The molybdenum cofactor of Escherichia coli nitrate reductase A (NarGHI). Effect of a mobAB mutation and interactions with [Fe-S] clusters

We have studied the effect of a mobAB mutation and tungstate on molybdo-molybdopterin-guanine dinucleotide (Mo-MGD) insertion into Escherichia coli nitrate reductase (NarGHI). Preparation of fluorescent oxidized derivatives of MGD (Form A and Form B) indicates that in a mobAB mutant there is essentially no detectable cofactor present in either the membrane-bound (NarGHI) or purified soluble (NarGH) forms of the enzyme. Electron paramagnetic resonance characterization of membrane-bound cofactor-deficient NarGHI suggests that it has altered electrochemistry with respect to the dithionite reducibility of the [Fe-S] clusters of NarH. Potentiometric titrations of membrane-bound NarGHI indicate that the NarH [Fe-S] clusters have midpoint potentials at pH 8.0 (Em,8.0 values) of +180 mV ([3Fe-4S] cluster), +130, -55, and -420 mV ([4Fe-4S] clusters) in a wild-type background and +180, +80, -35, and -420 mV in a mobAB mutant background. These data support the following conclusions: (i) a model for Mo-MGD biosynthesis and assembly into NarGHI in which both metal chelation and nucleotide addition to molybdopterin precede cofactor insertion; and (ii) the absence of Mo-MGD significantly affects Em,8.0 of the highest potential [4Fe-4S] cluster.

Is serum cystatin C a sensitive marker of glomerular filtration rate (GFR)? A preliminary study on renal transplant patients

Human cystatin C is a basic low molecular mass protein (13,359 Dalton) freely filtered through the glomerulus and almost completely re-absorbed and catabolized by proximal tubular cells. We measured serum cystatin C in 38 kidney transplant patients (23 males, 15 females) aged between 6 and 32 years. To assess renal function, serum and urinary creatinine were also determined in all patients, and creatinine clearance was finally calculated. Cystatin C was determined by a particle-enhanced turbidimetric assay, and creatinine was measured by gas chromatography-mass spectrometry. To compare the diagnostic efficiency of cystatin C with that of creatinine, inulin clearance was performed on 12 renal transplant patients, and receiver operating characteristic (ROC) analysis was applied. The results of this study demonstrate that serum cystatin C significantly increases in renal transplant patients with reduced creatinine clearance (< 70 mL/min per 1.73 m2) and that the diagnostic accuracy of serum cystatin C is better than of serum creatinine. Cystatin C may be utilized as a very marker of reduced GFR.

A novel sec-independent periplasmic protein translocation pathway in Escherichia coli

The trimethylamine N-oxide (TMAO) reductase of Escherichia coli is a soluble periplasmic molybdoenzyme. The precursor of this enzyme possesses a cleavable N-terminal signal sequence which contains a twin-arginine motif. By using various moa, mob and mod mutants defective in different steps of molybdocofactor biosynthesis, we demonstrate that acquisition of the molybdocofactor in the cytoplasm is a prerequisite for the translocation of the TMAO reductase. The activation and translocation of the TMAO reductase precursor are post-translational processes, and activation is dissociable from translocation. The export of the TMAO reductase is driven mainly by the proton motive force, whereas sodium azide exhibits a limited effect on the export. The most intriguing observation is that translocation of the TMAO reductase across the cytoplasmic membrane is independent of the SecY, SecE, SecA and SecB proteins. Depletion of Ffh, a core component of the signal recognition particle of E. coli, appears to have a slight effect on the export of the TMAO reductase. These results strongly suggest that the translocation of the molybdoenzyme TMAO reductase into the periplasm uses a mechanism fundamentally different from general protein translocation.

Toxic thyroid adenoma: absence of DNA mutations of the TSH receptor and Gs alpha

DNA point mutations of the TSH receptor and of the alpha subunit of the stimulatory GTP-binding protein (Gs alpha) have been suggested as major causes of hyperfunctioning thyroid adenomas. However, significant differences in the prevalence of these mutations (from 0.3 to 84%) have been found in different populations. The present study was designed to evaluate further the presence of mutations in discrete fragments of cDNA encoding critical regions of the TSH receptor and of the Gs alpha involved in signal transduction and cAMP production. Genomic DNA extracted from 15 thyroid adenomas and surrounding quiescent thyroid tissues was used as a template to amplify four DNA fragments of TSH receptor and one DNA fragment of Gs alpha. TSH receptor and Gs alpha DNAs were analyzed by a number of techniques. We did not detect any mutations (new or previously described) in our patients. These results confirm that the causes of solitary toxic adenomas are protean, and only some of them may be somatic DNA point mutations. Since the clinical features of solitary toxic adenoma are homogeneous, it could be important to establish the specific molecular defect underlying each case, in order to follow up the patients and to assess their clinical evolution.

