Taking care of inpatients with fragility hip fractures: the hip-padua osteosarcopenia (Hip-POS) fracture liaison service model.

PURPOSE: Osteoporotic fragility fractures (FF), particularly those affecting the hip, represent a major clinical and socio-economic concern. These fractures can lead to various adverse outcomes, which may be exacerbated by the presence of sarcopenia, especially among older and frail patients. Early identification of patients with FF is crucial for implementing effective diagnostic and therapeutic strategies to prevent subsequent fractures and their associated consequences. METHODS: The Hip-POS program, implemented at Azienda Ospedale-Università Padova, is a Fracture Liaison Service (FLS) program to evaluate patients aged > 50 years old admitted with fragility hip fractures, involving an interdisciplinary team. After the identification of patients with hip fractures in the Emergency Department, a comprehensive evaluation is conducted to identify risk factors for further fractures, and to assess the main domains of multidimensional geriatric assessment, including muscle status. Patients are then prescribed with anti-fracture therapy, finally undergoing periodic follow-up visits. RESULTS: During the first five months, a total of 250 patients were evaluated (70.4% women, median age 85 years). Following assessment by the Hip-POS team, compared to pre-hospitalization, the proportion of patients not receiving antifracture therapy decreased significantly from 60 to 21%. The prescription rates of vitamin D and calcium increased markedly from 29.6% to 81%. CONCLUSIONS: We introduced the Hip-POS program for the care of older adults with hip fractures. We aspire that our model will represent a promising approach to enhancing post-fracture care by addressing the multifactorial nature of osteoporosis and its consequences, bridging the gap in secondary fracture prevention, and improving patient outcomes.

Horacio Quiroga y su relación con los venenos / Horacio Quiroga and his relationship with poisons

Resumen La vida y obra del literato Horacio Quiroga ha estado signada por venenos en varias oportunidades. Profundo conocedor de la selva misionera, plasmó en sus personajes el conocimiento de ponzoñas y venenos que poseía su flora y su fauna. En cuanto a su vida personal y la de sus familiares, el veneno estuvo presente hasta sus últimos días. Se describen en este trabajo tanto los venenos detallados en su obra como también el desenlace de su suicidio con cianuro de potasio.

Abstract The life and the work of the writer Horacio Quiroga has been marked by poisons and venoms on several occasions. Connoisseur of the flora and fauna of the Misiones jungle, he reflected in his characters the knowledge of poisons and venoms that he possessed. As for his personal life and that of his family, the poison was present until his last days. Both the poisons and venoms detailed in his work as well as the outcome of his suicide with potassium cyanide are detailed in this work.

Endothelial activation and injury by cigarette smoke exposure.

Endothelial activation/injury following exposure to cigarette smoke may explain incidence of atherosclerosis and cardiovascular disease in smokers. We investigated cigarette smoke extract (CSE) effects relative to activation, injury, and survival of human umbilical vein endothelial cells (HUVEC) and compared circulating levels of specific endothelial activation markers between smokers and healthy non-smokers before and after smoking cessation. Viability and toxicity of HUVEC were tested by MTT and LDH assay. Release (by endothelial cells) and circulating levels (in smokers) of von Willebrand Factor (vWF), thrombomodulin (TM), was evaluated by ELISA. Incubation with increasing concentrations of CSE reduced the percentage of viable cells, being 33.9%, 23.9% after CSE 4%, 6% respectively. Dose- and time-dependent release of LDH was observed after incubation with CSE. vWF, TM release were assayed after CSE 2% HUVEC stimulation. Significant 42%, 61%, 76% increase in vWF concentration was detected respectively at 30', 60', 120'. Reduction in circulating levels of vWF, from a median value of 144.0% to 123.7%, was observed in the quitters group after smoking cessation. Exposure to cigarette smoke is cytotoxic and induces activation/injury of endothelium in vitro and in vivo. These findings may provide pathogenetic basis by which smoking can predispose to development of atherothrombosis and cardiovascular disease.

