Hospital admission rates for distal forearm fractures: an epidemiological survey in patients referred to a large emergency department in Northern Italy.

UNLABELLED: In this survey, the proportion of patients with distal forearm fractures admitted to the Parma University Hospital during 2012 (13 %) was relatively low and generally lower than that reported in other studies. In our region, the main orthopedic approach remains conservative. PURPOSE: The purpose of this study was to define the ratio between hospitalized and non-hospitalized fragility fractures of the distal forearm in our province (Parma, Northern Italy). METHODS: All forearm fractures referred during 2012 to the emergency department of the Parma University Hospital (the main hospital in the province with a catchment area of approximately 345,000) were retrieved from the hospital database using both ICD-9-CM codes and text strings. The diagnosis of distal forearm fracture due to low-energy trauma and the need for hospitalization were individually confirmed by medical records and X-ray reports. The analysis was limited to subjects aged 40 years and over. RESULTS: In both sexes combined, 66 subjects out of 505 were hospitalized (13.1 %; confidence interval (CI) 95 % 10.4-16.3 %), 47 immediately (8.1 %) and 25 (5 %) after a few days. The percentage of cases hospitalized was 12 % in women (CI 95 % 9.2-15.6 %) and 17 % in men (CI 95 % 11.1-25 %; p = 0.16). CONCLUSIONS: The percentage of fragility distal forearm fractures hospitalized in our area is relatively low and generally lower than that reported in other studies.

Factors associated with climacteric symptoms in women around menopause attending menopause clinics in Italy.

OBJECTIVE: To obtain data on correlates of climacteric symptoms in women around menopause attending menopause clinics in Italy. METHODS: Since 1997 a large cross sectional study has been conducted on the characteristics of women around menopause attending a network of first level menopause outpatient's clinics in Italy. A total of 66,501 (mean age 54.4 years) women are considered in the present paper. RESULTS: The odds ratios of moderate and severe hot flashes/night sweats were lower in more educated women and (for severe symptoms only) in women reporting regular physical activity. Depression, difficulty to sleep, forgetfulness and irritability tended to be less frequent in more educated women and (depression only) in women reporting regular physical activity. Parous women reported more frequently these symptoms. CONCLUSIONS: This large study confirms in Southern European population that low education, body mass index and low physical activity are associated with climacteric symptoms. Parous women are at greater risk of psychological symptoms.

Risk factors for type 2 diabetes in women attending menopause clinics in Italy: a cross-sectional study.

OBJECTIVE: To analyze risk factors for type 2 diabetes among women attending menopause clinics in Italy for counselling about the menopause. SUBJECTS: Women attending a network of first-level outpatient menopause clinics in Italy for general counselling about menopause or treatment of menopausal symptoms. METHODS: Cross-sectional study with no exclusion criteria. Type 2 diabetes was defined according to National Diabetes Data Groups Indications and the fasting blood glucose at an oral glucose tolerance test within the previous year. RESULTS: Out of the 44 694 considered in this analysis, 808 had a diagnosis of diabetes type 2 (1.8%). In comparison with women aged < 50 years, the multivariate odds ratios (OR) of type 2 diabetes were 1.31 (95% confidence interval (CI), 0.99-1.74) for women aged 50-52 years, 1.66 (95% CI, 1.27-2.17) at 53-56 years and 2.84 (95% CI, 2.20-3.67) in women aged > or = 57 years. Type 2 diabetes was less frequently reported in more educated women (OR high school/university vs. primary school = 0.44 (95% CI, 0.36-0.55)). Being overweight was associated with an increased risk of type 2 diabetes. In comparison with women reporting a low level of physical activity, the multivariate OR of type 2 diabetes was 0.67 (95% CI, 0.54-0.84) for women reporting regular physical activity. In comparison with premenopausal women, the multivariate OR of type 2 diabetes was 1.38 (95% CI, 1.03-1.84) in women with natural menopause. This finding was present also after allowing for the potential confounding effect of age. The multivariate OR of diabetes for users of hormonal replacement therapy was 0.58 (95% CI, 0.46-0.73). CONCLUSIONS: This large cross-sectional study suggests that postmenopausal women are at higher risk of type 2 diabetes after allowance for the effect of age. Other main determinants of risk of type 2 diabetes in women around menopause were low socioeconomic status and being overweight. Diabetes was found less frequently in those taking hormone replacement therapy.

[The conservative treatment of placenta accreta. A clinical case report]. / Trattamento conservativo della placenta accreta. Descrizione di un caso clinico.

