Comparing the COVID-19-related PTSD symptoms between psychiatric patients and healthy subjects: an observational retrospective study from Northern Italy.

COVID-19 pandemic had a great impact on mental health, both in the general population and psychiatric patients. Little is known about the difference between these two populations in perceiving the pandemic as a traumatic event. The aim of the study was to compare psychiatric patients and healthy controls (HC) in terms of change over time of post-traumatic (PTSD) symptoms. Demographic and clinical variables were collected. Impact of Event Scale Revised (IES-R) scores were registered at T1 as lockdown period (March-April 2020) and T2 as restarting (May-June 2020). Descriptive analyses and linear regression models were performed. A total of 166 outpatients and 57 HC were recruited. Time (F = 15.76; p < 0.001) and diagnosis (F = 4.94; p < 0.001) had a significant effect on the change of IES-R scores, which resulted T1 > T2 (p < 0.001), except for subjects affected by Obsessive-Compulsive Disorder (OCD). Overall, IES-R scores were < in patients than in HC (p = 0.02), particularly in the schizophrenia (SKZ) subgroup (p < 0.001). IES-R scores of subjects with personality disorders (PDs) resulted to be > HC, although not statistically significant. The lockdown period was perceived as more traumatic than the reopening phase by both groups, with the exception of OCD patients, probably because of the clinical worsening associated with the urge of control against risks of contamination. Overall, HC reported more PTSD symptoms than psychiatric patients did, particularly SKZ ones. PD patients, in contrast, may be more vulnerable to PTSD symptoms probably as a result of poor coping skills. Together with OCD patients, subjects with PDs may need closer monitoring during the different phases of the pandemic. Trial Registration: ClinicalTrials.gov Identifier: NCT04694482.

Clinical course of IPF in Italian patients during 12 months of observation: results from the FIBRONET observational study.

BACKGROUND: FIBRONET was an observational, multicentre, prospective cohort study investigating the baseline characteristics, clinical course of disease and use of antifibrotic treatment in Italian patients with idiopathic pulmonary fibrosis (IPF). METHODS: Patients aged ≥ 40 years diagnosed with IPF within the previous 3 months at 20 Italian centres were consecutively enrolled and followed up for 12 months, with evaluations at 3, 6, 9 and 12 months. The primary objective was to describe the clinical course of IPF over 12 months of follow-up, including changes in lung function measured by % predicted forced vital capacity (FVC% predicted). RESULTS: 209 patients (82.3% male, mean age 69.54 ± 7.43 years) were enrolled. Mean FVC% predicted was relatively preserved at baseline (80.01%). The mean time between IPF diagnosis and initiation of antifibrotic therapy was 6.38 weeks; 72.3% of patients received antifibrotic therapy within the first 3 months of follow-up, and 83.9% within 12 months of follow-up. Mean FVC% predicted was 80.0% at baseline and 82.2% at 12 months, and 47.4% of patients remained stable (i.e. had no disease progression) in terms of FVC% predicted during the study. CONCLUSIONS: FIBRONET is the first prospective, real-life, observational study of patients with IPF in Italy. The short time between diagnosis and initiation of antifibrotic therapy, and the stable lung function between baseline and 12 months, suggest that early diagnosis and prompt initiation of antifibrotic therapy may preserve lung function in patients with IPF. TRIAL REGISTRATION: NCT02803580.

Response to clozapine in acute mania is more rapid than that of chlorpromazine.

The purpose of the present study was to compare the efficacy of clozapine with that of chlorpromazine in an open label manner (both given in association with lithium salts) in the treatment of acute mania. Thirty hospitalized manic patients were entered into the study. All patients met DSM-IV criteria for bipolar disorder, Manic Episode; 27 patients completed the study and three patients dropped for noncompliance. The duration of the study was 3 weeks. Patients were randomly assigned to two treatment groups; group 1 (n = 15) was treated with clozapine at a mean dose of 166 mg/day and group 2 (n = 12) was treated with chlorpromazine at a mean dose of 310 mg/day. Manic symptomatology was rated on Young Rating Scale for Mania (YRSM) each week; side effects were recorded on dosage records and treatment emergent symptoms; extrapyramidal acute side effects were rated on the Simpson-Angus Rating Scale performed at the beginning of the study and after 3 weeks of treatment. A two-way repeated measures analysis of variance on YRMS scores showed a significant time effect (p < 0.0001) and a significant time-group interaction (p < 0.0001). Post-hoc comparison between the two groups showed a significant difference after 2 weeks of treatment (p = 0.0001), with clozapine treated patients showing lower YRSM scores than chlorpromazine treated patients. YRSM scores at the end of the study were not significantly different. Patients treated with clozapine showed a more rapid trend toward amelioration. No clinically relevant side effect was observed during the study.

