Independent Functioning in Nonagenarians Living in a Rural Italian Community: The Mugello Study

Nonagenarians are a fast-growing population deserving specific research. We explored the prevalence and characteristics of functionally independent nonagenarians from a rural community-dwelling Italian population. Data were collected in the Mugello Study; 475 persons aged ≥90 years (median age, 92) underwent a home-based clinical and functional assessment, including psychosocial, clinical, functional, and lifestyle history and status and physical and instrumental examinations. Sixty-eight (15%) persons reported no need for help in basic and instrumental daily living activities. Among variables significantly associated with independent functionality after age- and gender-adjusted cross-sectional analysis, lower body mass index (BMI; p = .034) and depressive symptoms (p = .028), higher current physical activity (p < .001), better cognitive status (p = .033), and lower medication intake (p = .048) were associated with reporting no disability in the logistic regression analysis. Disability was mainly associated with current lifestyle-related potentially modifiable factors. Thus, lifestyle-oriented multidimensional interventions, should be developed and evaluated for their potential effects on functionality, even in the oldest old.

HDL Cholesterol Is Independently Associated with Cognitive Function in Males But Not in Females within a Cohort of Nonagenarians: The MUGELLO Study

OBJECTIVES

To investigate the possible relationship between lipid profile and cognitive functions in a cohort of nonagenarians enrolled within the Mugello Study, an epidemiological study aimed at investigating both clinically relevant geriatric items and various health issues.

DESIGN

Cross-sectional survey.

SETTING

This study focused on oldest old community-dwelling participants.

PARTICIPANTS

Three hundred twenty-five nonagenarians (218 F, median age: 92 years).

MEASUREMENTS

Participants were evaluated through laboratory, instrumental examinations and questionnaires concerning lifestyle, dietary habits and cognitive status.

RESULTS

Females are older, with a lower level of education, live more prevalently on their own and have higher values for total cholesterol and high-density lipoprotein cholesterol (HDL) compared to males. With regard to functional and cognitive measures females report a significantly lower skill level in the physical activity performance, with a level of independence that is better for both basic and instrumental activities. In order to investigate whether there was an association between lipid variables and cognitive function as measured by the Mini-Mental State Examination a multiple regression analysis was performed with adjustments for confounding variables based on gender. In males, HDL cholesterol showed a significant relationship with Mini-Mental State Examination after a complete adjustment with years of education, physical activity performance and daily living activities (β = 0.174; p=0.037). In females HDL cholesterol showed a significant association only in the model adjusted for age and body mass index, losing its associations as soon as the cohabitation state and the depression status entered the model.

CONCLUSION

Our results support the hypothesis that HDL cholesterol is significantly linked to cognitive functions, especially in males of a cohort of very old people.

Metabolic control and complications in Italian people with diabetes treated with continuous subcutaneous insulin infusion

BACKGROUND AND AIM

The objective of this cross-sectional study was to evaluate the degree of glycaemic control and the frequency of diabetic complications in Italian people with diabetes who were treated with continuous subcutaneous insulin infusion (CSII).

METHODS AND RESULTS

Questionnaires investigating the organisation of diabetes care centres, individuals' clinical and metabolic features and pump technology and its management were sent to adult and paediatric diabetes centres that use CSII for treatment in Italy. Information on standard clinical variables, demographic data and acute and chronic diabetic complications was derived from local clinical management systems. The sample consisted of 6623 people with diabetes, which was obtained from 93 centres. Of them, 98.8% had type 1 diabetes mellitus, 57.2% were female, 64% used a conventional insulin pump and 36% used a sensor-augmented insulin pump. The median glycated haemoglobin (HbA_1c) level was 60 mmol/mol (7.6%). The HbA_1c target (i.e. <58 mmol/mol for age <18 years and <53 mmol/mol for age >18 years) was achieved in 43.4% of paediatric and 23% of adult participants. Factors such as advanced pump functions, higher rate of sensor use, pregnancy in the year before the study and longer duration of diabetes were associated with lower HbA_1c levels. The most common chronic complications occurring in diabetes were retinopathy, microalbuminuria and hypertension. In the year before the study, 5% of participants reported ≥1 episode of severe hypoglycaemic (SH) episodes (SH) and 2.6% reported ≥1 episode of ketoacidosis.

