[An example of migrating workers advisory services: the Turin District council project]. / Un esempio di servizi per i lavoratori migranti: le iniziative della Provincia di Torino.

The regulations that govern the job admission procedure in Italy has been revised in the last 15 years in order to improve the work demand and supply meeting and this development is outlined. The reform is centered on the Employment Offices introduction: they cover the province setting up a network wich distributes various service and attends workers and companies to promote employment opportunities. The special status of the migrating workers, wich are a weaker social part compared to national workers, is stressed. In support of this category a new form of civil service executive has been inaugurated, the educational mediator, who knows foreign workers language and culture and leads them to integrate into italian society. In the end migrating workers occupational levels trend in the last 3 years is reported, sorted by nationality and line of work.

[The diagnosis of diseases due to occupation]. / La diagnosi delle malattie do lavoro.

Occupational diseases are essentially defined by aetiological characteristics, and not by nosological characteristics, because the latter in most cases are not specific. This is particularly so for "work-related" diseases but still stays true for most "occupational" diseases. This implies that the diagnostic path for occupational diseases must include one additional step as compared to the standard procedure typical of non occupational medicine. The last is satisfactory after a suitable history and clinical-instrumental phase and thus a nosological definition are completed. The former includes an additional mandatory third phase, the one defining a reliable causal relationship taking into account a reasonable relationship between, on one side, the qualitative, quantitative and temporal aspects of the specific risk, and, on the other side, the observed "effect". These items must be systematically looked for (unless they are practically unobtainable) if a correct diagnosis of an occupational disease has to be reached.

Cimetidine does not influence cellular immunity in patients with chronic renal insufficiency.

Numerical and functional markers of peripheral lymphocytes were adopted to study the influence of cimetidine on the immune response in immunocom-promized patients. Twenty-three patients on regular dialysis treatment, who had been given cimetidine (400 mg daily) for peptic ulcer, were studied during a follow-up of 3 months. Thirty healthy people served as controls for the study of the immunological parameters, i.e. DNCB and PPD skin tests, E-rosetting assays, monoclonal antibodies to T-cells, membrane immunoglobulins for the B-cells, serum immunoglobulins and complement. Before therapy was started CMI was impaired in all patients, with a significant reduction in the E-rosette count (P less than 0.01) and depressed DTH (DNCB, PPD). The number of active E-rosettes and OKT4 subsets increased slightly during the period of treatment, though this finding was not confirmed by functional in vivo tests. No change was observed in the B-lymphocyte count and in serum immunoglobulins or complement. The fact that treatment with cimetidine does not seem to influence the immune response in patients on RDT, may suggest that this therapy does not restore the principal immunopathological disorder of these patients, and further justifies its use in patients awaiting renal transplantation or in those who have been given transplant.

The influence of blood transfusion on cellular immunity.

To evaluate the effect of transfusion on immunity, we studied some immunological parameters in 14 uremic patients treated with 3 blood transfusions (5 with HLA-compatible and 9 with random transfusions). Before transfusions 8/14 patients were DNCB-negative; both spontaneous and active E-rosettes were below normal range. The parameters of humoral immunity (S-Ig, C3, C4, IC, CRP) were normal. After both the first and second transfusions an increase in T- and B-lymphocytes was found. The third transfusion led to a more pronounced and prolonged immunosuppression in patients treated with compatible transfusions than in those treated with random transfusions. Our findings suggest that blood transfusion--HLA-compatible transfusion in particular--results in an impairment of the lymphocyte role.

[Quantification of treatment time in the high-efficiency dialysis method]. / Quantificazione dei tempi di trattamento nelle metodiche di dialisi ad alta efficienza.

Precise quantification of treatment time is allowed by using the urea kinetic models for dialytic therapy prescription: the dialytic dose may be expressed by the KT/V ratio, the nutritional status by PCR. Due to dialysis disequilibrium urea extraction was significantly lower in high efficiency dialysis than in traditional schedules, suggesting to increase the KT/V value when treatment time is reduced. The comparison of KT/V and PCR values obtained by the Gotch model (single pool variable volume) with the results derived by the diagram of Keshaviah has shown significant correlation for both, confirming the usefulness of this simplified model in clinical practice.

[Anti-HCV in patients undergoing dialysis in Piedmont and in Valle d'Aosta]. / Anti-HCV nei pazienti in dialisi in Piemonte ed in Valle d'Aosta.

