Diagnostic Accuracy of Point-of-Care Ultrasound Integrated into Clinical Examination for Acute Diverticulitis: A Prospective Multicenter Study.

PURPOSE: Diverticulitis is a common cause of abdominal pain and CT scan is commonly used for its diagnosis in the emergency department (ED). The diagnostic performance of point-of-care ultrasound (POCUS) integrated into a clinical exam for diverticulitis is still not established. We evaluate the accuracy of clinical-sonographic assessment for the diagnosis of diverticulitis and whether POCUS could improve the selection of patients needing CT scan for complicated diverticulitis. MATERIALS AND METHODS: This is a multicentric observational study involving adult patients suspected of having diverticulitis presenting at 4 EDs. 21 sonographer physicians were asked to diagnose diverticulitis and complicated diverticulitis based on clinical-sonographic assessment. The final diagnosis was established by two reviewers, blinded to POCUS, based on data collected during the one-month follow-up comprehensive CT scan. RESULTS: Among 393 enrolled patients, 218 (55.5 %) were diagnosed with diverticulitis and 33 (8 %) had complicated diverticulitis. The time to diagnosis by the sonographer physicians was shorter compared to standard care (97 ±â€Š102 vs. 330 ±â€Š319 minutes, p < 0.001). Clinical-sonographic assessment showed optimal sensitivity (92.7 %) and specificity (90.9 %) for diverticulitis. However, the sensitivity (50 %) for complicated diverticulitis was low. The sonographer physician would have proceeded to CT scan in 194 (49.4 %) patients and the CT scan request compared to the final diagnosis of complicated diverticulitis demonstrated 94 % sensitivity. CONCLUSION: Clinical-sonographic assessment is rapid and accurate for the diagnosis of diverticulitis. Even if POCUS has low sensitivity for complicated diverticulitis, it can be used to safely select patients needing CT.

Intake of vitamin A and carotenoids from the Italian population--results of an Italian total diet study.

The present study focused on vitamin A and carotenoids (alpha-and beta-carotene, lutein and zeaxanthin, beta-cryptoxanthin, lycopene) daily intake from the Italian total diet. The input of some food groups (cereals, vegetables, fruits, milk and dairy, meat and meat products, fish) most responsible for major and minor contributions to the daily intake of these molecules was evaluated. Furthermore the contribution to the dietary intake of beta-carotene and lutein of the most consumed vegetables in the market basket of the Italian total diet (beets, brassica vegetables, carrots, chicory, courgette (zucchini), green beans, lettuce, peas, pepper, spinach, tomatoes) was also investigated. Vitamin A daily intake was 855 mg/person/day. The vegetables food group made the greatest contribution (37%), followed by the meat and meat products food group (23%). The Italian total diet provided 14.3 mg/person/day of carotenoids; lycopene was the highest (7.4 mg/day), followed by lutein + zeaxanthin (4 mg/day), beta-carotene (2.6 mg/day), alpha-carotene (0.15 mg/day), and beta-cryptoxanthin (0.17 mg/day). Carrots and tomatoes were the main sources of beta-carotene in the diet, otherwise the daily consumption of leafy vegetables (spinach, beets, lettuce) made the main contribution to lutein + zeaxanthin daily intake.

Platelet kinetic study in patients with idiopathic thrombocytopenic purpura (ITP) refractory or relapsing after corticosteroid treatment.

BACKGROUND: A platelet kinetic study (PKS) is not indicated in the evaluation of adult patients with idiopathic thrombocytopenic purpura (ITP) at presentation. However, in ITP patients refractory to or relapsing after corticosteroid therapy, its appropriateness is considered uncertain. METHODS: We prospectively performed a PKS with (111)In oxine-labeled autologous platelets in 93 consecutive adult ITP patients failing steroid treatment. RESULTS: In 22 patients (24%) a primary condition accounting for thrombocytopenia was identified (17 with myelodysplastic syndrome and three aplastic anemia). Non-ITP patients had significantly longer platelet circulating life span (P=0.0001), lower splenic platelet uptake (P=0.008) and higher liver platelet uptake (P=0.05) compared to 71 patients with confirmed ITP. Among ITP patients with platelets persistently <50 x 10(9)/L, splenectomy was considered in 48 cases. In 23 (48%) it was prospectively excluded because of platelet life span > or = 7 days (11 cases), no splenic platelet uptake together with high liver uptake (10 cases), or both conditions (two cases). Splenectomy was successfully carried out in the other 25 patients, obtaining a response rate of 100% (22 complete responses; three partial responses). Persistent relapse occurred in six of 25 (24%) splenectomized patients after a median of three months (range 1-8). PKS parameters were not able to predict post-splenectomy relapse, although relapsed patients had lower splenic/hepatic platelet uptake ratio (2.6 in relapsed vs 4.9 in persistently responsive patients; P=0.08). CONCLUSIONS: It was concluded that in patients with chronic ITP failing steroid therapy, some PKS parameters may be prospectively used to increase the short term success rate of splenectomy.

