of this study was to describe the socio-demographic medical and other characteristics of the patients coming for this type of treatment and to describe the characteristics of the residential treatment itself including referring and aftercare. METHODS: Two thousand sixty-one hospitalized patients of the 12 rehabilitative alcohol units were examined by using a questionnaire and collecting various sociodemographic variables and clinical diagnosis of the patients. Even it was asked who had referred the patients, the characteristics of the residential treatment and of the planned aftercare. RESULTS: The present residential facilities are mainly distributed in the North of Italy. The typical patient is male, with a high school instruction and with a comorbidity regarding psychiatric and liver disorders. The majority of the patients were referred by the public ambulatory services for addictions (SerT/SerD). The characteristics of the residential treatment were medical, pharmacological and psychotherapeutic interventions with a high intensity and the presence of a general-purpose staff. CONCLUSIONS: This study outlined a model of residential rehabilitation of alcohol disorders characterized by short duration and a complex, intense therapeutic intervention mainly addressed to patients with a severe clinical condition and a low level of social problems. Further research should be useful to understand better which sort of patient characteristics obtain a better clinical result and for that even economically a major effectiveness from this type of residential treatment.

[The role of oral probiotic for bacterial vaginosis in pregnant women. A pilot study]. / Studio pilota sul ruolo dei probiotici nel trattamento della vaginosi batterica in gravidanza.

AIM: The aim of this study was to compare the effects of a dietary supplementation with oral probiotic, and the treatment with vaginal clindamycin in pregnant women with bacterial vaginosis. METHODS: Fourty pregnant women, with a diagnosis of bacterial vaginosis according to the Amsel criteria, were enrolled between the 10th and the 34th week of gestation. The patients were randomized in two groups. Patients in the group A were treated with probiotic orally (VSL3® Ferring), 2 tablets a day for 5 days, followed by 1 tablet daily for 10 days. Patients in group B were treated with vaginal clindamycin 100 mg daily for 15 days. After 5-10 days from the end of the treatment the patients returned for the follow-up. RESULTS: After treatment the vaginal discharge was completely absent in group A, and reduced in group B. The itching occurred only in 10% of patients in each of the two groups. The improvement of constipation occurs only in the group A (P=0.002). Vaginal swabs resulted negative in both groups in particular for Gardnerella V. CONCLUSION: The oral treatment with VSL#3® is effective in the treatment of VB in pregnant women as a topical treatment with clindamycin. In particular for the resolution of leukorrhea, itching and in particular in the bacterial vaginosis caused by Gardnerella V.

Retrospective, multicenter evaluation of complications in the treatment of diaphyseal femur fractures in pediatric patients.

INTRODUCTION: Femoral shaft fractures are the commonest major pediatric fractures. For generations, traction and casting were the standard method of treatment for children. However, over the past two decades there has been growing recognition of the advantages of fixation and rapid mobilization. METHODS: A prospective multicenter study was conducted at four Italian centers of reference for pediatric fractures (January 2005 to December 2014). The study involved 62 patients of both sexes, between 6 and 14 years of age, with closed femoral shaft fractures. The aim was to find out more about the short-term complications of titanium elastic nailing in diaphyseal femur fractures in children in order to reduce them. RESULTS: The commonest complication observed in our study was pain at the nail entry point (24.19%) due to a local inflammatory reaction. After 1 year, 3.22% had limbs of different lengths. Proximal migration occurred in 1.61% of cases. DISCUSSION: Over the last two decades, the treatment of femoral shaft fractures in pediatric patients has developed to include internal fixation using Titanium Elastic Nails (TEN). We only observed a few complications in our study, most of which were minor and associated with the surgical technique employed, particularly during the initial phase of the surgeon's learning curve. CONCLUSIONS: TEN are an excellent internal fixation system if used by an expert surgeon and have a very low rate of complications. None of them produced permanent damage in the patients. In older children weighing more than 50 kg, alternative techniques such as subtrochanteric nailing, plates, or external fixation are advisable.

[Preliminary experience with transobturator tape for treatment of urinary incontinence in women]. / Esperienza preliminare con benderella transotturatoria per il trattamento dell'incontinenza urinaria femminile.

