Cross-sectional study of readmissions to the psychiatric ward of Hospital Estadual Mário Covas in Santo André, state of São Paulo, between 2008 and 2015.

Objectives: To assess the sociodemographic and diagnostic profile of data related to psychiatric readmissions to the psychiatric ward at Hospital Estadual Mário Covas between January 2008 and September 2015, in order to investigate the possible correlation between the rate of admission and readmission and the presence or absence of a discharged patient unit or other outpatient treatment unit.

Methods: This was a cross-sectional, descriptive study. Data on patients readmitted during the study period were sourced from a statistical analysis of the Hospital Estadual Mário Covas database using STATA 11.

Perioperative albumin ratio is associated with post-operative pancreatic fistula.

Background: Despite improvements in surgical techniques and perioperative management, post-operative pancreatic fistula (POPF) remains a serious complication after pancreaticoduodenectomy (PD). The aim of this study was to evaluate the role of perioperative clinical variables of patients, including albumin level, in predicting pancreatic fistula.

Methods: A total of 86 patients underwent PD for pancreas cancer between 2011 and 2017 at our institution.

Influence of splanchnic artery stenosis on the in-hospital clinical course of elderly patients.

Background: Chronic mesenteric ischaemia (CMI) has a long asymptomatic period, but little is known about the clinical implications of this phase of the disease, particularly in the elderly, who are most exposed to the condition.

Aims: The aim of the present observational study was to survey the in-hospital clinical course of elderly patients during the non-specific phase of the disease due to occlusion of at least one splanchnic artery.

Methods: For a median of 29 months, we followed up 85 patients aged 65 and over who, for various clinical reasons, had undergone computed tomographic and magnetic resonance angiography during 2010 at Padua Teaching Hospital, assessing economic impact and reasons for admission.

Performance of the Multidimensional Geriatric Assessment and Multidimensional Prognostic Index in predicting negative outcomes in older adults with cancer.

Unlabelled: The Multidimensional Geriatric Assessment (MGA) is currently used for assessing geriatric oncological patients, but a new prognostic index - the Multidimensional Prognostic Index (MPI) - has a demonstrated prognostic value in cancer patients too. The present work was designed to compare the MPI and MGA as predictors of 12-month mortality. 160 patients ≥70 years old with locally-advanced or metastatic solid cancers consecutively joining our Geriatric Oncology Program were administered a Comprehensive Geriatric Assessment to calculate their MGA and MPI scores.

Difficult colonoscopies in the propofol era.

Background: To study the relationship between endoscopic practice and adverse events during colonoscopy under standard deep sedation induced and monitored by an anesthetist.

Methods: We investigated the routine activity of an endoscopy center at the Padova University teaching hospital. We considered not only endoscopic and cardiorespiratory complications, but also the need to use high-dose propofol to complete the procedure, and the inability to complete the procedure.

Local recurrence of gastric cancer after total gastrectomy: an unusual presentation.

A 71 years old Italian man had type 3 gastric cancer of the greater curvature. Total gastrectomy with splenectomy and D2 lymph node dissection were performed. After discharge chemotherapy ELF regimen was administered for 6 months.

Usefulness of a fast track list for anxious patients in a upper GI endoscopy.

Background: To determine whether patients with no alarm signs who ask the endoscopist to shorten their waiting time due to test result anxiety, represent a risk category for a major organic pathology.

Methods: At our open-access endoscopy service, we set up an expedite list for six months for outpatients who complained that the waiting time for gastroscopy was too long. Over this period we studied 373 gastroscopy patients.

Death after an accidental fall of a 101 year old hospitalized patient. Medico-legal implication of falling in geriatrics.

Background: The case presented by the authors gives the opportunity to discuss the medico-legal issues related to lack of prevention of falls in elderly hospitalized patients.

Case Presentation: A 101 year old Caucasian female was admitted to a surgery division for evaluation of abdominal pain of uncertain origin. During hospitalization, after bilateral bed rails were raised, she fell and reported a femoral fracture.

Current practice in colonoscopy in the elderly.

Colonoscopy in the elderly is a reliable practice of great diagnostic and management value. However, patient's age has long been considered to affect the success of the procedure, achieved when the cecum is intubated, there is a good view of the colon if preparation has been properly carried out, and the examination does not cause excessive discomfort or complications. Substantial improvements have been made to the latter two aspects, due to more widespread use of deep sedation with propofol and cardiocirculatory monitoring during the procedure.

Maximizing the general success of cecal intubation during propofol sedation in a multi-endoscopist academic centre.

Background: Achieving the target of 95% colonoscopy completion rate at centres conducting colorectal screening programs is an important issue. Large centres and teaching hospitals employing endoscopists with different levels of training and expertise risk achieving worse results. Deep sedation with propofol in routine colonoscopy could maximize the results of cecal intubation.

Infrapopliteal arterial reconstructions for limb salvage in patients aged > or =80 years according to preoperative ambulatory function and residential status.

Background: Although numerous studies have addressed peripheral revascularizations for critical limb ischemia (CLI) in patients aged > or =80 years, few have focused exclusively on infrapopliteal arterial reconstructions. This study aimed to analyze early and long-term outcomes in very elderly patients who underwent surgical infrapopliteal revascularization for CLI according to their pre-operative ambulatory function and residential status.

Methods: Over an 18-year period, all consecutive patients aged > or =80 years referred to our institution for CLI requiring primary infrapopliteal or inframalleolar arterial reconstruction were enrolled in the study.

