[Plasmatic glutathione levels and their relationships with clinical and therapeutic features in patients with schizophrenia]. / Concentrations plasmatiques des glutathions et leurs corrélations avec les caractéristiques cliniques et thérapeutiques des patients atteints de schizophrénie.

INTRODUCTION: Altered glutathione systems (GSH) are suggested to participate in the pathophysiology of schizophrenia. The purpose of this study was to determine the plasmatic glutathione levels of patients with schizophrenia compared to healthy controls and to examine their relationships with clinical and therapeutic features. METHODS: It was a case-control study carried out on 100 patients with schizophrenia according to DSM-IV-TR criteria and 95 healthy controls. All patients were assessed by Clinical Global Impressions-severity (CGI-severity) and Global Assessment of Functioning (EGF). Most of the patients (55%) were under first-generation antipsychotics. Plasmatic glutathione levels (total glutathione GSHt, reduced glutathione GSHr, oxidized glutathione GSSG) were determined by spectrophotometry. RESULTS: The levels of GSHt and GSHr were significantly decreased in schizophrenic patients in comparison with the healthy controls. These reductions were noted to be more pronounced in the untreated patients. No correlation was observed between the GSH levels and the clinical subtypes of schizophrenia and EGF scores. Depending on the therapeutic status, there were no significant differences in the GSH levels. In addition, there was no correlation between the GSH levels and the daily dosage of the antipsychotic treatment. CONCLUSION: Our results suggest that the observed changes are related to the physiopathology of schizophrenia rather than to the presence of neuroleptic treatment. These results provide support for further studies of the possible role of antioxidants as neuroprotective therapeutic strategies.

Therapeutic Strategies and Clinical Outcome in Papillary Thyroid Microcarcinoma: A Multicenter Observational Study.

PURPOSE: Papillary thyroid microcarcinoma (MPTC) has an excellent prognosis. We aimed to evaluate the evolution of therapeutic strategies over time and the clinical outcome of MPTC. METHODS: In this retrospective multicenter observational study in a northwest Italian region, patients with intrathyroidal, unifocal tumor ≤1 cm in size, incidentally found at histology or preoperative cytology diagnosis, were included. Exclusion criteria were a previous head-and-neck irradiation and/or node metastases. RESULTS: From 1985 to 2012, 437 patients had an MPTC diagnosis, which was incidental in 85% and preoperative in 15%. Patients with a preoperative diagnosis were younger at the time of diagnosis (47.6 ± 12.7 years, p < 0.01) and had a larger tumor (7.0 ± 2.5 mm, p < 0.0001) than patients with an incidental diagnosis (age 52 ± 13.5 years, size 4.4 ± 2.8 mm), but there were no differences in clinical outcome between both groups. We observed a significant (p < 0.001) reduction in radioiodine remnant ablation during the years. TSH levels were: <0.1 mIU/l in 27.5%, 0.1-0.5 mlU/l in 33.7%, 0.5-2.5 mlU/l in 32.6%, 2.5-4.2 mlU/l in 3.9%, and >4.2 mlU/l in 2.3% of patients. Six patients (1.37%) had nodal recurrence; 5 of them were cured after therapy. MPTC-linked mortality was null. CONCLUSIONS: We confirmed the favorable clinical outcome of MPTC. Despite the reduction in radioiodine ablation, overtreatment of MPTC is still observed.

Endoscopic management of symptomatic choledocholithiasis in pregnancy without the use of radiations.

We report a case of 26-year-old woman at 10th week of gestation with cholestatic jaundice due to a common bile duct (CBD) stone managed by endoscopical retrograde cholangiopancreatography (ERCP). The procedure was successfully carried out without the use of ionizing radiations and under trans-abdominal ultrasonographical (US) control. A few cases are reported in literature in which ERCP was performed without fluoroscopy examination. We believe that ERCP with US guidance is an effective and safe procedure to treat symptomatic choledocholithiasis in pregnant women.

[Hemochromatosis associated with hereditary spherocytosis]. / Asociación de hemocromatosis y esferocitosis hereditaria.

Hereditary spherocytosis is a chronic hemolytic anemia that very infrequently produces severe iron overload. Only 15 cases of hereditary spherocytosis associated with hemochromatosis have been described previously. It was initially thought that hemochromatosis was the result of the increase of iron stores secondary to chronic hemolysis. Afterwards, it became apparent that iron overload could appear in patients splenectomized. This fact suggested that spherocytosis and idiopathic hemochromatosis could be inherited independently. We describe the case of a 45-year-old man, with known hereditary spherocytosis, splenectomized at 5 years of age, who developed iron overload which affected his heart, liver and pancreas.

Clinical pathways and coronary artery bypass surgery.

Use of a multidisciplinary clinical pathway helps eliminate variations in patients' care. Organizing the care delivered each day of the patient's hospitalization may lead to fewer complications, a quicker recovery, and an earlier discharge. In today's healthcare arena, much attention is being focused on improving the quality of care and decreasing the need for acute care. Clinical pathways facilitate patients' outcomes and earlier discharge and thus reduce the cost of care.

