Nuove acquisizioni in termini di insufficienza mitralica: complicanze tromboemboliche dopo chirurgia della valvola mitrale: incidenza, predittori e implicazioni cliniche

Objectives: to define in patients undergoing surgery for mitral regurgitation (MR) the risk of thrombo-embolic complications, particularly ischemic stroke (IS) compared to that in the general population. Background: MR is frequent, occurs mostly in the elderly and guidelines recommend surgery in asymptomatic patients but IS risks are unknown. Methods: in 1344 patients (65±12 years) consecutively operated for MR (procedures: 897 valve repair, MRep; 447 valve replacement, 231 mechanical, MVRm; 216 biological, MVRb), thrombo-embolic complications particularly IS (diagnosed by a neurologist) during follow-up were assessed early (<30 days), mid-term (30-180 days) and long-term (180 days). Results: IS occurred in 130 patients and IS or transient ischemic attack in 201. IS rates were 1.9±0.4% and 2.7±0.5%, at 30 and 180 days and 8.1±0.8% at 5 years. IS rates were lowest after MRep vs. MVRb and MVRm (6.1±0.9, 8±2.1 and 16.1±2.7% at 5 years, p<0.001). Comparison to IS expected rates in the population showed high risk within 30 days of surgery (Risk-ratio 41[26-60], p<0.001 but p>0.10 between procedures) and moderate risk after 30 days (risk-ratio 1.7 overall, p<0.001; 1.3 for MRep, p=0.07; 0.98 for MVRb, p=0.95; 4.8 for MVRm, p<0.001). Beyond 180 days, IS risk declined further and was not different from the general population for MRep (1.2, p=0.30) and for MVRb (0.9, p=0.72). Risk of IS or transient ischemic attack was higher than the general population in all groups up to 180 days. The risk of bleeding beyond 30 days was lowest in MRep vs. MVRb and MVRm (7±1, 14±4 and 16±3% at 10 years, p<0.001). Conclusion: thrombo-embolic complications after MR surgery are both reason for concern and encouragement. IS risk is notable early, irrespective of the procedure performed, but long-term is not higher than in the general population after MRep and MVRb. Preference for MRep should be emphasized and trials aimed at preventing IS should be conducted to reduce the thrombo-embolic and hemorrhagic risk in patients undergoing surgery for MR.

La città e i consumi. Consumi e trasformazioni urbane a Bologna tra anni '50 e '70

Il primo capitolo di questo lavoro è dedicato all’opera svolta dagli amministratori locali e da un ente governativo come la Camera di commercio per arrivare a decifrare le effettive caratteristiche del quadro locale dal punto di vista economico, sociale, della percezione e del significato che assumono i consumi e gli spazi urbani ad essi dedicati. La caratteristica più originale rilevata dagli amministratori (che contano tra le proprie fila studiosi come Ardigò, Zangheri e Bellettini) è quella di una notevole omogeneità politica e culturale del quadro sociale. E questo, nonostante le massicce immigrazioni che sono, in proporzione, seconde solo quelle di Milano, ma per la stragrande maggioranza provenienti dalla stessa provincia o, al massimo, dalla regione e da analoghi percorsi di socializzazione e di formazione. Fondando essenzialmente su questa omogeneità (capitolo secondo), gli enti bolognesi cercarono di governare la trasformazione della città e anche l’espansione dei consumi che appariva colpita da eccessi e distorsioni. Facendo leva sulle pesanti crisi del 1963-1965 e del 1973-1977, gli amministratori locali puntarono ad ottenere la propria legittimazione fondandola proprio sui consumi, sulla base di una precisa cognizione del nuovo che arrivava, ma schierandosi decisamente a contenerne gli effetti dirompenti sul tessuto locale e indirizzando gli sforzi acquisitivi dei bolognesi sulla base di una temperante razionalizzazione nutrita di pianificazione urbanistica. Ritardi, spinte dal basso, ostacoli burocratici e legislativi resero questi percorsi difficili, o comunque assai poco lineari; fino a che l’ingresso negli anni Ottanta non ne modificò sensibilmente il corso. Ma questo, allo stato attuale delle conoscenze, è già tema per nuova ricerca. Il terzo capitolo è dedicato alla visualizzazione cartografica (GIS) dell’espansione degli spazi commerciali urbani durante le fasi più significative del miracolo.

Adulthood with Turner Syndrome: Quality of life, psychosocial adjustment and clinical management in 70 Italian women

Abstract Background: Turner syndrome (TS) is a chromosomal abnormality (total or partial absence of one of the sexual chromosomes in some or all cells of the body), which affects approximately 1:2000 female. Principal characteristics are short stature and gonadal disgenesis. Clinical management consist of Growth Hormone (GH) treatment and oestrogen replacement therapy (HRT), to induce development of secondary characteristics and to avoid the sequelae of oestrogen deficiency. Aim of the study: To assess clinical management, quality of life (QoL) and general psychosocial adjustment of women with TS. Population: 70 adult Caucasian females with TS (mean age: 27.8, ± 7.6; range 18-48 y.). Setting: Specialist service for Rare Disease care, University Hospital. Methods: Subjects were required to fill in questionnaires collecting ASR, WHOQOL, and 8 open questions. Data were compared with those of the Italian population or to those collected in a comparison group (70 healthy females, mean age: 27.9, ±7.3, range 21-48 y.). Results: Women with TS are educated as well as the Italian Population, but they have a less successful professional life. They show good QoL in general, but they appeared less satisfied in social area. They had statistically higher scores than the comparison group for depression, anxiety and withdrawal. Are less involved in a love relationship. Diagnosis communication was mostly performed by doctors or parents, satisfaction was higher when information was given by parents. Main preoccupation about TS are infertility, feeling of being different and future health problem. Conclusions: Italian people with TS were generally well adapted and have a good QoL, but lived more often with parents and show impaired sentimental and sexual life. They have higher degree of psychological distress compared to a comparison group. Psychological intervention should firstly address parents in order to encourage an open communication on diagnosis issues and on sexual education.