Special questionnaires were distributed in order to assess the current incidence of anti-HCV antibodies in Dialysis Centres in Piedmont and the Aosta Valley. The analysis of findings showed an overall positivity of 23.9%, with higher values in those cases treated with extracorporal methods and lower values in those patients treated with peritoneal dialysis. The data also confirmed the correlations between anti-HCV antibodies and the number of transfusions performed, and suggested the possible influence of previous operations, high risk manual occupation, or more than one of these factors, in addition to environmental conditions. Lastly, the paper reports the prophylactic measures currently in use for patients and medical staff in the various centres in Piedmont and the Aosta Valley.

[Clinical and epidemiologic characteristics of selected long-term survivors undergoing dialysis]. / Caratteristiche cliniche ed epidemiologiche di pazienti selezionati da una lunga sopravvivenza in dialisi.

At the end of December, 1993, 389 patients treated by means of dialysis for more than 15 years were registered in the Piedmont Dialysis and Transplantation Register; among them, 183 were alive. Characteristics of these patients as age at the beginning of dialytic treatment, casual nephropathies, causes of death, high risk conditions, dialytic schedules, vascular access, hospitalization requirements, rehabilitation, dialysis efficacy, gross mortality, were compared with those of patients treated for a shorter time, concluding that a very long dialytic survival can be achieved with a good clinical and social rehabilitation.

[Comorbidity factors in the dialysis registries and the experience of the Piedmontese Registry]. / I fattori di comorbidità nei Registri di Dialisi e nell'esperienza del Registro Piemontese.

The parameters used at present by the Dialysis and Transplant Registries of various countries to evaluate dialyzed patients' comorbidity show great differences, mostly owing to the different epidemiological, social and racial characteristics of the studied populations. Moreover, the typology of the dialyzed patient is changing: the mean age is increasing, patients with high-risk conditions as vasculopathy and diabetes are widely accepted to the treatment. Thus the Piedmont Registry will be implemented as follows: new fields about comorbidity for clinical (blindness, cachexy and dementia), social (smoking, alcohol and drugs addiction) and diagnostic (type of diabetes, of neoplasm, of cardiovascular problem) parameters, and questions needing dichotomic response (vasculopathy yes or no) will be added. The exact time of appearance of any risk factor will be requested, and a field for "others" risk factors will be added as well, trying to deeply identify the dialytic population not affected by any comorbidity factor. Finally, a new improved control system of the collected data will be used: our registry needs to be implemented in the future by such evaluations, to go on giving useful informations about epidemiology of the dialyzed patients.

[Survival of patients starting dialysis at an advanced age in the Piedmont]. / La sopravvivenza del paziente entrato in dialisi con un'età molto avanzata in Piemonte.

BACKGROUND: Patients starting dialysis in old age (age > 70 and > 80) in Piedmont are widely increasing: the survival curves of this group of patients can give very important information to evaluate the quality of both the delivered therapy and our very wide criteria of acceptance to the treatment. To this end, using data from the Piedmont Dialysis and Transplant Register, the survival curves of patients with age over 70 and 80, beginning dialysis in all Piedmont Dialysis Units between 1981 and 1996, have been examined. METHODS: These curves have been considered both in a general way and according to the presence or absence of further high risk conditions; they show results better than expected and improving from 1981 to 1995. RESULTS: If the survival curves of these patients are considered according to the kind of dialytic treatment performed, they do not show any significative difference. CONCLUSIONS: The conclusion is drawn that these data strongly support first, the fitness of criteria of very wide acceptance to the treatment and modulated choice of the kind of dialytic treatment at present followed in Piedmont; and second, that dialysis treatment can give very good results also in elderly patients. So, it is suggested that the economic and structural difficulties of dialysis Units must not influence the nephrologist's choice towards elderly patients.

[Helicobacter pylori in patients undergoing periodic hemodialysis]. / L'Helicobacter pylori in pazienti sottoposti ad emodialisi periodica.