Impact of recombinant human growth hormone treatment on psychological profiles in hypopituitary patients with adult-onset growth hormone deficiency

BACKGROUND

We examined the effect of growth hormone (GH) administration on the psychological capacity and sense of well-being in 25 patients with adult-onset GH-deficiency (GHD).

METHODS

Very low dosages [0.5-1.0 UIday(-1) s.c. at bed-time] of recombinant human (rh)-GH (n = 13; aged 50+/-15 years, mean+/-SD) or placebo (n = 12, 53+/-14 years) were given at random for a 6-month period. Quality of life was assessed by using the Italian version of the self-rating Kellner Symptom Questionnaire (KSQ) and the Hamilton Depression Scale (HDS).

RESULTS

No difference in insulin-like growth factor I (IGF-I) levels was noted between groups on entry to the study. A significant increase in IGF-I [month 0 56.2+/-10.4 microg L(-1) vs. month 6 125.7+/-16.7 microg L(-1); P < 0.001] levels was noted only in the rh-GH-treated group. There was no difference in overall scores on the KSQ between the rh-GH-treated and control groups on entry. A slight, non-significant, decrease in overall scores was noted in both groups of subjects. Subsection analysis of items from the KSQ did not show significant differences in either group during the 6-month period. A significant decrease (month 0 28+/-1 vs. month 6 25+/-1; P = 0.02) in the HDS score was noted in rh-GH-treated but not in placebo-treated patients. There was a significant correlation (rs, -0.56, P = 0.05) between increase in IGF-I levels and decrease in HDS scores in rh-GH treated patients.

CONCLUSION

The data demonstrate that low rh-GH dosages significantly improve psychological profiles as rated by HDS evaluation in adult-onset patients with GHD. On the other hand, a 6-month period of treatment does not produce any significant differences in quality of life as measured by KSQ between treated patients and placebo controls.

Transcranial Doppler monitoring during carotid endarterectomy: is it appropriate for selecting patients in need of a shunt?

PURPOSE

This report summarizes our experience in evaluating a series of 168 patients who underwent a total of 175 carotid endarterectomy procedures under local anesthesia. Patients were monitored by stump pressure (SP) measurement and transcranial Doppler scanning (TCD). The need for shunting was compared between SP/TCD flow velocity reduction and the awake response (gold standard).

METHODS

The study cohort represented 56% of all the carotid patients treated during the study period. Clamping ischemia was defined as the appearance of focal deficit (focal ischemia) or unconsciousness (global deficit) on carotid clamping. In the case of clamping ischemia, a shunt was inserted. To define the optimal value of SP and TCD flow velocity that is able to discriminate patients with clamping ischemia, a receiver operator characteristic (ROC) curve was constructed. Sensitivity and specificity tests, together with negative and positive predictive values (NPV and PPV), were calculated. Cutoff values were defined as the ROC curve values that correlated the highest sensitivity with the highest specificity for both SP and TCD.

RESULTS

Clamping ischemia was present in 18 procedures (10%) in which a shunt was used. No perioperative deaths were recorded. Major perioperative morbidity occurred in one patient (0.6%). Two nondisabling strokes were also recorded (1.8% overall rate of neurologic morbidity). Cutoff values for both SP and TCD, using the ROC curve, were < or = 50 mm Hg and > or = 70% flow velocity reduction from baseline, respectively. SP values of < or = 50 mm Hg or less showed a sensitivity of 100%, a specificity of 83%, a PPV of 40%, and an NPV of 100%. TCD flow monitoring (> or = 70% flow reduction) revealed a lower sensitivity (83%) but a greater ability to avoid false positive results (96% specificity), resulting in increased PPV (71%) and NPV (98%). Combining SP and TCD failed to provide better results in terms of specificity (81%) and PPV (38%).

CONCLUSIONS

SP measurement using a 50 mm Hg cutoff appears to be a reliable predictor of clamping ischemia but requires the use of a shunt in 17% of the patients who would otherwise not require this procedure. In contrast, TCD has greater specificity but is associated with a lower sensitivity, with 17% false negative results. In our experience, both SP and TCD show limitations, as they overestimate or underestimate carotid endarterectomy procedures in need of a shunt. We believe that sensitivity is more important than specificity in carotid endarterectomy, and thus conclude that TCD flow velocity measurement is not an optimal method for detecting clamping ischemia.

