Influence of splanchnic artery stenosis on the in-hospital clinical course of elderly patients.

BACKGROUND: Chronic mesenteric ischaemia (CMI) has a long asymptomatic period, but little is known about the clinical implications of this phase of the disease, particularly in the elderly, who are most exposed to the condition. AIMS: The aim of the present observational study was to survey the in-hospital clinical course of elderly patients during the non-specific phase of the disease due to occlusion of at least one splanchnic artery. METHODS: For a median of 29 months, we followed up 85 patients aged 65 and over who, for various clinical reasons, had undergone computed tomographic and magnetic resonance angiography during 2010 at Padua Teaching Hospital, assessing economic impact and reasons for admission. RESULTS: Thirty-four of these patients had at least one occluded artery, and 68 % of them had at least one hospital admission. Elderly CMI patients were characterised by a higher number of admissions (median 2 vs 1 p = 0.05) and a higher cost (6044 vs 1733 Euros p = 0.04), but did not present typical gastrointestinal symptoms. The higher number of hospital admissions was not due to specific clinical risks (admitting wards: general medicine: 32 vs 29 %, p = 0.77; general surgery 8 vs 14 %, p = 0.73; vascular surgery: 26.5 vs 20 %, p = 0.46). CONCLUSIONS: In the asymptomatic phase of CMI, hospitalised elderly patients with at least one occluded splanchnic artery can be subject to a more challenging in-hospital clinical course.

Severe delayed postpolypectomy bleeding in elder patient with post-polycythemia myelofibrosis.

BACKGROUND: The interest of the case lies in an unexpected delayed bleeding following an endoscopic procedure in a patient with post-polycythemia myelofibrosis. The case gives the opportunity to discuss the medical management and monitoring of patients with myeloproliferative disorders undergoing minimally invasive surgery interventions. CASE PRESENTATION: A 75 years old woman affected by post-polycythemia myelofibrosis underwent endoscopy polypectomy followed by a delayed major local bleeding. At the time of the endoscopy followed by bleeding, the platelet count was 837 × 109/L, haemoglobin 113 g/L, PCV 35,2% and WBC 20.22 × 106/L. No antithrombotic prophylaxis with low molecular weight heparin was used. Antiplatelet drug was withdraw seven days before endoscopy and restarted one week after the procedure. Polyp size was 11 x 19 mm and it was located on right side of the colon. CONCLUSION: There are some patients in whom current guidelines do not apply and our case stress the importance of myeloproliferative neoplasms as a risk factor for complications of endoscopic polypectomy. The delayed haemorrhage we observed suggest to strictly control the patient for a period longer than only one week also in case of antithrombotic treatment with antiplatelet drugs.

Ethical and medico-legal implications of capacity of patients in geriatric surgery.

OBJECTIVES: The aim of this study was to assess the decision-making capacity of elderly patients hospitalized in a geriatric surgery division, and the clinician's ability to assess that capacity. SUBJECTS AND METHODS: The study was conducted on patients (aged >66 years) undergoing surgical procedures. Exclusion criteria were a diagnosis of psychogeriatric disorders interfering with decision-making capacity; hearing or visual impairment; and inability to communicate. Patients previously declared legally incompetent were also excluded. The methodological approach consisted of additional interviews to collect data on patients' awareness of the reasons for their hospitalization, their informed consent, and their ability to sign a consent form. The interview was integrated with a clinical-behavioral assessment by means of the Mini-Mental State Examination and the Clock Drawing Test. Data were collected anonymously. RESULTS: The inclusion criteria were met by 123 patients, with a mean age ± SD of 77.65 ± 7.91 years (range 67-98). Their mean (±SD) Mini-Mental State Examination and the Clock Drawing Test scores were 24.53 ± 4.29 and 5.36 ± 2.41, respectively. Mild-to-severe cognitive impairment was identified in 39 patients (31.7%). The consent form was signed by 111 patients (90.25%), including 33 patients (29.72%) with mild-severe cognitive impairment; 18 patients (16.21%) were unaware of the reason for their admission to hospital. DISCUSSION: Many factors may interfere with elderly patients' ability to give their valid consent to treatment, and this study reveals that clinicians may overestimate their patients' decision-making capacity. Physicians should be aware of this problem, and intellectual capacity assessments and/or enhanced consent procedures should be considered when treating elderly patients.

Analysis of suicide in the elderly in Italy. Risk factors and prevention of suicidal behavior.

