Management of severe epistaxis during pregnancy: a case report and review of the literature

Epistaxis is a common problem during pregnancy. Few cases of severe epistaxis, not associated with nasal lesions or clotting disorders, were described in the literature. We reported a case of severe epistaxis in a pregnant patient, exploring all the different possible management options

Lie-Algebraic Characterization of 2D (Super-)Integrable Models

It is pointed out that affine Lie algebras appear to be the natural mathematical structure underlying the notion of integrability for two-dimensional systems. Their role in the construction and classification of 2D integrable systems is discussed. The super- symmetric case will be particularly enphasized. The fundamental examples will be outlined.Comment: 6 pages, LaTex, Talk given at the conference in memory of D.V. Volkov, Kharkhov, January 1997. To appear in the proceeding

Risk-adjusted econometric model to estimate postoperative costs: An additional instrument for monitoring performance after major lung resection

ObjectivesThe objectives of this study were to develop a risk-adjusted model to estimate individual postoperative costs after major lung resection and to use it for internal economic audit.MethodsVariable and fixed hospital costs were collected for 679 consecutive patients who underwent major lung resection from January 2000 through October 2006 at our unit. Several preoperative variables were used to develop a risk-adjusted econometric model from all patients operated on during the period 2000 through 2003 by a stepwise multiple regression analysis (validated by bootstrap). The model was then used to estimate the postoperative costs in the patients operated on during the 3 subsequent periods (years 2004, 2005, and 2006). Observed and predicted costs were then compared within each period by the Wilcoxon signed rank test.ResultsMultiple regression and bootstrap analysis yielded the following model predicting postoperative cost: 11,078 + 1340.3X (age > 70 years) + 1927.8X cardiac comorbidity − 95X ppoFEV1%. No differences between predicted and observed costs were noted in the first 2 periods analyzed (year 2004, $6188.40 vs$6241.40, P = .3; year 2005, $6308.60 vs$6483.60, P = .4), whereas in the most recent period (2006) observed costs were significantly lower than the predicted ones ($3457.30 vs$6162.70, P < .0001).ConclusionsGreater precision in predicting outcome and costs after therapy may assist clinicians in the optimization of clinical pathways and allocation of resources. Our economic model may be used as a methodologic template for economic audit in our specialty and complement more traditional outcome measures in the assessment of performance

Long-range Radio for Underground Sensors in Geothermal Energy Systems

The paper presents the design of a temperature monitoring system in a very harsh environment, such as Shallow Geothermal Systems (SGS), where the information of underground temperature is necessary to assess the thermal potential of the soil, for maximizing the efficiency of the SGS. The challenge is to get information at different depths (sometimes up to - 100m), to transmit data wirelessly in rural areas where conventional wireless connections (e.g. WiFi, GSM) are not guaranteed and energy availability poses severe limits. Our design exploits a recent new modulation protocol developed for long-range transmission, at the minimum energy cost, and a two-tier hardware architecture for measuring underground temperature. Aggressive duty cycling permits to achieve lifetime of several years. Experimental results demonstrate the utility of such a system during the design and the operational activity of a SGS

Overdentures on implants placed in bone augmented with fresh frozen bone

Introduction In the last decade several studies have been performed to evaluate the clinical outcome of one or two stage loaded implants supporting overdentures. Aim Since fresh frozen bone (FFB) has an ever-increasing number of clinical applications and few reports are available on implants inserted into FFB, we performed a retrospective study on fixtures inserted in FFB and bearing overdentures. Methods In the period between December 2003 and December 2006, 17 patients (14 females and 3 males with a median age of about 56 years) were grafted and 60 implants inserted thereafter. A total of 17 overdentures were delivered: 8 in the mandible and 9 in the maxilla. Multiple implant systems were used: 22 Double etched, 7 SLA, 9 Anodic oxidized, and 22 CaPo4 ceramic-blasted. Implant diameter ranged from 3.25 to 4.3 mm and length from 11.5 to 16.0 mm. Implants were inserted to replace 23 incisors, 9 cuspids, 20 premolars and 8 molars. Results No implants were lost (i.e. survival rate = 100%) and no differences were detected among the studied variables. Kaplan Meier algorithm and Cox regression did not reveal any statistical differences among the studied variables also as regards the success rate. Conclusion Implants inserted FFB and bearing overdentures have a high survival rate and success rates, which are comparable to those of implants inserted in non-grafted bone. FFB bone is a reliable material for alveolar ridge augmentation. No difference was detected among removable prostheses supported by 2 or more implants

Development of a patient-centered aggregate score to predict survival after lung resection for non–small cell lung cancer

ObjectiveThe objective of this analysis was to develop a survival aggregate score (SAS), including objective and subjective patient-based parameters, and assess its prognostic role after major anatomic resection for non–small cell lung cancer.MethodsA total of 245 patients underwent major lung resections for non–small cell lung cancer with preoperative evaluation of quality of life (Short-Form 36v2 survey) and complete follow-up. The Cox multivariable regression and bootstrap analyses were used to identify prognostic factors of overall servival, which were weighted to construct the scoring system and summed to generate the SAS.ResultsCox regression analysis showed that the factors negatively associated with overall survival and used to construct the score were 36-item short-form health survey physical component summary score less than 50 (hazard ratio [HR], 1.7; P = .008), aged older than 70 years (HR, 1.9; P = .002), and carbon monoxide lung diffusion capacity less than 70% (HR, 1.7; P = .01). Patients were grouped into 4 risk classes according to their SAS. The 5-year overall survival was 78% in class SAS0, 59% in class SAS1, 42% in class SAS2, and 14% in class SAS3 (log-rank test, P < .0001). SAS maintained its association with overall survival in patients with stages pT1 (log-rank test, P = .01), pT2 (log-rank test, P = .02), or pT3-4 (log-rank test, P = .001), and in those with stages pN0 (log-rank test, P = .0005) or pN1-2 (log-rank test, P = .02). The 5-year cancer-specific survival was 83% in class SAS0, 71% in class SAS1, 63% in class SAS2, and 17% in class SAS3 (log-rank test, P < .0001).ConclusionsThis system may be used to refine stratification of prognosis for clinical and research purposes

