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Chronic subdural hematoma (CSDH) is a blood collection occoured in the space between dura madre and arachnoid, which is usually a consequence of veins running across dura and cortex surface rupture. Subdural hematoma is very frequent in the elderly and old patients are at high risk of CSDH. Main symptoms and signs are aspecific and are represented by mental confusion and focal neurological disorder. Several disesases and common disorders in the elderly have similar symptoms of CSDH and sometimes they could co-exist and create problems on differential diagnosis. We describe a case of CSDH in a 87-year man affected by advanced-dementia (CDR 2) presenting with fast progression of cognitive functions and focal neurological deficit, successfully treated by neuro-surgery. The aim of our paper is to highlight the major difficulties, especially in old patients affected by multiple chronic diseases and dementia, in CSDH diagnostic-therapeutic process. © 2015, Pacini Editore S.p.A. All rights reserved. Source

Rondanelli M.,University of Sfax | Rondanelli M.,University of Pavia | Opizzi A.,University of Sfax | Opizzi A.,University of Pavia | And 5 more authors.
Journal of the American Geriatrics Society | Year: 2011

OBJECTIVES: To determine whether nightly administration of melatonin, magnesium, and zinc improves primary insomnia in long-term care facility residents. DESIGN: Double-blind, placebo-controlled clinical trial. SETTING: One long-term care facility in Pavia, Italy. PARTICIPANTS: Forty-three participants with primary insomnia (22 in the supplemented group, 21 in the placebo group) aged 78.3±3.9. INTERVENTION: Participants took a food supplement (5 mg melatonin, 225 mg magnesium, and 11.25 mg zinc, mixed with 100 g of pear pulp) or placebo (100 g pear pulp) every day for 8 weeks, 1 hour before bedtime. MEASUREMENTS: The primary goal was to evaluate sleep quality using the Pittsburgh Sleep Quality Index. The Epworth Sleepiness Scale, the Leeds Sleep Evaluation Questionnaire (LSEQ), the Short Insomnia Questionnaire (SDQ), and a validated quality-of-life instrument (Medical Outcomes Study 36-item Short Form Survey (SF-36)) were administered as secondary end points. Total sleep time was evaluated using a wearable armband-shaped sensor. All measures were performed at baseline and after 60 days. RESULTS: The food supplement resulted in considerably better overall PSQI scores than placebo (difference between groups in change from baseline PSQI score=6.8; 95% confidence interval=5.4-8.3, P<.001). Moreover, the significant improvements in all four domains of the LSEQ (ease of getting to sleep, P<.001; quality of sleep, P<.001; hangover on awakening from sleep, P=.005; alertness and behavioral integrity the following morning, P=.001), in SDQ score (P<.001), in total sleep time (P<.001), and in SF-36 physical score (P=.006) suggest that treatment had a beneficial effect on the restorative value of sleep. CONCLUSION: The administration of nightly melatonin, magnesium, and zinc appears to improve the quality of sleep and the quality of life in long-term care facility residents with primary insomnia. © 2011, The American Geriatrics Society. Source

Rondanelli M.,University of Pavia | Opizzi A.,University of Pavia | Antoniello N.,Azienda di Servizi alla Persona di Pavia | Boschi F.,University of Pavia | And 4 more authors.
Clinical Nutrition | Year: 2011

Background & aims: This study assessed the efficacy of supplemented essential amino acids on depressive symptoms, nutrition, muscle function, daily physical activity, and health-related quality of life (HRQoL) of institutionalized elderly patients. Methods: Forty-one patients (58.5% women; mean age 79.8 yrs) with sequelae of coronary artery disease (73%), femoral fracture (34%), were randomly assigned to receive oral essential amino acids 4 gr 2 times a day for 8 weeks or isocaloric placebo. Before randomization and 8 weeks after the protocol started, the following variables were measured: depressive symptoms (Geriatric Depression Scale, GDS), nutritional panel (Mini Nutritional Assessment, MNA; serum albumin and prealbumin levels), muscle strength (Hand Grip, HG), Activity Daily Life (ADL), Quality of Life (SF-36, HRQoL) and amino acid profile. Results: Compared with the placebo group, EAA patients improved nutrition (MNA score 22.6 ± 1.5 post vs 21.8 ± 1.6 pre; p < 0. 04, albumin g/dl 4.04 ± 0.35 post vs 3.88 ± 0.3 pre; p < 0.01), GDS(score 10.3 ± 1.75 post vs 13.85 ± 3.37 pre; p < 0.001), HG (Kg 19.75 ± 1.7 post vs 18.68 ± 1.36 pre; p = 0.001), ADL (p < 0.04) and both physical and mental components of SF-36 (p < 0.002). Conclusions: Oral supplementation with essential amino acids improved several determinants of quality of life in institutionalized elderly patients, including depressive symptoms, nutrition, muscle function and daily life activity. © 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. Source

Objective. To determine if a food supplement of melatonin, magnesium and zinc conveyed by pear pulp can improve quality of sleep and morning alertness in elderly patients with primary insomnia. Methods. Forty-three primary insomnia patients (22 in the supplemented group, 21 in the placebo group) aged over 70 years (78.3 ± 3.9 years). An 8-week program consisting in the assumption, one hour before bedtime, of a food supplement (melatonin, 5 mg, magnesium, 225 mg, and zinc, 11.25 mg, conveyed by pear pulp, 100 g), versus placebo treatment. Results. The food supplement improved considerably the global PSQI scores relative to placebo (Δ change 6.8; 95%CI 5.4-8.3, P < 0.001). Moreover, a significant improvements in all the four domains of LSEQ, in total sleep time and in the physical score of SF-36 suggest a beneficial treatment effect on the restorative value of sleep. Conclusions. We can conclude that this food supplement can be useful for maintaining and encouraging the physiological mood and promote a state of relaxation and night rest in elderly patients. Source

Rondanelli M.,University of Pavia | Peroni G.,University of Pavia | Miccono A.,University of Milan Bicocca | Guerriero F.,Azienda di Servizi alla Persona di Pavia | And 3 more authors.
Therapeutics and Clinical Risk Management | Year: 2016

The ingestion of corrosive industrial chemical agents, such as caustic soda, that are mostly used for household cleaning, usually occurs accidentally or for suicidal purposes. Multiple protocols are based on documented success in preventing impending complications. In this study, we present a case of a 70-year-old man who swallowed caustic soda in a suicide attempt, causing a development of strong esophageal and gastric necrosis with subsequent gastrectomy and digiunostomy. Initially, the recommended nutritional approach was via percutaneous endoscopic jejunostomy by a polymer and high-caloric formula, with an elevated content of soluble fiber. After 5 months, the medical team removed the percutaneous endoscopic jejunostomy and the patient switched from enteral to oral nutrition. In this step, it was decided to introduce two oral, high-caloric supplements: an energy supplement in powder, based on maltodextrin, immediately soluble in foods or in hot/cold drinks and a high-energy and protein drink, enriched with arginine, vitamin C, zinc, and antioxidants. Oral administration (per os) was well tolerated by consuming homogenized food mixed in water. After 1 month, the patient was discharged from the hospital and was able to eat a regular meal. © 2016 Rondanelli et al. Source

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