Assunzione di farmaci a scopo autolesivo: studio retrospettivo su 111 pazienti ricoverati al Policlinico di Modena

Summary AIM OF THE STUDY The aim of this work was to evaluate the epidemiology of suicidal attempts by ingestion of drugs in our area. MATERIALS AND METHODS This is a retrospective study considering all patients admitted to the hospital between January 2004 and December 2006 for suicidal attempts using drugs. RESULTS A total of 111 patients were seen in our Department in the evaluated period. The large majority of patients were women (75%). Suicidal attempt was more common in individuals aged 31 to 40 years. The more common drugs used were: BDZ (28%), anti-depressive (21%), anti-psychotics (10%) and anti-epileptics (8%). A gastric washout was performed in 65.8% of all patients admitted to the hospital. The most used antidote was flumazenil. Alterations of laboratory exams were seen only in a small percentage of the cases. In the majority of cases, suicide was at the first attempt. 71% of patients were followed by psychiatrist and were taking daily psychiatric pharmacologic therapy; 5% had a history of previous admission to the hospital in a psychiatric ward; only 24% had no a history of a prior mental illness. 43% of patients were admitted to a psychiatric ward after intensive treatment in our department. Self-discharging was not usual (10%), and only few patients were restrained against their will (3%). CONCLUSIONS Our study has identified some risk factors for a suicidal attempt. Family doctors should have a stronger control of their patients with mental illness especially during the first period of treatment. In future it should be very helpful to create an informatic network connecting all departments involved in the care of these patients. Moreover, it is crucial to increase the role of family doctors in the care of psychiatric patients after their hospitalizatio

PRIMARY SYSTEMIC AMYLOIDOSIS WITH GIANT HEPATOMEGALY AND PORTAL-HYPERTENSION - A CASE-REPORT AND A REVIEW OF THE LITERATURE

Amyloidosis is a manifestation of a group of diseases resulting from the variable infiltration of multiple organs by a fibrillar protein called amyloid. Hepatic involvement in amyloidosis is common both in the primary and in the secondary forms, whereas clinically-dominant liver amyloidosis is relatively rare. The Authors describe a case of primary systemic amyloidosis with giant hepatomegaly, portal hypertension and renal insufficiency; the patient did not develop jaundice, ascites or gastrointestinal bleeding but died 6 months later, death being due to cerebral haemorrhage

THE ROLE OF EPIDERMAL GROWTH-FACTOR IN THE PATHOGENESIS OF PEPTIC-ULCER DISEASE

Duodenal biopsies obtained from seven normal subjects and six ulcerous patients were cultured in vitro for 30 min at 37-degrees-C under various experimental conditions. Epidermal growth factor (EGF) and somatostatin released in the culture medium were determined by radioimmunoassay. Under basal conditions, EGF and somatostatin levels were significantly higher in normal subjects (11.49 +/- 3.07 ng/mg protein and 3.06 +/- 0.8 ng/mg protein, respectively) than in ulcerous patients (6.9 +/- 1.98 ng/mg protein and 1.75 +/- 1.23 ng/ mg protein, respectively). However, when antibodies to somatostatin and vasoactive intestinal polypeptide (VIP) were added together to the culture media, in ulcerous patients, EGF levels also were lower as absolute values, but were higher as a percentage of variation than controls (p < 0.05). The fall of EGF secretion from tissue cultures of ulcerous patients could be the consequence of endocrine cellular loss or damage, rather than the cause of ulceration. Moreover, the EGF-producing cells around the lesion in ulcerous patients seems to be hyperactive, and this hyperfunction of EGF-producing cells might contribute to the in vivo repair of tissue damage

Hospitalizations for hyponatremia and syndrome of inappropriate antidiuretic hormone hypersecretion at the Policlinic of Modena, Italy from January 2006 to September 2008

Introduction: Hyponatremia is the most common electrolyte imbalance among hospitalized patients. The cause is not always identified, but 30-40% of cases are the result of the syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH). The aim of this study was to determine the frequency of hyponatremia in our hospital, its underlying causes (in particular the proportion of cases caused by SIADH), and approaches to treatment. Materials and methods: We retrospectively analyzed all nonpediatric hospitalizations occurring between 1 January 2006 and 30 September 2008 in which the discharge diagnosis was hyponatremia or SIADH. Results: A total of 64 cases were reviewed; 56 of the patients were aged &gt; 60. The hyponatremia was classified as severe (&lt; 125 mEq/L) in 36/64 cases (56%) (most involving patients aged &gt;70); moderate (129-125 mEq/L) in 22 (34%); and mild (134-130 mEq/L) in 6 (9%). Neurologic symptoms were present in 11 patients with severe hyponatremia (confusion, hallucinations, coma) and 9 with moderate hyponatremia (weakness, impaired memory). Thirteen had hypovolemic hypotonic hyponatremia, 16 had hypervolemic hypotonic hyponatremia, and 35 had normovolemic hypotonic hyponatremia, including 23 who met the criteria for SIADH: 5 patients with neoplastic disease, 6 with pulmonary disorders, 3 with drug-related hyponatremia (a selective serotonin reuptake inhibitor in 1 case, a tricyclic antidepressant in 1, carbamazepine in 1), 2 whose SIADH developed after surgery, 4 with head trauma, 1 receiving noninvasive ventilatory support, and 2 elderly patients whose SIADH appeared idiopathic. Thirteen patients had hyponatremia related to the use of diuretics (thiazides in 7 cases), and one other had long-standing untreated hypothyroidism. In most cases, treatment consisted of infusion of hypertonic saline (sometimes with fluid restriction and/or furosemide administration). Discussion: Over one third (36%) of the adults hospitalized in the Policlinic of Modena for hyponatremia during the 3-year study had SIADH, a figure that is consistent with literature data. In most cases, the cause of hyponatremia can be identified on the basis of simple laboratory tests and complete patient histories

