Effectiveness of an uninterrupted procedure to transfer adolescents with Type 1 diabetes from the Paediatric to the Adult Clinic held in the same hospital: eight-year experience with the Parma protocol.

This paper reports an 8-yr retrospective study on the effects of an uninterrupted procedure of transition of 73 adolescents with Type 1 diabetes from the Paediatric to the Adult Clinic held in the same hospital. Interviewed patients had a mean age of 21.0+/-0.95 yr at transition. Patients were satisfied with the information received before transition (100%), and appreciated being introduced to the adult physician prior to being transferred (92%), and having found their paediatrician during the first visit at the Adult Clinic (100%). Consensus for transition was attained after 2-4 consultations in 66.6% of patients. Seventy-nine percent of patients considered 20 yr of age as an appropriate age to be transferred. Patients confirmed to have found at the Adult Clinic: privacy (85%), confidentiality (95%), short waiting times (78%), informal atmosphere (100%), and the same consultant (100%). Only 3% of patients tried to go back to the Paediatric Clinic but they were discouraged. Clinic attendance rate ranged between 92 and 100%. We consider that the key factors for a successful process of transition from a Paediatric to an Adult Clinic are: age at transfer around 20 yr, smooth movement within the same hospital, consensus of patients and their parents, prior personal contact with the adult physician, paediatrician attendance at the first visit at the adult service and his unambiguous role against all attempts to go back to the paediatric service and, finally, the availability of the same physician at out-patient clinic visits.

Adrenaline plus cyanoacrylate injection for treatment of bleeding peptic ulcers after failure of conventional endoscopic haemostasis.

BACKGROUND: Endoscopic therapy is a safe and effective method for treating non-variceal upper gastrointestinal bleeding. However failure of therapy, in terms of continuing bleeding or rebleeding, is seen in up to 20%. Cyanoacrylate is a tissue glue used for variceal bleeding that has occasionally been reported as an alternative haemostatic technique in non-variceal haemorrhage. AIM: To retrospectively describe personal experience using cyanoacrylate injection in the management of bleeding ulcers after failure of first-line endoscopic modalities. PATIENTS AND METHODS: Between January 1995 and March 1998, 18 [12 M/6 F, mean age 68.1 years) out of 176 patients, referred to our Unit for non-variceal upper gastrointestinal bleeding, were treated with intralesional injection of adrenaline plus undiluted cyanoacrylate. Persistent bleeding after endoscopic haemostasis or early rebleeding were the indications for cyanoacrylate treatment. RESULTS: Definitive haemostasis was achieved in 17 out of 18 patients treated with cyanoacrylate. One patient needed surgery. No early or late rebleeding occurred during the follow-up. No complications or instrument lesions related to cyanoacrylate were recorded. CONCLUSIONS: In our retrospective series, cyanoacrylate plus adrenaline injection was found to be a potentially safe and effective alternative to endoscopic haemostasis when conventional treatment modalities fail in controlling bleeding from gastroduodenal ulcers.

[Synthesis of pyrazolo[3,4-e][1,4]diazepine-4,7-diones with central nervous system activity]. / Sintesi di derivati pirazolo[3,4-e][1,4]diazepin-4,7-dioni attivi sul sistema nervoso centrale.

The synthesis of 1-phenyl-5,8-dimethyl-1,4,5,6,7,8-hexahydro-pyrazolo[3,4-e][1,4] diazepin-4,7-dione and of 1-phenyl-3,5,8-trimethyl-1,4,5,6,7,8-hexahydro-pyrazolo[3,4-e] [1,4]diazepin-4,7-dione is described. These compounds exhibit activity on CNS in animals.

[Hyperlipidemia, diabetes and atherosclerosis: efficacy of treatment with pantethine]. / Iperlipidemia, diabete ed aterosclerosi: efficacia del trattamento con pantetina.

The hypolipidemizing effects of Pantethine were investigated by the Authors in 37 hypercholesterolemic and/or hypertriglyceridemic patients. Of these, 21 were also diabetic, in a satisfying glucidic compensation, in order to verify the action of this drug also in this metabolic condition. The study was carried out for three months and during this period the patients were given Pantethine at the dose of 600 mg/die orally. At the 30th, the 60th, the 90th day of treatment the following parameters were controlled: cholesterolemia, HDL cholesterol, apolipoproteins A and B, triglyceridemia, systolic and diastolic arterial pressure, uricemia, body weight. Thirty days after suspending the treatment, the parameters were controlled again to detect a possible "rebound" effect. The results were analyzed on the whole case-record, subdividing the patients in dislipidemic and diabetic-dislipidemic, and on the basis of the Fredrickson's classification. Pantethine induced in all groups a quick and progressive decrease of cholesterolemia, triglyceridemia, LDL cholesterol and Apolipoproteins B with increased HDL cholesterol and Apolipoproteins A. After suspending the treatment, there is a clear inversion of the state of these parameters. The Authors conclude that the present work shows that Pantethine, a natural and atoxic substance, an important component of Coenzyme A, is efficacious in determining a clear tendency towards normalization of the lipidic values.