AIM: Aim of this study is to report our preliminary experience with a minimally invasive surgical procedure using transobturator approach. METHODS: We enrolled in our study 19 patients with stress urinary incontinence and urethral hypermobility without genital prolapse. All patients underwent suburethral transobturator tape (TOT) procedure. Four patients underwent previous surgical procedure for incontinence (3 Kelly and 1 Burch). No patients reported previous major gynaecological surgery. Mean age was 58.68 years (range 36-75). The sling was placed according to the technique described by Delorme. RESULTS: Mean operating time was 21 min (range 14-48). No bladder lesions or intraoperative complications occurred. Fifteen patients were dismissed the same day of surgery. Mean hospital staying was 1.4 days (range 1-5). No infections, erosions or sieromas have been observed. CONCLUSIONS: Our experience shows as TOT technique is extremely rapid, reproducible and with a very short learning curve. The transobturator approach avoids the risk of bladder, bowel or vascular injuries. Compliance and patient satisfaction have been very encouraging, restoring a real functional well-being. However, the small number of patients in our study and the short follow up do not actually allow us to draw definitive results and further studies are needed to confirm the technique success.

Influence of a decisional tree on the route of hysterectomy for benign disease in Italy: personal experience.

BACKGROUND: Mainly to report our experience in the route of hysterectomy after introducing specific guidelines according to the Society of Pelvic Reconstructive Surgeons and to record all hysterectomy-related complications after abdominal and vaginal hysterectomies. METHODS: The records of 22 patients who underwent abdominal hysterectomy and 59 who underwent vaginal hysterectomy for benign disease were reviewed. Complications related to hysterectomy were recorded during surgery, postoperative hospital stay and a period of six weeks. Statistical methods used were t-tests and chi square analysis. RESULTS: Operation time was shorter with the vaginal route. Patients operated on via the vaginal route had less blood loss and shorter hospital stay. CONCLUSIONS: The main standard to select the route for hysterectomy is the severity of the clinical status. Decreasing the ratio between the abdominal and vaginal route is possible, but it is crucial to make the indications clear, based on scientific evidence.

Uterine arteriovenous malformation: a case report diagnosed by sonohysterography.

PURPOSE OF INVESTIGATION: The aim of this report is to describe a case of uterine arteriovenous malformation that occurred in a 54-year-old postmenopausal woman referring recurrent postmenopausal bleeding, after two years of tamoxifen therapy. METHODS: Medical therapy with GnRh agonists was unsuccessful. Ultrasound and Doppler flow ultrasound scanning were normal and the following hysteroscopy was normal as well. RESULTS: Hysterosonography performed on the patient made us suspect the presence of an intracavitary vascular lesion which was confirmed histologically after hysterectomy. CONCLUSION: In our case hysterosonography allowed us--by creating optimal contrast between the uterine wall and the uterine cavity--to suspect and identify the lesion and to recognize the typical ultrasound findings of this pathology not visualized with standard transvaginal ultrasound.

Clinical and immunologic follow-up study of patients with neurocysticercosis after treatment with praziquantel.

In a prospective study, 17 Brazilian patients with parenchymatous neurocysticercosis were monitored for a period of 12 months after treatment with praziquantel. Taenia solium-specific IgG antibodies, interleukin-1 beta (IL-1 beta), tumor necrosis factor alpha, neopterin, and soluble interleukin-2 receptor (sIL-2R) were measured in serum and CSF before starting the therapy, on the last day of treatment, 5 weeks after treatment, and 3, 6, and 12 months after treatment. The most common symptoms and signs found in patients before treatment were headache, neck stiffness, and seizures. Six months after commencement of therapy, 13 of the 17 patients were free of complaints. Clinical normalization was paralleled by a significant decrease (p < 0.05) in the amount of intrathecally produced anti-T solium IgG 1 year after treatment. IL-1 beta was undetectable in serum at all times, whereas in the CSF it was within the normal range during the whole study period. The mean concentration of sIL-2R in the CSF was 65 kU/l (normal, < 50 kU/l) 5 weeks after treatment, whereas in all subsequent investigations sIL-2R was undetectable. The median CSF neopterin level was slightly elevated before treatment (6.8 nmol/l). One year after treatment, it had dropped by 69% (p < 0.001) to a median value of 2.1 nmol/l. The size of planimetrically measured focal cystic brain lesions on CT correlated with the amount of intrathecally synthesized anti-T solium IgG at the end of the study (r = 0.89, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Nucleus pulposus regeneration after chemonucleolysis with chymopapain?

