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Celiac disease (CD) is an autoimmune disease with inflammatory characteristics, having a condition of chronic malabsorption, affecting approximately 1% of the population at any age. In recent years, a concrete correlation between eating disorders and CD has emerged. Hypothalamus plays a central role in determining eating behaviour, regulating appetite and, consequently, food intake. One hundred and ten sera from celiac patients (40 active and 70 following a gluten-free diet) were tested for the presence of autoantibodies against primate hypothalamic periventricular neurons by immunofluorescence and by a home-made ELISA assay. In addition, ghrelin was measured by ELISA. As control, 45 blood serums from healthy age matched were analysed. Among active CD, all patients resulted positive for anti-hypothalamus autoantibodies and sera showed significantly higher levels of ghrelin. All of the free-gluten CD were negative for anti-hypothalamus autoantibodies and had low levels of ghrelin, as well as healthy controls. Of interest, anti-hypothalamic autoantibodies directly correlate with anti-tTG amounts and with mucosal damage. In addition, competition assays with recombinant tTG showed a drastically reduction of anti-hypothalamic serum reactivity. Finally, ghrelin levels are increased in CD patients and correlated with anti-tTG autoantibodies and anti-hypothalamus autoantibodies. This study demonstrates for the first time the presence of anti-hypothalamus antibodies and their correlation with the severity of the CD. It also allows us to hypothesize the role of tTG as a putative autoantigen expressed by hypothalamic neurons.

We consider a Cauchy–Dirichlet problem for a quasilinear second order parabolic equation with lower order term driven by a singular coefficient. We establish an existence result to such a problem and we describe the time behavior of the solution in the case of the infinite–time horizon.

In the last 6-7 years there has been a progressive increase in the use of nurses or secretaries in Paediatric Primary care setting. Regional incentives (few) and the rising (remarkable) of the workload and patients’ requests, convinced about the 40% of the italian Family Paediatricians (FP) to hire new staff. In the 70% of cases the employers were organized in working group in one private practice that, thanks to the costs’ sharing, frequently had nurses in their staff (the data represent the situation at the end of 2013 and were obtained asking directly FP's professional organizations). Solo Paediatricians and Associated Paediatricians (that work in several private practices in coordination each other), on the other hand, hired more frequently secretaries with a working time generally reduced if compared to working groups’ colleagues. Economic factors (the fear to be unable to fulfill the expenses related to hiring) and those concerning organization and management (the not perfect knowledge of how best to use the staff) are the main causes that prevent most of Paediatricians to employ [1]. Who decided to use co-workers, did it to delegate certain duties, to filter patients’ requirements, to share work experience [1]. Secretaries can officiated the following tasks: sorting incoming calls, appointments, advise on admission to medical consultation, set up patient's recording (1st consultation), illustration and delivery of the services charter, delivery questionnaires, registration of diagnostic services, recurrent prescriptions, preparation of medical certificates, patients’ active call for programmed medical examinations, billing, payment deadlines and commitments, check of the monthly payment slips obtained by the Health Service, registration deadlines of drugs and medical devices, suppliers list, mantainance men and contracts list, health servicices summaries, statistics, chart statistic diagrams, waiting room monitoring (games, cartoons, magazines, books, etc.), appointment calendar update. Nurses can perform the following functions: Telephone Triage; Telephone advices based on defined protocols that are recorded in the electronic patient health card, auxological recordings, performing diagnostic tests and screening (urine examination, rapid Strep test, RCP, Blood Count, Prick Test, oximetry, spirometry, eye test, Lang test, Boel test, Plicometry, etc.), infant care, clinical and epidemiological research, health education messages in the waiting room, drugs and medical devices deadlines monitoring, provisions supervision, medical equipment efficiency preservation, health care protocols update and recording, check office's e-mails. In the near future the decrease of FP's number, the need to take care of a larger number of patients and to organize work in some way of collaboration, will push more and more colleagues to hire staff.