[Aspects of glycolipid metabolism in chronic renal insufficiency: interference of oral glucose administration during and after dialysis with changes induced by short dialyses with glucose free dialysate]. / Aspetti del metabolismo glicolipidico nell'insufficienza renale cronica: interferenza della somministrazione orale di glucosio durante e dopa dialisi sulle modificazioni indotte da dialisi brevi con bagno senza glucosio.

As part of some research into certain aspects of glycolipidic metabolism in chronic renal insufficiency, a study has been made of alterations in glycaemia, insulinaemia, free fatty acids and triglycerides during and following brief periods of dialysis by glucose-free bath in 26 subjects: within this group, 50 g of glucose were administered to 8 patients at the 2nd hour of dialysis and 100 g to another 8 at the end of therapy. The following findings were made during glucose-free dialysis: marked hypoglycaemia starting from the first hour until the end, marked increase in FFA and marked fall in TG upon the lipolytic action of heparin. In the post-dialysis period, immediate normalization in glycaemia, steady diminution in FFA and notable increase in TG as early as the 1st hour. Administration of glucose during dialysis prevents hypoglycaemia by altering FFA and TG behaviour in the post-dialysis period. Administration of glucose at the end leads to hyperglycaemia and hyperinsulinaemia with marked fall in FFA and TG. During dialysis, the phenomena observed depend on the action of heparin, acetate and the absence of glucose. This absence brings on hypoglycaemia with secondary glycogenolysis and-or neoglucogenesis during dialysis; in the post-dialysis period, hepatic neosynthesis of TG in the presence of normal glycaemic and insulinaemic values. Glucose per os determines hyperglycaemia and secondary hyperinsulinaemia with FFA esterification at the level of adipose tissue and a fall in serous TG.

Epidemiological aspects and social importance of obesity. The situation in Italy compared with other developed countries.

Epidemiological aspects of obesity have been the object of few studies in Italy, and the results of these are reviewed and compared with those obtained in other developed countries. The prevalence of obesity has been investigated in pre-school and school-age children, in young conscripts and in workers at the Riuniti Hospital in Parma, and the results show that the problem of obesity in Italy is a serious one. More than 2000 obese subjects, attending the First Medical Clinic of Parma University, have been studied to establish how far overweight is responsible for pathological and disabling complications. Obesity was implicated as a major contributing factor in diabeties, atherosclerosis, hypertension, arthritis and many other disabling diseases. The social aspects of the problems of obesity are discussed, together with possible preventive and curative measures.

Observations on lipid metabolism in chronic renal failure, during conservative and haemodialysis therapy.

The main variables of glycolipid metabolism (blood non-esterified fatty acids, triglycerides, cholesterol, insulin, glucose) have been measured in basal conditions in uraemic patients on conservative treatment and on dialysis of different duration and bath glucose concentration (no glucose, 1 g/l, 2 g/l). Basal values for the patients on conservative dietary treatment are not different from normal. In dialysed patients, the blood non-esterified fatty acid and triglyceride concentrations are increased (p less than 0.001) while cholesterol glucose and insulin levels are unchanged. No significant difference is found between the various types of dialysis, having different duration and bath glucose concentration

[Epidemiological study on coronary risk factors in a population of clerks in Parma. Methods of research and 1st results]. / Indagine epidemiologica sui fattori di rischio coronarico in una popolazione impiegatizia di Parma. Metodica di ricerca e primi risultati

After a review of current literature, the AA. present the purposes and the methods of an epidemiological study on coronary risk factors in selected bank-clerks of Parma, in view to correlate the dietary factors, possible methabolic alterations, psychical behaviour, social and environmental position and coronary risk evaluated by electrocardiographic stress test. In this respect, the AA. report and discuss, as example of the reliability and validity of the investigative model followed, the preliminary results observed in the 274 subjects up to this time controlled.

Glycolipid modifications during peritoneal dialysis in patients with chronic renal failure.

Ten patients with progressive CRF were studied for the major indices of glycolipid metabolism during the first application of peritoneal dialysis. From the 2nd hour the concentration of dialysis fluid is 4.5g%, while the electrolyte content is unchanged. During treatment a constant increase of glycemia and insulinemia with a fall of plasma-free fatty acids and serum triglycerides was observed. The authors attribute such modifications to hyperglycemia and consequently to the high glucose of the dialysis bath.

[Aspects of glycolipid metabolism during chronic renal insufficiency. Effects of dialytic treatments of short duration (3-4 hours on alternate days)]. / Aspetti del matabolismo glicolipidico in corso di insufficienza renale cronica. Effetti di applicazioni dialitiche con tempi brevi (3-4 ore a giorni alterni)

The main indices of glycolipid metabolism were examined during and after dialysis in 11 patients receiving chronic treatment. Each dialysis period lasted 3-4 hr and was carried out on alternate days with individual machines and Coil UF2, Coil UF100 and Dasco SP75 dialysers. The liquid contained 35 mEq/l sodium acetate and 2 g glucose and flowed at 500 cc/min. Heparin was injected in the arterial line in a single initial dose. During treatment, there was an increase in free fatty acids and a decrease in serum triglycerides. Blood sugar and insulin were unchanged. The first 4 hr after treatment were marked by decreased fatty acid and increased trigylceride values. Blood sugar and insulin were again constant. The part played by sodium acetate and heparin in these changes is discussed.