Capillaroscopic skin ulcer risk index: a new prognostic tool for digital skin ulcer development in systemic sclerosis patients

OBJECTIVE

Digital ulcerations are one of the most frequent manifestations of microangiopathy in patients with systemic sclerosis (SSc; scleroderma). The early detection of SSc patients who are at high risk to develop digital ulcers could allow a preventive treatment of these complications with reduction of morbidity and social costs. The aim of our study was to develop a capillaroscopic skin ulcer risk index (CSURI) that can predict the onset of new digital ulcers by using nailfold videocapillaroscopy (NVC) in patients with SSc.

METHODS

We performed NVC in 120 consecutive unselected patients with SSc (13 men, 107 women, mean +/- SD age 56.1 +/- 13.4 years, mean +/- SD SSc duration 44.7 +/- 60.7 months) to assess the total number of capillaries in the distal row (N), maximum loop diameter (D), number of megacapillaries (M), and the M:N ratio.

RESULTS

Within 3 months since NVC examination, 35 of 120 patients experienced digital ulcers. A significant association between ischemic lesions and the M:N ratio, N, and D was observed; the combination of these parameters allowed us to develop the CSURI, which is characterized by the formula D x M:N(2). A receiver operating characteristic curve analysis showed an area under the curve of 0.926 for ulcer appearance, with specificity and sensitivity of 85.9% and 94.3%, respectively, at the cutoff value of 2.94. Interestingly, 33 of 35 patients with new skin ulcers had a CSURI >2.94, but only 2 of 35 had a CSURI < or =2.94.

CONCLUSION

The proposed CSURI may represent a novel tool with the ability to predict the development of digital ulcers in patients with scleroderma.

Characterization of innate responses elicited by neoadjuvant radio-chemotherapy for rectal cancer

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Background: The neoadjuvant chemo-radiotherapy (CT-RT) has improved the treatment of locally advanced rectal cancer reducing the local recurrence. However a survival benefit has not been reached yet. In order to increase the rate of pathological complete remissions in our Institution we intensified both the CT schedule adding oxaliplatin to 5-FU and the RT program with tomotherapy. The aim of this study was to verify: whether the pattern of innate response elicited by the neoadjuvant CT-RT is heterogeneous among pts and whether this information can be used to identify which pts will benefit from the treatment. Methods: We collected samples of T3N+M0 rectal cancer pts before, during and after neoadjuvant CT-RT (3 cycles of oxaliplatin + 5-FU; 45 Gy). At each time point we characterized circulating monocytes by flow cytometry, infiltrating macrophages by immunoistochemistry (IHC) and selected inflammatatory molecules by ELISA.Results: We recruited so far 25 pts, of whom 10 have reached the surgery with three pathological complete remission and four down staging. No substantial changes were detectable in the number of circulating monocytes. In contrast we observed a clear expansion of CD14/CD86 and CD14/CD163 double positive subsets. This event was transient and apparently causally related to the treatment since it abated at the later time point. Moreover, it correlated with sensitivity to the treatment: 5/7 pts who underwent disease regression had an early and transitory increase of the number of CD14/CD86 and CD14/CD163 positive cells, which was absent or negligible in non responder pts. The IHC study revealed a massive tumoral infiltration by macrophages which displayed clear features of alternative M2 polarization as assessed by expression of the CD163 and 206 scavenger receptors. A subset of pts had elevated PTX3 and low CRP concentration at the onset of treatment. PTX3 concentration abated after the first CT cycle. Conclusions: These data suggest that neoadjuvant CT-RT modulates the cellular components of innate immune responses, that could represent valuable predictive factors.

No significant financial relationships to disclose.

[Correlation of a quantitative videocapillaroscopic score with the development of digital skin ulcers in scleroderma patients]

BACKGROUND

Systemic sclerosis (SSc) is an autoimmune disease characterized by fibrosis of the skin and visceral organs. The microangiopathy is early detectable in the course of the disease by nailfold videocapillaroscopy (NVC), a non-invasive technique with a high diagnostic value.

OBJECTIVE

Aim of our study was to evaluate the feasibility of a quantitative score and its correlation with the digital skin ulcers, which frequently complicate SSc microangiopathy.