As much as 1% of the gluten-consuming world is gluten-intolerant. New screening methods are increasingly identifying gluten intolerance in individuals previously free from health problems. The often-abrupt major change in diet may adversely affect the patient's quality of life. Our aim was to evaluate self-perceived quality of life in a large cohort of adult celiac patients after at least one year of a gluten-free diet. In all 581 members (410 females) of five regional celiac societies were on a gluten-free regimen for at least one year. In this cross-sectional study, a modified version of the Zung Self-Rating Depression Scale was administered to the 581 patients from five Italian regions. Most patients correctly defined celiac disease, and compliance with the gluten-free diet was high, although reporting bias cannot be excluded. Most felt well (83.6% "very well" and "well"); consequently, anxiety and depression scores were low. Happiness also scored low. Most participants did not feel that a gluten-free life differentiated them from the general population. Women and patients diagnosed after 20 years of age had better dietary compliance, but more problems in their social life. Happiness scores were higher in patients diagnosed before 20 years of age. Anxiety and depression were infrequent in this group; however, anxiety was frequently related to feeling different from the general population, and depression to an unsatisfactory sexual life. In conclusion, celiac disease does not appear to be associated to a low level of self-perceived quality of life in members of the Italian Celiac Society.

Portal vein resection during pancreaticoduodenectomy has recently experienced renewed interest. We describe our results with this procedure over a 20-year period. Among 88 consecutive pancreatectomies for cancer of head of the pancreas, 14 included en bloc removal of the portal vein. There was no hospital mortality. Only 21% were found to have histologically confirmed cancer invasion, and the remainder had inflammatory adherence. Two-year survival was 15% compared to 34% for patients who did not have portal vein resection. There were no 5-year survivors. We discuss our results in light of other recent reports.

An abnormal mucosal cell-mediated immune response plays a fundamental role in the pathogenesis of celiac disease. To characterize locally infiltrating T cells, gliadin-specific T-cell clones were isolated from two treated celiac patients. Mucosal biopsies were cultured in vitro for 24 hr with a peptic-tryptic digest (PT) of gliadin. T-cell clones (TCC) were then isolated by limiting dilution. The production of interferon-γ (IFN-γ) and interleukin-4 (IL-4) was evaluated by ELISA in culture supernatants obtained after a short incubation with anti-CD3 and PMA, or with antigen. Twenty-two TCC were specific for gliadin and/or PT. All were CD3+, CD4+, CD8+, TCR αβ+. In one such clone the PT-specific response was inhibited by an anti-DQ, but not by an anti-DR antibody. Of the five gliadin-specific TCC examined, four produced IL-4 and high levels of IFN-γ; the remaining one initially produced only IL-4, but subsequently also IFN-γ. All clones obtained from the celiac mucosa, including the gliadin-specific ones, produced high levels of IFN-γ, in most cases with IL-4. This cytokine profile could explain most of the immunological features of the celiac mucosa.

The clinical and biochemical presentation of carcinoma of the pancreas (PC) and of the papilla of Vater (CPV) are very similar, and, consequently, detailed investigations are required to correctly distinguish between them. The aim of the present study was to select the clinical and biochemical variables that would most efficiently discriminate the precise site of tumor origin. The study group consisted of 72 patients with PC and 22 patients with CPV consecutively hospitalized in our department. The following clinical parameters were considered: age, asthenia, anorexia, vomiting, weight loss, pain, fever, pruritis, and constipation; the biochemical parameters considered were total, direct, and indirect bilirubin, glucose, alkaline phosphatase, gamma glutamy transferase, transaminase, total protein, amylase, and occult blood in stools. The results indicated that in the initial phase of PC the most frequent clinical parameters were weight loss (P

Si dimostra, sotto opportune ipotesi l'analiticita dell'integrando del Γ−-limite di una successione di funzionali semplici del C.d.V. ad integrando analitico.

The probability integral (p.i.) values of the correlation coefficient in samples from a normal bi-variate population are usually computed by approximate methods, except for the first few values ofn. In this note we shall obtain the explicit expression for any sample size through a relation which also enables us to calculate easily and quickly the p.i. exact values as well as those of the density function (d.f.). From this p.i. expression it is also possible to obtain, among others, that of Student'st.

