Clinical management and outcome of major bleeding in patients on treatment with vitamin K antagonists.

BACKGROUND: The optimal management of major bleeding associated with vitamin K antagonists remains unclear. OBJECTIVES: The aim of the study was to assess the determinants of outcome of vitamin K antagonists-associated major bleeding and the outcome of bleeding in relation with the therapeutic management. METHODS: Patients hospitalized for major bleeding while on vitamin K antagonists were included in a prospective, cohort study. Major bleeding was defined according to the criteria of the International Society of Thrombosis Haemostasis. The primary study outcome was death at 30days from major bleeding. RESULTS: 544 patients were included in this study, of which 282 with intracranial hemorrhage. Prothrombin complex concentrates were used in 51% and in 23% of patients with intracranial hemorrhage or non-intracranial major bleeding, respectively (p<0.001); fresh frozen plasma was used in 7% and in 17% of patients with intracranial hemorrhage or non-intracranial major bleeding (p<0.001). Death at 30days occurred in 100 patients (18%), 72 patients with intracranial hemorrhage and 28 patients with non-intracranial major bleeding. Age over 85years, low Glasgow Coma Scale score and shock were independent predictors of death at 30days. Invasive procedures were associated with decreased risk of death. CONCLUSIONS: Among the patients hospitalized for major bleeding while on vitamin K antagonists, the risk for death is substantial. The risk for death is associated with the clinical severity of major bleeding as assessed by the GCS score and by the presence of shock more than with the initial localization of major bleeding (ICH vs other sites).

[Computerized digital thermometry in Raynaud's disease. Personal experience]. / La termometria digitale computerizzata nel morbo di Raynaud. Esperienze personali.

BACKGROUND: Computerized digital thermometry has been used for instrumental diagnosis of Raynaud's disease, that is characterized by diminution of the cutaneous temperature of the fingers and the late delayed recovery. Thermometry permits to measure basal temperature of the ten fingers, during cooling to 10 degrees C ("cold test") and the response, measuring temperature minute by minute up to 25 degrees. METHODS: In order to assess vasospastic ischemic disease a total of 66 subjects have been examined: 19 were asymptomatic for acrolocalised pathologies (control subjects) and 47 were symptomatic. RESULTS: No close correlation was observed between clinic and instrumental data. In fact 31.5% of the asymptomatic subjects had a "non-normal" reaction to the test; on the other hand, in the group of female over-50-years-old with symptoms suggesting Raynaud's disease, 38.5% of cases revealed "normal" instrumental patterns. Therefore no discriminating parameters were identified which might have allowed the instrumental identification of subjects suffering from Raynaud's disease compared to healthy individuals. CONCLUSIONS: In conclusion, computerised digital thermometry is a technique with a good level of sensitivity, while the specificity is scarce.

[The medical angiology outpatient clinic today. The authors' personal experience and operational proposals]. / L'ambulatorio di angiologia medica oggi. Esperienza personale e proposte operative.

Over the past two decades the demographic characteristics of our population have changed resulting in a major increase in older age groups and a consequent real increase in the prevalence of vascular diseases' of an atherosclerotic type. This had led to an almost exponential increase in the number of requests for instrumental tests, such as Doppler. The aim of this study, the outcome of a review of the patients attending our outpatient clinic over the past twelve months, was to evaluate the current role of a clinic specialising in medical angiology compared to the changing requests for assistance and to elaborate operating proposals for clinics at various levels, aiming to attain the efficacy and efficiency of outpatient activity in accordance with the objective limitations of health spending and current legislation.

[The evaluation of rehabilitative therapy in peripheral arteriopathy. Our experience]. / Valutazione della terapia riabilitativa nell'arteriopatico periferico. Nostra esperienza.

Motor rehabilitation alone is considered and effective treatment for patients affected by claudicatio intermittens although underlying diseases may often influence but not exclude its efficacy. According to the literature no agreement exists about rehabilitative methods. The authors, in order to contribute to a standardization of rehabilitative methods, report their experience characterized by good results. Moreover, the authors stress the importance of the treatment in desisting from habits like cigarette smoking.

Quality of life in a group of patients with intermittent claudication.

In view of the increasing importance of chronic diseases in recent years, not only quantity but also quality of life has been taken into consideration. The aim of this study was to verify the quality of life in patients with peripheral obstructive arteriopathies of second degree according to the Leriche-Fontaine classification. Therefore, the authors administrated three different questionnaires to patients selected among those who came to the Angiology Ambulatory Care of the Medical Clinic of the University of Trieste. The questionnaires used were the following: McMaster Health Index Questionnaire (MHIQ), "Squibb" Quality of Life, General Health Index Questionnaire (GHIQ). The analysis of the results of the questionnaires shows the severe limitation of physical capacities of this kind of patients (overall mean functional limitation of 69% of the maximum value of 1, corresponding to an ideal state of well-being, with negative peaks of 50%). A negative tendency regarding social life and relationship is represented by different scores (from 52% to 66% of ideal maximum) from different items and questionnaires. Also the items concerning somatic disorders, sleeplessness, and states of anxiety gave results near the percentage of 70% and for this reason were indicative of a state of unwell-being. The data obtained from the items regarding the presence of a state of depression gave a result less predictable: a score of 87% with peaks over 90% could be indicative of a positive tendency. This last result, consistent with others of analogous studies in the literature, seems to indicate that peripheral arterial disease, even if physically restricting, does not have a strong impact on the psychological and emotional equilibrium of the patients.