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Objectives: To investigate a comprehensive geriatric assessment (CGA) with subsequent investigation of healthcare patterns in older patients with urological cancers undergoing initial surgery or radiotherapy, to verify the usefulness of the incorporation of geriatric principles in future care plans., Material and Methods: This is a prospective cohort study. From November 2011 to March 2015, CGA was offered to all patients aged 70+ years treated with radiotherapy or surgery at seven tertiary centers. Patients were classified as fit, vulnerable, or frail according to Balducci's definition. CGA and follow-up data were collected by two trained evaluators at 6 and 12months. The information collected was not available to the caring physicians during follow-up., Results: CGA was performed in 453 patients with prostate cancer (295), bladder cancer (126), or kidney cancer (32). 40% of patients with prostate cancer were fit, 47% vulnerable, and 13% frail. The corresponding values for renal cancer were 25%, 40%, and 34%, and for bladder cancer, 21%, 42%, and 37%. During follow-up, 60% of patients with cardiac diseases, 42% of those with diabetes/other metabolic disorders, 35% of those with hypertension, and 35% of those with respiratory diseases were followed by a specialist (for these severe/extremely severe comorbidities). Of 16 patients with ADL impairment and 63 with IADL impairment, only 4 (25%) and 6 (10%), respectively, were referred to a rehabilitation service. Only one case was referred to a geriatrician., Conclusions: Appropriate clinical care patterns are advisable to improve quality of survivorship in older patients with urological cancers., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The leather industry (tanneries) generates high amounts of toxic wastes, including solid and liquid effluents that are rich in organic matter and mineral content. Vermicomposting was studied as an alternative method of treating the wastes from tanneries. Vermicompost was produced from the following tannery residues: tanned chips of wet-blue leather, sludge from a liquid residue treatment station, and a mixture of both. Five hundred earthworms (Eisenia fetida) were added to each barrel. During the following 135 days the following parameters were evaluated: pH, total organic carbon (TOC), organic matter (OM), cation exchange capacity (CEC), C:N ratio, and chromium content as Cr (III) and Cr (VI). The results for pH, TOC and OM contents showed decreases in their values during the composting process, whereas values for CEC and total nitrogen rose, indicating that the vermicompost reached maturity. For chromium, at 135 days, all values of Cr (VI) were below the detectable level. Therefore, the Cr (VI) content had probably been biologically transformed into Cr (III), confirming the use of this technique as an advanced biological treatment. The study reinforces the idea that vermicomposting could be introduced as an effective technology for the treatment of industrial tannery waste and the production of agricultural inputs.

Context: Chronic pain increases with age, and in the elderly, comorbidities and polypharmacotherapy make the choice of treatment for pharmacological pain control a complex matter., Objectives: We conducted a multicenter, prospective, observational study to evaluate the efficacy and safety of the buprenorphine transdermal delivery system (TDS) in elderly patients with chronic noncancer pain. The aim was to assess the cognitive and behavioral status of patients during treatment., Methods: The study included 93 patients (69 women and 24 men); the mean age was 79.7 years, and in most cases, the pain was due to osteoarthritis. Almost three-quarters (74.2%) of the patients had suffered pain for more than 12 months. The treatment was buprenorphine TDS, starting from a dose of 17.5 μg/h. Outcomes were assessed using the Mini-Mental State Examination (MMSE), the 17-item Hamilton Depression scale (HAM-D 17), the Neuropsychiatric Inventory, the Barthel Index, the Short-Form Health Survey (SF-12), a verbal numeric rating scale, and the Cumulative Illness Rating Scale (CIRS)., Results: Buprenorphine treatment was associated with a decrease in pain severity without negative effects on the central nervous system. On the HAM-D scale, there were reductions in both the psychological and somatic scores. On the MMSE, values at the beginning and end of the study were comparable. Evaluation by SF-12 showed improvements in physical and mental status. CIRS values at baseline and at the end of the study were superimposable, indirectly confirming the tolerability and safety profile of the drug., Conclusion: Our experience confirms the analgesic activity and safety of buprenorphine TDS in the elderly. There was an improvement in mood and a partial resumption of activities, with no influence on cognitive and behavioral ability., (Copyright © 2011. Published by Elsevier Inc.)

From a sample of 265 elderly subjects (age 80.2 +/- 6.8 years) admitted to a geriatric care unit, free from cardiac and respiratory diseases, with normal chest X-ray and gas analysis, 53 subjects were selected and their respiratory functions (assessed by spirometric parameters and airway resistance 'Raw') were studied to correlate them with nutritional status, cognitive impairment, independence in everyday life activities and mood disorders, assessed, respectively, by the Mini Nutritional Assessment, rapid Mini Mental State test (MMSr), activities of daily living (ADL), instrumental activities of daily living (IADL) evaluation, Barthel Index and Cornell Depression Scale. The enrolled subjects were able to perform normally a forced expiration, although most of them committed errors in this test, according to the American Thoracic Society (ATS) criteria. Thus, about 32% started at lung volume0.12 s); in 62% of the subjects expiration time was too short and in 58% the terminal plateau was <2 s. Nevertheless, the spirometric parameters (and Raw) were considered normal. Forced vital capacity and peak expiratory flow (but not FEV1) were higher in the subjects without disability, while cognitive and nutritional status did not seem to have any influence on spirometric performance; MMSr score was related to compliance with ATS criteria for acceptability of the forced manoeuvre; mental and mood disorders, nutritional conditions and disability did not seem to have any influence on error rates. Our data show that our geriatric enrolled patients were able to perform an imperfect, often unfinished, but acceptable forced expiration; dynamic index values were related to disability, while the errors in starting the test were related to the mental conditions.

