Faculty practice plans: the organization and characteristics of academic medical practice.

The contemporary academic medical center is a complex organization providing medical and other professional health education, biomedical and behavioral research, and a comprehensive range of patient care services. This paper presents data from the Association of American Medical Colleges' 1989 survey of 125 member faculty practice plans. The survey data showed that 62% of the 74 responding plans were units or associations within the medical school corporate structure. Plans were organized along a broad continuum from the autonomous, departmental model with decentralized governance and management to the group model with centralized governance and management. The growth of managed care, increased competition, and a greater reliance by the medical school on clinical practice income as a financing source are causing the practice plan to expand beyond billing of professional fees. The survey data showed that 75% of the practice plans operated satellite centers, and 61% planned to build new ambulatory care facilities in order to expand and improve services to patients. The practice plans also have adapted to changes in third-party reimbursement and are establishing mechanisms to negotiate managed care contracts involving multiple clinical departments to increase referrals and maintain patient shares; 86% of the plans participate in at least one managed-care organization. The role of the practice plan will continue to evolve in response to the needs of the academic medical center for a cooperative and supportive environment in which to conduct its traditional missions of teaching, research, and patient care.

[Emergency ultrasound cardiography in acute precordial pain of cardiovascular origin]. / Ultrasuonocardiografia d'urgenza nelle precordialgie acute di origine cardiovascolare.

In emergency surgery, the essential prerequisites for success are speed, promptitude and precision. For this reason diagnosis must be equally prompt and precise and may require not only clinical examination but also a number of instrumental examinations designed to confirm or even to formulate the diagnosis which is usually the case in precordialgias of cardiovascular origin. In such syndromes ultrasound cardiography is particularly advantageous for the following reasons: it is non-invasive, provides immediate results and any number of examinations can be performed on the patient in bed. Since such ultrasound techniques are also reliably accurate, they constitute the method of choice when the patient's condition is critical, when a serial study of a single patient is required and when the results are required immediately, as is the case in emergency heart surgery. Four types of ultrasound cardiography are currently available for the diagnosis of precordialgias of cardiovascular origin: 1) one dimensional M-mode echocardiography; 2) two dimensional real time echocardiography; 3) Doppler ultrasound cardiography; 4) the echo-Doppler system in which Doppler ultrasound cardiography is combined with one or two dimensional echocardiography. Acute precordial pain of cardiovascular origin may be due to the following pathological conditions: 1) ischaemic cardiopathy especially acute myocardial infarction and transitory myocardial ischaemia; 2) acute pericarditis; 3) aortic stenosis; 4) idiopathic hypertrophic subaortic stenosis; 5) mitral prolapse; 6) dissecting aneurysm of the aorta; 7) pulmonary thromboembolism. In all these cases the single and two dimensional image and Doppler ultrasound cardiography provide highly sensitive and specific information that is, in some cases, decisive for diagnosis and in others confirms the diagnosis already formulated. In addition these techniques may provide valuable prognostic data. Ultrasound cardiography is indeed useful in all cardiological emergencies, such as those caused by cardiomegaly, new and developing murmurs, peripheral embolisms, cardiac traumas and arrhythmias. It is therefore suggested that every Emergency and Intensive Care Unit should be able to use the resources offered by ultrasound cardiography in diagnosis.

[Aculeate Hymenoptera pathology. Clinical, therapeutic and preventive aspects]. / Patologia da imenotteri aculeati. Aspetti clinici, terapeutici e preventivi.

Dramatic cases of hymenoptera stings have been reported from various sources for several years now. According to recent statistic from North America 0.4-0.8% of the population have shown allergic reaction to these stings. There are no reliable statistics on Italy. After classifying the taxonomy of the Hymenoptera, the present report carefully analyses both the diagnostic and therapeutic aspects of these allergic responses and the preventive measures that can be used reduce the risk of hymenoptera stings.

