Translation and cultural adaptation of the Italian version of the Paediatric Palliative Screening Scale.

The number of children eligible for Paediatric Palliative Care has dramatically increased over the years, with few tools that can help with early identification. The Paediatric Palliative Screening Scale is a dedicated German, English, and Portuguese screening tool. We aimed to translate and perform a cultural adaptation to the Italian setting of the Paediatric Palliative Screening Scale. This paper was a descriptive observational cross-sectional study. We carried it out in two consecutive steps: (1) translation and back translation and (2) cultural adaptation through a Delphi process. Twenty Paediatric Palliative Care national experts were invited to judge the content and structure of the translated scale and to assess the appropriateness and clarity of each question. Consensus was defined as 70% or more of experts agreeing with each item's appropriateness and clarity. The Italian version of the Paediatric Palliative Screening Scale was obtained after two rounds of Delphi. After the second round of consultation, a substantial increase in experts' consensus was found, especially for questions 1.1, 3.2 and 3.3 (from 56.3 to 93.8%), and reaching more than 83% for all the revised items. CONCLUSIONS: The Paediatric Palliative Screening Scale is a reliable tool that can assist in timely evaluating children who qualify for Paediatric Palliative Care. The tool can be used in Italian healthcare settings with its cultural adaptation. WHAT IS KNOWN: • Despite the lack of early diagnosis techniques, there is a significant increase in the number of children entitled to Paediatric Palliative Care. • A specific screening tool called the Paediatric Palliative Screening Scale determines a child's suitability for paediatric palliative treatment. WHAT IS NEW: • The Paediatric Palliative Screening Scale is necessary to assess the psychosocial needs of patients eligible for Paediatric Palliative Care. The Italian scale has good content and face validity ensuring equivalence between the original and target populations.

3D early embryogenesis image filtering by nonlinear partial differential equations.

We present nonlinear diffusion equations, numerical schemes to solve them and their application for filtering 3D images obtained from laser scanning microscopy (LSM) of living zebrafish embryos, with a goal to identify the optimal filtering method and its parameters. In the large scale applications dealing with analysis of 3D+time embryogenesis images, an important objective is a correct detection of the number and position of cell nuclei yielding the spatio-temporal cell lineage tree of embryogenesis. The filtering is the first and necessary step of the image analysis chain and must lead to correct results, removing the noise, sharpening the nuclei edges and correcting the acquisition errors related to spuriously connected subregions. In this paper we study such properties for the regularized Perona-Malik model and for the generalized mean curvature flow equations in the level-set formulation. A comparison with other nonlinear diffusion filters, like tensor anisotropic diffusion and Beltrami flow, is also included. All numerical schemes are based on the same discretization principles, i.e. finite volume method in space and semi-implicit scheme in time, for solving nonlinear partial differential equations. These numerical schemes are unconditionally stable, fast and naturally parallelizable. The filtering results are evaluated and compared first using the Mean Hausdorff distance between a gold standard and different isosurfaces of original and filtered data. Then, the number of isosurface connected components in a region of interest (ROI) detected in original and after the filtering is compared with the corresponding correct number of nuclei in the gold standard. Such analysis proves the robustness and reliability of the edge preserving nonlinear diffusion filtering for this type of data and lead to finding the optimal filtering parameters for the studied models and numerical schemes. Further comparisons consist in ability of splitting the very close objects which are artificially connected due to acquisition error intrinsically linked to physics of LSM. In all studied aspects it turned out that the nonlinear diffusion filter which is called geodesic mean curvature flow (GMCF) has the best performance.

Stroke rehabilitation pathways and procedures in Italy.

