[Managing the hospitalizations for older patients in University Hospital of Pisa]. / L'andamento dei ricoveri ordinari relativi ai pazienti anziani in un' Azienda Ospedaliera di Alta Specializzazione.

We have analyzed hospitalizations of older people (> 64) from 2002 to 2005. Patients, discharges and stay in hospital have increased, the variation has been statistically significant. We have noticed the same trend about the rehospitalizations. Patients and discharges coming from ASL 5 and zone 4 have decreased in relation with all the elderly people. The reduction of stay in hospital and the decrease of rehospitalizations have been statistically significant.

[Appropriateness in the health system: past, present and future]. / L'appropriatezza nel mondo sanitario: passato, presente e futuro.

Nowadays, a health procedure or a clinical pathway are considered appropriate when they appear adequate with respect to scientific knowledge, consistent with the patient's values, safe as to risk management, and convenient with regard to the allocation of resources. This has not always been the case during the course of history, as the different clinical-methodological approaches to the same pathology in different Schools and Universities indicate, even in the same country. A hundred years ago, the difference of approaches could be explained by the limited circulation of ideas, usually based upon weak evidence, if not the personal impressions, of individual physicians. Today, on the contrary, evidence based medicine can represent a useful element in rendering homogeneous different types of behaviour in the same situation, and one of its characterising features is the elaboration of the concept of appropriateness. Appropriateness is a parameter internal to the evolution of health professions, requiring reasoned and shared employment. It originates from the need of health operators to explain why so many different kinds of behaviour exist in the context of the same clinical question. All the issues related to the concepts of clinical judgement and clinical decision-making derive from this and today more and more attention is being dedicated to the idea of appropriateness. The search for appropriateness is a progressive and cyclic process, that may always be improved. At present, strenuous team work is needed to avoid the features of the health system that are more clearly inappropriate, and that emerge from very simple analyses. Doing this is in the interest of the citizens, of health professionals and of the health economy as well.

[Risk stratification in patients with a first myocardial infarct based on simple clinico-instrumental variables]. / Stratificazione del rischio in pazienti con primo infarto miocardico in base ad alcune semplici variabili clinico-strumentali.

UNLABELLED: It is an acknowledged fact that the prognosis for patients with a first myocardial infarction depends mainly on the degree of residual left ventricle function. We wanted to evaluate the importance that certain simple clinical and instrumental variables can have in stratifying post-infarction cardiovascular risk with particular emphasis on chronic obstructive lung disease (COLD). We selected 97 out of the 512 patients treated in the coronary intensive care unit (CICU) from February 1, 1988 to October 31, 1990 according to the following criteria: First myocardial infarction; no cardiogenic shock; no serious concomitant diseases with considered negative prognosis within 6 months. The following variables were considered for all the patients: age; sex; positive family history for ischemic heart disease; history of diabetes mellitus; arterial hypertension; previous cerebrovascular incident; history of obstructive arteriopathy of the lower limbs, of angor and COLD. The following tests were performed on all the patients: echocardiogram prior to discharge form the CICU; angiocardioscintigraphy with Tc-99 between the 20th and 30th day following the acute event; bicycle ergometer stress test on the 30th day. END POINTS: general mortality; cardiac mortality; non-fatal reinfarction; residual angina at 3 months. All the patients were treated with aspirin (325 mg/die) and/or heparin (12,500 units subcutaneously). All 97 patients were monitored for a mean follow-up time of 19.8 months. General mortality was 2.08% (for reinfarction) 24 (24.7%) non-fatal cardiac events.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of beta cell function in non-insulin-dependent diabetes mellitus (NIDDM) and its correlations with clinico-metabolic parameters]. / Valutazione della funzione beta-cellulare nel diabete mellito non insulino-dipendente (NIDDM) e sue correlazioni con alcuni parametri clinico-metabolici.

Authors studied plasma C-peptide in basal period and after stimulation with one mg of glucagon intravenous in 73 patients with NIDDM. The results have confirmed initial clinical diagnosis of NIDDM. Significative correlations were obtained between basal C-peptide and C-peptide response to glucagon (r = 0.861; p less than 0.01); delta C-peptide (difference between C-peptide basal and after response to glucagon) (r = 0.361; p less than 0.01); body mass index (r = 0.423; p less than 0.01). The significant correlations between basal C-peptide, C-peptide response to glucagon and delta C-peptide show that basal C-peptide measurement is a sufficient test for beta-cell secretory capacity, even though do not give indicative signs for therapy choice of NIDDM for its multifactorial pathogenesis.

Cross-sectional echocardiography with pulsed and continuous wave Doppler in the management of ventricular septal defects.

We designed this study in order to evaluate those cross-sectional echocardiographic projections of most value in the diagnosis of ventricular septal defects and to compare the techniques of cross-sectional and Doppler echocardiography in these lesions. We studied 71 cases with ventricular septal defects confirmed by cross-sectional and/or pulsed Doppler echocardiography. The defect was imaged by cross-sectional echocardiography in 49 patients but not imaged in 22. In the group of 49 patients, except two with pulmonary hypertension, pulsed Doppler enabled us to detect a left-to-right shunt at ventricular level. In the second group of 22 patients, a positive pulsed Doppler signal was detected in the ventricles although no defect was visualized. Pulsed Doppler examination supplemented the information detectable from cross-sectional echocardiography in small defects; in the diagnosis of multiple septal defects; in the presence of aortic valve regurgitation in doubly committed and subarterial defects; in those having residual shunts after surgical correction; and in those with tricuspid valve regurgitation in the setting of perimembranous defects. Continuous wave Doppler cannot always be reliably employed in the evaluation of transventricular pressure gradient because of a failure to align with the jet in the presence of poor signals. The sub-costal oblique projections and the introduction of the right oblique sub-costal view proved, in our hands, to be the most important tools for identifying and classifying the various types of ventricular septal defect.