[Clinical, diagnostic and therapeutic aspects of non-allergic forms of rhinitis: non-allergic rhinitis with eosinophilia syndrome and vasomotor rhinitis]. / Aspetti clinici, diagnostici e terapeutici delle riniti non allergiche: NARES e rinite vasomotoria.

Two clinical syndromes of non-allergic rhinitis -- NARES and vasomotor rhinitis -- were studied. In recent years there has been a moderate statistical increase in both conditions which are still not easily diagnosed or treated, given the fact that they are often confused with allergic rhinitis. In this context a brief review of aetiopathogenic and physiopathological factors is followed by the suggestion of certain elements that may be assessed in order to obtain a more correct classification and diagnosis. Finally the drugs providing a more effective and long-lasting cure are listed.

[Value of allergic intradermal reactions to antibiotics in preparation for surgery (in patients with a history of drug allergy)]. / Utilità delle intradermoreazioni allergologiche agli antibiotici nella preparazione ad interventi chirurgici (in pazienti con anamnesi farmaco-allergica).

An allergological examination technique for application in patients with a history of hypersensitivity to antibiotics is described with reference to a personal series of 250 subjects admitted to the Bologna University obstetric and gynaecological pathology department for small pelvis surgery. The method of investigation is described and the results obtained are reviewed. It is felt that the investigation is of value in preoperative screening insofar as it eliminates or reduces the risk of allergic shock, and enables more precisely directed antibiotic management to be employed.

[Behavior of blood gamma glutamyltransferase in workers exposed to hepatotoxic agents]. / Comportamento della gamma-GT sierica in alcune categorie di lavoratori esposti ad agenti epatotossici.

The behaviour of serum GT is evaluated as an indicator of exposure to enzymatic inductors that are potentially hepatotoxic. Serum GT was measured in 437 exposed workers and 149 controls. The statistically significant variation observed in the exposed group probably indicates enzymatic induction.

[Possible risk of liver diseases from exposure to bitumen]. / Possibile rischio di epatopatie da esposizione a bitumi.

The influence of exposure to bitumen on hepatic enzymatic induction was examined. Measurement of serum GT in a group of exposed workers and a control group produced statistically significant results, indicating that exposure to bitumen causes enzymatic induction.

Magnesium pidolate in the treatment of seasonal allergic rhinitis. Preliminary data.

This paper describes how the authors, after examining the calcium modulating action of the Mg ion and its antihistamine-like action, tested a salt containing Mg (Mg pidolate, MAG2) in the clinical treatment of seasonal allergic rhinitis. A total of 38 hayfever subjects were studied. They were given 1.5 g Mg salt three times a day for one month (oral MAG2 vials); placebo was used as a control in a randomized double-blind study. The efficacy of the product was assessed using the following criteria: intensity of rhinorrhoea, daily consumption of Kleenex tissues, number of sneezes in a day, intensity of lacrimation. The results were analysed using Student's t test and demonstrated the clinical efficacy of the product in the control of seasonal allergic rhinitis symptoms (P less than 0.001).

[Echocardiographic study of the left ventricle function in heroin dependence]. / Studio ecocardiografico della funzione ventricolare sinistra nella tossicodipendenza da eroina.

The left ventricular function has been examined in 20 drug addicts with echo-Doppler and echocardiographic methods. The results obtained demonstrate that, in a certain percentage of drug addicts, there is, in comparison to controls, a subclinical alteration of the ejection fraction and the circumferential shortening velocity; on the contrary, alterations of cardiac output are not observed.

Headache and recurrent abdominal pain: a controlled study by the means of the Child Behaviour Checklist (CBCL).

