After illustrating the new set of rules in matter of stupefacient and psychotropic drugs, introduced in Italy on December 1975, and the duties assigned by the law to the judicial power, the findings are set forth here of an investigation carried out on 40 youths whose addiction to the use of drugs had been reported to the juvenile court of Rome up to April 30, 1977. Anamnestic, social, judicial and clinical data on such subjects were obtained. Even with the obvious reservations resulting from the extremely small sample, some findings are observed that appear to be significant: a considerable portion of the minors addicted to the use of drugs was the recipient of other interventions by the juvenile court in the civil, administrative and criminal sphere; for the males, the prevailing anamnestetic and social data correspond to the characteristics of the other subjects, with whom the court usually deals at the "re-educational" or criminal level, while, with regard to females, the picture is remarkably different. The use of heroin seems to be wide-spread among the males, where also prevail previous hospitalizations caused by the use of drugs. The Authors advocate a new and more extensive verification, to be carried out after a period of time.

Adolescent↗

PubMedDate not supplied

Adult patients with the nephrotic syndrome: really at high risk for deep venous thromboembolism? Report of a series and review of the literature.

BACKGROUND: The reported incidence of thromboembolic episodes in people with nephrotic syndrome (NS) ranges from 6% to 44% and it has been ascribed to the presence of a hypercoagulable state, as suggested by abnormalities of several hemostatic parameters in these patients. However, the results of the studies are often contradictory and fragmented and are rarely based on prospective studies. To assess the incidence of venous thrombosis and the pattern of abnormalities of the hemostatic parameters in NS, we planned a prospective study of a group of patients with NS. PATIENTS AND METHODS: Thirty-six consecutive patients with NS were enrolled during a 9-month period. Every 4-6 months, clinical history was collected and physical examination was carried out. Blood samples for laboratory investigation were taken at entry into the study and 24 months later. A critical review of the literature was also carried out (Medline database and Current Contents). RESULTS: During the follow-up (mean 45.2 months), no thrombotic symptoms were recorded, PTT, PT, TT and mean AT-III levels were within the normal range, whereas fibrinogen, plasminogen, protein C and S, heparin cofactor II levels were significantly higher than normal both at entry into the study and 24 months later. No patient was positive for antiphospholipid antibodies. Slightly decreased levels of AT-III and heparin cofactor II were found in only two cases. CONCLUSIONS: Our study confirms neither the high incidence of thrombotic complications in NS nor the presence of abnormalities of hemostatic parameters commonly associated with venous thromboembolism.

Adolescent↗

PubMedDate not supplied

Phospholipid hydroperoxide glutathione peroxidase in the normal human kidney: a possible role in protecting cell membranes.

Reactive oxygen species have been implicated in the pathogenesis of tissue injury. It is generally accepted that selenium-glutathione peroxidases form an integrated system defending the living organism against oxidative damage. Phospholipid hydroperoxide glutathione peroxidase (PHGPX) is thought to play a prominent role in preventing lipid peroxidation. Indeed, the function of PHGPX is to reduce the lipophilic substrates in membranes. In the present study, we evaluated the expression of PHGPX in normal human kidney by immunohistochemistry. The enzyme in glomeruli is mainly expressed in podocytes and parietal epithelial cells. In addition, PHGPX antigen was detected in tubule epithelial cells. Therefore, these results suggest that renal epithelial cells possess an important antioxidizing activity related to the presence of PHGPX.

Cell Membrane↗

PubMedDate not supplied

Factors affecting bicarbonate transfer with bicarbonate-containing CAPD solution.

OBJECTIVE: To evaluate bicarbonate fluxes across the peritoneal membrane and bicarbonate gain in patients treated with continuous ambulatory peritoneal dialysis (CAPD) using dialysis solutions with different bicarbonate concentrations. PATIENTS AND DESIGN: Ninety-seven exchanges, using different dwell times and glucose and bicarbonate concentrations were performed in 43 stable CAPD patients. Dialysate effluent bicarbonate concentration and volumes were measured at different dwell times. Net dialytic bicarbonate gain was calculated. Patients' acid-base status was determined at the middle of the dwell. RESULTS: In prolonged dwells (6-12 hours) the dialysate effluent bicarbonate concentration correlated with arterial plasma bicarbonate concentration (F = 129, p < 0.0001), but not with ultrafiltration rate or dialysis solution bicarbonate concentration. In 4-hour dwells, effluent bicarbonate concentration correlated with both plasma bicarbonate concentration and ultrafiltration rate (F = 32.52, p < 0.0001 and F = 4.4, p < 0.05, respectively). The effluent bicarbonate concentration may be predicted from the patient's plasma bicarbonate concentration and net ultrafiltration rate for either a 4-hour or prolonged (6-12 hours) dwell time. Net bicarbonate gain by the patient correlated with ultrafiltration rate, plasma bicarbonate, and dialysis solution bicarbonate concentration (F = 100.56, p < 0.0001 at 4 hours and F = 108.08, p < 0.0001 at 6-12 hours), with the ultrafiltration rate being the predominant parameter. CONCLUSIONS: The effluent bicarbonate concentration is related to plasma bicarbonate concentration, with ultrafiltration playing a marginal role only during short dwells. However, the ultrafiltration rate has a profound effect on net patient bicarbonate gain. Multiple linear regression analysis allows the prediction of the effect of acid-base status, ultrafiltration, dwell time, and dialysis solution bicarbonate content on net patient bicarbonate gain. It seems that bicarbonate content in the CAPD dialysis solution should be progressively increased with increasing solution osmolality.

