Minor head injury in anticoagulated patients: Outcomes and analysis of clinical predictors. A prospective study.

BACKGROUND: The optimal management of patients taking oral anticoagulants who experience minor head injury (MHI) is unclear. The availability of validated protocols and reliable predictors of prognosis would be of great benefit. We investigated clinical factors as predictors of clinical outcomes and intracranial injury (ICI). METHODS: We conducted a single-cohort, prospective, observational study in an ED. Our structured clinical pathway included a first head CT scan, 24 h observation and a second CT scan. The primary outcome was the occurrence of MHI-related death or re-admission to ED at day +30. The secondary outcome was the rate of delayed ICI (dICI), defined as second positive CT scan after a first negative CT scan. We assessed some clinical predictors derived from guidelines and clinical prediction rules as potential risk factors for the outcomes. RESULTS: 450 patients with a negative first CT scan who underwent a second CT scan composed our 'study population'. The rate of the primary outcome was 4%. The rate of the secondary outcome was 4.7%. Upon univariate and multivariate analysis no statistically significant predictors for the outcomes were found. CONCLUSIONS: Previous retrospective studies showed a lot of negative predictive factors for anticoagulated patients suffering a minor head injury. In our prospective study no clinical factors emerged as predictors of poor clinical outcomes and dICI. So, even if we confirmed a low rate of adverse outcomes, the best management of these patients in ED remains not so clear and future trials are needed.

Tocilizumab in COVID-19 interstitial pneumonia.

BACKGROUND: Published reports on tocilizumab in COVID-19 pneumonitis show conflicting results due to weak designs or heterogeneity in critical methodological issues. METHODS: This open-label trial, structured according to Simon's optimal design, aims to identify factors predicting which patients could benefit from anti-IL6 strategies and to enhance the design of unequivocal and reliable future randomized trials. A total of 46 patients with COVID-19 pneumonia needing of oxygen therapy to maintain SO2 > 93% and with recent worsening of lung function received a single infusion of tocilizumab. Clinical and biological markers were measured to test their predictive values. Primary end point was early and sustained clinical response. RESULTS: Twenty-one patients fulfilled pre-defined response criteria. Lower levels of IL-6 at 24 h after tocilizumab infusion (P = 0.049) and higher baseline values of PaO2/FiO2 (P = 0.008) predicted a favourable response. CONCLUSIONS: Objective clinical response rate overcame the pre-defined threshold of 30%. Efficacy of tocilizumab to improve respiratory function in patients selected according to our inclusion criteria warrants investigations in randomized trials.

[The role of hypomagnesiuria in urolithiasis and renal colic: results from a prospective study of a metabolic evaluation protocola]. / Ruolo dell'ipomagnesuria nella colica renale da urolitiasi: risultati di uno studio prospettico sull'impiego di un protocollo di valutazione metabolica.

AIM: The stone disease of the urinary tract (urolithiasis) is a growing disease. The identification of metabolic disorders, treatable with prophylactic therapy, appears to be clinically important. The aim of this study was the analysis of metabolic disorders that promote and support the urolithiasis in a cohort of patients with renal colic at an Emergency Department. METHODS: In this prospective case series, we enrolled consecutive patients with renal colic treated at an Emergency Department within a Regional Teaching Hospital. We implemented a structured metabolic evaluation, which included blood chemistry studies, stone analysis and a 24-hour urine collection. We then evaluated the frequency of metabolic abnormalities alone or in combination. RESULTS: We enrolled 39 patients whit renal colic and a diagnosis of urolithiasis: 21 (54%) were males and the median age was 43.6 years (range 20-70). The most frequently observed type of stone was that of calcium oxalate (74%). Hypomagnesiuria was the most common metabolic abnormality found at the 24-hour urine collection (22/39, 56%), followed by hypocalciuria (31%), hypernatruria (20%), hyperuricuria (18%) and hyperoxaluria (15%). Among the associations of metabolic abnormalities, the hypocalciuria /hypomagnesuria was that observed with higher frequency (23%). CONCLUSION: We report an incidence of hypomagnesiuria (60%) in patients with renal colic higher than has ever been described in the literature. This result could be of importance in the knowledge of the pathogenesis of the urolithiasis and could have interesting implications in clinical practice.

Coagulative modifications in patients with systemic sclerosis treated with iloprost or nifedipine.

This study compared iloprost and nifedipine to ascertain whether they could improve parameters of endothelial and platelet functions in the treatment of Raynaud's phenomenon secondary to systemic sclerosis. Thirteen patients affected by systemic sclerosis were treated with intravenous infusion of iloprost, and 7 patients were treated with oral nifedipine. Blood samples were taken at baseline and after 6 and 12 months of therapy to assess main serological indexes of endothelial damage, thrombin activation, fibrinolysis, as well as natural inhibitors of coagulation. After 12 months of therapy, the patients treated with iloprost had a significant decrease in thrombomodulin levels (p = 0.02) and a significant increase in tissue-plasminogen activator levels (p = 0.007), in comparison with the patients taking nifedipine (p = 0.007). Moreover, patients treated with nifedipine showed increased levels of thrombin-antithrombin complex after 12 months of therapy in comparison with baseline values (p = 0.03) and in comparison with the values of the patients treated with iloprost over the same period (p = 0.05). These preliminary results thus seem to indicate that iloprost plays an important, if at least partial, role in the protection and restoration of endothelial integrity in patients with systemic sclerosis.