Nitric oxide modulates in vivo and in vitro growth hormone release in acromegaly

Nitric oxide (NO) has recently been shown to modulate pituitary secretion both in vivo and in vitro. The aim of this study was to investigate the effects of this chemical transmitter on spontaneous and growth-hormone-releasing hormone (GHRH)-induced growth hormone (GH) secretion in acromegalic patients, as well as from GH-secreting tumors maintained in vitro. The study was carried out in 7 acromegalic patients (46.2 +/- 2 years) and in 5 normal subjects (40.1 +/- 1.5 years). GH and prolactin (PRL) secretion were assayed during the administration of isosorbide dinitrate (ID, 5 mg, orally), an NO donor, GHRH, and ID plus GHRH. During ID, a significant (p < 0.05) increase (37%) over basal GH levels was only observed in acromegalics. There was no change in GH levels in response to GHRH or ID plus GHRH in either group. No significant change in PRL levels was observed in either group during ID, while GHRH, with or without ID, induced a slight increase in PRL levels in acromegalics only. Tumor specimens were obtained by selective transsphenoidal adenomectomy, and the cells were plated and incubated for 1, 2 and 24 h in the presence of sodium nitroprusside, a releaser of NO (SNP, 0.3 or 0.6 mM), of GHRH (10-8 M) or of both. SNP significantly (p < 0.001) increased GH levels in a dose-dependent manner (R = 0.99, p = 0.02), but was unable to modify the GH response to GHRH. In acromegalics, a significant correlation (R = 0.822, p < 0.045) and a correlation near the limit of significance (R = 0.73, NS) were observed respectively between the in vivo GH response to ID and the in vitro response to SNP at 24 h. No significant effect was observed on PRL secretion during SNP incubations, while GHRH produced a significant increase in PRL after 2 and 24 h incubation in acromegalics. These observations indicate that NO plays a stimulatory role in vivo and in vitro on GH secretion in acromegalic patients.

Immunoreactive endothelin in nodular pathology of the thyroid

OBJECTIVES

Endothelins (ETs) can act as autocrine and/or paracrine regulators of thyroid homeostasis and growth. The aim of this study was to evaluate immunoreactive ET (i-ET) levels in a group of patients with nodular pathology of the thyroid and to correlate them with the cytomorphological features after fine-needle aspiration (FNA) and with hormonal and immunological status and blood pressure levels.

DESIGN

Plasma and cystic i-ET were assayed in a group of patients with varying thyroid function, who underwent FNA for solid and cystic nodular pathology.

PATIENTS

47 patients (32-81 years) with nodular pathology of the thyroid and 18 controls (28-70 years) with normal thyroid function and morphology were studied.

MEASUREMENTS

Fasting venous blood samples were collected and the plasma for i-ET was frozen at -80 degrees C until assayed. Sera were frozen at -20 degrees C for FT3, FT4, TSH, TPO autoantibodies and thyroglobulin autoantibodies assay. Cystic fluid was obtained by FNA, centrifuged, and the supernatant was stored at -20 degrees C until i-ET assay. FNA cytology was examined by light microscopy.

RESULTS

In patients with cystic nodules, plasma i-ET levels were significantly (P = 0.002) higher (5.7 +/- 1.1 ng/l, +/- SEM) than in both patients with solid nodules (2.6 +/- 0.4 ng/l) and (P = 0.02) controls (3.0 +/- 0.3 ng/l). In patients with cystic nodules, cystic i-ET levels (12.6 +/- 1.9 ng/l) were significantly (P = 0.003) higher than plasma levels (5.7 +/- 1.1 ng/l) and did not correlate with the percentage of FNA cellularity. i-ET levels in cystic fluid (12.6 +/- 1.9 ng/l) were significantly (P = 0.0001) higher than plasma i-ET levels in both patients with solid nodules and controls. No difference in either plasma or cystic i-ET levels was found in patients with cystic nodules in relation to differences in thyroid function. No difference in plasma i-ET levels was found between patients with solid nodules and controls. In controls, no significant difference in plasma i-ET levels was found between males and females. A negative correlation (r = -0.55, P = 0.02) was found between cystic i-ET levels and systolic and diastolic blood pressure. No correlation between cystic or plasma i-ET levels and FT3, FT4 or TSH was found in any of the subjects studied.

CONCLUSIONS

It seems that endothelins do not possess a primary role in determining thyroid function and that the increased levels in cystic fluid found in our subjects could be secondary to cystic nodule development.

