Long-term follow-up of idiopathic thrombocytopenic purpura in 310 patients

BACKGROUND AND OBJECTIVES

Idiopathic thrombocytopenic purpura (ITP) induces thrombocytopenia by means of an autoimmune mechanism. Despite the available therapies a subset of patients develop chronic refractory severe thrombocytopenia (i.e. a platelet count consistently lower than 20 to 30x10(9)/L), and life-threatening bleeding can occasionally occur. It has been suggested that the risk of major bleeding is higher in elderly patients and in patients with bleeding at diagnosis. However, since clear data on the influence of clinical and/or laboratory parameters on outcome are lacking, some patients may be receiving unnecessary treatment.

DESIGN AND METHODS

We made a retrospective analysis of a series of 310 patients with chronic ITP (108 males and 202 females), with a median age at diagnosis of 40 years (range 8-87 years). The median follow-up time was 121 months, (range 7-434 months). Therapy was most often started in the presence of hemorrhagic complications and/or a platelet count <30x10(9)/L either at diagnosis or during follow-up.

RESULTS

Our findings confirmed that patients who were symptomatic at diagnosis were more likely to have bleeding during their follow-up. Moreover, all the patients who suffered major bleeding during their follow-up had median platelet counts of 10x10(9)/L (range 1-20) at that time. Only one patient, aged 43 years, died of hemorrhage following prolonged severe thrombocytopenia. Age >60 years was not associated with any significant differences in incidence of bleeding at diagnosis or during follow-up.

INTERPRETATION AND CONCLUSIONS

We conclude that prospective studies are required to evaluate whether it may be reasonable to treat only symptomatic patients, independently of age.

Role of 2-[18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) in the early assessment of response to chemotherapy in metastatic breast cancer patients

We investigated the role of 2-[18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) in the early evaluation of response to chemotherapy in metastatic breast cancer patients. Breast cancer patients who received an epirubicin/paclitaxel--containing regimen as first-line treatment for metastatic disease were included in this study. A PET study was performed within 1 week before the start of treatment, at day 8 after the first course, and at the end of the planned program of chemotherapy. Tumor response was determined clinically and radiographically every 2 courses of treatment. Thirteen patients with metastatic breast cancer who were referred for treatment protocols with gemcitabine/epirubicin/paclitaxel or epirubicin/paclitaxel chemotherapy regimens were included in this study. All metastatic sites were easily visualized on the baseline FDG-PET images, obtained 50 to 60 minutes after tracer injection. Nine patients who completed the planned courses of chemotherapy and the FDG-PET studies were available for analysis. In the six patients who achieved a response to treatment, median glucose standard uptake value (SUV) (semiquantitative analysis) was 7.65 (range, 3.4-12.3) at baseline, 5.7 (range, 2.8-7.6) at day 8 after the first course, and 1.2 (range, 0.99-1.3) at the end of the 6 planned courses of chemotherapy. Three patients who obtained a stable disease as best response had no significant decrease in tumor glucose SUV compared to baseline levels. Qualitative visual analysis in the six responding patients showed a decrease in delineation of tumor mass from background activity soon after the first course, while the nonresponding patients had no significant modification from basal levels. Semiquantitative FDG-PET scanning of metastatic breast cancer sites showed a rapid and significant decrease in tumor glucose metabolism soon after the first course of treatment in patients who achieved a response to first-line chemotherapy. On the contrary, no significant decrease was observed in nonresponding patients.

Monitoring brevetoxins during a Gymnodinium breve red tide: comparison of sodium channel specific cytotoxicity assay and mouse bioassay for determination of neurotoxic shellfish toxins in shellfish extracts

