Depression and distress in burning mouth syndrome: A case control study.

To compare the results of psychometric tests in patients with BMS and controls, participants were tested for depression, anxiety, fatigue and distress. Patients with BMS had noticeably higher scores for depression, fatigue and distress, compared to controls. Depression and distress were significantly correlated with the burning symptom. Moreover, distress and burning symptoms proved to be interdependent. Depression seems to play a specific role in BMS. Burning symptoms affect quality of life of patients and they could be a predictor of distress.

Psychiatric disorders in oral lichen planus: a preliminary case control study.

The aim of this study was to evaluate the prevalence of psychiatric symptoms in patients with oral lichen planus (OLP) compared to a control group. Eleven patients (mean age 65.2 years-old), with diagnosis of OLP and 13 controls (mean age 64.8 years-old) underwent a psychiatric evaluation with five psychometric scales: Visual Analogue Scale (VAS), Hamilton Rating Scale for Depression (HAM-D), State-Trait Anxiety Inventory (STAI 1-2), Distress Thermometer (DT) and Brief Fatigue Inventory (BFI). Seventy-three % of OLP group presented a VAS score of mild type; 9% had depressive symptoms; 100% of the sample had a score above the cut-off for state and trait anxiety; 45% presented Distress (36% moderate type). However, no statistical difference was found in comparison with the control group. In this study, there was no difference in these parameters between the OLP group and the control group. Perhaps, a larger cohort of patients could give different results.

A standardized protocol for the perioperative management of myasthenia gravis patients. Experience with 110 patients.

BACKGROUND: Video-assisted thoracoscopic extended thymectomy (VATET) is well established in the treatment of myasthenia gravis; however, patient selection remains controversial. Perioperative management protocol is lacking, and concerns regarding post-operative myasthenic crisis still remain. We performed a retrospective observational study evaluating the impact of the introduction of a protocol in the perioperative management of patients with myasthenia gravis who underwent VATET. METHODS: The perioperative management protocol was developed by a team of neurologists and anesthesiologists who reviewed the literature and their previous experience on myasthenia gravis patients. Respiratory, clinical, and neurological patient features were included in the protocol evaluation. A retrospective review of patients who underwent VATET before and after introduction to the protocol was finally performed. RESULTS: The medical records of 66 patients (pre-protocol group) and 44 patients (protocol group) were available for the study. In the pre-protocol group, 17 patients (26%) were admitted to intensive care unit (ICU) during the post-operative period, while three patients (6.8%) of the protocol group met the criteria for ICU post-operative admission. This resulted in a reduction of 73.5% of patients admitted to ICU (P = 0.023) and in an 80% (P = 0.002) reduction of the use neuromuscular blocking agents. Two post-operative myasthenic crises preceded by bulbar symptoms (1.8%) were identified in the pre-protocol group patients. CONCLUSIONS: Although the application of our protocol results in a substantial reduction in the recovery of patients in the ICU and in hospital costs, there was no substantial difference in mortality and morbidity between patients admitted to the surgical ward or to ICU.

The use of desflurane or propofol in combination with remifentanil in myasthenic patients undergoing a video-assisted thoracoscopic-extended thymectomy.

BACKGROUND: Although several studies of the use of desflurane in anesthesia have revealed many desirable qualities, there are no data on the use and effects especially on the neuromuscular function of desflurane on myasthenia gravis (MG) patients. The purpose of this study was to evaluate the use of either desflurane or propofol, both combined with remifentanil, in patients with MG undergoing a video-assisted thoracoscopic-extended thymectomy (VATET). METHODS: Thirty-six MG patients who underwent VATET were enrolled. Nineteen patients were anesthetized with remifentanil and propofol infused with a target-controlled infusion plasma model, and 17 patients with desflurane and remifentanil. No muscle relaxant was used. The intubating conditions, hemodynamic and respiratory changes, neuromuscular transmission and post-operative complications were evaluated. RESULTS: Neuromuscular transmission was significantly decreased in the desflurane group (6.7%, from 3% to 9% during anesthesia P=or<0.05). The intubating conditions were good in all 36 patients and 35 patients were successfully extubated in the operating room. The time-to-awakening, post-operatory pH and base excess were significantly different in the two groups, with a decreasing mean arterial pressure in the group administered with desflurane. No patients required reintubation due to myasthenic or cholinergic crisis, or respiratory failure. No other significant differences between the two groups studied were observed. CONCLUSION: Our experience indicates that anesthesia with desflurane plus remifentanil in patients with MG could determine a reversible muscle relaxation effect, but with no clinical implication, allowing a faster recovery with no difference in extubation time and post-operative complications in the two groups.