Effect of a nicotine-free inhalator as part of a smoking-cessation programme.

Smoking-cessation drugs are inadequate at addressing the behavioural component of tobacco dependence. Nicotine-free inhalators are plastic devices that may provide a coping mechanism for conditioned smoking by replacing some of the rituals associated with smoking gestures. This study assessed the effect of using a nicotine-free inhalator to improve success in a cessation programme. At baseline, 120 smokers attending a smoking-cessation programme were assessed for their sociodemographic factors, smoking history, depression, physical and behavioural dependence, and motivation. Participants were randomly assigned to two groups, nicotine-free inhalator group (PAIPO; Echos Srl, Milan, Italy) versus reference group. For the whole sample, no significant difference was found in quit rates at 24 weeks between the PAIPO group and the reference group. However, the quit rate in the PAIPO group (66.7%) was more than three-fold higher than the reference group (19.2%) for those individuals with high Glover-Nilsson Smoking Behavioural Questionnaire (GN-SBQ) scores at baseline. The results of the logistic model analysis indicate that a high GN-SBQ score is a strong independent predictor for successful quitting at 24 weeks (OR 8.88; 95% CI 2.08-37.94) in the PAIPO group. Nicotine-free inhalators may be beneficial when used in the context of smoking-cessation interventions, particularly for those smokers for whom handling and manipulation of their cigarettes plays an important part in the ritual of smoking.

Functional analysis of bioprosthetic heart valves.

Glutaraldehyde-treated bovine pericardium is used successfully as bioprosthetic material in the manufacturing of heart valves leaflets. The mechanical properties of bovine pericardial aortic valve leaflets seem to influence its mechanical behaviour and the failure mechanisms. In this study the effect of orthotropy on tricuspid bioprosthetic aortic valve was analysed, using a three-dimensional finite element model, during the entire cardiac cycle. Multiaxial tensile tests were also performed to determine the anisotropy of pericardium. Seven different models of the same valve were analysed using different values of mechanical characteristics from one leaflet to another, considering pericardium as an orthotropic material. The results showed that even a small difference between values along the two axes of orthotropy can negatively influence leaflets performance as regard both displacement and stress distribution. Leaflets of bovine pericardium bioprostheses could be manufactured to be similar to natural human heart valves reproducing their well-known anisotropy. In this way it could be possible to improve the manufacturing process, durability and function of pericardial bioprosthetic valves.

Incidence of extragenital vascular disease in patients with erectile dysfunction of arterial origin.

This research was carried out to evaluate the prevalence of carotid and/or lower limb artery abnormalities in patients with arterial erectile dysfunction (ED). To this end, patients with ED (Andrology Unit) or suspected peripheral atherosclerosis (Angiology Unit) underwent an independent and parallel echo-Duplex examination. The Andrology Unit examined 167 patients with ED of different etiologies: 52 of them had penile artery insufficiency and consequently their carotids and lower limb arteries had to be evaluated by means of echo-Doppler. In all, 36 out of the 46 patients with nonarterial organic ED and 22 out of the 69 patients with nonorganic ED underwent the same evaluation and served as controls. The Angiology Unit enrolled 457 ED patients who initially underwent echo-Doppler for suspected carotid and/or arterial leg atherosclerosis and subsequently dynamic echo-Doppler. Isolated penile artery insufficiency was found in 23.1 and 25% of the patients evaluated in the Angiology and Andrology Units, respectively. The remaining patients were shown to have ED associated with an atheroma or marked intima-media thickness of the carotid vessels and/or of leg arteries. The frequency of penile arterial insufficiency and of carotid and/or lower limb artery abnormalities was significantly higher (P < 0.01) compared to that found in patients with ED of nonarterial organic or psychogenic origin. Both Units found that the frequency of penile artery insufficiency and carotid or lower limb artery abnormalities was significantly higher than that of penile artery insufficiency alone or plus both carotid and lower limb artery abnormalities. This study showed that penile artery insufficiency is associated with carotid and/or lower limb artery ultrasound abnormalities in about 75% of the cases. Therefore, arterial ED may be regarded as a sign of a more generalized atherosclerosis.

