The physical phenotype of frailty for risk stratification of older medical inpatients.

OBJECTIVES: To determine the usefulness of physical phenotype of frailty, cognitive impairment, and serum albumin for risk stratification of elderly medical impatients. DESIGN: Prospective, observational cohort study. SETTING: A general internal medicine unit of a university hospital in Italy. PARTICIPANTS: Inpatients with an average age of 80.8 ± 7.5 yr (N = 470). MEASUREMENTS: Frailty was defined using the Study of Osteoporotic Fractures Index, a parsimonious version of the physical phenotype (two of the following markers: weight loss, inability to rise five times from a chair, and exhaustion). Two frailty markers from non-physical dimensions were also evaluated: cognitive impairment (Mini-Cog score < 3) and low serum albumin on ward admission (< 3,5 gr/dl). Logistic regression adjusted for preadmission and admission-related confounders was used to investigate whether the physical phenotype of frailty and the two non-physical markers were associated with ward length of stay and unfavorable discharge (death plus any other ward discharge disposition different from direct return home). Areas Under the receiver operating characteristic Curve (AUCs) and Likelihood Ratios (LRs) were used for evaluation of discriminatory ability and clinical usefulness of significant predictors. RESULTS: The physical phenotype of frailty was associated with both study outcomes (p < 0.010) but the association was mainly mediated by chair standing ability. Non-physical markers were associated only with unfavourable discharge (p < 0.001). All of these predictors, either alone or in combination, had poor discriminatory ability (AUCs < 0.70) and poor clinical usefulness (+LRs near 1) for the study outcomes. CONCLUSIONS: The physical phenotype of frailty appears of limited clinical use for risk stratification of older medical inpatients. Combination with markers from non-physical dimensions does not improve its prognostic abilities.

Effects of phacoemulsification time on the corneal endothelium using phacofracture and phaco chop techniques.

PURPOSE: To quantitatively assess early postoperative endothelial damage caused by two phacoemulsification techniques and to ascertain the effect of differences in phacoemulsification time. SETTING: Department of Ophthalmology, Umberto Hospital, Lugo, Italy. METHODS: This prospective study evaluated 100 patients who had phacoemulsification using one of two techniques: phaco chop (n = 50) or four-quadrant, divide and conquer phacofracture (n = 50). The endothelium of both groups was analyzed preoperatively and 8 weeks postoperatively by specular microscopy. RESULTS: Phaco chop led to significantly shorter phacoemulsification time and less endothelial damage. Mean equivalent phacoemulsification time was 25.53 seconds +/- 11.26 (SD) in the phaco chop group and 87.26 +/- 48.03 seconds in the phacofracture group. Endothelial cell loss was 4.72 +/- 1.2% and 13.80 +/- 4.3%, respectively. CONCLUSION: The phaco chop technique led to shorter phacoemulsification time and less endothelial cell loss.

[Epidural sacral anesthesia with 3% mepivacaine in rectal surgery]. / Epidurale sacrale con mepivacaina 3% nella chirurgia proctologica.

The authors think that the sacral epidural anaesthesia effected with Mepivacaine 3%, 6 ml (180 mg) and Fentanyl 2 ml (100 mcg) is perfectly indicated for the proctologic surgery as it is of simple execution and presents a short latency (12 min.), good deepness and perfect haemodynamic stability. Besides, it does not endanger the lower limbs innervation. No urinary retention.

[Cancer of the colorectum in the aged. Clinical considerations with reference to our case series of 65 operated cases during the triennial, 1984-1986]. / Il cancro del colon retto nell'anziano. Considerazioni cliniche in riferimento alla nostra casistica di 65 casi operati nel triennio 1984-1986.

Starting from the note that in industrialised countries colorectal tumours are an increasingly serious problem, especially in the elderly, and after some epidemiological remarks, a personal series of 65 consecutive operations on over--70s in a three-year period is considered. Personal statistics are analysed following careful assessment of risk factors and the immediate and long-term surgical results, also examined on the basis of reported data. It is noted, first, that age is never an absolute contraindication to surgery; second that early diagnosis is basic for the achievement of an improved prognosis: proof of this lies in the excessive number of emergency operations for occlusion or perforation. On the other hand, while it is true that extreme radicalism at an advanced stage does not imply any substantial modification to prognosis, it should also be recognised that the shortening of surgical times (after the introduction of mechanical staplers and the improvement in anaesthesiological assistance techniques) offer greater scope for manoeuvre.

The incidence of optic neuropathy in 84 patients treated with ethambutol.

The authors examined 84 patients with pulmonary TBC treated with ethambutol (25 mg/Kg/die). The patients were divided into two groups on the basis of zinc plasma levels: 53 patients with zinc plasma level greater than 1 mg/l and 31 with zinc plasma levels less than 0.7 mg/l. The two groups underwent periodical follow-up of visual acuity, fundus, color vision (Fransworth 100 HUE) and visual field. The checks were monthly on the first group and fortnightly in the second. Eight patients presented signs of optic neuropathy. Patients with lower zinc plasma levels showed a higher percentage of optic neuropathy.

[Retrobulbar optic neuritis as an initial symptom of multiple sclerosis. Results of a prospective study]. / La neurite ottica retrobulbare come sintomo d'esordio della sclerosi multipla. Risultati di uno studio prospettico.

40 patients with idiopathic optic neuritis (ON) between 1st January 1967 and 31st December 1977 have been checked again from oculistic and neurological point of view between 1st January and 31st March 1983. 10 of 40 examined patients (25%) are found suffering from multiple sclerosis (MS) at the time of check up. Our research points out that idiopathic ON evolutive risk towards MS is greater in females, in people between 20 and 40 years old, in people with one or more relapses as well as in people with neurological microsymptoms at the time of ON.

[Correlation between tryptophan, NEFA and albumins in the nephrotic syndrome]. / Studio delle correlazioni fra triptofano, NEFA e albumina nella sindrome nefrosica.

Many connections were considered between bound and free tryptophan and albumins, NEFA and other aminoacids in 18 proofs in ten subjects of paediatric age affected by nephrotic syndrome. A decrease of total tryptophan and a tendency to increase of free tryptophan were showed in our experience. NEFA, at normal concentrations, should not be responsible for this; and this could suggest that the binding sites on albumins for NEFA and tryptophan are different. Besides there is appearance of a positive correlation between albumins and bound tryptophan and a negative correlation between albumins and free tryptophan. These results can suggest that the reduction of the total tryptophan is due to the loss of the fractions bound to albumins, but urinary tryptophan is not increased in our studies. As the albumins get fewer, there is a lost in linked tryptophan and an increase of free tryptophan. A total reduction of other aromatic aminoacids can also explain, through a reduced intestinal absorption, the decrease of the tryptophan in the nephrotic syndrome.