METHODS

We retrospectively analysed the NVC of 65 SSc patients, performed by 200x videocapillaroscopy connected to image analyse software (Videocap; DS MediGroup, Milan, Italy). The analysis of NVC images included: total number of capillaries in the distal row (N), maximum diameter (D) and number of giant capillaries (M), M/N ratio and percentage of M, presence/absence of micro-haemorrhages and tortuosity.

RESULTS

21/65 SSc patients experienced digital ulcers within three months after the NVC examination. The N, D, M/N, and percentage of M significantly correlated with the appearance of ischemic ulcers. A multiple regression analysis showed a statistically significant correlation for N, M/N and D, while sensitivity and specificity of these parameters were unsatisfactory. A capillaroscopic score, according to the formula D x M/N2, showed a high specificity and sensibility (93.2% and 85.7% respectively; area under ROC curve: 0.918) to predict the appearance of digital ulcers.

CONCLUSIONS

This capillaroscopic score may represent a feasible and simple tool in SSc patients' assessment. The routinely use of this parameter might permit to recognize and to preventively treat SSc patients at high risk to develop digital ulcers.

Cardiovascular risk and prostanoids in systemic sclerosis

OBJECTIVE

Systemic sclerosis (SSc) is characterized by Raynaud's phenomenon and frequent cutaneous ulcers. In patients resistant to oral treatments, i.v. prostanoids are usefully employed. Some anecdotal reports underlined the potential risk to develop cardiovascular ischemic complications in prostanoid-treated SSc patients.

METHODS

Fifty SSc patients (group 1: 44 female and 6 male, mean age 60.4 +/- 13.8SD) undergoing long-term prostanoid therapy (iloprost or alprostadil) and 42 control patients (group 2), treated with only oral drugs, were retrospectively evaluated for the cardiovascular risk and incidence of ischemic events.

RESULTS

Ischemic cardiovascular complications, i.e., myocardial infarction or stroke, were recorded in a significantly higher number of patients undergoing prostanoid treatment compared to controls (group 1: 7/50, 14% vs. group 2: 1/42, 2.4%; p=0.041). Interestingly, these events were significantly more frequent in the subgroup of patients with high cardiovascular risk (group 1: 6/10, 60% vs. group 2: 1/19, 5.2%; p=0.0026).

CONCLUSION

The present study suggests a possible role of prostanoid treatment in the pathogenesis of ischemic cardiovascular complications in SSc patients non-responders to oral vasodilators and high cardiovascular risk. Since prostanoids represent the first choice treatment of the most severe scleroderma ischemic cutaneous lesions, cardiovascular risk should be carefully evaluated in all patients before therapy.

Secular trends in first hospitalizations for major mood disorders with comorbid substance use

In the past half-century, the incidence of major mood disorders reportedly has risen, and onset age, diminished. Substance-use disorders (SUDs) are commonly comorbid with mood disorders and may influence their course and outcome. Since secular relationships of these disorders remain unknown, we evaluated medical records of 421 patients (233 men, 188 women) at first-lifetime admissions for major depression, mania or mixed bipolar episodes at a public hospital in Italy during 1978-2002, updated diagnoses to DSM-IV criteria, and compared selected factors between subjects with vs. without SUDs, seeking evidence of secular trends in SUDs in association with early mood disorders. SUD was diagnosed in 122 patients (29.0%). SUD risk was greatest in young males. Relative risk (RR) of diagnostic association with SUDs ranked: mixed states (RR 1.80), mania (RR 1.06), depression (RR 0.55). Annual rates of comorbid SUD and mood disorders increased continuously over the 25-yr epoch for all substances (r=0.640, p<0.001). Age at onset of illness and at first hospitalization (averaging 36 yr and 38 yr) were unrelated to year of hospitalization in this relatively brief sampling, but patients with SUD were younger at onset and admission, overall. Clinical Global Impression (CGI) ratings of illness severity at hospitalization and discharge were stable across years. These findings indicate a secular increase of comorbid SUD among first admissions for mood disorder, especially in young males, with a parallel increase in the proportion of bipolar disorder diagnoses over the past quarter of a century.