The authors describe the nationwide scale of suicides among the elderly in Italy for the period 1993-2010. The data are derived from the Italian Institute for Statistics (ISTAT) and the World Health Organization (WHO). The elderly turned out to represent the highest risk category for suicide, with risk increasing with age (suicide rates, per 100,000, in men aged 75 or over and aged 65-74 were respectively 28.3 and 15.7 in 2007). The rates for men were three times higher than those for women. The north-east and north-west regions of Italy had the highest rates of suicide in the elderly. Education was inversely related to the risk of suicide. Hanging was the most frequent method of suicide in men, and precipitation in women. The reasons for suicide, as inferred from available data, were predominantly mental-physical illnesses. The risk factors emerging from our analysis are discussed from the preventive point of view, in relation to the Italian situation and a review of the literature.

Current practice in colonoscopy in the elderly.

Colonoscopy in the elderly is a reliable practice of great diagnostic and management value. However, patient's age has long been considered to affect the success of the procedure, achieved when the cecum is intubated, there is a good view of the colon if preparation has been properly carried out, and the examination does not cause excessive discomfort or complications. Substantial improvements have been made to the latter two aspects, due to more widespread use of deep sedation with propofol and cardiocirculatory monitoring during the procedure. The aim of our work was to assess whether, in the everyday practice of an open-access, digestive endoscopy teaching center, staffed by various providers delivering screening for polyposis, age is still a limitation to the success of the procedure and whether appropriate measures have been taken to improve colonoscopy in geriatric patients. We analysed 1480 consecutive colonoscopies, of which 319 were performed in patients aged over 73 years. The examination was significantly less successful in this group of patients (88.1 vs 94.4, p=0.0001), but there were no major technical or use-related complications connected with administration of propofol for sedation purposes, despite lower doses to the elderly (2.2 ± 1.1 mg/kg total dose, mean 151 ± 72.4 mg vs 2.9 ± 1.3 mg/kg total dose, mean 199 ± 77.9 mg in younger patients, p<0.001). More experienced technical staff were not allocated to these colonoscopies (for endoscopic or anesthesiological purposes) and, according to the results of multivariate stepwise logistic regression analysis, inadequate preparation was the main factor affecting the success of the procedure in elderly patients (OR 5.9, 95% CI 2.25-15.72; p=0.0003). Only body weight over 60 kg facilitated it (weight ≥ 60 kg, OR 0.46, 95% CI 0.26-0.83). In colonoscopy in the elderly, safety appears to be the primary concern and, good outcomes can be achieved, but sometimes at the expense of diagnostic accuracy. This could probably be improved through better pre- and post-procedure care, not currently differentiated between young and elderly patients.

N0 Stage colon cancer: prognostic role of age in relation to tumor site.

This work investigates the prognostic role of advanced age as a risk factor for recurrence in a population of patients undergoing surgery for N0 stage colon cancer, and also evaluates whether that role is affected by tumor location. A population of 129 consecutive patients who underwent radical surgery for N0 stage colon cancer was selected. Patients were subdivided into three age groups: <65, 65-80 and >80. The only correlation found in the examined population between age and clinical-pathological features was between advanced age (>80) and tumor location in the right side of the colon. Overall survival (OS) and disease- free survival (DFS) were significantly lower in patients over 80 than in the other two classes. Two multivariate analyses were carried out: when tumor location was not considered, age >80 represented a negative prognostic factor for risk of recurrence, regardless of the other factors examined. This role was also confirmed when tumor location was considered. As hypothesized by several authors, the role of advanced age which emerges from this study is mainly due to the increased fragility of elderly patients caused by multiple pathophysiological factors, but it does not necessarily represent an absolute contraindication to surgery. The role played by tumor location remains controversial, as more and more studies show that right colon cancer (RCC) is a biological entity distinct from left colon cancer (LCC). Further studies are required to examine right and left colon cancers as two separate diseases.

Choices in surgical treatment of diverticulitis.