Characterization by electron paramagnetic resonance of the role of the Escherichia coli nitrate reductase (NarGHI) iron-sulfur clusters in electron transfer to nitrate and identification of a semiquinone radical intermediate

We have used Escherichia coli cytoplasmic membrane preparations enriched in wild-type and mutant (NarH-C16A and NarH-C263A) nitrate reductase (NarGHI) to study the role of the [Fe-S] clusters of this enzyme in electron transfer from quinol to nitrate. The spectrum of dithionite-reduced membrane bound NarGHI has major features comprising peaks at g = 2.04 and g = 1.98, a peak-trough at g = 1.95, and a trough at g = 1.87. The oxidized spectrum of NarGHI in membranes comprises an axial [3Fe-4S] cluster spectrum with a peak at g = 2.02 (g(z)) and a peak-trough at g = 1.99 (g(xy)). We have shown that in two site-directed mutants of NarGHI which lack the highest potential [4Fe-4S] cluster (B. Guigliarelli, A. Magalon, P. Asso, P. Bertrand, C. Frixon, G. Giordano, and F. Blasco, Biochemistry 35:4828-4836, 1996), NarH-C16A and NarH-C263A, oxidation of the NarH [Fe-S] clusters is inhibited compared to the wild type. During enzyme turnover in the mutant enzymes, a distinct 2-n-heptyl-4-hydroxyquinoline-N-oxide-sensitive semiquinone radical species which may be located between the hemes of NarI and the [Fe-S] clusters of NarH is observed. Overall, these studies indicate (i) the importance of the highest-potential [4Fe-4S] cluster in electron transfer from NarH to the molybdenum cofactor of NarG and (ii) that a semiquinone radical species is an important intermediate in electron transfer from quinol to nitrate.

Effect of the somatostatin analog, octreotide, and of other hormones on the release of the acid-labile subunit of the 150 kDa complex by rat hepatocyte in primary culture

OBJECTIVE

In normal subjects, the major form of circulating IGF is the GH-dependent 150 kDa complex. The liver appears to be the main source of the three components of the 150 kDa complex and, in particular, hepatocytes synthesize the insulin-like growth factor (IGF) peptide and the acid-labile subunit (ALS), whereas Kupffer and sinusoidal endothelial cells produce IGF-binding protein-3 (IGFBG-3). We have studied the effects of the somatostatin analog octreotide, IGF-II des(1-3)IGF-I, transforming growth factor (TGF)-beta 1 and tri-iodothyronine (T3) on ALS secretion into the medium conditioned by rat hepatocytes in primary culture.

METHODS

The regulation of ALS release was evaluated in the conditioned medium of adult rat hepatocytes exposed to increasing concentrations of test substances or to vehicle alone (control), after gel filtration in basic conditions, by immunoblot using an antiserum generated against the N-terminal 34 amino acids of human ALS.

RESULTS

The results demonstrate that: 1) octreotide in vitro produces a dose-dependent inhibition of both basal and GH-stimulated ALS secretion into the hepatocyte conditioned medium; 2) the release of ALS by adult rat hepatocytes is not affected by the presence during the incubation of des(1-3)IGF-I or IGF-II; 3) an inhibitory effect, although only with very high doses, can be observed after treatment with TGF-beta 1; and 4) a small but significant increase of ALS released into the medium can be seen when hepatocytes are treated with T3.

CONCLUSIONS

Evaluation of the effect of substances known to affect the production of IGF peptides, the IGFBPs, or both, on adult rat hepatocytes in primary culture revealed no powerful stimulator, but instead a potent inhibitor of ALS release/synthesis. Our data suggest that the effect of somatostatin on the 150 kDa complex is mediated not only by the reduction in GH concentration, but also by a direct inhibition of ALS release or synthesis.

[Immunohistochemical and ultrastructural study of a case of carcinosarcoma (biphasic sarcomatoid carcinoma) of the lung with rhabdomyoblastic differentiation]

Histologic, immunohistochemical and ultrastructural features of a case of carcinosarcoma of the lung are described. The biphasic pattern of this neoplasm is characterized by the presence of a carcinomatous component that corresponds to an adenosquamous carcinoma, and a sarcomatous component with rhabdomyoblastic differentiation. Since the biphasic sarcomatoid carcinoma has an aggressive clinical behaviour, immunohistochemical expression of prognostic markers, such as Ki-67 and p53 is evaluated to individuate differences between the carcinomatous and the sarcomatous components of the tumor. The higher p53 expression and Ki-67 positivity in the former, suggests that the carcinomatous component probably represents the more aggressive portion of the tumor. Moreover, P53 expression is nuclear in both carcinomatous and sarcomatous areas, thus it is likely that the biphasic sarcomatoid carcinoma of the lung is monoclonal in origin.

