Neuroautonomic evaluation of patients with unexplained syncope: Incidence of complex neurally mediated diagnoses in the elderly

BACKGROUND: The incidence of syncope increases in individuals over the age of 70 years, but data about this condition in the elderly are limited. Little is known about tilt testing (TT), carotid sinus massage (CSM), or supine and upright blood pressure measurement related to age or about patients with complex diagnoses, for example, those with a double diagnosis, ie, positivity in two of these three tests. METHODS: A total of 873 consecutive patients of mean age 66.5±18 years underwent TT, CSM, and blood pressure measurement in the supine and upright positions according to the European Society of Cardiology guidelines on syncope.1 Neuroautonomic evaluation was performed if the first-line evaluation (clinical history, physical examination, electrocardiogram) was suggestive of neurally mediated syncope, or if the first-line evaluation was suggestive of cardiac syncope but this diagnosis was excluded after specific diagnostic tests according to European Society of Cardiology guidelines on syncope, or if certain or suspected diagnostic criteria were not present after the first-line evaluation. RESULTS: A diagnosis was reached in 64.3% of cases. TT was diagnostic in 50.4% of cases, CSM was diagnostic in 11.8% of cases, and orthostatic hypotension was present in 19.9% of cases. Predictors of a positive tilt test were prodromal symptoms and typical situational syncope. Increased age and a pathologic electrocardiogram were predictors of carotid sinus syndrome. Varicose veins and alpha-receptor blockers, nitrates, and benzodiazepines were associated with orthostatic hypotension. Twenty-three percent of the patients had a complex diagnosis. The most frequent association was between vasovagal syncope and orthostatic hypotension (15.8%); 42.9% of patients aged 80 years or older had a complex diagnosis, for which age was the strongest predictor. CONCLUSION: Neuroautonomic evaluation is useful in older patients with unexplained syncope after the initial evaluation. A complex neurally mediated diagnosis is frequent in older people. Our results suggest that complete neuroautonomic evaluation should be done particularly in older patients

The CRATI Project: New Insights on the Consolidation of Salt Weathered Stone and the Case Study of San Domenico Church in Cosenza (South Calabria, Italy)

This paper presents the results of a laboratory experimentation carried out on stone materials in the framework of the CRATI project (Knowledge and Restoration through Advanced Integrated Technologies) aimed at testing new products with consolidating properties by means of an integrated methodological approach. After the preliminary characterization of stone materials collected in the pilot site, the second stage of the activities within the project were focused on the formulation and testing of products for the conservation of the same materials against decay, especially salt crystallization, one of the most aggressive and common degrading processes. The San Domenico Church, located in the old town of Cosenza (Calabria, Southern Italy) has been chosen as the pilot site and for the in situ tests. Several specimens with the same features of the stone materials used in San Domenico church were collected from a historical quarry near the city of Cosenza. These specimens were treated and then artificially degraded by salt crystallization tests in order to evaluate their susceptibility to weathering intensity. Three different consolidating products were used; respectively, two commercial and another one formulated in laboratory: (a) a suspension of nanosilica (Nano Estel®); (b) a suspension of nanolime (CaLoSiL®), and (c) a suspension of nano calcium-hydroxide dispersed in isopropyl alcohol and then mixed with diammonium hydrogen phosphate. A systematic approach, including minero-petrographic, geochemical and physico-mechanical techniques, was applied to evaluate (a) the nature and main features of materials; (b) the efficacy of consolidating treatments, and (c) the resistance of treated stone to the salt crystallization processes. The tested products demonstrated a significant efficiency to consolidate and protect stone material samples, enhancing their resistance to salt crystallization. Thus, such a case history may be useful in order to plan appropriate restoration interventions that consider the interactions between the building stone and the protective/consolidating product