Complications after surgical treatment of diverticulitis are not very frequent, in view of the total number of patients affected by this pathology, but they do become significant in absolute terms because of the high prevalence of the disease itself. Surgeons continue to debate which option is better: Hartmann resection or combined resection and anastomosis. Since age is a crucial factor when surgery is being considered, we evaluated the outcome of surgical treatment for diverticulitis in patients treated in our unit over a six-month period, in view of the number of elderly patients generally admitted. Between January 2001 and June 2012, 77 patients underwent surgery for diverticular disease in the Geriatric Surgery Unit of the Department of Surgical and Gastroenterological Sciences, University of Padova Hospital. Gastrointestinal resection and anastomosis were performed in 75 patients (97%), resulting in an overall complication rate of 37% and a mortality rate of 1%. This surgical strategy was chosen because, when it is performed by experienced surgeons, it offers the same results in terms of mortality and morbidity as Hartmann resection, while presenting significant advantages as regards the patient's quality of life. Various factors such as the timing of surgery, severity of the disease defined according to the Hinchey classification, patient's clinical condition, and surgeon's experience and expertise can all influence the surgical choice. Several studies in the literature confirm that combined resection and anastomosis is safe and efficacious, but more research is needed to confirm these data.

The importance of sexual health in the elderly: breaking down barriers and taboos.

Aging-related physical changes do not necessarily lead to a decline in sexual functioning: good physical and mental health, a positive attitude toward sex in later life, and access to a healthy partner are associated with continued sexual activity, and regular sexual expression is associated with good physical and mental health. However, it is usually assumed that older adults do not have sexual desires, and elderly people often find it difficult to discuss this topic with their doctor. There are many potential barriers concerning sexuality in older age: the lack of a healthy sexual partner, depression, the monotony of a repetitive sexual relationship, a spouse's physical unattractiveness, hormone variability, and illness and/or iatrogenic factors. Adaptive coping strategies can considerably mitigate the impact of such factors, however, and one way of contributing to breaking down barriers and taboos is undoubtedly to ensure that physicians are willing to discuss their patients' sexual history. The aim of this review was to explore the barriers and taboos to sexual expression in seniors, to propose strategies to foster this aspect of their lives, and to help physicians investigate the sexual history of their elderly patients.

Diagnosis of chronic mesenteric ischemia in older patients: a structured review.

BACKGROUND AND AIMS: Chronic mesenteric ischemia in older patients is a challenge for the physician because it coincides with a vague and non-specific clinical presentation with abdominal pain. It can frequently cause diagnostic errors and lead to legal consequences. The aim of this work was to evaluate the literature on chronic mesenteric ischemia and focus on the limited data concerning the geriatric population. METHODS: This research focused on observational studies, randomized controlled trials, and clinical reports (excluding case reports and reviews) dealing with patients at least 65 years old with a clinical or instrumental diagnosis of chronic intestinal ischemia, published between 2000 and 2010. The search was conducted in PubMed using the following key words: chronic ischemic splanchnic disease, chronic mesenteric ischemia, angina abdominis, chronic abdominal angina, intestinal ischemia. RESULTS: We selected 925 articles with the key words as follows: chronic mesenteric ischemia in 355 cases; chronic ischemic splanchnic disease in 46; angina abdominis in 4; abdominal angina in 242; and chronic intestinal ischemia in 278. We then excluded articles judged scarcely pertinent, case reports, reviews, works concentrating only on diagnostic, methodological, instrumental and surgical approaches, and articles based on animal or experimental models. This selection left us with 13 articles (after excluding duplicates), only three of which were considered valid for our purposes. CONCLUSIONS: Our review indicates that there is a shortage of useful literature on chronic intestinal ischemic disease diagnosed in the older adults, and the appropriate geriatric management of these patients is consequently not well established.

Role of bioelectrical impedance analysis in follow-up of hospitalized elderly patients with congestive heart failure.

BACKGROUND AND AIMS: Congestive heart failure (CHF) is characterized by high levels of B-type natriuretic peptide (BNP), expanded total body water (TBW) and extracellular water (ECW). Bioelectrical impedance analysis (BIA) has demonstrated high diagnostic accuracy in CHF but no information is available for older patients. We hypothesized that, in the follow-up of patients with CHF, body fluid changes estimated by BIA are related to BNP variations rather than with body weight. The aim of this study was to evaluate the relationship between variations in body fluid compartments, body weight and BNP in hospitalized elderly patients with decompensated CHF. METHODS: 49 elderly patients admitted to the Geriatric Department for decompensated CHF were included in the study. On admission and at discharge, all patients underwent clinical and functional assessment and BNP dosage. TBW and ECW were also determined by the BIA method. RESULTS: At discharge, all patients showed reductions in TBW (ΔTBW -2.9 ± 3.0 liters), ECW (ΔECW 1.9 ± 2.1 liters) and BNP levels (ΔBNP -219.6 ± 458.1 pg/mL). Variations in TBW and ECW were correlated with BNP changes (r=0.65 and 0.62, respectively) rather than with body weight variations and BNP changes (r=0.51). CONCLUSIONS: The stronger relationship between fluid variations determined by BIA and BNP changes may make BIA a useful method in the follow-up of decompensated CHF elderly patients.

