Effect of chronic clonidine administration on GH secretion in adult human subjects

It is well known that the acute administration of clonidine, an alpha 2-adrenergic agonist commonly used as an antihypertensive drug, stimulates GH secretion, likely via hypothalamic growth hormone releasing hormone (GHRH) release. Conversely, evidences of a hyperactivity of GHRH-GH-somatomedin C (SMC) axis during chronical administration of clonidine are controversial. In this study, GH and SMC levels have been evaluated in 16 hypertensive patients chronically treated with clonidine. The subjects were randomized to receive either TRH or saline with the aim of evaluating the non specific GH response to TRH as compared to spontaneous fluctuations during a control test. In basal conditions, GH and SMC concentrations in clonidine treated patients were similar to those observed in an age and sex matched group of normal untreated subjects. An abnormal increase in plasma GH occurred in 5 out of the 10 patients who received TRH, while plasma GH did not show significant variations during testing in the subjects who received saline. It is suggested that chronical administration of clonidine does not induce an hyperactivity of GHRH-GH-SMC axis as estimated by plasma GH and SMC concentrations, but may induce a disorder in hypothalamic control of GH secretion, possibly implicated in the abnormal GH responsivity to TRH.

CRH and lysine-vasopressin stimulation tests in the diagnosis of hypoadrenalism secondary to hypothalamic or pituitary disorders

Ten patients with secondary hypoadrenalism have been tested with corticotropin releasing hormone (CRH) and lysine-vasopressin (LVP). One patient had isolated ACTH deficiency; 9 had deficiency of other pituitary hormones attributable to a primary pituitary disease in 3 and to an hypothalamic disorder in 6. After CRH administration, a definite increase in plasma ACTH was observed in all 6 patients with hypothalamic disorder. No response was elicited in the 3 patients with pituitary disease and in the patient with isolated ACTH deficiency. In the responsive patients. ACTH showed a delayed and prolonged pattern of response. Lysine-vasopressin administration produced an increase in plasma ACTH in 4 of the 6 hypothalamic patients and no response in those with pituitary disease and in the patient with isolated ACTH deficiency. These findings suggest that CRH represents a reliable test in differentiating hypothalamic from pituitary adrenal failure; LVP appeared a less sensitive diagnostic test.

A black adrenocortical adenoma causing Cushing's syndrome not imaged by radiocholesterol scintigraphy

In a 33-year-old female patient with left adrenal tumour and Cushing's syndrome, adrenocortical scintigraphy with radiocholesterol did not image the tumour nor the suppressed contralateral gland. Histology showed a black adrenocortical adenoma composed only of compact cells; there was no evidence of malignancy. This demonstrates that non-visualization of the adrenal glands in a patient with Cushing's syndrome is not invariably due to adrenal carcinoma. The literature on black adrenal adenomas causing Cushing's syndrome is reviewed.

Selenium intake with diet in Italy: a pilot study

Selenium is an element essential to man. The main environmental pathway of Se-exposure for the general population is through food. As is true for all essential elements, not only deficient but also excessive exposure results in adverse health effects. Between these extremes there is a range of safe and adequate Se intakes. In 1980 the Italian National Research Council recommended 50-200 micrograms/day as an interval adequate to meet nutritional requirements, being at the same time below the threshold of toxic effects. Therefore the evaluation of dietary Se intake has become very important. The purpose of this work is the estimation of dietary intakes of Se using data on the amount and composition of an average Italian diet. Complete meals from a factory canteen were analyzed and calculations of weekly intake of Se carried out. Analyses were performed by means of Inductively-coupled Plasma Atomic Emission Spectrometry. The results obtained, related to the average and indicative food consumption of Italian people, showed that the daily intake is well within the recommended range.

A syndrome of primary gonadal failure, short stature, mitral valve prolapse, and mental retardation

Two brothers referred for hypogonadism presented with short stature, mild mental retardation, and minor anomalies. In addition, both patients had hypogonadism due to primary gonadal failure and mitral valve prolapse, in the absence of other heart defects. A complete hormonal evaluation in one of the patients showed abnormal growth hormone (GH) and gonadotropin responses to different stimuli, findings suggestive of a disorder of hypothalamic-pituitary regulation. Both patients had normal chromosomes (46,XY) as did their mother (46,XX), who had some of the clinical manifestations found in her sons but in a milder form. We propose that this is a new syndrome.