Forty-nine haemodialyzed patients have been submitted consecutively, under informed consent, to endoscopy with multiple antral gastric mucosa biopsies for Helicobacter pylori (HP) identification, performed by urease, microscopic and cultural tests, as well as histologic examination. Patients have been considered HP negative when negative for all tests; positivity for HP has been correlated with gastritis histologically evaluated according to Whitehead; at endoscopy, blood samples for HP specific IgG, IgA, IgM have been collected; patient's life style concerning smoke, alcohol and drugs as FANS has been investigated as well. HP prevalence in our haemodialyzed patients is 38.8 per cent, similar to general population submitted to endoscopy; a statistically significant correlation between HP and gastritis and specific IgG, but no correlation between HP and age, dialysis duration, IgA, IgM, smoking, alcohol or drugs consumption has been found.

[Social rehabilitation, state of the disease and quality of life. What are the parameters to evaluate rehabilitation of the patient under dialysis in the '90s?]. / Riabilitazione sociolavorativa, stato di malattia e qualità di vita. Quali indicatori per il paziente in dialisi negli anni '90?

The parameters used at present by the Piedmont Dialysis and Transplant Register to evaluate rehabilitation and quality of life of the dialyzed patients have been useful in the past, but they will no longer be so in the future, as the typology of the dialyzed patient is changing: the mean age is increasing, patients with high-risk conditions as vasculopathy and diabetes are widely accepted to the treatment. Thus, rehabilitation has to be evaluated not only from a social and professional viewpoint, but also as "illness situation" and "quality of life" and this can be done using the Karnofsky scale and the test of Spitzer: our Register needs to be implemented in the future by such evaluations, to go on giving us useful information about rehabilitation of the dialyzed patients.

[The status of peritoneal dialysis in Piedmont by 12/31/1997]. / La situazione della dialisi peritoneale in Piemonte al 31/12/1997.

BACKGROUND: The aim of the study is to examine the situation of chronic uremia substitutive treatment by means of peritoneal dialysis in Piedmont on December 31, 1997 using data from the Piedmont regional dialysis and transplant register. METHODS: Starting from the year 1981, data are reported (absolute, per million population, and according to different patient's anagraphic ages) about peritoneal dialysis prevalence and incidence; about basic nephropathies; drop-out from treatment; patient's rehabilitation; complications incidence, particularly peritonitis; patient's survival compared with survival of patients treated, during the same years with extracorporeal techniques. RESULTS: The data demonstrate, during these years, an increase of peritoneal dialysis incidence and prevalence; patients' survival curves, compared with those of patients treated with extracorporeal techniques, are very similar during the first years of treatment and worse afterwards, but never reaching statistical significance. CONCLUSIONS: They support Peritoneal Dialysis as a very good kind of substitutive treatment for some years, but this opinion deserves further examination and investigation on a longer period of time.

[The quarantined dialysis room for Australia-antigen-positive patients. Theoretical, normative, structural, operational, organizational and management aspects]. / La sala dialisi contumaciale per pazienti antigene Australia positivi. Aspetti teorici, normativi, strutturali, operativi ed organizzativo-gestionali.

The technical features of dialysis facilitate the transmission of hepatitis B virus and the outbreak of possibly serious epidemics among patients and hospital staffs. Statistical, epidemiological and clinical data have been collected on many occasions. They serve to emphasise the problem and the need for quarantined centres. The establishment of such a centre for HBsAg-positive patients is discussed in the light of personal experience in the design and setting up of quarantined rooms. The underlying technical and structural requirements are also examined. Reference is also made to two years' experience in the running of a room of this kind. Stress is laid on the importance of having a room for these patients, not only from the clinical standpoint (lessening of contagion), but also from teh social and exonomic standpoint (reduced costs and length of hospital stay, greater rehabilitation).

[Home dialysis. Review of clinical organizational and management problems encountered in more than 6 years of activity]. / La dialisi domiciliare. Rassegna sintetica dei problemi clinici, organizzativi e gestionali relativi all'esperienza di oltre 6 anni di attività.

Together with other forms of self-dialysis (including limited assistance and self-service), home dialysis keeps down cost to much lower levels than those ruling within the hospital. Self-management, which is a common factor of various types of extra-hospital dialysis, also enables the patient to fit in better to society and, in the majority of cases, offers complete working rehabilitation by way of deeper consciousness of his disease and of the various treatments for it. Personal experience of home dialysis covering 6 years activity in the sector is reported. 91 patients have been trained in self-management and 65 of these have already been sent home or are about to be. The most important problems tackled over this period are examined and the experience analysed. Particular reference is made to clinical, organizational and management problems. The paper thus forms a practical guide for those wishing to direct their efforts towards a home dialysis programme.