Clinical correlation of mesenteric vascular disease in older patients.

Mesenteric vascular obstruction is difficult to characterize, since it may produce differing acute or chronic clinical pictures and various organic symptoms, such as ischemic colitis and abdominal angina. The diagnosis of chronic mesenteric ischemia (CMI) is thus still mainly based on historic diagnostic criteria drawn up before non-invasive radiological imaging of the mesenteric vessels became widespread, and before the current demographic developments leading to a rise in the number of older patients with multiple pathologies. With this premise, we studied the clinical condition of 85 patients aged over 65 years of age, submitted to angio-CT scan for reasons other than neoplastic and general pathologies which may cause alterations in mesenteric blood flow, and without the typical symptoms of acute intestinal ischemia. Of these, 34 patients presented occlusion of at least one mesenteric vessel and 13 were affected by multivessel injury. Compared with controls, patients with mesenteric artery disease had lower BMI (24.9+/-3.3 vs 26.8+/-4.5) and longer hospital stays (14 vs 6 days), and were more frequently affected by vasculopathies in other districts (97.1% vs 80.4%), but the only bowel symptom present was diarrhea (21.2% vs 5.9%). These patients also took more benzodiazepines and acetylsalicylic acid. The results of stepwise logistic analysis of length of hospital stay, vasculopathies, diarrhea, and use of benzodiazepines yielded a predictive model with an AUC (area under the curve) of 0.81. Our data show that some features characterizing CMI in the geriatric population differ from those of the general population.

Statins and the elderly: recent evidence and current indications.

Cardiovascular disease (CVD) is estimated to remain as the main cause of death in developed nations over the next 30 years, with increased prevalence in the older population. This is because the observed decline in the incidence of CVD owing to improvements in prevention has now been counterbalanced by the increased shift toward an older and thus more fragile population. Statin treatment reduces cardiovascular morbidity and mortality in middle-aged adults. However, few studies have included older individuals, particularly those aged 80 years or over. The adverse effects associated with high doses of statins and their interactions with other drugs may give rise to more problems in the elderly population. Evidence remains limited regarding the overall benefit of starting statin therapy in adults aged 80 and over; so that clinical judgment remains necessary in making the decision to use them. In this review, we present available evidence from randomized clinical trials, as well as relative community and post-approval data directly applicable to the management of CVD in the elderly, in both primary and secondary prevention. Also discussed is the latest evidence regarding the putative protective effects of statins on senile dementia and the relationship between statin treatment and cancer.

Death after an accidental fall of a 101 year old hospitalized patient. Medico-legal implication of falling in geriatrics.

BACKGROUND: The case presented by the authors gives the opportunity to discuss the medico-legal issues related to lack of prevention of falls in elderly hospitalized patients. CASE PRESENTATION: A 101 year old Caucasian female was admitted to a surgery division for evaluation of abdominal pain of uncertain origin. During hospitalization, after bilateral bed rails were raised, she fell and reported a femoral fracture. Before surgical treatment of the fracture, scheduled for the day after injury, the patient reported a slight reduction in hemoglobin. She received blood transfusion but her general condition suddenly worsened; heart failure was observed and pulseless electrical activity was documented. The patient died 1 day after the fall. Patient relatives requested a judicial evaluation of the case.The case was studied with a methodological approach based on the following steps: 1) examination of clinical records; 2) autopsy; 3) evaluation of clinicians' behavior, in the light of necroscopic findings and a review of the literature. CONCLUSIONS: The case shows that an accurate evaluation of clinical and environmental risk factors should be always performed at the moment of admission also in surgery divisions. A multidisciplinary approach is always recommended also with the involvement of the family members. In some cases, as in this one a fall of the patient is expectable but not always avoidable. Physical restraint use should be avoided when not necessary and used only if there are no practical alternatives.

Usefulness of a fast track list for anxious patients in a upper GI endoscopy.