Chemonucleolysis was unsuccessful in 100 out of 519 patients with herniated lumbar discs treated within a period of 3 years. These patients were subsequently submitted to open surgery. Disc material from 88 of the 100 patients was examined by light microscopy (hematoxylin and eosin, van Gieson's, Nissl's and periodic acid-Schiff staining) to verify the effect of enzymatic activity compared to the histologic findings in a similar control group. In 84 of the 88 cases, signs of enzymatic activity were revealed by eosinophilia of the ground substance, altered Nissl staining and positive periodic acid-Schiff reaction within the chondrocyte halos. These alterations indicate that the enzyme was active and confirm the results of previous studies with smaller numbers of cases. Histologic alterations were quantified according to the intensity and extent of staining. The signs of enzymatic activity were significantly (P < 0.01) stronger after short time intervals between chemonucleolysis and surgery than after long intervals. These findings may be interpreted as indicating a regenerative potential of the nucleus pulposus.

Use of adjunctive modalities in occupational therapy.

This article reminds us that as practice evolves, we must revisit and reaffirm the fundamental philosophy and precepts in which our profession is grounded. The face of practice is fluid. Its superficial appearance is molded by external forces and stresses. These include the changes in the needs of the persons we serve, the emergence of new and different treatment modalities, and the realities of the socioeconomic environment in which we work. Beneath the surface, however, are the basic structures that all of us hold in common. These are our philosophical beliefs that are articulated both in the professional literature and in the ethical principles that we espouse.

A new way to treat forearm post-traumatic non-union in young patients with intramedullary nailing and platelet-rich plasma.

INTRODUCTION: Non-union rate in forearm fractures is generally less than 2% when a proper technique is used; this rate increases when ulnar lesions are involved. PATIENTS AND METHODS: We present a case series of seven young patients whose average age was 14 years (range 11-19 years) at the time of surgery and who presented with a forearm post-traumatic non-union that was previously treated in different ways (three isolated ulnar non-union, two isolated radial non-union and two combined). Average follow-up was 34 months (range 9-72 months). Surgical treatment began with the removal of the previous synthesis and with curettage of the non-union area. The Acumed ulnar rod, Acumed radial rod and Thalon elastic nail (all of them are unreamed and locked nails) together with autologous platelet-rich plasma (PRP) obtained with the Biomet System (concentration of 158.2×10(4) platelets/µL) were chosen to treat the patients. X-rays and clinical controls were conducted every 30 days until recovery. RESULTS: All patients recovered: average recovery was 23 weeks from operation (range 16-36 weeks) and nails were removed 3 months after complete healing. Six patients had excellent results and one patient had a good result (Patient 2, forearm pronosupination 60-0-40 degrees). DISCUSSION: The purpose of the case series was to establish a better way of treatment and to find a technique that could avoid the use of bone grafts, because obtaining autologous bone requires a further surgical procedure that can be really invasive depending on the amount of bone needed. CONCLUSION: All patients in the study showed complete recovery, with excellent clinical outcomes. Although there were only seven patients in this case series, and there is a need to analyse more patients, this study showed that the use of a specific locking nail system can provide proper stability to ulnar or radial atrophic non-union despite rotational forces, and when combined with autologous growth factors (PRP) is sufficient to promote bone healing in young patients without the necessity to take autologous bone grafts.

The results of "lumbar disc surgery" following unsuccessful chemonucleolysis.

A group of 100 patients submitted to microsurgical treatment for herniated lumbar disc following unsuccessful chemonucleolysis with chymopapain were retrospectively compared to a statistically comparable group of patients primarily submitted to microsurgery. This comparison demonstrated that previous unsuccessful chemonucleolysis has no influence on either the short-term or the long-term results of subsequent microsurgery.