Eversion versus conventional carotid endarterectomy: a prospective study

OBJECTIVES

To analyse comparatively eversion and conventional CEA for later association with restenosis, perioperative stroke/death and ipsilateral cerebrovascular events (early, late, disabling and non-disabling).

DESIGN

Prospective non-randomised clinical study.

MATERIALS AND METHODS

A total of 469 patients underwent 514 procedures; 274 (53%) eversion CEA and 240 (47%) conventional CEA. Perioperative monitoring was carried out by clinical evaluation under local anaesthesia or by transcranial Doppler under general anaesthesia. Follow-up was carried out by clinical evaluation and Duplex scanning.

RESULTS

Clamping time was significantly shorter in the eversion group (25.5 +/- 7.4 vs. 28.3 +/- 10.1 min; p = 0.0001; CI delta 4.40/1.12). The perioperative disabling stroke/death rate was 0.7% for eversion vs. 1.2% for conventional CEA, p = 0.6; odds ratio (OR), 0.58. There were two early carotid occlusions (within 30 days) in both groups. According to life-table analysis, after 3 years the probability of > 50% carotid restenosis was significantly lower in the eversion group (2.2% vs. 6.9%, p = 0.03; relative risk reduction 67%). There were no significant differences between the two groups relative to new cerebrovascular events (92% in both groups, p = 0.6). Using multivariate analysis (Cox regression), eversion CEA, and to a lesser extent standard CEA with patch, appeared to protect the vessel from restenosis.

CONCLUSIONS

The eversion technique was associated with reduced clamping time and probability of restenosis. However, because of the nature of a non-randomised study, the present analysis should be confirmed by a multicentre randomised trial.

Immunoreactive and bioactive LH release from pituitaries of intact or castrated male rats: effect of in vitro GnRH and KCl administration

The in vitro immunoreactive (i-LH) and bioactive (b-LH) LH release from hemipituitaries of intact adult male rats (INT) or rats castrated 7 days earlier (CAS) was studied. Hemipituitaries were incubated for 30 min (time 1) plus an additional 30 min (time 2) with GnRH (10 nM) and/or KCl (50 mM), according to one of the following protocols: media alone (C), KCl+KCl (K/K), GnRH+GnRH (G/G), KCl+GnRH (K/G), GnRH+KCl (G/K). All of the hemipituitaries were further incubated in media alone for 120 min (time 3). I-LH, b-LH and i-FSH were assayed on the media. In both models, the highest bioactive:immunoactive (b/i) ratio was noted during time 1; however, CAS always secreted more b-LH than INT at any given time of the study. In INT, GnRH--but not KCl--administration during time 2 resulted in blunted i-LH. During the same time, the b/i ratios decreased in all groups but G/K. LH secretion recovered during time 3 in all groups. In CAS, i-LH levels comparable to those of time 1 were sustained by either stimulus during time 2, while the b/i ratios were markedly decreased. LH secretion recovered in the K/K group during time 3. These results suggest that: 1) promptly releasable pools of b-LH are available in both models; 2) CAS always secrete more b-LH; 3) in INT, desensitization occurs involving parallel changes in both i-LH and b-LH, while changes in b-LH rather than i-LH are noted in CAS; 4) prolonged KCl administration might play a role in new gonadotropin synthesis and/or release.

Melatonin receptors are present in adult rat Leydig cells and are coupled through a pertussis toxin-sensitive G-protein

