Trauma in elderly patients: a study of prevalence, comorbidities and gender differences.

AIM: Trauma, in geriatric patients, increases with age, and is a leading cause of disability and institutionalization, resulting in morbidity and mortality. The aim of our study was to analyse the prevalence of trauma, the related risk factors, mortality and sex differences in the prevalence in a geriatric population. PATIENTS AND METHOD: We observed 4,554 patients (≥65 years) with home injuries or car accidents. Patients were evaluated with ISS (Injury Severity Score) and major trauma with ATLS (Advanced Trauma Life Support). The instrumental investigation was in the first instance, targeted X-Ray or whole-body CT. RESULTS: In over four years of study we treated 4,554 geriatric: 2,809 females and 1,745 Males. When the type of trauma was analysed the most common was head injury, followed by fractures of lower and upper limbs. In our experience hospitalization mainly involved patients over 80. In all patients mortality during assessment was 0.06%. DISCUSSION: The geriatric patient is often defined as a "frail elderly", for the presence of a greater "injury sensitivity". This is due to the simultaneous presence of comorbidity, progressive loss of full autonomy and exposure to a high risk of traumatic events. Optimal management of the trauma patient can considerable reduce mortality and morbidity. CONCLUSIONS: Falls and injuries in geriatric age are more frequent in women than in men. Among typical elder comorbidities, osteoporosis certainly causes a female preponderance in the prevalence of fractures. Our discharge data demonstrate that disability, which requires transfer to health care institutions, has a greater effect on women than men.

[A complication in biliary surgery: the biloma]. / Una complicanza degli interventi sulle vie biliari: il biloma.

Authors stress that complications in laparotomic and laparoscopic extrahepatic biliary surgery aren't exceptional. Lesions could be due to section or to stenosis of biliary duct. We can distinguish: intraoperative lesions, which consist in a intraperitoneal bile groan that needs an immediate treatment; lesions that could be found in postoperative period and in any case many days after surgery. Among this complications there is biloma, i.e. a localized uncapsulated extraductal bile collection. Authors refer about their experience and describe clinical findings of this complication. They conclude affirming how biloma treatment doesn't require always resurgery or CT scan drain. Main biliary tract endoscopic decompression could be often useful.

[Hepatic hydatidosis: old and actual therapeutic strategies]. / L'idatidosi epatica: pregresse e attuali strategie terapeutiche.

The authors, reporting on their experience, confirm as the incidence of the hepatic hydatidosis and the complications related to this pathology today are very meaningful. They specify that the objectives to be pursued are: elimination of the parasite, prevention or treatment of the complications, prevention of the development of a new infestation. They dwell therefore upon the various techniques, both conservative and radical, that marked the history of the hepatic hydatidosis surgery, and they conclude affirming that the procedures of eradication of the parasite and the pericystectomy, in particular in laparotomic way, also represents the ideal treatment in consideration of the a little encouraging results of the medical therapy.

[Closed trauma of the spleen. Indications to surgical treatment]. / I traumi chiusi della milza. Indicazioni al trattamento chirurgico.

The Authors mention the historical evolution that led to consider the splenectomy as the ideal operation in patients with post-traumatic lesions of the spleen. They linger then on the actual knowledges about the physiopathology of this organ that determined a substantial change of mind to a conservative treatment, when possible. By reporting their experience of the last decade, they weigh up how every therapeutic choice must be consequent to an accurate clinical evaluation that suggests the surgical abdomen exploration in urgency or, on the contrary, the monitoring of the patient. They linger particularly on the validity of the investigation and quantization of organ lesions and of the subsequent hemoperitoneum. The Authors end affirming that an accurate diagnostic evaluation and the subsequent therapy must take place in a specialized Trauma Center that ensures intensive monitoring and, if necessary, a timely operation in these patients.

Pre and intra-operative methods of staging gastric cancer.

