[Managing waiting lists outpatients clinic. An experience in ASL 4--Turin]. / I tempi di attesa per le prestazioni ambulatoriali: la gestione nell'esperienza dell'ASL 4 di Torino.

Waiting lists issue is one of the main matters of every public health system. The aim of this study is to design a pathway in the Local public health authority 4 in Turin (Piedmont Region, Italy) as far as waiting lists management of outpatient service is concerned between 2004 and 2006. This study emphasizes a new approaching methodology based on: a) clearly defined criteria of clinic priorities to accessing public health facilities; b) working groups composed by a representing member of the District, one or more medical and general practitioners representing different equipe; c) monitoring priority criteria as objectives to both medical practitioners and equipe in order to assess them at the end of the year Results are encouraging because equipe correctly applied defined priority criteria so that they reached objectives improving their performance during considered period (66.3% of conformity with "U", "B" and "D" codes in 2006 and 84.2% with all codes, improving the value of 81.3% in the past year).

[Intestinal occlusion caused by Morgagni-Larrey diaphragmatic hernia]. / Occlusione intestinale da ernia diaframmatica di Morgagni-Larrey.

Morgagni-Larrey's hernias, which are both infrequent and generally asymptomatic, are often diagnosed by chance during routine diagnostic tests performed for other pathologies. Usually congenital in adults, they are often small or only take the form of a pre-hernia lipoma. Intestinal occlusion is rarely described and frequently entails diagnostic difficulties before hydroaerial levels are demonstrated in the thoracic region. In these cases, surgery using an abdominal approach should be preferred in order to treat compressed abdominal viscera at the same time and to exclude the bilateral nature of the lesion. The authors present two cases of an adult man and woman who were referred to their attention for occlusive pathologies. Both were operated using a laparotomy approach. The reduction of abdominal viscera did not present any difficulties. The hernial sac was only removed in the first patient. Plastic surgery was completed by attaching the diaphragmatic flap to the costal and sternal wall using separate non-reabsorbing suture stitches. No complications were reported.

[Carcinoid of the cecal appendix]. / Il carcinoide dell'appendice cecale.

Carcinoid tumors are infrequent but not exceptional neoplasias. The gastroenteric tract is affected in 80% of cases and almost half of these involve the appendix where they almost always represent an occasional finding after appendicectomy due to acute or subacute appendicitis. Although they have a low malignancy potential in this site, with a reduced index of metastasization and scant capacity to determine clinical symptoms, they are of considerable clinical importance in view of the prognostic and therapeutic type problems that their diagnosis entails. The authors report the case of a female 14-years-old patient, operated for acute appendicitis, and the finding of a yellowish hard tumefaction with a diameter of around 2 cm near the appendicular cone which histological tests showed was a relatively benign classic carcinoid.

[The radical treatment of sacrococcygeal pilonidal cysts]. / Il trattamento radicale della cisti pilonidale sacrococcigea.

Sacrococcygeal pilonidal disease may take a variety of forms: a silent chronic form, acute with abscess and a chronic or acute form with fistula. In the acute form surgery consists of the incision and evacuation of the purulent matter, postponing definitive surgery to a second phase, which is not always necessary, considering that in 60% of cases patients do not manifest any further symptoms. The final operation may be performed using a closed, semi-closed and open technique. The authors performed a retrospective review of 64 patients, including 44 males and 20 females. 75% of operations were performed using an open method, 22% with a closed method and 3% with a semi-closed method. Recidivations using the open method amounted to 8% (6% with a single recidivation, 2% with two recidivations), and 14% with the closed method. Average hospital stay was 5.8 days with the open method and 7.3 with the closed method. Patients operated using the open method were discharged after two or three days and dressings were applied using gauze soaked in Betadine solution after cleaning with hydrogen peroxide. The scar was fully formed in around 45 days.

[Chyloperitoneum after traumatic rupture of subdiaphragmatic thoracic duct. A clinical case]. / Chiloperitoneo da rottura traumatica del dotto toracico sottodiaframmatico. Caso clinico.

Chyloperitoneum following traumatic rupture of the subdiaphragmatic thoracic duct is a very rare lesion and in fact no case was found when reviewing the last five years of international literature. The authors report a case of traumatic chyloperitoneum caused by a penetrating sidearm wound in a young 19-year-old woman. Emergency exploratory laparotomy enabled the precise identification of the site of the thoracic duct lesion and to proceed to its immediate suture. At one year after the operation the patient is in good health.

[Our experience in the surgical treatment of perforated peptic ulcer]. / La nostra esperienza nel trattamento chirurgico dell'ulcera peptica perforata.

The authors report their experience in the treatment of perforated peptic ulcer. From August 1992 to December 1995 a total of 23 patients (14 cases of gastric ulcer and 9 cases of duodenal ulcer), mean age 67.5 years, underwent emergency surgery for perforated peptic ulcer. The operations performed included: simple gastrorrhaphy in 19 cases (11 for gastric ulcer, 8 for duodenal ulcer); gastrorrhaphy with pyloroplasty + GEA in 1 case of gastric ulcer; gastrorrhaphy with pyloroplasty in 2 cases (1 for gastric ulcer, 1 for duodenal ulcer); gastric resection in 1 case of gastric ulcer. One case of perioperative mortality occurred, equivalent to 4.3%, whereas the percentage of complications observed was 13% (2 cases of IRA, 1 case of wound infection). The mean age of patients (67.5 years) and the high percentage of associated major pathologies (39.1%) oriented the choice of therapy towards ulcerorrhaphy. In the authors' opinion this rapid and easy to perform method represents the best treatment of perforated peptic ulcer; the validity of ulcerorrhaphy is confirmed by the reduced mortality (4.3%) and the low percentage of morbidity (13%) found in this series.

