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Presso la UO di Micro-Chirurgia della Mano dell’ A.O. G. Pini di Milano vengono eseguiti interventi di chirurgia ambulatoriale a bassa complessità, pertanto è stata scelta come UO pilota per la sperimentazione di un Percorso Diagnostico Terapeutico (PDT) relativo a tali interventi che rispondesse alla direttive di legge e che permettesse di migliorare il servizio offerto. Dal 2011 al 2012 sono stati raccolti i dati relativi a 102 pazienti sottoposti a interventi BOCA e monitorati una serie di indicatori. Nella maggioranza dei casi i pazienti sono stati classificati con punteggio ASA 1–2 (98%), hanno avuto un periodo di osservazione postoperatoria inferiore alle 24 h (95%), hanno riferito una riduzione costante del dolore nei giorni post intervento (VAS alla dimissione

Lo sviluppo di nuove megaprotesi per il trattamento di grandi difetti ossei ha offerto importanti opportunità ai chirurghi ortopedici oncologi per la sostituzione di grandi segmenti scheletrici, come le ossa lunghe degli arti superiori e inferiori e le relative articolazioni. La nostra esperienza clinica nel trattamento di pseudoartrosi e grave perdita di tessuto osseo ci ha portato, a volte, a confrontarci con la realtà di alcuni fallimenti chirurgici dopo tentativi infruttuosi di ricostruzione. Di fronte a certe situazioni cliniche o radiologiche drastiche abbiamo voluto applicare i principi della Camera Biologica in associazione con soluzioni di sostituzione megaprostesica. Abbiamo impiantato megaprostesi sia con tecnica a 1 o 2 step(precedentemente trattati con spaziatore antibiotato) a seconda delle condizioni del paziente. Lo scopo di questo studio è quello di valutare retrospettivamente i risultati clinici e radiologici in pazienti sottoposti a megaprotesizzazione di arto inferiore e di registrare le complicanze. In totale, abbiamo trattato 32 pazienti con megaprostesi mono e bi-articolare così suddivisi: femore prossimale, femore distale, tibia prossimale, femore totale. Il follow-upmedio dei pazienti è di circa 18 mesi (5 anni max, min 3 mesi) con rivalutazioni radiografiche e cliniche seriate con metodi standard (raggi X a 45 giorni, 3–6–12–18–24 mesi) come pure il monitoraggio dei parametri ematici di infiammazione per almeno 2 mesi. Nonostante il follow-upmedio non sia molto lungo, i primi pazienti hanno ormai raggiunto cinque anni di monitoraggio e in tutti i casi abbiamo avuto incoraggianti risultati clinici con buona articolarità dei segmenti, senza defict somato-sensoriali o motori e recupero funzionale accettabile. Durante l’intervento chirurgico e, ancor più, nella pianificazione pre-operatoria, si dovrebbe dare molta attenzione alla valutazione dell’apparato estensore preservandolo e, quando necessario, rinforzandolo con sostituti tendinei. Le megaprostesi in fallimenti traumatici e nella revisione protesica possono quindi essere considerate, in casi estremi, opportunamente selezionati, come soluzione a disposizione del chirurgo ortopedico? In chirurgia oncologica l’opportunità di ridonare una funzione, anche se non ad integrum, al paziente è certamente un elemento di grande fascino per il chirurgo e un’opportunità per il paziente. Purtroppo, l’alta mortalità associata a queste patologie non ci consente di avere un follow-upa lungo termine. Questo crea quindi