[Echocardiographic evaluation of coronary flow reserve in patients with essential hypertension]. / Studio ecocardiografico della riserva di flusso coronarico in pazienti con ipertensione arteriosa essenziale.

BACKGROUND: In patients with essential arterial hypertension (EAH) the left heart ventricular hypertrophy (LVH) causes structural and functional alterations of the coronary vessels that can alter the coronary blood flow reserve. The aim of this study is to evaluate in hypertensive patients with or without LVH versus normotensive subjects, the blood flow and the coronary vasodilatation capability and the coronary blood flow reserve in basal conditions and during dipiridamole i.v. infusion. METHODS: Eighty patients have been selected by ECG, echo color Doppler, transesophageal echocardiography: 50 were hypertensive patients with and without LVH, from mild to moderate to severe and 30 were normotensive subjects. The enrolled patients underwent a first transesophageal echocardiography, before and during infusion of 0.86 mg/kg of dipiridamole in growing doses, 0.56 in four minutes followed after three minutes by 0.30 mg/kg. The observation lasted 18 months, and no patients left the study. RESULTS: The coronary resistances in hypertensive patients were significintally reduced during dipiridamole infusion, maintaining their level higher compared to the normal controls. The reduced coronary vasodilatation capability in hypertensive subjects could be due to an increase of the basal vessel tone and/or a reduced compliance of the coronary resistances. The coronary blood flow reserve is significantly reduced in all hypertensive studied, included those without LVH. It is suggested that this is secondary to increase of the coronary blood flow and tone. CONCLUSIONS: In conclusion essential arterial hypertension is the cause of early anatomical and functional coronary alterations leading hypertensive subjects to risk for coronary events before LVH.

[Histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoto disease. Report of a case]. / Linfoadenite istiocitica necrotizzante o malattia di Kikuchi-Fujimoto. Descrizione di un caso.

Histiocytic Necrotising Lymphadenitis by Kikuchi-Fujimoto (NHL) is a rare disease of unknown etiopathogenesis, characterized by cervical lymphadenomegaly, fever and asthenia. It has a good prognosis with a complete functional recovery of the affected lymph nodes. In 1998 a 28 year-old patient (A. G.) was admitted in the Department of Internal Medicine, Garibaldi Hospital, Catania for fever, asthenia and cervical lymphadenopathy. Hemato-chemical tests performed during hospitalization showed only relative leukopenia and a significant increase of ESR. An initial cervical lymph node biopsy made the diagnosis of Hodgkin's lymphoma. However, the favourable clinical course and the normalization of the previous altered hematochemical tests, induced to perform a second lymph node biopsy which led to diagnosis of NHL. The patient was given antibiotics and anti-inflammatory drugs for ten days with a complete healing which persisted at a twelve-month follow-up. The conclusion is drawn that NHL of unknown etiopathogenesis and with a good prognosis is more frequent than what revealed by the data in the literature because of its insidious and aspecific clinical presentation.

[Juvenile primary refractory anemia with excess of blasts. Report of a case]. / Anemia refrattaria con eccesso di blasti primaria giovanile. Descrizione di un caso.

Myelodysplastic syndromes (MDS) are diseases typical of the adult age, characterized by a clonal alteration of the totipotent staminal cell which causes an inefficient hemopoiesis, reduction of bone marrow cell number, increased bone marrow cell destruction, dysplasia of at least two of the three hemopoietic cell lines and by the tendency to evolve towards acute myeloid leukemia (AML). In patients with MSD, particularly in the advanced primary form, single or multiple chromosomal abnormalities can be found frequently, which may show up and/or modify themselves in any moment of the disease (multistep pathogenetic hypothesis) and whose severity influences significantly the prognosis of MSD patients. In November 1998, a 22 year old female patient (C. C.) was admitted to the Department of Internal medicine of the Garibaldi Hospital, Catania for anemia of unknown origin. The normalities of the hematochemical tests and of other instrumental examinations, induces to perform an osteo-medullary biopsy which revealed the presence of a typical MSD, refractory anemia with excess of blasts type. This disease in its primary form is rare in youth and has a high tendency to evolve in AML. The good clinical conditions of the patient, the absence of chromosomal abnormalities, the normal levels of HbF, the short time interval of the initial diagnosis induced to proceed to bone marrow transplantation, that, as shown by the data reported in the international literature, may give her a good quoad vitam prognosis.

