Clinical presentation and epidemiology of brain tumors firstly diagnosed in adults in the Emergency Department: a 10-year, single center retrospective study.

BACKGROUND: Several patients with new onset brain tumors present to the Emergency Department (ED) complaining for new symptoms. Although information exists on symptom prevalence in the entire population of patients with brain tumors, little is known about the clinical presentation in ED. This retrospective study was planned to investigate clinical presentation and epidemiology of brain tumors firstly diagnosed in a large urban ED throughout a 10-year period. METHODS: All medical records of patients aged ≥18 years, discharged from our ED with a diagnosis of brain tumor were retrieved from the electronic hospital database during a 10-year period (2006 to 2015). The records were reassessed for selecting only brain tumors firstly diagnosed in the ED. The symptoms at presentation were divided in six categories: (I) headache; (II) seizures; (III) focal signs; (IV) altered mental status; (V) nausea/vomiting/dizziness; (VI) trauma. For all cases, the hospital record was retrieved, to obtain histologic classification of tumors. Patients with inflammatory neoformations were excluded from the study. RESULTS: Overall, 205 patients with firstly diagnosed brain tumor were identified among 870,135 ED visits (i.e., <1%). Glial tumors were the most frequent (50% of the entire sample). No significant differences were found between mean age of patients in the different histologically based groups (meningiomas 66±14; glioblastomas 65±16 years; metastases 66±13 years; other miscellaneous 66±19 years). Focal signs accounted for more than 50% of all presentation signs/symptoms. CONCLUSIONS: First presentation of brain tumor in the ED is not a rare occurrence, so that the emergency physicians should be aware of this possibility.

A prospective case-control clinical trial comparing 1- and 2-stage Nobel Biocare TiUnite implants: resonance frequency analysis assessed by Osstell Mentor during integration.

OBJECTIVE: To compare implant stability between 1- and 2-stage Nobel Biocare TiUnite implants at various points of time after placement. METHOD AND MATERIALS: Thirty patients were enrolled according to specific selection criteria to 1- or 2-stage treatment. Nineteen patients received 35 1-stage early loaded implants, and 10 patients received 26 2-stage early loaded implants. A total of 32 Branemark System MKIII Groovy and 29 NobelSpeedy Groovy implants were placed in the premolar and molar areas. Implant stability was assessed, in both groups, by means of the Osstell Mentor device at the time of implant placement and at 8 and 12 weeks. All patients were monitored from implant placement until 6 months of function. RESULTS: One 1-stage complicated implant showed discontinuous measurements, and this patient was excluded from the analysis. In the maxilla (31 implants), there was no significant difference for implant stability quotients between the groups at any point (P > .05). In the mandible (29 implants), there was no significant difference for ISQ between the groups at baseline or 8 weeks (P > .05); however, a significant difference was found after 12 weeks (P = .0261). No implant failed between surgery and the end of the study, and there was an overall survival rate of 100%. CONCLUSION: High ISQ values were found in both groups at each time point. One-stage technique is a viable alternative to 2-stage technique. The utilized implants seem to be suitable for early loading in both arches. NobelSpeedy Groovy showed a higher primary anchorage, especially in the maxilla.

Management of primary headaches in adult Emergency Departments: a literature review, the Parma ED experience and a therapy flow chart proposal.

Adults seeking treatment at hospitals' Emergency Departments (EDs) because of headache represent a major health-care issue. To date, there are no special guidelines for management of primary headache in adults seen at EDs and therapeutic approaches are often inconsistent. This review describes the therapeutic strategies that are most frequently used to treat primary headache in adult ED patients and their in situ efficacy, based on literature data, the type of medications studied in randomized clinical trials for the management of adult ED patients, and the recommendations found in the guidelines for symptomatic treatment of migraine. We also report on the experience of the Parma University Hospital ED in the year 2007 for the management of adult patients diagnosed with primary headache. Finally, we propose an algorithm for primary headache management in ED patients, which is based on the literature data and clinical experience, and is suitable for application in Italy.

[The indication to statin therapy in primary prevention patients with dyslipidemia: implications for using national risk functions in the Italian population]. / L'indicazione alla terapia con statine nel paziente dislipidemico in prevenzione primaria: implicazioni dell'uso di funzioni di rischio specifiche per la popolazione italiana.

BACKGROUND: Risk functions for cardiovascular risk estimation, specific for the Italian population, have recently been developed. It is possible that using them, instead of the Framingham algorithm, to assess risk and define the indication to cholesterol-lowering therapy might substantially change the rate of statin prescription in primary prevention. METHODS: In this study, two different national risk functions, the CUORE Project algorithm and the risk function incorporated in the software Riscard 2002, have been compared to the Framingham algorithm in a cohort of 517 dyslipidemic asymptomatic patients consecutively addressed to a lipid clinic. Contingency tables and kappa value estimation have been used to assess the extent of concordance between them in classifying patients into risk categories, as well as in identifying among them those deserving statin therapy, according to two different sets of guidelines, such as the Adult Treatment Panel III and the reimbursement criteria for statins set by the Italian National Health System. RESULTS: Both national algorithms gave lower risk estimations, in comparison with the Framingham algorithm. A low concordance was found even between the two national algorithms, with lower risk estimates by Riscard 2002. As a consequence, less patients were selected for treatment according to national risk functions. However the prescription rate was more strongly affected by the set of guidelines used to assess the indication to treatment, independent of the method used to estimate risk. CONCLUSIONS: Our study confirms that using different risk functions can substantially change risk estimation in dyslipidemic patients, with some implications for statin prescription rate. However, the latter is mainly influenced by the set of guidelines used to identify patients for treatment. Furthermore, the two national algorithms so far available for risk estimation in the Italian population strongly differ in risk estimates, suggesting the need for further testing their accuracy.