In October of 1996, a Gymnodinium breve bloom occurred in shellfish harvesting waters of Alabama, Mississippi and Louisiana, Gulf of Mexico, USA. Bloom densities reached 5.6x10(5) cells liter(-1) and bloom residence at shellfish sampling stations ranged from 3 to 28 days. Brevetoxin-2 dominated G. breve toxin profiles in bloom seawater extracts. Shellfish toxicity, assessed by mouse bioassay, exceeded the guidance level for up to 75 days after the bloom had dissipated. Cytotoxicity assays and mouse bioassays showed similar temporal patterns of shellfish toxicity, but the two methods differed in estimations of brevetoxin-3 equivalent toxicity by a factor of 93 to 1. LC-ESI-MS showed the temporal patterns in shellfish toxicity reflected metabolism of G. breve toxins. The molecular ions m/z 1004, 1017 and 1033 dominated LC-ESI-MS spectra of toxic chromatographic fractions from the extracts and were identified as brevetoxin metabolites on the basis of LC-APCI-MS-MS. The discrepancy between cytotoxicity and mouse bioassay estimates of brevetoxin-3 equivalent toxicity resulted from the difference in extraction efficiency of solvents used in the respective methods and the relative sensitivity of the assays to toxin metabolite mixtures present in the extracts. The normalized cytotoxicity assay showed 75% agreement with mouse bioassay positive test samples and 64% agreement with mouse bioassay negative test samples. Published in 1999 by John Wiley & Sons, Ltd.

Human papillomavirus infection in atrophic smears. A case report

BACKGROUND

Human papillomavirus (HPV) infection in atrophic smears can be misleading and may produce the diagnosis of cervical intraepithelial neoplasia.

CASE

A routine cervical smear in a 62-year-old female revealed an atrophic smear with nuclear changes suggestive of a high grade squamous intraepithelial lesion (HSIL). An estrogen cream for topical vaginal use was prescribed. A new smear was collected seven days later and revealed koilocytosis but no evidence of HSIL.

CONCLUSION

Koilocytosis is a cellular finding of mature epithelial cells. The use of estrogen produces maturation of HPV-infected basal cells, allowing a correct diagnosis of this disease in patients with atrophic smears.

Comparison of food composition tables and direct chemical analysis for the assessment of macronutrient intake in a military community

Food composition tables (FCT) were validated against chemical analysis (CA) to assess energy, carbohydrate, lipid, protein and fibre content of the food consumed by Italian Army cadets. The absolute difference between FCT and CA in 2 separate weeks was < or = 0.7% for energy, < or = 4.1% for carbohydrates, < or = 2.9% for lipids, < or = 6.2% for proteins and < or = 31.6% for fibre. It is concluded that FCT can be used to assess energy, carbohydrate, lipid and protein but not fibre intake in this military community.

Effects of home-based food preparation practices on the micronutrient content of foods

We studied the effects of cooking on the vitamin and mineral content of vegetables (vegetable soup, cauliflower), meat (beefsteak) and fish (sole) and those of cutting (fruit salad) and squeezing (orange juice) on the vitamin content of fruits. In cooked dishes, vitamin retention ranged between 0 (folic acid, all dishes) and 94% (retinol, sole) and mineral retention between 63 (copper, cauliflower) and 96% (iron, vegetable soup). In orange juice, ascorbic acid appeared to be protected from oxidation for at least 12 h as compared with fruit salad. Our study shows that preparation of foods with techniques available at home may be responsible for losses of vitamins and minerals. Further studies are needed to ascertain the effects of these losses on nutritional status.

Use of bioelectric impedance analysis (BIA) in children with alterations of body water distribution

Validation studies of bioelectric impedance analysis (BIA) were performed in children with obesity, Duchenne muscle dystrophy and juvenile rheumatoid arthritis. BIA allowed an accurate assessment of total body water in all groups (CV from 4.1 to 5.1%). However, the prediction of extracellular water by BIA was not always satisfactory (CV from 8.5 to 12.5%), being better in the groups of children with the lowest variability in body water distribution.

Carotid artery atherosclerosis and risk factors for stroke in a selected population of asymptomatic men

The prevalence of carotid atherosclerosis in the general population is variable. Also, the relationship between cardiovascular risk factors and carotid atherosclerosis has yet to be clearly defined. We carried out a cross-sectional study of 441 asymptomatic male subjects to investigate possible relationships between extracranial carotid plaques, cardiovascular risk factors and asymptomatic coronary obstructive disease. Carotid atheromatous plaques, detected by means of B-mode ultrasonography, were present in 31.7% of the study population. Prevalence and severity of atherosclerosis were significantly correlated with age, total cholesterol and signs of ischemia upon exercise stress test. However, hypercholesterolemia seemed to play a significant pathogenic role only in the youngest subjects (<55 years old). Our study confirms the high prevalence of asymptomatic carotid plaques in the general population, especially in elderly subjects. The only reversible risk factor related to carotid atherosclerosis is hypercholesterolemia, and this is reversible only at a young age.