Nat. Genet.; doi:10.1038/ng.543; corrected online 12 March 2010 In the version of this article initially published online, the P value ranges in the second paragraph of the Results section under (iii) and (iv) were noted incorrectly. These errors have been corrected for the print, PDF and HTML versions of this article.

Four hundred and sixty-three new diagnoses of coeliac disease in children were made during 1973 to 1986 in our department. The distribution of new diagnoses per year did not show any decreasing trend in the period 1973 to 1986. No changing trend in breast feeding attitudes was found in the region during the same period. Analysis of the clinical pattern showed a constant distribution of age at diagnosis, onset of first symptoms and nature of symptoms throughout the period studied. These data suggest that coeliac disease is predominantly genetically determined and its expression is modulated by individual and environmental factors. The stability of the observed prevalence of the disease is parallel to the unchanging pattern of breast feeding attitudes in the region.

Three peptidase activities were found to be present in human and rabbit small intestinal mucosa: the aminopeptidase A, hydrolyzing the α-L-glutamyl-B-naphthylamide (BNA); the dipeptidyl aminopeptidase IV, hydrolyzing glycyl-L-proline from glycyl-L-prolyl-BNA; a carboxypeptidase, hydrolyzing N-CBZ-L-prolyl-L-alanine. These enzymatic activities are almost totally localized in the brush border and have maximal activity in the distal ileum: they were due to three different enzymes, which have been separated each from the other, as well as from the oligoaminopeptidase (hydrolyzing L-leucyl-BNA), and partially purified. The identification of these new peptidases of the brush border demonstrates a previously unrecognized importance of this subcellular organelle in the digestion of proteins and peptides, in a complementary way to intraluminal and intracellular digestion.

We evaluated the ability of 24-h intraesophageal pH monitoring in discriminating 78 patients(pts) with gastroesophageal reflux (GER) disease(GERD) from 22 controls (Cpts): 17 pts had GERD alone(Apts) and 61 GERD and esophagitis diagnosed by endoscopy and biopsy (B-pts). Mean(±SD) age (months) was 30.0±34.7 (A), 50.1±53.8 (B), 19. 0±29.1 (C). Total exposure acid time (% GER)(A: 5.4±2.9; B: 9.0±9.9, p 5′ to clear (A: 3.3±2.9; B: 5.7±5.5, p 5′ in the early post-cibal period (pcp)(respectively: 3.9±5.1% vs 2.1±1.9%, p 5′ in 47.1% of Apts and 41.0% of Bpts. We conclude that: 1)Acid reflux in the early pcp plays a role in the development of mucosal injury; 2) the 24-h intraesophageal pH test has a remarkable incidence of negative results that limit its sensitivity.

Coeliac children exhibit a considerable increase in growth velocity during the remission phase. Objective of the research is to analyse the dynamics of catch up growth on gluten-free diet. Methods. Height and weight of 98 Coeliac children, diagnosed according to the 1970 ESPGAN protocol, have been obtained at monthly inervals on gluten free diet by quality controlled procedures. Growth velocities have been computed between monthly measures. Results. When individual's growth velocities are computed at 3-6 months distance between measurements, most cases show a single peak of height and weight velocities When velocities are computed at monthly intervals each case exhibits at least 2 peaks in the first year of gluten free diet. ‘Mean’ velocity curves have been obtained bty measuring 8 parameters from 98 individual curves. For height as well as for weight the pattern shows a first peak after 63 days of diet and a second peak after 200-210 days of diet. Conclusions. Catch up growth in treated coeliac children is not a continuous and linear process, but it occurs by a pattern of Pulse Growth, with an alternation of peaks and nadirs. Pulse growth is not specific of coeliac disease, but probably common to several chronic conditions in childhood. The results obtained in coeliac cases give a first concrete evidence of pulse growth in weight as well as in height in children.