The metabolic syndrome and high C-reactive protein: prevalence and differences by sex in a southern-European population-based cohort.

Background: To evaluate the prevalence of the metabolic syndrome (MS) and its components in a population-based cohort, and to analyse the association between gender, environmental conditions, C-reactive protein (CRP), and the syndrome.

Methods: Out of 1877 subjects aged 45-64, who represented all the patients of six family physicians, representative of the sanitary districts of Asti (north-western Italy), 88% accepted to participate in an interview on personal habits, and several clinical and laboratory measurements.

Results: The MS (National Cholesterol Education Program criteria) was present in 24% of males and 22% of females.

Environment and respiratory diseases in childhood: the Italian experience.

To estimate the prevalence of respiratory disorders in children, and to investigate the roles of potential environmental risk factors, including exposure to outdoor air pollution, a large multicenter, population based survey (SIDRIA) was conducted in Italy in 1994-1995. The study enrolled more than 40,000 children. Results allowed international comparisons of the prevalences of asthma and allergies in childhood in the framework of the ISAAC (International Study of Asthma and Allergies in Childhood) study, and supplied further evidence of the adverse respiratory effects of many environmental factors.

Guidelines for preoperative assessment: impact on clinical practice and costs.

Objective: To describe preoperative evaluation in the San Giovanni Battista Hospital in Turin and to forecast the economic impact when preoperative assessment guidelines are implemented.

Design: We enrolled, in a month, 702 consecutive patients, excluding cardiac, thoracic, neuro- and vascular surgery, as well as emergency operations. Preoperative assessment data were collected individually, followed by simulating various applications of guidelines based on: (i) preoperative tests relying on full medical history and physical examination to discriminate preoperative risk patients; (ii) organization of a preoperative evaluation unit and tests before patient hospitalization.

Side-to-side stapled anastomosis strongly reduces anastomotic leak rates in Crohn's disease surgery.

Purpose: Anastomotic configuration may influence anastomotic leak rates. The aim of this study was to determine whether a side-to-side stapled ileocolonic anastomosis produces lower anastomotic leak rates than those with a handsewn end-to-end ileocolonic anastomosis after ileocecal or ileocolonic resection for Crohn's disease.

Methods: A series of 122 consecutive patients underwent elective ileocecal or ileocolonic resection with ileocolonic anastomosis for Crohn's disease from January 1998 to June 2003: 71 had handsewn end-to-end anastomosis and 51 had side-to-side stapled anastomosis.

Renal damage in patients with Type 2 diabetes: a strong predictor of mortality.

Aims: (i) To compare mortality rates in a cohort of Type 2 diabetic patients with those of the general population; (ii) to assess the prognostic role of pre-existing chronic conditions; (iii) to evaluate the impact of different severity of renal damage on mortality.

Methods: All 3892 patients with Type 2 diabetes attending our Diabetic Clinic during 1995 and alive on 1 January 1996 were identified and followed for 4.5 years.

Patients with type 2 diabetes had higher rates of hospitalization than the general population.

Objective: We describe the rate, causes, and predictors of hospitalization for all patients with type 2 diabetes in a diabetes clinic in Turin, Italy and compare their hospitalization rates with those of the general population.

Study Design And Setting: All patients were recruited and followed up for hospital admissions from January 1996 to June 2000. The role of risk factors was analyzed with a conditional proportional hazard model for repeated events.

Peripheral neuropathy in hepatitis-related mixed cryoglobulinemia: electrophysiologic follow-up study.

A retrospective study was performed on 27 patients with hepatitis C (HCV)-related mixed cryoglobulinemia (purpura, arthralgia, hepatitis, glomerulonephritis, peripheral neuropathy) to assess peripheral nerve involvement during follow-up of up to 8 years. All patients had the same degree of organ/system involvement initially and were clinically evaluated at least annually. All 27 patients received steroids; 15 also received recombinant interferon-alpha 2b (rIFN-alpha 2b).

Muscle tenderness in different headache types and its relation to anxiety and depression.

To assess in patients with migraine and tension type headache, both episodic and chronic, the extent to which muscle tenderness may relate to anxiety and depression, 459 patients with Episodic Migraine (EM, 125), Chronic Migraine (CM, 97), Episodic Tension Type Headache (ETTH, 82), Chronic Tension Type Headache (CTTH, 83), and EM+ETTH (72) were enrolled. For each patient, a psychological assessment on the Axis 1 of the DSM-IV and muscle palpation of pericranial and cervical muscles were carried out. A Pericranial Muscle Tenderness Score (PTS) and a Cervical Muscle Tenderness Score (CTS) were calculated (range 0-3).