Effects of cooking and storage methods on the micronutrient content of foods

Food processing has the potential to alter the nutrient quality of foods. This review deals with the effects of home-based cooking and storage practices on the micronutrient content of foods. It describes the effects of cooking, freezing and refrigeration on the vitamin and mineral content of meats, fish, fruit, vegetables and cereals. Based on this review, we suggest that the consumer should be aware of the possibility that losses in nutritional quality of foods may result from an improper use of cooking and storage techniques available at home.

Voltage breakdown follower avoids hard thermal constraints in a Geiger mode avalanche photodiode

A novel approach to single-photon detection by means of an avalanche photodiode is described and preliminary results obtained by implementation of a prototype are reported. The electronic circuit (breakdown voltage follower) avoids the use of complex temperature controls typically used with these devices, thus reducing system complexity and cost. Data obtained without any thermoregulation show the same behavior with respect to systems thermoregulated to within a few hundredths of a degree celsius.

Autoimmune hemolytic anemia in multicentric Castleman's disease

We report on a patient affected by multicentric Castleman's disease who developed an acute immunohemolytic anemia due to warm antibody. The clinical course was characterized by refractoriness to the steroidal treatment and by a dramatic improvement of the hematological and objective picture following combination chemotherapy (CHOP regimen). The possible existence of a link between the lymphoproliferative syndrome and the immunological derangement is also discussed.

[Piperacillin in prevention and therapy in gynecological surgery]

The authors have studied the use of sodic piperacillin in surgical gynecological prophylaxis. The drug, used in the intravenous tract, has proved efficacious for broad spectrum of antibacterial action versus gram+, gram-, and anaerobic and aerobic. It has shown an excellent tolerability by reducing hospital surgical infections (11% of cases) and sepsis (9.2% of cases) with social, economic and professional advantages.

Enthesopathies and diabetes mellitus

OBJECTIVE

There is evidence of a close relationship between diabetes mellitus and disorders of the insertions of tendons, ligaments and articular capsules into bone (enthesopathies). It has been suggested that these disorders may represent genuine complications of diabetes. We therefore conducted a study to determine whether insertion disorders at the calcaneum (calcaneal spurs) represent a complication of non-insulin-dependent diabetes.

METHODS

The incidence of calcaneal spurs was studied in a group of 100 patients with non-insulin-dependent diabetes in comparison to 100 sex- and age-matched controls. Patients with disorders involving hyperostosis were excluded.

RESULTS

Calcaneal insertion disorders were found to be more common among the diabetics than among the controls. These disorders, however, were also associated with other factors such as the body mass index and age. Discriminant analysis, which would have in theory highlighted any relationship between diabetes and insertion disorders at the calcaneum, did not show definitively that these disorders were a complication of diabetes.

CONCLUSION

These results suggest that enthesopathies are not a complication of diabetes mellitus, and we would suggest that this conclusion may be extended to the relationship between diabetes and insertion disorders at other joints.

Autoantibodies against oxidatively modified low-density lipoproteins in NIDDM

Diabetes is an independent risk factor in the development of atherosclerosis, although the pathophysiological processes underlying this association are poorly understood. The oxidation of low-density lipoprotein (LDL) is considered a key event in the development and progression of atherosclerosis because it generates molecular epitopes that are more atherogenic than parent LDL. A total of 138 patients suffering from non-insulin-dependent diabetes mellitus (NIDDM) and 80 matched control subjects were investigated. LDL oxidation was evaluated as the presence of autoantibodies against oxidatively modified LDL, since they mirror the in vivo occurrence of oxidative processes. NIDDM patients had an antibody ratio (calculated as the ratio of antibodies against modified versus native LDL) significantly higher than control subjects for Cu(2+)-oxidized LDL (1.88 +/- 0.6 vs. 1.05 +/- 0.3, P < 0.01, for IgG), malondialdehyde-modified LDL (2.54 +/- 0.73 vs. 2.04 +/- 0.11, P < 0.01, for IgG and 3.96 +/- 1.51 vs. 2.90 +/- 0.15, P < 0.01, for IgM), and malondialdehyde-modified human serum albumin (1.79 +/- 0.54 vs. 1.46 +/- 0.1, P < 0.05 for IgG). The possible role played by glycation in sensitizing LDL to oxidation was investigated by measuring autoantibodies against both glycated LDL (glycLDL) and glycoxydated LDL (glycoxLDL). NIDDM patients had an antibody ratio significantly higher than control subjects for anti-glycLDL and anti-glycoxLDL IgG (1.79 +/- 0.38 vs. 1.12 +/- 0.23, P < 0.01 and 2.55 +/- 1.03 vs. 1.39 +/- 0.44, P < 0.01, respectively) but not anti-glycLDL and anti-glycox-LDL IgM.(ABSTRACT TRUNCATED AT 250 WORDS)

