Addition of Intermittent Pneumatic Compression to Conventional Treatment Improves Volume Reduction Before Lymphatic Surgery for Lower Limb Lymphedema: A Pilot Study.

This study assesses the impact of an advanced intermittent pneumatic compression device (IPC - Lympha Press® Optimal Plus) when added to Complete Decongestive Therapy (CDT) compared to CDT alone on volume reduction of limbs with lymphedema. The goal is to maximally reduce edema in preparation for microsurgery. Fifty subjects scheduled for Multiple Lymphatic-Venous Anastomosis (MLVA) were randomly (sequentially) assigned to experimental or control group: 25 (21 females and 4 males) in the experimental IPC group and 25 (20 females and 5 males) in the control group. The two groups were similar in age, sex distribution, and type of lymphedema. Results indicate the IPC group reported greater volume loss than the control group (p= 0.00137) comparing final vs. initial limb volume. The average percentage edema volume loss achieved with added IPC was two times greater (11.7%) than in the control group (5.0%). When differences in treatment duration were accounted for, the IPC group achieved consistently greater proportional volume loss (12.83% vs 6.30%) than conservative therapy alone. In our pilot study, IPC added to CDT resulted in greater proportional volume loss and provides better preparation for MLVA surgery.

The management of patients with acute ischemic stroke while on direct oral anticoagulants (DOACs): data from an Italian cohort and a proposed algorithm.

Approximately 1-2% of patients with non-valvular atrial fibrillation have an acute ischemic stroke (AIS) while on direct oral anticoagulant (DOAC) treatment every year. However, current evidence on stroke subtypes, pathophysiology and factors leading to the failure of DOAC preventive therapy in a "real world" setting is still scanty. This study aimed at investigating whether there is any relationship between DOAC plasma levels and the stroke occurrence, on the basis of the phenotypic classification and pathophysiology of the stroke, in a cohort of DOAC-treated patients admitted to our hospital for AIS over 1-year period. A total of 28 patients had DOAC plasma levels determined in emergency and were included in the study, nine patients receiving dabigatran, 11 rivaroxaban and 8 apixaban. The DOAC levels were low in 8/28 patients (28.6% of the sample), intermediate in 4 (14.3%) and high in 16 (57.1%). The most prevalent stroke subtype was the small vessel disease, according to the A-S-C-O phenotypic classification, in 53.6% of our sample. The most common clinical presentation was "minor stroke" in 71.4% of the cases. There was a significantly higher proportion of patients with high DOAC levels in the small vessel group, compared to the cardioembolic group without other phenotypes. The question arises as to the most suitable clinical management of AIS in these patients on DOACs. In the current absence of clear evidence, taking into account the DOAC levels (low/intermediate/high) and the underlying stroke pathophysiology, we present a flowchart of our proposed clinical management of ischemic stroke in patients while on DOAC.

Evaluación de la adherencia a las recomendaciones para disminuir el riesgo de Síndrome de Muerte Súbita del lactante / Adherence to recommendations to reduce the risk of Sudden infant Death Syndrome

Introduction: Recommendations for Sudden Infant Death Syndrome (SIDS) are available, although it is uncertain the degree of adherence to these measures. The aim of the study is to assess the adherence to recommendations to reduce the risk of SIDS, seeking factors associated to the noncompliance with these recommendations. Patients and Method: 468 infants were enrolled in two maternity hospitals, one public and one private. Postpartum and 4-month assessments were performed. A questionnaire was used adapting a model validated by the International Child Care Practices Study. Results: Adherence to obstetric recommendations was higher (75.4%) than to pediatric recommendations (53.3%). Regarding pediatric recommendations, a compliance decrease was detected after 4 months. Follow-ups showed decrease in breastfeeding (p < 0.001 84.9% vs 48.6%) and supine position (61.2% vs 21.2%, p < 0.001). Conclusions: The decreased adherence to recommendations for SIDS prevention was mainly observed in younger and less educated women, who were not in a relationship and living in poor housing quality and crowded environments.

Introducción: Existen recomendaciones preventivas en el Sindrome de Muerte Súbita del lactante (SMSL), aunque es incierto el grado de adherencia a dichas medidas. El objetivo del estudio fue evaluar la adherencia a las recomendaciones para disminuir el riesgo de SMSL, buscando factores asociados al no cumplimiento de dichas recomendaciones. Pacientes y Método: Se incluyeron 468 recién nacidos de dos maternidades, pública y privada. Se efectuó una evaluación posparto y a los 4 meses de la adherencia a las recomendaciones. Se utilizó un cuestionario adaptando un modelo de encuesta validado por el International Child Care Practices Study Resultados: La adherencia a las recomendaciones obstétricas fue mayor (75,4%) que a las recomendaciones pediátricas (53,3%). A su vez en las recomendaciones pediátricas se evidenció una caída del cumplimiento de las recomendaciones a los 4 meses. Al seguimiento se observó reducción de lactancia (84,9% vs 48,6%; p < 0,001) y de posición supina (61,2% vs 21,2%; p < 0,001). Conclusiones: La disminución de la adherencia a las recomendaciones para la prevención del SMSL se observó principalmente en las mujeres de menor edad y menor nivel educativo, no estar en pareja, mala calidad habitacional y presencia de numerosos convivientes.