Isolated systolic hypertension in a cohort of type 2 diabetic patients.

Background And Aims: Previous studies of the adverse effects of isolated and borderline isolated systolic hypertension excluded or under-represented type 2 diabetic patients. The aim of this study was to evaluate the prevalence and role of isolated and borderline isolated systolic hypertension in a cohort of 3892 type 2 diabetic patients.

Methods And Results: The hypertensive patients were classified as treated (n= 1806; 46.

Efficacy of low-dose thalidomide and dexamethasone as first salvage regimen in multiple myeloma.

Purpose: The efficacy of low-dose thalidomide (THAL) plus dexamethasone (DEX) has been evaluated in myeloma. The clinical outcome of patients treated with THAL-DEX was compared with that of a control group treated with conventional chemotherapy (CC).

Experimental Design: A total of 120 relapsed/refractory patients to one (52%), or two or more(48%) lines of chemotherapy were treated with THAL 100mg/day (continuous) and DEX 40 mg (days 1-4 of each month).

Intermediate-dose melphalan improves survival of myeloma patients aged 50 to 70: results of a randomized controlled trial.

High-dose therapy is an effective standard treatment for multiple myeloma patients. Evidence that intermediate-dose therapy improves survival is limited. At diagnosis, about 70% of patients are older than 65.

[Hospital mortality at a cardiosurgical unit in Torino: international comparisons and time trend].

Objective: To compare hospital mortality in a cardiac surgery unit with external data and to assess changes in time (patients undergoing surgery in two different periods).

Materials And Methods: Data on risk factors for hospital mortality were collected from clinical records (retrospectively for the first period and prospectively for the second) for all patients undergoing open heart surgery at the Heart Surgery Unit of the University of Turin (Italy) during 1991 and 1995 (n = 1794) and 1999 (n = 892). Comparisons of in-hospital mortality, expressed as Standardized Mortality Ratios (SMR), were adjusted for risk factors defined according to EuroSCORE (European System for Cardiac Operative Risk Evaluation).

Discharge criteria from intensive care unit in brain injured patients.

Objective: We investigated the value of information on clinical features and intensity of treatment activity in the Intensive Care Unit (ICU) in predicting the need for further interventions after a patient is discharged from the Intensive Care Unit. Our aim was to assess if this could aid in making decisions about transfer to an Immediate Care Unit (sub-ICU).

Methods: We studied 39 patients with acute brain damage (traumatic or vascular causes).

Low-dose continuous iron therapy leads to a positive iron balance and decreased serum transferrin levels in chronic haemodialysis patients.

Background: Iron balance is critical for adequate erythropoiesis, but its optimal therapeutic regimen remains to be defined. Continuous maintenance therapy with iron has been proposed for dialysis patients on recombinant human erythropoietin (rHuEpo) in the hope that the regimen is adequate and safe.

Methods: We determined serum ferritin, transferrin, transferrin saturation (TSAT), serum transferrin receptors, albumin and C-reactive protein (CRP) in a 3-year prospective study in 30 chronic haemodialysis patients on dialysis treatment for 132+/-111 months (18 males, 12 females; mean age 56+/-14 years).

[Occupational and environmental risk factors for essential thrombocythemia: a case-control study].

Background: Essential Thrombocythemia (ET) is a chronic myeloproliferative disorder characterized by a long median survival, even though serious complications such as acute hemorrhagic or thrombotic events are not infrequent. Very few information are available about risk factors for ET because of lack of epidemiological studies focused on this topic.

Methods: We conducted a case-control study in order to analyze the possible association between ET and some occupational and environmental risk factors.

Validation of serum ferritin values by magnetic susceptometry in predicting iron overload in dialysis patients.

Background: Guidelines for treating anemia in dialysis patients accept, as high-end range of serum ferritin useful to optimize erythropoietin therapy, values high as 500 to 900 microg/L, on the hypothesis that ferritin might be not representative of iron overload.

Methods: A superconducting quantum interference device (SQUID) was used to make direct noninvasive magnetic measurements of nonheme hepatic iron content in 40 dialysis patients treated with intravenous iron, and liver iron content was compared with biochemical markers of iron status.