Psychosocial problems secondary to cancer: an Italian multicentre survey of consultation-liaison psychiatry in oncology. Italian Consultation-Liaison Group.

Data relative to consultation-liaison psychiatry (C-L) in oncology are lacking. In order to examine this area, a multicentre investigation was conducted in 17 general hospitals in Italy. All psychiatric consultation requests for cancer patients referred to C-L during a 1-year period were evaluated. Only 5% (n=217 referred patients: 114 men and 103 women) of all C-L activity were for cancer patients. Most were 'routine' consultations (72%) for current psychiatric symptoms (69%) or coping/compliance problems (12%). Previous psychological or psychiatric disorders were shown in 32% of cases. Approximately 40% of patients were not informed of their referral to C-L. The most frequent ICD-10 psychiatric diagnoses were adjustment disorders (27%) and major affective disorders (23%). Transfer to psychiatric units was low (1%). These findings indicate the need for improvement of referral criteria to C-L and closer attention to continuity of psychosocial care of cancer patients during hospitalisation and post-discharge.

Colposcopic findings in virgin and sexually active teenagers.

The colposcopic findings in 86 virgin teenagers are reported and compared with a matched control group of 172 sexually active teenagers. The results show that an atypical transformation zone may be observed in virgins and that the prevalence rate of this condition is different when compared with that of sexually active teenagers. These data suggest that: 1) the presence of a colposcopically observed atypical epithelium is due to a normal maturation process occurring in young women after the menarche, and 2) coitus is responsible for the prolongation of this process in sexually active teenagers.

Electrocoagulation and the risk of cervical neoplasia.

The relationship between electrocoagulation diathermy and the risk of cervical neoplasia was evaluated in a case-control study of 145 women with cervical intraepithelial neoplasia compared with 145 age-matched outpatient control subjects, and 191 cases of invasive cervical cancer compared with 191 control subjects in the hospital for acute conditions unrelated to any of the identified or suspected risk factors for cervical cancer. History of electrocoagulation was associated with an apparently reduced risk of cervical intraepithelial neoplasia (relative risk = 0.50, with 95% confidence interval = 0.29-0.87), and of invasive cancer (relative risk = 0.42, 95% confidence interval = 0.22-0.82). However, this apparent protection could be largely explained in terms of a different frequency of previous Papanicolaou smears in patients and control subjects. When adjustment was made for that variable, the risk estimates of CIN and invasive cancer among women who had undergone electrocoagulation increased to 0.62 and 0.83 and became statistically nonsignificant. Further allowance for other identified potential confounding factors by means of multiple logistic regression raised these estimates to 0.73 and 0.94, respectively. Thus, these data provide evidence against the hypothesis that electrocoagulation may have an important and independent role in the prevention of cervical neoplasia.

Randomized clinical trial of short-term antibiotic prophylaxis in 750 patients undergoing vaginal and abdominal hysterectomy.

