Traumatic aortic arch false aneurysm after blunt chest trauma in a motocross rider

This article details a case report of a traumatic aortic arch false aneurysm after blunt chest trauma. Thoracic aorta false aneurysms are a rare and life-threatening complication of aortic surgery, infection, genetic disorders and trauma

The successful introduction of an adapted form of the mini extra corporeal circulation used for cardiac surgery in an obese patient

Obese patients undergoing cardiac surgery have been shown to have a high risk of developing postoperative complications, specifically: increased length of hospital stay, readmission to intensive care unit, acute renal failure, deep sternal wound infections and new onset of atrial fibrillation

Cardioprotection and Anticholinesterases in Patients with Alzheimer's Disease: Time for Reappraisal

Background/Aim: Traditional risk factors, like impaired transmitral flow in diastolic filling [vortex formation time (VFT) as echocardiographic parameter], contribute to Alzheimer's disease (AD). Moreover, we observed that acetylcholinesterase inhibitors provide a significant cardioprotection. We assessed the pathogenetic role of VFT as early cardiovascular risk factor in 23 AD patients and 24 controls. Results: The results showed no statistical difference between the two groups, but the VFT values were significantly lower in nontreated AD patients, and higher value were observed in AD patients treated with anticholinesterases. Conclusions: The results support the beneficial effects of anticholinesterases on the cardiovascular system of AD patients. Thus, the transition to evidence-based medicine and an in vivo model of cardiomyocytes might strengthen these results

A Piece of Chainlink Fence in the Heart

A 63-year-old man was mowing the grass along a chainlink fence when he felt a brief stab of intense pain in the middle of his chest. Hours later, precordial pain suddenly arose. On his arrival at our emergency department, a small, bleeding lesion was evident near the right edge of the sternum (Fig. 1). Electrocardiographic (ECG) results were normal, as were cardiac enzyme levels. Chest radiographs revealed a metallic foreign body over the cardiac silhouette (Fig. 2). Transthoracic echocardiography (TTE) showed a hyperechoic fixed mass (1.5 cm) between the interventricular septum and the posterior-inferior left ventricular wall (Fig. 3). Mild pericardial effusion was present. Although very near the mass, the mitral valve apparatus appeared neither damaged nor functionally altered, and no segmental wall-motion abnormalities were seen. On contrast-enhanced computed tomography (CT), the fragment seen was near the apex (Fig. 4A); on volume-rendered 3-dimensional reconstruction, it appeared to be almost completely embedded within the left ventricular wall (Fig. 4B). Because the patient was clinically and hemodynamically stable, he did not undergo urgent surgery; he was admitted for follow-up. Blood cultures were obtained, and therapy with broad-spectrum antibiotics was started. At the 6-month follow-up examination, the patient was asymptomatic. The Holter ECG was unremarkable, without any arrhythmic event during the 24-hour recording. The TTE and CT scans were substantially unchanged; the foreign body lay in the same position

The epidemiology of domestic injurious falls in a community dwelling elderly population: an outgrowing economic burden.

In Italy, more than 3 million people annually sustain a domestic injury; the elderly experience it the most. From a healthcare perspective, elderly falls are a major clinical issue with an outgrowing socioeconomic burden. The aim of the study was to evaluate the epidemiology of injurious falls in a community dwelling population, admitted to the emergency room (ER) because of a domestic injury, to assess the socioeconomic burden. Seventy-four hospitalized patients among 227 were examined. Falls represented the main cause of admittance to the ER; the average cost for fall-related hospitalization was of E5479.09

