[Evolution and current tools of multidimensional assessment in Italy]. / La valutazione multidimensionale in Italia: evoluzione e strumenti in uso.

Evaluation of the health status of elderly patients clearly should take into consideration the older individual's medical (physical and mental health), psychosocial and economical status, and functional capabilities and problems (multidimensional evaluation). This methodology has been used in anglo-saxon countries since over 20 years and is now quite diffuse in Italy as well. This paper reports the results of a study performed by the Epidemiology Unit of Tor Vergata University in Rome (Italy) to verify whether a national project regarding the elderly population (Progetto Obiettivo Anziani), has been put into effect across Italy and, in particular, whether, in the context of this project, Geriatric Evaluation Units have been activated. The study evaluated the structural features of the existing Geriatric Units, as well as the type of employed staff and tools used. The results confirm that multidimensional assessment of the elderly is well established in Italy even though Geriatric Evaluation Units across the country are very diverse with respect to the type of employed staff and their work experience. The number of elderly persons evaluated in the Geriatric Units appears to be low but this is also due to the fact that multidimensional evaluation is only one of the many activities performed by the Units. This fact should be reflected upon however, and may call for a greater investment in this important sector of geriatric care.

Spontaneous splenic rupture after the start of lung cancer chemotherapy. A case report.

Hamartoma of the spleen, first described by Rokitansky in 1861 under the name of "splenoma", is a rare benign lesion that is nearly always asymptomatic. Apart from the congenital forms there are also acquired forms of splenoma that are frequently associated with hematological diseases or solid tumors. We describe the case of a man suffering from splenoma who had a spontaneous rupture of the spleen with serious hemoperitoneum a few hours after the start of polychemotherapy for squamous cell lung cancer. The close temporal relationship with the event led us to suspect that the drugs used (cisplatin, vinorelbine and corticosteroids) could have played a causal role. From a review of the literature this seems to be the third case reported of spontaneous rupture of the spleen with hamartoma, and the first with the concomitant occurrence of lung cancer.

Do primary care physicians underprescribe antibiotics for peptic ulcer disease? Report from an Italian research network.

OBJECTIVE: To determine how often primary care physicians prescribe eradication therapy for peptic ulcer disease (PUD) and nonulcer dyspepsia (NUD). STUDY DESIGN: During a 2-year period (1998-2000) we analyzed data concerning patients with PUD or NUD seen by 80 Italian primary care physicians uniformly distributed throughout the country. We classified patients as having a definitive or a presumptive diagnosis on the basis of the completeness of the diagnostic workup and interpreted the prescription of antibiotics for dyspepsia as evidence of attempted eradication of Helicobacter pylori. POPULATION: Consecutive ambulatory patients. OUTCOMES MEASURED: The frequency with which predefined groups of patients received eradication therapy. RESULTS: Of 6866 patients, 690 (10%) received eradication therapy. Of 2162 patients with PUD, 596 (27.6%) received eradication therapy; of 4704 patients with NUD, however, only 94 (2%) received this treatment (P =.0001). A total of 341 (37.7%) of 904 PUD patients with a definitive diagnosis were given eradication therapy and 255 (20.3%) of 1258 PUD patients with a presumptive diagnosis were given therapy (P <.0001). In NUD patients, 7 of 743 (0.9%) with a definitive diagnosis received eradication therapy, while 87 (2.2%) of 3961 of those with a presumptive diagnosis were given the same therapy (P =.025). CONCLUSIONS: While Italian primary care physicians appropriately target eradication therapy for H pylori infection in patients with peptic ulcer disease rather than nonulcer disease, the intervention was still underused in these patients. Improvements in this prescribing behavior are needed.