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"Governare il diabete" (the Italian translation of "to steer diabetes") is a project which gives young diabetics the opportunity of sailing with non-diabetic companions in a protected and educational environment. The education technique, based on the parallelism between sailing and diabetes, encourage correct self-management of both diabetes related and unrelated problems. The impact of the experience on self-esteem, quality of life and metabolic control is currently under investigation.

The prevalence of pediatric obesity is increasing and many patients are followed by specialized centers or private doctors. The aim of this study was to verify short- and medium term results of a therapeutic approach based on nutritional intervention in a large pediatric population: 1383 subjects (695 females, 688 males) aged 10.1 +/- 2.7 yr, followed in 11 pediatric departments in Italy. No difference was found between centers in age, height, weight, BMI and IBW. The drop-out rate after the first visit was 30.2% (58.1% IBW > 140%) in females and 34.2% (70.7% IBW > 140%) in males. After two years of follow-up only 9.7% of females and 6.4% of males remained on treatment. Of these patients only 7.3% of females and 6.4% of males had IBW < 120%. These data show that an approach based on nutritional intervention alone is not sufficient for long-term treatment of pediatric obesity. Only an approach started early and involving the family can produce permanent results.

Prader-Willi syndrome (PWS) is the most frequent cause of secondary obesity, characterized by neonatal hypotonia, dysmorphic facies, acromicria, hypogonadism, stunted growth, obesity, behavioural disturbances and cognitive impairment. Clinical diagnosis is confirmed by alteration of imprinted genes on the proximal long arm of chromosome 15 (15q11-13) for deletion, translocation, uniparental disomy for maternal chromosome 15 or imprinting center defect. Methylation test is the most reliable test for diagnosis. This issue explains diagnostic tests, clinical, metabolic, endocrinological features, and the most frequent complications observed in this syndrome. Precocious diagnosis and multidisciplinary approach allow in these patients to prevent the severe obesity and linked complications.

The aim of the present study was to establish the prevalence and the type of psychiatric disturbances in a group of 42 obese children (18 boys aged from 6.8 to 13.8 years and 24 girls aged from 2.8 to 15.4 years; weight excess mean +/- 1SD 146.7 +/- 17.4%) and to evaluate the efficacy of a psychological approach of obesity in childhood. The children were in a normal caloric diet and they were encouraged to reach a "target weight" in a given period of time. 22 children were randomly assigned the "analyzed" group (auxological, alimentary and psychological evaluation) and 20 to the "control" group (auxological and alimentary assessment). The psychological evaluation was performed in 20 children (the parents of two children refused to give their consent) by the following tests: creative drawing test; draw a man test (Machover); draw a tree test (Koch); draw a family test (Co-man); Rorschach's test; TAT (Thematic Apperception Test) or, in the younger, the Düss's tales. The results of these psychological tests have been communicated to the patients and or parents. The children were followed for a period of 7 months. We found in 8 children (40%) personality disturbances (which were severe in two cases) and a psychological support was started. The observed main types of disturbances were depression and anxiety. Both were due to a missing harmony between their parents, to a difficult relationship either with their mother or with other children, and to the bad child's opinion of himself. In 4 subjects a psychological support associated with diet promoted a slow, progressive and continuous weight loss.(ABSTRACT TRUNCATED AT 250 WORDS)

These data describe the effects of purified preparations of several growth factors on thymidine incorporation into phyto-haemagglutinin-activated (PHA) human lymphocytes. The somatomedins selected for this study included human somatomedins A and C, insulin-like growth factors (IFG1 and IGF2) and multiplication stimulating activity (MSA). Assays were carried out with and without serum. Complementary assays were performed with a low-molecular serum ultrafiltrate added to somatomedin C and to MSA. We found that all the peptides tested, except MSA, stimulated thymidine incorporation into PHA-activated lymphocytes in a dose-dependent manner, even though different doses were required to obtain a response. The data reported point out the multiplicity and the interrelationships of the serum factors involved in the stimulation of human cells growth.

