RESUMEN
BACKGROUND: Current guidelines recommend beta-blockers for primary prevention of variceal haemorrhage in cirrhotic patients, and band ligation for patients with contraindications or intolerance to beta-blockers. However, it has been suggested that these patients may respond poorly to band ligation. AIM: We evaluated the usefulness of a strategy in which band ligation was used to treat patients with contraindications or intolerance and patients not responding to beta-blockers identified by hepatic vein pressure gradient measurement. Haemodynamic responders and patients refusing hepatic vein pressure gradient measurement were given long-term beta-blockers. METHODS: One hundred and thirty-five consecutive patients with high-risk oesophageal varices and no prior bleeding were enrolled. Twenty-five patients with contraindications (group A), 26 with intolerance to beta-blockers (group B) and 25 showing a poor haemodynamic response (Group C) underwent band ligation. Twenty-two haemodynamic responders (Group D) and 37 refusing hepatic vein pressure gradient measurement (Group E) were treated with beta-blockers. RESULTS: Median follow-up was 32 months. 12/135 patients (8.9%) bled: 3/25 (12%) in group A, 1/26 (3.8%) in group B, 0/25 (0%) in group C, 0/22 (0%) in group D and 8/37 (22.2%) in group E. Mortality was 8/135 (5.9%). CONCLUSIONS: Patients with contraindications, intolerance or not responding to beta-blockers treated with band ligation achieve protection from variceal bleeding comparable to that of good responders to beta-blockers.
Asunto(s)
Endoscopía , Várices Esofágicas y Gástricas/cirugía , Hemorragia Gastrointestinal/prevención & control , Cirrosis Hepática/complicaciones , Antagonistas Adrenérgicos beta/efectos adversos , Contraindicaciones , Várices Esofágicas y Gástricas/tratamiento farmacológico , Várices Esofágicas y Gástricas/etiología , Femenino , Estudios de Seguimiento , Humanos , Ligadura , Masculino , Persona de Mediana EdadRESUMEN
The prevalence of comorbidities in patients dismissed from hospitals has already been investigated to obtain economical, administrative and epidemiological information, or for health insurance-related problems. Originally designed for billing purposes, administrative data could be the basis for clinical research as well, although the clinical element has somehow been disregarded till now. The aim of this research is (i) to study the prevalence, and (ii) to evaluate the clinical relevance of comorbidities in patients dismissed from a Department of Internal Medicine. In a recent series of 1605 patients (since the Diagnosis-Related Groups-DRG-based hospital financing system has come into common use in Italy) comorbidities have been observed in 92.65% of the cases, while the percentage of comorbidities was rated as 71.97% in a previous series of 2551 patients dismissed from the same Department before the introduction of the DRG system. In the recent series, the prevalence of a single comorbid condition and of two and of three comorbid conditions was 19.50, 32.89 and 47.61%, respectively. In any case, the so-called comorbid conditions were active diseases requiring medical investigation and therapy. They included hypertensive heart disease, ischemic heart disease and angina, arrhythmias, peripheral vascular diseases, chronic bronchitis, chronic hepatitis, liver cirrhosis, diabetes, metabolic disorders, etc. In conclusion, patients referred to a Department of Internal Medicine have a high severity of illness due not only to the gravity of the primary diagnosis but also to the number and seriousness of comorbid conditions. For these patients more hospital resources and a high level of professional skill are required.
Asunto(s)
Comorbilidad , Departamentos de Hospitales/estadística & datos numéricos , Medicina Interna , Manejo de Atención al Paciente , Revisión de Utilización de Recursos , Adulto , Anciano , Grupos Diagnósticos Relacionados , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Alta del Paciente , PrevalenciaRESUMEN
In this study we analyse the frequency of testicular microlithiasis in a group of otherwise infertile healthy men, visited at the Andrology Service of Prato Hospital. Here the ultrasound machine is located in the ambulatory and it is possible to use it during the first visit of the patient, as we have done in 250 consecutive infertile men. This examination, easy and not invasive, has been performed to evaluate the pampiniform plexus to find possible varicocele, epydidimis for obstructive signs and testes for the presence or absence of parenchymal calcifications or masses. We found 106 positive sonographic records (42.4%) for scrotal diseases. Between them, two cases of testicular microlithiasis (0.8% of 250 consecutive ultrasound examinations and 1.7% in the last twelve months). Our data, although with a lower incidence than literature, show the importance of ultrasound examination in absence of specific diagnostic questions too, in the study of male infertility. Clinical management of testicular microlithiasis is difficult, due to loss of treatment and to cancer risk. A long term follow up is request, with periodical (6-12 months) sonographic controls. A classification (here we propose) can be useful for a more precise monitoring.