BACKGROUND: To determine whether patients with no alarm signs who ask the endoscopist to shorten their waiting time due to test result anxiety, represent a risk category for a major organic pathology. METHODS: At our open-access endoscopy service, we set up an expedite list for six months for outpatients who complained that the waiting time for gastroscopy was too long. Over this period we studied 373 gastroscopy patients. In addition to personal details, we collected information on the presence of Hp infection and compliance with dyspepsia guideline indications for gastroscopy. RESULTS: Average waiting time was 38.2 days (SD 12.7). The 66 patients who considered the waiting time too long underwent gastroscopy within 15 days. We made 5 diagnoses of esophageal and gastric tumour and gastric ulcer (7.6%) among the expedite list patients and 14 (4.6%) among those on the normal list (p=0.31). On including duodenal peptic disease in the analysis, the total prevalence rate rose to 19.7% in the short-wait group and to 10.4% (p=0.036) in the longer-wait group. DISCUSSION AND CONCLUSIONS: Our data suggests that asking to be fast-tracked does not have prognostic impact on the diagnosis of a major (gastric ulcer and cancer) pathology.

Local recurrence of gastric cancer after total gastrectomy: an unusual presentation.

A 71 years old Italian man had type 3 gastric cancer of the greater curvature. Total gastrectomy with splenectomy and D2 lymph node dissection were performed. After discharge chemotherapy ELF regimen was administered for 6 months. After 16 months from the operation a local recurrence was discovered by CT scan. Surgical en-bloc resection was performed removing pancreatic tail, splenic colic flexure and a portion of left diaphragm. Histological examination confirmed local recurrence of gastric adenocarcinoma infiltrating pancreas, colon and diaphragm with lymph node metastasis.

GERD in elderly patients: surgical treatment with Nissen-Rossetti laparoscopic technique, outcome.

BACKGROUND: The gastro-esophageal reflux disease (GERD) is one of the most frequent disease of the upper gastro-entheric tract. Surgical treatment is reserved to selected patients, affected by severe forms of disease and/or without compliance to medical therapy.In 95%-60% of the patients submitted to surgical antireflux intervention, a notable improvement of the quality of life is observed.Functional evaluations performed on pre and post--surgical pHmetric and manometric examination have provided new acquisitions about improvements in the restoration of anatomical and functional integrity of the esophagus-gastric antireflux barrier. METHODS: 45 elderly patients with GERD were recruited in a 27 months period. All patients were subjected to laparoscopic Nissen-Rossetti 360° fundoplication. The subjects had a pre-surgical evaluation with:• 24 hours pHmetry,• esophageal manometry,The same evaluation was repeated 1 month and 6 months after surgical intervention. RESULTS: In our series all patients get benefit from surgical treatment, with an improvement of pHmetric and manometric parameters and a regression of complications of GERD such as Barrett's metaplasia. In 8.33% of patients a PPI therapy was necessary, after the surgical intervention, to control symptoms. CONCLUSIONS: The role of surgery in GERD concerns selected patients. Nissen-Rossetti mini-invasive approach is performed with an acceptable percentage of complications (3%-10%). This technique is associated with a good control of GERD symptoms in a short and middle term and with an improvement of functional parameters, such as pHmetric and manometric.

Morpho-functional gastric pre-and post-operative changes in elderly patients undergoing laparoscopic cholecystectomy for gallstone related disease.

BACKGROUND: Cholecystectomy, gold standard treatment for gallbladder lithiasis, is closely associated with increased bile reflux into the stomach as amply demonstrated by experimental studies. The high prevalence of gallstones in the population and the consequent widespread use of surgical removal of the gallbladder require an assessment of the relationship between cholecystectomy and gastric mucosal disorders.Morphological evaluations performed on serial pre and post - surgical biopsies have provided new acquisitions about gastric damage induced by bile in the organ. METHODS: 62 elderly patients with gallstone related disease were recruited in a 30 months period. All patients were subjected to the most appropriate treatment (Laparoscopic cholecystectomy). The subjects had a pre-surgical evaluation with:• dyspeptic symptoms questionnaire,• gastric endoscopy with body, antrum, and fundus random biopsies,• histo-pathological analysis of samples and elaboration of bile reflux index (BRI).The same evaluation was repeated at a 6 months follow-up. RESULTS: In our series the duodeno-gastric reflux and the consensual biliary gastritis, assessed histologically with the BRI, was found in 58% of the patients after 6 months from cholecystectomy. The demonstrated bile reflux had no effect on H. pylori's gastric colonization nor on the induction of gastric precancerous lesions. CONCLUSIONS: Cholecystectomy, gold standard treatment for gallstone-related diseases, is practiced in a high percentage of patients with this condition. Such procedure, considered by many harmless, was, in our study, associated with a significant risk of developing biliary gastritis after 6 months during the postoperative period.