[Adherence to recommendations to reduce the risk of Sudden infant Death Syndrome]. / Evaluación de la adherencia a las recomendaciones para disminuir el riesgo de Síndrome de Muerte Súbita del lactante.

INTRODUCTION: Recommendations for Sudden Infant Death Syndrome (SIDS) are available, although it is uncertain the degree of adherence to these measures. The aim of the study is to assess the adherence to recommendations to reduce the risk of SIDS, seeking factors associated to the noncompliance with these recommendations. PATIENTS AND METHOD: 468 infants were enrolled in two maternity hospitals, one public and one private. Postpartum and 4-month assessments were performed. A questionnaire was used adapting a model validated by the International Child Care Practices Study. RESULTS: Adherence to obstetric recommendations was higher (75.4%) than to pediatric recommendations (53.3%). Regarding pediatric recommendations, a compliance decrease was detected after 4 months. Follow-ups showed decrease in breastfeeding (p < 0.001 84.9% vs 48.6%) and supine position (61.2% vs 21.2%, p < 0.001). CONCLUSIONS: The decreased adherence to recommendations for SIDS prevention was mainly observed in younger and less educated women, who were not in a relationship and living in poor housing quality and crowded environments.

[Deep venous thrombosis and cancer in the elderly]. / La trombosi venosa profonda nell'anziano talora marker tumorale.

BACKGROUND: The aim of this study was the assessment of Deep Venous Thrombosis (DVT), and its relationship with malignant neoplasm in elderly. METHODS: The study sample included six-hundred patients admitted to the University Department of Geriatric Medicine in Turin in 1997 (332 male and 268 female, mean age 77.7+/-8 year). Not-neoplastic subjects affected with DVT were followed up for two years. We analysed incidence of malignant cancer in this group and then it was compared with incidence of new neoplasm in subjects without DVT at baseline. RESULTS: Prevalence of deep venous thrombosis at hospital admission and during the hospitalization was 4.8%. About 50% of patients with DVT had a related neoplastic disease. Patients with DVT were affected with malignant disease four times more than subjects without DVT. The risk of a neoplasm, during the two-years follow-up, was 6.8 times higher for patients with DVT at baseline in comparison with elderly without DVT. We didn't find significative differences between subjects with primary DVT and elderly with DVT due to neoplasm. CONCLUSIONS: There is a wide association between DVT and malignant disease. For this reason a careful follow-up of people with DVT is recommended.

[Predictive variables of mortality in elderly patients after hospitalization. Significance of multidimensional evaluation]. / Variabili predittive di mortalità negli anziani dopo il ricovero ospedaliero. L'importanza della valutazione multidimensionale.

Functional status evaluation in the elderly is stronger predictor of hospital outcomes than type and number of pathology. Multidimensional and functional assessment among hospitalized elderly allows to identify, as well as acute and chronic illness, disabilities of sanitary problems and socio-economical aspects that in the elderly can complicate illness. Our study has identified six-month mortality post hospitalization of 20.2%. The high mortality observed in our follow-up agrees with the literature and it is a marker of considerable frailty among elderly patients. The independent predictor variables of six month post hospital mortality in the study were: male gender, dependence DMI score, low serum albumin (2.8 g/dl), impaired IADL score, cancer illness and APACHE score < 13.7. These measures represent distinct domains: demographic, functional and clinical. Identifying predictors of high-risk patients is an important way in accurate targeting.

[Polypharmacy in the ambulatory care of aged patients]. / La politerapia nella pratica ambulatoriale del paziente anziano.

The aim of this study was to assess the prevalence and possible predictors of polypharmacy in a sample of the general population. The sample consisted of 638 subjects (267 males, mean age 54.7, and 371 females, mean age 55) taken from the records of three general practitioners in the city of Turin, Italy. The prevalence of polypharmacy, for prescription drugs, was 12.5% (80 subjects). The prevalence of polypharmacy, for non prescription drugs, was 17.4% (111 subjects). The number of prescription drugs per patient rises progressively with age, averaging 2.28 and 2.5 respectively in males and in female aged older than 80 years. The number of non prescription drugs was observed to decrease with age: in women, subjects that used two or more non prescription drugs were 35% in those aged under 50 years, 20% in subjects aged from 65 to 80 years and 12.5% in those aged older than 80 years. Subjects aged older than 65 years, an IADL score < 10, more than 20 physical exams performed by practitioner in the last year, a recent hospitalisation, presence of cardiovascular disease, and presence of genito-urinary disease, were significantly and independently associated to polypharmacy for prescription drugs. Only female sex was significantly associated to polypharmacy for non prescription drugs. Our conclusion is that although age should not be involved in polypharmacy as a variable, several phenomena that influence medical treatment goals become more prevalent with increasing age and explain the high drugs consumption in the elderly. A rational, essential therapy, helped by guidelines could reduce potential problems associated with polypharmacy in the elderly.

