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Milk is an important food of the daily diet. Many countries include it in their dietary recommendations due to its content in several important nutrients that exert beneficial effects on human health. Human milk is a newborn's first food and plays an important role in the growth, development, and future health of every individual. Cow milk is the type of milk most consumed in the world. However, its relatively high content of saturated fats raises concerns about potential adverse effects on human health, although epidemiological studies have disproved this association. Indeed, dairy consumption appear to be linked to a lower risk of mortality and major cardiovascular disease events. In the last few years many researchers have begun to focus their attention on both the production and quality of cow milk as well as the analysis of milk from other animal species to evaluate their effect on human health. The need to investigate the composition and metabolic effects of milk from other animal species arises from the adverse reactions of individuals in several groups to certain components of cow milk. It has emerged that donkey milk compared with that of other animal species, is the nearest to human milk and an excellent substitute for it. Milk from various animal species shows substantial differences in nutritional composition and distinct metabolic effects. In this review, we discussed the main compositional features and metabolic effects of 3 types of milk: human, cow, and donkey milk.

Squamous cell carcinoma (SCC) has been commonly reported by foot and ankle specialists. Marjolin's ulcer is a malignancy that involves a posttraumatic scar or ulceration that can develop into SCC from chronic neuropathic pedal wounds, venous stasis, or decubitus ulcerations. Most Marjolin's ulcers are found in the lower extremity, specifically the feet, and it is twice as common in females as males. Biopsy of the tumor is the reference standard to diagnose SCC, and wide excision of SCC is the most common treatment option. The present case study describes an 83-year-old diabetic wheelchair-bound female who presented to the wound care clinic with a right heel nonhealing pressure ulceration. After biopsy and surgical excision, the patient was found to have SCC. This case was followed up for 5 years in which the patient had successful excision of the tumor with no recurrence. The clinical significance of our case study is to assist in the diagnosis, management, and prognosis of patients with SCC. In addition, this study has shown that adequate excision of the tumor margins and depth is necessary to prevent potential recurrence and metastasis.

Tibialis posterior (TP) tendon ruptures are common after ankle injuries, degenerative processes, or biomechanical instability. The TP tendon decelerates the subtalar joint pronation and internal rotation of the leg during the contact phase. It also plantarflexes and inverts the foot on the leg during the static phase of gait. When this function is lost, the medial longitudinal arch collapses, increasing the length of time of rearfoot pronation, eventually rupturing the TP tendon. Conservative treatment includes immobilization, strapping, antiinflammatories, custom-fabricated orthotics, and physical therapy. If the TP tendon rupture is severe, conservative treatment will provide little relief and surgery is indicated. This case study presents 53-year-old female who presented with left TP tendon rupture with a defect of 6 cm after sustaining an ankle injury that was surgically repaired using a TP tendon fresh frozen allograft and flexor digitorum longus tenodesis. After a 16-month follow-up, the patient was healed without complications and returned to preinjury activity. We believe that surgically repairing a TP tendon rupture with a TP tendon allograft and flexor digitorum longus tenodesis can be 1 of the treatment options for patients with extensive disruption of the TP tendon.

Thrombosis of the abdominal veins is a rare clinical condition which can be assimilated with the more frequent localization of deep venous thrombosis of the lower limbs. In the last few years great attention has been paid to possible risk factors for thrombosis of the abdominal veins. Two risk factors that have been identified are the presence of internal diseases and congenital and/or acquired abnormalities of haemostasis. The authors describe 3 clinical cases (splenic and portal thrombosis due to congenital thrombophilia, Budd-Chiari syndrome, portal cavernoma consequent to ovarian neoplasia) with different etiopathogenesis to show how this apparently rare condition is today more frequently encountered and easier to recognize. In the presence of thrombosis of major venous structures the search and the identification of intrinsic internal risk factors and of congenital and acquired thrombophilic disorders remains of great importance. Screening for thrombophilia includes blood C and S proteins, AT III, homocysteine, Leiden mutation of the factor V gene, G20210A mutation of the prothrombin gene, antiphospholipid antibodies. The presence of one or more of these risk factors allows the identification of the cases of portal thrombosis (EHPVO) responsible for about 10% of all the cases of portal hypertension, without cirrhosis or other hepatic lesions. The primary diagnostic procedure however remains color-Doppler ultrasonography which represents the most simple and the cheapest diagnostic investigation for the study of the portal and suprahepatic vein system, but it's strictly operator dependent.

Aim of this paper is to describe and discuss, on the basis of the available current literature, the case of a female patient affected by a tophaceous gout associated with plurimetabolic syndrome. Hyperuricemia and gout may be seen today in all the populations of developed countries, with increasing frequency on the last fifty years. Increased production or reduced urinary excretion of uric acid (and hypoxanthine and xanthine) are the most important pathogenetic mechanisms of primary or secondary hyperuricemia. Gout is an acute rheumatic disorder (characterized by a limited range of manifestations) which occurs in humans in connection with deposition of crystals of monosodium urate (the final product of purine metabolism) in the articular and soft periarticular tissues. Hyperuricemia and/or gout are often associated with hyperinsulinemia, obesity, diabetes mellitus, hyperlipemia, hypertension and atherosclerosis to form the syndrome called "Plurimetabolic syndrome" or "Syndrome X". Here we report the clinical case of a 64-year-old female patient who had android obesity, type 2 diabetes mellitus, hypertension, dyslipidemia and hyperuricemia and had been suffering (over many years) from intermittent episodes of severe pain and inflammatory joint swelling (first metacarpo- and metatarso-phalangeal joints) with development of pronounced multiple tophi in bone articular and soft periarticular tissues. Hyperuricemia and acute episodes had never been treated with anti-hyperuricemic drugs because gouty arthritis had never been diagnosed. This severe tophaceous gout associated to multiple metabolic disorders prompted us to present knowledge on gout and to focus on the interrelationships between hyperuricemia and/or gout and plurimetabolic syndrome, important risk factors for coronary heart disease.