una mancanza di certezza sulla sopravvivenza di questo tipo di protesi e le complicanze che possono verificarsi a medio e lungo termine. Tuttavia, i pazienti da noi trattati devono essere considerati alla stregua di un paziente oncologico, non a causa della malattia, ma per le limitate opzioni terapeutiche disponibili. Possiamo considerare le megaprotesi come una preziosa opportunità per ripristinare la funzionalità per i pazienti che sono, loro malgrado, costretti ad affrontare malattie altamente invalidanti. The development of new megaprosthesis for the treatment of large bone defects has offered important opportunities to orthopedic oncologic surgeons for the replacement of skeletal segments such as the long bones of the upper and lower limbs and the relative joints. Our experience, treating non union and severe bone loss, has brought us, sometimes, to be confronted with the reality of some failures after unsuccessful attempts to reconstruct. Faced with certain radiological and/or clinical drastic situations we wanted to apply the principles of Biological Chamber and oncologic surgery with megaprosthetic replacement solutions. We implanted megaprosthesis with either 1 step or 2 steps (previous antibiotated spacer) technique depending on the septic patient conditions. The aim of this study is to retrospectively evaluate both clinical and radiological outcomes in patients underwented to a lower limb megaprosthesis implant and to record complications. In total, we treated 32 patients with megaprosthesis mono-and bi-articular subdivided as follows: proximal femur, distal femur, proximal tibia and total femur. The mean follow-up of patients is about 18 months (5 years max, min 3 months) with clinical and serial radiographic revaluations with standard methods (X-ray in 45 days, 3–6–12–18–24 months) as well as monitoring of blood parameters of inflammation for at least 2 months. Despite the follow up average is not so long, the first patients have now reached five years of monitoring and in all cases we have had encouraging clinical results with good articulation of the segments, no somato-sensory or motorial defict and acceptable functional recovery. During surgery and, even more, in the pre-operative planning much attention should be given to the evaluation of the extensor apparatus preserving it and, when necessary, reinforcing it with tendon substitutes. Could megaprosthesis in traumatic and prosthetic failures therefore be considered, in extreme cases appropriately selected, as a solution available to the orthopedic surgeon? In oncological surgery the opportunity to regive a function, although not ad integrum, to the patient is certainly an element of great fascination for the surgeon and an opportunity for the patient. Unfortunately, the high mortality associated with this disease does not allow us to have long-term follow-up. This then creates a lack of certainty about the survival of this type of prosthesis and the medium and long-term complications that may occur. Nevertheless, the patients treated by us should be considered as a oncologic patient, not because of the disease but for the limited therapeutic options available. We can consider megaprosthesis as a valuable opportunity to restore functionality to patients who have, despite themselves, to deal with highly disabling diseases.