Evaluation of prognostic indices in elderly hospitalized patients

Aim: Prognosis informs the physician's decision-making process, especially for frail older adults. So far, any non-disease-specific index has proven full evidence for routine use in clinical practice. Here, we aimed at assessing, prospectively, the calibration and discriminating accuracy of validated prognostic indices in a cohort of elderly hospitalized patients. Methods: This was a prospective observational study that enrolled elderly patients (n = 100). The patients' assessment included clinical variables, as well as the following five prognostic indices of mortality: (i) Levine index (2007); (ii) Walter index (2001); (iii) CARING (C, primary diagnosis of cancer; A, 65 2 admissions to the hospital for a chronic illness within the last year; R, resident in a nursing home; I, intensive care unit admission with multiorgan failure, NG, noncancer hospice guidelines [meeting 65 2 of the National Hospice and Palliative Care Organization's guidelines]) criteria of Fischer (2006\u20132011); (iv) Silver Code of Di Bari (2010); and (v) Burden of Illness Score for Elderly Persons of Inouye (2003). Results: Patients' clinical characteristics: 70% women (age 86.20 \ub1 0.69 years), 30% men (age 85.40 \ub1 1.07 years), Comorbidity Illness rating scale (CIRS) 4.3 \ub1 0.61 and Barthel Index 28 \ub1 0.54. Walter and Burden of Illness Score for Elderly Persons scores showed similar prediction rates when compared with the expected validated values (ancova: F = 14.00, P < 0.008). Burden of Illness Score for Elderly Persons was the most calibrated and accurate index (receiver operating characteristic curve 0.72; P < 0.02). Conclusions: None of the assessed prognostic indices, in a \u201creal world\u201d scenario, afforded the optimal predictive accuracy (receiver operating characteristic curve 0.90); all these indices are still far from a robust answer to the prognosis in older age, reflecting a poor ability to encompass the spectrum of frailty. Effort should be made to tailor the prognostication in geriatrics, moving from a disease-centered model to a precision model, tailored to the frail phenotype. Geriatr Gerontol Int 2017; 17: 1015\u20131021

A Dedicated Nutritional Care Program NUTRICARE to reduce malnutrition in institutionalised dysphagic older people: A quasi-experimental study

Aims and objectives: To assess the effects of a texture-modified food program for dysphagia on the nutritional, biochemical and functional profile in a cohort of institutionalised older people in Italy. Background: Dysphagic institutionalised older people, often also affected by dementia, are frequently exposed to malnutrition. Malnutrition in older people has negative effects on mortality, days of hospitalisation, infection, wound healing and risk of pressure injuries. Therefore, it is very important to prevent malnutrition in this frail population. Design: A pre-post study without a control group. Methods: The study included 479 dysphagic institutionalised older people from 20 nursing homes. Anthropometrical, biochemical, nutritional and functional parameters were collected retrospectively, 6 months before the study intervention, at time zero and, prospectively for 6 months after implementing the NUTRICARE food programme, for a total of nine evaluations. The NUTRICARE programme includes meals without nutritional supplementation, and personalised levels of density, viscosity, texture and particle size. Results: The total mean body mass index of our sample passed from 17.88-19.00; body weight averagely improved by 7.19%, as well as their nutritional and biochemical profiles. There was a progressive improvement of total protein and serum albumin values. Nutritional parameters (serum transferrin and lymphocytes) displayed similar changes. Plasma lymphocytes reached normal levels in 98.23% of the sample. Plasma creatinine levels remained steady throughout the study and within the normal range. No side effects were reported. Conclusion: The NUTRICARE food programme with a adequate proteins, calories, balanced nutritional and bromatological properties, and appropriate texture and palatability significantly improved the nutritional, biochemical and functional profile in a cohort of institutionalised dysphagic older people. Relevance to clinical practice: The introduction of a balanced nutritional programme, using high-quality natural ingredients, appropriate texture and palatability can significantly improve health and quality of life in dysphagic older people

Extracorporeal membrane oxygenation for critically ill patients with coronavirus-associated disease 2019. An updated perspective of the European experience

Infection due to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), i.e. Coronavirus-associated disease 2019 (COVID-2019), may occasionally lead to acute respiratory distress syndrome (ARDS), requiring in the most severe cases extracorporeal membrane oxygenation (ECMO). Yet, limited data, if any, are currently available on the role of ECMO in critically ill patients with COVID-19. We aimed at providing a snapshot analysis of ECMO for COVID-19 in Europe