[Therapeutic strategies in neoplasms of the distal bile duct and the Vater's ampulla]. / Strategie terapeutiche nelle neoplasie della via biliare distale e dell'ampolla di vater.

Malignant periampullary and ampullary tumors represent an anatomic and clinical entity of complex surgical approach due to the difficulty in setting out an early diagnosis, for the back of symptoms at early stages. The Authors at the Department of Surgery and Medical Technology Applications "F. Durante", University of Rome "La Sapienza", since 1990 to 2001 observed 19 cases. The results of surgical treatment of these tumors are here reported. By the analysis of the cases it is evident that long-term survival if mainly conditioned by prompt diagnosis stage of the tumor, and patient status before the operation.

[Significance of health education in schools. Strategy for the prevention of cardiovascular diseases]. / L'importanza dell'educazione sanitaria nelle scuole. Una strategia per la prevenzione delle malattie cardiovascolari.

Cardiovascular diseases are the first cause of death in our Country. They mainly manifests in adult age but it is the result of initiated lesions since the young age and imputable often to errors of behaviours and to non appropriate styles of life. The knowledges related to the prevention of some illnesses, allows a reduction of the incidence of these, a reduction of the mortality, with consequent reduction of the health and social costs related to the care and to the rehabilitation. In our educational system, unlike what happens in the most greater part of the other European countries, these themes are only partially present and however treated in sporadic and insufficient way. For these raisons Pronto Cuore onlus Association has decided to start, in collaboration with the Regione Lazio, a project of health education to the high schools students considering that a more informed population has a longer expectancy of life and a better life quality. This job wants to underline the necessity to undertake a health education program to teach and inform students and teachers: to recognize some factors of risk as principal causes of cardiovascular diseases; to change life style; to recognize critical situations and behaviours to be adopted.

[Atrial fibrillation and hyperthyroidism: results after thyroidectomy]. / Fibrillazione atriale ed irpertiroidismo: risultati dopo intervento di tiroidectomia.

Hyperthyroidism patients can develop atrial fibrillation (AF) with a frequency range between 10 and 25%. The Authors consider 256 hyperthyroid patients operated in their Department, from 1985 to 2001. Before and after surgery, thyroid examination, routine blood tests and common diagnostic evaluations were performed. The follow-up has been 12 months and during this period a L-Thyroxine (50-200 mg/die) therapy has been arranged. Before surgery 59 patients (23%) showed an AF associated with palpitations (76%), asthenia (66%), tremors (54%) and dyspnea (43%). The onset of AF was less than 1 months in 18% of cases, less than 3 months in 30% and chronic in remaining 52%. The 87% of patients was already pharmacologically treated. All the patients were treated with anticoagulants, with a INR value between 2 and 3. After the surgery, 47% of patients presented a restoration of the sinusal rhythm, while the 53% showed a stronger therapeutic responsiveness to specific antiarrhythmic therapy. Treatment of FA hyperthyroid patients with FA tends to normalize the function of the thyroid gland (euthyroidism). In our experience the restoring of sinusal rhythm usually develops in patients with 50 years of age (45 +/- 5 years), while in older patients AF tends to be resistant to treatment.

Reliability in evaluating passive intervertebral motion.

Reliable measurements are prerequisite to the successful conduct of outcome studies. In a study of the performance of physical therapists (n = 5) in evaluating passive mobility of the vertebral column with normal subjects (n = 5), several sources of measurement variability were assessed: the reliability within and between therapists, the criteria for grading, and the subjects themselves. Intratherapist reliability was found to be dependable; intertherapist reliability was not. Problems that merit further study were identified as idiosyncratic behaviors that may develop with experience, subject characteristics, and the instrument itself. Periodic assessment of the reliability of therapists in performing evaluations is recommended because of its importance to therapeutic programming.

Self-instruction in a perceptual motor skill.

A self-instructional strategy using an audio-visual medium for learning the rehabilitation skill of a three-point crutch gait was developed and demonstrated to be effective with normal women of various activity levels naive to task demands. Briefly discussed are theoretical considerations based upon Fitt's three stages of acquiring a perceptual-motor skill and Fleishman and Hempel's experimental demonstrations that abilities required in learning change as learning progresses. In a modified posttest-only control group experiment with 20 women, ages 36 to 60, the hypothesis that subjects could learn the cognitive aspects of a motor skill in one viewing of a 6 1/2-minute film was supported. That some transfer of learning occurred to the performance of the skill was substantiated in a second experimental-control study with 20 women, ages 35 to 54. Six criteria were used to judge filmed motor performance of the subjects. Differences in performance between the two groups appeared to be in the quality of movement and the speed with which a subject moved from one stage of learning to the next. The limitations of the two studies and applications of the findings also were discussed.

Functional recovery from cancer surgery: estimation of expectations.

Level of expected functional recovery from colostomy, laryngectomy and mastectomy was established by the Delphi technique. One hundred fifteen cancer rehabilitation experts responded to 2 rounds of questionnaires and provided their judgments regarding degrees and timing of recovery in 14 functional, physical and psychological areas. Feedback of first round judgments was provided in the second round and 85% agreement was set as the standard for consensus. The mastectomy patient is expected to have the quickest recovery with former level of functioning reached in most areas by 3 months postdischarge. The colostomy patient is expected to be functioning normally in most areas by 6 months postdischarge. The laryngectomy patient is expected to be functioning normally in most areas by 12 months postdischarge. Some functions were judged to have the same rate of recovery for all 3 patient types; for example, the experts agreed that for the 55-year-old patients described in the case abstracts, sexual activities would not reach the preoperative frequency until 12 months postdischarge.