[The measurement of bronchial hyperreactivity for military service fitness]

The authors discuss the efficacy of methacholine challenge to discriminate fit subjects to military service. We evaluated the relation between bronchial hyperreactivity and clinical symptoms, airways caliber and atopic status in a group of italian conscripts who reported to have bronchial asthma. Five-hundred-four subjects were studied. Bronchial hyperreactivity was measured by methacholine test, and atopic status was assessed by skin-tests. A measurable PC20 FEV1 was detected in 424 subjects. On the basis of the methacholine threshold concentration the overall sample was divided in four categories. The four categories differed as regards onset of disease, lung function and skin reactivity towards Dermatophagoides Pter, whereas no difference was found as regards skin reactivity towards Grass. In the group evaluated in spring, the four categories differed as regards skin reactivity towards Grass. In conclusion we found that bronchial hyperreactivity is related to clinical history, lung function and atopic status; the measurement of bronchial hyperreactivity is important to evaluate conscripts referring bronchial asthma.

Synthesis and anticonvulsant properties of 3-(1,3,4-thiadiazol-2-yl) thiazolidin-4-ones

A series of 2-substituted 3-(1,3,4-thiadiazol-2-yl)thiazolidin-4-ones were synthesized and evaluated for anticonvulsant activity in a genetic model of reflex epilepsy (sound-induced seizures in DBA/2 mice). The combination of preferred substituents in the 2-position coupled with the introduction of a mercapto group on the thiadiazole moiety led to a number of active compounds. The anticonvulsant activity of most derivatives is better than that of the clinically useful anticonvulsant sodium valproate and some of them appear to possess potencies in the same range as phenytoin and clobazam.

Anti-HIV agents II. Synthesis and in vitro anti-HIV activity of novel 1H,3H-thiazolo[3,4-a]benzimidazoles

A series of 1-aryl-1H,3H-thiazolo[3,4-a]benzimidazoles was synthesized starting from o-phenylenediamine, disubstituted aromatic aldehydes and 2-mercaptoacetic acid. Their antiviral activity against human immunodeficiency virus (HIV) was explored: the 1-(2',6'-dichlorophenyl) (4c), 1-(2',6'-difluorophenyl) (4i), 1-(2'-chloro,6'-fluorophenyl) (4K) and 1-(2'-chloro,5'-nitrophenyl) (4m) derivatives significantly inhibit in vitro the viral cytopathic effect in HIV-infected CEM cells. Compound 4i was selected by NCI's Review Committee for initial preclinical development studies.

Anti-HIV agents. I: Synthesis and in vitro anti-HIV evaluation of novel 1H,3H-thiazolo[3,4-a]benzimidazoles

A series of 1-aryl-1H,3H-thiazolo[3,4-a]benzimidazoles were synthesized by one-pot reaction from o-phenylenediamine, 2-mercaptoacetic acid and a variety of aromatic aldehydes. All compounds obtained were evaluated for antiviral activity against human immunodeficiency virus (HIV). Compounds 4g, 4i, 4j, 4l and 4q exhibit reproducible in vitro anti-HIV activity.

The Defense Mechanism Test in nonpsychotic psychiatric outpatients and normal controls

In the Defense Mechanism Test, stimuli representing a central figure threatened by a peripheral person are presented tachistoscopically, at increasing exposure times. The threat is assumed to trigger defense mechanisms that are expressed by several types of perceptual distortions. Given that to date no experimental study has validated the discriminative power of the Defense Mechanism Test between normal controls and clinical groups, 99 normal controls and 57 nonpsychotic psychiatric outpatients were given the test. Significantly more psychiatric patients than controls were coded for presence of each of the ten main defensive signs of the Defense Mechanism Test (with a peak significance for reaction formation). Ten codings or subcodings of defense which were particularly rare in the control sample were employed to discriminate between groups. This procedure correctly allocated 85.8% of the control subjects and 85.9% of the psychiatric patients. The present findings allow a preliminary distinction between codings of defense with questionable, moderate, or strong clinical significance, in the area of nonpsychotic psychopathology.

FK-506 prevents diabetes in diabetes-prone BB/Wor rats

The effect of the immunosuppressant FK-506 on the development of diabetes in BB/Wor rats was investigated. Using a treatment schedule (25 micrograms i.m. from day 27 to 120), not associated with detectable general ill effects, this drug was found to completely inhibit the appearance hyperglycemia and to reduce the histological signs of pancreatic insulitis. The treatment was also able to reduce the percentages of Ia+ T-lymphocytes and to block the appearance of detectable serum levels of gamma interferon (IFN).