[Rare venous pathology: Mondor's disease]. / Una rara patologia venosa: la malattia di Mondor.

A case of Mondor's disease is described. They remark etiopathogenesis and clinical signs of this rare disease that affects thoraco-epigastric vein or one of its confluents. They point to the benignity of the disease that tends to evolve to a spontaneous healing in a few weeks. Authors confirm the advisability of performing appropriate exams to exclude malignancies of the breast.

Diagnostic delay, clinical stage, and social class: a hospital based study.

STUDY OBJECTIVE: To measure delay in admission to a large hospital and to study the role of social class and other potential determinants of delay. DESIGN: Interview of a 10% sample of newly diagnosed patients admitted to medical or surgical wards, and all those admitted for external hernia or colon cancer between June 1989 and May 1990. SETTING: The largest hospital in an Italian region of five million inhabitants. SUBJECTS: The study population consisted of 330 patients with a range of different medical and surgical conditions, 83 patients with external hernias, and 97 patients with colon cancers. MEASUREMENTS AND MAIN RESULTS: After patient interview and discharge from hospital, the clinical record was consulted for information on the length of stay and the diagnosis, and in particular for the staging of hernia or colon cancer (according to the protocol of the Jefferson Medical College). Multiple logistic regression was used to estimate odds ratios and 95% confidence intervals. There was an association between advanced disease at hospital admission and the patient's educational level. In each of the three groups of patients, those with the highest educational level had a 30% or lower probability of being admitted to hospital with advanced disease compared with those with the lowest education level (after allowance for sex, age, area of residence, and marital status). CONCLUSION: Lower social class was associated with a more advanced clinical stage of hernia or colon cancer, and with a higher probability of urgent admission to the hospital for a newly diagnosed disease. Delay in seeking care, did not however, seem to explain the social class differentials for disease stage.

[Use of house dust extracts in allergological diagnosis and therapy]. / Considerazioni sull'uso degli estratti di polveri domestiche nella diagnostica e nella terapia allergologica.

In this study (1980-1987) the Authors considered the incidence of sensitization to house dust in patients with respiratory allergic disease. The Authors identified 399 subjects with sensitization to house dust out of 1825 subjects sensitized to at least one of the tested allergens (21.9%). The number of patients exclusively sensitized to house dust resulted very small (13 patients, 0.7%). Most frequently the Authors identified sensitization to house dust and mites (324 patients, 81.2%). Bronchial asthma resulted in 156 patients (39.1%). These results are similar to those recognized in subjects with mites sensitization. The conclusion is drawn that, at the moment, mites are the only house dust allergens with clinical importance.

[Housedust mites: their importance in the pathogenesis of respiratory allergic diseases in Piedmont]. / Acari della polvere domestica: loro importanza nella patogenesi di malattie allergiche respiratorie in Piemonte.

In this study we have considered the importance of house dust mites (Dermatophagoides farinae and pteronyssinus) in the pathogenesis of respiratory allergic diseases in Piedmont. We have identified, from 1980 to 1986, 1530 subjects with sensitization to at least one of the tested allergens; 479 of these (31.3%) were allergic to both or to one of the tested mites. Particularly 97 subjects (6.3%) were sensitized to Dermatophagoides farinae, 73 (4.8%) to Dermatophagoides pteronyssinus and 309 (20.2%) to both of them. This group included 258 males (53.9%) and 221 females (46.1%). Most of the examined subjects had shown the clinical symptoms before the 35th year of age (366 subjects, 76.4%). The mean age of beginning of clinical picture has come out to be of 27.377 +/- 11.527 SD year old. This result shows no significant differences with the mean age come out in allergic subjects to other allergens (26.939 +/- 10.755 SD); 196 subjects (40.9%) presented rhinitis-conjunctivitis, while 102 subjects presented bronchial asthma-rhinitis-conjunctivitis. We have found that bronchial asthma (alone or with other symptoms) was present in 186 subjects (38.8%), while in the allergic subjects sensitized to other allergens was present only in 299 out of 1051 (28.4%); 277 subjects had continuous symptoms (57.8%) while 202 subjects (42.2%) had symptoms only in some periods of the year.

[Evaluation of the prognostic value of certain biological indices in acute pancreatitis]. / Valutazione del valore predittivo di alcuni indici biologici nella pancreatite acuta.

After a review of the aetiological, clinical and diagnostic aspects of acute pancreatitis, personal experience is reported of the prognostic indications supplied by the analysis of certain simple haematic parameters. The reliability of the results is confirmed. This technique will be used in a personal diagnostic and therapeutic protocol as a means of early identification of patients at the greatest risk.

[Computerized methods in the diagnosis and prognosis of surgically treated bilio-pancreatic diseases]. / Metodi computerizzati per la diagnosi e la prognosi delle malattie bilio-pancreatiche di interesse chirurgico.

Multivaried and trend analyses were applied to a set of 27 periodic haematochemical checks on 37 patients given surgery for biliopancreatic pathology. Preoperative and postoperative data were separately analysed. The software employed was specially designed for the purpose. The discriminating function was used in the preoperative period to establish the best moment for diagnosis, which turns out to be 5 days after admission to hospital. Variance and regression analyses were used for short term prognosis by calculating survival chances. In one case the prognosis turned out to be distinctly inaccurate.