Impact of alcohol consumption on winter sports-related injuries.

INTRODUCTION: This study was carried out to evaluate data about trauma-related winter sports, including risk factors such as high speed, gender, age, alcohol consumption, details about the accident and snow conditions. METHODS: A retrospective review was conducted to determine the injury patterns and crash circumstances in holiday skiers and snowboarders. The data recorded were obtained from the database of the Pre-Hospital Emergency Registry of six skiing areas in the Dolomite mountains during the winter seasons November 2004-May 2009, injury data for major traumas from Ski Patrol Injury reports (helicopter, ambulance or ski slopes' patrol reports), and intrahospital Emergency Department data. Alcohol concentration in blood was detected in 200 individuals suffering from major trauma. RESULTS: A total of 4550 injured patients, predominantly male (69%), mean age 22 years (range 16-72), were included in the observational analysis. Knee, wrist and shoulder injuries were frequently associated with major thoracic, abdominal or head traumas (64% of cases). Suboptimal technical level, high speed, low concentration, snow or weather conditions, faulty equipment and protective devices were among the various causes of accidents. The analysis revealed that high alcohol blood concentration was present in 43% of 200 patients. CONCLUSIONS: Even though the major causes of accidents were excessive speed, excessive fatigue, technical errors and bad weather conditions, alcohol abuse was often discovered. Random sampling and a non-systematic detection of alcohol blood levels likely led to an underestimation of alcohol consumption-related injuries. It is recommended that investigations into alcoholic intoxication in injured skiers should be carried out on a large scale.

Chronobiology of non fatal pulmonary thromboembolism.

BACKGROUND: It as been demonstrated that acute myocardial infarction, sudden cardiac death, stroke, and fatal pulmonary embolism show an increased onset rate during certain periods of the day, week, or year. According to some authors, the highest risk appears to occur in the morning, on weekends and during winter. This paper, therefore, intends to examine whether a circadian, weekly, or annual rhythm in the incidence rate of deep vein thrombosis (DVT) and non-fatal pulmonary embolism (PE) in ageing patients does exists. METHODS: A survey was conducted into 212 patients affected by DVT and PE, admitted to the Second Medicine Institute of Padua, Italy, over a period of two solar years. Thromboses were diagnosed via echo-Doppler examination of the legs and pulmonary embolism via perfusive and ventilatory scintiphotographs. RESULTS: In the overall sample, a circadian variation was found, both for deep vein thrombosis (peak at 12:26 hrs, p=0.001), and pulmonary embolism (peak at 10:26 hrs, p=0.001). A weekly, rhythmic recurrence was also found for the two complaints, with a peak on Saturdays, while no significant annual rhythmic recurrence was found. There was, however, a tendency towards an increase during the winter and summer months. CONCLUSIONS: The results may have important clinical applications, both in prevention and in the timing of drug dosage.

[Herpes zoster and post-herpetic neuralgia. Comparison between elderly patients and young adults treated with acyclovir]. / Herpes zoster e nevralgia post-erpetica. Confronto tra anziani e giovani adulti trattati con acyclovir.

Herpes zoster (HZ) is a common skin disease due to a virus identical to that responsible for chickenpox. In a variable number of cases neuritic pain persist after cutaneous healing. Aim of this investigation was to analyze zoster clinical evolution in 102 immunocompetent patients, subdivided by age (< 60 years and > or = 60 years) and sex, after treatment with acyclovir (4 g/die x 10 days). Signs and symptoms of the disease were evaluated, with particular attention to pain and the duration of post-herpetic neuralgia. Vescicular eruption was most frequently found in the thoraco-abdominal region and in the trigeminal one, with no significant differences among the subgroups. Two thirds of the subjects complained of pain and it was prevalent in female sex (84% of cases vs 53%, p < 0.01) but not in any age-class. After 1 months from the episode (and its pharmacological treatment), post-herpetic neuralgia was still present in about 20% of the patients, above all in those > or = 60 years; this last difference reached statistical significance after 6 months (9.7% vs 1.4% for subjects > or = 60 years and < 60 years respectively, p < 0.05). No patient showed any adverse pharmacological effect after treatment. We conclude that acyclovir is well accepted both in young and elderly immune-competent subjects suffering from HZ, but it necessitates further efficacy investigations in sight of its broader utilization.

