[Segmental bullous pulmonary emphysema under pressure from a bronchogenic cyst].
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Biomedical subjects
Publications and source records attributed to M Lattere.
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A computerized program for children and adolescents with insulin dependent diabetes mellitus (IDDM) and their parents has been developed. Our program consists of computed assisted education, of aid to routine insulin dosage self adjustment and of records of home and hospital controls. Technically it has been implemented in DBIII plus: it runs on IBM PC computers (and compatible computers) and MS DOS (version 3.0 and later). Computed assisted education consists of 80 multiples choice questions divided in 2 parts: the first concerns basic informations about diabetes while the second one behavioral attitudes of patient in particular situations. Explanations are displayed after every question, apart from correct of incorrect choice. Help for self-adjustment of routine insulin dosage is offered in the third part. Finally daily home urine and/or blood controls and results of hospital admissions are stored in a database.
In 35 patients (13F/22M; age range 2-15 years), affected by insulin dependent diabetes mellitus (IDDM), basal and glucagon stimulated C peptide was determined and correlated with the daily insulin requirement (U/Kg/die), the glycosylated hemoglobin (HbA1c), the age of onset (months) and the length of the illness (months). The results of C peptide determinations are illustrated in tab. 1: in 20 patients (group I) the basal value of C peptide is higher than 1 ng/ml and increases after glucagon load; in 15 patients (group II) the basal value of C peptide is lower than 1 ng/ml; in 9 ones (group IIA) of these 15 a glucagon load does not elicit a residual insulin secretion; in the other 6 ones (group IIB) a significative C peptide increase is observed after glucagon load. A better metabolic control (p less than 0.01); Student t test) and a shorter length of the illness (p less than 0.05; Mann-Withney U test) was noticed in the group I in comparison with the group IIA, in which no insulin reserve, even after glucagon load, was demonstrated (tab. 2). However, no difference in the metabolic control, insulin requirement, age of onset or length of the illness resulted between group IIA and group IIB (in which an insulin reserve had been demonstrated only after glucagon load). The basal C peptide evaluation and follow up is useful in the assessment of the individual case of IDDM: a glucagon load may demonstrate a residual insulin reserve in some patients with a low basal C peptide.
In type I diabetes mellitus (DM) the presence of C peptide (Cp), whose determination is unaffected by exogenous insulin, is considered expression of a residual beta-cell activity, which allows a better metabolic control. In 35 children affected by type I DM the fasting Cp was measured: in 18 cases (1st group) a value greater than or equal to 1 ng/ml was observed, while in the remaining 17 (2nd group) the Cp value was less than 1 ng/ml. A statistical comparison between the two groups demonstrated that in the first one a better metabolic control was achieved with a daily lower insulin dosage. Moreover in the 1st group the onset of the disease was more recent, while there was no difference between the two groups with regard to the age at diagnosis. The Cp evaluation and follow-up is useful in the assessment of the individual case; furthermore, on the basis of these studies, an immunosuppressive treatment may be considered during the early phase of the disease, when a residual beta-cell activity is demonstrated.
Epidemiological and clinical aspects of 233 children below 14 years of age with acute carbon-monoxide poisoning are presented. Patients were recorded in the retrospective part of the M.S.P.C. (Multicentre Study of Poisoning in Children) at Genova, Torino and Trieste pediatric hospitals during 1975/90. Carbon-monoxide poisoning resulted to be a main toxic risk in children by considering its frequency and the severity of symptoms; three cases of death occurred. In particular, differences between symptoms in small children (under the age of 4 years) and adults are emphasised. This poisoning has to be suspected even in the presence of minor symptoms; the blood carboxyhemoglobin assay confirms the diagnosis and is useful to avoid further exposure.