Previous studies have suggested that melatonin (MLT) acts directly on rat Leydig cells by modulating androgen production. In the present study, the site of action of MLT was investigated. The binding of 2-[125I]iodomelatonin (125I-MLT; 7-240 pmol/l) to Leydig cell membrane fragments was tested in the presence or absence of guanosine 5'-O-(3-thiotriphosphate) (GTP-gamma-S; 50 mumol/l). Saturation studies and Scatchard analysis revealed the existence of a high-affinity binding site with a Bmax of 46.70 +/- 3.50 fmol/mg protein and a Kd of 88.70 +/- 6.20 pmol/l; treatment with GTP-gamma-S reduced the concentration of 125I-MLT binding sites (Bmax 34.03 +/- 4.50), while increasing the Kd to 106.5 +/- 2.61 pmol/l. Pretreatment of the cells with pertussis toxin (PTX; 10 ng/ml for 16 h) resulted in a decreased binding of 125I-MLT and a lack of effect of GTP-gamma-S. Moreover, the effect of MLT on testosterone secretion induced by LH (30 mIU/ml), forskolin (1 mumol/l) and LHRH (100 nmol/l) was studied after 3-h incubation of cells which had been precultured with or without PTX. The inhibition of testosterone secretion due to MLT administration was eliminated by PTX pretreatment during forskolin and LH, but not during LHRH administration. However, 17-hydroxyprogesterone levels were higher in all groups incubated in the presence of MLT, irrespective of PTX pretreatment. Our data suggest that: (a) MLT receptors are present on the membranes of adult rat Leydig cells; (b) they couple through PTX-sensitive G-protein-coupled binding sites; (c) the mechanism by which MLT blocks 17-20 desmolase enzymatic activity (thus leading to increased 17-hydroxyprogesterone levels), and testosterone secretion during LHRH stimulation is likely to depend on one or more different mechanism(s) of action.

[Comparative study of endocrine differentiation in early and advanced stomach carcinoma]

To comparatively evaluate the frequency of the neuroendocrine differentiation in the early and in the advanced stage of the disease, 189 gastric carcinomas (67 early gastric cancers and 122 advanced gastric cancers) were studied by immuno-histochemistry using a monoclonal antibody against chromogranin A (CgA). CgA-positive tumor cells were detected in 55 of 189 gastric carcinomas (29.1%). Twenty-two of 67 early gastric cancer (EGC) (32.8%), and 33 of 122 advanced gastric cancer (AGC) (27.0%) were CgA positive. The latter included 23 intestinal type, 8 diffuse type and 2 mixed type tumors. The distribution of CgA-positive tumor cells in most AGC and EGC was focal and the endocrine cells were singularly scattered in the neoplastic glands or, more rarely, grouped in small clusters. CgA-positive tumor cells, moreover, were observed in the lymph node metastases of 12 AGC and 1 EGC. Statistical analysis of data showed no significant difference in the frequency of CgA-positive endocrine cells with regard to the stage of tumor growth, histotype, sex and age. These results indicate that neuroendocrine differentiation is a phenomenon independent of tumor stage, histotype, age, and sex and that CgA-positive cells are present during the whole neoplastic progression.

LH isoform profiles during short-term pulsatile LHRH administration in elderly men

LH isoform profiles were analyzed in sera resolved with isoelectrofocusing from 5 elderly men (age 70.6 +/- 2.95) and 5 young adult men (age 28.2 +/- 1.24), by using polyclonal antibodies (RIA), monoclonal antibodies directed against the beta-subunits (IRMA) and in vitro LH bioassay. Despite the fact that the elderly had lower testosterone levels than the young (293 +/- 38 vs 512 +/- 77 ng/dl, p < 0.05), no differences were noted in the isoforms detected by any of the assays, although each assay yielded a characteristic profile. Indeed, RIA showed most LH in the acidic range, while IRMA revealed LH profiles with a major peak in the basic range, thus resembling the profiles determined by means of the bioassay. In the elderly, the profiles were also analyzed on day 7 and day 14 of short-term pulsatile sc LHRH administration (150 ng/bw/120 min). Only the LH bioassay detected an LHRH-induced shift to more basic and bioactive forms; these changes accompanied an increased in testosterone levels on day 7 (396 +/- 83 ng/dl, p < 0.05 vs day 0) and on day 14 (320 +/- 58 ng/dl NS vs day 0). Our data suggest that: 1) the profiles obtained in young and elderly subjects are similar, irrespective of the antisera used; 2) as a result of treatment with LHRH in the elderly an increase in T levels occurs, possibly due to the observed changes in LH bioactivity; 3) the in vitro LH bioassay appears to be the most sensitive assay in detecting such changes, which consisted of an enrichment in more basic and bioactive glycoforms.

Insulin-like growth factors (IGF-I and IGF-II) and IGF-binding protein-3 production by fibroblasts of patients with Turner's syndrome in culture