Specificity of autoantibodies against oxidized LDL as an additional marker for atherosclerotic risk

BACKGROUND

LDL oxidation is a crucial step in the development and progression of atherosclerotic lesions. The detection of an increase in the anti-oxidized LDL antibody titre may thus represent a biological marker of enhanced LDL oxidation in vivo.

METHODS

The occurrence of anti-oxidized LDL autoantibodies was investigated in control patients, in patients with atherosclerotic coronary artery disease, in those without clinically relevant signs of atherosclerosis, but considered at risk, and in patients with chronic alcohol-related liver disease.

RESULTS

Anti-oxidized LDL autoantibodies were present in the plasma of the majority of patients with overt coronary atherosclerosis. An increased antibody titre can also be detected well before the onset of clinically relevant signs of the atherosclerotic disease in patients classically considered at risk, indicating the occurrence of in-vivo LDL oxidation during atherosclerosis development. The specificity of molecular targets (LDL) for oxidative modifications is supported by the demonstration that anti-oxidized LDL autoantibodies are absent in the plasma of alcoholic patients who exhibit a marked increase in biological markers of oxidative stress but do not classically develop atherosclerosis.

CONCLUSION

These data demonstrate that the occurrence of anti-oxidized LDL autoantibodies could be specifically related to the promotion and progression of atherosclerosis and is not a simple epiphenomenon of any oxidative process occurring in vivo.

[Wegener's syndrome (or granulomatosis). A clinical case]

Wegener granulomatosis is characterized by focal necrotizing granulomatosis of the upper respiratory and pulmonary tracts, by a necrotizing vasculitis and focal necrotizing glomerulonephritis. Clinical symptoms typically include intractable sinusitis or persistent nasal obstruction, serous otitis media, hemoptysis and pleurisy. These symptoms can also be accompanied by intermittent fever, weight loss, myalgia and sensory neuropathy. The oral lesions, including palatal ulceration, lingual ulceration, aphthae, nonhealing extraction sockets, gingivitis, have been infrequently described. Wegener's granulomatosis occasionally presents in the early stages as a characteristic hyperplastic gingivitis, named by the authors "strawberry gums", which fails to respond to conventional periodontal therapy. A case is reported, in which this clinically distinctive gingivitis was the presenting lesion with the serous otitis, illustrating that less frequently occurring entities, such as Wegener's granulomatosis, should be considered in the differential diagnosis of localized gingival lesions which fail to respond to conventional therapy.

[Use of seat belts during pregnancy]

After a review of the world literature on the advantages and compulsiveness of seat belts, the authors recommend pregnant women to use them. Moreover, they invite gynaecologists and midwives to favour their use during psycho-prophylaxis courses.

[Risk factors of endometrial carcinoma]

The authors base their experience on 12 women affected by endometrial carcinoma. Problems have been diagnosed in the post-menopausal and climacterium period, considering the clinical, hormonal and lipidic profile and some tumoral markers. The most risk factors for the endometrial adenocarcinoma have been collected in the adiposity with hypertension and hyperglycemia, above all in nullipara women with late menopause and dyslipidemia.

[Laparoscopic total hysterectomy and its complications]

The Authors base their experiences on 135 total laparohysterectomy operations. Of a sample of 39 cases the postoperative lapses have shown complications with a percentage of 28.87% so divided: 25 infectious complications (18.51%); 9 thrombophlebitis (6.66%); 3 vascular lesions (2.22%); 2 intestinal lesions (1.48%). They end by saying that to have good clinical conduction of such operations it is necessary to respect the specific hygienic and preventive rules.