[Glucose metabolism and chronic renal insufficiency]. / Metabolismo glucidico e insufficienza renale cronica.

Chronic renal failure is characterized by abnormalities in glucose metabolism. In fact there are present a normal fasting plasma glucose level )or mild hyperglycemia) in the presence of hyperinsulinemia, blunted decrease in the plasma glucose concentration in response to exogenous insulin administration, and diminished effect of intravenous insulin on glucose uptake in forearm perfusion studies. The glucose intolerance is not the result of reduced insulin secretion, or circulating insulin antagonists, and does not correlate with the coexisting metabolic acidosis. Glucose intolerance exists because the peripheral insulin-sensitive tissue (muscle, adipose tissue, liver) of the patients with chronic renal failure are insulin resistant. However there are two subgroups of uremic patients with regard to glucose tolerance: about half of uremic patients can augment their insulin secretion sufficiently to maintain normal glucose tolerance despite glucose intolerance. In the other half, insulin secretion following glucose loads is not different from normal values, so that glucose intolerance results. The cause of the peripheral insulin resistance remain unclear. Besides deranged renal function can result in the development of hypoglycemia. The most important predisposing mechanism to hypoglycemia is diminished glucose availability due to substrate limitation; the second important mechanism (alcohol, insulin, propranolol, etc.). Finally, in chronic renal failure persistent hyperinsulinemia can contribute hyperlipemia and to high incidence of cardiovascular disease.

[Value of bone scintigraphy with Tc99MDP in the early diagnosis of mobilization of the total hip prosthesis]. / Validità della scintigrafia ossea con Tc99MDP nella diagnosi precoce delle mobilizzazioni delle protesi totali d'anca.

The authors confirm the validity of the scintigraphy scansion in the early diagnosis of failure of a total hip replacement and they specify the indications and the use's possibilities relating to their experience. Then they propose a clinical case of difficult differential diagnosis which confirms its importance and clearness of interpretation.

[Clinico-functional evaluation of patients operated for the removal of total prosthesis of the hip]. / Valutazione clinico funzionale dei pazienti operati di rimozione di protesi totale d'anca.

The authors report the clinico-functional results observed in 109 patients subjected to removal of a total hip replacement. After remarking the progressive increase in the aseptic mobilizations recorded during the last years, and after shortly stating the criteria whereby the prosthesized patients are controlled along with the time, they detailedly set forth the results. In conclusion, the results recorded are generally satisfactory, although the operation for removal of the replacement is an expedient badly fitting subjects in young or, anyhow, working age.

[Our experience in the treatment of septic pseudarthrosis. Recent advances and technical details]. / La nostra esperienza sul trattamento delle pseudo-artrosi settiche. Nuove acquisizioni e dettagli di tecnica.

We felt that it was both necessary and useful to complete what had been said and written on other occasions regarding our cases. This updating paper therefore contains the impressions arising out of expansion of our experience, some details of technique and above all a better designed therapeutic strategy that we feel will be more effective in solving the long-standing polymorphous problem of treatment of septic pseudoarthrosis.

[Modified Villadot's operation in brain-damaged patients]. / L'intervento di Villadot modificato nei pazienti cerebrolesi.

The Authors' purpose is to propose an operation, based on Viladot's, which will be technically simple and not involve any mutilation: it is performed in order to provide good support to children with valgus flat foot suffering from cerebral paralysis of spastic type or secondary to other neurological forms; it may however also be indicated in primitive valgus flat foot.

[The treatment of medical fractures of the femoral neck]. / Il trattamento delle fratture mediali del collo del femore.

It is first stressed that medial fractures of the femur neck pose therapeutic and prognostic problems linked above all to biological factors. After reference to the criteria of classification adopted by Linton and Pauwels, the need to adopt fixed parameters in establishing the surgical indication is then asserted. These parameters are the patient's age, understood not only as number of years but also as general and psychic state, and the obliquity of the fracture line or its degree of decomposition. The Authors conclude by establishing four theorectical groups of patients and indicating the treatment they adopted for each group.

[Limits of prosthetic restoration of the hip joint and possibilities of recovery in failures]. / Limiti della protesizzazione dell'anca e possibilita' di recupero negli insuccessi.

The Authors report on treatment of patients with total prosthesis of the hip, in whom mobilisation of the prosthesis or one or both its components has occurred. In particular, stress is put on the results of the operation of removal of the prosthesis, which finds its major indications in cases of acute or remote, deep sepsis, and in case of aseptic mobilisation when the theoretical presuppositions allowing its substitution do not exist.

On the distribution of some genetic markers in libya.

On a sample of N equals 169 nonrelated blood donors from Libya several blood group, serum protein group and enzyme frequencies are within the range of those of other Caucasoid populations. However, the frequencies of cDe, Jk-a, Fy-c, Hp-1, Gc-1, aP-b and AK-1 show some greater differences and seem to indicate certain Negroid influence on the genetic composition of our Libyan sample. This assumption is conceivable considering the racial history of Libya.