Functional recovery following a second hip fracture.

AIM: Patients who have a fracture of the hip, usually are considered at a risk of fracturing the contralateral hip. This risk, not sufficiently addressed to in literature, becomes increasingly important in the light of increasing longevity of the population. In this retrospective study, we present some of our epidemiological and post-operative data on limb function in a group of our patients. METHODS: We examined the database of our patients over 50 years of age, admitted at our hospital in the last 9 years for fracture of the proximal third part of the femur bone. These patients did not have a history of neoplasms or severe multitrauma. The variables considered were: unilateral or bilateral fracture, age, sex, the level of physical activity before trauma (MET scale), the severity of the trauma, fracture site (cervical or trochanteric), the type of surgery and the level of functional autonomy (FIM scale) at time of discharge. RESULTS: A total of 2 771 patients were identified. Bilateral fractures were present in 7.58% (n=210). Among bilateral fractures, the female to male ratio was 1 to 7.08 and the site of the contralateral fracture remained similar to the original site. In more than 48%, the second fracture occurred in patients over 85 years of age. The most common causes of both bilateral and mono lateral fractures, were either a moderate trauma or a fall in domestic premises. Cervical fractures were treated with cemented endoprothesis of the hip while for trochanteric fractures osteosyntesis with endomedullar nails were used. After the second fracture, the level of functional autonomy was found to be significantly reduced (FIM score mean difference +/-SD of 16.77+/-10.72) and the number of non deambulatory patients were tripled. Furthermore, these patients were found to be more sedentary, before the second fracture, as compared to the ones with only one fracture. CONCLUSIONS: Bilateral fractures of the femur neck bone is still considered to be a rare event. The second fracture seems to be more frequent in sedentary women over 85 years of age. More often, the second fracture is caused by a simple domestic accident. Due the increasing age of the population, in future this event might become statistically relevant. The drastic decrease in post-operative functional autonomy in such patients might become a serious socio-economic and welfare policy problem. It is advisable to render domestic premises less hazardous and intense and prolonged postoperative physical rehabilitation treatment must be continued after discharge.

Sexual dysfunction in multiple sclerosis: a case-control study. I. Frequency and comparison of groups.

Sexual dysfunction is a very important but often overlooked symptom of multiple sclerosis. To investigate the type and frequency of symptoms of sexual dysfunction in patients suffering from multiple sclerosis, we performed a case-control study comparing 108 unselected patients with definite multiple sclerosis, 97 patients with chronic disease and 110 healthy individuals with regard to sexual function, sphincteric function, physical disorders impeding sexual activity and the impact of sexual dysfunction on social life. Information has been collected from a face-to-face structured interview performed by a doctor of the same gender as the patient. The disability, the cognitive performances, the psychiatric conditions and the psychological profile of patients and controls have been assessed. Sexual dysfunction was present in 73.1% of cases, in 39.2% of chronic disease controls and in 12.7% of healthy controls (P<0.0001). Male cases reported symptoms of sexual dysfunction more frequently than female cases (P<0.002). Symptoms of sexual dysfunction more commonly reported in patients with multiple sclerosis were anorgasmia or hyporgasmia (37.1%), decreased vaginal lubrication (35.7%) and reduced libido (31.4%) in women, and impotence or erectile dysfunction (63.2%), ejaculatory dysfunction and/or orgasmic dysfunction (50%) and reduced libido (39.5%) in men. Seventy-five per cent of cases, 51.5% of chronic disease controls and 28.2% of healthy controls (P<0.0001) experienced symptoms of sphincteric dysfunction. In conclusion, a substantial part of our sample of patients with multiple sclerosis reported symptoms of sexual and sphincteric dysfunction. Both sexual and sphincteric dysfunction were significantly more common in patients with multiple sclerosis than in either control group. Our findings suggest that a peculiar damage of the structures involved in sexual function is responsible for the dysfunction in patients with multiple sclerosis, but the highly significant lower frequency of symptoms of depression and anxiety in healthy controls may also imply a possible causative role of psychological factors.

Sexual dysfunction in multiple sclerosis: II. Correlation analysis.

