Prevalence of protein-energy malnutrition risk in European older adults in community, residential and hospital settings, according to 22 malnutrition screening tools validated for use in adults ≥65 years: A systematic review and meta-analysis.

This systematic review and meta-analysis assesses the prevalence of protein-energy malnutrition risk across different health-care settings in European older adults, using 22 malnutrition screening tools recently validated for use in older adults. Systematic searches were performed in six electronic databases (2006 through 2017). Included were studies which reported malnutrition risk in adults aged ≥65y in Europe. Frequency of high and moderate malnutrition risk for each malnutrition screening tool was collated. Meta-analyses of malnutrition risk using a random-effects model were performed where data from at least 10 study samples were available. Of 21,465 studies, 196 studies were available for data extraction, representing 223 study samples from 24 European countries and 583,972 older adults. Pooled prevalence rates of high malnutrition risk across all countries and malnutrition screening tools were 28.0% (n = 127 study samples), 17.5% (n = 30), and 8.5% (n = 32), for the hospital, residential care and community settings respectively. Using meta-regression, prevalence rates were higher in adults aged >80y (p < 0.0001), in women (p = 0.03) and in patients with one or multiple comorbidities (p < 0.0001). Prevalence rates differed by country, from 15.2% in Spain to 37.7% in Switzerland, and by screening tool, from 14.9% using MNA-SF to 40.6% using NRS-2002. In conclusion, the prevalence of high malnutrition risk in European older adults varies widely between countries and across health-care settings. Malnutrition risk is associated with older age, gender and presence of disease. As prevalence rates differ depending on the screening tool used, the use of one preferred malnutrition screening tool per setting is strongly recommended.

[Batson's paravertebral venous plexus and single vertebral metastases from renal cell carcinoma]. / Circolo venoso paravertebrale di Batson e metastasivertebrali singole da carcinoma renale.

OBJECTIVES: The presence of a single site bone metastasis in patients with renal cell carcinoma (RCC) is a rare clinical event. We report a single case of RCC with solitary vertebral metastasis and review of literature about renal tumor spreading in order to understand the anatomic explanation for this peculiar clinical case. METHODS: We have considered the single case and reviewed current and past literature to describe the anatomic and functional background of this clinical situation. RESULTS: There are rare cases of single vertebral metastasis from RCC and these are characterized from a contemporary neoplastic thrombus. The neoplastic thrombus could justify the tumoral back-flow into the paravertebral anasthomoses and so into vertebral venous sinusoids. The rich anasthomotic system that surrounds kidneys and the experimental evidence of anasthomotic links among perirenal Lejars venous system and paravertebral Batson's venous system could explain these clinical evidences. CONCLUSION: Enrolment of para-vertebral Batson's venous system could have a major role in the RCC vertebral metastatic diffusion.

[The role of non-invasive urodynamics in bladder outlet obstruction diagnosis in male patients]. / Il ruolo dell'urodinamica non-invasiva nella diagnosidell'ostruzione cervico-uretrale nell'uomo.

PURPOSE: Many methods have been suggested to assess bladder outlet obstruction, as defined by the gold standard of pressure flow studies. A comprehensive review of the literature on the different methods used to diagnose bladder outlet obstruction by non-invasive means was performed in order to compare those methods to invasive urodynamics in terms of sensitivity and specificity. MATERIALS AND METHODS: A MEDLINE search was done of the published literature covering from December 2003 on non-invasive methods, including only single measures to diagnose bladder outlet obstruction. We performed a comparison between all methods in terms of sensitivity and specificity for each test. For many techniques these values were calculated directly from the data presented in the article. RESULTS: There has been applied many methods to diagnose bladder outlet obstruction. Those methods were divided into uroflowmetry, condom-catheter method, penile cuff method and Doppler ultrasonography urodynamics. Each method has been described and discussed in terms of its role in adding information to the diagnostic work-up for bladder outlet obstruction. CONCLUSIONS: Pressure flow studies still remain the gold standard for assessing bladder outlet obstruction. However non-invasive urodynamics is a promising branch. Probably the most reliable information is given by the association of numerous methods together.

[Carcinoma of the bladder with pseudosarcomatous stroma. Presentation of a case]. / Carcinoma a stroma pseudosarcomatoso della vescica. Presentazione di un caso.

Carcinoma with pseudosarcomatous stroma of the bladder. Case report. We report a case of transitional cells carcinoma of urinary bladder with pseudosarcomatous stroma in a 54 years old male. The patient was admitted in hospital owing to recidivous haematuria events for about 3 months. Three urine samples were sent for cytological studies that showed the presence of transitional neoplastic cells. Subjected to a cystoscopic examination the patient revealed a roundish peduncled bladder formation of about 3.5 cm. in size. Hence three bladder lesion biopsies were done. The histological sections obtained pointed out the existence of two cellular populations: the first one presented roundish or lengthened, pluristratified cells arranged in solid nests, with transitional morfology and high atypias; the other population had sarcomatoid features characterized by lenghtened cells with hyperchromic nuclei. The two populations were mixed up and there were sometimes carcinomatous areas that merged into sarcomatoid areas. Chondroid areas were also observed. We diagnosed a G3 transitional cells carcinoma with pseudosarcomatous stroma. The lesion, after literature review, results to be somewhat rare and not easily interpretable since it may be confused with carcinosarcoma. The rarity of this case and the problems of differential diagnosis connected with it urged us to this pubblication along with a short review of literature.

[Surgery of Zollinger-Ellison syndrome]. / Il trattamento chirurgico della sindrome di Zollinger-Ellison.

Two personal cases of Zollinger-Ellison syndrome (ZES) are described. Total gastrectomy (TG) was performed in the first case as an emergency measure, following acute peritonitis caused by a recurrence of ulcer, with perforation 27 days after the first gastric resection. The patients is in good health, though with persistently high blood gastrin levels. The second case was marked by a long history of recurrent ulcer, with two earlier gastric resections. Here, success was obtained by simply enucleating a small gastrinoma from the head of the pancreas in view of the arteriographic evidence. The patient is in excellent health 2 1/2 yr after surgery with stable, normal blood gastrin. The recent literature and these cases suggest that surgery is the method of choice for ZES, its primary aim being the removal of gastrinomas, since these prove malignant in 60-100% of cases, and TG does not in any way inhibit their growth, as was once supposed. Blood gastrin values permit early diagnosis and postoperative monitoring, while arteriography and transhepatic portal catheterisation constitute a useful guide to the location of the tumour. Hyperchlorhydria can be effectively controlled with H2 receptor inhibitors, both in the preoperative diagnostic stage, and after surgery in the event of failure. TG offers the best results in over 60% of cases, when the tumours is multifocal, widely metastasised, or undiscoverable.