Central vascular catheters are used to access the central vascular system in both acute and chronic uremic patients undergoing hemodialysis. Among different approaches, the internal jugular vein seems to have less adverse effects. We describe our long-term experience with a two-catheter system. Percutaneous jugular vein cannulation was performed using Medcomp silicone rubber catheters. The study included 108 patients undergoing hemodialysis. One- and 2-year survival was 93 and 91%, respectively; 36 died because of unrelated causes. Blood flow rate was 284 mL/min; venous pressure at 1 year was 90 mm Hg. Complications included accidental withdrawal (6), dysfunction (4), catheter clotting (11), mediastinal hematoma (2), pneumothorax (1), and sepsis (7). Good long-term survival and a low complication rate make this system a safe and reliable method of access for long-term hemodialysis.

Study objective -To analyse the relationship between menstrual and reproductive factors and the risk oflow bone mineral density (BMD). Design -This was a population based screening programme carried out between 1991 and 1993 among 1373 perimenopausal women in northern Italy by means of dual photon absorptiometry at the lumbar spine. Main results -BMD was strongly related to the age at menopause. In comparison with women reporting menopause below 45 years of age, the odds ratios (OR) of being in the lowest compared with the highest BMD tertile were 0.7 (95% confidence interval (CI) 0.3,1.5) and 0.3 (95% CI 0.1,0.8), respectively, in those with menopause at age 45-49 and above 50 years: the trend in risk was significant. Likewise, the risk of being in the lowest tertile increased with years since the menopause. Compared with women who reported they had undergone the menopause less than two years before interview, the OR of being in the lowest BMD tertile were 2.1 (95% CI 1.1,4.3), 2.3 (95% CI 1.1, 5.0), and 5.7 (95% CI 2.5,12.9) respectively in women who reported menopause 2-5, 6-9, and .10 years earlier. The protective effect on bone density of late age at menopause was observed in different strata of years since menopause. Likewise, the increasing risk ofa low BMD with increasing years since the menopause was evident in strata of different age at menopause. No relationships were observed between BMD and the age at menarche, characteristics of menstrual cycles, and the duration of menses. Likewise, no association emerged between reproductive history, including parity and age at first pregnancy, and BMD. Conclusions -In this Italian population the risk of being in the lowest BMD tertile decreased with increasing age at menopause and increased with years since menopause. No relationships emerged between BMD and other menstrual characteristics or reproductive factors.

We studied the determinants of low bone mineral density, using data from a population-based screening program of osteoporosis carried out among 1,373 women (age 40-64 years) in the province of Pordenone, Italy, by means of dual photon absorptiometry of the lumbar spine. Menopause had a major effect on bone mineral density. Age had little influence before menopause. In multivariate linear regression analyses, weight was the strongest predictor of bone mineral density in pre- as well as postmenopausal women. After the inclusion in a single model of a term for current weight, weight at ages 12 and 30 years explained some additional variance, whereas high waist-to-hip ratio (an indicator of central adiposity) had no influence. Smoking 15 or more cigarettes per day entailed a small increased risk of osteoporosis, but this effect, independent of weight, appeared to be restricted to premenopausal women. No food or micronutrient that we examined was predictive of bone mineral density, nor was coffee or alcoholic beverage intake.

Osteoporosis is a major health issue in post-menopausal women on account of the association between low bone mineral density and fractures. A role of physical activity in the prevention and treatment of low bone mineral density is possible but still unclear. The relationship between low spine bone mineral density measured by means of dual photon absorptiometry at lumbar spines, and levels of past and recent physical activity has been assessed by means of a population-based screening study carried out on 1373 women (age 40-64 years) in the North-East of Italy. Physical activity at work and in leisure time was investigated for three specific periods of life: at age 12, between 15 and 19 years (during bone formative years), and in the recent years prior to the interview (30-39 or 50-59 years). Data were analysed comparing low versus high bone mineral density tertile (i.e., 458 and 461 women, respectively), after controlling for other known contributory factors in the development of osteoporosis. A positive association emerged with leisure time physical activity, with significant trends at age 15-19 (odds ratio (OR) for low versus high tertile of leisure time activity: 1.4, 95% confidence interval (CI): 0.8-2.4) and at most recent age (OR: 1.7, 95% CI: 1.1-2.6). Risk trends with occupational physical activity were less clear and non-statistically significant. The present Southern European cross-sectional study lends further support to the possibility that past and recent physical activity helps increasing bone mineral density in middle-aged women. Although the most beneficial type and intensity level of exercise has yet to be determined, the present results provide further evidence that participation in even moderate exercise programs should be encouraged.