The following description is a clinical case of placenta accreta and its conservative treatment. According to some authors, abnormal adhesion of the placenta depends on the alteration of the equilibrium between the trophoblastic tissue invasion and the reaction of the decidua. Consequently we have various degrees of penetration of the myometrium by chorionic villi into areas of deficit, sparse or absent decidua. Whatever the pathogenetic mechanism, the final clinical picture is slight to deep penetration of the trophoblastic tissue into the uterine wall. That causes absence of the normal plane of cleavage between placenta and maternal decidua, no spontaneous placental detachment during the third stage of labour and no possible manual removal. The patient, primigravida, was admitted at the 36th Week of gestation with PROM and physiologically delivered a neonate weighing 1820 g, after she spontaneously began labour. The newborn was admitted in the neonatal-pathology ward because it was premature although the Apgar score at 1-5 minutes after birth was 5-9. Placental ejection was awaited for 1 hour, then manual exploration of the uterine cavity was undertaken. The normal plane of cleavage between placental tissue and decidua was absent and therefore manual extraction of the placenta was impossible. Surgery was stopped and, after informed consensus was obtained from the patient, a conservative treatment was tried. After cutting the umbilical cord as short as possible and checking for vaginal bleeding, the patient was moved to obstetrics ward.(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute pancreatitis in pregnancy]. / Pancreatite acuta in gravidanza.

This paper describes a case of acute pancreatitis occurring in a patient immediately after delivery and in primigravida. The patient had a family case history of dyslipidemia (Type IV). The pregnancy had been complicated by preeclampsia treated at home with nifedipine tablets (one tablet three times a day) with good results on pressure values; lipidic values were high despite dietary measures taken. The baby at birth weighed 3830 g after physiologic labour and a natural delivery. Acute pancreatitis was diagnosed after observation of epigastralgia with irradiation on the left shoulder, vomiting, symptoms of acute abdomen such as sweating, increased pulse rate, hypotension, abdominal pain on palpation, and absence of peristalsis. An analysis of the blood showed high levels of amylase and hyperglycemia, an increase in XDP, and leucocytosis. Instrumental tests such as pancreatic echography revealed an increase in pancreatic volume, uneven structure of the parenchyma and higher levels of liquid in the peritoneum. The patient was moved to intensive-care, a nasal gastric probe inserted, hydroelectrolytic treatment was begun, vital functions monitored, pain kept under control by medical therapy, and antibiotics administered. Subsequent tests showed an improvement in the parameters of pancreatic functions (amylase, lipase, calcium hematic) and their gradual return to normal values. The computerized tomography of abdomen additionally revealed the presence of pancreatic pseudo-cysts and effusion of peritoneal liquid near the right kidney. The patient was discharged after two weeks in the surgical ward. There are many caused of acute abdomen during and immediately after pregnancy, and one of these is acute pancreatitis, though rare (occurring between 1:3800 and 11.467 according to Rabkin).(ABSTRACT TRUNCATED AT 250 WORDS)

[Hysteroscopic diagnosis in patients with abnormal uterine hemorrhage and previous endometrial curettage]. / Diagnosi isteroscopica in pazienti con sanguinamento uterino anomalo e pregresso curettage endometriale.

Thirty-four patients, with a history of persistent abnormal uterine bleeding and dilatation and curettage or suction curettage performed within the previous year, were evaluated by office hysteroscopy and biopsy. For 16 patients (47%) the hysteroscopic diagnosis was in agreement with the curettage. Hysteroscopy revealed more information in 18 patients (53%): 8 had polyps, 6 had submucous or pedunculated myoma, 2 had endometrial neoplasia, 1 had myoma and polyp, 2 had endometrial neoplasia and 1 had synechia. Moreover in 3 patients with diagnosis of suspected myoma by curettage, hysteroscopy revealed a normal cavity. The high incidence of missed diagnosis of pathologic conditions by "blind" curettage supports the opinion that diagnostic hysteroscopy is the method of choice in the evaluation of abnormal uterine bleeding.

[Delivery after previous cesarean section. Experience with 173 patients]. / Il parto nella precesarizzata. Esperienza relativa a 173 pazienti.

We have taken into consideration the obstetric outcome in 173 women, with prior cesarean section, who were delivered in our hospital between june 1988 and january 1991. This group of patients represented 5.3% of our obstetric population. Overall 64 patients (37%) achieved vaginal delivery and 109 (63%) underwent an iterative cesarean section. Considering the 76 patients (44%) admitted to trial of labour, 64 (84.2%) achieved vaginal delivery and 12 (15.8%) were delivered with iterative cesarean section. No maternal or neonatal complications occurred, even though the silent dehiscence of the uterine scar, found during cesarean section, seems to occur four times (12%) more frequently than that reported in recent literature. It follows that vaginal delivery after prior cesarean section is, in our experience, lacking in risks, and we think that such management may be widely adopted. In 1986 iterative cesarean section represented 35% of cesarean section indications, in 1990 this rate was reduced to 23.7% by the introduction of a policy to allow women to undergo trial of labour.

[Ambulatory hysteroscopic diagnosis. Analysis of 425 cases]. / Isteroscopia diagnostica ambulatoriale. Analisi di 425 casi.