Power Doppler sonography: clinical applications.

OBJECTIVE: Color Doppler imaging (CD) has had a great impact on ultrasonography (US). This technique depicts local flow by encoding an estimate of the mean Doppler frequency shift at a particular position in color. However, the choice of the mean frequency shift as the parameter for representing flow in color Doppler is somewhat arbitrary. Power Doppler ultrasound is a technique that encodes the power in the Doppler signal in color. This parameter is fundamentally different from the mean frequency shift. The frequency is determined by the velocity of the red blood cells, while the power depends on the amount of blood present. Providing an image of a different property of blood flow, power Doppler has shown several key advantages over colour Doppler, including higher sensitivity to flow, better edge definition and depiction of continuity of flow. In this paper we review the results of power Doppler clinical studies. MATERIALS AND METHODS: All relevant information available in the literature on the potential clinical applications of this technique was revised to give a detailed survey. RESULTS: The increased flow sensitivity and better vascular detailing of power Doppler have been used to detect flow presence and characteristics in vessels that are poorly imaged with conventional color Doppler. The improved depiction of tissue vasculature has shown potential advantages, especially in some areas, such as the cortex of native kidneys and renal allografts, the prepuberal testis, the infant hip and the bowel wall, in which color Doppler is not sensitive enough to detect clinically important, slow and poor flow in small vessels. In inflammatory conditions, power Doppler was valuable in depicting increased flow in vessels that are dilated because of inflammatory response. In this field, advantages have been reported in acute cholecystitis and in inflammatory states of musculoskeletal tissues. The higher sensitivity to slow flow and the improved detailing of the course of tortuous and irregular vessels made power Doppler a promising technique to image intratumoral vessels and, thereby, to ameliorate the accuracy of color Doppler in predicting the likelihood of benign versus malignant nature of nodules. Specific flow patterns, missed at color Doppler studies, have been indicated with power Doppler in some tumors of the liver and breast. In different settings, power Doppler also permitted to monitor serial blood flow changes after therapy and to display them as color intensity, allowing the observer to distinguish flow changes. CONCLUSION: Although the actual role of power Doppler in changing patient management has not been assessed yet, this technique can depict flow which was previously undetectable, and thus permits an easier and more confident diagnosis in body regions where the ultrasound signal is weak because blood vessels are small.

Mixed germ cell tumour of the mediastinum (seminoma, embryonal carcinoma, choriocarcinoma and teratoma). Light and electron microscopic cytology and histological investigation.

A mixed germ cell tumour of the mediastinum was found in a 27-year-old subject. It had four components: seminoma, embryonal carcinoma, choriocarcinoma and teratoma. Material for light microscopy (L.M.) and ultrastructural studies were obtained with computerized tomography (CT) guided fine needle aspiration. Three histotypes were identified with ultrastructural studies while only seminoma was identified with L.M. The slides prepared for L.M. were reexamined in the light of findings with electron microscopy (E.M.) and previously unidentified cellular elements were found to be characteristic of choriocarcinoma and teratoma. Histological examination of surgical and autopsy material confirmed the cytological findings. Because of the singularity of this case, the rarity of this type of neoplasm and the difficulty in arriving at a differential diagnosis from other neoplastic and non neoplastic lesions, only the ultrastructural cytological examination allowed us to identify the mixed nature of the tumour. Such an identification is not always possible with L.M. but it is a determining factor in the prognosis and therapy.

[Psychometric and electromyographic studies in patients with chronic uremia subjected to periodic hemodialysis]. / Osservazioni psicometriche ed elettromiografiche in pazienti uremici cronici sottoposti ad emodialisi periodica.

Twenty-five patients suffering from chronic renal insufficiency and who had been undergoing dialysis for a long time were tested on the Wechsler-Bellevue Intelligence Scale with a control of twenty-five subjects of the same age with a comparable educational and social background. The results of the statistical analysis of the difference between the two groups demonstrates a significant psychological deterioration in the group of uremic patients which was particularly noticeable in the performance test. The rate of deterioration was not significantly related to the duration of the dialysis. At the same time electromyography (motor conduction velocity of the S.P.E. nerve) show in 40% of the uremic patients evidence of neuropathy.