Course of autism signs in the first year of life

Autism spectrum disorders (ASD) are thought to be present right from birth, even if a minority of children displays a normal course during infancy followed by a regression during the second year of life. However, established criteria are not yet available to differentiate these different courses of ASD, and data coming from different sources have not yet been organized into a clear definition. The aim of this study was to elucidate the time of onset, as well as type, frequency and stability of symptoms during the first year of life in ASD. The behavioral summarized evaluation scale, applied to 40 home movies of children later diagnosed as having ASD, showed that most of the subjects (87.5%) display symptoms within the first year of life, when only a small group (12.5%) is completely symptom free. A group of more rated symptoms was found, constituting a typical pattern characterized by being withdrawn, and displaying poor social initiative, hypoactivity, and lack of emotional modulation. The importance of these findings is discussed in relation to early diagnosis and treatment.

A new polytopic bis-diazacrown-ether-polypyridine ligand and its complexes with Zn(II) salts and mononuclear and dendritic Ru(II) precursors. Synthesis, absorption spectra, redox behavior, and luminescence properties

The new polytopic receptor 1 containing two terpyridine, one phenanthroline, and two diazacrown-ether sites has been prepared using a modular approach. Such a new species contains several pieces of information in its structure which can be processed by different metal ions to give different supramolecular inorganic architectures. Actually, reaction of 1 with Zn(CH(3)COO)(2) in methanol, and subsequent anion exchange, afforded the intramolecular ring-type [Zn(1)](2+) complex, which appears to be formed by a self-assembling reaction. A different synthetic approach, stepwise synthesis, allowed us to synthesize the two multicomponent compounds [(bpy)(2)Ru(mu-1)Ru(bpy)(2)](4+) (Ru2; bpy = 2,2'-bipyridine) and [[(bpy)(2)Ru(mu-2,3-dpp)](2)Ru(mu-1)Ru[(mu-2,3-dpp)Ru(bpy)(2)](2)](12+) (Ru6; 2,3-dpp = 2,3-bis(2-pyridyl)pyrazine). The absorption spectra and luminescence properties of 1 and [Zn(1)](2+) are dominated by pi --> pi transitions and excited states. The absorption spectra of the ruthenium compounds are dominated by ligand-centered (LC) bands in the UV region and metal-to-ligand charge-transfer (MLCT) bands in the visible. The latter compounds undergo several reversible metal-centered oxidations and ligand-centered reductions in the potential window investigated (-2.0/+2.0 V versus SCE) and exhibit MLCT luminescence in both acetonitrile fluid solution at room temperature and in butyronitrile rigid matrix at 77 K. Both the redox and photophysical properties of Ru2 and Ru6 can be assigned to specific subunits of the multicomponent structures. The data indicate that the [Ru(bpy)(2)](2+) and the dendritic [Ru[(mu-2,3-dpp)Ru(bpy)(2)](2)](6+) fragments appended to the polytopic 1ligands behave as independent components of the multicomponent arrays.

A new polytopic bis-diazacrown-ether-polypyridine ligand and its complexes with Zn(II) salts and mononuclear and dendritic Ru(II) precursors. Synthesis, absorption spectra, redox behavior, and luminescence properties

The new polytopic receptor 1 containing two terpyridine, one phenanthroline, and two diazacrown-ether sites has been prepared using a modular approach. Such a new species contains several pieces of information in its structure which can be processed by different metal ions to give different supramolecular inorganic architectures. Actually, reaction of 1 with Zn(CH(3)COO)(2) in methanol, and subsequent anion exchange, afforded the intramolecular ring-type [Zn(1)](2+) complex, which appears to be formed by a self-assembling reaction. A different synthetic approach, stepwise synthesis, allowed us to synthesize the two multicomponent compounds [(bpy)(2)Ru(mu-1)Ru(bpy)(2)](4+) (Ru2; bpy = 2,2'-bipyridine) and [[(bpy)(2)Ru(mu-2,3-dpp)](2)Ru(mu-1)Ru[(mu-2,3-dpp)Ru(bpy)(2)](2)](12+) (Ru6; 2,3-dpp = 2,3-bis(2-pyridyl)pyrazine). The absorption spectra and luminescence properties of 1 and [Zn(1)](2+) are dominated by pi --> pi transitions and excited states. The absorption spectra of the ruthenium compounds are dominated by ligand-centered (LC) bands in the UV region and metal-to-ligand charge-transfer (MLCT) bands in the visible. The latter compounds undergo several reversible metal-centered oxidations and ligand-centered reductions in the potential window investigated (-2.0/+2.0 V versus SCE) and exhibit MLCT luminescence in both acetonitrile fluid solution at room temperature and in butyronitrile rigid matrix at 77 K. Both the redox and photophysical properties of Ru2 and Ru6 can be assigned to specific subunits of the multicomponent structures. The data indicate that the [Ru(bpy)(2)](2+) and the dendritic [Ru[(mu-2,3-dpp)Ru(bpy)(2)](2)](6+) fragments appended to the polytopic 1ligands behave as independent components of the multicomponent arrays.

