A 7-year-old female Shih-tzu dog was presented with severe dyspnoea. A large mass was palpated in the left cranial neck. Cytological examination of an aspirate sample revealed cells with marked ...anisokaryosis, giant elements and many bare nuclei. Scattered intact giant cells showed scant, granular cytoplasm and intranuclear inclusions. Histologically, neoplastic cells were subdivided into lobules by fine collagenous trabeculae. Numerous pleomorphic giant, or ‘monster’, cells were observed, showing a highly indented nuclear envelope, intranuclear cytoplasmic pseudoinclusions (ICPs) and ‘ground-glass’ nuclear appearance. Neoplastic emboli were present, but no distant metastases were detected grossly. Immunohistochemically, the neoplastic cells expressed synaptophysin and had variable expression of neuron-specific enolase and vimentin. The cells were negative for pan-cytokeratin, CAM 5.2, glial fibrillary acidic protein and S100. Nuclear abnormalities and cytoplasmic neurosecretory granules were noted ultrastructurally. These features were consistent with a diagnosis of carotid body carcinoma (chemodectoma). Monster cells with ICPs have not been documented previously in canine chemodectoma.
Summary
What is known and Objective: Adherence to evidence‐based drug therapy after acute myocardial infarction has increased over the last decades, but is still unsatisfactory. Our objectives are ...to set out to analyse patterns of evidence‐based drug therapy after acute myocardial infarction (AMI), and evaluating socio‐demographic differences.
Methods: A cohort of 3920 AMI patients discharged from hospital in Rome (2006–2007) was selected. Drugs claimed during the 12 months after discharge were retrieved. Drug utilization was defined as density of use (boxes claimed/individual follow‐up; chronic use = 6+ boxes/365 days) and therapeutic coverage, calculated through Defined Daily Doses (chronic use: ≥80% of individual follow‐up). Patterns of use of single drugs and their combination were described. The association between poly‐therapy and gender, age and socio‐economic position (small‐area composite index based on census data) was analysed through logistic regression, accounting for potential confounders.
Results and Discussion: Most patients used single drugs: 90·5% platelet aggregation inhibitors (antiplatelets), 60·0%β‐blockers, 78·1% agents acting on the renin–angiotensin system (ACEIs/ARBs), 77·8% HMG CoA reductase inhibitors (statins). Percentages of patients with ≥80% of therapeutic coverage were 81·9% for antiplatelets, 17·8% for β‐blockers, 64·4% for ACEIs/ARBs and 76·1% for statins. The multivariate analysis showed gender and age differences in adherence to poly‐therapy (females: OR = 0·84; 95% CI 0·72–0·99; 71–80 years age‐group: OR = 0·82; 95% CI 0·68–0·99). No differences were observed with respect to socio‐economic position.
What is new and Conclusion: The availability of information systems offers the opportunity to monitor the quality of care and identify weaknesses in public health‐care systems. Our results identify specific factors contributing to non‐adherence and hence define areas for more targeted health‐care interventions. Our results suggest that efforts to improve adherence should focus on women and older patients.
Objective In countries where the National Health Service provides universal health coverage, socioeconomic position should not influence the quality of health care. We examined whether socioeconomic ...position plays a role in short-term mortality and waiting time for surgery after hip fracture. Design Retrospective cohort study. Settings and participants From the Hospital Information System database, we selected all patients, aged at least 65 years and admitted to acute care hospitals in Rome for a hip fracture between 1 January 2006 and 30 November 2007. The socioeconomic position of each individual was obtained using a city-specific index of socioeconomic variables based on the individual's census tract of residence. Main outcome measures Three different outcomes were defined: waiting times for surgery, mortality within 30 days and intervention within 48 h of hospital arrival for hip fracture. We used a logistic regression to estimate 30-day mortality and a Cox proportional hazard model to calculate hazard ratios of intervention within 48 h. Median waiting times were estimated by adjusted Kaplan–Meyer curves. Analyses were adjusted for age, gender and coexisting medical conditions. Results Low socioeconomic level was significantly associated with higher risk of mortality adjusted relative risk (RR) = 1.51; P < 0.05 and lower risk of early intervention (adjusted RR = 0.32; P < 0.001). Socioeconomic level had also an effect on waiting times within 30 days. Conclusions Individuals living in disadvantaged census tracts had poorer prognoses and were less likely than more affluent people to be treated according to clinical guidelines despite universal healthcare coverage.
Comparative outcomes data are widely used to monitor quality of care in the cardiovascular area; little is available in the respiratory field. We applied validated methods to compare hospital ...outcomes for chronic obstructive pulmonary disease (COPD) exacerbation. From the hospital information system, we selected all hospital admissions for COPD exacerbation in Rome (for 2001-2005). Vital status within 30 days was obtained from the municipality mortality register. Each hospital was compared to a pool of hospitals with the lowest adjusted mortality rate (the benchmark). Age, sex and several potential clinical predictors were covariates in logistic regression analysis. 12,756 exacerbated COPD patients were analysed (mean age 74 yrs, 71% males). Diabetes, hypertension, ischaemic heart disease, heart failure and arrhythmia were the most common coexisting conditions. The average crude mortality in the benchmark group was 3.8%; in the remaining population it was 7.5% (range 5.2-17.2%). In comparison with the benchmark, the relative risk of 30-day mortality varied widely across the hospitals (range 1.5-5.9%). A large variability in 30-day mortality after COPD exacerbation exists even considering patients' characteristics. Although these results do not detect mechanisms related to worse outcomes, they may be useful to stimulate providers to revision and improvement of COPD care management.
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