Results: Only 12/40 (30%) patients showed normal hepatic iron content (SQUID <400 microg/g), while 32.

Interaction between gene polymorphisms of nitric oxide synthase and renin-angiotensin system in the progression of membranous glomerulonephritis.

Background: The renin-angiotensin system (RAS) and nitric oxide synthase (NOS) play a key role in the progression of primary glomerulonephritis (GN). Although previous studies have examined genetic risk associated with single gene variations, experiments assessing risk conferred by multiple gene variations are still scanty.

Methods: The effect of combination of variant alleles of four genes encoding for three components of the RAS [angiotensin converting enzyme insertion/deletion (ACE I/D), angiotensin II receptor 1 (AT1R 1166A/C), angiotensinogen (AGT M235T)] and for NOS (ecNOS4b/a) on the development and progression of membranous GN (MGN) were evaluated in a longitudinal study comparing 117 patients with serum creatinine (s-Cr) <1.

[Evaluation of quality of care through hospital discharge reports: an example of rectal cancer surgery].

This study was undertaken to evaluate the usefulness of hospital discharge data for monitoring the impact of a regional practice guideline on treatment of colorectal cancer. The aims of the study were: i) estimating process and outcome indicators; ii) exploring the relationship between patient and hospital characteristics and these indicators. Odds ratios (OR) and 95% confidence intervals (CI) were adjusted for all risk factors analysed.

Risk factors for early and late mortality in hospitalized older patients: the continuing importance of functional status.

Background: Prognostic information collected at hospital admission may be useful in defining care objectives and in deciding on therapy for older people. The aim of our study was to identify admission risk factors for in-hospital and postdischarge mortality.

Methods: The study included 987 patients aged 70 years and older admitted to the geriatric ward of San Giovanni Battista Hospital in Torino during 1995 and 1996.

A randomized 4-arm multicenter study of interferon alfa-2b plus ribavirin in the treatment of patients with chronic hepatitis C relapsing after interferon monotherapy.

To determine whether a higher dosage of interferon (IFN) and/or a prolonged time of administration may improve the efficacy of combination therapy, we conducted a 4-arm randomized trial on patients with chronic hepatitis C relapsing after 1 or more previous treatment courses with IFN monotherapy. Group A (n = 70) received 3 MU IFN alfa-2b 3 times per week plus ribavirin 1,000 mg/d for 12 months; group B (n = 70) received 5 MU 3 times per week plus ribavirin for 12 months; group C (n = 82) received 3 MU 3 times per week plus ribavirin for 6 months, and group D (n = 73) received 5 MU 3 times per week plus ribavirin for 6 months. The primary end point was the clearance of viremia at the end of 6-month follow-up: test results for hepatitis C virus (HCV)-RNA were negative in 54% of group A, 56% of group B, 40% of group C, and 49% of group D patients (P = NS).

Oral melphalan at diagnosis hampers adequate collection of peripheral blood progenitor cells in multiple myeloma.

Background And Objectives: Since optimal collection of peripheral blood progenitor cells (PBPC) remains crucial for high-dose therapy in patients with multiple myeloma (MM) in relapse phase or refractory to chemotherapy, we evaluated several variables that may influence mobilization.

Design And Methods: Eighty-nine patients who underwent a standard mobilization procedure with cyclophosphamide (3 g/m2) and growth factors entered the study. A composite collection totalling at least 2x106 CD34+/kg was defined as a sufficient yield: 59 patients achieved an adequate collection.

Validity of hospital morbidity records for amyotrophic lateral sclerosis. A population-based study.

The validity of discharge diagnosis of amyotrophic lateral sclerosis (ALS) and of the main procedures performed during hospitalization was assessed using as gold standard the data from the Piemonte and Valle d'Aosta Register for ALS (PARALS), a collaborative population-based registry aimed at determining prospectively the incidence and the factors related to ALS outcome. All patients discharged with ICD code 335.2 (primary and secondary diagnoses) in the period 1995-1996 in Piemonte, Italy, were considered.

Evidence-based medicine and radiology: how to build a guideline. An attempt in minor head injury.

Purpose: To evaluate the use of Evidence-based Medicine (EBM) to build radiological Guidelines, with the aim to have a better compliance by users. It has been decided to work on minor head injury, where we have found, in our institution, a wide and unjustified use of conventional skull x-ray.

Material And Methods: A Workgroup, that reunites the main figures that enter in the management of the patient with minor head injury, has been created within our Hospital.