AIM: Rehabilitation pathways and procedures after first stroke vary widely. We wanted to determine in what ways first stroke rehabilitation in Italian rehabilitation centers are similar and in line with the Italian Ministry of Health guidelines and international reports. METHODS: Data from the study, Cerebral Ictus and Rehabilitation: Clinical Indicators and Outcomes, of the Italian Cooperative Research (ICR(2)), on 997 inpatients in 18 rehabilitation centers were analyzed and the rehabilitation procedures were compared. To do this, we compared the variables: onset admission interval, length of stay, intensity of treatment and discharge destination. Statistical analyses were performed using the Kruskal-Wallis test, the post hoc Mann-Whitney U test and the chi squared test. RESULTS: Major differences among the centers were found for onset of admission, length of stay, intensity of treatment and discharge destination, whereas the clinical characteristics and the functional outcomes of the study population were similar. CONCLUSIONS: Our results emphasize the importance of better integration between the acute treatment phase and the rehabilitation teams in reducing the onset admission interval of first acute stroke patients. To define optimal intensity of treatment and length of stay, randomized multicenter studies will be needed.

Complications of internal jugular vein retrograde catheterization.

We report on the incidence of complications of 172 internal jugular vein retrograde catheterizations (IJVRCs) performed on 126 patients. Standard cannulation and X-ray control of the catheter tip placement were performed. Difficulties encountered during the manouvre were registered. Patients with a jugular catheter in place for more than one day had neck echography on catheter removal and one week later. Carotid artery puncture occurred in 20 (12%) cases and lymphatic vessel puncture in one. In 13 (8%) cases IJVRC failed due to difficulties in advancing the guide. X-ray films documented catheter misplacement in 39 (23%) cases: loop into the internal jugular vein in 11 (6%); paravertebral venous plexus cannulated in one; other extracranial jugular afferent cannulated in 4 (2%); catheter tip into the jugular lumen in 10 (6%); catheter tip beyond the jugular bulb in 13 (8%). First neck echography documented: one perivascular hematoma (absent one week later); 3 (4%) jugular vein thrombosis (2 asymptomatic and absent one week later; one symptomatic and still evident one week later). Positive neck echography was not associated with difficulties, length of catheterization, diameter of the catheter. IJVRC is a simple and safe procedure with a low incidence of serious complications.

The utility and cost-effectiveness of D-dimer measurements in the diagnosis of deep vein thrombosis.

BACKGROUND AND OBJECTIVE: The potential utility of D-dimer measurements for the diagnosis of deep vein thrombosis became evident soon after the development of reliable commercial assays. The purpose of this review is to outline some critical aspects affecting cost-effectiveness of D-dimer measurements in the diagnosis of deep vein thrombosis (DVT). METHODS: The authors have been working in this field contributing original papers whose data have been used for this study. In addition, the material analyzed in this article includes papers published in the journals covered by the Science Citation Index and Medline. RESULTS: D-dimer levels are very sensitive to the process of fibrin formation/dissolution occurring with ongoing thrombosis. However, they may not be highly specific for venous thromboembolism as they are influenced by the presence of comorbid conditions potentially elevating plasma D-dimer (cancer, surgery, infectious diseases). In addition, commercially available ELISA assays, although quantitative and reproducible, cannot be used under emergency conditions because they are time-consuming and suited for batch-processing of plasma samples. Recently, new assays have been introduced which permit fast and quantitative D-dimer estimations in individual patients. We have evaluated the utility of two new rapid assays (LPIA D-dimer. Mitsubishi, and VIDAS D-DIMER, bio-Merieux) in combination with compression real-time-B-mode ultrasonography for the detection of deep vein thrombosis in asymptomatic patients following elective hip replacement and in patients with clinically suspected deep vein thrombosis. In both settings, we identified cut-off values with optimal sensitivity which allow exclusion of deep vein thrombosis in a considerable percentage of patients, with substantial sparing of economic resources. In fact, based on a cost-effectiveness analysis, a diagnostic algorithm combining D-dimers measurement and compression ultrasonography would result in cost-savings ranging from 5% to 55% in patients with high or low clinical pretest probability respectively. However, the specificity of D-dimer measurements for deep vein thrombosis was much higher in symptomatic than in asymptomatic patients. Choice of the cut-off value proved to be dependent on the method as well as on the patient populations studied. CONCLUSIONS: The cost-effectiveness of D-dimers measurement in the diagnosis of asymptomatic DVT remains questionable. Conversely, our data strongly support the utility of D-dimers determinations in the diagnosis of symptomatic DVT. In terms of sparing economic resources, the introduction in the clinical laboratory of the rapid quantitative assays would be highly convenient, because they avoid a source of bias in the interpretation of D-dimers results, are easy to perform and do not require dedicated personnel or instrumentation. Prospective management studies validating the utility of D-dimer measurement in the diagnosis of deep vein thrombosis are urgently needed.