Structural changes in spinal ganglion neurons of lizards after cold-exposure.

We studied structural changes in spinal ganglion neurons that occur in lizards exposed to the cold, both at the light and electron microscope levels. Two types of perikaryal changes were found in the cold-exposed animals: (a) In 25% of all ganglion neurons, the central region of the perikaryon was devoid of Nissl bodies and a narrow peripheral zone stained deeply basophilic. Electron microscopic examination of these cells showed that mitochondria, Golgi complexes and other organelles were assembled in the central region of the perikaryon, while most cisternae of granular endoplasmic reticulum and free polysomes were confined to the periphery of the perikaryon. These changes seem to take place mainly in dark neurons. (b) In 8.6% of all ganglion neurons, Nissl bodies were present throughout the perikaryon, but separated by large, clear spaces. Under the electron microscope, these clear spaces were filled with large numbers of densely packed filaments. It seems that mainly light neurons undergo this type of structural change. The degree of nuclear eccentricity was significantly greater in the neurons of cold-exposed animals than in controls. The nucleolar volume was significantly increased and both the percentages of nuclei with two nucleoli and of nuclei with 'vacuolated' nucleoli were significantly greater in neurons displaying structural changes than in the other neurons. The structural modifications observed in spinal ganglion neurons of cold-exposed lizards closely resemble those seen in the same lizard neurons following axonal section. They could be due to a) metabolic changes induced by low temperature and fasting, b) alterations in the flow of nerve impulses from the periphery, or c) impaired retrograde transport of trophic substances from the periphery to the cell body.

Cell body volume of spinal ganglion neurons: estimation by three different methods.

We estimated the mean volumes of two series of nerve cell bodies, one from rabbit and one from rat spinal ganglia by three different methods: a procedure we devised 25 years ago (the circle-fitting method), one of the new stereological methods (the nucleator method) and the method of serial sectioning--the most direct and accurate procedure presently available for estimating cell size. In the case of the rabbit, in which most spinal ganglion neurons have a single nucleolus, the mean volumes estimated by the first two methods are closely similar and deviate by less than 2% from the mean obtained by serial sectioning. In the case of the rat, in which approximately half of the spinal ganglion neurons have more than one nucleolus, the mean volumes estimated by the first two methods are again closely similar, but deviate by about 12% from the mean obtained by serial sectioning. These findings show that: a) both the nucleator method and the circle-fitting procedure are more accurate when applied to neurons with a single nucleolus; b) if certain conditions are respected, not all the methods previously used to estimate cell size give biased results. However, the new stereological procedures are easier and quicker to use than the earlier methods. These findings also show that our previous results obtained by the circle-fitting method are to be considered valid.

[Solitary primary cerebral echinococcosis. Report of a case]. / Echinococcosi cerebrale primaria solitaria. Descrizione di un caso.