On a Rare Cutaneous Metastasis from a Sacrococcygeal Chordoma

Chordomas are rare malignant tumors of notochordal origin and are rare locally aggressive ones with a metastatic potential. The skin rarely is seen as metastatic site. We describe a case of an adult woman with cutaneous metastasis of a primary sacral chordoma excised ten years before, which appeared as a painless cutaneous mass located in the dorsal region. Once removed, the surgical specimen was formalin fixed and in paraffin embedded. Sections were stained with haematoxylin-eosin, and histochemical and immunohistochemical investigations were performed. Histologically, the neoplasia was characterized by cords or single tumor cells with an abundant myxoid stroma, conspicuous pale vacuolated cytoplasm (the classic "physaliphorous cells"), and mild nuclear atypia. Mitotic activity was scanty. At immunohistochemistry, the tumor cells were diffusely positive for S-100 protein, pan-keratins, EMA, and vimentin. A diagnosis of cutaneous metastasis of chordoma was performed. This case illustrates a diagnostic challenge because of the unusual presentation of an already rare tumor

Clinical characteristics and prognostic impact of atrial fibrillation in patients with chronic heart failure

AIMS: To assess the prevalence, clinical characteristics and independent prognostic impact of atrial fibrillation (AF) in chronic heart failure (CHF) patients, and the potential protective effect of disease-modifying medications, particularly beta-blockers (BB). METHODS: We retrospectively reviewed the charts of patients referred to our center since January 2004, and collected all clinical information available at their first visit. We assessed mortality to the end of June 2015. We compared patients with and without AF, and assessed the association between AF and all-cause mortality by multivariate Cox regression and Kaplan-Meyer analysis, particularly accounting for ongoing treatment with BB. RESULTS: A total of 903 patients were evaluated (mean age 68\ub112 years, 73% male). Prevalence of AF was 19%, ranging from 10% to 28% in patients 6460 and 6577 years, respectively. Besides the older age, patients with AF had more symptoms (NYHA II-III 60 vs. 44%), lower prevalence of dyslipidemia (23 vs. 37%), coronary artery disease (28 vs. 52%) and left bundle branch block (9 vs. 16%). On the contrary, they more frequently presented with an idiopathic etiology (50 vs. 24%), a history of valve surgery (13 vs. 4%) and received overall more devices implantation (31% vs. 21%). The use of disease-modifying medications (i.e. BB and ACE inhibitors/angiotensin receptor blockers) was lower in patients with AF (72 vs. 80% e 71 vs. 79%, respectively), who on the contrary were more frequently treated with symptomatic and antiarrhythmic drugs including diuretics (87 vs. 69%) and digoxin (51 vs. 11%). At a mean follow-up of about 5 years, all-cause mortality was significantly higher in patients with AF as compared to those in sinus rhythm (45% vs. 34%, p value &lt;0.05 for all previous comparisons). However, in a multivariate analysis including the main significant predictors of all-cause mortality, the univariate relationship between AF and death (HR 1.49, 95% CI 1.15-1.92) became not statistically significant (HR 0.98, 95% CI 0.73-1.32). Nonetheless, patients with AF not receiving BB treatment were found to have the worst prognosis, followed by patients with sinus rhythm not receiving BB therapy and patients with AF receiving BB therapy, who both had similarly worse survival when compared to patients with sinus rhythm receiving BB therapy. CONCLUSIONS: AF was highly prevalent and associated with older age, worse clinical presentation and underutilization of disease-modifying medications such as BB in a population of elderly patients with CHF. AF had no independent impact on mortality, but the underutilization of BB in this group of patients was associated to a worse long-term prognosis

The conventional non-articulated SACH or a multiaxial prosthetic foot for hypomobile transtibial amputees? A clinical comparison on mobility, balance, and quality of life

The effects of a non-articulated SACH and a multiaxial foot-ankle mechanism on the performance of low-activity users are of great interest for practitioners in amputee rehabilitation.The aim of this study is to compare these two prosthetic feet and assess possible improvements introduced by the increased degrees of freedom provided by the multiaxial foot. For this purpose, a group of 20 hypomobile transtibial amputees (TTAs) had their usual SACH replaced with a multiaxial foot. Participants’ functional mobility, involving ambulatory skills in overground level walking, ramps, and stairs, was evaluated by performing Six-Minute Walking Test (6MWT), Locomotor Capability Index-5 (LCI-5), Hill Assessment Index (HAI), and Stair Assessment Index (SAI). Balance performances were assessed using Berg Balance Scale (BBS) and analysing upper body accelerations during gait.Moreover, the Prosthesis Evaluation Questionnaire (PEQ) was performed to indicate the prosthesis-related quality of life. Results showed that participants walked faster using themultiaxial foot ( &lt; 0.05) maintaining the same upright gait stability. Significant improvements with themultiaxial foot were also observed in BBS, LCI-5, and SAI times and 4 of 9 subscales of the PEQ. Our findings demonstrate that a multiaxial foot represents a considerable alternative solution with respect to the conventional SACH in the prosthetic prescription for hypomobile TTAs