Somatic symptoms and depression in general practice in Italy.

Among primary care attenders, depression is a common and debilitating disturbance. These patients imply higher medical costs compared with those without depression, even after controlling for comorbid physical illness. A study performed in 15 countries worldwide has shown that ICD-10 mental disorders were present in 24% of primary care attenders. Detection and management of depression in primary care have received increasing attention. Most individuals with depression have been shown to consult their GPs for somatic symptoms rather than psychological ones. In the study mentioned above, 69% of the depressed patients reported only somatic symptoms. Another study found that GPs were able to diagnose a mental disorder in 90% of subjects presenting psychopathological symptoms and in 50% of those with somatic symptoms. In the light of the above, the Italian College of General Practitioners (Società Italiana di Medicina Generale-SIMG) in the area of Varese (north of Italy) organised a course on depression. Then a study was carried out in our setting. The aim was to evaluate the frequency of depression in patients who seek care for somatic symptoms, where tests showed that these symptoms were without an organic cause

Hemostatic effects of tranexamic acid in elective thoracic aortic surgery: A prospective, randomized, double-blind, placebo-controlled study

AbstractObjective: We studied the hemostatic effects of tranexamic acid in patients undergoing elective surgery involving the thoracic aorta. Methods: In a double-blind, randomized fashion, 60 consecutive patients were assigned to two treatment groups: 30 patients (placebo group) received infusion of saline solution, and 30 (treatment group) received tranexamic acid (1 g before skin incision, an infusion of 400 mg/h during the operation, and 500 mg in the pump priming). Perioperative bleeding was considered as a primary outcome. Perioperative allogeneic transfusions, major thrombotic complications (myocardial infarction, pulmonary embolism, renal insufficiency), and surgical outcomes were also considered. Results: Patients treated with tranexamic acid showed significant reductions in postoperative bleeding, both in terms of the amount collected during the first 4 postoperative hours (median 307 mL, interquartile range 253-361 mL in the placebo group vs median 211 mL, interquartile range 108-252 mL in the treatment group, P =.002) and in terms of total bleeding (median 722 mL, interquartile range 574-952 mL in the placebo group vs median 411 mL, interquartile range 313-804 mL in the treatment group, P =.04). Consequently, the number of patients transfused differed significantly between groups (21 patients [72.4%] in the placebo group vs 13 [44.8%] in the treatment group, P =.033). Patients in the treatment group showed significant reductions in the total amount for the entire group of packed red cells transfused (13,500 mL in the treatment group vs 28,000 mL in the placebo group, P =.012) and in the total amount of allogeneic transfusions (23,400 mL in the treatment group vs 53,000 mL in the placebo group, P =.024). No differences in perioperative thrombotic complications were found. Conclusions: In this initial series of patients undergoing thoracic aortic surgery, tranexamic acid appeared effective in reducing perioperative bleeding, with a significant reduction in the need for allogeneic transfusions and without any increased risk of thrombotic complications.J Thorac Cardiovasc Surg 2002;123:1084-9

Evaluation of radiological and pathological prognostic factors in surgically-treated patients with bronchoalveolar carcinoma

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Comparison of VerifyNow-P2Y12 test and Flow Cytometry for monitoring individual platelet response to clopidogrel. What is the cut-off value for identifying patients who are low responders to clopidogrel therapy?

