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Aims: The study examined the role of alexythimia and emotional distress in patients with diagnosis of chronic headaches (tension-type and medication overuse headache)., Materials and Methods: The Toronto Alexithymia Scale (TAS-20)and the Rapid Stress Assessment (RSA) were administered to a sample of 104 patients (day hospital and outpatients) composed by 70 with CTTH and 34 with MOH., Results: In total sample, 16.3% of patients were classified as alexithymics, 20.2% as intermediates and 63.5% as non-alexithymics, according to the TAS-20 criteria. Anxiety and Lack of social support (RSA) showed the higher values, yet the RSA mean profile didn't exceed the normative range. Alexithymics scored higher on all the RSA scales; significant positive correlations were also obtained among RSA and TAS-20 values. MOH patients were more frequently classifi ed as alexithymics and reported higher values on Aggressiveness scale (RSA) compared to CCTH patients., Conclusions: Findings supported a link between alexithymia and emotional distress, as an index of psychological maladjustment in chronic headache patients.

We analyzed, in a middle-sized hospital, the problems related to the so-called "difficult discharges", conceived as situations involving an economic, human and organizational burden exceeding patients' and their families' capacities and requiring a specific involvement of territorial services. During a whole year (July 1, 2001-June 30, 2002) the cases found were 591. We demonstrated that the problem concerns mainly elderly patients, almost equally distributed between males and females, a quarter of the sample being represented by patients who had recently undergone surgery and whose discharge difficulties were mostly related to mixed social and sanitary problems. This kind of patients is faced with long-term hospitalization implicating a large number of intra-hospital transfers due to the presence of severe and disabling pathologies, mainly neoplasms and strokes, often associated with other serious diseases, various complications and difficult situations from the health point of view. About half of the patients had the possibility to go back home, while the rest required lodging in territorial structures such as nursing homes and retirement homes. The average time-lapse between the possible discharge indicated by the hospital physician and the actual discharge was 10 days, with global annual 6106 days of "improper" hospitalization. Our conclusion is that the phenomenon of difficult discharges is nowadays a very topical problem and that it should be faced with a new model of continuous and integrated assistance organization.

Unlabelled: The cardioversion of atrial fibrillation is linked to a substantial risk of systemic embolization. In an effort to reduce it, the American College of Chest Physicians (ACCP) periodically publishes guidelines for the use of anticoagulation in the conversion of atrial fibrillation., Objective: Determination of the physician's compliance with the recommendations of the "Fourth ACCP Consensus Conference on Antithrombotic Therapy"., Methods: The charts of people admitted to a community hospital in 1998 with a diagnosis of atrial fibrillation (n = 202) were evaluated retrospectively. Consideration was given to the ACCP's recommendation to give anticoagulants 3 weeks before and 4 weeks after elective cardioversion to patients who had been in atrial fibrillation for more than 2 days., Results: Ninety-one of the 202 patients admitted with atrial fibrillation reported the onset of arrhythmia more than 48 hours before. Thirty-four of them underwent elective cardioversion and 13 cases (33%) went without anticoagulation in the preceding 2 weeks. Of these 13 cases, 8 were patients aged over 75 (range 78-88, mean 84). After sinus rhythm had been restored in 30 people (spontaneously in 5 of them), the anticoagulant therapy was not administered during the 4 recommended weeks in 10 people (33%), all of them over 75 (range 77.94, mean 84)., Conclusions: Anticoagulation for cardioversion of atrial fibrillation is underused, especially among elderly patients. In order not to let age itself be an obstacle to the correct treatment of patients with high embolic risk, our efforts must be improved in order to identify the correct therapeutic choice in each particular case. Initiatives aimed at identifying and removing any impediment to the application of guidelines may contribute to stimulating physicians in the process of evaluating the quality of hospital treatment.