Long-term results in patients with disk displacement without reduction treated conservatively

Sixty-eight patients (seven men, 61 women) treated for disk displacement without reduction with extraoral mandibular manipulation followed by splint insertion, physical and drug treatment as needed, were re-examined at the end of treatment and after a subsequent period, ranging from 18 to 147 months. Two parameters were considered: 1. degree of spontaneous mandibular opening; and 2. presence of pain (score 1-4). Mean opening was 28.78 mm before treatment, 42.85 mm after treatment and 43.5 mm at long-term (P < .001 after paired T-test and one-way ANOVA). Mean pain level dropped from 2.91 before treatment to 1.22 after treatment and 1.38 at long-term (P < .001 after Friedman non-parametric test). It was concluded, that in the majority of cases, disk displacement without reduction can successfully be treated by conservative means.

Oxygen-induced retinopathy in the newborn rat: effects of hyperbarism and topical administration of timolol maleate

BACKGROUND

Lesions resembling those of human retinopathy of prematurity can be provoked in newborn Wistar rats by exposure to an FiO2 of 80% for the first 5 days of life followed by 5 days recovery under room-air conditions.

METHODS

We evaluated the effects of moderate hyperbarism (+60.75 kPa, i.e. 455 mmHg or 0.6 atm) and topical administration of 0.25% timolol maleate on oxygen-induced retinopathy (OIR) in this experimental model.

RESULTS

OIR (including neovascularization in most cases) was observed in 100% of the retinas of normobaric oxygen-reared ratlings that did not receive timolol. OIR was less frequent in oxygen-reared ratlings treated with hyperbarism (60%) or timolol (65%). Hyperbaric oxygen supplementation combined with timolol treatment during both the hyperoxic and room-air phases reduced the incidence of OIR to 30%. There was no sign of vasoproliferation in any of the retinas from the latter three groups.

CONCLUSIONS

The highly significant protective effects of hyperbarism and timolol observed in this study are not fully understood. We speculate that vasoconstriction induced by the hyperbarism reduces the amount of oxygen that reaches the retina from the choroid during O2 supplementation, while an increased ocular perfusion pressure caused by timolol-induced reduction of the intraocular pressure might decrease the stimulus to vasoproliferation that normally occurs with room-air recovery.

Age-related changes in interleukin 2 responsiveness of resting and activated human mononuclear cells

BACKGROUND

Although the "T cell model" on the immunological decline associated with aging is gaining increasing support, the relationship between response to IL2 and aging has not yet been investigated.

METHODS

Human peripheral blood mononuclear cells (PBMC) from healthy elderly donors were cultured with increasing concentrations (1-1000 U/ml) of recombinant interleukin 2 (rIL2).

RESULTS

PBMC from older donors proliferated as much as those from younger donors until the fifth day of culture, but showed a reduced capability to proliferate in the following days (8th and 10th). Culturing PBMC with PHA we obtained the opposite result. In fact, the known depressed proliferative response of elderly people to the mitogen PHA is detectable only in the early days of culture. Furthermore, the response to rIL2 of 1% or 0.125% PHA-stimulated PBMC showed an important impairment of the proliferative rate in the elderly population with respect to younger controls, although no differences in the number of IL2 receptor-positive cells were detected. This phenomenon was demonstrable mainly in the first several days of culture.