Electrocardiographic findings in obese subjects.

BACKGROUND: Obesity is often associated with cardiovascular pathology. Cardiac arrhythmias and sudden death are reported for obese subjects during severe caloric restriction and weight loss. Also obese patients without dieting are at increased risk of arrhythmias and sudden death in the absence of cardiac dysfunction. This is probably due to a delayed cardiac repolarization and prolongation of heart rate corrected electrocardiographic QT interval (QTc). METHODS: This paper examined the electro-cardiographic findings of a group of obese young males compared with normal patients and whether QTc interval duration was associated with relative body mass index. All patients were free of cardiovascular diseases and came to the First Aid Department for other pathology than cardiac. We studied 109 subjects (50 obese males and 59 normal males; aged 43.4+/-14.8 and 42.8+/-9.8 years respectively). RESULTS: Obese patients presented a shorter PQ, a prevalence of left cardiac axis, a higher heart rate, a longer QT, but not QTc compared with normal males. There was no correlation between QTc and obesity. CONCLUSIONS: This study noticed that obese patients present some differences in electrocardiographic findings compared with normal subjects and that these alterations are not ascribed to cardiac repolarization. This is probably due to the young age of the studied groups.

[Short term changes in risk factors of cerebrovascular diseases. A failure of preventive measures?]. / Modificazioni nel breve termine dei fattori di rischio delle malattie cerebrovascolari. Un insuccesso degli interventi di prevenzione?

BACKGROUND AND PURPOSE: Stroke is the third main cause of death in western countries. To evaluate its ever-changing characteristics and the impact of recent public campaigns on cardiovascular risk factors (CRFs) in stroke morbidity and mortality, we carried out a retrospective investigation on subjects with cerebrovascular disease in different periods. METHODS: All clinical data of patients with acute cerebrovascular disease (TIA or stroke) admitted to a regional hospital (Padua, Italy) during two distinct years (1985 and 1992) were examined (381 in 1985 and 440 in 1992). In every case the characteristics of the episode, clinical course, concomitant CRFs and relevant biochemical and instrumental examinations were recorded. RESULTS: Altogether Transient Ischemic Attack (TIA) represented almost half the records; remaining cases could be classified as ischemic stroke (66% vs 55%), Intracerebral Haemorrhage (17% vs 26%) and subarachnoideal haemorrhage (17% vs 19%) (1985 vs 1992, respectively). The mean hospitalization period was longer in the most recent year, particularly in haemorrhagic patients (H-P, subarachnoid + intracerebral haemorrhage); the in-hospital case fatality rate was reduced in HP while it was significantly increased in those with Cerebral Ischemia (CI-P, TIA + ischemic stroke). The prevalence of blood hypertension, atrial fibrillation and dyslipidaemias rose significantly in 1992 compared to 1985. High plasma lipids were more frequently present in CI-P than in H-P; their 7-year increase was particularly related to combined forms, rather then isolated hypercholesterolemia or hypertriglyceridemia. CONCLUSIONS: These results do not agree with an hypothetical improvement in the prognosis of stroke in the period we considered. Besides the efforts aiming at reducing CRFs in the short term have not shown to be successful.

[Epidemiologic evaluation of cardiac decompensation and its impact on health costs]. / Valutazione epidemiologica dello scompenso cardiaco e sue implicazioni sulla spesa sanitaria.