[Hyperparathyroidism in endocrinology and nephrology]. / L'iperparatiroidismo in endocrinologia e in nefrologia.

The literature on primary and secondary hyperparathyroidism is surveyed in the presentation of an account of the present positon. Reference is also made to personal clinical experience, particularly in secondary cases. The physiopathology of parathormone, calcitonin and vitamin D is described; the last, in fact, has proved useful in the treatment of secondary forms. The usual symptomatological tests of performance are explained, together with their diagnostic value. The clinical symptoms and their physiopathological significance are also illustrated. Stress is laid on the importance of conservative management in secondary forms. Good results now enable parathyroidectomy to be avoided or delayed in many cases.

[Diabetic nephropathy. Review of the current status and practical considerations concerning etiopathogenetic, clinical and therapeutic aspects]. / La nefropatia diabetica. Rassegna di attualità e considerazioni pratiche di ordine etiopatogenetico, clinico e terapeutico.

Reference is made to personal research and clinical experience, coupled with a select bibliography, in a survey of the most significant current knowledge with regard to diabetic nephropathy, designed for the nonspecialist practitioner and intended to enable him to update his knowledge without plunging into details, and to quickly decide what measures he should adopt in his daily practice. Questions of histopathology and aetiopathogenesis are examined, together with the relations between proteinuria, hypertension, renal function, and diabetic nephropathy. The clinical profile and progress of the disease are illustrated. Lastly, an account is given of the conventional modes of treatment, and of the still partly unsatisfactory results offered by more recent forms of replacement therapy (dialysis and transplantation).

[Basic aspects and current trends in iatrogenic kidney diseases. Correlations between their physiopathological mechanisms and clinical findings for the general practitioner]. / Elementi fondamentali e di attualità in tema di patologia iatrogena nefrologica. Correlazione tra i meccanismi fisiopatologici e rilievi clinici per il medico pratico.

Iatrogenic origins may be assigned to any form of kidney disease. Of the pathogenetic mechanisms involved, increasing importance is now attached to immunological responses and intravascular coagulopathies, though other processes long known to medicine have not ceased to play their part. Moreover, recent advances in the improvement of drugs and the standardisation of their use have given a better idea of the potential damage to the kidneys from many substances. A re-examination is made of the main findings in this field with a view to offering a simple summary of the underlying physiopathogenetic mechanisms, and drawing the diagnostic and clinical conclusions therefrom, so as to aid the general practitioner rather than the specialist. An account of the various medical interventions that may lead to kidney lesions, and the circumstances in which such interventions are most likely to be harmful, is followed by an analysis of recent opinions on the correct way of administering drugs in patients with kidney disease, so as to limit their potentially harmful effects as far as possible.

[Lead poisoning in the newborn and infants: an epidemiological study in an area of Northern Italy]. / L'intossicazione da piombo nel neonato e nel lattante: rilevazione epidemiologica in un'area del nord Italia.

OBJECTIVE: Lead crosses the placenta and can cause permanent neurological impairment by prenatal poisoning. Blood lead levels higher than 10 mcgr/dl in children age 1 to 2 years may be toxic. In 1991 the CDC (Centers for Disease Control and Prevention) published "Preventing Lead Poisoning in Young Children" with the new guidelines defining the value of 10 mcgr/dl as the security limit. Since no blood lead levels in childhood have been collected in Italy this study reports blood lead levels in newborns and 4 month old infants in the Piemonte Region. DESIGN: The study was carried out on a random sample of 55 mother-infant couples attending the Mauriziano Hospital in Turin. The cohort was divided into urban versus rural residence. In every subject attending the study lead, ALA-d and Zn-PP were measured on venous blood specimens in three different moments. RESULTS: Even though our study refers to a small population our data were reassuring. The mean lead values found in the cohort in the three different stages were all below 10 mcgr/dl. ALA-d and Zn-PP resulted also in normal ranges. No statistical difference emerged between urban and rural coming subjects. CONCLUSIONS: In consideration of the results obtained we cannot confirm the necessity of a general screening programme for lead poisoning in our population. We assert the utility of a selective screening on the basis of a questionnaire as already experimented in some states of the U.S.A.