[The Pap test in menopause]

In a study covering 156 Pap-tests in menopause, the Authors observed a reduction in infectious phlogosis, in dysplasias and neoplasias. They suggested that even during menopause in the Pap-test showed be conducted to monitor the VIN and a physiological senescence of the female genitalia.

[Preventive and therapeutic use of cefriaxon in gynecologic surgery]

The Authors have been investigating the behaviour of ceftriaxone in gynecological surgery employing 1 g of the drug through intravenous injection an hour before the operation, after executing a cutaneous pomphus the night before. They obtained satisfactory results since out of 25 cases analyzed nowhere had they to intervene with other antibiotics. The drug, despite the 15 cases of infectious pathology observed, has been showing great tolerance and an utmost ease and usefulness of usage.

[Prophylactic and therapeutic use of ceftriaxone in cesarean section]

Authors did the antibiotic-prophylaxis with ceftriaxone in twenty cesarean sections (1 phial EV). Prophylaxis was sufficient in thirteen cases; on the other hand, in the remaining seven prophylaxis was followed by the three days therapy (1 phial EV). A good tolerance of the medicine was revealed in all cases. Moreover, it was tested a wide antimicrobial action with resolution of all the verified infections, except for one bacterial resistance case where some other antibiotic was used.

[Value of the Pap-test in the cervical cytological screening]

Fourteen thousand three hundred fifty six cervical smears were performed in the Obstetric and gynaecologic Department of Casorate Primo Hospital (USSL no. 77) and Oncologic Center of Milan (USSL no. 75/II) between 1-1-1987 and 30-6-1991. The incidence and mortality of uterine cervix neoplasm are discussed and the uterine cervix neoplasm are discussed and the analysis of data shows a reduction of this cancer in all countries. In italy it is estimated that the incidence is of 20.88 per 1000,000 women of all ages.

[Changes in sexual behavior of women receiving substitution therapy after surgical menopause and women in physiological menopause]

We have made this study with the aim of comparing changes in sexuality between women who are in surgical menopause taking a substitutive therapy and those who are in physiological menopause. We have used a questionnaire instrument. It has been filled in by a physician during an individual conversation with the women. The results showed that sexuality valued through the parameters of satisfaction, coital frequency and desire, has been have penalized in the first group than in the second. It can be said that the trauma linked to hysterosalpingo-oophorectomy provokes alterations in sexuality which are not sufficiently counterbalanced by substitutive estrogenic therapy.

Complement activation in diabetes mellitus

To see whether or not there is complement activation in patients with diabetes mellitus, we investigated the plasma concentrations of C4, C3, C4a, C3a and SC5b-9 in either juvenile or adult onset insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetic patients at least 2 years after diagnosis. C4, C3, SC5b-9 plasma levels were not significantly different in IDDM and NIDDM patients than in age-matched controls. Anaphylatoxin peptide conversion product C4a, but not C3a, was found significantly higher in adult-onset IDDM patients than in patients with juvenile onset IDDM, NIDDM patients and age-matched controls. Complement activation did not appear to be correlated with the metabolic control, nor the duration of disease nor the presence of circulating antibodies (including islet cells (ICA), insulin (IA), thyroid microsomal (TMA), and thyroglobulin (TGA)). Although there are many factors that may trigger complement activation, we found the highest levels of C4a in elderly subjects (both diabetics and control subjects) and particularly in those who had clinically detectable vascular complications.

[Cases of endometrial hyperplasia diagnosed at a regional hospital in the Province of Pavia]

Two hundred and fourteen cases of endometrial hyperplasia were diagnosed at the Hospital of Casorate (USSL 77, Pavia) between 1 january 1984 and 31 december 1989. Cases were subdivided as follows: 60 glandular hyperplasias, 54 glandular cystic hyperplasias, 83 adenomatous glandular hyperplasias, 13 atypical glandular hyperplasias and 24 cases of endometrial cancer. The analysis of data shows an increase in hyperplasia, but only the adenomatous and atypical varieties have a potentially carcinomatous evolution.

[Short term post-surgical prophylaxis in gynecology. Use of cefonicid]

In this study the Authors have evaluated the use of cefonicid in "short-term" post-surgical prophylaxis in gynecology. No effects, nor alteration to hematochemical parameters related to the administration of this medicine have been observed and the analysis of data shows that the use of cefonicid contributes to reducing the incidence of post-surgical infections in hospital in a cure group compared to a control group.