CONCLUSIONS

These data suggest a delay in the activation rather than a real functional impairment of PBMC from old donors.

Enantioselective oxidations of sulfides catalyzed by chloroperoxidase

The chloroperoxidase-catalyzed and horseradish peroxidase catalyzed oxidations of sulfides by tert-butyl and other peroxides have been investigated. The former metal enzyme afforded the corresponding sulfoxides having R absolute configuration in up to 92% enantiomeric excess (ee), whereas the latter gave racemic products. The various factors that control the enantioselectivity of the oxygenation have been examined.

Improvement of continuous arteriovenous hemofiltration (CAVH) and hemofiltration (HF) efficiency by adding hemoperfusion (HP)

Aiming to improve the efficiency of the blood purification convective methods either with spontaneous (CAVH) or with pump-assisted (HF) extracorporeal circulation we inserted after the hemofilter a cartridge containing 70 g of collodion-coated activated charcoal (CAC) microencapsulated, obtaining so hemofiltration and hemoperfusion in series (HF+HP). The obtained results show that in both methods HP addition gives a negligible increase of urea clearance and a practically null increase of phosphate clearance, whereas creatinine and uric acid clearances increase is remarkable especially, in percentage, with low blood flows (CAVH). In the HF+HP system we have also been studying B2-microglobulin (B2-M) clearance aiming at examining the possibility of increasing the removal of substances with higher molecular weight. We have been finding HP addition increases further on B2-M clearance already high in HF. Therefore we think HP addition to convective methods is an interesting step in the attempt to carry out highly efficient blood purification methods.

Chronic treatment with a long-acting somatostatin analogue in a patient with intestinal carcinoid tumor: occurrence of cholelithiasis

The long-acting somatostatin analogue SMS 201-995 has been used efficaciously in the therapy of metastatic carcinoid tumor, vasoactive intestinal peptide producing islet cell carcinoma, acromegaly, and TSH secreting pituitary tumors. We report the development of a gallstone in a patient treated for 23 months with a long acting somatostatin analogue for a metastatic carcinoid tumor. Symptomatic improvement and a reduction in the urinary excretion of 5-hydroxyindoleacetic acid occurred. There was no evidence of a gallstone on ultrasound and CT scan of the abdomen prior to somatostatin therapy. A progressively enlarging, asymptomatic gallstone developed during therapy.

[Hemofiltration and hemoperfusion performed in series for the purpose of removing beta 2 microglobulin]

With the objective to develop most efficient method for Beta-2-microglobulin elimination, the authors, using extracorporeal circulation placed behind the haemofilter a capsule containing 70 g of collodion coated with activated medicinal charcoal. This combination was used in 3 haemofilters made from different membranes. The results showed polysulphon to be the highest efficiency membrane out of those tested for Beta-2 microglobulin elimination. In combination with haemoperfusion, its efficiency increases significantly. Even if haemoperfusion increases efficiency by considerable percentage, the Beta-2 microglobulin elimination using other types of membranes lasts long and the total clearance remains low.

[Unusual anatomo-clinical features of thyroid metastasis]

The authors report a case of metastatic tumor from clear cell carcinoma in the thyroid gland occurred in a patient who had his primary tumor previously treated with right nephrectomy. The time interval before the appearance of the metastasis was 6 years. The diagnosis was made preoperatively because of the peculiar biological behavior of the primary tumor. In fact, the metastasis and the primary presented with neoplastic invasion of the middle thyroid vein and the renal vein respectively. The ultrasound examination revealed the vein thrombus arising from the thyroid and reaching the internal jugular vein through the middle thyroid vein. Subsequent fine needle aspiration biopsy confirmed the diagnosis of metastasis from clear cell renal carcinoma. The low grade of malignancy of the primary from the clinical point of view and the absence of other metastatic locations influenced the therapeutic approach.