[Predictive value of ultrasonography in the study of aortic abdominal aneurysms]. / Valore predittivo dell'ecografia nello studio degli aneurismi dell'aorta addominale.

Several authors have collected a great deal of data in the study of abdominal aorta aneurysm through the swift diffusion of ultrasonography in the abdominal diagnostics. The authors illustrate their experience confirming the excellent reliability of ultrasonography in the diagnosis of abdominal aorta aneurysms with respect to other methods of imaging (Angiography, CAT, etc) not with a view to replacing them but as a useful means of screening.

[Invaginating colonic lipoma as a cause of intestinal occlusion]. / Lipomi del colon invaginanti causa di occlusione intestinale.

The authors describe three cases of single invaginating colon lipoma, causing ileus. They review the literature and make some remarks.

[Unusual case of reappearing biliary ileus in a cholecystectomized patient with late stenosis of ileo-ileal anastomosis]. / Caso insolito di ileo biliare a va e vieni in colecistectomizzato con stenosi tardiva di anastomosi ileo-ileale.

An unusual case of alternating jejunal obstruction, caused by a former latero-lateral anastomosis stenosis, complicated by two stones into the afferent jejunal tract bottom, is described. The anamnestic data of previous cholecystectomy and operative finding of no one biliary fistula clue, make the authors doubtful about a hypothetic calculi migration: it is likely calculi are formed into the bowel.

[Use of the computer in total parenteral nutrition. Our experience]. / Utilizzo del computer nella N.P.T. Nostra esperienza.

The Authors show their method to set up and to plan a T.P.N. for surgical patients. They emphasize how the introduction of the computer in the intensive therapy practice, not only helps the work of the medical corps and the hospital attendants, but it marks and plans again every day the components' dosages on the blood-metabolical alterations, daily checked on the patients. They are here showing their experiences since 1977, appraising in a critical way the directions and the results.

[Lead arsenate as an underestimated cause of polyneuropathy in rural environment: description of two cases]. / L'arseniato di piombo come causa misconosciuta di polineuriti in ambiente rurale: descrizione di due casi clinici

Two cases of lead arsenate polyneuropathy are described in two farmers from the same rural area; the etiology of the neurologic al disorder was ascertained only after repeated hospital admissions. It was a neuropathy of the radial nerve associated with signs of peripheral impairment of the lower limbs with pains and paresthesias. Abdominal colies, arterial hipertension, anaemia and signs of renal impairment were also present. Specific therapy was undertaken which was soon followed by nearly full recovery. Lead and arsenic toxicology are discussed with particular focusing on the necessity emphasis on commun occupational hazards both in terms of diagnostic and therapeutic procedures. The differential diagnosis is considered between the observed clinical picture and other polyneuropathies of different etiology i.e. dysmetabolic (porphyria) or toxic (insecticides, T.O.C.P., etc).

[Gastric acid secretion in the rat following end-to-side porto-caval and mesenteric-caval anastomosis]. / La secrezione gastrica acida nel ratto dopo anastomosi porto-cava termino-laterale e anastomosi mesenterico-cava termino laterale.

Marked gastric acid hypersecretion by comparison with a control group was noted following the collection of samples 2 hr after ligation of the pylorus in rats 20 days after subjection to total portosystemic deviation or deviation of the mesenteric flow only into the vena cava.