CONCLUSIONS

Advanced personal skills and use of sensor-based pump are associated with better metabolic control outcomes in Italian people with diabetes who were treated with CSII. The reduction in SH episodes confirms the positive effect of CSII on hypoglycaemia.

CLINICAL TRIAL REGISTRATION NUMBER

NCT 02620917 (ClinicalTrials.gov).

Paediatric burns in the acute phase: specific aspects

This paper deals with specific aspects of paediatric burns in the acute phase and considers how the treatment of burned children differs from that of burned adults. The epidemiology of paediatric burns is reviewed. Particular aspects of the treatment of burned children are presented, with regard to treatment at the site of the accident, first aid, resuscitation, and local treatment. The importance of the accurate assessment of paediatric burns is stressed.

[Neonatal urinary ascites secondary to posterior urethral valves]

Urine collection within the perirenal spaces and subsequent urinary ascites may be caused either by calyceal perforation or filtration through the walls of urinary tract as a consequence of urinary obstruction. The obstruction to urine deflow is more frequently secondary to the presence of posterior urethral valves (PUV) in the paediatric age group. Urine collecting within the perirenal spaces may act as a decompressive mechanism that allows endoluminal pressure to decrease, being thus glomerular function and prognosis improved. The case of a newborn in poor clinical conditions with PUV who underwent an emergency surgical procedure for the onset of urinary ascites is described. On operation, no perforation of the upper urinary tract was found, being urinary ascites probably caused by filtration secondary to increased endoluminal pressure. PUV were coagulated by means of a Bugbee electrode and a nephrostomy set in place. Congenital obstruction of the urinary tract caused by PUV may lead to renal, ureteric and vesical damages. Surgery is necessary in order to preserve and improve renal function.

[Esophageal atresia with distal tracheo-esophageal fistula. Evolution of the treatment in the period of 1955-2000 at the Anna Meyer Children's Hospital of Florence]

BACKGROUND

Over the past decades the esophageal atresia (EA) has represented the greatest challenging malformation encountered by the pediatric surgeon. Since then, there have been considerable advancements in the treatment of EA. In this paper the experience at the "Anna Meyer Children's Hospital of Florence" in regards to the surgical treatment of the EA from 1955 to present day is reported, so that the analysis of the various medical and surgical choices followed by the authors and their predecessors in this long period, can be an important learning tool for the EA management.

METHODS

From 1955 to 2000, 223 newborns affected by EA with tracheoesophageal fistula (TEF) have been operated on out of a total of 250 cases of EA. Our experience has been subdivided into periods on the basis of homogeneous medical and surgical treatment adopted in that determined time. We have analyzed particularly the data of the last period 1995-2000, where there has been a well standardized protocol of treatment from the medical, surgical and intensive care points of view.

RESULTS

The mortality rate has decreased from 44.8 to 3.4% with a significant reduction (p<0.001) between the years 1979-1983 and 1984-2000, due to the introduction of a perioperative treatment in the newborn intensive care unit. Moreover, a significant correlation (p<0.05) has been shown between low birthweight and associated malformations, two risk factors that however do not negatively influence the results of the treatment in the last period 1995-2000.

CONCLUSIONS

A full integration between the surgeon and neonatologist is necessary in order to guarantee a good result. The risk connected to EA is not as much the surgical procedure as the presence or absence of associate malformations that are undetected in the prenatal diagnosis. It is suggested that, in order to further reduce the mortality and morbidity rate after EA correction, the number of prenatal diagnoses should be increased.

[Acute scrotal involvement as onset of a testicular Sertoli cell tumor in a two-month-old baby]

Sertoli cell tumour is an uncommon neoplasm, either in the adult and in the pediatric age groups. An intrascrotal, slowly growing, painless swelling generally represents its clinical onset. Orchiectomy definitively is successful in these patients, since Sertoli cell tumour very rarely metastatise elsewhere. The case of a two-month old baby in which an acute intrascrotal involvement (requiring immediate surgical therapy), was the atypical onset of a testicular Sertoli cell tumour, is described. The hystogenesis as well as the clinical and pathological peculiarities of this neoplasm in pediatric patients are discussed.