Abbiamo trattato un paziente di 47 anni giunto alla nostra osservazione tramite il Servizio Traumatologico d’Urgenza del nostro Istituto con diagnosi di frattura di trochine dalla testa omerale destra in paziente sottoposto a stabilizzazione della spalla omolaterale con tecnica secondo Letarjet nel 1993. Il paziente pertanto è stato sottoposto a intervento chirurgico di osteosintesi a cielo aperto mediante ancorette. Il decorso post-operatorio è stato regolare e il recupero funzionale buono con grande soddisfazione del paziente. We treated a patient aged 47, came to our attention by the Trauma Emergency Service of our Institute with diagnosis of fracture of the tuberculum minus of the humeral head in patient who underwent stabilization of the shoulder with Letarjet technique in 1993. The patient has been treated by open reduction and osteosynthesis using anchors. The postoperative course was uneventful with good functional recovery and great patient satisfaction.

L’innesto osseo autologo è stato a lungo considerato il gold standardper il ripristino dei difetti ossei. Tuttavia questa procedura si associa nel tempo allo sviluppo di un alto tasso di complicazioni senza, peraltro, garantire benefici clinici assoluti. Per questo motivo la ricerca si è concentrata negli ultimi anni sullo sviluppo di sostituti ossei alternativi (biologici e sintetici). Scopo di questo articolo di aggiornamento è quello di fornire una panoramica completa dei dati presenti in letteratura in merito ai sostituti ossei utilizzati in chirurgia ortopedica e traumatologica per la correzione dei difetti ossei. Per questo scopo abbiamo analizzato i due più importanti databasedisponibili: Embase e PubMed. Abbiamo incluso articoli inglesi trattanti l’argomento “sostituti ossei” che si occupassero delle proprietà strutturali, biologiche o biomeccaniche del prodotto puro e del suo utilizzo in traumatologia e chirurgia ortopedica. Tutti i materiali inclusi nell’articolo possiedono un’attività osteoconduttiva con differenti caratteristiche nei tempi di riassorbimento e proprietà biomeccaniche. Per ogni materiale sono state fornite le caratteristiche strutturali, biologiche e biomeccaniche, così come le indicazioni cliniche e chirurgiche. Le dimensioni, la localizzazione del difetto osseo e il tipo di dispositivo utilizzato sono i principali fattori da tenere in considerazione per ottenere un sostituto osseo ottimale. Non sono ancora presenti in letteratura studi in grado di definire come ottimale un singolo specifico sostituto; alcune questioni non sono ancora state risolte, soprattutto nei casi di difetti ossei critici in cui l’applicazione della “politerapia” (scaffold, cellule mesenchimali staminali, fattori di crescita) sembra dare risultati migliori. The gold standardfor restoring bone defects is still considered to be autologous bone grafting. However, clinical benefits are not guaranteed and donor-site complications and morbidity is not infrequent. Research is on-going for the development of alternative bone substitutes of both biological and synthetic origin. The purpose of this study was to evaluate the type of materials used and their efficacy for the treatment of large bone defects in traumatology and orthopaedic surgery. A literature review was carried out of Embase and PubMed database. Inclusion criteria were articles in English language focusing on the use of bone substitutes in trauma and orthopaedic surgery for the treatment of bone defects and included details on the structural, biological or biomechanical properties of the pure product. Furthermore, based on two clinical challenges, fracture non-union and impaction grafting we elaborated on the use of polytherapy for large bone defects as guided by the diamond concept. All the products indicated in this manuscript possess osteoconductive activities but have different resorption times and biomechanical properties. Bone graft substitute materials are used for a wide range of clinical applications even when the level of clinical evidence is low. The size and location of the defect and the local biological and mechanical environment as well as the biomechanical characteristics of the material determine the type of device that can be implanted in a bone defect. Proper assessment of the biological and mechanical environment and accurate patient selection are necessary to judge the extent of therapy the injury warrants. A sound understanding of various aspects of biomaterial properties and their relation and influence towards bone healing is of utmost importance. We suggest the application of polytherapy for the treatment of large bone defects and advocate the use of the diamond concept as a guideline.

Le pseudoartrosi (PSA) e le perdite di sostanza ossea juxta-articolari sono una rara complicanza in ortopedia e traumatologia, ma rappresentano situazioni assai impegnative dal punto di vista clinico e della scelta del trattamento.Le pseudoartrosi (PSA) e le perdite di sostanza ossea juxta-articolari sono una rara complicanza in ortopedia e traumatologia, ma rappresentano situazioni assai impegnative dal punto di vista clinico e della scelta del trattamento.

Riassunto: Vengono presentati i risultati del trattamento chirurgico mediante osteosintesi interna di 107 casi di fratture omerali complesse che si estendono dall’epifisi prossimale al 1/3 medio diafisario. L’intrinseca difficoltà di posizionamento di una placca lunga, relativamente alla necessità di non danneggiare strutture vascolo-nervose e muscolari, ha determinato la scelta, come via di accesso, della via transdeltoidea laterale. Tutte le fratture trattate sono giunte a consolidazione senza procedure accessorie mediamente in 20 settimane. La valutazione clinico-funzionale numerica secondo il Costant score ha evidenziato un progressivo miglioramento con un indice medio di 83 punti. La valutazione analogica del dolore (VAS) ha evidenziato un netto miglioramento a partire dal 6° mese post-operatorio con un indice massimo di 13,5 punti su 15. In 6 casi (6,42%) si è registrata intolleranza al mezzo di sintesi correlata in 1 caso a dolore al passaggio deltoideo-brachiale e nei rimanenti 5 a “fastidio” di origine psicologica. In 11 casi (11,77%) si è riscontrato un conflitto sottoacromiale del mezzo di sintesi che però non ha determinato la rimozione dello stesso prima della consolidazione ossea. Tutti i pazienti sono stati sottoposti a rimozione del mezzo di sintesi ad almeno 12 mesi dall’impianto.