The use of outpatient diagnostic hysteroscopy is discussed with reference to a series of 425 women. The test was performed in an outpatient setting with no form of analgesia, anesthesia or premedication in 385 patients (90.6%); the degree of acceptability was very low (intolerable) in 5.5%, supportable in 15.8% and excellent in 78.7% of patients. Fourty-two per cent of patients were aged between 45 and 54 years old, and the mean age was 47.5 years with a range between 18 and 83 years. The indication for the test was pre- or postmenopausal anomalous uterine bleeding in 74% of patients. Hysteroscopic diagnosis was normal in 56% of cases; endometrial polyps were diagnosed in 11.4% of patients; myomas in 11%; low-risk hyperplasia in 9.9% and malignant tumours in 3.6%. The correlation between hysteroscopic diagnosis and histological tests was above 95% in cases of malignant tumours, atrophy and functional endometrium, whereas it was 67% in cases of low-risk hyperplasia. No accidents or complications related to hysteroscopy were reported.

[Various echographic features in testicular torsion]. / I diversi aspetti ecografici nella torsione del testicolo.

The Authors discuss the informations that can be obtained from sonography in testicular torsion on the basis of 21 patients. The different sonographic features of the twisted testis, which are time-related, are reported and stressed. Ultrasonography is a very sensitive diagnostic tool and can be a useful complement of clinical examination.

[Rupture of the testicle: comparison of the echographic picture and operative findings]. / Fratture del testicolo: confronto fra quadri ecografici e reperti operatori.

9 patients suffering from testicular rupture, owing to blunt scrotal trauma, were examined with ultrasound and then underwent surgical exploration. Sonography correctly diagnosed testicular rupture in 8 patients, 1 false-negative occurred. Clinical examination often is difficult in evaluating testicular trauma, sonography provides a useful tool for improved diagnosis in testicular rupture.

Tissue distribution of drug-metabolizing enzymes in humans.

1. The activities of the ethoxycoumarin O-deethylase (ECOD), epoxide hydrolase (EH), UDP-glucuronyl transferase (GT), glutathione S-transferase (GST), acetyl transferase (AT) and sulphotransferase (ST) were measured in 6 liver, 8 lung, 8 kidney, 8 intestinal mucosa and 22 urinary bladder mucosa specimens from human subjects. EH and GT were studied with styrene oxide and 1-naphthol, respectively, as substrates, GST, AT and ST were studied with benzo(a)pyrene-4,5-oxide, p-aminobenzoic acid and 2-naphthol, respectively. 2. The enzyme activities were detectable at significant rates in liver, lungs, kidneys and gut. In urinary bladder, EH, GT, GST and ST only were detectable. The liver catalyzed the various reactions at higher rates than did other tissues. 3. Of the extrahepatic tissues, the intestinal mucosa contained the highest activities of AT (50% of liver) and ST (30% of liver), whereas kidneys contained the highest activity of GT (50% of liver) and GST (80% of liver). GST was the enzyme with the widest tissue distribution.

Analysis of amniotic fluid proteins by isoelectrofocusing (IEF) in pregnancies complicated by polyhydramnios and Rh-sensitization.

Among the most recent methods for investigation of proteins in biological fluids SDS polyacrilamide-gel-electrophoresis (SDS-PAGE) and isoelectrofocusing (IEF) have recently been introduced into laboratory practice. The present investigation was performed on 14 samples of amniotic fluid obtained during the third trimester in pregnancies complicated by Rh-sensitization and polyhydramnios in which protein concentration was higher than in normal pregnancies. The obtained results suggest that IEF analysis seems to have a selective advantage in allowing the separation of bands which cannot easily be recognized with SDS electrophoresis. These bands detected by IEF and present in amniotic fluid during late pregnancy seem to be related to some molecular weight lipoprotein fractions and we suggest that they might be used as a possible marker for monitoring fetal lung maturation. In conclusion we think that it would be of great interest to evaluate the usefulness of IEF analysis in examining amniotic fluid obtained during pregnancies complicated by polyhydramnios and Rh-sensitization.

Effects of orally administered ritodrine on carbohydrate and lipid metabolism in pregnant patients with abnormal glucose tolerance.

The metabolic effects of a widely used betamimetic agent (ritodrine) were studied in two groups of pregnant patients with abnormal glucose tolerance. No significance modification of various metabolic parameters was detected when the drug was orally administered in standard doses for at least 1 week. The possible reasons for this finding are discussed. Following the absence of any diabetogenic effect, a prolonged use of betamimetics to achieve tocolysis seems to be safe even in patients with metabolic disorders.

Poly-plethysmographic study on the effects of ritodrine on the cardiovascular system of patients in labour.

The effects of ritodrine infusion on the cardiovascular system of six women in threatened or premature labour are reported. In contrast to other betamimetics, ritodrine caused a moderate rise in systolic blood pressure, the corresponding fall in diastolic pressure leading to a widened pulse pressure but no risk of hypotension. Ritodrine caused a rise in cardiac output, and was well tolerated by the patients. Special care should be taken in treating patients with known heart disease.