BACKGROUND: Heart failure is a frequent pathology that requires a high degree of hospitalization. These characteristics have a high assistance cost. The purpose of this study was to evaluate the prevalence, acuteness, predisposing factors and therapy carried out in patients of a northeastern Italian town, and to evaluate their impact on health costs. METHODS: We have examined patient under observation of the Department of Emergency at the Padua Hospital for 12 months. They had been hospitalized for heart failure symptoms. They all underwent individual and pharmacological anamnesis, objective exam, ECG, thorax X-rays and echocardiogram. The health expenses were calculated in relation to hospital stay, the cost of daily assistance, exams and medical treatments used. RESULTS: 630 patients of both sexes (422 males and 208 females) aged 74.6 +/- 6.1 were studied. Among significantly interrelated factors were: hypertension in 51.4% of the patients; diabetes mellitus in 9% of the patients; hypercholesterolemia in 31.3% of the patients; hypertriglyceridemia in 7.2% of the patients; cigarettes smoking in 19.3% of the patients, whereas obesity was present in 19.7% of all the subjects. Heart diseases directly correlated with heart failure were respectively: myocardial ischemia (65.6%); hypertensive cardiopathy (14.7%); idiopathic dilatative (15%); and valvular cardiopathy (4.7%). In 9.5% of cases, patients presented episodes of TIA, ictus, or they were carriers of neurologic focal deficiencies. As far as NYHA functional class was concerned, the third was most prevalent with a different distribution (p < 0.05) between males and females. ACE inhibitors, digitalis and calcium antagonists are to be indicated among the most widely used drugs. The health cost for patients in this survey was deduced on the basis of: average; hospitalization stay (9.8 days); estimated daily expenses for patient and for further controls (L. 282,000); the area of users (85% of residents). Therefore the full hospital assistance of patients with heart failure is approximately L. 2.1 thousand millions. CONCLUSIONS: Given the high preponderance of heart failure, the frequent relation with vascular risk factors and with ischemic cardiopathy, further investigation is necessary to curb these high rates. On the other hand, the NYHA advanced state of patients is not likely to allow lower costs in relation to hospital admission or the reduction of hospital stay. Nevertheless, the individualization of standardized therapeutic protocols and an adequate home care surveillance follow-up may reduce the number of hospitalizations and consequently the connected health expenses.

[Chronobiological approach to renal colic]. / Approccio cronobiologico alla colica renale.

The concentration of lithogenic and antilithogenic substances in urine shows circadian fluctuations. With this investigation we intended to verify the presence of a chronobiologic rhythm of colic pain in urinary tract calculosis. Four hundred and forty seven consecutive patients with a clinical symptomatology related to urinary tract colic pain were studied. They were subdivided according to sex and age (297 M, 150 F; > or = 65 ys 29, < 65 ys 428). Urinary and blood chemical analysis and instrumental examinations permitted to confirm the clinical diagnosis. To evaluate the circadian and circannual variability, acute events were grouped into one calendar year by the month and into a ideal day by the hour of occurrence respectively. Chronobiologic analysis was performed utilising Halberg single cosinor test. The results pointed out that the symptomatology related to urinary tract colic pain presents a circadian rhythmicity either in patients as a whole or in single subgroups (males, females, younger or older than 65 ys). Besides no seasonal variability was demonstrated, perhaps because of the mild climate present in the geographic area in which the study was carried on.

[Chronobiology of acute pulmonary edema in an emergency service]. / Cronobiologia dell'edema polmonare acuto in un Dipartimento di Emergenza.

Some diseases like acute myocardial infarction, sudden death and stroke have been reported to disclose daily, weekly or annual incidence fluctuations. We analyzed the rhythm of pulmonary edema occurrence. We considered 105 consecutive subjects (mean age 73.7 +/- 9.7 years) who came to an Emergency Department because of acute pulmonary edema during a solar year. Chronobiologic analysis was performed using Halberg single cosinor test. Pulmonary edema incidence was higher during the night with an acrophase at 2:14 a.m. (p < 0.001). No significant weekly or circannual rhythms were detected. We discuss the possible relations with diminished heart output, increase in sympathetic tone or partial baroceptor desensitization, occurring at night.