Riassunto: Abbiamo trattato una paziente di 62 anni giunta alla nostra osservazione tramite il Servizio Trauma — tologico d’Urgenza del nostro Istituto con diagnosi di frattura sovracondiloidea del femore destro in paziente portatrice di protesi totale d’anca bilateralmente e recentemente nefrectomizzata per carcinoma renale. Durante la degenza veniva posta diagnosi di frattura patologica in metastasi da carcinoma renale. La paziente pertanto è stata sottoposta a intervento chirurgico di asportazione del femore in toto e protesizzazione con protesi total femur. Il decorso post-operatorio è stato regolare e il recupero funzionale buono con grande soddisfazione della paziente.

The incidence of adenocarcinoma and bronchoalveolar carcinoma has increased in recent years. The aim of this study was to retrospectively evaluate radiological and pathological factors affecting survival in patients with bronchoalveolar carcinoma (BAC) or BAC associated with adenocarcinoma who underwent surgical treatment.

Hypoglycaemia is an important complication of insulin treatment in Type 1 diabetes mellitus (DM). Pancreas transplantation couples glucose sensing and insulin secretion, attaining a distinctive advantage over insulin treatment. We tested whether successful transplantation can avoid hypoglycaemia in Type 1 DM. Combined kidney and pancreas transplanted Type 1 DM who complied with good function criteria (KP‐Tx, n= 55), and isolated kidney or liver transplanted non‐diabetic subjects on the same immunosuppressive regimen (CON‐Tx, n= 14), underwent 1‐day metabolic profiles in the first 3 years after transplantation, sampling plasma glucose (PG) and pancreatic hormones every 2 hours. KP‐Tx had lower PG than CON‐Tx in the night and in the morning and higher insulin concentrations throughout the day. KP‐Tx had lower PG nadirs than CON‐Tx (4.40 ± 0.05 vs 4.96 ± 0.16 mmol l−1, ANOVA p= 0.001). Nine per cent of KP‐Tx had hypoglycaemic values (PG ≤3.0 mmol l−1) in the profiles, both postprandial and postabsorptive, whereas none of CON‐Tx did (p< 0.02). In conclusion, after pancreas transplantation, mild hypoglycaemia is frequent, although its clinical impact is limited. Compared to insulin treatment in Type 1 DM, pancreas transplantation improves but cannot eliminate hypoglycaemia. Copyright © 1998 John Wiley & Sons, Ltd.

Between 1989 and 1993, 62 patients underwent Whipple pancreatoduodenectomy and 75 pylorus-preserving pancreatoduodenectomy (PPPD); 35 patients in the first group and 37 in the second had pancreatic adenocarcinoma while 17 and 21 patients respectively had periampullary adenocarcinoma. The aim of this retrospective study was the comparison of operative outcome, nutritional recovery and survival of patients who underwent these two operations. No significant differences were found between the two groups in operative mortality or morbidity, duration of gastric aspiration and time to start of solid meals. Patients who underwent PPPD had a better nutritional recovery: the increase of both body-weight and serum albumin level at 6 months after discharge was significantly higher for those who had preservation of the whole stomach (P< 0.001 and P< 0.05 respectively). No significant difference in survival was found between the two procedures when patients with pancreatic or periampullary adenocarcinoma were analysed separately.