[Regulation mechanisms in prolactin secretion. Possible role of the hypophyseal renin-angiotensin system]

Recent studies have shown a possible role of different factors in the regulation of prolactin secretion. In fact many neurotransmitters (dopamine) and peptides can modulate prolactin release from anterior pituitary lactotrophs. In vitro and in vivo studies, Angiotensin II has been shown to increase prolactin release. On the basis of these data we have studied the effects of enalapril (ACE-Inhibitor) on baseline plasma prolactin in nine hypertensive post-menopausal women. The results indicate that 15-day inhibition of angiotensin-converting enzyme by enalapril significantly reduced serum prolactin levels. These data suggest that the Angiotensin II may play a role in the control of prolactin secretion in hypertensive women.

[Use of sulprostone in abortion induced during the first pregnancy trimester in women with previous cesarean section]

The paper describes the advantages and negligible side-effects of the use of E2-type (Suprostone) synthetic prostaglandin, administered i.m. in a dose of 250 mg, 2-3 hours before voluntary abortion during the first trimester of pregnancy in pre-cesarean-section patients.

[Clinical evaluation of endometrial biopsy]

This study comprehends evaluation of endometrial biopsy performed between June 1986 and June 1989 in the Obstetric and Gynaecologic Department of Casorate Primo Hospital in fertile, perimenopausal and post-menopausal patients with uterine bleeding. The results show that on a total amount of 459 cases we registered 78 cases of initial abortions, 3 vesicular mola, 300 dysfunctional bleeding, 63 precancerous situations and 15 endometrial cancers. We confirm the diagnostic and prognostic validity of endometrial biopsy carried out with fractional curettage. The opportunity to prevent and diagnose precancerous pathology through a multiple screening is also estimated.

Spectral analysis of heart rate variability in the assessment of autonomic diabetic neuropathy

We studied heart rate variability in 49 uncomplicated diabetics (27 with insulin therapy; 22 with oral hypoglycemic agents) and in 40 age-matched controls. An automatic autoregressive algorithm was used to compute the power spectral density (PSD) of beat by beat RR variability derived from the surface ECG. The PSD contains two major components (a low frequency approximately 0.1 Hz (LF) and a high frequency, respiratory linked, approximately 0.25 Hz (HF] that provide, respectively, quantitative markers of sympathetic and vagal modulatory activities and of their balance. As compared to controls, in diabetics, besides a reduced RR variance at rest (2722 +/- 300 and 1436 +/- 241 ms2, respectively), we observed during passive tilt an altered response of spectral indices of sympathetic activation and vagal withdrawal, suggestive of a complex modification in the neural control activities. In addition, we compared this approach to the commonly used clinical tests score, and observed that the latter provides overall results similar to those obtained with spectral changes induced by tilt (r = 0.42; P less than 0.01). Of potential clinical importance is that the data obtained with spectral analysis appear more thoroughly quantifiable and do not require the active collaboration of the patients.

Prolactin lowering effect of dihydroergokryptine in rat and in man

The prolactin lowering activity of dihydroergokryptine was investigated both in rats and in humans. The drug was administered orally at the doses of 0.2, 1 and 5 mg/Kg to intact or reserpinized male rats. Nine male adult volunteers were given 300 mg cimetidine iv 90 min after receiving 2, 3 or 4.5 mg of dihydroergokryptine and 3, 4.5 and 6.75 mg of dihydroergocristine or placebo per os in a randomized, cross-over design. Eight young adult males were injected im with 10 mg sulpiride 120 min after randomly receiving dihydroergokryptine 2.5 and 5 mg or placebo in a cross-over manner. Finally, five healthy young women were given dihydroergokryptine 2.5 and 5 mg, bromocriptine 2.5 mg and placebo in a cross-over design. Dihydroergokryptine caused a strong, long-lasting, dose-dependent fall of plasma prolactin concentrations in both rats and humans. Moreover, it inhibited the reserpine-induced rise of plasma prolactin in rats, as well as the cimetidine-or sulpiride-induced hyperprolactinemia in humans. Dihydroergokryptine proved twice as potent as dihydroergocristine and about half as potent as bromocriptine. Effective doses of both dihydrogenated ergot alkaloids were much better tolerated than bromocriptine.