A relational database in neurosurgery.

UNLABELLED: This paper describes teh automatic procedure for a clinical record management in a Neurosurgery ward. The automated record allows the storage, querying and effective management of clinical data. This is useful during the patient stay and also for data processing and analysis aiming at clinical research and statistical studies. The clinical record is problem-oriented. It contains a minimum data set regarding every patient and a data set which is defined by a classification nomenclature (using an inner protocol). The main parts of the clinical record are the following tables: PERSONAL DATA: contains the fields relating to personal and admission data of the patient. The compilation of some fields is compulsory because they serve as input for the automated discharge letter. This table is used as an identifier for patient retrieval. ANAMNESIS: composed of five different tables according to the kind of data. They are: familiar anamnesis, physiological anamnesis, past and next pathology anamnesis, and trauma anamnesis. GENERAL OBJECTIVITY: contains the general physical information of a patient. The field hold default values, which quickens the compilation and assures the recording of normal values. NEUROLOGICAL EXAMINATION: contains information about the neurological status of the patient. Also in this table, ther are default values in the fields. COMA: contains standardized ata and classifications. The multiple choices are automated and driven and belong to homogeneous classes. SURGICAL OPERATIONS: the information recording is made defining the general kind of operation and then defining the peculiar kind of operation. INSTRUMENTAL EXAMINATIONS: some examination results are recorded in a free structure, while other ones (TAC, etc.) follow codified structure. In order to identify a pathology by means of TAC, it is enough to record three values corresponding to three variables. THis classification fully describes a lot of neurosurgical pathologies. DISCHARGE: contains conclusions, therapies, result, and hospital course. Medical language is closer to the natural one and presents some abiguities. In order to solve this problem, a classification nomenclature was used for diagnosis definition. DISCHARGE LETTER: the document given to the patient when he is discharged. It extracts data from the previously described modules and contains standard headings. The information stored int he database is structured (e.g., diagnosis, name, surname, etc.) and access to this data takes place when the user wants to search the database, using particular queries where the identifying data of a patient is put as conditions for the research (SELECT age, name WHERE diagnosis="TRAUMA"). Logical operators and relational algebra of the relational DBMS allows more complex queries ((diagnosis="TRAUMA" AND age="19") OR sex="M"). The queries are deterministic, because data management uses a classification nomenclature. Data retrieval takes place through a matching, and the DBMS answers directly to the queries. The information retrieval speed depends upon the kind of system that is used; in our case retrieval time is low because the accesses to disk are few even for big databases. In medicine, clinical records can have a hierarchical structure and/or a relational one. Nevertheless, the hierarchical model presents a disadvantage: it is not very flexible because it is linked to a pre-defined structure; as a matter of fact, the definition of path is established in the beginning and not during the execution. Thus, a better representation of the system at a logical level requries a relational DBMS which exploits the relationships between entities in a vertical and horizontal way. That is why the developers adopted a mixed strategy which exploits the advantages of both models and which is provided by M Technology with SQL language (M/SQL). For the future, it is important to have at one's disposal multimedia technologies, which integrate different kinds of information (alp

Palliative surgery of metastatic bone disease: a review of 83 cases.

Of a total of 83 patients with metastatic bone disease, surgery was performed in 17 cases at the prefracture stage, in 54 cases after complete fracture and in 10 cases to decompress the spinal cord. Positive short-term results were obtained in 75% of cases. 7 patients presented mild complications. In 2 cases, the patients had to be reoperated. 55% of the patients were still alive after 6 months, 31% after 12 months and 10% after 2 years.

Clinical-tomographic evolution of a giant intracranial aneurysm. Case report.

The Authors report about the case of one patient with stroke picture of aphasia and right pyramidal deficiency hemisyndrome evidencing at the CT a picture of multiple bilateral malacic areas associated with a picture of bilateral megadolichosiphon. The later tomographic controls evidenced the occurrence of a right latero-supra-sellar expansive injury compatible with a picture of giant aneurysm of the homolateral carotidal siphon. The Authors analyze the clinical, neuroradiological and anatomopathologic findings in the light of the present publications in the recent literature.

[Recent trends in the serologic diagnosis of pertussis]. / Recenti indirizzi nella diagnostica sierologica della pertosse.

Anti-whooping cough agglutinin titrations were performed in various groups of children by employing a special antigen and a microtechnique. Moderate agglutinating titers were detected in the first trimester of life and were interpreted as transmitted from the mother. Rare and moderate titers were observed in a group of children of school age, randomly selected and non institutionalized, while, on the contrary, an analogous institutionalized group showed more frequent and higher rate of antibodies. In clinically diagnosed whooping cough titers resulted high when the disease turned out to have set in more than three week earlier. Anti-whooping cough vaccination determined agglutinating titers mainly moderate and not long-lasting.