Low-molecular-weight heparins (LMWHs) are obtained by depolymerization from standard heparin and show substantial advantages compared with the parent compound, by virtue of their different pharmacokinetics and lower interaction with platelets, so that they are supplanting heparin in various clinical indications. In the prophylaxis of venous thromboembolism, LMWHs are more efficacious than unfractionated heparin in patients at high thrombotic risk, and equally efficacious in patients at moderate thrombotic risk, with the benefit of once-a-day administration. In the treatment of acute deep venous thrombosis and pulmonary embolism, LMWHs administered subcutaneously in fixed dose per kg of body weight show equivalent efficacy and safety than intravenous heparin in adjusted dose, and allow home treatment in selected cases. In the treatment of deep venous thrombosis after the acute phase, LMWHs are equally effective and safer than oral anticoagulants. In unstable angina and non Q myocardial infarction, nadroparine and enoxaparin plus aspirin have been shown to be more efficacious than unfractionated heparin plus aspirin. In acute ischemic stroke, preliminary results are promising, but the evidence of efficacy must be substantiated by other studies, which are currently in progress.

A case of a 49-year-old woman affected by wide ulcerations on the face which have been caused by the patient herself, as she has admitted, is reported. The lesions were strictly limited to the area of innervation of the first and second branch of the trigeminal nerve. The patient presented parasthesias and analgesia in the trigeminal area as the consequence of a neurosurgical operation. She also suffered from important psychosis. All these elements enable us to diagnose "trigeminal trophic ulcers". The pathogenesis of this syndrome is discussed.

Chronic arterial occlusive disease of lower limbs is recognized as a typical multifactorial disease, but the role of some risk factors is still debated, because contrasting results have been obtained in epidemiological studies. We investigated the prevalence of hypercolesterolemia, hypertriglyceridemia, hypertension, smoking habits and diabetes in a population of 172 patients with peripheral arterial disease admitted to the III and V Medical Division of the "Ospedale Regionale" of Parma in the period January 1979 - April 1983, and in a control group of 174 subjects comparable for age and sex, free of clinical symptoms or signs of atherosclerosis. Statistically significant (p less than 0,005) increases in the prevalence of hypercolesterolemia, hypertriglyceridemia, smoking and hypertension were found in vascular patients compared with controls, the relative risk for the various considered factors being respectively: 6.40; 4.72; 4.03; 3.16.

The clinical diagnosis of deep vein thrombosis is unreliable and venography remains the best single method of investigation. In the last ten years several non-invasive procedures have been introduced in the vascular laboratories, sometime without adequate assessment of their reliability. We tested sensitivity and specificity of three different non-invasive procedures, namely phleboscintigraphy with 99Technetium, Doppler ultrasound technique and strain-gauge plethysmography in patients with clinically suspected deep vein thrombosis of lower limbs or pulmonary embolism. A total of 288 patients entered the study. Venography was used as the reference standard and was assessed independently, without knowledge of the results of non-invasive methods. In the first 36 patients phleboscintigraphy and Doppler ultrasound were evaluated: sensitivity and specificity of phleboscintigraphy resulted only a little more than 50%; the method was therefore considered unreliable and subsequently abandoned. Doppler ultrasound could be evaluated upon a total of 81 patients, showing an unsatisfactory sensitivity (63%), but a quite reliable specificity (86%). Best results were obtained with strain-gauge plethysmography, using maximal venous outflow and venous capacitance as diagnostic parameters. 209 patients entered this study, and a sensitivity of about 90% with a specificity of about 95% was observed. If we consider only acute proximal deep vein thrombosis, sensitivity approaches 97%, while it is only 60% in distal deep vein thrombosis.

We describe the case of a patient 4 months old transferred to our hospital for evaluation of occasionally detected cardiac alterations: ecg showed abnormal Q and negative T waves in D1 - aVL leads and chest x-ray was consistent with enlargement of the left ventricular cavity. After admission, 2D echocardiographic examination disclosed, in the left ventricular cavity, a large mass extending from the papillary muscles to the outflow tract. The mass was of uniform density and easily recognizable as a tumor. Although asymptomatic, the patient underwent operation 10 months later because of the risk of occurrence of severe conduction disturbances or arrhythmias. Histological examination demonstrated that the mass was a fibroma. At post-op echocardiographic and angiographic evaluation the left ventricle appeared abnormally dilated with a large aneurysm of the lateral wall and very poor pump function. Nevertheless the patient did well in the following months until a ventricular fibrillation occurred at home. He was immediately brought to hospital and resuscitation was attempted unsuccessfully. We discuss the role of 2D echocardiography in the diagnosis of cardiac tumors, the indication of the early surgical removal and the possible limitations of the technique we used in this case.