A rare case of solitary plasmacytoma mimicking submucosal lesion of ascending colon: a case report and literature review.

Solitary primary extraosseous plasmacytoma is a rare disease in the gastrointestinal tract, recently classified as an "exceptional" tumor of the colon site. The real incidence (one case/population/year) is unknown but reasonably less than 1/10,000,000 cases/year with very few descriptions in the literature. The rare cases described in the literature are often diagnosed after surgery for perforation and with predominant localization of the left colon.

Constipation: a neglected condition in older emergency department patients.

Constipation and fecal impaction are common issues with the potential for significant morbidity in older people presenting to the Emergency Department (ED). While many of these patients present with classical symptoms of constipation or fecal impaction, atypical presentations are also frequent. These atypical presentations may include paradoxical diarrhea, fecal incontinence, urinary retention or overflow incontinence, hyperactive or hypoactive delirium, anorexia/dysphagia, and syncope.

Congestive heart failure and comorbidity as determinants of colorectal cancer perioperative outcomes.

There has been an increase in surgical interventions in frailer elderly with concomitant chronic diseases. The purpose of this paper was to evaluate the impact of aging and comorbidities on outcomes in patients who underwent surgery for the treatment of colorectal cancer (CRC) in Veneto Region (Northeastern Italy). This is a retrospective cohort study in patients ≥ 40 years who underwent elective or urgent CRC surgical resection between January 2013 and December 2015.

Clinical practice in the management of postoperative delirium by Chinese anesthesiologists: a cross-sectional survey designed by the European Society of Anaesthesiology.

Objective: In this survey, we assessed the current clinical management of postoperative delirium (POD) among Chinese anesthesiologists, after publishing the European POD guideline.

Methods: We administered an electronic survey, designed according to the European POD guideline. The survey was completed using mobile devices.

Routine management of postoperative delirium outside the ICU: Results of an international survey among anaesthesiologists.

Background: Postoperative delirium (POD) is a severe brain dysfunction. Although data indicate a high relevance, no survey has investigated the routine practice to monitor delirium outside the ICU setting after surgery. Prior to publishing of the new European Society of Anaesthesiology (ESA) guidelines on POD, an international survey was conducted to assess current practice.

European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium.

The purpose of this guideline is to present evidence-based and consensus-based recommendations for the prevention and treatment of postoperative delirium. The cornerstones of the guideline are the preoperative identification and handling of patients at risk, adequate intraoperative care, postoperative detection of delirium and management of delirious patients. The scope of this guideline is not to cover ICU delirium.

Is polypharmacy an independent risk factor for adverse outcomes after an emergency department visit?

This study aimed at verifying the role of polypharmacy as an independent risk factor for adverse health outcomes in older emergency department (ED) patients. This was a large (n = 2057) sample of older ED patients (≥65 years) participating in an observational cohort study. Polypharmacy and excessive polypharmacy were defined as having 6-9 drug prescriptions and 10 or more drug prescriptions in the last 3 months, respectively.

Operationalization of the physical frailty & sarcopenia syndrome: rationale and clinical implementation.

Over the years, different operational definitions have been elaborated to identify frail older persons, but none of them has received unanimous consensus. This, in turn, has hampered the clinical implementation of frailty as well as the design of targeted interventions. To overcome the current limitations in the field, a novel operationalization of physical frailty (PF) is proposed which grounds its roots in the recognition of sarcopenia as its central biological substrate.

Pattern of use and presenting complaints of older patients visiting an Emergency Department in Italy.

Background And Aims: The number of older persons admitted to the Emergency Department (ED) is dramatically increasing due to their complex medical and social problems, which in turn lead to longer clinical evaluation times and increased use of resources compared to younger adults. However, scant data are available for Italian EDs. Similarly, no data are available about the reasons to ED visit and its role in determining the ED utilization pattern.

Underrecognition and undertreatment of dementia in Italian nursing homes.

Objective: To determine the prevalence of dementia diagnoses and the use of antidementia drugs in a cohort of Italian older nursing home (NH) residents.

Design: Cross-sectional study.

Setting: The NH residents participating in 2 studies: the U.

Underprescription of beneficial medicines in older people: causes, consequences and prevention.

Underprescription of potentially useful drugs is widespread among older people and may herald several adverse outcomes. We aimed to review the evidence pertaining to the epidemiology, causes and consequences of underprescribing, as well as recent advances in the development of interventions able to reduce underprescribing and improve outcomes in older people. Underprescribing is highly prevalent across different settings, including in the community, hospitals and nursing homes.

Adverse drug events as a cause of hospitalization in older adults.

Older adults are about four to seven times more likely than younger persons to experience adverse drug events (ADEs) that cause hospitalization, especially if they are women and take multiple medications. The prevalence of drug-related hospitalizations has been reported to be as high as 31%, with large heterogeneity between different studies, depending on study setting (all hospital admissions or only acute hospital admissions), study population (entire hospital, specific wards, selected population and/or age groups), type of drug-related problem measured (adverse drug reaction or ADE), method of data collection (chart review, spontaneous reporting or database research) and method and definition used to detect ADEs. The higher risk of drug-related hospitalizations in older adults is mainly caused by age-related pharmacokinetic and pharmacodynamic changes, a higher number of chronic conditions and polypharmacy, which is often associated with the use of potentially inappropriate drugs.

