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Lecco, Italy

Damiani G.R.,University of Bari | Gaetani M.,University of Bari | Landi S.,Hospital of Sondrio | Lacerenza L.,University of Bari | And 3 more authors.
International Journal of Surgery Case Reports | Year: 2013

Introduction: Uterine rupture (UR) in early pregnancy in nulliparous women is a rare and unpredictable occurrence with high maternal morbidity and fatal fetal outcomes. Intrauterine anomalies could be the primum movens of this dangerous condition and underestimated in the literature. Presentation of Case: An uncommon case of uterine rupture at the 23rd week of gestation in a nulliparous woman, who became pregnant before the resection of an uterine septum. To provide more insight into the possible risk factors, a literature review was performed. Discussion: Loss of pregnancy is common, despite prompt uterine repair. In all cases reviewed abdominal pain characterized by indistinct vague symptoms constitutes the initial symptom of this obstetrical life threatening condition. Conclusion: The current case highlights the association of curettage and septate uterus as a risk factor for UR in the second trimester of pregnancy. It's reasonable that obstetricians must take into account that common gastrointestinal tract problems might be an indicator of the initial weakness of uterine wall leading to the rupture, which is unpredictable all of cases reviewed. © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

De Socio G.V.,Azienda Ospedaliero Universitaria di Perugia | Parruti G.,Pescara Hospital | Ricci E.,Luigi Sacco Hospital | Maggi P.,University of Bari | And 8 more authors.
AIDS | Year: 2014

Cardiovascular risk profile was compared in 765 Italian HIV-infected outpatients enrolled in 2005 and in 765 individually age-matched and sex-matched patients enrolled in 2011. Median Framingham risk score was 8.6% in 2005 vs. 7.9% in 2011 (PS=S0.04); metabolic syndrome was present in 40.3% vs. 33.4% (PS=S0.006). Blood glucose, triglycerides, prevalence of smokers, and lipodystrophy were all significantly lower in 2011 (all PS0.0001). Cardiovascular risk improved over a 6-year period in Italian HIV-infected patients. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Bonaiuti D.,S. Gerardo Hospital | Sioli P.,S. Gerardo Hospital | Fumagalli L.,San Gerardo Hospital | Beghi E.,Istituto di Ricerche Farmacologiche Mario Negri | Agostoni E.,Manzoni Hospital
Neurological Sciences | Year: 2011

Acute medical complications often prevent patients with stroke from being transferred from stroke units to rehabilitation units, prolonging the occupation of hospital beds and delaying the start of intensive rehabilitation. This study defined incidence, timing, duration and risk factors of these complications during the acute phase of stroke. A retrospective case note review was made of hospital admissions of patients with stroke not associated with other disabling conditions, admitted to a stroke unit over 12 months and requiring rehabilitation for gait impairment. In this cohort, a search was made of hypertension, oxygen de-saturation, fever, and cardiac and pulmonary symptoms requiring medical intervention. Included were 135 patients. Hypertension was the most common complication (16.3%), followed by heart disease (14.8%), oxygen de-saturation (7.4%), fever (6.7%) and pulmonary disease (5.2%). Heart disease was the earliest and shortest complication. Most complications occurred during the first week. Except for hypertension, all complications resolved within 2 weeks. © 2011 Springer-Verlag.

De Luca G.,University of Piemonte Orientale | Savonitto S.,Manzoni Hospital | Van't Hof A.W.J.,Isala Hospital | Suryapranata H.,Njimegen University
Drugs | Year: 2015

Coronary artery disease and acute myocardial infarction still represent the leading cause of mortality in developed countries. Therefore, great efforts have been made in the last decades to improve reperfusion strategies and adjunctive antithrombotic therapies. In fact, despite optimal epicardial recanalisation, a large proportion of patients still experience impaired reperfusion and in-stent thrombosis. The adjunctive use of glycoprotein (GP) IIb-IIIa inhibitors may certainly contribute in the reduction of such complications, especially when administered in the early phase of infarction. In fact, in this phase a larger platelet composition of the thrombus and the presence of a larger amount of viable myocardium, as compared to a delayed phase, may increase the benefits from this therapy and counterbalance the potential higher risk of bleeding. A large body of evidence has been accumulated on the benefits from GP IIb-IIIa inhibitors in terms of prevention of stent thrombosis, and benefits in mortality, especially among high-risk patients and as upstream strategy. Therefore, based on current available data, GP IIb-IIIa inhibitors can be recommended as early as possible (upstream strategy) among high-risk patients, such as those with advanced Killip class or anterior myocardial infarction (MI), and those presenting within the first three hours. Even though it is not universally accepted, in our opinion this strategy should be implemented in a prehospital setting (in ambulance) or at first hospital admission (Emergency Room or Coronary Care Unit, irrespective of whether they are in the spoke or hub hospitals). Peri-procedural intracoronary administration of GP IIb-IIIa inhibitors has not provided additional benefits as compared to intravenous administration and therefore cannot be recommended. Even though the vast majority of trials have been conducted with abciximab, several meta-analyses comparing small molecules (mainly high-dose tirofiban rather than eptifibatide) versus abciximab showed similar angiographic and clinical results between the molecules. Several recent investigations and meta-analyses have documented the higher risk of stent thrombosis associated with bivalirudin as compared to unfractionated heparin (UFH). Being that these results are independent from the use of GP IIb-IIIa inhibitors, UFH should still remain the anticoagulation therapy of choice in ST-segment elevation myocardial infarction (STEMI) patients. Minimisation of bleeding complications by extensive use of the radial approach, in the setting of STEMI, may further contribute to the adoption of a more aggressive antithrombotic and antiplatelet therapy incorporating the use of GP IIb-IIIa inhibitors. The establishment of dedicated networks for STEMI, and the large STEMI campaign, will certainly contribute to increase the proportion of patients presenting at first medical contact within the early phase (3 h) of infarction and therefore highly suitable for a more aggressive pharmacoinvasive approach with upstream administration of GP IIb-IIIa inhibitors. In fact, although the current therapeutic targets of increased rates of timely reperfusion, mainly by primary percutaneous coronary intervention (PCI), has been achieved, a deep look into the future in the fight against MI will certainly put aborting infarction as the major desirable target to be achieved.

Zanini A.,Sacra Famiglia Hospital | Lissoni D.,San Gerardo Hospital | Andreotti C.,Sacra Famiglia Hospital | Spreafico C.,Sacra Famiglia Hospital | And 4 more authors.
Italian Journal of Gynaecology and Obstetrics | Year: 2013

The caesarean section (CS) rate in Italy has increased to alarming figures, raising form 11% in 1980 to 38% in 2008. In addition there is a significant difference in the CS rate among various Italian Regions and different hospitals. Data from the birth assistance certificates for the year 2009 in Lombardia show 98871 deliveries occurring in 76 hospitals: 28 had a number of deliveries/ year less than 800; 29 had a number of deliveries/year between 800 and 1600; 19 had more than 1600 deliveries per year. Two hundred and twenty seven cases were excluded because of incomplete or incorrect data. The number of physiological nulliparae, belonging to Robson Class I, is higher in the delivery units with more than 1600 deliveries/year (33.6% vs 30.5% e 31.9%). Hospitals with a number of deliveries/year less than 800 have a CS rate in the Robson Class I significantly superior compared to both delivery units with 800-1600 deliveries/year and to delivery units with more than 1600 deliveries/year (16.2% vs 12.0% e 11.1%). These data highlight the many critical areas including organizational, cultural, clinical management aspects of labour wards with less than 800 deliveries/year. © 2014, CIC Edizioni Internazionali, Rome.

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