Sexual dysfunction affects a large part of patients suffering from multiple sclerosis, but some aspects of its clinical presentation and aetiology are not clearly defined yet. In an unselected sample of 108 patients with definite multiple sclerosis we investigated the relationship between symptoms of sexual dysfunctioning and sphincteric dysfunction, patients' and disease characteristics, disability and neurological impairment, psychological and cognitive functioning. Sexual dysfunction directly correlated with presence of physical disorders (r=0.37, P=0.0004), low educational level (r=0.32, P<0.002), disability (r=0.31, P<0.003), age at onset of symptoms (r=0.30, P<0.003), sphincteric dysfunction (r=0.30, P<0.003), age (r=0.30, P<0.004), depression (r=0.29, P<0.005), fatigue (r=0.29, P=0.005), cognitive deterioration (r=0.26, P<0.01), primary-progressive course of disease (r=0.25, P<0.02), neurological impairment (r=0.25, P<0.02), marriage (r=0.24, P<0.02), anxiety (r=0. 23, P<0.03), male gender (r=0.22, P=0.03) bladder dysfunction (r=0. 29, P<0.04), and unemployment (r=0.21, P<0.04). Sexual dysfunction correlated inversely with relapsing - remitting course of disease (r=-0.31, P<0.002). No correlation was found between sexual dysfunction and bowel dysfunction, duration of disease, secondary-progressive course of disease, number and frequency of sexual intercourses in the last year, number of partners, number of exacerbations in the last year, number of months since last exacerbation, masturbation, and fertility. In conclusion, the association between sexual dysfunction and sphincteric dysfunction indicates a common aetiology corresponding to the frequent involvement of the spinal cord in multiple sclerosis, but the concomitant correlation between sexual dysfunction and other variables suggests the possible aetiological role of physical, psychological and sociological factors as well.

Hyperglycemia at ischemic stroke onset as prognostic factor.

To find out whether the high blood glucose values sometimes found in the first stage of ischemic stroke have any prognostic value, we considered 76 patients hospitalized within 24 h of an acute cerebral infarction, documented by CT brain scan and/or necropsy, whose fasting blood glucose was recorded before any treatment was given. The patients were sorted into 3 groups: diabetics, normoglycemic non-diabetics and hyperglycemic nondiabetics. On the CT findings cases with large cortical and/or subcortical infarcts were analyzed separately from those with lacunar infarcts. The clinical symptoms on admission proved to be more severe (p less than 0.02) and 30-day mortality higher (p less than 0.02) among the hyperglycemic non-diabetics, who also showed a highly significant (p less than 0.00001) preponderance of large cortical and subcortical infarcts over lacunar infarcts. Multivariate analysis, which took account of variables of known relevance to the prognosis of cerebral infarction (age, sex, arterial hypertension, severity of the clinical pattern, type of brain lesion), confirmed the statistically discriminant power, in terms of mortality, of belonging to the hyperglycemic nondiabetic group. The results of the study confirm that hyperglycemia at stroke onset in nondiabetic patients is an adverse prognostic factor and suggest that it may be a reaction to stress, depending on the size of the infarcted area.

[Mesoglycan in acute focal cerebral ischemia]. / Il mesoglicano nelle ischemie cerebrali acute a focolaio.

An open, randomized, controlled study including 57 patients with acute cerebral infarct was performed. All the patients, followed and controlled by the same examiner, received, in the first ten days, 24 mg/die i.v. of dexamethasone. 28 patients were also treated with mesoglycan (150 mg/die i.m. for five days and 144 mg/die per os for a further twenty-five days). The differences between the basal and final scores in the mesoglycan group and in the controls were not statistically significant as analysed by the Mann-Whitney U test. The mesoglycan influenced only slightly the laboratory values (PT, PTT, alkaline phosphatase, GOT, GPT, cholesterol and triglycerides, fibrinogen, blood glucose, azotemia and creatinine) performed before the beginning of the treatment, as their changes after thirty days of therapy were in the normal range. The mesoglycan was very well tolerated and no side-effects were observed during the treatment.

[The electroencephalogram and lacunar infarcts]. / Elettroencefalogramma ed infarti lacunari.

The authors compare the conventional EEG of 16 patients with lacunar infarct, 18 patients suffering from subcortical infarct and 59 patients suffering from cortico-subcortical infarct, all confirmed by CT scan. They remark that while among patients with single or multiple lacunar infarct, 62% of the EEG turned out to be normal and 31% showed unilateral abnormalities, among those suffering from subcortical and cortico-subcortical infarct the EEG was normal only in 14% and showed unilateral abnormalities or focal alterations in 74% of the patients (chi square = p less than 0.01). According to these results the authors discuss the EEG's value in the differential diagnosis of lacunar infarcts and the influence on prognosis and on the therapeutical and diagnostic approach of these patients.

[The hematocrit and atherothrombotic cerebral infarcts]. / Ematocrito ed infarti cerebrali aterotrombotici.

The authors compare the hematocrit values of 131 patients suffering from an acute cerebral atherothrombotic infarct, confirmed by CT scan, with those of 165 controls of the same age and sex. Both the analysis of the average by the Student's t test and the comparison between the distribution of frequencies by the chi square test, point out that hematocrit is significantly higher (p less than 0.001) in infarcts than in controls. Dividing patients according to CT scan (negative, lacunar infarct, cortical and/or subcortical infarct), no significant difference in hematocrit levels among the three groups is noticed. The authors confirm the positive association between hematocrit and atherothrombotic cerebral infarct and discuss the possible implications in the prevention and the therapy of cerebral ischemic stroke.