Communication and informed consent in elderly people.

Physician-patient relationship is the key-point for an optimal management of any medical procedure. Before performing any diagnostic or therapeutic procedure, clinical communication with patients is necessary. It should regard the nature and purpose of a proposed procedure including potential risks and benefits.

Preoperative evaluation in geriatric surgery: comorbidity, functional status and pharmacological history.

The demand for elective and emergency surgery by older patients is increasing. This review examines the current practice of preoperative evaluation in geriatric anesthesia and provides an overview of new insights in this field. Preoperative anesthesia consultation is essential to examine the patient, evaluate the operative risk and plan preventive perioperative actions.

Association between glomerular filtration rate and adverse drug reactions in elderly hospitalized patients: the role of the estimating equation.

Background: Reduced renal function increases the risk of adverse drug reactions (ADRs) to hydrosoluble drugs (hADRs). However, the ability of different equations to calculate estimated glomerular filtration rate (eGFR) or estimated creatinine clearance (eCCr) and thereby predict the risk of developing hADRs has not previously been compared.

Objective: The aim of this study was to investigate which of three different equations for estimating renal function (Cockcroft-Gault [CG], Modification of Diet in Renal Disease [MDRD] and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) was the most effective at predicting incident hADRs.

Agreement between equations estimating glomerular filtration rate in elderly nursing home residents and in hospitalised patients: implications for drug dosing.

Background: detecting chronic kidney disease (CKD) may have important implications for the management of older and frail people. We aimed at investigating whether clinical setting (nursing home: NH versus hospital: H) affects the agreement between glomerular filtration rate (GFR) values estimated by Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI), Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) equations.

Design: observational study.

Anaesthesia for the elderly outpatient: preoperative assessment and evaluation, anaesthetic technique and postoperative pain management.

Purpose Of Review: Epidemiological data show a continuous expansion of elderly population, associated with an increased demand for surgical treatments by older patients. Geriatric anaesthesia is emerging as a new subspecialty. Outpatient anaesthesia for elderly patients requires greater specific knowledge and skills.

Chronic kidney disease and 1-year survival in elderly patients discharged from acute care hospitals: a comparison of three glomerular filtration rate equations.

Background: Glomerular filtration rate (GFR) is directly associated with survival. However, the prognostic significance of GFR might be different according to the formula used to estimate it. We aimed at comparing the association between GFR estimated using three different formulas and 1-year survival in elderly patients discharged from acute care hospitals.

Psychosocial aspects and zinc status: is there a relationship with successful aging?

It is very interesting and innovative to study the interrelationships between biological characteristics, particularly zinc status, and psychosocial conditions in old age, because there are few and fragmentary data in the literature. The aim of this study was to examine the interrelationship between serum albumin value (an indicator of zinc status) and some psychosocial characteristics in elderly Italian volunteers recruited for the ZINCAGE project, which is supported by the European Commission in the Sixth Framework Programme (Food-CT-2003- 506850). A protocol of tests and questionnaires was used: the Lifestyle Questionnaire, the Mini-Mental Status Examination (MMSE), the Geriatric Depression Scale (GDS, 15 items), and the Perceived Stress Scale.

Identifying pathways involved in leptin-dependent aggregation of human platelets.

Objective: To investigate the role of phospholipase C (PLC), phospholipase A(2) (PLA(2)), calcium, and protein kinase C (PKC) in mediating leptin-enhanced aggregation of human platelets.

Design: In vitro, ex vivo study.

Setting: Outpatient's Service for Prevention and Treatment of Obesity at the University Hospital of Messina, Italy.

Zinc and immunoresistance to infection in aging: new biological tools.

Infections can cause mortality when the immune system is damaged. The catalytic, structural (in zinc-finger proteins) and regulatory roles of zinc mean that this ion is involved in the maintenance of an effective immune response. Both zinc deficiency and impaired cell-mediated immunity combine during aging to result in increased susceptibility to infection.

Therapeutic application of zinc in human immunodeficiency virus against opportunistic infections.

The relevance of zinc in resistance to infections by virus, fungi and bacteria is recognized because of its pivotal role in the efficiency of the entire immune system, in particular in conferring biological activity to a thymic hormone called thymulin, which has differentiation properties on T-cell lines. In infection with human immunodeficiency virus (HIV), the zinc-bound form of thymulin (active thymulin, ZnFTS) is strongly reduced in stage IV of the disease (Centers for Disease Control and Prevention classification) with concomitant decrements in CD4(+) cell count and zincemia values. The zinc-unbound form of thymulin (inactive thymulin, FTS) is, in contrast, very high.

Antihypertensive drug therapy and hypoglycemia in elderly diabetic patients treated with insulin and/or sulfonylureas. Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA).

We performed this case control study to evaluate the risk of hypoglycemia associated with the use of antihypertensive drugs in older hospitalized diabetic patients treated with sulfonylureas and/or insulin. All diabetic patients admitted during 4 months in 1988, month in 1991, 4 months in 1993 and 4 months in 1995 (n = 3477, mean age 71.4 +/- 0.