[Assisted peritoneal dialysis]. / La Dialisi Peritoneale Assistita con l'impiego degli OSS come caregiver.

Peritoneal dialysis (PD) has a prevalence in Italy that does not exceed 10% of patients in substitution treatment. Among the barriers, which hinder access to DP, the lack of patient autonomy or family support has great importance. In 2012 in Lombardy, the lack of support has prevented 155 new patients to use DP and has forced 17 to stop it. According to the Italian Census of 2012, made by the Peritoneal Dialysis Study Group, Assisted DP involved the 24.5% of patients in 2010. In these cases, the caregiver was a family member in 80.8% of cases, a carer in 12.4%, a homecare nurse in 2.5% and the retirement home staff in 3.9%. In Italy, several regional Governments have sought to encourage home dialysis with economic contributions to the patient or the family. However, so far, none of these interventions has managed to increase the use of DP. In January 2004, we started a program of Assisted PD, using health worker as caregiver, in agreement with ASL Milano and ICP Milano Hospital. In the first 6 months of activity we treated 4 patients, 3 of them had been treated with hemodialysis. We had no critical cases and patients have welcomed this solution. In addition, the costs related to the Assisted PD are lower in comparison with the costs of the hospital hemodialysis. Considering the reliability of the first results, ASL has decided to raise the economic contribution for this activity, allowing us to increase the number of patients to include in Assisted PD.

Duodenal perforation and right hydronephrosis due to toothpick ingestion.

We report a case of a 36-year-old man who was admitted to the Emergency Department with right flank pain. The clinical presentation was suggestive of renal colic. However, a computed tomography scan showed the presence of a foreign body in the inferior duodenal flexure. Upper gastrointestinal endoscopy demonstrated a 6.5-cm wooden toothpick deeply embedded in the duodenal wall; this was removed via endoscopy. The peri-duodenal inflammatory reaction had encased the right ureter, resulting in hydronephrosis. The patient did well and was discharged on post-operative day 7. He did not recall toothpick ingestion. When evaluating patients with acute abdominal pain, foreign body ingestion should be considered. In patients with a history of toothpick ingestion, immediate diagnosis with endoscopic management should be performed.

Long-term observation of 87 girls with idiopathic central precocious puberty treated with gonadotropin-releasing hormone analogs: impact on adult height, body mass index, bone mineral content, and reproductive function.

OBJECTIVE: We assessed in a retrospective unicenter study the impact of treatment with GnRH analogs (GnRHa) on adult height (AH), body mass index (BMI), bone mineral density (BMD), and reproductive function in girls with idiopathic central precocious puberty (ICPP). PATIENTS: Eighty-seven ICPP patients were treated with GnRHa for 4.2 +/- 1.6 yr (range 3-7.9) and observed for 9.9 +/- 2.0 yr (range 4-10.6 yr) after discontinuation of treatment; to estimate the efficacy better, 32 comparable ICPP untreated girls were analyzed. RESULTS: AH was 159.8 +/- 5.3 cm, significantly higher than pretreatment predicted AH (PAH) either for accelerated or for average tables of Bayley and Pinneau. The gain in centimeters between pretreatment PAH and AH was 5.1 +/- 4.5 and 9.5 +/- 4.6 cm, respectively. Hormonal values and ovarian and uterine dimensions, reduced during treatment, increased to normal after 1 yr without therapy. Age of menarche was 13.6 +/- 1.1 yr with an interval of 0.9 +/- 0.4 yr after therapy. Menstrual pattern was normal. Six girls became pregnant and delivered normal offspring. BMI sd score for chronological age increased, but not significantly, before, during, and after therapy. BMD at discontinuation of treatment was significantly lower and increased to control values after gonadal activity resumption. CONCLUSIONS: GnRHa treatment in ICPP is safe for the reproductive system, BMD, and BMI and helpful in reaching AH close to target height; however, the variability of individual responses suggests that one choose more parameters than increment in height, especially in girls with pubertal onset over 8 yr of age.

Seminal profile of subjects with testicular microlithiasis and testicular calcifications.

Two hundred eighty-one male partners of infertile couples were studied to determine the prevalence of subjects with testicular microlithiasis (TM) or testicular calcifications (TC) to define the seminal profile of this population and to initiate a longitudinal study to evaluate the significance of TM and TC as predictive markers of cancer. The prevalence found was 4.6% and 3.9%, respectively, which is sufficiently high to merit careful research attention, although TM and TC do not appear to be pathogenic factors of dyspermia.