Reports indicate that in plasma insulin-like growth factor I (IGF-I) and IGF-binding protein-3 (IGFBP-3) are normal in patients with Turner's syndrome (TS). The aim of our study was to evaluate both the spontaneous and the stimulated synthesis of these peptides by mesenchymal cells obtained from skin biopsies of patients affected with TS. We compared the ability of fibroblasts from six TS patients with that of fibroblasts from six age-matched control (C) subjects to synthesize in vitro IGF-I, IGF-II, and IGFBP-3 under basal and GH-, estradiol (E2)-, or GH- plus E2-stimulated conditions. Furthermore, we evaluated IGF-I, IGF-II, and IGFBP-3 messenger ribonucleic acid (mRNA) expression in fibroblasts from TS and C subjects. Fibroblasts obtained from TS patients release into the medium significantly lower amounts of IGF-I and IGF-II than C fibroblasts (P = 0.0435 and 0.0318, respectively). In TS fibroblasts, GH and E2 are able to induce a similar increase, although not significant, of IGF-I secretion into the medium (163 +/- 75% and 112 +/- 41% of control values). On the contrary, in C fibroblasts, GH is more effective (275 +/- 61%; P = 0.0277) than E2 (75 +/- 46%). In both cell lines, GH and E2 do not significantly modify IGF-II release. Interestingly, the medium conditioned by fibroblasts from TS contains, under basal conditions, significantly higher amounts (273 +/- 79 ng/1 x 10(6) cells) of IGFBP-3 than that from control fibroblasts (67 +/- 19 ng/1 x 10(6) cells; P = 0.0191). GH exerts a stimulatory effect, although it is not statistically significant, on IGFBP-3 secretion, particularly in control fibroblasts. By contrast, the effect of E2 is inhibitory in all TS fibroblast cell lines, although it does not reach statistical significance (P = 0.067). In agreement with these data, a reduced mRNA expression of the genes encoding for IGF peptides was evident in TS fibroblasts, whereas no significant difference could be demonstrated for IGFBP-3 mRNA. The results suggest a reduced autocrine/paracrine action of IGFs in TS and indicate that skin fibroblast cultures can give information on the local responsiveness to the treatment.

[Total anomalous pulmonary venous drainage. Description of a case]

A case of total anomalous pulmonary venous drainage (TAPVD) is reported, which according to Darling classification corresponded to infradiaphragmatic type (type III) and is associated to pulmonary arterial thrombosis and infarctions. It's emphasized the need of an accurate dissection of cardiovascular system in perinatal necropsies, specially in cases of sudden infant death. By an appropriate dissection, cardiovascular malformations can be recognized. Moreover, it's explained the pathogenesis of pulmonary arterial thrombosis and infarctions.

Simultaneous measurement of the rates of appearance of palmitic and linoleic acid in critically ill infants

Lipolysis has been measured in humans by means of stable isotope techniques using labeled palmitic acid (PA) or glycerol as tracers. If other fatty acids (FA) such as linoleic acid (LLA) have the same rate of appearance (Ra) as PA and therefore contribute equally to oxidative and nonoxidative metabolism is unknown. We infused albumin-bound [U-13C]PA and [U-13C]LLA in seven critically ill infants (weight 3.6 +/- 1.3 kg, age 57 +/- 64 d) receiving 20.9 +/- 5.4 kcal. kg-1.d-1 of i.v. glucose only, and measured simultaneously the Ra of PA and LLA from the isotopic enrichment of plasma FFA by mass spectrometry. A needle biopsy of the s.c. adipose tissue was obtained for FA composition. PA in adipose tissue was higher than LLA (40 +/- 6.7 versus 5.4 +/- 3.2 mol %, p < 0.001). The Ra values of PA and LLA were 5.73 +/- 2.79 and 1.34 +/- 0.92 mumol.kg-1.min-1, respectively (p = 0.005). However, the ratio of the FA's Ra to their respective mol% values in adipose tissue was lower for PA than for LLA (0.15 +/- 0.06 versus 0.25 +/- 0.06, p = 0.02). The Ra of LLA acid was higher than could be expected from the FA composition of adipose tissue, thus indicating a preferential release of LLA during lipolysis. In critically ill infants receiving only i.v. glucose, the contribution of LLA to the oxidative and nonoxidative metabolism may be larger than what assumed from the FA composition of plasma and adipose tissue.

Comparison of target organ damage in renovascular and essential hypertension

In many reports, the prevalence of target organ damage in renovascular hypertension (RVH) appears to be higher than in essential hypertension (EH). Since in most studies the renal artery stenosis is part of a diffuse atherosclerotic disease, it is not known whether these complications are due to RVH itself or to the vascular disease. We have undertaken a case control study of 92 patients divided into two groups (46 in each), one with RVH and the other with EH and abdominal aortic aneurysm, with a comparable degree of diffuse atherosclerotic vascular disease. The vascular state of the extracranial carotid arteries and abdominal and inferior limb districts was investigated with angiography and sonography. The prevalence of left ventricular hypertrophy (LVH) and ischemic heart disease (IHD) were assessed by electrocardiography. Serum creatinine and urinary protein excretion were employed in the renal evaluation. While the analysis of the results confirmed an even diffusion of atherosclerotic vascular disease between the two groups, a significant difference was found in the prevalence of heart and renal damage. LVH was present in 32.6% of RVH patients versus 10.8% in EH (P = .02). Serum creatinine > 1.4 mg/dL was found in 50% of RVH and in 23.9% of EH, (P = .01). The prevalence of proteinuria in RVH was also higher although not reaching the statistical significance. The results suggest that, in patients with comparable degrees of atherosclerotic vascular disease, RVH is responsible for the higher prevalence of target organ damage in this condition compared to those with EH.