In previously thrombolysed patients, we analysed residual myocardial viability using the PET-FDG technique and correlated its presence and extent to the angiographic appearance of the infarct-related vessel and left ventricular function. Thirty-six patients who had undergone intravenous thrombolysis for acute myocardial infarction 4.8 ± 7.2 months previously were studied. Coronary angiography, left ventriculography, and assessment of myocardial perfusion and metabolism were all performed within 1 week. All patients exhibited perfusion defects consistent with the clinically identified myocardial infarction site. Residual viability, as assessed by the PET-FDG technique, was present in 53 of cases. The infarct-related coronary artery was patent in 19 (53) patients (TIMI grade 3, 79); of the remaining 17 with occluded infarct-related arteries, 11 had collaterals to the infarct area. Significant FDG uptake was observed in 63 of patients with a patent infarct-related artery and in 41 of those with an occluded infarct-related artery. The same study protocol was adopted in a control group of 30 patients with myocardial infarction who did not receive thrombolysis. The number of infarct-related patent vessels was significantly lower in these patients (30 vs53) (TIMI grade 3, 56), but the overall percentage of PET viability was again 53. Qualitative analysis of the regional perfusion pattern showed that the magnitude and severity of the perfusion defect was similar in the two groups, regardless of the presence or absence of FDG uptake. Global left ventricular function was also similar in the two groups. However, regional wall motion was significantly better in the thrombolysed patients with a patent infarct-related artery than in those who had not received thrombolysis and whose culprit vessel was also patent.

High resolution ultrasonography of the hand and wrist was performed on 20 patients with definite or probable rheumatoid arthritis (ARA standard criteria) in its early stage. In all the patients, swelling of the soft tissues of the fingers corresponded to an enlargement of the joint capsule containing a hypoechoic exudate. The rheumatoid nodules appeared as fluid-filled rounded cavities with sharp borders. Rheumatoid tenosynovitis was observed in 18/20 patients. This corresponded to oval or spindle-shaped cavities with a hypoechoic (10/18 cases) or anechoic content (8/18 cases) and with the tendon ribbon inside. Rupture of a tendon was diagnosed in 8/20 cases and it was always confirmed at surgery. Tenosynovitis of the flexor carpi ulnaris at the wrist level was observed in 10/20 patients. Ultrasonography is proposed as an effective first-line approach and as a periodical follow-up survey in early stage rheumatoid arthritis, in combination with standard radiography.

Factors associated with residual insulin secretion and spontaneous remission in Type 1 diabetic patients are important in the evaluation of treatment aimed at modifying the natural history of Type 1 DM. We investigated the effect of parameters at onset on residual beta cell function in 215 Type 1 DM children and adolescents. Blood gas analysis, HLA, GAD and IA‐2 antibodies before the start of insulin treatment were recorded for each patient. Residual C‐peptide secretion was assessed by the glucagon test, and parameters of metabolic control (HbA1cand insulin dose U kg−1day−1) were examined at disease onset and after 3, 6, and 12 months. Residual C‐peptide secretion throughout the first year of disease was significantly reduced in patients with disease onset before age 5. Multiple regression analysis showed that low pH at onset showed a significant and independent association with reduced C‐peptide at 3 months (p= 0.02) and that the detection of GAD antibodies had a significant independent association with decreased C‐peptide secretion at 6 months of follow‐up (p= 0.02). Insulin requirement was higher in the youngest patients group and in patients with GAD antibodies. Spontaneous insulin remission (HbA1c<6 % and insulin <0.3 U kg−1day−1) occurred in 22/192 (11 %) patients at 3 months of follow‐up, in 15/190 (8 %) patients at 6 months and in 8/169 (5 %) patient at 12 months. Remission was more prevalent in older patients (p= 0.01) and in patients without detectable GAD antibodies: (14/64 vs 8/128, p= 0.001). Sex, IA‐2 antibodies and HLA DR were not independently associated with C‐peptide secretion, insulin requirement or remission in the first year of Type 1 DM. This study confirms the association of young age, severe acidosis at disease onset, and GAD antibodies with decreased residual beta‐cell function and spontaneous remission during the first year of insulin treatment. These factors should be considered in trials evaluating therapies to retain beta‐cell function and induce remission at and after disease onset. © 1998 John Wiley & Sons, Ltd.