EFFECT OF ASPIRIN AND INDOMETHACIN ON EPIDERMAL GROWTH-FACTOR SECRETION IN DUODENAL TISSUE FRAGMENTS CULTIVATED INVITRO

The aim of the present study was to determine the effect of aspirin and indomethacin on epidermal growth factor (EGF) secretion in duodenal tissue fragments cultivated in vitro. The fragments were obtained from healthy subjects by gastroscopy, cultured in McCoy's medium and gassed with 95% O2 and 5% CO2 at 37-degrees-C. After an incubation of 30 min, the culture medium was decanted, and the quantity of hormone determined by radioimmunoassay. The mean EGF level detected in the medium was 10.94 ng/mg protein tissue. The addition of aspirin (final concentration 10(-7) M) to the medium reduced mean EGF levels to 7.5 ng/mg (p < 0.05), whereas aspirin 10(-8) M did not produce such a modification. The addition of indomethacin (final concentration 10(-8) M) decreased mean EGF levels to 5.3 7 ng/mg (p < 0.001). In all experimental conditions, the addition of anti-somatostatin (SRIF) antibodies determined a remarkable increase in EGF (p < 0.01). The results of this study show aspirin and indomethacin to be direct, not SRIF-mediated inhibitors of EGF release

Assumption of drugs with self-injurer purpose: a retrospective study about 111 patients hospitalized in Policlinico of Modena

AIM OF THE STUDY The aim of this work was to evaluate the epidemiology of suicidal attempts by ingestion of drugs in our area. MATERIALS AND METHODS This is a retrospective study considering all patients admitted to the hospital between January 2004 and December 2006 for suicidal attempts using drugs. RESULTS A total of 111 patients were seen in our Department in the evaluated period. The large majority of patients were women (75%). Suicidal attempt was more common in individuals aged 31 to 40 years. The more common drugs used were: BDZ (28%), anti-depressive (21%), anti-psychotics (10%) and anti-epileptics (8%). A gastric washout was performed in 65.8% of all patients admitted to the hospital. The most used antidote was flumazenil. Alterations of laboratory exams were seen only in a small percentage of the cases. In the majority of cases, suicide was at the first attempt. 71% of patients were followed by psychiatrist and were taking daily psychiatric pharmacologic therapy; 5% had a history of previous admission to the hospital in a psychiatric ward; only 24% had no a history of a prior mental illness. 43% of patients were admitted to a psychiatric ward after intensive treatment in our department. Self-discharging was not usual (10%), and only few patients were restrained against their will (3%). CONCLUSIONS Our study has identified some risk factors for a suicidal attempt. Family doctors should have a stronger control of their patients with mental illness especially during the first period of treatment. In future it should be very helpful to create an informatic network connecting all departments involved in the care of these patients. Moreover, it is crucial to increase the role of family doctors in the care of psychiatric patients after their hospitalization

Urinary excretion of glucagon-like peptide 1 (GLP-1) 7-36 amide in human type 2 (non-insulin-dependent) diabetes mellitus

The urinary excretion of insulinotropic glucagon-like peptide 1 (GLP-1) was investigated as an indicator of renal tubular integrity in 10 healthy subjects and in 3 groups of type 2 diabetic patients with different degrees of urinary albumin excretion rate. No significant difference emerged between the groups with respect to age of the patients, known duration of diabetes, metabolic control, BMI, or residual beta-cell pancreatic function. Endogenous creatinine clearance was significantly reduced under conditions of overt diabetic nephropathy, compared with normo and microalbuminuric patients (p < 0.01). Urinary excretion of GLP-1 was significantly higher in normoalbuminuric patients compared to controls (490.4 +/- 211.5 vs. 275.5 +/- 132.1 pg/ min; p<0.05), with further increase under incipient diabetic nephropathy conditions (648.6 +/- 305 pg/min; p < 0.01). No significant difference resulted, in contrast, between macroproteinuric patients and non-diabetic subjects. Taking all patients examined into account, a significant positive relationship emerged between urinary GLP-1 and creatinine clearance (p = 0.004). In conclusion, an early tubular impairment in type 2 diabetes would occur before the onset of glomerular permeability alterations. The tubular dysfunction seems to evolve with the development of persistent microalbuminuria. Finally, the advanced tubular involvement, in terms of urinary GLP1 excretion, under overt diabetic nephropathy conditions would be masked by severe concomitant glomerular damage with the coexistence of both alterations resulting in a peptide excretion similar to control subjects