The loss of hearing abilities can be seen as a complex event because psychological discomfort and relational inhibitions interact and lead to behaviours and attitudes which are insidious and dangerous for the quality of life of the patient. The complexity of the psychological-organic inconvenience, such as impairement disability and handicap led to the testing of recovery patterns. In this specific context interventions coming from different fields sustained from a complex operative model where different professional competences and evaluation processes interact. Therapeutic interventions have been carried out by an audiologist, an audiometrist, a speech therapist, an audioprostethist and a psychologist, all sharing the obtaining of the same result. The role of the audiologist is simply clinical and concerns the knowledge of the entire process of rehabilitation through the use of a prosthesis. This process concerns the audiologist, who operates in close collaboration with the audiometrist and the audioprosthesist: it is therefore a therapeutic activity that is interested mainly in the prescription of the prosthesis and the restoring of the communicative function. The speech therapist and the psychologist carry their interventions through a relationship with the patient, which places the respect of the patient's personality before any other procedural and technical aspect. Therefore they pay attention more to ergonomic factors than to the hearing loss, through the obtaining of the patient's self-confidence and of a better general psychological situation. Therefore the main purpose of each intervention is to create a process of rehabilitation aimed at restoring the communicative functions and the individual motivation in trying to do so both in the domestic and in the social environment. The authors refer the experience and the informations put together during three years of research activity. The results of the therapeutic intervention have brought to the acceptance of the prosthesis help, the adaptation to amplification, the reduction of the subjective and relational uneasiness for the use of prosthesis, the use of the prosthesis, the reintroduction to the world of sounds, the restoring of levels of autonomy and of self-estime, the discover of eventual abilities, which had never been used or underestimated, the reactivation of more rewarding social relationships and the reduction of the conditions of dependency related to the hearing disability.

Correct identification and evaluation of balance disorders and an assessment of their repercussions on a patient's life are common problems faced by the otoneurologist. These symptoms may not infrequently have a chronic or recurrent course and can lead to in restrictions in the patient's everyday life and even have consequences for the patient' mental health. In the doctor-patient relationship anamnesis is of crucial importance in diagnosis as well as in establishing a relationship of professional confidence with the patient which may influence the outcome of the treatment. An awareness of those situations of daily life which bring about or aggravate the symptoms provides the doctor with valuable information in formulating an etiopathogenetic hypothesis. This observation led us to design the anamnestic self-questionnaire "Disability" whose purpose is to describe the type of disability or impairment to daily life suffered by the patient as a result of the pathology, while at the some time measuring their effects. Our history questionnaire has confirmed the importance of careful history in assessing balance disorders, has highlighted the striking extent of disability and impairment caused by these disorders, and has enabled us to identify the chief features of all pathologies encountered in the specific field of balance disorders. The questionnaire enables us, in particular, to highlight the interference of extra-vestibular factors (muscle-strain, states of irritation, phobias, drugs, dietary factors, etc.). The use of this questionnaire has proved to be of great assistance, therefore, in carrying out routine clinical diagnosis, in the absence of complex technical equipment. Moreover, it constitutes a valuable method in monitoring the outcome of the therapy, or the natural course of the balance disorders.

The Authors describe their personal experience in a rare case of total arhinia in a young boy, now seven years old, whose psycho-physical development is normal and who is healthy except for recurrent conjunctivitis due to the absence of nasolacrimal ducts. The Authors consider the possibility that in the case of total absence of the nasal function, as in total arhinia, the oropharyngeal and laryngotracheobronchial mucosa may acquire those functional and defensive properties typically belonging to nasal mucosa. In the subject in question, in fact, functional respiratory and immunosecretory parameters are normal. On the other hand, being well known how problematic acquired severely compromised nasal functions are one would think that only in the case of congenital absence of the nose can the lower aerodigestive structures compensate successfully. In the Authors' opinion this clinic observation contradicts the widely held belief that nasal respiration is absolutely necessary from the moment of birth on.

In the present multicentre study, the antiphlogistic activity of seaprose S was assessed according to an experimental design of the controlled type versus nimesulide in patients with phlogistic pathology of ENT relevance and in patients undergoing otoiatric surgical operations. One hundred and sixty patients (87 M, 73 F) were treated with seaprose S in 30 mg tablets (3tab/day) while 160 patients (95 M, 65 F) were treated with nimesulide in 100 mg (2 tab/day). The treatment lasted 7 days. At the beginning of the study, on the 3rd, 7th and 14th day (follow-up) the most significant signs and symptoms present in the pathological forms under consideration were evaluated. Common haematological and haematochemical laboratory parameters were also evaluated and any side effects occurring during the treatment were recorded. Considering the efficacy demonstrated, it was shown how the two drugs used possess an analogous action (NS) and are always able to exert positive control over the symptoms under examination. Administering seaprose S there were 9 cases of unexpected events (5.6%) while with nimesulide 26 patients (16.3%) showed problems of intolerance, with a highly significant statistical difference (p < 0.01) between the two groups. The analysis of the data obtained allows us thus to support the therapeutic use of seaprose S in the treatment of phlogosis of ENT relevance, since it has shown efficacy comparable to that of a NSAID such as nimesulide, but with greater safety.