[Intracranial arachnoid cyst in pediatric age]

Arachnoid cysts are a pathological condition in which an arachnoid-lined cavity is filled with a CSF-like fluid, often creating a disturbance in intracranial dynamics, due to shift and displacement of surrounding structures, and intracranial hypertension. Primary or congenital arachnoid cysts are maldevelopmental anomalies and contain clear CSF-like fluid. Acquired cysts may result from a variety of aethiologies such as traumas and infections. In these cases the intracystic fluid may be emosiderin-stained or may contain inflammatory cells. A general survey of this peculiar pathological finding in the pediatric age group is reported by the Authors in this paper.

[Hydrocephalus in the pediatric age group: considerations on a series of 245 shunted patients]

A series of 245 hydrocephalic patients in the pediatric age group who underwent 544 surgical shunting procedures is reviewed in this paper. The subsequent average of 1.5 operations per patient appears therefore significantly low, when compared with the Literature data. The authors emphasize that this result may be due mainly to the fact that all the surgical procedures were performed by the same surgeons, even if two other concepts appear extremely important in this regard: the great care in prevention of shunt infections and the use of one-piece shunting devices. A pattern for the "clinical surveillance" of hydrocephalic children is proposed and the neuropsychological follow-up of the series is described in the paper. Authors conclude that serious damage to cerebral parenchyma due to intracranial hypertension related to the hydrocephalic condition may be avoided by an accurate selection of patients to be operated on, a correct surgical timing and a careful postoperative control.

Varicocele in Paediatric Age: Comparison between Testicular Size Measured by Ultrasound, Prader Orchimeter and Sliding Calibre

Varicocele in paediatric age requires a different clinical management from that in adults. Because of the lack of seminal data, the accurate evaluation of the testicular size is of great value in the clinical approach and in the follow-up of varicocele in the child. The Authors present their experience, refering to 57 children with left idiopathic varicocele, in which the testicular size was measured by three different means: Prader's orchimeter, sliding calibre and scrotal ultrasound. The measurements were carried out by the same surgeons and radiologists. No significant differences were observed between the measurements obtained by the use of the different means. The data were compared by Fisher's statistical test. In conclusion the sliding calibre and the orchimeter are accurate enough methods, and very cheap. The ultrasound is more accurate in the evaluation of testicular size and is the method employed in the presence of other testicular and scrotal diseases.

[Congenital anomalies of the penis in children. A few consideration about 92 cases]

The authors present their experience of 92 cases of anomalies of the penis, hypospadias excepted, occurring in children between 12 months and 10 years old, during the last 5 years, in their Pediatric Surgical Department. In the literature, there are reported only many single cases of these anomalies, for the most part associated in serious multiple malformations, or with hypospadias. The children included in this report present the anomalies of the penis as a sole malformations. The classification of these anomalies was made by embryological criteria and by the frequency of occurrence. In 41 cases there was congenital curvature of the penis, in 9 cases there was a webbed penis, in 6 cases a concealed penis. Torsion of the penis occurred in 6 cases (in 5 anticlockwise) the microphallus in 5 cases. The "hypospadias without hypospadias" occurred in 5 cases, in the others there was an association among these anomalies. The authors emphasize the importance of these malformations for the children and their families, also in order to prevent, also serious, psychological effects.

[Postprandial and postural dyspnea: a clinical sign of intraperitoneal pseudocyst in patients with hydrocephalus and ventriculo-peritoneal shunt]

The surgical treatment of hydrocephalus has been greatly improved by the techniques of ventriculo-peritoneal shunting. Several complications may however occur following these operative procedures. Most of the complications are related to the distal end of the shunt device and include obstruction of intraperitoneal catheter, development of inguinal hernia or hydrocele, perforation of viscera. Many observations have been dedicated to these pathological findings, due to their frequency and the relatively easy diagnosis. Intraperitoneal pseudocysts are also a known complication of ventriculo-peritoneal shunts. Owing to their relative rare incidence and the aspecificity of their clinical presentation, this last type of complication has received a minor consideration. In the present report the authors describe two cases of intraperitoneal pseudocysts clinically manifested by the occurrence of postprandial dyspnea and hiccupping, without any apparent sign of CSF shunt device dysfunction.