Denial of separation anxiety as measured by a serial tachistoscopic technique

A mother-child separation stimulus was repeatedly presented by standard Defense Mechanism Test procedure, at increasing durations of tachistoscopic exposure to 60 clinical and nonclinical subjects. Subjective verbal reports were coded blindly for evidence of perceptual distortions presumably indicative of denial of separation anxiety. Low scores on two items measuring sensitivity to separation anxiety and intolerance of aloneness were, as predicted, significantly more often characterized by codings of denial on the tachistoscopic exposures than subjects with high sensitivity to separation anxiety. Stability of effect became stronger when only very low and very high scores were compared for perceptual denial on the last four presentations of the series. This technique, employing other types of anxiety-evoking stimuli, may represent a reliable instrument to reveal the presence of defences toward each of the most relevant conflictual areas of the personality.

Microgenetic patterns of adaptation on the Stroop task by patients with bronchial asthma and duodenal peptic ulcer

Microgenetic patterns of adaptation on the Stroop task were assessed by means of the Serial Color-Word Test given 21 patients with bronchial asthma and 20 with duodenal peptic ulcer, who were compared with 41 normal controls matched for sex, age, and education. Two measures were calculated on each of the five trials of the test, one of linear change and one of nonlinear change in reading times. As predicted, patients presented more frequently patterns characterized by high nonlinear change and less frequently stabilized patterns (low linear and nonlinear change of reading speed). Linear and nonlinear change were then calculated on the five linear change scores and the five nonlinear change scores; again patients presented more frequently patterns characterized by high nonlinear change on both the linear change scores and nonlinear change scores and less frequently stabilized patterns. These findings indicate strong similarities between the adaptation patterns of patients with ulcer and asthma and the microgenetic patterns previously known to characterize neurotic and psychotic patients. Furthermore, scores on the Serial Color-Word Test also differentiated between ulcer and asthma groups.

Glucagon and insulin secretion in low birthweight preterm infants. The effect of glucose infusion

The effect of the intravenous glucose on plasma levels of glucagon and insulin were evaluated in thirty-five LBW preterm infants who were appropriate for gestational age. Their mean birthweight and gestational age were 1220 +/- 55 g (range 750-1730 g) and 29 +/- 1 weeks (range 25-35 weeks), respectively. A 30 min glucose infusion in 16 infants (1 g/kg b.w. in 30 min) caused a prompt and sustained suppression of plasma glucagon and a delayed but significant insulin release. The mean of the sum of maximal plasma glucagon decrements below the baseline was 173 +/- 42 pg/ml. In another 12 infants a significant fall in plasma glucagon and a variable but significant plasma insulin release also occurred throughout the 24 h study on continuous intravenous glucose (rate 2.4-2.7 mg/kg/min). The mean of the sum of maximal plasma glucagon decrements below the baseline up to 12 h was 282 +/- 36 and was similar to that seen in the previous group.

Isolated lissencephaly: report of four patients from two unrelated families

Lissencephaly is a brain malformation manifested by a smooth cerebral surface and caused by incomplete neuronal migration. Clinical sequellae include minor craniofacial changes (bitemporal hollowing, small jaw), severe mental retardation, and other neurological abnormalities. Patients with classical or type I lissencephaly and its sequellae but no other significant anomalies are classified as having isolated lissencephaly sequence. Possible causes of isolated lissencephaly sequence include ischemia or viral infection during the time of neuronal migration, microdeletion within the Miller-Dieker syndrome critical region in chromosome band 17p13.3, and Mendelian inheritance. The last is based on a report of a single family with three affected children in 1933. We report four patients with isolated lissencephaly sequence from two unrelated families who provide further support for autosomal (or possibly X-linked) recessive inheritance. In the first family, three brothers were affected. In the second, the parents are first cousins.

Synthesis and anticonvulsant properties of 2,3,3a,4-tetrahydro-1H-pyrrolo[1,2-a]benzimidazol-1-ones

A series of 2,3,3a,4-tetrahydro-1H-pyrrolo[1,2-a]benzimidazol-1-ones were synthesized and evaluated for anticonvulsant activity in DBA/2 mice against sound-induced seizures and in rats against maximal electroshock-induced seizures. Most of the derivatives showed an anticonvulsant effect better than that of valproate, a commonly used anticonvulsant drug. Compound 3 possessed an anticonvulsant activity comparable to that of diphenylhydantoin in both tests and was selected for further studies. Structure-activity relationships are discussed.

