The implications of complexity, systems thinking and philosophy for pediatricians.

National service systems in child healthcare are characterized by diversity and complexity. Primary, secondary, tertiary and quaternary healthcare services create complex networks covering pediatric subspecialties, psychology, sociology, economics and politics. Can pediatrics exist without philosophy? Does the absence of integrating philosophical perspectives during conceptualization of pediatric care contribute to deficiencies in the service systems structuring child healthcare? Philosophy offers new ways of complex systems thinking in scientific and clinical pediatrics.

A contribution to the history of common salt.

Salt has influenced human nutrition, health, politics, taxation, economy, freight, transport, and commerce throughout the ages. All human activities have been influenced by salt including economy, religious beliefs and practices, art, literature, psychoanalysis, superstitions, and exorcism. Salt is recognized as a symbol for friendship, hospitality, chastity, alliance, table fellowship, fidelity, fertility, blessing, curse and endurance, etc.

Plants as a source of salt.

Ecological and ethnobotanical aspects of some halophylous plants are presented. These plants possess several morphophysiological adaptations to face salinity in their habitats. They are a source of salt and could represent new potential crops in saline environments.

Edema in childhood.

There are two types of edema: localized edema and generalized edema. The causes of generalized edema in childhood are diverse. Formation of generalized edema involves retention of sodium and water in the kidney.

Neonatal edema.

Edema develops in the neonate from diverse clinical conditions; sometimes it heralds serious underlying disorders. In this review, we discuss the diagnosis and treatment of edema in the neonate.

Creatinine clearance: an inadequate marker of renal filtration in patients with early posthepatitic cirrhosis (Child A) without fluid retention and muscle wasting.

Glomerular filtration rate (GFR) was measured in 19 patients with Child A liver cirrhosis by comparing the endogenous creatinine clearance with inulin clearance. Inulin clearance averaged 90 +/- 4.4 ml/min x 1.

Renal synthesis of prostaglandins and thromboxane has no causative role for protein-induced glomerular hyperfiltration in healthy humans.

The study was devised to establish the role of prostaglandin E2, prostaglandin1 alpha and thromboxane A2 in the genesis of glomerular hyperfiltration response to a meat meal in healthy humans. To this end, a group of 8 healthy women was studied 4 times: in the control state (study 1), after a meat meal (study 2), following a meat meal associated with intravenous aspirin (study 3) and finally after a meat meal associated with intravenous aspirin following 2-day pretreatment with oral aspirin (study 4). Urinary excretion of prostaglandins and thromboxane increased during the glomerular hyperfiltration response to a meat meal and was suppressed by aspirin administration which did not suppress the renal hemodynamic response to the meat meal.

Renal handling of sodium after an oral protein load in adult humans.

This investigation was designed to study (1) renal sodium handling after an oral protein load and (2) its relationship to some known determinants of the hemodynamic response (glucagon, insulin, growth hormone, renin, aldosterone, and plasma amino acid concentration). To this end of group of 8 adult subjects was studied before (three 30-min clearances) and after a meat meal (MM; five 30-min clearances at 30, 60, 90, 120 and 180 min). The MM provided 2 g/kg BW of protein.

Predicted creatinine clearance to assess glomerular filtration rate in chronic renal disease in humans.

The work was designed to assess the suitability of both measured endogenous creatinine clearance (CCR) and predicted creatinine clearance (P-CCR) to evaluate GFR in chronic renal disease (CRD) by utilizing the renal clearance of inulin (CIN) as gold standard. A total of 124 subjects were studied (62 healthy, 62 with CRF). CCR significantly overestimated GFR in healthy subjects as well as in CRF, whereas P-CCR was identical to GFR.

Age-related changes in renal reserve and renal tubular function in healthy humans.

To explore the age-related changes in tubular function and in the renal reserve (RR) a total of 98 healthy subjects were studied while on free living conditions. Enrolled people were divided into 3 groups: group A (n = 40, age range 5-18 years, Na intake 80 +/- 20 mM/day, protein intake 1.30 +/- 0.

Lithium clearance in patients with chronic renal failure.

Lithium clearance (CLi) was studied in the healthy subjects (H) and in patients with chronic renal failure (CRF) with a mean GFR of 36.08 +/- 3.8 ml/min x 1.

IgA glomerulonephritis in Wiskott-Aldrich syndrome.

Renal morphology was evaluated in 2 siblings with Wiskott-Aldrich syndrome (WAS) aged 12 and 4 years. They gave a typical history of recurrent episodes of respiratory infection and presented with microhematuria of glomerular origin and proteinuria. The study disclosed a membranoproliferative glomerulonephritis with IgA mesangial deposition in the elder child, while immunofluorescence was negative in the younger.

Circadian rhythm with acrophase at night for urinary excretion of calcium and magnesium in childhood: population-based data of the cimitile study in southern Italy.

A population-based study on daily and overnight urine excretion of Ca and Mg was performed in 220 children aged 4-15 years living in Cimitile, Campania Region, Southern Italy. The Ca/creatinine and the Mg/creatinine ratio in overnight urine were significantly higher than in daily urine (p less than 0.01).

Intraerythrocytic cation metabolism in children with uremia undergoing hemodialysis.

Erythrocytes from children with uremia who are undergoing hemodialysis show normal maximal velocity of NA+-Li+ countertransport and Na+/K+/Cl- cotransport and normal intracellular sodium content. These aspects of intracellular sodium metabolism are not affected by dialysis. The normality of intraerythrocytic cation metabolism in children with uremia is associated with anemia, increased systolic and diastolic blood pressure, reduced body mass index, retention of solutes (urea, creatinine, potassium), a low triiodothyronine and thyroxine syndrome, and high parathormone levels.

Tumor markers in uremia: carcinoembryonic antigen, neuron-specific enolase, carbohydrate antigen CA-50 and alpha-fetoprotein.

The incidence of the tumor markers was studied in 140 patients aged between 18 and 84 years who had been on dialysis for 4-188 months. Neuron-specific enolase increased in 81 cases, CA-50 carbohydrate antigen in 44, while alpha-fetoprotein was within the normal range. Carcinoembryonic antigen (CEA) with 2 monoclonal assays was increased in 7 cases.