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Effect of endogenous organic hyperinsulinemia on blood pressure and serum tryglicerides.
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Effects of pirenzepine on plasma insulin, glucagon and pancreatic polypeptide levels in normal man.
No full textThe secretion of various pancreatic hormones (insulin, glucagon and pancreatic polypeptide) is affected to a different extent by the cholinergic system. In 7 healthy subjects the effects of treatment for 1 week with pirenzepine, an anticholinergic drug selective for muscarinic receptors, on basal secretion of these hormones and on that induced by i.v. glucose (IVGTT) and arginine were evaluated. The drug did not reduce basal levels of insulin and glucagon whereas it caused an appreciable reduction in basal pancreatic polypeptide (PP). The responses of insulin and blood glucose to IVGTT and to arginine were not changed by treatment, nor was that of plasma glucagon to arginine. The infusion of arginine did induce an increase in PP level, which reached a statistically significant maximum at 90 min. This response was not particularly different after administration of pirenzepine. Thus, the results confirm the finding that arginine stimulates PP secretion in vivo and that pirenzepine reduces the basal level of the hormone, whereas it did not appear to affect the response to arginine. The findings exclude any direct action of the drug on insulin or glucagon secretion or on glucose metabolism in general
MRI in insulinomas: preliminary findings.
No full textAfter establishing the diagnosis of an insulinoma, most surgeons prefer preoperative localization. Selective arteriography is usually considered the gold standard for this purpose. Recently, computed tomography (CT) and preoperative US have contended the role to angiography. MRI has been used in few cases of endocrine pancreatic tumors, and its role in this particular field has to be defined. Between November 1988 and September 1990 we evaluated 7 adult patients who had had surgery in our Surgical Department. Eight tumors were resected in 6 patients who were cured; in an 18-year-old woman surgical treatment was unsuccessful. Arteriography, CT, preoperative US, MRI and intraoperative US detected 2, 6, 6, 5 and 6 tumors, respectively. Two insulinomas (0.2 and 0.7 cm) were found at histologic examination in resected specimen. The ability of intraoperative US and careful surgical exploration to resolve more than 90% of cases makes the preoperative use of arteriography and CT of questionable value. If further experience confirms these findings, US and MRI may suffice
Progetto formativo acrofragile: impiego del metodo Delphi
No full textLa formazione continua del professionista adulto ha da sempre rappresentato una sfida pedagogica che si è fatta ancora più importante dal momento che, negli ultimi anni, l'aggiornamento della prestazione professionale, da obbligo morale, è divenuto, come nel caso del personale sanitario italiano, un obbligo di legge. Il presente lavoro riporta le modalità applicative e i risultati ottenuti dalla sperimentazione di un evento formativo nazionale itinerante attuato mediane lo strumento pedagogico "Delphi" opportunamente modificato, avente come tema le scelte terapeutiche in pazienti affetti da malattia acromegalica, con aspetti di fragilità clinica. Il metodo Delphi, nato negli anni Cinquanta come strategia di previsione di eventi futuri, è stato successivamente impiegato anche come strumento per formulaer, su di un tema specifico, decisioni condivise ("Consensus"). L'evento formativo, della durata di un'intera giornata, è stato replicato in più riprese a Messina, Ancona, Padova e Torino, al fine di testarne la validità in ambienti formativi diversi. In sintesi, ai futuri partecipanti è stato preliminarmente inviato, molto tempo prima del corso residenziale, un questionario, nel quale si rappresentavano alcune situazioni di particolare complessità clinica, riguardanti pazienti acromegalici, prospettando ance alcune possibili opzioni decisionali. Ai partecipanti, veniva chiesto di indicare, tramite mail, le loro scelte......
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
La clinica tra cronicità e polipatologia: necessità di un nuovo paradigma diagnostico
Full text linkSulla scia del dibattito sul tema “Ridiscutere la clinica” svoltosi all’interno del XVII° Congresso Nazionale SIPeM (settembre 2014), sono state esposte, da chi scrive, le ragioni della scelta di un titolo parso a più di una persona, sorprendente o, per lo meno, inaspettato, che almeno inizialmente ha fatto sorgere in più d’una persona del pubblico, qualche perplessità. Ripensare la clinica presuppone, in fatti, una modificazione dell’agire medico, considerato ormai largamente legittimato dall’uso. Attualmente, l’opinione comune considera cosa ovvia un’ evoluzione della medicina clinica in conseguenza del rinnovarsi e del perfezionarsi di conoscenze e di strumentazioni. Meno evidente appare l’idea che anche fattori socio-epidemiologici possano richiedere una diversa visione dell’agire del medico. La cronicità e il fenomeno della “polipatologia, costituiscono caratteristiche comuni della moderna società che costringono effettivamente a ripensare e a ridiscutere la clinica.Tracking the debate on “Revisit the clinic” held inside the XVII National Congress SIPeM (September 2014), were exposed, by the writer, the reasons for choosing a title, to more than one person, surprising or, at least, unexpected, which did rise, at least initially, some misgivings on more than one person in the audience. Rethinking the clinic assumes, in fact, a modification of the main diagnostic points considered widely legitimized by custom. Currently, the common opinion considers obvious an evolution of clinical medicine as a result of a renewal or the improvement of knowledges and of equipment. Less obvious is the idea that differences in socio-epidemiological may require some changes also in doctor’s way of proceedings. Chronicity and the phenomenon of “polypathology”, are common features of modern society that actually force to rethink and reconsider the clinic
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