Adult siblings of people with and without intellectual and developmental disabilities: Sibling relationship attitudes and psychosocial outcomes.

There is still little research on the relationships between adults with intellectual and developmental disabilities and their typically-developing siblings, despite the importance of these ties for siblings' psychological well-being, especially in terms of depression, anxiety, and life satisfaction. In this study, the sibling relationship attitudes of adult siblings of people with (N = 133) and without (N = 140) intellectual and developmental disabilities were explored. Feelings, behaviors, and thoughts related to sibling relationships were measured using the Lifespan Sibling Relationship Scale; depression was measured using the Beck Depression Inventory-II; anxiety was measured using the Beck Anxiety Inventory; and life satisfaction was measured using the Satisfaction With Life Scale. Results indicate that higher levels of positive sibling relationship attitudes are negatively related to levels of depression and anxiety, and positively related to levels of life satisfaction. Furthermore, adult siblings of people with intellectual and developmental disabilities show less positive sibling relationship attitudes, higher levels of depression and anxiety, and lower levels of life satisfaction. Finally, group membership, indirectly through sibling relationship attitudes, was related to depressive and anxious symptoms, as well as to life satisfaction. Implications for future research and policies are discussed.

Osteoporosis: recent physiopatologic acquisitions and new therapeutic perspectives.

The World Health Organization (WHO) declared osteoporosis "social disease". The present revision of the literature will focus on the recent acquisitions in bone pathophysiology and the efforts in the formulation of new molecules able to change successfully the course of the disease. Osteocyte cell is now thought to be the main biomechanical transducer of bones, able to release sclerostin that produces inhibition on osteosynthesis and on the other hand to release substances like nitrid oxide and prostaglandins that provide a stimulus to osteosynthesis through direct or indirect activation of osteoblasts. In this work the authors analyze the most important clinical trials involving the use of new molecules, like denosumab, integrin avb3 inhibitor, cathepsin k inhibitors, able to interfere in the new osteometabolic pathways. Two trials, phase I and II, have been conducted using denosumab. The endpoint of the first phase was the evaluation of the markers of resorption and bone formation, while the second phase II trial focused on the use of this molecule in double-blind matching placebo and open alendronate with the evaluation of bone mass density (BMD) over one year in lumbar area. Another clinical trial in double-blind versus placebo was carried on and published on the use of a competitive integrin avb3 inhibitor in various dosages for the evaluation of bone mass modification in the lumbar and femoral area and of bone markers modification. Many studies focus on the use of cathepsin k inhibitors. Odanacatib has demonstrated to have worked on dose-dependent increase of densitometric value and to have reduced the bone turnover.

[Using parathyroid hormone 1-84 in the treatment of osteoporosis: presentation and comments of main clinical trial]. / Terapia dell'osteoporosi con paratormone 1-84: presentazione e commento dei principali trial clinici.

Osteoporosis and associated fractures associated constitute a real and serious socio-medical problem. The purpose of this research is to report the most important clinical studies regarding the effect of parathyroid hormone PTH 1-84 for osteoporosis. TOP study has demonstrated the antifracture effectiveness of PTH 1-84 in patients of primary prevention and particular attention has been paid to show a clear achievement of the primary end-point that consists in a reduction of the vertebral fracturing event. PATH study has evidenced that the administration for one year of alendronate after one year of PTH 1-84 reduced the risk of osteoporotic fractures. The primary endpoint has been the evaluation of the densitometry values in the femoral and lumbar side and the evaluation of markers of bone turnover. In this case it is possible to assume that the above mentioned therapy could offer benefits in the long term.

Evidence based medicine and effective interventions of pharmacological therapy for the prevention of osteoporotic fractures.

Osteoporosis and fractures associated with it constitute a real and serious socio-medical problem, which only recently has come to the forefront of social consciousness. The authors are carrying out a critical re-examination of the medical literature of osteoporosis pharmacological treatment. Particular attention has been paid to studies which show a clear reduction of the primary endpoint that, in the case of this pathology, consists of a reduction of the fracturing event. According to the examination of the clinical studies introduced, antiresorptive bone agents, such as alendronate and risenderonate, turn out to be molecules with higher levels of evidence implicated on the reduction of the main osteoporotic fractures, in particular the reduction of vertebral and femoral fractures. The 10 years long-term extension studies, in particular those that have seen the employment of alendronate, found a positive outcome regarding densitometry data and a favorable trend in antifracture effectiveness. Ibandronate is another amino-bisphosphonate which was recently validated as an effective drug for the treatment of osteoporosis with its documented ability to meaningfully reduce vertebral fractures. Also ranelate of strontium, a drug that seems to explain its own result in a different way from the other antiresorptive bone agents, constitutes another valid alternative in the treatment of this pathology. Both of these molecules however, need further studies in order to estimate their antifracture effectiveness in the long term, particularly those related to femoral fractures. Teriparatide and the entire molecule paratohormone are usually not prescribed for its high cost in treatment and because, typically, patients with high-risk level fractures that are already affected, produce more vertebral fractures from moderate to severe intensity.

