RESUMO
A survey on glycemic control in 201 diabetic children and adolescents, aged 0-18 years, was performed in two Italian Centers for Childhood Diabetes (Chieti and Parma). Mean HbA1c was 7.8+/-1.4 (range 4.8-13.3%; median 7.6%). With progression of diabetes duration, deterioration of glycemic control was observed (r=0.20; p< 0.002), more evident in girls than in boys, with peaks at 14 (8.9+/-2.0 vs 6.9+/-1.7%; p<0.05) and 16 years (9.5+/-1.4% vs 8.1+/-1.1; p<0.02). No differences were found in BMI values in boys or girls, or for insulin doses which were increased significantly in both sexes according to age (r= 0.33, p<0.04). The number of insulin injections did not influence glycemic control. Only one severe hypoglycemic episode was reported during the period of observation. This study demonstrates that modern management, continuous education and patient and family empowerment are effective in attaining excellent glycemic control without increasing the risk of hypoglycemia.
Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 1/terapia , Adolescente , Fatores Etários , Índice de Massa Corporal , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Hemoglobinas Glicadas/análise , Hemoglobinas Glicadas/metabolismo , Humanos , Hipoglicemia/sangue , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/efeitos adversos , Hipoglicemiantes/uso terapêutico , Insulina/efeitos adversos , Insulina/uso terapêutico , Itália/epidemiologia , Masculino , Fatores SexuaisRESUMO
Two cases of nephrogenic adenoma are presented. The authors consider nephrogenic metaplasia as a reaction to inflammatory agents and point out the importance of differential diagnosis with nephrogenic adenocarcinoma, in which a different surgical procedure is requested.
Assuntos
Adenoma/patologia , Neoplasias Renais/patologia , Rim/patologia , Adulto , Diagnóstico Diferencial , Humanos , Masculino , MetaplasiaRESUMO
According to the literature and the personal experience of the authors there seem to exist many controversies on the treatment of pancreatic pseudocysts, partly due to the lack of definitions and to the fact that prognosis is different based upon the pathophysiology of the lesions. We report 4 cases of pancreatic pseudocysts successfully treated with a multidisciplinary approach, stressing the role of pharmacology and of artificial nutrition and endoscopy on the outcome of these lesions.
Assuntos
Pseudocisto Pancreático , Humanos , Masculino , Pessoa de Meia-Idade , Pseudocisto Pancreático/complicações , Pseudocisto Pancreático/diagnóstico , Pseudocisto Pancreático/cirurgiaRESUMO
The authors present a case of PPD, stressing the importance to distinguish "true" PPD from pagetoid spread, for correct diagnosis and appropriate treatment. This distinction is possible by using immunohistochemical stains, with particular regarding Ab-GCDFP-15, considered specific marker for Paget's cell.
Assuntos
Neoplasias do Ânus/patologia , Doença de Paget Extramamária/patologia , Idoso , Humanos , MasculinoRESUMO
The authors describes a case of ischemic chronic stenosis of colon after aneurysmectomy. They consider eziopatogenesis, clinical aspects and differential diagnosis with other causes of large bowel stenosis. They illustrate on therapeutic sequence after examination of recent literature.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Colite Isquêmica/etiologia , Idoso , Anastomose Cirúrgica , Doença Crônica , Colectomia , Colite Isquêmica/cirurgia , Colo Sigmoide/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias , Reto/cirurgiaRESUMO
Carcinoid tumours of the anorectum are rare (0.7% of malignant rectal tumours). Because of this rarity several aspects of the management of these tumours remain controversial. Diagnosis may be delayed because of failure to recognize their morphological characteristics and histological appearance may not reflect their biological behaviour. Immunocytochemistry for neuroendocrine-cells are essential to identify different types of carcinoid tumours and to do differential diagnosis from other malignant tumours. All that allow an exact therapeutic approach to these tumours. The tumours less than cm 1 in diameter can be safely treated by local excision; the tumours more than cm 1 in diameter are treated by radical surgery (AAP).
Assuntos
Carcinoma Neuroendócrino/diagnóstico , Neoplasias Retais/diagnóstico , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Six cases of anal canal squamous carcinoma are presented. The authors precise the present view about pathological, epidemiological, clinical and therapeutical aspects of these lesions. They stress, also, the primary role of embryology and anatomy in the oncogenesis of such tumours; the importance to single out specific population at risk, absolutely different from the typical one for rectal adenocarcinoma and the role of chemoradiation therapy as treatment of choice of these neoplasms. Particular importance is given to modern histologic and histogenetic classification of these tumours, stressing the difficulties to distinguish the various histologic types.