[Internal abdominal hernias. Presentation of 10 treated cases]. / Le ernie interne addominali. Presentazione di 10 casi trattati.

Ten cases of abdominal internal hernia observed at the Niguarda Hospital Emergency Surgery Division, Milan, during the period 1969-1978 are described. Even though it is extremely uncommon, this form must be kept in mind in the course of differential diagnosis when the picture includes: typical and striking symptoms of ileal strangulation, radiographical evidence of marked distension of the ileal loops with hydro-air levels, and a negative history of abdominal surgery.

[Clinical and therapeutic aspects of stab and gunshot wounds]. / Aspetti clinici e terapeutici delle ferite d'arma bianca e da fuoco.

In the last three years (1992-1995) 130 stab (114) and gunshot (16) wounds were observed at and admitted to the Emergency Surgical Department of Fatebenefratelli Hospital of Milan. We observed a high incidence of non-EEC patients (62%). Imaging devices (US and CT scan) and surgical minimally invasive procedures have reduced open surgery rate with a remarkable reduction in drawbacks and mortality.

[Laparoscopic and thoracoscopic reintervention after mini-invasive surgery in emergencies]. / Reinterventi laparo e toracoscopici dopo chirurgia mini-invasiva in urgenza.

One-hundred-eighty patients underwent emergency minimally invasive procedures (laparo and thoracoscopy) in the last two years. In twelve postoperative drawbacks another surgical procedure was performed. Laparoscopic or thoracoscopic exploration was undertaken in 8 cases while open surgery was done in 4. Complications and surgical overtiming rate was higher after endoscopic than open surgery. This approach allows us to correct very few and selected disease when a skilled surgical team is available especially during reoperations.

[Internal abdominal hernia caused by anomaly of the falciform ligament (a case report)]. / Ernia interna addominale da anomalia del legamento falciforme (osservazione di un caso).

The authors describe a truly uncommon case of internal abdominal hernia attributable to malformation of the falciform ligament. The patient, a man aged 26, had complained in the past of cramping pain in the epigastric region, usually occurring after meals and sometimes ending with vomiting of ingested food; but all diagnostic methods and procedures had consistently ruled out any extant pathology of the stomach, duodenum, biliary tract, or pancreas. Present hospitalization was justified by a clinical picture suggesting peritonitis from perforated gastric or duodenal ulcer. At operation the authors found a strangulated loop of small intestine following left-to-right migration through a hole in the falciform ligament of the liver. In the authors' interpretation the background cause of the trouble was incomplete development of the falciform ligament, and the immediate cause of the acute episode was abnormal motility and exaggerated peristalsis of the ileum, possibly due to the presence of a diverticulum; the latter two conditions are invoked as a possible explanation for the repeated episodes of abdominal pain in the patient's history.

[Barium peritonitis: report of four cases (author's transl)]. / La peritonite da bario. (Osservazione di 4 casi).

Prompted by several cases of barium peritonitis of their own observation, the authors review the literature on the subject and outline the more common etiopathogenetic factors involved and gross and histological aspects of the disorders. After describing their own four cases of barium peritonitis, the authors outline some basic principles for the prevention and treatment of this rare complication.

Determination of substances of abuse in biological fluids by GC/MS using chemical ionization with acetonitrile.

GC/ms is an important method to determine drugs in biological fluids. For each of the most commonly used drugs a methanolic solution (100 micrograms/ml) was prepared; 30 microliters of each solution was evaporated using nitrogen flow and than diluted in 100 microliters of a derivatizing mixture constituted by MSTFA and toluene (30/70). After a short reaction time at room temperature 1 ml of each solution was injected into a SE-52 column (15 m x 0.25 mm) using chemical ionization with acetonitrile. This method has a good signal/noise ratio and is very useful in screening techniques.

[Our experience in the use of mechanical staplers in the execution of step-by-step subtotal gastrectomy]. / Nostra esperienza nell'impiego delle suturatrici meccaniche nell'esecuzione della gastrectomia sub-totale a scalino.