INTRODUCTION AND AIMS: Echinococcosis is a widespread parasitic disease caused by Echinococcus granulosus. Hydatid cysts are mainly diagnosed in adults except for primary cerebral localisation which is electively observed in childhood owing to the early manifestation of signs and/or symptoms of the space-occupying mass. In July 1995 P.N., a 55-year-old woman, was referred to our attention. She complained of intense asthenia, cephalea not responding to NSAIDs and paroxysms of tremor. RESULTS: The anamnesis revealed close relationships with dogs since infancy and an attack of pleurisy of unknown etiology. The objective examination was negative except for an increased volume of the right-hand thyroid lobe. Hematochemical tests showed relative eosinophilia, a significant positivity of anti-thyroglobulin antibodies and antiperoxidase with normal thyroid function indices. Thyroid scan showed a multinodular goitre. Confirmation of eosinophilia suggested the performance of a parasitological examination of feces with negative results. ECG and EEG were normal. Persistent cephalea led to the performance of an encephalic CAT which revealed a cystic formation in the rolandic region, subsequently confirmed by encephalic MNR. The positivity of the Ghedini-Weinberg test led to the diagnosis of cerebral echinococcosis. Chest X-ray and hepatic scan excluded hydatid localisation in these organs. CONCLUSIONS: The case was diagnosed as solitary primary cerebral echinococcosis. Medical follow-up was commenced with albendazole for six months, after which a control encephalic CAT showed the unchanged size of the cysts. The patient consequently underwent surgical exeresis.

[Angiodysplasia of the right colon and aortic stenosis. A case report]. / Angiodisplasia del colon destro e stenosi aortica. Descrizione di un caso.

We report the case of a female patient who came to our observation for a severe enterorrhage. Following colonoscopic examination and color-Doppler M-B Mode echocardiography we made the following diagnosis: "angiodysplasia of the right colon in females with aortic stenosis". It was possible to ascertain whether there were similar lesions in other parts of the gastro-intestinal tract because the patient opposed firmly. In agreement with other authors, we believe that colonoscopic examination is the appropriate method to diagnose gastro-intestinal angiodysplasia. The advanced age and the clinical conditions of the patient did not allow surgical treatment, so we treated her with antihaemorrhagic drugs and elevated doses of ascorbic acid (4 g/die). The disappearance of enterorrhagies, the rapid clinical recovery and the normalization of red blood cell (RBC) count allowed us to discontinue antihaemorrhagic treatment and to continue the administration of elevated doses of ascorbic acid. Eight days later, the patient was discharged in good clinical condition and ascorbic acid was prescribed to be continued at home. A good clinical and haemodynamic balance was observed at the six-month follow-up. In conclusion we think that the clinical case we observed, characterized by the association angiodysplasia of the right colon-aortic stenosis, may be included in the diction Heyde's syndrome. In aging patients with severe concomitant diseases, ineligible for surgical interventions, the enterorrhage caused by a non complicated angiodysplastic lesion of the gastro-intestinal tract may benefit from the acute administration of ascorbic acid as the therapeutic agent of first choice capable to loose and/or stop the haemorragic complication and, in chronic administration, to reduce the number of relapses.

Left ventricular performance after intravenous infusion of captopril in patients with congestive heart failure.

BACKGROUND: Although oral administration of captopril, an angiotensin-converting enzyme inhibitor, is effective for the treatment of congestive heart failure (CHF), the effect of its intravenous (iv) administration is not well known. METHODS AND RESULTS: Ten patients (age range 48-72 years), with CHF belonging to the second and third NYHA class, were given an iv bolus of 25 mg of captopril. Before and 30 minutes after the infusion of captopril, a number of parameters of the left ventricular function were evaluated by echocardiography IREX 3 M-B Mode. Eight patients showed a significant improvement of left ventricular performance indices. In fact, the ejection fraction (13.8%, p < 0.05), the cardiac output (24%, p < 0.001), the circumferential shortness fraction (29.9%, p < 0.05), and the fraction shortening (16.0%, p < 0.005) increased significantly, whereas the end-systolic diameter (21%, p < 0.001), the endsystolic stress (23.8%, p < 0.01) and the left ventricle ejection time (4.8%, p < 0.05) decreased significantly. Systolic and diastolic blood pressure values also underwent a significant reduction by 17% and 11% (p < 0.01 and p < 0.05 respectively). No evident correlation between the improvement of the left ventricular function and the basal renin rates was noticed. CONCLUSIONS: A significant improvement of parietal kinesis was observed especially in those segments which showed movement abnormalities (hypokinesia and akinesia) and in many cases this was detected by M-B Mode echocardiography. Our findings may be the result of the following factors: 1) reduction of parietal stress; 2) increased district coronary flow; 3) inhibition of tissue renin-angiotensin-aldosterone system; and 4) "scavenging" action exerted by the SH group of captopril.