Effect of unbalanced diets on the long-term metabolism of a toxicant. 1. Lead in rats: preliminary note

The aim of this study was the evaluation of the effect of dietary imbalances on absorption and distribution of lead in the female Sprague-Dawley rat. In this note preliminary results on the relationship between blood concentrations of lead and unbalanced diets are presented. Hyperproteic, hyperglycidic, hyperlipidic and balanced diets were prepared, and most of them included 15 mg/kg lead. Blood samples were collected at day 0, 21, 36, and 95 of the diets and analyzed by anodic stripping voltammetry (ASV). Lead uptake as a function of feed consumption was found to decrease in the order: balanced, hyperproteic and hyperglycidic, hyperlipidic diet. On the other hand lead blood levels were as follows (decreasing order): hyperlipidic, hyperproteic, hyperglycidic, balanced. Further research is being carried out on the influences of dietary imbalances on whole-body distribution of lead.

Effect of methyldopa on prolactin serum concentration. Comparison between normal and sustained-release formulations

In a group of ten hypertensive patients, the effects of methyldopa administration in two different formulations on serum prolactin (PRL) were studied. A single oral dose of normal release methyldopa significantly increased serum prolactin levels, peak concentrations occurring 3 to 6 h after drug administration. On the contrary, administration of sustained release methyldopa at the same dose was only followed by slight and not significant fluctuations in prolactin plasma levels. Both formulations produced a significant decrease of systolic and diastolic blood pressures, without significant differences between sustained and normal release methyldopa effects.

Investigation of microelement content of bulk milk from different regions of Italy

Samples of bulk milk were analyzed for their lead, cadmium, zinc, chromium and copper contents in relationship to the production zone and at various periods of the year. The results obtained showed that the milk samples examined would be considered free from peaks of metal contamination. The metal contents of milk analysed were not related to the different degrees of pollution in the various zones or the type of the animals' diet, but mainly to chance.

Improvement of diabetes after treatment with somatostatin analogue SMS 201-995 in an acromegalic patient

The beneficial effects of long acting somatostatin analogue SMS 201-995 in an acromegalic patient affected by severe diabetes mellitus are reported. Neither human insulin alone nor human insulin plus bromocriptine allowed satisfactory metabolic control though, with the latter treatment, virtually normal plasma GH levels were reached. Conversely, addition of SMS 201-995 to insulin treatment led to normalization of blood glucose. This result was obtained with a dose of SMS 201-995 of 400 micrograms/day and only after 3 weeks of therapy.

Haemangioblastoma of the brain. Computed tomography and angiographic studies in 17 patients

Between 1975 and 1983, 17 patients who underwent surgery for haemangioblastomas of the brain (16 lesions occurring in the posterior fossa) were studied with CT scans (17 cases) and vertebral angiograms (15 cases). The CT scans were superior for demonstrating a cystic tumour, its topography in the posterior fossa, its relationship to the fourth ventricle, and the presence and degree of an obstructive hydrocephalus. The vertebral angiographies were more sensitive and specific than CT for revealing the vascular nature, and were imperative in order to establish the supply and drainage of the tumours. It is clear that CT and angiography each make an important contribution toward defining these tumours. Their association is necessary.

Direct imaging of live human platelets by flash x-ray microscopy

A 100-nanosecond pulse of long-wavelength x-rays was used to produce high-resolution stop-motion images of living human platelets. Although some aspects of the structure conform to those seen in dehydrated specimens, novel features are apparent. The technique should permit detailed stop-motion examination of the interaction of platelets with their surrounding medium as well as exploration of the phagocytic and secretory activities of a wide variety of other cells.

Evidence for differing dopaminergic activity in childhood- or adult-onset obesity

In order to investigate dopaminergic activity in two types of human obesity, childhood- and adult-onset, we have studied the responses of plasma TSH and prolactin to domperidone, a dopamine receptor antagonist, in 12 patients obese since early childhood, 12 patients with adult-onset obesity, and in 12 lean controls. All subjects were females. In childhood-onset obese patients the responses of plasma prolactin and TSH to antidopaminergic stimulation were lower than those of adult-onset obese patients and lean controls. Conversely, the stimulus elicited a normal response of plasma prolactin and an exaggerated response of plasma TSH in adult-onset obese patients. These data indicate the presence of differing dopaminergic tone in the two types of human obesity.