The Authors describe their reconstruction technique after a "step" gastric resection for peptic or neoplastic pathology. The use of staplers such as TA 30 or GIA for the duodenum is reported. After skeletonizing the lesser curve up to the cardias by sectioning the left gastric artery at its origin and up to the penultimate short vessel on the greater curve, the stomach is resected distally to this two points using a TA90 staplers. So it is possible to remove the greater part of the acid-secreting area in order to avoid ulcers of the anastomosis or of the gastric stump, and also to achieve a complete lymphadenectomy in case of neoplasm. Then a Roux-en-Y gastro-jejunal anastomosis is performed using an EEA28 circular stapler. The jejunal stump is closed with a TA30. Finally, a manual jejuno-jejunal anastomosis is made at least at 50 cm from the previous one. From November 1987 to January 1989, 13 patients were operated: 9 for peptic ulcer and 4 for antrum neoplasms. There were no complications during and after the operations. Mortality was 0%. The patient, usually starts eating on the 6th or 7th day after operation, and is discharged on the 10th day. After 6 months an EGD scopy is required: the 8 performed till now have demonstrated excellent anastomosis and no peptic lesions. Scintigraphic evaluations and pH monitoring are still in course to define the gastric stump acid secretion and the absence of biliary reflux.

Sonographic detection of renal changes in pseudoxanthoma elasticum.

Pseudoxanthoma elasticum (PXE) is a rare hereditary disease whose basic abnormality is degeneration of elastic tissue, with calcification of the tonaca media of the arteries, and typical yellowish papules of the skin. We report the sonographic findings observed in a young patient with PXE at the level of the kidneys: fine hyperechogenic spots suggesting small calcifications were diffuse at the corticomedullary junction; however, normal waveforms were obtained at the level of intraparenchymal renal vessels. The presence of this structural pattern in a young patient with dermatologic abnormalities should lead to the consideration of PXE in the differential diagnosis list.

[Captopril-induced changes in renal flow: evaluation using Doppler echography]. / Variazioni del flusso renale indotte da captopril: valutazione mediante eco Doppler.

It is well known that angiotensin antagonists cause increase of renal blood flow. We have examined, using duplex Doppler sonography, the changes of renal blood flow velocity induced by oral administration of 50 mg. of Captopril. We examined 19 kidneys in 17 subjects without hypertension. Both peak systolic and diastolic velocities were measured at renal hilum and at arcuate arteries, and the resistive index (RI) was calculated. In conclusion duplex Doppler sonography shows significant increase of blood flow velocities both at the hilum and at the arcuate arteries, without variation of the RI, thus showing that changes affect the whole Doppler wave, both in systole and diastole.

Efficacy of SH U 508 A (Levovist) in color Doppler ultrasonography of hepatocellular carcinoma vascularization.

To assess the efficacy of a new US contrast agent [SH U 508 A (Levovist), Schering] in evaluating hepatocellular carcinoma (HCC) vascularization, 38 patients with 43 lesions were submitted to color Doppler US before and after i.v. contrast medium administration. Four patients were studied after arterial chemoembolization. The patients had been selected on the basis of suboptimal color Doppler signals on baseline images. Each patient received two to four injections of Levovist in standard doses. Tumor vascularization was qualitatively graded on a 0-3 scale. Twelve tumors (27.9%) appeared avascular at baseline examinations, while 31 (72.1%) exhibited low to moderate flow signals. After contrast agent administration, color Doppler signals were markedly enhanced in 35/43 lesions (81.4%), lasting 40 to 240 seconds. The lack of enhancement was related to tumor hypovascularity (necrosis at CT), portal vein thrombosis, deep location and successful chemoembolization. The detection of flow signals in chemoembolized tumors was explained by the persistence of viable tumor tissue. After Levovist administration, flow signals were detectable in 97.6% of the HCCs. Therefore, Levovist proved to be an effective tool for color Doppler evaluation of HCC vascularization.

Superior vena cava stents: Doppler US of the internal mammary veins to detect collateral flow--preliminary observations.

In 12 patients with superior vena cava syndrome secondary to malignant disease, duplex Doppler ultrasound (US) was performed in the internal mammary veins. In all patients, flow was retrograde. After stent placement, flow direction was again antegrade on one side (17%) or both sides (83%). During follow-up in the internal mammary veins, blood flow remained unchanged in 10 patients and retrograde flow recurred in two patients at 2 and 5 months, respectively. In these two patients, helical computed tomography showed stent failure. Successful treatment in one patient normalized the direction of flow in the internal mammary vein. Doppler US in the internal mammary veins allowed accurate evaluation of function of superior vena cava stents.