<p>Abstract</p> <p>Background</p> <p>Dual anti-platelet therapy with aspirin and a thienopyridine (DAT) is used to prevent stent thrombosis after percutaneous coronary intervention (PCI). Low response to clopidogrel therapy (LR) occurs, but laboratory tests have a controversial role in the identification of this condition.</p> <p>Methods</p> <p>We studied LR in patients with stable angina undergoing elective PCI, all on DAT for at least 7 days, by comparing: 1) Flow cytometry (FC) to measure platelet membrane expression of P-selectin (CD62P) and PAC-1 binding following double stimulation with ADP and collagen type I either in the presence of prostaglandin (PG) E₁; 2) VerifyNow-P2Y₁₂test, in which results are reported as absolute P2Y₁₂-Reaction-Units (PRU) or % of inhibition (% inhibition).</p> <p>Results</p> <p>Thirty controls and 52 patients were analyzed. The median percentage of platelets exhibiting CD62P expression and PAC-1 binding by FC evaluation after stimulation in the presence of PG E₁was 25.4% (IQR: 21.4–33.1%) and 3.5% (1.7–9.4%), respectively. Only 6 patients receiving DAT (11.5%) had both values above the 1^stquartile of controls, and were defined as LR. Evaluation of the same patients with the VerifyNow-P2Y₁₂test revealed that the area under the receiver-operating-characteristic (ROC) curve was 0.94 (95% CI: 0.84–0.98, p < 0.0001) for % inhibition and 0.85 (0.72–0.93, p < 0.005) for PRU. Cut-off values of ≤ 15% inhibition or > 213 PRU gave the maximum accuracy for the detection of patients defined as having LR by FC.</p> <p>Conclusion</p> <p>In conclusion our findings show that a cut-off value of ≤ 15% inhibition or > 213 PRU in the VerifyNow-P2Y₁₂test may provide the best accuracy for the identification of patients with LR.</p

Efficacy and safety of anti-VEGF therapy with intravitreal ranibizumab (LUCENTIS™) for naïve retinal vein occlusion: one-year follow-up

International audiencePurpose: To evaluate the efficacy and safety of intravitreal ranibizumab in patients with retinal vein occlusion (RVO). Methods: Seventeen eyes of 17 consecutive patients received, on demand, intravitreal 0.5 mg of ranibizumab and were followed for a minimum of 12 months. Results: Nine patients with Central RVO had mean pre-treatment BCVA of 20/240 (1.08 ± 0.25 logMAR) and final BCVA of 20/46 (0.36 ± 0.16 logMAR), with significant improvement at one year of follow-up (p <0.0001). At 12 months mean BCVA improved 36.7 letters, with a gain of 6.4 lines, and OCT showed a mean reduction of 360 µm (p <0.0001) from baseline (mean 631 µm). Eight patients with Branch RVO had mean pre-treatment BCVA of 20/126 (0.80 ± 0.29 logMAR) and final BCVA of 20/50 (0.41 ± 0.23 logMAR) (p <0.0001). The mean OCT CMT had a mean reduction of 275 µm (p <0.0001) from baseline (mean 553 µm). No ocular or systemic side effects were observed. Eyes with CRVO received an average of 3 injections and those with BRVO 3.6. Conclusions: Intravitreal ranibizumab for the management of RVO can favorably modify the course of the occlusion, reducing CMT, and significantly improving visual function, with a good safety profile

Gamma glutamyltransferase, alanine aminotransferase and risk of cancer:Systematic review and meta-analysis

The prospective evidence for the associations of gamma glutamyltransferase (GGT) and alanine aminotransferase (ALT) with risk of cancer in the general population is uncertain. We conducted a systematic review and meta-analysis of published prospective observational studies evaluating the associations of baseline levels of GGT and ALT with risk of overall (incidence and/or mortality) and site-specific cancers. Relevant studies were identified in a literature search of MEDLINE, EMBASE, Web of Science, reference lists of relevant studies to April 2014 and email contact with investigators. Study specific relative risks (RRs) were meta-analyzed using random effects models. Fourteen cohort studies with data on 1.79 million participants and 57,534 cancer outcomes were included. Comparing top versus bottom thirds of baseline circulating GGT levels, pooled RRs (95% confidence intervals) were 1.32 (1.15-1.52) for overall cancer, 1.09 (0.95-1.24) for cancers of the breast and female genital organs, 1.09 (1.02-1.16) for cancers of male genital organs, 1.94 (1.35-2.79) for cancers of digestive organs and 1.33 (0.94-1.89) for cancers of respiratory and intrathoracic organs. For ALT, corresponding RRs for overall cancer were 0.96 (0.94-0.99) and 1.65 (1.52-1.79) in European and Asian populations, respectively. There was an increased risk of cancers of the digestive organs 2.44 (1.23-4.84). The pooled RR for overall cancer per 5 U/L increment in GGT levels was 1.04 (1.03-1.05). Available observational data indicate a positive log-linear association of GGT levels with overall cancer risk. The positive association was generally evident for site-specific cancers. There are geographical variations in the association of ALT and overall cancer