The nature of instability, its diagnostic components, and the facts needed to treat it are presented in this article from the viewpoints of orthopedic surgeons of varying philosophies.

Regression of cardiovascular structural changes is a main goal of antihypertensive treatment. Two recent meta-analyses of relatively small noncomparative studies have suggested that angiotensin-converting enzyme (ACE) inhibitors may be more effective than other classes of drugs in inducing regression of left ventricular hypertrophy (LVH). The effect of different antihypertensive drugs on arteriolar structural changes has not yet been properly investigated. The aim of this study was to evaluate the effect of 6 months of treatment with amlodipine (5-10 mg o.d.) or enalapril (10-20 mg o.d.) on blood pressure (BP) (ambulatory monitoring), heart rate (HR), LV mass and function (M-mode echo, two-dimensionally guided), forearm minimal vascular resistance (min VR = BP/max blood flow-venous occlusion plethysmography, taken as an index of vascular structural changes) in 24 hypertensive patients in a comparative single-blind, randomized study, with blind reading of echocardiograms and plethysmographic tracings. After 6 months of treatment with amlodipine 5-10 mg o.d., significant reductions in LV mass index (p = 0.004) and forearm min VR (p = 0.02) were observed. Before and during treatment, LV systolic function, both at rest and during stress (handgrip test), evaluated by fractional shortening as related to end-systolic stress, was in every case within 95% confidence limits calculated in normal subjects. Similar results were observed with enalapril. No significant differences were observed for Doppler indices of diastolic filling after 6 months of treatment with either drug. These results indicate that a significant regression of structural changes in the heart and in the small resistance vessels can be observed after long-term treatment with amlodipine in essential hypertensive patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Some epidemiological aspects of AN are considered. The personal experience with this disease, and the results of a study on the tubular function in analgesic abusers are reported.

The cellular immune system is impaired in uraemic and haemodialysed patients. We describe a method of studying leukocytes eluted from dialysers at the end of the dialysis session, and we have studied five haemodialysers: cuprophane (CU), cellulose acetate (CA), polymethylemethacrylate (PMMA), polyacrylonitrile (PN), and polysulphone (PS). The analysis was performed by flow cytofluorimetry using monoclonal antibodies. The absolute number of eluted leukocytes was rather elevated, ranging from 88 (CU) to 9 (PS) millions of cells. When compared to peripheral blood values, the percentage analysis revealed an increase of PMN and monocytes and a decrease of lymphocytes. A relative increase of B lymphocytes was observed in all filters studied. A trapping of T lymphocytes (PAN) and a minor increase of NK cells (PMMA, PS, CA) were also observed. The elution of leukocytes from dialysers may be helpful in evaluating the biocompatibility of membranes for haemodialysis.

Norfloxacin is an antibacterial drug chiefly eliminated by the kidney and therefore useful in the treatment of urinary tract infections. To study its pharmacokinetics in chronic renal failure, we administered a single oral dose of 400 mg to 14 patients and 6 controls with normal renal function. Patients were divided into three groups according to the severity of renal failure. Norfloxacin was measured in serum and urine by bioassay. Serum half-life in controls was 3.87 hours and prolonged to 5.85 hours in group I (creatinine clearance 80-45 ml/min), 7.25 hours (p less than 0.05) in group II (creatinine clearance 44-20 ml/min) and 8.34 hours (p less than 0.01) in group III patients (creatinine clearance less than 20 ml/min). A good linear correlation between the elimination rate constant and creatinine clearance (r = 0.79, p less than 0.01) has been found. Total urinary excretion in the 72 hour period after administration achieves 40.4% in controls, falls to 23.5% (p less than 0.05), 15.6% (p less than 0.01) and 8.2% (p less than 0.01) of administered dose in groups I, II and III, respectively. Similarly, urinary concentrations decrease in all patient groups with respect to controls. Our data show that effective urinary antibacterial concentrations of norfloxacin after 400 mg single oral dose were obtained even in patients with severe renal failure. In these patients systemic accumulation after repeated dose administration is a probable event. Therefore, dosage adjustment is advisable in patients with creatinine clearance less than 20 ml/min, although it will inevitably cause lower urinary concentrations.

An ionic (diatrizoate) and a non ionic (iopamidole) radiocontrast medium were compared as to their nephrotoxicity in a cohort of 21 patients with renal disease, 18 of which with normal renal function. The elevation of the urinary excretion of enzymes from renal tubular cells has been considered as a good index for renal tubular damage. We measured two lysosomal enzymes (NAG and beta glucuronidase) and a brush-border enzyme (gamma GT). In all patients we demonstrated an elevation of urinary excretion of the three enzymes already 12 hours after contrast medium administration. However, the elevation was statistically significant only after employment of the ionic contrast medium and concerned gamma GT and beta-glucuronidase; the urinary excretion of NAG did not vary significantly. Urinary enzymes levels returned to basal values 36 hours after intravenous pyelography. In conclusion, iopamidole showed a lower nephrotoxicity with respect to diatrizoate, as demonstrated by the lower levels of urinary enzymes excretion reached after its use.