We have carried out a controlled, prospective, randomized study with the aim of evaluating the efficacy of a short-term antibiotic prophylaxis on patients undergoing simple total hysterectomy. 750 patients entered the trial, starting in September 1977, 260 underwent vaginal hysterectomy, 490 abdominal hysterectomy. The patients were subdivided randomly into four groups, which were homogeneous in number, age, weight, associated disease, indication for surgery and hormonal status: control group, without treatment; prophylaxis with Cefazolin; prophylaxis with Thiamphenicol; prophylaxis with Cefazolin plus Thiamphenicol. Each antibiotic was administered parenterally, at the dose of 1 g, 1 hour before surgery, and 5 and 12 hours later. Postoperative infectious morbidity was evaluated according to febrile morbidity, the need for antibiotic therapy during the postoperative period and the length of postoperative hospitalization. The incidence and severity of febrile morbidity was significantly reduced in the three groups of patients who received prophylaxis. The use of antibiotics in the postoperative period resulted significantly reduced and the period of hospitalization was shorter for the groups with prophylaxis than for the control group.

[Beta-interferon treatment of HPV infections of the lower genital tract in women]. / Trattamento con beta-interferone delle infezioni da HPV del basso tratto genitale femminile.

In the period 9-1989/12-1991, 47 fertile women affected by genital HPV infection have been treated with i.m. systemic beta-interferon (3 x 10 x 6 UI every other day for 4 weeks). We have noticed 1 case of drop-out (2, 1%). At the short-medium follow-up (> or = 6 months), the therapy has proved to be probably and/or certainly efficacious in 74.4% of cases (35/47). In patients with condylomas in the cervical region, the less respondent part, we have noticed a reaction in 64.3% of cases; in those who have an extra-cervical or diffused HPV infection, in 89.4%. In the patients with complete follow-up, treated with supplementary DTC if necessary, the recovery ratio reached 92.5%. The i.m. systemic therapy with beta-IFN is efficacious in the treatment of genital HPV infections: it is well tolerated and offers the possibility of obtaining a useful "therapeutic integration" with the traditional destructive physical techniques of therapy.

[The psychopathological aspects of oral lichen planus (OLP)]. / Sugli aspetti psicopatologici del lichen planus orale (LPO).

The etiopathology of oral lichen planus (OLP) is still uncertain. It is probably caused by a T lymphocytes cell-mediated autoimmune reaction. This reaction, caused by different pathogenic noxae, develops in subjects with a specific genetic pattern (HLA-DR on the keratinocytes) and some psychic attitude (higher Hamilton anxiety scale (HAS) and Hamilton depression scale (HDS) scores. In literature a psychic component has been often mentioned in OLP etiopathology. This work is a case-control study of replication: it aims to evaluate the importance of psychopathologic trait in patients affected by OLP. The study has been carried out on 16 patients (7 male and 9 female--average age 56) with OLP histologically confirmed. Before biopsy, they had been tested with: General health questionnaire (GHQ). Hamilton anxiety scale (HAS). Hamilton depression scale (HDS) with melancholia scale (MES). We have also studied a survey group of 14 patients affected by leukoplakia and neoplasms of the oral cavity (12 males and 2 female--average age 51). Before biopsy the survey group has been tested with the same questionnaire faced by the studied group. We chose the survey group as follows. Patients with leukoplakia show such similar lesions to OLP that the diagnosis is often histological; as far as patients with oral cavity tumours are concerned we hypothesized a more than usual anxious and depressed behaviour. We compared the score of the OLP patients to the one of the survey group patients using the "One-way Analysis of Variance" (ANOVA) method. The results confirmed that the patients with OLP showed very high scores in HAS and HDS, while the survey group scores were significantly lower.(ABSTRACT TRUNCATED AT 250 WORDS)

New diagnostic tools for neonatal sepsis: the role of a real-time polymerase chain reaction for the early detection and identification of bacterial and fungal species in blood samples.

