Abstracts
acid, with partial improvement. After 8 cycles of therapy he was
admitted to the Medical ward with fever, agitatation and back pain.
Physical examination was not significant. Blood tests showed
leukocytosis and mild increase in PCR. Head CT scan did not showed
signs of stroke or intracranial hypertension. Chest X ray was negative.
In the suspicion of meningitis, Ceftriaxone was started but the patient
was soon referred to the intensive care unit due to persistance of fever
and appearance of drowsiness and hemodynamic instability. From
blood and cerebrospinal fluid cultures penicillin-sensitive Listeria
Monocytogenes was found. Despite adequate antibiotic therapy, multi
organ failure occurred and the patient died few days later. Discussion:
Listeria central nervous system infections have 100% mortality if
untreated and 13 to 43% if properly treated. Listeria is the most
common cause of bacterial meningitis in patients with underlying
neoplastic disease, especially lymphoma, in organ transplant recipients
and in those receiving glucocorticoids for any reason, so that
appropriate treatment should be started immediately in patients with
suspected meningitis and those conditions. On the other hand,
screening for malignancy is recommended among survivors of Listeria
meningitis, mostly over 50 years of age.
Studio osservazionale sulla qualità dell’assistenza
infermieristica in cure palliative
G. Miele1, C. Mastroianni2, M. Roccu2, G. Pentella1, G. Uomo3,
M. Iannuzzo4, A. Fontanella5
1 in the European Pharmacopoeia, it is now possible to administer this
Ospedale Buon Consiglio Fatebenefratelli, Napoli; 2Centro Studio San
Giovanni di Dio, Univerisità “La Sapienza”, Roma; 3UOC Medicina
Interna, A. Cardarelli, Napoli; 4UOS Epidemiologia Risk Management,
Ospedale Buon Consiglio Fatebenefratelli, Napoli; 5UOC Medicina Interna,
Ospedale Buon Consiglio Fatebenefratelli, Napoli, Italy
Premessa: Il grado di soddisfazione dei servizi di Cure Palliative è con-
siderato un outcome da perseguire ad assistenza conclusa quindi al
decesso del paziente. Lo studio ha lo scopo di comprendere come mi-
ci
gliorare l’assistenza fornita, che cosa implementare, dove destinare le
risorse e dare un segno di interessamento alle opinioni dei familiari,
er
permettendogli di dichiarare la propria situazione emozionale.
Materiali e Metodi: In letteratura la scala più utilizzata per valutare la
soddisfazione dei familiari dei pazienti in Cure Palliative è il FamCare,
m
modificato in italiano nel FamCare2 che definisce le percezioni dei fa-
miliari. Lo studio è stato condotto nel 2014 su un campione di 390 fa-
om
miliari di pazienti assistiti e deceduti nel centro di cure palliative ANTEA.
Risultati: Del totale dei 390 familiari hanno risposto 150 con un livello
di soddisfazione alto. Il 76% del campione considera positivo il rispetto
dell’equipe verso la dignità del paziente e il 71% la disponibilità nei
-c
confronti della famiglia. Tuttavia è emerso che alcuni familiari non sono
soddisfatti delle informazioni loro fornite circa gli effetti collaterali dei
on
trattamenti e per l’assistenza quotidiana.
Conclusioni: I risultati ottenuti, conformi alla letteratura, sottolineano
che l’approccio multidisciplinare al malato terminale rappresenta la
N
strategia più efficace per rispondere alle sue complesse esigenze e per
garantirgli la migliore qualità di vita. L’equipe attraverso audit interni
deve analizzare caso per caso con l’obiettivo di offrire una qualità sem-
pre più elevata di assistenza.
A mysterious case of Kikuchi-Fujimoto disease
G. Minafra, L. Iamele, S. Cappello, M. Pipino, A. Giancola, L. Caccetta,
M. Insalata, M. Carbone, F. Ventrella
ASL FG-Ospedale “G. Tatarella”, SC Medicina Interna, Cerignola (FG), Italy
A 45 year-old African male, who had concluded 4 months of therapy
with pegylated interferon+ribavirin for hepatitis C, by getting a Sustained
Virologic Response, was hospitalized for fatigue, cough, fever for 1
month. His bilateral axillary lymph nodes and supraclavicular area were
enlarged, but painless.
Diagnostic study: Leukopenia, ESR 63 mm/h; autoimmunity study, in-
fectious serology and other biochemical exams were normal. TC total
body: micro-nodules in both lungs, pleural and pelvic effusion, massive
mediastinal and hilar lymphadenopathy without cervical lesions.