Compounds with potential antitumor activity. VI--2-Alkyl-3-[2-(1,3,4-thiadiazolyl)]-4-thiazolidinones

The antitumor activity of a series of 2-alkyl-3-[2-(1,3,4-thiadiazolyl)]-4-thiazolidinones was tested against the leukemic P 388 tumor system in mice. Only compounds (V-VII) showed significant activity.

[Role of ambulatory electrocardiography in the evaluation of interventions: rehabilitation of a patient who has undergone surgery]

The authors relate their own experience with 24 hr Holter monitoring in course of cardiac rehabilitation after coronary bypass surgery as well as after valvular replacement. As regards patients after coronary surgery they report the experience they got in the evaluation of heart rate trend and cardiac arrhythmias as well as in silent ischemia study. About this last problem 116 patients with signs of ischemia both in stress test and in Holter recording are considered out of 491 who had undergone coronary surgery. Ischemia during 24 hr Holter monitoring develops at an heart rate lower than effort ischemia. Holter monitoring proves to be very useful also in patients after valvular replacement to study arrhythmias and to check drugs' efficacy. After displaying the results concerning arrhythmias of 24 hr Holter electrocardiograms recorded in 207 randomized patients who had undergone valvular replacement 15 days before, the authors dwell upon the use of Holter electrocardiography in 82 valvular patients after pharmacological cardioversion and show that major arrhythmias get a clear reduction thanks to rehabilitation.

Diprosopus with associated malformations: report of two cases

We report on two patients with craniofacial duplication and anencephaly. In addition to these anomalies, one patient showed vertebral fusion and diaphragmatic hernia, and the other one presented cheilognathopalatoschisis.

Dextrocardia with and without situs viscerum inversus in two sibs

We described two sibs born to consanguineous Sicilian parents who died of severe congenital heart malformation. Both had dextrocardia; however, only the girl had situs viscerum inversus. At necropsy she was found to have a right spleen and right pulmonary isomerism (three lobes in each lung, as commonly found in the asplenia syndrome). This observation, together with other literature reports, suggest that isolated dextrocardia, situs viscerum inversus, and the asplenia-polysplenia complex may be different end results of a unique dysmorphogenetic process involving the embryonic midline.

Oversized infant of diabetic mother: its cause and prevention

In this study the birth weights of 431 infants of diabetic mothers of the Milan series have been compared with the birth weights of infants of a control group. The averages and the centile distributions of weights of infants of gestational diabetic mothers (Class A) and of diabetic mothers without vascular complications (Classes B and C) did not differ substantially from those of control newborns (table I, figure 1). This confirms the clinical indication, based on the hyperglycemia-hyperinsulinism theory that fetal macrosomia can be prevented provided maternal metabolism is strictly controlled. In this series insulin was administered at the maximal tolerated dose (MTD), a therapeutic regimen that provides excellent metabolic control of the mother. In multiparae, the birth weights of the infants of the latest pregnancy were drastically lower than the birth weights of the infants in their previous pregnancies (without MTD insulin) (table II). Our results do not confirm the recent hypothesis that pregnant diabetics with strict metabolic control during pregnancy generally give birth to growth retarded infants. The MTD of insulin has also been administered to gestational diabetic mothers, and fetal macrosomia was prevented (table I, figure 1). This confirms the opinion of those who believe that a diet-regimen must be accompanied by insulin administration to correct the slight metabolic abnormality of these patients. As would be expected because of placental insufficiency, infants of patients with vascular complications, including those who have only calcifications of the pelvic vessels (White' Class E), were growth retarded (table I, figure 1). The risk of fetal growth retardation in Class E has not been remarked upon in the literature, since pathology of pelvic vessels is usually disregarded and the patients remain undifferentiated among Classes A-C. The possibility to prevent fetal macrosomia with a strict control of maternal diabetes has been questioned because of the lack of correlation between fetal macrosomia and the degree of maternal hyperglycemia and of fetal hyperinsulinism. We postulate that, if fetal hyperinsulinism causes hypoxia, as it does in experimental animals, the lack of correlation may be due to the fetal hyperinsulinism itself.