Surgical treatment of tentorial arteriovenous malformations draining into the subarachnoid space. Report of four cases

Four patients with tentorial arteriovenous malformations (AVM's) were treated surgically. The operative findings in the first case suggested that clipping of the draining vein close to the AVM may result in complete cure. The three subsequent cases were treated with this technique. The clinical and radiological implications are discussed.

Gonadotropin response to gonadotropin releasing hormone in acute schizophrenia

To evaluate hypothalamic-pituitary-gonadal axis in acute schizophrenia, plasma FSH and LH concentrations were estimated both in basal conditions and after stimulation with gonadotropin releasing hormone (GnRH, 200 micrograms i.v.) in 14 young male patients with acute schizophrenia and in a age-matched group of 14 healthy male controls. Basal plasma PRL and testosterone levels were also measured. The mean basal levels of LH and FSH were slightly lower in schizophrenics, while the mean testosterone and prolactin levels were similar in the two groups. The FSH response to GnRH was significantly reduced in patients with acute schizophrenia, while the response of LH was similar in schizophrenics and in the controls. The possible significance of these findings is discussed in the contest of the complex neuroendocrine regulation of gonadotropin secretion and the overactivity of dopaminergic systems in acute schizophrenia.

Intrasellar meningioma

Two purely subdiaphragmatic intrasellar meningiomias are described. The rarity of this unusual intrasellar tumor is stressed, and the differential diagnosis of intrasellar meningioma versus pituitary adenoma is discussed. The good results of the rhinoseptal route for surgery are emphasized.

Meralgia paraesthetica following weight loss. Case report

The authors report on a case of persistent meralgia paraesthetica of the left side, following a weight loss of 8 kg in one month. Not only volumetric changes of the panniculus adiposus in the inguinal region but also a slight arrangement of the inguinal ligament and a state of undernourishment contribute to the compression of the lateral femoral cutaneous nerve. By microsurgical epineurectomy and interfascicular neurolysis the disappearance of the meralgia and preservation of the sensation on the antero-lateral aspect of the thigh are obtained.

Diagnostic value of objective campimetry

The results obtained in ten normal subjects with a new method of pupillocampimetry are described and compared with those obtained with routine campimetry. Once the relationship between the two methods was established, ten subjects suffering from pregeniculate or postgeniculate lesions of the optic pathways were examined by pupillocampimetry. This study shows the value of this new method, particularly for the differential diagnosis of pre- or postgeniculate lesions.

Charcterization and measurement of normal platelet-associated immunoglobulin G by fluorospectrophotometry

Platelet-associated immunoglobulin G of normal healthy subjects was measured and its binding characteristics studied by use of a newly developed assay which is rapid, quantitative, sensitive and inexpensive. The assay is based on fluorospectrophotometry. Fluorescein isothiocyanate was used as a fluorescent marker to label IgG. Measurement of platelet-associated IgG by this method showed that normal platelets have at least two types of binding sites for IgG of normal healthy subjects. High- and low-affinity binding sites numbering 410 +/- 200 and 1800 +/- 500, respectively, were identified. Specificity of binding was shown by competition between fluorescein isothiocyanate-labeled IgG and nonlabeled IgG. The effect of pH and temperature and the kinetics of binding were also investigated.

Indications for the surgical treatment of hydrocephalic dementia

Eighteen patients with chronic hydrocephalic dementia who had a ventriculo-atrial or ventriculo-peritoneal shunt are reported. The indications for operating on this type of dementia are discussed on the basis of the clinical and instrumental protocol and the postoperative results.

The Empty Sella syndrome secondary to Rathke's cleft cyst

A case of Empty Sella secondary to Rathke's cleft cyst, successfully operated on, is reported. Asymptomatic cysts of Rathke's pouch are fairly frequent autopsy observations. They can cause optic-chiasmatic and endocrine symptomatology or, very rarely, an Empty Sella syndrome if the cyst is very large.

Neurological results in spinal cord metastases

Btween 1971 and 1978 140 cases of spinal metastasis treated by decompression or possible removal of secondary neoplasm, were studied. Patients were divided according to their preoperative neurological conditions and then evaluated on the ground of regression of spinal cord and root symptom. The possibility of treating this type of compressive spinal pathology surgically is discussed.