High resolution ultrasonography of the hand and wrist was performed on 20 patients with definite or probable rheumatoid arthritis (ARA standard criteria) in its early stage. in all the patients, swelling of the soft tissues of the fingers corresponded to an enlargement of the joint capsule containing a hypoechoic exudate. the rheumatoid nodules appeared as fluid-filled rounded cavities with sharp borders. Rheumatoid tenosynovitis was observed in 1820 patients. This corresponded to oval or spindle-shaped cavities with a hypoechoic (1018 cases) or anechoic content (818 cases) and with the tendon ribbon inside. Rupture of a tendon was diagnosed in 820 cases and it was always confirmed at surgery. Tenosynovitis of the flexor carpi ulnaris at the wrist level was observed in 1020 patients. Ultrasonography is proposed as an effective first-line approach and as a periodical follow-up survey in early stage rheumatoid arthritis, in combination with standard radiography

This study was undertaken to assess the sensitivity of hydroxylysylpyridinoline (HP), lysylpyridinoline (LP), galactosylhydroxylysine (GHyl) and glucosylgalactosylhydroxylysine (GGHyl) to monitor bone response to estrogen deficiency and replacement by comparing their excretory patterns in ovariectomized aged (11–14 months old) rats. The ovariectomized (OVX) rats were randomized into two groups: (1) OVX plus vehicle; (2) OVX plus 17β-estradiol (17-βE, 10 μg/kg, s.c., 4 days/week). Treatment with 17-βE started immediately after OVX and continued for 60 days. The collagen catabolites were measured in urine for 1 month before OVX and thereafter for 60 days. In temporal coincidence with urine collection, bone area and bone mineral density (BMD) of lumbar vertebrae, femoral diaphysis and distal metaphysis were measured by dual-energy X-ray absorptiometry. In the untreated rats, BMD of the femoral metaphysis and lumbar vertebrae decreased significantly and the urinary excretion of LP, HP, GHyl and GGHyl increased with different patterns. In the treated rats, 17-βE replacement prevented the increment in LP excretion, partially prevented the increase in HP excretion, but had no effect on the excretion of GHyl and GGHyl. In conclusion pyridinolines and glycosides have different sensitivities to the bone response to OVX. Glycoside excretion after OVX also reflects metabolic processes not strictly related to bone loss and, in contrast with LP, is not sensitive to estrogen replacement.Journal of Endocrinology(1996) 150,383–390

This study was undertaken to identify and validate possible existing sources of information to estimate the prevalence of known diabetes and the incidence of Type I (insulin-dependent) diabetes in Italy.

It has been shown that peripheral glucagon secreting cells (A-cells) are lost during most of the isolation procedures employed for pig islets. Loss of A-cells decreases intra-islet glucagon levels and cAMP levels in B-cells and might reduce glucose-induced insulin release. This study was designed to test this hypothesis, by evaluating the effects of culture of porcine islets with exogenous glucagon on insulin secretion and on insulin and cAMP content in islets. Islets were isolated from adult 2-year old Large White pigs using an automated method. The number of A-cells was calculated by immunostaining for glucagon in islets before and after isolation and a significant decrease in A-cells was observed. After an overnight culture, islets were cultured for 48 h in a standard medium (CMRL 1066, 10% foetal calf serum, 1% antibiotics, 1% glutamine) alone or in the presence of glucagon at two different concentrations (1·0 and 10·0 μm); exposure to glucagon was either continuous or alternated with periods of incubation in CMRL 1066 alone. After the 48-h culture in standard medium, the islet glucagon response to arginine was almost negligible and significantly lower than that observed in human islets. After culture, islet insulin response to glucose, and islet insulin and cAMP content were evaluated; continuous exposure to glucagon did not produce any significant effect on either insulin secretion or insulin and cAMP content; in contrast, discontinuous exposure to glucagon induced a significant improvement in insulin release, proportional to glucagon concentrations (integrated insulin release: −13·8 ±20·12 pg/islet/20 min in control islets, 111·0±50·73 and 144·7± 47·54 pg/islet/20 min in islets exposed to 1·0 and 10·0 μg glucagon respectively; n=10, P=0·01). Intracellular insulin and cAMP content of islets cultured in different culture media were not different. In conclusion, discontinuous exposure of isolated pig islets to exogenous glucagon induced a significant increase in glucose-induced insulin release which was not associated with an increase in cAMP content. The fact that even in the presence of glucagon the secretory activity of pig islets was lower than the reported activity of human or rat islets suggests that glucagon is only one of the factors involved in the poor insulin responsiveness of pig islets.Journal of Endocrinology(1995) 147,87–93

