Telematic expert system Diabeto. New tool for diet self-monitoring for diabetic patients.

OBJECTIVE: To evaluate Diabeto, a computer-assisted diet education system. RESEARCH DESIGN AND METHODS: One hundred five patients with insulin-dependent diabetes mellitus (IDDM) or non-insulin-dependent diabetes mellitus (NIDDM) were divided into two randomized groups to participate in the evaluation of Diabeto. With free access through Minitel, the French public videotex network, Diabeto helps diabetic patients self-monitor their diets and balance their meals with personalized counseling. RESULTS: During the first 6-mo study, group A (54 patients) used Diabeto, whereas group B (51 patients) were control subjects. For the second 6-mo study, group B used the system. Evaluation was based on patients' dietetic knowledge, dietary habits, and metabolic balance. CONCLUSIONS: Diabeto led to a significant improvement of dietetic, knowledge in group A (P less than 0.0005) and also to improved dietary habits; decreased caloric intake in patients initially overeating (P less than 0.05), increase of dietary carbohydrate from 39.7 +/- 0.7 to 42.9 +/- 0.9% in patients with an initial intake less than 45% carbohydrate, and decrease of fat intake from 41.9 +/- 0.9 to 37.4 +/- 1.1% in patients with an initial intake of greater than 35% fat (P less than 0.0005). In the second study, in addition to similar improvements to those observed in the first study, HbA1 decreased from 11.0 +/- 0.4 to 9.9 +/- 0.4% (P less than 0.005) and fructosamine from 5.00 +/- 0.17 to 4.57 +/- 0.17% (P less than 0.001). Diabeto appears to be an effective therapeutic tool in the control of metabolic diseases.

[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).

[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).

[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.

[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.

[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.

Direct interaction between polymorphonuclear neutrophils and cuprophan membranes in a plasma-free model of dialysis.

Plasma-free, purified, normal, human polymorphonuclear neutrophils (PMN) were recirculated for 60 minutes in an experimental model of dialysis using cuprophan membranes and acetate or bicarbonate dialysate. At different time intervals, the intracellular contents of PMN-derived cationic proteins (NCP), the release of lysosyme, beta-glucuronidase and PAF as well as the occurrence of PMN and platelet aggregating activities in the supernatants were evaluated. The formation of PMN aggregates, the depletion of intracellular contents of NCP together with the release of lysosomal constituents occurred early (5-10 min) in the course of recirculation. These events were concomitant with the occurrence of PMN aggregating activity in the supernatants due to the release of NCP, as it was antagonised (30-40%) by a rabbit anti-human NCP, and to the release of PAF which also accounted for the platelet aggregating activity that was independent from both adenosine diphosphate and cyclo-oxygenase inhibitors. These data suggest that direct interaction occurs between human PMN and cuprophan in in vitro conditions in the absence of plasma factors and point to a role for cellular mediators in the pathogenesis of the intravascular alterations occurring early in haemodialysis.