Assuntos
Neoplasias do Ânus/patologia , Carcinoma de Células Escamosas/patologia , Idoso , Neoplasias do Ânus/epidemiologia , Neoplasias do Ânus/terapia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , PrognósticoRESUMO
The authors propose a jejunostomy on an omega loop distal to the Treitz ligament as a treatment for unresectable gastric lymphomas. The rationale is to provide nutritional support during chemotherapy in a situation when the stomach is defunctionalised. As assessed by clinical, morphological and biological parameters, the association of chemotherapy and jejunostomy may represent a valid therapeutical strategy for patients considered unresectable.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Nutrição Enteral , Jejunostomia/métodos , Linfoma não Hodgkin/terapia , Nutrição Parenteral Total , Neoplasias Gástricas/terapia , Bleomicina/administração & dosagem , Terapia Combinada , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Humanos , Leucovorina/administração & dosagem , Masculino , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Dosagem Radioterapêutica , Estômago/cirurgia , Vincristina/administração & dosagemRESUMO
A case of Tietze's syndrome is reported. A 55-year-old woman had experienced left anterior chest pain and tender swelling of the left second costosternal junction for one month. CT showed a focal enlargement of the left second costal cartilage with partial calcification. Six months later a complete recovery was registered and a second CT scan was negative. These clinical and CT findings are consistent with Tietze's syndrome.
Assuntos
Síndrome de Tietze/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Osso e Ossos/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , CintilografiaRESUMO
The authors after a review of the literature report a case of anterior tibial artery false aneurysm in a seventeen year old male, due to traumatic sprained ankle during a basketball match. Surgical techniques used in repairing the lesion as well as microsurgical technique for the direct suture of the artery, which allowed to resolve the problem, are discussed.
Assuntos
Falso Aneurisma/etiologia , Artérias da Tíbia/lesões , Adolescente , Falso Aneurisma/diagnóstico , Falso Aneurisma/cirurgia , Traumatismos em Atletas/complicações , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/cirurgia , Basquetebol/lesões , Humanos , Masculino , Artérias da Tíbia/cirurgiaRESUMO
The authors report a case of juvenile vasculopathy in a homocystinuria patient. They point out that thromboembolism may be the only symptomatic expression of this genetically determined metabolic disease. Diagnostic approach and surgical therapy of the vascular lesions as well as medical therapy to prevent further complications are analysed. The opportunity to perform clinical tests for the diagnosis of homocystinuria in all those young patients presenting vascular lesions without other risk factors is finally stressed.
Assuntos
Homocistinúria/complicações , Artéria Ilíaca , Claudicação Intermitente/etiologia , Obstrução da Artéria Renal/etiologia , Artéria Renal , Tromboembolia/etiologia , Adulto , Angioplastia com Balão , Terapia Combinada , Homocistinúria/diagnóstico , Homocistinúria/terapia , Humanos , Hipertensão/diagnóstico , Hipertensão/etiologia , Hipertensão/terapia , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/cirurgia , Masculino , Artéria Mesentérica Inferior , Oclusão Vascular Mesentérica/diagnóstico , Oclusão Vascular Mesentérica/etiologia , Oclusão Vascular Mesentérica/cirurgia , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/terapia , Tromboembolia/diagnóstico , Tromboembolia/cirurgiaRESUMO
The endoscopic technique in chronic venous insufficiency is simple and almost complication free. Our preliminary results due to a good postoperative course and to a quick return to social activity induce the Authors to indicate this type of procedure as the best treatment in chronic venous insufficiency.
Assuntos
Insuficiência Venosa/cirurgia , Doença Crônica , Endoscopia , Humanos , Procedimentos Cirúrgicos VascularesRESUMO
The Authors report a review of the Literature and their personal series to evaluate the role of total thyroidectomy in the surgical management of non-toxic multinodular goiter. On the basis of the data obtained, the Authors consider total thyroidectomy the therapy of choice for this pathology.
Assuntos
Bócio Nodular/cirurgia , Tireoidectomia/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/cirurgiaRESUMO
The Authors, on the basis of their experience with 196 patients aged from 18 to 45, affected by relapsing varicose veins, stress the advantages of the outpatient treatment according to Muller's technique. For these lesions excellent aesthetic and functional results, easy surgical technique, low incidence of complications, prompt resumption to work were registered.