[Role of MB-mode transthoracic echography in the early diagnosis of acute pulmonary embolism]. / Ruolo dell'ecografia transtoracica M-B mode nella diagnosi precoce di embolia polmonare acuta.

The aim of the present study was to evaluate whether transthoracic ecocardiography M-B mode was a sensitive and/or specific test for the early diagnosis of acute pulmonary embolism (PEA). For this purpose, we studied 7 patients with PEA as a complication of: deep leg venous thrombosis (3 cases), complicated bone fractures (2 cases), meniscectomy (1 case) and postpartum (1 case). The patients (3 males and 4 females), mean age of 46 +/- 7 years, did not have any previous earlier heart and/or pulmonary diseases. The diagnosis of PEA was made on the basis of clinical criteria, ecg and laboratory tests. Ecocardiography was performed using an IREX 3 M-B mode equipment; the measurements for the calculation of the indexes were made utilizing a short axis parasternal window. The parameters studied were: RVEDD/LVEDD ratio, LVDI Okubo index and the TR grade. Data were analyzed employing the paired Student's t test. In all patients was observed a statistically significant enlargement on the right heart cavities; while only in 3 of them was it possible to observe a slight reduction of the left ventricular cavities. In conclusion, the ecocardiographic exam was is a sensitive test for the diagnosis of PEA. Particularly, the RVEDD/LVEDD ratio gave an early and quantitative indication of the obstruction severity. Indeed, the morphological alteration of the right cavities became evident when the embolic obstruction was of at least 30%. Hence, we suggest that the standard ecocardiography M-B. mode may be regarded has a rapid diagnostic tool for the diagnosis of PEA.

Perikaryal projections of spinal ganglion neurons: quantitative differences between membrane domains in contact with different microenvironments.

The perikarya of spinal ganglion neurons display numerous slender projections. In the present investigation we have studied whether the extent of these projections is uniform over the entire perikaryal surface or whether there is a difference between the regions of the perikaryon in contact with different microenvironments. In spinal ganglia of the rat and the lizard we have analysed about 200 neuronal cell bodies arranged in pairs and have compared the extent of the projections quantitatively in the areas of interneuronal contact with that in the areas of neuron-to-satellite cell contact. In both species we have found that the projections are present over the entire perikaryal surface and that the overall development of the perikaryal projections is significantly greater in those portions of the surface in contact with satellite cells than in the portions in contact with another neuron. On the basis of these observations we conclude that the outgrowth of perikaryal projections is an intrinsic property of the nerve cell body which is manifested over the entire perikaryal surface; there is, however, an extrinsic influence from the microenvironment of the neuron, which may account for the quantitative differences in different domains of the perikaryal surface.

Immunohistochemical study of placental endothelium in physiologic and gestosis-complicated pregnancies.

In this study we examined the placentae of gestosic patients and controls, with immunoistochemical method and HLA-DR monoclonal antibody, in order to show the role of placental endothelium in gestosic pathology onset. Our results show a marked expression of class II histocompatibility antigens in gestosic placentae with respect to controls. We suppose, in gestosic patients, a role for a particular, genetically determined HLA haplotype which increases disease receptivity.

[Chickenpox and Schönlein-Henoch purpura: a report of a case with nephropathy]. / Varicella e porpora di Schönlein-Henoch: descrizione di un caso con nefropatia.

Authors describe a child affected by chickenpox, Schönlein-Henoch purpura and nephropathy. The ecchymotic lesions were diffused in buttocks and legs and they were associated with vesicular haemorrhagic injury in the back of hands and in pavilions of the ears. They suggest that varicella-zoster virus can play a "trigger" role in etiopathogenesis of Schönlein-Henoch purpura and that this syndrome worsens the renal failure. Steroids don't improve the renal disease in the acute phase but they seem to reduce the relapses.