PET/CT: increased signal in bilateral axillary lymph nodes, in supra-
clavicular and mediastinal areas and hilar lymphadenopathy. Bone
biopsy was normal; sputum exams and BAL for BK were negative.
[page 78] [Italian Journal of Medicine 2016; 10(s2)]
Biopsy of the lymph nodes shows structure subverted for many histio-
cytic cells and plasmacytoid and necrotizing granuloma.
For ex-juvantibus test, we treated him with prednisone for a month, with
rapid improvement. At six months, he was healed.
Discussion: The exclusion of other more common causes of lym-
phadenopathy and the favourable outcome have led to the diagnosis
of Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis. It
is a rare idiopathic self-limiting disease, most commonly in Asian and
Caucasian females of childbearing age. The clinical course can mimic
lymphoma, sarcoidosis and tuberculosis.
Conclusions: The interest of the case lies in the rarity for the African
race and in the possible trigger of interferon therapy. This disease comes
in differential diagnosis of fever of unknown origin.
✪ 93% oxygen: the emerging technology for health system
D. Minniti1, S. Passi2, M.R. Gualano3, F. Cattel4, G. Ceravolo5, R. Siliquini3,
F. Boraso6
1
Direzione Sanitaria Intersede, ASL TO3, Torino; 2Scuola di Specializzazione
in Igiene e Medicina Preventiva, Università degli Studi di Torino, Torino;
3
Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università
degli Studi di Torino, Torino; 4SC Farmacia, Presidio Molinette, AO Città
della Salute, Torino; 5SC Farmacia, ASL TO3, Torino; 6Direzione Generale,
ly
ASL TO3, Torino, Italy
Introduction: With the introductions of the Oxygen O2 93% monography
on
medicinal gas to patients as an alternative to the traditional O2 99%.
The ASLTO3, a Public Local Health Service in Piedmont, is the first in
e
Italy to decide to experiment the production of O2 93% at the Venaria
Reale Hospital in Turin.
us
Materials and Methods: Since July 2015 (12 months), a Randomized
Controlled Trial has been carried out. O2 93% or O2 99% were been
randomly administered to the patients hospitalized in General
al
Medicine. Clinical efficacy and management safety were defined as
outcomes of the present study. Cost-efficacy and cost-efficiency
analysis have been performed.
Results: The pilot study demonstrated an overlapping of the clinical
efficacy (Group O2 93%: 95% flux l/min, 91% SaO2 in range, 92% blood
gas analysis T1 in range; Group O2 99%: 97% flux l/min, 90% SaO2,
93% in range, blood gas analysis T1 in range), an absence of chemical
alterations and no interruption of supply measured through a remote
monitoring. The new system (costs of installation: 39000€) has
produced a saving cost of 15000€, already in the first year, compared
to the current 55000€ per year for 18000m3 of O2 99% and it would
produce a saving cost of 50000 € in the following years, as well as an
increase in availability of O2 (32000 m3).
Conclusions: O2 93% represents an emerging technology with a clinical
and economic impact on the Health Systems with a large-scale saving
costs estimated in 20 million euro per year for Piedmont Region only.
✪ Consensus document shared among Internal Medicine
(FADOI), Endocrinologista (AME) and General Practitioners
(SNAMID) Societies to improve prescriptive and
operational appropriateness of thyroid disease
P. Montanari1, M. Zini2, P. Spriano3, M. Lucarelli3, M. Cambielli3
1
UO Medicina Interna, Ospedale E. Franchini, FADOI, Montecchio Emilia
(RE); 2Endocrinologia, ASMN RE- AME, Reggio Emilia; 3SNAMID, Milano,
Italy
Background: The population suffering from thyroid problems is increas-
ing; however there are incidental findings, simple morphological or func-
tional conditions that are not to be considered illnesses and they could
be handled in different stages by general practitioner (GP). There is a
greater demand of specialist advice resulting in increased wait times.
Goals: To reduce waiting times and improve prescriptive and manage-
ment appropriateness between GP and medical specialists defining di-
agnostic criteria for the identification of specialist indications and mode
of care.
Methods: It was produced a consensus document FADOI-AME-
SNAMID containing the general criteria for the clinical management of
the most frequent thyroid diseases. Document requirements have been
based on the best available evidences, resulted concise and easily ac-
cessible and workable.