[Sleep disorders in the aged]. / I disturbi del sonno in età avanzata.

OBJECTIVES: The aim of the study was the assessment of prevalence and risk factors of sleep disorders in the elderly. METHODS: The study sample consisted of a group of institutionalized elderly, from two university affiliated community nursing homes in Turin. The following subjects were excluded: a) those aged less than 65 years; b) had length of stay less than thirty days; c) were not able to communicate because of severe aphasia or severe hearing loss and d) had cognitive impairment based on the Short Portable Mental Status Questionnaire (SPMSQ ) > 5. A total of 88 subjects (65-102 ys; 24 male and 64 female) have been studied. Comorbidity was measured using the Acute Physiology and Chronic Health Evaluation scale (APACHE), disability using the index of Activity Daily Living (ADL), depressive symptoms using the Geriatric Depression Scale (GDS); sleep quality was determined using the Pittsburgh Sleep Quality Index (PSQI) and the subjective health by the Self-Rated Health (SRH) was also evaluated. RESULTS: Using the PSQI questionnaire, 70 subjects (79.5%) were identified as "poor sleepers" (PSQI > 5). They complained of difficulties in getting sleep (85.7%) and frequent awakening (75.7%). The most common causes of sleep disturbances were nycturia (51.4%), cough (38.6%) and pain (32.9%). Insomnia correlated with depressive symptoms, poor physical activity, number of medications and bad self-rated health. CONCLUSION: Sleep disorders probably are due to physical, psychological or ambient factors. The identification and correction of treatable causes of insomnia are relevant for improving the quality of sleep and health in the elderly.

[Clinical considerations about psychopathy and delinquency]. / Consideraciones clínicas respecto de psicopatía y delincuencia.

Clinical differences the authors find between the psychopath's, and the offender's personalities organization are discussed. The authors disagree with an existing pattern tending to include both kinds of personalities under the sole denomination of antisocial personality--a concept they find fit for any discipline other than clinical psychology. Thus, a nosographic separation is set up by analyzing the different responses both organizations yield when facing some basic situations.

Consideraciones clínicas respecto de psicopatía y delincuencia. / [Clinical considerations about psychopathy and delinquency]

Clinical differences the authors find between the psychopaths, and the offenders personalities organization are discussed. The authors disagree with an existing pattern tending to include both kinds of personalities under the sole denomination of antisocial personality--a concept they find fit for any discipline other than clinical psychology. Thus, a nosographic separation is set up by analyzing the different responses both organizations yield when facing some basic situations.

Consideraciones clínicas respecto de psicopatía y delincuencia. / [Clinical considerations about psychopathy and delinquency]

Clinical differences the authors find between the psychopaths, and the offenders personalities organization are discussed. The authors disagree with an existing pattern tending to include both kinds of personalities under the sole denomination of antisocial personality--a concept they find fit for any discipline other than clinical psychology. Thus, a nosographic separation is set up by analyzing the different responses both organizations yield when facing some basic situations.

Asa yeyunal antiperistaltica de Rienhoff. A proposito de una observacion. / Rienhoff's antiperistaltic interposition. Apropos of an observation

Se presenta una observacion luego de reseccion esofago-gastrica por cancer, donde se utilizo yeyuno antiperistaltico en la reconstruccion. Se demostro en la evolucion el caracter antifisiologico del procedimiento de Rienhoff. La experimentacion es concluyente al afirmar que la interposicion de segmentos de intestino delgado en antiperistaltismo, se consituyen en obstaculo al transito digestivo. Pese a la posicion favorable de Goni Moreno, y a los casos exitosos ocasionales; la revision de Pories, el estudio de Orsoni y nuestra observacion hacen notar el caracter peligroso del procedimiento

Carcinoide de bronquio. A proposito de una observacion. / Bronchial carcinoid.Apropos of one observation

Se presenta una observacion de tumor carcinoide de bronquio, con sindrome carcinoide.El diagnostico fue clinico y endoscopico y la terapeutica la reseccion quirurgica. Se hacen consideraciones terapeuticas sobre la cirugia endoscopica y las resecciones economicas transbronquicas con o sin anastomosis

Carcinoma de tiroides luego de radioterapia de cuello. / Thyroid carcinoma after radiotherapy of the neck

Se presenta una observacion de cancer de tiroides originado en una glandula previamente irradiada durante el tratamiento de un neuroblastoma dorsal. Se hacen consideraciones historicas, clinicas y terapeuticas. Se concluye que la cirugia de eleccion, debe ser seguida de terapeutica supresiva y de control clinico seriado; frente a la recidiva se hara tiroidectomia total