The aim of this paper was to examine the indications and limits of pre- and intra-operative instrumental diagnosis of gastric cancer. In order to achieve this effectively, the authors emphasized the importance of proper staging methods and obtained a detailed description of tumor diffusion. The most important diagnostic instruments considered were magnetic resonance, endosonography, intra-operative echography, pre- and intra-operative immunoscintography and a cytological examination of peritoneal lavage fluid. The authors concluded that pre- and intra-operative staging of gastric cancer is important for two major reasons: it results in the most accurate definition possible of disease evolution, enabling a proper therapeutic program; and it involves a combination of three complementary metasurgical treatments.

[Spontaneous rupture of the esophagus]. / La rottura spontanea dell'esofago.

A series of 8 patients with spontaneous rupture of the esophagus is analysed. Correct diagnosis is difficult. The time lapse between the rupture and diagnosis nevertheless seems to be the most important single factor in the outlook for treatment of spontaneous rupture of the esophagus. Early primary closure of the tear and good drainage of the mediastinum and pleural cavity give the best results in such cases. Sometimes a conservative management should be advocated for the treatment of esophageal perforations.

[Digestive hemorrhage in portal hypertension: role of sclerotherapy]. / Le emorragie digestive da ipertensione portale: ruolo della scleroterapia.

Haemorrhage is perhaps the most terrible complication of portal hypertension whatever is the etiopathology. The authors point out how sclerotherapy of the varices is either a prophylaxis and a therapeutic procedure with a low rate of local and systemic complications. Even if they are supported by good results in personal experience, the authors notice as important is to tailor the treatment for each patient.

[Informatics in a surgery department]. / Informatizzazione di un reparto di chirurgia.

In this paper the Authors describe their own experience in applying informatics at the Surgical Division III of Azienda Policlinico Universitario of Messina. After a discussion about existing hardware (LAN of PC) and daily used software (commercial suite) for managing the clinical reports and correlated data (images, medical prescription, reservations, and so on), their conclusion is that a great development on this way will be possible with extension of the services to all the business network and then to WAN as Internet.

[Bilateral carcinoma of the breast]. / Il carcinoma bilaterale della mammella.

From 1990 to 1996, a total of 223 patients, with breast cancer, were treated. Out of these patients, 7 (3.04%) developed a second primary carcinoma in the controlateral breast. Two (28.5%) had a synchronous manifestation while the remaining 5 (71.5%) had a metachronous manifestation. The seven patients were followed up for periods between 4-8 years: 80% of the metachronous tumours occur within 5 years of follow-up. The 7-year actuarial survival was 100% in the two synchronous tumours and 60% in the five metachronous tumours (two patients died on account of intervening diseases). The prognosis does not depend on the length of the interval between the development of the two carcinomas but it is in relation with the anatomo-clinical state, to the adequate treatment of each primary tumour and to the rigorous clinical-instrumental follow-up, in which the mammography plays a fundamental role.

[US or CT-guided percutaneous drainage of pancreatic pseudocyst]. / Il drenaggio percutaneo Eco o T.C. guidato delle pseudocisti pancreatiche.

Authors, after illustrating the pathogenesis of Pancreatic Pseudocysts (PPC) and classifying them into secondary to acute pancreatitis and arising in course of chronic pancreatitis, underline that the use of Ultrasound (US), CT-scan, Magnetic Resonance, Endoscopic Retrograde CholangioPancreatography and, above all, percutaneous drainage of the cysts has modified the therapeutic approach to this pathology. They describe indications and technique of US or CT-guided percutaneous drainage, and report their experience about 12 cases of PPC secondary to acute pancreatitis and 4 of PPC arising during chronic pancreatitis. They analyze the limits of this technique (risk of infections, recurrences, fistulas), and conclude that Percutaneous Drainage of Pancreatic Pseudocysts is a useful therapeutic approach in the treatment of PPC secondary to acute pancreatitis, while its use is complementary to surgery in the treatment of PPC due to chronic pancreatitis.

[Principles of rehabilitation of patients with ileostomy]. / Principi di riabilitazione nell'ileostomizzato.

Authors, believing that ileostomy is the cause of serious clinical, functional and psychological consequences, dwell upon principles of rehabilitation, which aim is the reinstatement of ileostomized patients into daily life. The most important aspect is to select the position of the stoma; it is necessary to consider some technical and functional aspects. The Authors examine local problems of the stoma, the unstable electrolytical balance, and report some therapeutical aspects. They expose early and late complications after surgical therapy and conclude underlining the advantages of a rapid social reinstatement of patients with an ileostomy.