Interleukin 2 and mitogen driven proliferation in human peripheral mononuclear cells: a kinetic analysis

The role of the T lymphocyte growth factor, interleukin 2 (IL2), on human lymphocyte proliferation was investigated. The results define the extent and the chronological sequence of IL2 effects on unstimulated mononuclear cells and on an activated population enriched in IL2 receptor positive cells. Important differences were observed in the proliferative response to the mitogen PHA when the IL2 concentration in the culture medium was varied. The data suggest that IL2 concentration is critical in the responsiveness to a mitogenic stimulus.

Comparison of methimazole, methimazole and sodium ipodate, and methimazole and saturated solution of potassium iodide in the early treatment of hyperthyroid Graves' disease

We have evaluated three regimens for the rapid control (10 days' therapy) of thyrotoxicosis in hyperthyroid Graves' disease: methimazole (MMI, 40 mg/day), MMI and sodium ipodate (MMI + Na Ipodate, 1 g/day and MMI and saturated solution of potassium iodide (MMI + SSKI, 6 drops twice daily). When serum T4 and T3 concentrations were analysed as the percent change from pre-treatment values, the following results were observed. Serum T4 concentration decreased in the three treatment groups and the decrease was similar in the MMI and MMI + SSKI groups but significantly lower than in the MMI + Na ipodate group. The serum T3 concentration decreased to the normal range in all seven MMI + Na Ipodate treated patients by the fourth day of treatment and the per cent decrease in serum T3 from pre-treatment values was significantly greater than in the MMI and MMI + SSKI treated patients. The decrease in serum T3 was similar in the latter two groups. Heart rate decreased in all three groups, but the decrease was significantly more in the MMI + Na Ipodate-treated patients. The present findings suggest that the rapid control of hyperthyroid Graves' disease is similar in patients treated with MMI and MMI + SSKI and that the combination of MMI + Na Ipodate is more efficacious since the decrease in serum T3 concentrations and heart rate was significantly greater in the MMI + Na ipodate-treated patients.

Design, synthesis and evaluation of fluorocarbons and surfactants for in vivo applications. New perfluoroalkylated polyhydroxylated surfactants

The progress achieved since the advent of Fluosol-DA is summarized in this paper, with special focus on the synthesis and evaluation of more adequate, reliable, industrially feasible fluorocarbons, structure/property relationships--molecular weight being recognized as the pre-eminent determining factor of both the fluorocarbon's excretion rate and the emulsion's stability-, the preparation of significantly more concentrated, more efficacious emulsions, etc. The key to further progress and better mastery of the emulsions' characteristics, especially in relation to increased shelf-life, prolonged i.v. persistence, and versatility, now lies in the development of new surfactants, better adapted to this objective. New families of well defined, monodisperse perfluoroalkylated polyhydroxylated surfactants derived from sugars and related compounds have been synthesized and fully characterized. Preliminary evaluation of their surface-active properties, emulsion stabilizing capacity and biocompatibility are reported.

Adenosine induced production of a soluble factor affecting lymphocyte activation

We show that a brief exposure of human peripheral blood mononuclear cells (PBMC) to adenosine or to theophylline results in a mitomycin C resistant regulatory activity. Adenosine induced suppression is also detectable in a lymphocyte subpopulation (T4+ enriched, originally described as helper inducer) resistant to the theophylline induced loss of capacity to form spontaneous rosettes with sheep erythrocytes (TTR). This activity is apparently dependent on the production of a soluble factor(s) since supernatants from adenosine treated TTR (SnA) exert a significant inhibition on the proliferative response of resting lymphocytes. On the contrary SnA increases the concanavalin A (ConA) preactivated lymphocytes proliferation. Similar results are detectable on the proliferative response in the mixed lymphocyte reaction (MLR). Perhaps these effects are related to different Interleukin 2 (Il 2) receptor expression on the cell surface of the resting and preactivated populations. A slow moving band corresponding to a protein of Mr of 64,500 and isoelectric point 7.6 is present in SnA. Only a slight Il 2 activity is detectable either in SnA and in control supernatant (SnC). These findings suggest that SnA may be a dynamic regulator of the early stages of lymphocyte activation.

