Predictors of menopausal hot flashes.

There are limited data on the factors associated with menopausal hot flashes, a common and potentially morbid condition. The objective of this study was to identify predictors of menopausal hot flashes. To meet this objective, 233 naturally perimenopausal or post-menopausal women (ages 45-65) attending a large urban hospital center primary care clinic, mammography unit, or women's health practice were enrolled. The women responded to a self-administered questionnaire assessing selected demographic factors, reproductive history, and behavioral factors. Sixty-seven percent of respondents experienced hot flashes, with 63% reporting frequent hot flashes (at least one hot flash per day) and 60% with hot flashes describing the hot flashes as severe. Women with hot flashes were significantly more likely to have mothers who experienced hot flashes (OR = 4.4, CI = 2.0-10.0) or to be smokers (OR = 2.0, CI = 1.2-3.5). There were no statistically significant associations between hot flashes and other selected demographic, reproductive, or behavior characteristics. These results reveal that menopausal hot flashes are associated with a maternal history of hot flashes as well as with cigarette smoking. These results may help physicians to counsel their patients about smoking cessation.

Primary care internal medicine training and women's health.

In this study, directors of primary care residency programs were sent a questionnaire that asked for information about their program and examined their perceptions of program curricula and resident mastery of seven preselected topics in women's health. An elective ambulatory gynecology experience was offered in 52% of programs, and 35% of programs had all residents experience such a rotation. All seven selected topics were felt to be important for residents to master, but the prevalence of structured teaching experiences and resident mastery for each topic varied widely. For the majority of programs, domestic violence was not a curricular component. However, 44% of respondents spontaneously commented that they were expanding their curriculum in the area of women's health.

[Prevention of postoperative complications in vertebro-spinal cord pathology]. / Prevenzione delle complicanze post-operatorie nelle patologie vertebro-midollari.

In 352 patients, affected by vertebral-medullary pathology, we evaluated the role played by the prevention or by the treatment of postoperative complications. We also evaluated their influence on the clinical outcome and neurological recovery. In every case we recorded a scrupulous post-operative neurological monitoring of the eventual complications, on the basis of the type, gravity and duration. From our results it appears that the complications, mostly secondary to infectious diseases, have an influence on the clinical and neurological recovery. We highlight the importance of an adequate nutritive management to prevent the complications, specifically those secondary to infectious diseases and cutaneous lesions.

Clinical, morphometric and ultrastructural aspects in a new model of spinal cord compression.

A new model of spinal cord compression is presented. Forty-two New Zealand albino rabbits weighing between 1.2 and 1.5 kg were submitted to spinal cord compression to about half of its normal diameter by vascular Sugita's clip to different compression time (sham, 5-10-20 minutes e 1-6-12 hours) and sacrified after 72 hours. The consequent neurological dysfunction size of lesion was graded by Tarlov's scale for voluntar motility. Ultrastructural and morphometrical studies were carried out to evaluate changes in shape, perimeters, axonal and myelin areas of the lateral and the posterior tract of spinal cord. A 10 minute decrease of 50% of the transverse diameter of the spinal cord causes a defined damage. The swelling of myelin is a useful index of the importance of the damage.

Brain metastases: surgical versus conservative treatment.

A comparative study on surgical versus conservative brain metastases treatment has been carried out. Patients have been divided in seven groups by means of treatment modalities. Follow-up, has been carried out taking into consideration mean survival time and quality life in particular, evaluated by means of Order's classes. Anaesthesiological management problems were discussed also. From data analysis, it follows that untreated patients, (group 1) had a lower mean survival time than that of the other patients. Thirty days after first evaluation, 85% of these patients had a very poor quality life. Patients who underwent surgery associated to radio and chemotherapy (group 2) have had better recovery of functional autonomy and longest mean survival time. Among these, thirty days after treatment only 3% had a very poor quality life, while 67% had the better quality life. Patients who underwent others treatment modalities had intermediate results.

Clinical skills problems. A valid instrument for assessing competence?

Physician assistants are required to take the clinical skills problems (CSP) portion of the National Certifying Examination administered by the National Commission on Certification of Physician's Assistants (NCCPA). No comparable section exists in entry-level physician certification examinations because studies have shown that this type of examination is neither a valid nor a reliable indicator of clinical competence. A published account of the studies used to implement the CSP portion of the National Certifying Examination contained serious flaws, calling the research into question. Denial of certification based solely on failure on the CSP portion of the National Certifying Examination could be challenged legally. The CSP is invalid and unreliable, and should be eliminated.

Epidural spinal meningioma. Role of magnetic resonance in differential diagnosis.

A rare case of an extradurally growing spinal meningioma in an elderly woman is reported. Neuro-imaging, particularly magnetic resonance (MR), allowed to recognize the lesion, which, otherwise, could raise problems of differential diagnosis with a spinal metastasis. An emergency operation, required by a sudden neurological deterioration, was decisive in recovery of neurological deficits. In a review of the literature, extradurally growing spinal meningiomas appear to occur with a higher frequency than it is thought. Therefore, they are to be suspected when dealing with extradural spinal lesions.

[Early stabilization in severe cervical vertebral and spinal cord injuries]. / La stabilizzazione precoce nei gravi traumi vertebro-midollari cervicali.

In the cervical vertebral-myelic trauma a high incidence of bronchopulmonary, metabolic, thromboembolic complications and bedsores is present. The authors, in agreement with the most recent literature (Tator, 1987), affirm that adoption of the precocious stabilization, allowing an equally precocious mobilization, considerably reduces the above-said complications. Thirty patients with vertebral-myelic lesions needing operation for stabilization have been followed. Twenty-one of these, presented irreversible myelic damages and nine cases had partially or completely reversible damages. Only in five cases severe bronchopulmonary affections and bedsores occurred. Thrombo-embolic complications did not occur. The authors conclude that the precocious mobilization allowed by the stabilization realized in acute state, permits a drastic decrease in the complications typical of this kind of affections.

[Considerations on the follow up of the hydrocephalic child]. / Considerazioni sul follow-up del bambino idrocefalico.

The AA. underline the evolution of the neuropsychiatrical approach to the shunt-dependent child and the need of constant and long lasting clinic monitoring to prevent or reduce possible deficit. Moreover they wish in this case a multicentric collaboration outlineing the notable importance. They tell, then, as a explication, their personal experience of follow-up about 49 cases.