Surgical treatment of thoracic disc protrusion

The Authors report on nine cases of thoracic disc hernia operated on through Carson's posterolateral approach. Several steps were taken to protect the spinal cord, and to remove completely disc fragments and any calcifications. The importance of the combined use of the operating microscope and the posterolateral approach are emphasized, and the longterm results are evaluated.

[Transitory ischemia of the mesencephalon caused by vertebral angiography]

Vertebral angiography, performed using catheterization according to Seldinger, is followed by a transitory Weber syndrome. The Authors maintain that the vessel spasm of the vertebro-basilar territory, visible during the angiography, is the main cause of the transitory ischemic attach at the base of the mesencephalon.

[Benign intracranial hypertension and thrombosis of the venous sinuses during contraceptive treatment: anatomo-clinical and neuroradiological observations (author's transl)]

The side-effects of oral contraceptives on the nervous system have been studied in 2 patients. The first case, a young woman who, after several years, of cyclic consumption of 4 mg of norethylsterone acetate and 0.05 mg of ethynilestradiol, died from a transtentorial temporal hernia due to severe intracranial hypertension. Angiography, and later autopsy, showed thrombosis of the dural venous sinuses and also of the majority of the emissary veins with C.S.F. blockage. The second case, a patient who took 1 mg of norethyndrone and 0.05 mg of mestranol for 20 months, developed a focal symptomatology (Grand Mal, global aphasia without lowering of the level of conscionsness) which cleared up rapidly. The CAT performed during the clinical illness showed mild signs of intracranial hypertension while cerebral angiography normal. It seems possible that the hormonal treatment may disturb the mechanisms of C.S.F. production-reabsorbtion and the filtration dynamics of the blood-brain barrier and perhaps, cause alteration of hypothalamic-hypophysial function. This would explain a transitory symptomatology, such as benign intracranial hypertension. However, the thrombosis of the venous sinuses (sometimes, as in our first case, massive) may be due to the venous stasis, that accompanies intracranial hypertension and to the altered blood coagulation.

[Isotopic study of the C.S.F. hydrodynamic in the Arnold-Chiari malformation (author's transl)]

Six cases of Arnold-Chiari malformation Type I were studied according to the following instrumental protocol; skull and atlanto-occipital hinge X-rays, including the tomography of these regions, X-rays of the spine, vertebral angiography, isotopic cisternography using RIHSA injected intraspinally, fractionated pneumoencephalography, Dimer-X ventriculography and iodized myelography. The AA emphasize the importance of the cisternographic test with radioisotopes for pre-operative and post-operative control of the C.S.F. dynamic.

[Combined treatment for malignant primitive brain tumors in infants using CCNU, neurosurgery and radiotherapy (author's transl)]

The preliminary data (13 cases) is used to make a comparison between the survival length from the beginning of chemotherapy of these pediatric neuro-oncotypes with that of adults bearing sovra-tentorial astrocytomas or glioblastomas given the same treatment. Approximating, by means of normal distributions, the experimental results the Authors also note that the clinical efficacy of CCNU is more or less the same for infants and adults.

Effect of chilling on platelet cyclic adenosine 3:5-monophosphate and adenylate cyclase activity

Exposure of platelets to 1 C led to a transient increase in cyclic AMP levels (determined either by a protein binding method or by radioimmunoassay) within five to ten minutes reaching a maximum 10 to 15 minutes after chilling was begun and returning subsequently to baseline values. Addition of EDTA to the platelet suspension medium prevented this increase. Rewarming at 37 C produced a sudden reduction in platelet cyclic AMP. To determine whether the cold-induced increase in cyclic AMP was due to a transient stimulation of platelet adenylate cyclase or a rapid inhibition of phosphodiesterase, these enzymes were assayed in ruptured platelet suspensions. Platelet adenylate cyclase activity was found to possess certain characteristics similar to those of the enzyme derived from other sources but there was a marked potentiation of fluoride-stimulated adenylate cyclase activity by 0.001 M EDTA. This effect was limited to low EDTA concentrations. Exposure of platelets to 1 C for up to 60 minutes did not increase adenylate cyclase activity but lowered it substantially compared with controls kept at room temperature. Phosphodiesterase activity at 1 C was depressed sooner and to a greater extent than was adenylate cyclase. The transient rise in cyclic AMP levels in chilled platelets appears to be due to a disproportionate reduction of cyclic nucleotide phosphodiesterase activity.