[Transmembrane sodium transport systems in various forms of hyperlipoproteinemia]

The possible interrelationships between the erythrocytic transport systems of Na+ (Na+/K+ pump, Na+/K+ cotransport, Na+/Li+ countertransport, Na+ passive permeability) and the plasmatic lipids (cholesterol, triglycerides, HDL, LDL, apoprotein A1, apoprotein B) were studied in 42 normotensive subjects with different forms of hyperlipoproteinaemia and with a negative familiarity for arterial hypertension. In subjects with hypercholesterolaemia (hyperlipoproteinaemia II A and II B) an elevated activity of the Na+/K+ pump was noticed, while in subjects with hypertriglyceridaemia (type IV) an increase in Na+ passive permeability and Na+/Li+ countertransport with a lower level of intraerythrocytic Na+ was shown. A negative correlation was observed between the total efflux of Na+ and Na+/K+ pump and the levels of cholesterol (r = -0.43, p < 0.04 and r = -0.41, p < 0.05) and the apoprotein B/A ratio (r = 0.42, p < 0.05 and r = -0.50, p < 0.01). A negative correlation was also noticed between the Na+/K+ pump and the levels of apoprotein B (r = -0.41, p < 0.05). The Na+/K+ cotransport appeared inversely correlated with the levels of HDL cholesterol (r = -0.42, p < 0.05), while the Na+ passive permeability was negatively correlated with the levels of LDL (r = -0.43, p < 0.04) and positively correlated with the plasmatic triglycerides (r = +0.54, p < 0.01). Such data show that the plasmatic lipids can influence the systems of transmembrane ionic transport of Na+ and play an important role also this way, in cardiovascular pathology.

Computerised tomography findings as a risk factor in carotid endarterectomy: early and late results

OBJECTIVES

To evaluate whether preoperative CT evidence of brain infarction is associated with an increased risk of early and late stroke and death in patients undergoing CEA.

DESIGN

Retrospective clinical study.

MATERIALS AND METHODS

We evaluated 844 CT scanning records from 893 patients undergoing CEA from 1986-1994: 43% (367) CT positive for cerebral infarction and 57% (477) negative. Univariate and multivariate analysis was performed for risk factors and preoperative symptoms in patients with positive and negative CT scans, and Kaplan Meier survival curves for late events.

RESULTS

A positive CT was significantly more frequent in males vs. females (p < 0.0001; O.R. 2.52; C.I. 1.73-3.73), diabetics vs. non-diabetics (p = 0.03; O.R. 1.52; C.I. 1.03-2.26), symptomatics vs. asymptomatics (p < 0.001; O.R. 2; C.I. 1.93-3.53) and contralateral occlusion vs. patency (p < 0.001; O.R. 2; C.I. 1.30-3.10). The perioperative disabling stroke/ death rate was higher in patients with a positive CT (p = 0.002; O.R. 6.27; C.I. 1.73-34.20); in asymptomatic patients this difference was striking (5 patients vs. O, p = 0.0002). Multiple logistic regression analysis for risk factors, CT findings, symptoms preceding surgery, and congruity of brain infarction confirmed a significantly higher incidence of perioperative stroke/death rate (p = 0.003; O.R. 6.37; C.I. 5.12-7.63) and early and late stroke (p = 0.02; O.R. 1.95; C.I. 1.38-2.53) and death (p = 0.0005; O.R. 2.38; C.I. 1.89-2.88) in patients with brain lesions. After 7 years, the survival rate (p = 0.0009) and stroke-free interval (p = 0.003) were lower in patients with a positive CT. After 5 years, in asymptomatic patients the survival rate (p = 0.003) and stroke-free interval (p = 0.01) were lower in the positive CT group.

CONCLUSIONS

A positive CT finding, regardless of congruity of the lesion, should be regarded as an indicator of an increased risk of stroke and death in patients scheduled for carotid surgery, especially in those with asymptomatic stenosis.