Goiter size and thyroid function in an endemic goiter area in northern Italy

Thyroid function was studied in a large number of subjects residing in Varsi, a town in the province of Parma, Italy. In this area, endemic goiter associated with moderate iodine deficiency [59 +/- 3 (+/- SE) microgram iodine/g creatinine], as defined by WHO criteria, affects 65% of the population. Serum T4, T3, thyroglobulin (Tg), and TSH concentrations were measured by RIA in 1218 subjects. The TSH response to TRH was determined in 108 subjects selected randomly from the groups with different grades of goiter. No significant change in serum T4 concentrations was found in subjects with different grades of goiter. Serum T3 concentrations were higher in subjects with the larger goiters. Serum Tg concentration progressively increased, and serum TSH progressively decreased with increasing goiter size. The TSH response to TRH was diminished in subjects with larger goiters. The findings of decreasing serum TSH concentrations and blunted TSH responses to TRH as goiter size increased suggest the possibility of autonomous thyroid function in the larger goiters in subjects residing in this area of moderate iodine deficiency.

Effect of sodium ipodate and iodide on free T4 and free T3 concentrations in patients with Graves' disease

Graves' hyperthyroid patients were treated daily for 10 days with 1 g sodium ipodate, a cholecystographic agent which exerts a blocking effect on the peripheral conversion of T4 to T3, or with 12 drops of saturated solution of potassium iodide (SSKI). Serum concentrations of free T4 (FT4) and free T3 (FT3) were measured before, during and 5 and 10 days after the administration of each drug. Sodium ipodate treatment induced a rapid decrement of serum FT4 concentrations which declined from 48.9 +/- 6.6 pg/ml to 26.0 +/- 2.7 pg/ml. In these patients serum FT3 concentrations declined from 12.4 +/- 2.0 pg/ml to 2.5 +/- 0.4 pg/ml. Ten days after sodium ipodate withdrawal, serum FT4 and FT3 concentrations returned to baseline values. In patients treated with SSKI serum FT4 concentrations declined from 51.1 +/- 8.8 pg/ml to 11.3 +/- 1.4 pg/ml and FT3 from 15.7 +/- 2 pg/ml to 2.6 +/- 0.3 pg/ml. Moreover, after therapy interruption serum free thyroid hormone concentrations returned to baseline values in these patients. Serum FT4 pattern during the study was not different between the two groups of subjects whereas serum FT3 concentrations were significantly lower in patients treated with sodium ipodate. These findings indicate that SSKI and sodium ipodate are effective in inducing a rapid decrement of serum free thyroid hormone concentrations. Therefore the employment of these drugs may be useful in the treatment of patients with thyroid storm and those undergoing thyroidectomy.

Comparative effects of sodium ipodate and iodide on serum thyroid hormone concentrations in patients with Graves' disease

Patients with thyrotoxic Graves' disease were treated daily for 10 d with 1 g sodium ipodate, an iodine rich X-ray contrast agent which impairs outer ring (5'-) deiodination of T4 to T3, or with 12 drops of a saturated solution of potassium iodide (SSKI). T4, T3 and reverse T3 (rT3) concentrations were measured before, during, and 5 and 10 d after the administration of each drug. SSKI therapy induced a decrease in the serum T4 concentration from 14.7 +/- 1.3 microgram/dl (mean +/- SE) to a nadir of 7.9 +/- 0.9 on days 9 and 10 of therapy, all values reaching the normal range by day 9; a decrease in the serum T3 concentration from 402 +/- 43 ng/dl to a nadir of 143 +/- 20 on day 10, remaining elevated in all patients until day 5 and decreasing into the normal range in all except one patient on days 9 and 10; and no change in the serum rT3 concentration. Serum T4 and T3 concentrations returned to baseline values 10 d after withdrawal of SSKI. In contrast sodium ipodate therapy induced only a modest decrease in the serum T4 concentration from 15.1 +/- 0.7 micrograms/dl to a nadir on day 9 of 11.3 +/- 1.0 and serum T4 remained above the normal range in most patients until day 8; a striking and rapid decrease (within 12 h) in ther serum T3 concentration from 340 +/- 36 ng/dl to mean values ranging from 79 to 85 during the last 5 d of therapy, with most values below the normal range during the last 3 d; and a marked increase in the serum rT3 concentration from 111 +/- 15 ng/dl to a peak value of 376 +/- 59 on day 5.(ABSTRACT TRUNCATED AT 250 WORDS)