Early diagnosis and treatment of neonatal sepsis are essential to prevent severe and life threatening complications. Consequently, rapid diagnostic tests capable to differentiate infected from non-infected newborns have the potential to make a significant impact on neonatal care. A new real-time polymerase chain reaction (PCR; LightCycler SeptiFast test M GRADE) has been proposed in the routine assessment of neonatal sepsis for the detection and identification of bacterial and fungal DNA from microorganisms which cause approximately 90% of all blood stream infections. The LightCycler SeptiFast test can detect and identify simultaneously the 25 most important bacterial and fungal species causing bloodstream infections within few hours by using a small volume of a single whole blood sample. Real-time PCR can be easily incorporated into the hospital setting for term or near-term infants admitted to the neonatal intensive care unit for sepsis evaluation.

Posttraumatic cerebral infarction in patients with moderate or severe head trauma.

OBJECTIVE: To evaluate the frequency, types, and location of posttraumatic cerebral infarction, to assess if secondary cerebral insults were associated with cerebral infarction, and to determine if cerebral infarction affected patients' outcome. METHODS: We based diagnosis of cerebral infarction on review of brain CT scans. We assessed frequency of secondary cerebral insults, including intracranial hypertension, cerebral hypoperfusion, systolic hypo- and hypertension, arterial blood oxygen desaturation, hypocapnia, and hyperthermia, using clinical charts. We used the Glasgow Outcome Scale to evaluate outcome at 6 months after trauma. RESULTS: Of the 89 patients included, a total of 28 cerebral infarctions were found in 17 cases (19.1%). Infarctions were territorial in 23 (82.1%) and watershed in 5 (17.9%) cases. Territorial infarctions were localized to the middle cerebral artery (n = 9, 32.1%), lenticulostriate arteries (n = 6, 21.4%), posterior cerebral artery (n = 3, 10.7%), anterior cerebral artery (n = 3, 10.7%), thalamoperforating arteries (n = 1, 3.6%), and basilar artery (n = 1, 3.6%) territories. Watershed infarctions were in the boundary (n = 4, 14.3%) and terminal (n = 1, 3.6%) zones. Intracranial hypertension was the only independent variable predicting cerebral infarction (odds ratio [OR] 13.3; 95% CI 2.8 to 62.6). At 6 months after trauma, there was a lower proportion of patients with good outcome among patients with cerebral infarction vs patients without (23.5 and 61.1%; p = 0.005). Cerebral infarction was the only independent predictor of 6-month outcome (OR of good outcome 0.19, 95% CI 0.06 to 0.66). CONCLUSIONS: The risk of developing posttraumatic cerebral infarction may be higher in patients with intracranial hypertension than in those without. Patients with posttraumatic cerebral infarction may be at increased risk of residual disability.

The impact of Psychiatric Reform on inpatient services in a metropolitan area of Southern Italy: the Naples case.

Six years after the Psychiatric Reform, phasing out of Mental Hospital and implementing a community based Mental Health System, i.e. the main goals of the Reform, are not yet performed in Southern big cities of Italian peninsula. In Naples metropolitan area this new Mental Health policy faces with a dramatic lack of community services. This paper summarizes data concerning the trends in psychiatric admissions to some inpatient public settings of Naples before and after the Reform, with the intent of pointing out the short-time outcomes of this law in a highly populated area. The Authors stress some positive results of the Reform in the study area, as well as the factors which have contributed to the inadequate application of the new law.

[Hormone therapy in advanced forms of carcinoma of the endometrium: analysis and prospects]. / L'ormonoterapia nelle forme avanzate del carcinoma dell'endometrio: analisi e prospettive.

PIP: Progestins have become normal medical practice in the treatment of endometrial carcinoma. An accurate review of the literature on the subject, involving about 1500 treated cases since 1951, reveals that a positive response is obtained in about 30% of cases. However, authors differ greatly as to the kind of progestin to be administered, and especially as to the dosage, which can go from 0.2 to 5.6 gr. According to the authors of this article great importance must be given to plasmatic levels and to the analysis of hormonal receptors before deciding on the type of therapy. Results from their personal observations of 45 cases show that some patients would benefit more from progestin thersapy, and others from traditional chemothersapy.^ieng