[A clinical and anatomical-histological contribution to the study of lipofibrocalcareous myopathy. Mattioli-Foggia and Raso disease]. / Contributo clinico e anatomo-istologico allo studio della miopatia lipo-fibro-calcarea. Malattia di Mattioli-Foggia e Raso.

The paper reports the clinical and histological biopsy data of a patient suffering from lipo-fibro-calcareous myopathy (Mattioli-Foggia and Raso's disease). It affirms that this pathology may be attributed to the group of phacomatosis and that in this instance this is a case of neurovascular phacomatosis (neuroblastodermosis).

[Testicular cancer. Open questions: prevention, early diagnosis and infertility]. / Le neoplasie del testicolo. Problemi aperti: prevenzione, diagnosi precoce e infertilità

Testicular cancer is the most common malignancy in men aged 15-35 years. Histologically, testicular germ-cell tumors have two main subtypes: pure seminoma and nonseminoma. Knowing the histopathological tumor type and detecting the relevant prognostic factors helps to guide the subsequent therapeutic course. At present there are no recommendations for testicular cancer screening in healthy young men, even among men showing high risk; however, a testicular cancer should be diagnosed as soon as a young man presents with suggestive signs and symptoms. Furthermore, thanks to highly effective treatments including surgery, chemotherapy, and radiation therapy, it is very important to effectively manage secondary prevention and improve these patients' quality of life. Secondary prevention of relapses or secondary malignancy onsets should be carried out through a regular follow-up of the patient; in selected cases of positive family history, it is possible to perform genome-wide analyses aiming at searching the genes possibly causing testicular germ-cell tumor in affected first-degree male relatives. Long-term therapies can yield infertility and sexual dysfunction, issues gaining more and more importance from a clinical point of view. Sperm cryopreservation should be systematically offered to all requiring patients; moreover, screening for gonadal dysfunction should be considered in the follow-up of testicular cancer survivors, with the aim of hormone supplementation in symptomatic patients.

Bateman's disease.

Bateman's disease is characterized by the presence of purpuric eruptions involving the extremities. Semi-thin sections and morphological pictures evidence the damage this illness can cause to the elastic fibres. After passing in review the various pathogenetic theories, the Authors consider this disease an expression of discrasic alterations of an amyloidosic character of all the vessel structures, of severe senile elastosis and of the lack of fibrin-like material.

[Cervical mucus in the evaluation of ovarian activity]. / Il muco cervicale nella valutazione dell'attivitá ovarica.

PIP: Cervical mucus, its biological characteristics and significance, is described as well as the cervical functional tests for the study of ovarian activity. The fern test, spinnbarkeit, and the crystallization of cervical mucus, and the significance of different findings are discussed, as well as the reliability of the tests and the factors that may interfere with them. The fern test is regarded as a sensitive, rapid, and sufficiently reliable test to evaluate ovarian activity, at least during the 1st phase of the cycle. Follicular maturation can be easily followed for diagnostic and therapeutic purposes and the time of ovulation can be determined. In view of their simplicity and reliability, it is suggested that cervical functional tests be routinely used.^ieng

[Cementoma of the jaw. Clinical case]. / Il cementoma delle ossa mascellari. Caso clinico.

The A.A. describe a case of cementoma come to their observation, reporting considerations resulting from an attentive analysis of the literature on the subject.

[Gingival hyperplasia associated with the therapeutic use of nifedipine: review of clinical cases]. / Iperplasia gengivale associata all'uso terapuetico di nifedipina: rassegna di casi clinici.

The AA., starting point for some clinical cases occurred to their observation, deal with gingival hyperplasia by calcium-antagonists, showing that, not with standing the unlike aetiology, the clinical and histological picture is like the anticonvulsive or immunedepressor gingivitis.

Some considerations about the "Fibrolipocalcareous myopathy" (Mattioli-Foggia and Raso disease).

Fibrolipocalcareous myopathy also known as Mattioli-Foggia and Raso Disease was observed first time in 1945. They described clinical, anatomopathologic and radiological Bigliardi aspects. At present the published cases are more than forty. We have pointed out our attention on the published cases. We believe, regard to histopathological and whole clinical data, that this disease could be considered as a) the outcome of a vascular hamartoma; or b) the consequence of a "mesoblastic phacomatosis".

Subchorionic placental cyst: histopathological and clinical aspects in two cases.

Authors report here two cases of subchorionic placental cysts with diameters of 5 x 6 cm and 10 x 12 cm, respectively, diagnosed by ultrasound in pregnancy. Subsequent histological and biochemical examinations seem to prove their origin from the trophoblastic "X-cells" and confirm their frequent benign nature.