Iodothyronine and thyrotropin concentrations after iodoamide administration for angiographic studies

In order to study the effect of iodoamide (a contrast medium widely used for urographic and arteriographic studies) on thyroid function, seventeen subjects were studied before and after arteriographic examinations employing this contrast compound. Serum concentrations of T4, T3, rT3 and TSH were not modified during the observation period by the administration of iodoamide. This finding is in contrast with the observation that iopanoic acid and ipodate, used for cholecystographic examinations, can reduce the serum concentrations of T4 and T3 with a concomitant increase in rT3. Therefore, iodoamide is not useful in the treatment of hyperthyroidism.

The value of serum thyroglobulin measurement as a marker of cancer recurrence in the follow-up of patients previously treated for differentiated thyroid tumor

In order to verify the value of serum thyrogolbulin (hTg) determination to detect cancer recurrence, 104 patients previously treated with surgical and 131I total thyroid ablation of differentiated thyroid cancer were studied. Comparison of serum hTg results and 131I total body scans (131I TBS) was attempted. In 87 patients with negative 131 I TBS, serum hTg was undetectable in 80% of the patients whereas in 20% detectable amounts of hTg were measured. In 57 patients with positive 131I TBS, serum hTg was measurable in 72% of the patients whereas in 20% was undetectable. These contrasting results of serum hTg measurement and 131I TBS suggest to us the usefulness to use both tests in the detection of thyroid cancer recurrence.

High Incidence of Von Willebrand’s Disease in a Little Area of South Italy

In a little region of South Italy(Puglia),we have evidenced 20 families (f.) with von Willebrand’s disease(vWd). The following tests were performed: BT, PR, RIPA, FVIII: C, FVIIIR: AG, FVIIIR:RCo and electrophoretic mobility (EM) of FVIII-related protein. 4 f. showed an autosomic recessive inheritance and severe bleeding tendency, every laboratory value was definitely abnormal. 16 f. showed an autosomic dominant inheritance and moderate bleeding tendency. Of these: 4 f. had classical vWd with all parameters reduced and normal EM; 3 f. showed a vWd vari ant (FVIII:C and FVIIIR:RCo reduced, FVIIIR:AG normal), the EM being abnormal in one and the RIPA increased in an other; 6 f. presented a decreased FVIIlR:RCo with normal FVIII:C and FVIIIR:AG (the EM was always normal); 3 f. showed an isolated deficiency of FVIIIR:RCo respectively combined with 1) FV deficiency (Bari variant), 2) FXII deficiency (San Diego variant), 3) hereditary hemorrhagic telangectasia.

[Traumatic chylothorax. A further indication for total parenteral nutrition]

Successful and rapid resolution of a serious cases of traumatic chylothorax by means of conservative management with TPN is reported. This method is clearly indicated as a mean of making up the calorie and amino acid need when litres of chyle are being lost every day. In addition, by resting the digestive tract it brings about a massive decrease in the production of lymph in the mesenteric district and thus leading to easier and earlier sufficiency of the collateral lymph drainage routes. The rapid decrease in quantity and the change over from chylous to serous chest drainage liquid after TPN are evidence of its soundness. An immediate lymphographic control revealed complete section of the duct. Two months later, collateral diaphragmatic and azygos circulation was observed. It is felt, therefore, that TPN extends the range of conservative management of posttraumatic and postoperative chylothorax.

[Traumatic thrombosis of the peripheral arteries]

Ten cases of post-traumatic arterial thrombosis are described. The anatomopathological, diagnosis and therapeutic aspects of peripheral artery lesions of this type are examined. Surgical exploration followed by reconstruction are dictated by the presence and degree of seriousness of ischaemia; they are not subordinate to arteriography, itself not always necessary. Resection of the confused segment and reconstruction is the management of choice. Thrombectomy and thromboendarteriectomy cannot be considered as rational operations, even though they can be used in a few special cases, such as iatrogenic forms. Reconstruction is best achieved by direct anastomosis or with the aid of venous grafts. A prosthesis, on the other hand, is liable to produce less satisfactory long-term results.