Difficult colonoscopies in the propofol era.

BACKGROUND: To study the relationship between endoscopic practice and adverse events during colonoscopy under standard deep sedation induced and monitored by an anesthetist. METHODS: We investigated the routine activity of an endoscopy center at the Padova University teaching hospital. We considered not only endoscopic and cardiorespiratory complications, but also the need to use high-dose propofol to complete the procedure, and the inability to complete the procedure. Variables relating to the patient's clinical conditions, bowel preparation, the endoscopist's and the anesthetist's experience, and the duration of the procedure were input in the model. RESULTS: 617 procedures under deep sedation were performed with a 5% rate of adverse events. The average dose of propofol used was 2.6 ± 1.2 mg/kg. In all, 14 endoscopists and 42 anesthetists were involved in the procedures. The logistic regression analysis identified female gender (OR=2.3), having the colonoscopy performed by a less experienced endoscopist (OR=1.9), inadequate bowel preparation (OR=3.2) and a procedure lasting longer than 17.5 minutes (OR=1.6) as the main risk factors for complications. An ASA score of 2 carried a 50% risk reduction (OR=0.5). DISCUSSION AND CONCLUSIONS: Our model showed that none of the variables relating to anesthesiological issues influenced which procedures would prove difficult.

Diverticular disease hospital cost impact analysis: evaluation of testings and surgical procedures in inpatient and outpatient admissions.

BACKGROUND: Diverticular Disease (DD) is a common condition in Italy and in other western countries. There is not much data concerning DD's impact on budget and activity in hospitals. METHODS: The aim is to detect the clinical workload and the financial impact of diverticular disease in hospitals.Retrospective observational study of all patients treated for diverticular disease during the period of seven years in AOU Federico II. Analysis of inpatient and outpatient investigations, treatment, hospitalization and financial refunds. RESULTS: A total of 738 patients were treated and 840 hospital discharge records were registered. There were a total number of 4101 hospitalization days and 753 outpatient accesses. The investigations generated were 416 endoscopies, 197 abdominal CT scans, 177 abdominal ultrasound scans, 109 X-rays tests. A total of 193 surgical operations were performed. The total cost of this activity was € 1.656.802 or 0.2% of the total budget of the hospital. € 1.346.218, were attributable to the department of general surgery, 0.9% of the department's budget . CONCLUSIONS: The limited impact of diverticular disease on the budget and activity of AOU Federico II of Naples is mainly due to the absence of an emergency department.

Quality of life and depression in a cohort of female patients with chronic disease.

BACKGROUND: Differences in health-related quality of life perception in patients with chronic disease may depend on pre-existing differences in personality profile. The purpose of the study was to investigate in a cohort of female patients with chronic diseases the relationship between the Quality of Life perception and the potential presence of depressive symptoms. PATIENTS AND METHODS: Female patients with chronic diseases were enrolled in the study. Exclusion criteria were diagnosis of psychopathological condition, treatment with psychoactive substances.Methodological approach was based on administration of the following test. Short Form health survey SF-36, Symptom Check List SCL-90-R, Satisfaction Profile test (SAT-P) and Beck Depression Inventory-II (BDI-II). The Pearson correlation coefficient was used to evaluate the relationship between depressive symptoms and Quality of life as assessed by psychometric test. RESULTS: 57 patients, aged 52(± 3,4), responded to inclusion criteria. 57% of patients had a diagnosis of functional dyspepsia or gastro-oesophageal reflux not complicated, and the remaining 43% musculoskeletal diseases. The statistical analysis showed an inverse correlation between the variable Bodily Pain of the SF-36 and the variable Depression scales of the SCL-90-R.In a second phase another sample of female patients was enrolled in the study. 64 patients, aged 49(± 3,2), responded to inclusion criteria.Another significant negative correlation was found between the Somatic-Affective factor of the BDI-II and the scale Physical Functioning of the SAT-P. DISCUSSIONS: In female patients with chronic disease depressive symptoms resulted influenced by pain and vice versa. The treatment of depressive symptoms could improve the quality of life of patients.