Nutrients and antioxidant molecules in yellow plums (Prunus domestica L.) from conventional and organic productions: a comparative study.

Yellow plums (Prunus domestica L) conventionally and organically grown in the same farm were selected to study the influence of different agronomic practices on antioxidant vitamins (ascorbic acid, vitamin E, beta-carotene) and phenolics (total polyphenols, phenolic acids, flavonols) concentration. Conventional plums were grown on tilled soil. Three organic cultivations were performed: tilled soil, soil covered with trifolium, and soil covered with natural meadow. Differences in macronutrients were marginal, whereas antioxidant vitamins and phenolic compounds concentration markedly differed among cultivations. Ascorbic acid, alpha-, gamma-tocopherols, and beta-carotene were higher in organic plums grown on soil covered with natural meadow. The highest phenolic acids content was detected in plums grown on soil covered with trifolium. Total polyphenols content was higher in conventional plums. Quercetin was higher in conventional plums, but myrecitin and kaempferol were higher in organic plums. Under the same cultivar and climate conditions, the type of soil management turned out of primary importance in influencing the concentration of health-promoting compounds.

Meat and meat products consumption in Italy: contribution to trace elements, heme iron and selected B vitamins supply.

This study was undertaken to estimate the contribution of meat and meat products consumption to the daily intakes of trace elements (Fe, Zn, Cu, Se), heme iron, and selected B vitamins (thiamine, riboflavin, niacin) in Italy. Meat and meat products were selected on the basis of their consumption frequency reported by the most recent nationwide dietary individual survey carried out in Italy (INN-CA study). The daily intakes of total iron and heme iron were 1.65 and 1.13 mg/person/day. Zinc intake was 3.65 mg/person/day. Beef made the main contribution to iron, heme iron, and zinc daily intakes. Copper daily intake was 107.3 microg/person/day, with meat products provided the highest contribution (40 microg/person/day). Daily intake of selenium (7.14 microg/person/day) was provided mainly by poultry consumption. Thiamine intake was 228 microg/person/day, and meat products were the main source (110 microg/person/day). Riboflavin intake was 136 microg/person/day, with both beef and meat products as the main contributors (40 microg/person/day). Niacin intake was 7.53 mg/person/day, and poultry was the main source (2.28 mg/person/day). Meat and meat products were a valuable source of micronutrients, supplying 47, 48, and 24% of zinc, niacin, and thiamin daily requirements, respectively, and over 10% of iron, copper, selenium, and riboflavin daily average requirement values of the italian RDAs calculated for the population involved in the survey (INN-CA study).

[Splenic traumas: indications and limitations of conservative treatment]. / I traumi splenici: indicazioni e limiti del trattamento conservativo.

According to the experience of the authors, comparison between two consecutive periods (1980-1994 and 1995-2000) has shown a substantial increase in splenic traumas simply treated by observation and monitoring. Their number in fact has risen significantly from 5 to 32. This has allowed a rise in the overall percentage of spleen conservation, which has increased from 16.4% to 52.9%. On the contrary, a reduction in surgical conservative operations has been observed, the number decreasing from 19 to 4. Such treatments require the same clinical conditions as non- operative treatments, but the latter have to be accompanied by efficient organization of intensive care and monitoring, in which surgeons and anesthesists, who are familiar with all the aspects of the problem, collaborate efficiently. Since this kind of organization has been achieved, the number of patients successfully treated without surgery has increased significantly. In a sample of 37 patients receiving non-surgical conservative treatment, the percentage of delayed splenectomies was as low as 5.4%.