It has been demonstrated that the insulin secretagogue beta-cell-trophin, ACTH(22-39), is present in human plasma. The hormone, separated from plasma by affinity chromatography on a corticotrophin-like intermediate-lobe peptide antibody column, behaves similarly to synthetic beta-cell-trophin on a gel filtration column and on reverse-phase high-performance liquid chromatography. Sufficient amounts of the hormone were isolated from the plasma of two patients with Nelson's syndrome to demonstrate its biological activity on the perfused rat pancreas.

The present paper analyzes the causes, signs and symptoms of hyperthyroidism in children and the problems, complications and results associated with the various therapeutic regimes. Childhood hyperthyroidism is usually due to Grave's disease, an autoimmune thyroid disease. Genetic factors are also involved in its development. The diagnosis and in particular the differential diagnosis with Hashimoto's thyroiditis are discussed. Treatment of Graves' disease is controversial, but medical therapy is commonly accepted as the treatment of choice. Some dosage schedules of antithyroid drugs are considered, and some techniques for predicting remission status and relapse of disease are reported. Both the minor and more serious complications of medical therapy are examined. Careful follow-up for the development of hypothyroidism is advocated, especially in patients treated with radiation or surgery. Autonomous hyperfunctioning thyroid adenoma is rare, but occurs even in childhood, and can degenerate into carcinoma.

16 cases of intussusception, occurred in the last 9 years in the Pediatric Department of the Ospedale di Circolo of Varese, are reported. Barium enema was carried out in 15 cases and the reduction of the intussusception, attempted in 5 of them, was obtained in 3 (20%). The low rate of the attempts of reduction by barium enema is consistently related to a delay in the diagnosis; 56% of the patients showed actually at the diagnosis the three main symptoms simultaneously: abdominal pain, vomiting, "currant jelly stool". The significant positive correlation (p less than 0.01) between the symptoms duration at the diagnosis and the hospitalization period points out that a correct treatment of the intussusception depends mainly on a precocious diagnosis.

The results of a social-nutritional investigation in a maternal school are reported. Aim of the present study was to evaluate the dietary habits and life style in a group of 3-6 years old children and their compliance in following a diet in accordance with the LARN86 recommendations. The enquiry was carried out by a questionnaire, by an analysis of the ingesta and by a paediatric and auxological examination. Blood and instrumental tests (Lipids panel, Blood glucose, Insulin, Fructosamine, IgE, ECG) were performed in children with high familial risk of atherosclerosis. The main findings were the following: i. 17 children (21%) were classified as having high atherosclerosis familial risk; ii. the atherosclerosis high risk group showed also increased incidence (p less than 0.01) of familial allergy; iii. children had higher approval for food with high carbohydrate and animal protein content; iv. fat intake was proportional to the number of different types of fat bought by the families; v. excessive dietary lipids and low carbohydrate intake were found in most families. The revaluation at the end of the study showed a good compliance for the proposed diet scheme by children, but a poor compliance by their families.

During the last 14 years 1620 children and adolescents, 806 boys and 814 girls, aged 2-20 yrs, were referred for overweight as outpatients to the Pediatric Endocrine Center of the University of Pavia. On first admission 170 (10%) of the 1620 subjects had a percent overweight of less than 20% referred to ideal weight for height; 350 (22%) patients with overweight ranging from 25 to plus 100 were lost to follow up. We report our dietary management on 1100 children with percent overweight between 25-120, treated for a period of at least 3 months to a maximum of 7 years (mean 3 yrs). All patients were provided with a physiological diet with an adequate or slightly reduced caloric intake for their height (P 15%, F 25%, C 60%). A regular physical activity was recommended to our patients. Before they started the diet patients kept a daily food diary for three days, which included recording information about what food was eaten, how it was prepared and the time at which it was consumed. Food recalls showed a higher caloric intake for height and age with fat and protein excess, especially of animal origin. A lot of snacks, particularly sweets, and soft drinks were consumed during the day.(ABSTRACT TRUNCATED AT 250 WORDS)