To provide complete prevalence data on diabetes mellitus in Italy (diagnosed and undiagnosed), a population survey was performed in the Health District of Cremona, a representative area of the Po river (north Italy). The survey is characterised by particular attention being paid to methodology, non-responders being investigated for possible selection biases affecting diagnosed and undiagnosed diabetes prevalence estimations. Out of a population aged 44 years or older from three municipalities, a random sample of 3097 subjects was selected to undergo an oral glucose tolerance test. In addition, past medical history, clinical and laboratory data were collected. A total of 1797 subjects participated (58%), and information on known diabetes status was obtained for 2618 persons (85%), also including 826 interviewed non-participating subjects. Overall rates were age-standardised according to the 1991 Italian census. Overall prevalence and 95% confidence interval of diagnosed diabetes was 8.5% (6.9–10.1) in males and 7.9% (6.7–9.3) in females over the age of 44 years; previously undiagnosed diabetes was 2.5% (1.4–3.6) in males and 3.4% (2.1–4.7) in females; glucose intolerance was 7.7% (5.7–9.7) in males and 8.9% (7.0–10.8) in females. Total diabetes prevalence above age 44 years, developed-world age, and sex standardised, was 10.7%. This study provides the first reliable prevalence estimation of impaired glucose tolerance, diagnosed and undiagnosed diabetes in Italy, according to World Health Organization criteria, and one of the few figures for Southern Europe. The role of body mass index on both prevalence of diabetes and cluster of cardiovascular risk factors is considered, with implications for prevention.

Abstract: To investigate the role of puberty on spontaneous clinical remission and on secretion of residual C-peptide during the first year of type 1 diabetes mellitus, we studied 77 pre-pubertal, 39 pubertal and 41 post-pubertal type 1 diabetic patients. Spontaneous partial clinical remission (HbA1c within the normal range and insulin dose less than 0.3 U ⋅ kg–1 body weight ⋅ day–1 lasting for at least 10 days) decreased with duration of diabetes: months 3 vs 6 vs 12, respectively 13 vs 7 vs 4% (P<0.025). Remission was higher in post-pubertal than pubertal and pre-pubertal patients: month 6 respectively 20 vs 5 vs 1% (P<0.001). Secretion of C-peptide was significantly lower in pre-pubertal than the other two groups of patients. Basal and stimulated C-peptide secretion were higher in patients in clinical remission than in those who were not: basal value 0.4 (0.26–0.53) vs 0.28 (0.14–0.4) nmol/l (P<0.05); stimulated value 0.63 (0.5–0.95) vs 0.56 (0.31–0.74) nmol/l (P<0.05). Spontaneous remission is less frequent in children and adolescent patients than in adult post-pubertal patients, but different mechanisms may be involved. Low residual insulin secretion seems implicated in children meanwhile low insulin sensitivity could be more important in pubertal patients.

Background:ATIII is decreased in sepsis and/or shock and its baseline value correlates with mortality. The efficacy of ATIII therapy on mortality was assessed in a selected group of patients admitted to the intensive care unit (ICU) in a double-blind, randomized, multicenter study.