Revascularization to an isolated ("blind") popliteal artery segment: a viable procedure for critical limb ischemia.

Background: The purpose of this study was to analyze our experience of bypass procedures to an isolated ("blind") popliteal artery segment (IPAS) to revascularize the perigeniculate arteries in patients with critical limb ischemia (CLI), to establish whether such revascularizations could yield acceptable results in terms of patency and limb salvage (LS) rates.

Methods: Over a decade, 347 above-knee arterial revascularizations were performed in 293 patients and in 51 (14.7%) of these the outflow vessels were the perigeniculate arteries arising from an IPAS, through a reversed saphenous vein or spliced veins (n = 30, 58.

Infrapopliteal arterial revascularization for critical limb ischemia: is the peroneal artery at the distal third a suitable outflow vessel?

Purpose: Though the peroneal artery (PA) often remains patent despite disease or occlusion of other infrapopliteal arteries, there is skepticism about using the terminal PA as the outflow tract in distal revascularizations for limb salvage, especially when a patent inframalleolar artery is available. We analyzed our experience of using the distal PA and inframalleolar or pedal branches arteries as outflow tracts in revascularizations for critical limb ischemia.

Methods: Over a decade, among 651 infrapopliteal arterial reconstructions performed in 597 patients, the PA was the outflow vessel in 214, its distal third being involved in 69 vein revascularizations (study group).

Open abdominal aortic aneurysm repair in octogenarians before and after the adoption of endovascular grafting procedures.

Objective: This study evaluated (1) elective open abdominal aortic aneurysm repair (OAR) in patients aged > or =80 years before and after stent graft devices for endovascular aneurysm repair (EVAR) became commercially available and (2) the effect on perioperative (30-day) outcome of the anatomic constraints that led to EVAR being excluded for many of them.

Methods: A review was conducted on the records of 111 patients aged > or =80 years who underwent elective OAR during a 14-year period at the University of Padua School of Medicine. Patients were separated into two groups: group 1 (n = 65) had OAR before and group 2 (n = 46) after an EVAR program was adopted at the medical school in mid-2000.

Autologous great saphenous vein tailored graft to replace an infected prosthetic graft in the groin.

The authors propose a technique using the autologous great saphenous vein to replace an infected prosthetic limb graft at the groin. The whole great saphenous vein is incised longitudinally and divided into 2 approximately equal segments, which are sewn side to side. The longitudinal edges of the resulting great saphenous vein are then joined and anastomosed side to side to form a conduit, whose caliber is twice the original vein's diameter.

Palliative surgery for gastric cancer in elderly patients.

Poor survival rate of elderly patients affected by locally advanced or metastatic gastric cancer is related to primary tumour complications. Bleeding is the most important adverse event, other major complications are gastric outlet obstruction and nutritional deprivation. Rarely the patients will perforate the stomach cancer and there is a sudden end to their life; contamination of the ascites result in a rapid death.

[Therapeutic strategy in neoplasia of the pancreas and ampulla].

The major symptoms of periampullary neoplasia are jaundice, lowering of weight, abdominal pain extending behind; diabetes, pancreatitis or exocrine pancreatic failure are uncommon. In the last years, surgery has been considered as the gold standard of the therapy because new technologies are able to reduce morbility and mortality. In the too advanced neoplasia, palliative surgical care permits better survival and quality of life.

[Septic shock: surgical and medical problems in the elderly].

The sepsis is a bacterial invasion of the organism producing many manifestations which are able to amplify themselves. In the United States of America there are 100,000 death per year and the incidence is among 300,000-500,000 cases. The major surgery in the elder (especially if it is in emergency) has a great percental of risk because the preoperative study isn't often complete.

[Surgery of inguinal and femoral hernia in the elderly].

Old people are continuously increasing in frequency but age is not a significant factor to value the operative risk in hernia surgery. From June 1985 to December 1996, 189 patients, aged > 80-year, were submitted to hernia surgery. No complications were noted when elective surgery was performed.

[Stomach cancer in the elderly].

Gastric cancer often affect very old patients even if it is not a typical disease of the elderly. The Authors report their experience on 108 patients (mean age of 77.8 years) affected by gastric cancer; early diagnosis and surgical technique are discussed.

[Complications of peptic ulcer disease in the elderly].

Peptic disease is even more described in the elderly patients. Is it different from the young people peptic disease? Is it a specific syndrome? These questions are debated by the authors from their experience about in the old age surgery. In 1997, out of 569 oesophago-gastro-duodenoscopies positive for peptic disease, about 2/5 of the patients were older than 65-year with a high percentage of hypersecretive patients.

[Breast cancer in elderly women].

Breast cancer represents an important epidemiological and clinical problem, and the elderly age represents a large proportion of women with breast cancer. In patients older than 65-year, the frequency of breast cancer is 50% and more. Early diagnosis and adequate therapy may play an important role also in the elderly.

[Physiopathology of intestinal anastomoses and dehiscences].

A lot of mechanisms of healing of intestinal anastomoses has been explained. A leading role in the intestinal wall is made by the submucosal tunica, where collagen synthesis and degradation process take place, but local and systemic factors are present by a definite causal action. Technique of suture, materials and surgeon's experience are of fundamental importance for the success of operation, even if in some cases it is important to take in consideration the clinical situation: emergency or not, the patient's state and age, concomitant diseases, pharmacological or radiotherapeutic treatments.