Annali dell'Ospedale Maria Vittoria di Torino最新文献

In this paper the authors use their own experience to focus on some of the problems of families with handicapped children. They use a systemic model as a paradigm to describe various levels of analysis and interactional processes within and between the various family systems. This also enables the authors to shape their solution to the complexity of the observed phenomena.

The aggressive use of multiple therapeutic modalities has led to a significant increase in the number of survivors of childhood malignancy. Abnormalities of linear growth, thyroid function and sexual development are encountered often in children and adolescents following the successful treatment of brain tumours.

This work shows the results obtained by the comparison between a period in which obstructive icterus was treated only surgically and a mixed period, based on endoscopic or endoscopic surgical treatment. In a period of 9 years (1979-87), 186 patients suffering from obstructive icterus were admitted into the 1st Division of General Surgery at Ospedale Maria Vittoria, Turin. In the first five years (1979-83) all the patients (78) were indistinctly operated after the usual diagnostic controls. In the following four years (1983-87) 62 out of 108 patients, considered as high-risk ones, underwent drainage by endoscopic way. In the high-risk patients, both neoplastic and not, morbidity rate, death rate and average stay in hospital were evidently lower after endoscopic or endoscopic-surgical treatment than after surgery alone. In conclusion, endoscopic pre-operating drainage in selected and/or high-risk patients greatly reduces perioperative complications and mortality.

In this article it is outlined the medical biopsychosocial approach with particular emphasis on the family viewed as the primary health care agency. It is presented the concept of consultation, its advantages and applications within the clinical work with families.

A patient with a rare IgG anti-Cartwright (anti-Yt(a)) is reported. An association with anti-Kidd(a) was also found. The behavior of this antibody "in vivo" is discussed. The clinical importance of this is compared with data in the literature. A satisfactory intercenter cooperation is emphasized.

Surgical correction of laparocele is still today a problem for the surgeon. Physiopathological aspects, preparation to surgery and most of all the indications to the use of synthetic prosthesis are reviewed. Easy application and lesser evidence of recurrency and complications suggest a wider field of indications of these procedures. Attention should be payed to the rules of a careful operative technique involving the use of foreign bodies.

The authors use clinical examples to describe their experience as child neuropsychiatrists treating the handicap. They emphasize the need for integration between services and the importance of structured interviews with families as well as rehabilitation and therapy for the child. Special attention must be dedicated to the patient during the adolescent phase, which is a crucial one for his/her family. He still needs to be supported and actively involved in what is a potentially positive transformation process.

This paper examines psychosis as a manifestation of the internal logic of a relation system. Our interest thus shifts from the singular individual to what may be considered his significant system--the family. The paper shows how the systemic view of this specific clinical syndrome has developed since the initial researches.

The best chance for a patient with a bleeding gastroduodenal ulcer is: "a diligent doctor and a reluctant surgeon". It is necessary to evaluate clinical and endoscopic elements and to check haemodynamic and general conditions of the patient. A better prognosis is ensured by prompt initiation of therapy. All patients with a bleeding since 12 hours or rebleeding must be selected for urgent surgery. The success of surgical intervention is the result of an exact indication and the most correct surgical procedure. Selection of patients for surgery must ensure careful local haemostasis and control of hyperchlorhydria.

The purpose of this paper is to restore the concept of "handicap" to its original etymologic meaning as a term that identifies a relationship rather than a property concerning only one subject. If the handicap is not considered only in terms of a single person but of the relationship between him and his environmental context, it is possible to avoid the dual ideological constraint whereby people are condemned to no-way-out disability or society is stigmatized as the receptacle for all ills. The wellbeing of the disabled and society alike can become feasible as a result of the flexible rediscovery of this relationship and the formulation of original new creative approaches to normality.