MDCT Findings in Gastrointestinal Perforations and the Predictive Value according to the Site of Perforation.

Background: Gastrointestinal perforations are a frequent cause of acute abdominal symptomatology for patients in the emergency department. The aim of this study was to investigate the findings of multidetector-row computed tomography of gastrointestinal perforations and analyze the impact of any imaging signs on the presurgical identification of the perforation site. Methods: We retrospectively reviewed emergency MDCT findings of 93 patients submitted to surgery for gastrointestinal perforation at two different institutions. Two radiologists separately reviewed the emergency MDCT examinations performed on each patient, before and after knowing the surgical diagnosis of the perforation site. A list of findings was considered. Positive predictive values were estimated for each finding with respect to each perforation site, and correspondence analysis (CA) was used to investigate the relationship between the findings and each of the perforation types. Results: We did not find inframesocolic free air in sigmoid colorectal perforations, and in rare cases, only supramesocolic free fluid in gastroduodenal perforations was found. A high PPV of perivisceral fat stranding due to colonic perforation and general distension of upstream loops and collapse of downstream loops were evident in most patients. Conclusions: Our data could offer additional information on the perforation site in the case of doubtful findings to support surgeons, especially in planning a laparoscopic approach.

Coping strategies and psychological distress in caregivers of patients with Amyotrophic Lateral Sclerosis (ALS).

BACKGROUND: Amyotrophic lateral sclerosis (ALS) causes distress in caregivers. The present study aims to examine the association between coping strategies and psychological distress in caregivers of ALS patients. METHODS: Coping strategies were assessed in 96 ALS informal caregivers by means of the Coping Inventory for Stressful Situations. Data about caregivers' demographic characteristics, levels of burden, depression and anxiety (psychological distress) were also gathered by standardised questionnaires. Patients' clinical, cognitive and behavioural disturbances were evaluated by ALS specific assessment tools. RESULTS: Sequential logistic regression analysis showed that emotion-oriented coping strategy was significantly associated with high levels of depressive (p < 0.01) and anxiety (p < 0.05) symptoms and high levels of burden (p < 0.05), after controlling for all other variables. Moreover, a significant relationship of patients' functional dependence levels with burden experienced by caregivers was observed. No relationships were detected between task-oriented and avoidance-oriented coping strategies and caregivers' levels of psychological distress. CONCLUSIONS: The present study supported the mediating effects of coping strategies on intensity of burden, depression and anxiety experienced by ALS caregivers. These findings suggest that interventions aimed at reducing utilisation of maladaptive coping strategies may improve well-being in ALS caregivers, and, possibly, management of symptoms in ALS patients.

Atopic asthma and TNF-308 alleles: linkage disequilibrium and association analyses.

The association of a tumor necrosis factor -308 allele (TNF2) to asthma has been reported in some studies but not in others. The aim of this study was to test this association in a population recruited on the basis of allergy to Parietaria. In the study population, asthma was positively associated to HLA-DRB1*03 (p = 0.01) and to the haplotype TNF2/DRB1*03 (p = 0.02). In the parent subgroup, the proportion of asthmatics was increased in patients with TNF2 (p = 0.01), but the primary association of asthma was to the haplotype TNF2/DRB1*1104 (p = 0.005). The study population was subdivided according to prick skin test (ST) positivity to Lolium, Parietaria, and D. pteronyssinus. Asthma was associated to HLA-DRB1*03 and to the haplotype TNF2/DRB1*03 (p = 0.0015 and 0.0001, respectively) in patients ST positive to Lolium, and to the haplotype TNF2/DRB1*1104 (p = 0.025) in patients ST positive to Parietaria. The transmission disequilibrium test detected excess transmission of HLA-DRB1*03 and of the haplotype TNF2/DRB1*03 (p = 0.03 and 0.04, respectively) to siblings with asthma and ST positivity to Lolium and of HLA-DRB1*1104 and of the haplotype TNF2/DRB1*1104 (p = 0.04 and 0.015, respectively) to siblings with asthma and ST positivity to Parietaria. Taken together, these observations indicate that the haplotypes TNF2/DRB1*03 and TNF2/*B1*1104 contain alleles controlling atopic asthma in patients with sensitization to Lolium and Parietaria, respectively. This suggests that the association of asthma to TNF2 reflects linkage disequilibrium with genes influencing specific immune response.