Acid-Base Equilibrium↗

PubMedDate not supplied

Clinical experience with a 39 mmol/L bicarbonate-buffered peritoneal dialysis solution.

OBJECTIVE: To investigate the effect on the patient's acid-base status of a 39 mmol/L bicarbonate-buffered continuous ambulatory peritoneal dialysis (CAPD) solution. DESIGN: This was an open, controlled, cross-over, two-center study in 9 patients. After three months of treatment with a 34 mmol/L bicarbonate-buffered solution (t0) patients were switched to a 39 mmol/L bicarbonate-containing solution for four weeks. At the end of the study period (t4) patients were again treated with a 34 mmol/L bicarbonate-buffered CAPD solution for one month (t8). RESULTS: Mean venous plasma bicarbonate level significantly increased during the study and decreased at the baseline level during the control period (t0 = 22.94 +/- 2.54, t1 = 26.74 +/- 3.07, t2 = 28.47 +/- 2.68, t3 = 28.11 +/- 3.56, t4 = 28.71 +/- 3.27, t8 = 24.94 +/- 2.56). Arterial blood pH and plasma bicarbonate significantly increased during the study and significantly decreased at the end of the control period (pH: t0 = 7.37 +/- 0.04, t4 = 7.42 +/- 0.04, t8 = 7.37 +/- 0.06. Bicarbonate: t0 = 21.97 +/- 2.57, t4 = 25.85 +/- 2.02, t8 = 21.87 +/- 2.89). The changes in plasma bicarbonate during the study period were inversely correlated with the metabolic acid production calculated from the protein catabolic rate and with the apparent distribution space for bicarbonate (ABS) of patients. CONCLUSIONS: The 39 mmol/L bicarbonate-buffered CAPD solution improved the patient's acid-base status. Potential undesirable metabolic alkalosis could be prevented by analyzing the ABS and the metabolic acid production of patients.

Acid-Base Equilibrium↗

PubMedDate not supplied

[Cancer of the extrahepatic bile ducts. Clinical experience and anatomic/surgical considerations].

Cancer of the extrahepatic biliary tract is a rare disease related to a severe prognosis. The resection of the extrahepatic biliary tract is a complex procedure and the preoperative assessment of resectability is made difficult because of the malignancies. Biliary cancer resection can be curative in some patients but in some cases a liver resection has also to be performed. The authors retrospectively analyzed their recent cases closely examining some anatomical and technical aspects of biliary cancer resection. Eight patients were treated, three had distal cancer, two a central and three a proximal one (Klatskin tumor). In seven patients (87%) the cancer had spread to the liver. In one patient there was a favourable anatomical variation. All eight patients underwent laparotomy and in two (25%) the biliary cancer could be resected but curatively only in one case. Six patients underwent palliative procedures with a maximal survival of 8 months. The only curatively resected patient is well, without recurrence, 13 months after surgery. These results are similar to those reported concerning resectability and survival but a higher rate of liver metastases strongly reduced the amount of possibly curative resections. The experience shows the importance of laparotomy and of the knowledge of anatomy for a correct approach to resection and palliation of this cancer.

Aged↗

PubMedDate not supplied

Cannulation of the internal jugular vein: comparison of the classic Seldinger technique and an ultrasound guided method.

Central venous catheterization allows immediate and easy vascular access for hemodialysis. Accidental arterial puncture is the most frequent complication of central vein cannulation and may occur in up to 8% of cases with the classic Seldinger procedure. We compared the Seldinger technique which implies manual localization of the vascular access, and an ultrasound guided technique, to assess whether the latter is an improvement on the Seldinger procedure.

Catheterization, Central Venous↗

PubMedDate not supplied

[Advantages of reabsorbable intradermal sutures in general surgery. Experience on 201 sutures].

Surgical wound suture is often considered of minor importance compared to the whole surgical operation. The aesthetical result of a wound suture is still hardly considered in general surgical practice compared to other "traditional" wound sutures. The Authors carried a prospective study an 201 intradermal absorbable sutures in clean general surgery. The results clearly show that with a limited increase of the mean operation time of 90 seconds, for a 10 cm suture, there are such positive clinical, and aesthetical results that it is advisable to use routinely this type of suture in elective clean surgery.

Absorption↗