[Alpha-glucosidase and alanine-amino-peptidase in the early diagnosis of renal failure in obstructive jaundice]. / Il ruolo dell'alfa-glucosidasi e dell'alanina-amino-peptidasi nella diagnosi precoce dell'insufficienza renale in corso di ittero ostruttivo.

Renal failure is a serious complication of obstructive jaundice. Early diagnosis and prevention of spontaneous evolution of the disease can improve prognosis, otherwise very poor in many cases. The Authors, on the basis of experimental researches from literature, expose their clinical experience about the validity of the determination of Alpha-Glucosidase and Alanine-Amino-Peptidase for early diagnosis and differentiation between organic or functional forms of renal failure. They conclude that determination of urinary levels of AGS and AAP is a valid aid for the evaluation of renal function in patients with obstructive jaundice.

[Changes in serum levels of folic acid after total gastrectomy]. / Le modificazioni dei livelli sierici di acido folico dopo gastrectomia totale.

The Authors, in consideration that Folic Acid is assimilated in the upper alimentary tract, effected a comparative study between its seric levels in normal patients and in patients submitted to gastrectomy for gastric cancer, at different times from the operation. In the patients of the first group, Folic Acid levels were not correlated with sex, but to age, decreasing with the increasing of it. In gastrectomized patients, serum levels, also if acceptable, were always lower than in control cases, and gradually decreasing with the increasing of the age. The Authors conclude that, obviously, intestinal assimilation and endogenous reserves are able to counterbalance for enough long time the insufficient alimentary absorption.

[Gastric precancerous conditions]. / Le precancerosi gastriche.

The Authors examine the anatomopathological and clinical features of the main gastric precancerouses and explain the diagnostic therapeutic protocols used. The diagnostic and therapeutic strategy can not leave a strict interdisciplinary collaboration out of consideration between radiologist, endoscopist, anatomist, gastroenterologist and surgeon. They conclude, in fact, affirming that the mentioned collaboration represents the one possibility for improving the results at distance of this neoplasia.

[Tumor markers in malignant anorectal pathology]. / I markers tumorali nella patologia maligna ano-rettale.

The Authors note the limits and the more rational directions of using the several tumour markers that they utilized in the study of the neoplastic pathology of the anus-rectum. They particularly point out the benefit as "dynamic indices" of variation of the tumor mass during the neoplasm's progress and treatment. For these neoplasies any new marker offers advantages of diagnostic accuracy and a greater specificity more CEA. Nevertheless other markers used appear interesting as biochemical parameters for tumour growth. The study and the tumour marker's development supported, in recent years, the introduction of new diagnostic methods that include the utilization of monoclonal localization of the tumour mass.

[Clinico-statistical features of breast pathology in old age]. / Rilievi clinico-statistici sulla patologia mammaria in età geriatrica.

The authors, after discussing the incidence and etiopathogenesis of displastic and neoplastic diseases of breast in geriatric age, state their experience in the treatment of such illnesses. They emphasize the necessity for a treatment suitable for aged people, based on the selection of the patients, their preparation and the constant pre- and postoperative monitoring, and, as a conclusion, affirm the necessity for a strict interdisciplinary cooperation, pith the purpose to ecectively treat such pathology, showing a more and more increasing incidence in the population of the most advanced nations.

[Clinico-statistical features on the operative risk in old age]. / Rilievi clinico-statistici sul rischio operatorio in età geriatrica.

The authors, after reporting the data concerning the increase of the average length of life and the increment of the population in geriatric age, studied the different aspects of the surgical risk. They consider the age, the existence or absence of associated diseases, the situation of the different organs or apparatuses, and the possibility to correct, in preoperative stage, the different functional unbalances remarked. At last, after confirming the conception whereby age for itself does not represent a specific factor of risk, they emphasize the importance of a multidisciplinary cooperation in the assistance to old patients, both during intervention and in the postoperative course.