Headache and recurrent abdominal pain (RAP) are common disorders in children and adolescents, frequently referred to paediatricians. Both disorders show similarities in trigger and comorbid factors, their burden on family and individual life, and a paroxysmal trend with risks of chronicization over time. However, very few studies have compared directly headache and RAP. The main aim of this study was to compare the psychological profile of headache and RAP patients vs. healthy controls. A total of 210 children and adolescents [99 boys, 111 girls; age range 4-18 years; mean age (m.a.) = 11.04, SD 4.05] were assessed: 70 headache patients (m.a. 12.4 years; SD 2.9; F = 35, M = 35), 70 RAP patients (m.a. 9 years; SD 3.6; F = 30, M = 40) and 70 controls (m.a. 11.7 years; SD 4.6; F = 46, M = 24). The diagnoses had been made according to international systems of classification both for headache (ICHD-II criteria) and RAP (Rome II criteria). The psychological profile had been made according to the Child Behaviour Checklist 4-18 (CBCL). anova one-way analysis was used to compare CBCL scales and subscales between groups. Headache and RAP showed a very similar trend vs. control for the main scales of the CBCL, with a statistically significant tendency to show problems in the Internalizing scale (anxiety, mood and somatic complaints) and no problems in the Externalizing (behavioural) scale. Only for the Attention Problems subscale migraineurs showed a significant difference compared with RAP. In conclusion, headache and RAP show a very similar psychological profile that should be considered not only for diagnostic and therapeutic purposes, but also from the aetiological aspect.

[Diabetes in dental patients. Clinical implications]. / Il diabete nei pazienti odontoiatrici. Implicazioni cliniche.

The Authors illustrate diabetic patients' problem in the dental surgery. The importance to have a good knowledge of the diabetic illness to consent the dentist the identification of the diabetic patient through oral manifestations of the illness has been put in evidence. The operator risks have been identified and connected with this pathology.

[Histologic patterns of liver damage in chronic poisoning from tri-ortho-cresyl phosphate (author's transl)]. / Aspetti istologici del danno epatico nelle intossicazioni croniche da triortocresilfosfato

Six subjects, affected with TOCP polyneuritis, were submitted to liver biopsy by means of Menghini's technique. By means of both optic and electron microscopy, histologic and ultrastructural findings of liver damage were evaluated, whose genesis is believed to be due to the toxic effect of TOCP. The hepatocytes showed changes, mainly represented by cloud-vacuolar swelling of the cytoplasm, with abnormalities of nuclear membrane and lipofuscin pigment accumulation. The above mentioned patterns were found in all the examined needle biopsies, which possibly account for their toxic nature.

Idiopathic calcium urolithiasis: genetic aspects.

Seventy-nine stone-formers underwent a metabolic investigation and ABO blood group determination. Incidence of blood groups in patients was similar to ABO phenotypes distribution in general population. The 37.7 p. 100 showed family history for stones. Idiopathic hypercalciuria was present in 40.3 p. 100 of cases; stone-formers with positive family history had a higher incidence of hypercalciuria (46.8 p. 100) than subjects without affected relatives (31.5 p. 100). Patients with blood group A displayed hypercalciuria in the 54.5 p. 100 of cases while subjects with blood group O only in the 30.7 p. 100 (p less than 0.05). Glycosaminoglycans (GAGs) were reduced in the 36.9 p. 100 of the whole group and particularly in patients of blood group A. Patients with blood group A, with positive family history, showed higher mean values of calcium excretion and lower ones of GAGs. Our results seem to suggest that not only familiar factors play a significant role in stone disease pathogenesis but also some metabolic alteration may be linked to ABO phenotypes.

Preliminary results of glycosminoglycans excretion in normal and stone forming subjects: relationship with uric acid excretion.

In calcium lithiasis, pathogenesis inhibitors have a significant role to play which permits raising of the upper metastability limit in the urine, thus reducing the crystallization processes. The aim of this work is to evaluate glycosaminoglycans excretion and concentration in a group of patients with idiopathic calcium lithiasis, and in a control group for detecting possible differences between the 2 groups. Analysis of our results shows that no significant differences exist between the 24-hour average excretion of glycosaminoglycans in normal and stone forming subjects, but there was a significant difference in the mean concentration values between the 2 groups, either as whole or when separately considered with respect to normal or increased uric acid excretion. Particularly interesting was the correlation study between glycosaminoglycans and uric acid which shows a linear relationship with a positive slope in all groups but in stone formers with hyperuricosuria.