[Jaundice from neoplastic lymphangitis in patients undergoing D2/3 lymphadenectomy for gastric neoplasms. Our experience]. / Ittero da linfangite neoplastica nei pazienti sottoposti a linfectomia D2/3 per neoplasia gastrica. Nostra esperienza.

The surgical treatment of gastric adenocarcinoma foresees, toghether with the gastric resection, the lymph nodes resection as indicated by the Japanese Research Society for Gastric Cancer. Obstructive jaundice, as a consequence of lymph nodes metastases, is one of the most debilitating pattern of recurrence. In the present paper three cases of jaundice, observed during the follow-up, after D2-D3 gastric adenocarcinoma resection, with no evidence of lymph nodes recurrence either at the restaging or at the intraoperative esploration are reported. We believe that the jaundice etiology, in the present series, could be due to neoplastic lymphangites of the biliar wall.

[Peritonectomy and chemohyperthermia in the treatment of peritoneal carcinomatosis: learning curve]. / Peritonectomia e chemioipertermia nel trattamento delle carcinosi peritoneali: "learning curve".

A prospective study has been carried on 37 patients affected by peritoneal carcinomatosis from various primary. Patients have been treated by cytoreductive surgery and intraoperative hyperthermic chemoperfusion. CC 0-1 has been achieved in 81%. The temperature distribution study showed a "barrier effect" with no statistically significant correlation to the survival. Major morbidity and mortality was respectively 37.8% and 16.2%. Two-yr overall survival was 49.1% for all series. Morbidity was significantly directly correlated to the duration of the surgical treatment. A learning curve of 19 months have been observed, after that only one death out 21 procedures has been recorded. Peritoneal carcinomatosis patients, that are submitted to integrated treatment, need a peculiar management that is not comparable to any other in the oncological setting and that requires specific competence.

[Integrated treatment of peritoneal carcinomatosis: preliminary experience]. / Trattamento integrato delle carcinosi peritoneali: esperienza preliminare.

A prospective study has been carried on 37 patients, 35 of them affected by peritoneal carcinomatosis from ovarian (16), appendiceal (7), colorectal (5), mesothelial (4), gastric (3) primary and 2 affected by sarcomatosis. Mean PCI was 22 (median, 22). Eighty-five percent of the patients presented debilitating ascites associated in 23% to initial symptoms of intestinal obstruction. All the patients have been treated with peritonectomy and intraoperative hyperthermic chemoperfusion and CC 0-1 cytoreduction was achieved in 81%. Major morbidity and mortality was respectively 37.8% and 16.2%, where 5 out 6 deaths recorded in the first 19 months of our experience, representing our learning curve. At a median follow-up of 8 months (range, 1-54), 18 patients are alive and disease-free and 4 patients are alive with disease. Two-yr overall survival was 49.1% for all series. Difference in survival evaluating CC 0-1 vs CC 2 patients was statistically significant.

[Remission of intraoperative complications in videolaparoscopic surgery of the colorectum]. / Risoluzione delle complicanze intraoperatorie nella chirurgia videolaparoscopica del colon-retto.

Intraoperative morbidity in the laparoscopic approach for colorectal surgery is 5.6%. We tried our experience in 4 out of 70 laparoscopic procedures. In 3 cases it was dealt with one missed estate of the suture of the rectal stump. Two of them were treated with new resection of the rectal stump using in one case the opening of the anastomosis. In 1 case of bleeding of a sacral vessel we practiced a service 6 cm Pfannestiel incision of 6 cm to handle the hemorrhage. Intraoperative morbidity has not modified the course of the postoperative one.

[Hypernatremia. Etiopathogenetic classification and description of a rare clinical case]. / Le ipernatremie. Inquadramento etiopatogenetico e descrizione di un raro caso clinico.

On the basis of a rare case of hypernatremia, the essential lines which allow a correct diagnostic and therapeutic approach to hypernatremia are underlined. Hypernatremia is classified according to the patient's state of hydratation and on the content of sodium as: hypovoloemic, euvolemic and hypervolemic. Even the concentrations of sodium in urine are often of great importance for a correct diagnosis. The patient studied suffered from hypernatremia, which is based on genetical factors. The state of dehydration, together with hypovolemia and acute tubular necrosis secondary to rhabdomyolisis, were the causes of hypernatremia. The above mentioned causes were resolved but an enterocutaneous fistula showed to be the cause, quite rare, of hypernatremia. It is suggested that this rare cause should always be mentioned when diagnosing hypernatremia; which it is important since this cause could be solved with an operation. All this was useless in our case since the patient had a drastic deterioration of his general clinical conditions.