[Compounds with potential antitumor activity. V. 2-Substituted 3-[2-(1,3,4-thiadazolyl)]-4-thiazolidinone]

The synthesis of a series of 2-substituted 3-[2-(1,3,4-thiadiazolyl)]-4-thiazolidinones is described. Evaluation of these derivatives against P 388 lymphocytic leukemia growth in mice revealed that no compound shows significant activity. 2-(2-Thienyl)-3-[2-(1,3,4-thiadiazolyl)]-4-thiazolidinone (I) whose significant activity on P 388 leukemia was reported in a previous paper, was tested against other experimental tumors: it exhibits slight activity also against L 1210 leukemia and M 5076 ascitic sarcoma.

Hydrocephalus, lissencephaly, ocular abnormalities and congenital muscular dystrophy. A Warburg syndrome variant?

The authors report a family in whom three members suffered from congenital hydrocephalus and ocular abnormalities. One of these patients showed along with these symptoms congenital muscular dystrophy. In this child, autopsy disclosed severe cerebral malformations consisting of lissencephaly, arhinencephaly, stenosis of aqueduct, Dandy-Walker cyst and cerebellar micropolygyria. The mode of transmission, the eyes abnormalities and the neuropathological findings of this family resemble the clinical and pathological aspects of Warburg syndrome. However, the presence of congenital muscle dystrophy in one of these children suggests some links with Fukuyama's congenital muscular dystrophy and/or with so-called brain-eye-muscle disease of Santavuori. These three syndromes are shortly discussed. The present case and few others reported in the literature obviously represent a severe and lethal form of a congenital disease involving brain, muscle and eyes.

The development and function of the endocrine pancreas of fetuses and infants born to normal and diabetic mothers

The development of the human endocrine pancreas is described. The hormone content and islet responsiveness of foetal and neonatal pancreases of diabetic and non-diabetic pregnant women are reported.

Ontogenetic development of pancreatic thyrotropin-releasing hormone in human foetuses and in infants

The ontogeny of thyrotropin-releasing hormone (TRH) in pancreata of human foetuses from 15-36 weeks of gestation and of infants has been studied. TRH was detectable in the pancreas of a 15 week old foetus; a progressive increase of pancreatic TRH content was observed until the 34th week of gestation, whereas a progressive decrease was found in the late period of pregnancy and in 1 year old infants. In contrast, the pancreatic insulin content showed a progressive increase during the entire pregnancy and in the first year after birth. These data indicate that TRH and insulin have different ontogenetic patterns in the human pancreas.

Beckwith-Wiedemann syndrome: a quantitative, immunohistochemical study of pancreatic islet cell populations

The endocrine cell content of the pancreas of two cases of Beckwith-Wiedemann syndrome with islet cell adenomatosis were studied. Insulin, glucagon, somatostatin and pancreatic polypeptide cells were evaluated qualitatively and quantitatively with the indirect immunofluorescence method and morphometry was used to establish the volume density of the four endocrine cell populations. This evaluation showed a marked increase of insulin and glucagon cells and a lesser augmentation of pancreatic polypeptide cells and somatostatin cells. However, the percent of somatostatin cells was decreased in comparison with controls. Qualitatively, the two pancreas were characterized by the lack of segregation of glucagon and pancreatic polypeptide cells to distinct parts of the gland, with each cell type being abundant in the pancreatic region in which they are normally very sparse. The marked increase of endocrine cells often took the form of giant islet-like structures formed by smaller subunits; however, despite this increase, the distribution of insulin cells respected the normal pattern, i.e. clusters of B cells surrounded by non-B cells. These findings indicate that besides the proliferation of pancreatic endocrine cells maintaining a normal topographical distribution of B versus non-B cells, the pancreas of patients with the Beckwith-Wiedemann syndrome may have undergone abnormal development with a consequent lack of segregation of glucagon and pancreatic polypeptide cells to different parts of the gland.

Cephalosporins. VII. Synthesis and antibacterial activity of new cephalosporins bearing a 2-imino-3-hydroxythiazoline (2-aminothiazole N-oxide) in the C-7 acylamino side chain

Introduction of a hydroxyl group into the thiazole ring nitrogen of cephalosporins belonging to the cefotiam and cefotaxime families gave rise to products, better described by the tautomeric N-oxide form, which proved particularly active against Gram-negative bacteria. Cephems bearing a (Z)-alkoxyimino functionality are of special interest for broadness of spectrum; among them, 7 beta-[(Z)-2-(2-amino-4-thiazolyl-N-oxide)-2 -methoxyiminoacetamido]-3-(tetrazolo-[1,5-b] pyridazin-6-yl)thiomethyl-3-cephem-4-carboxylic acid (5c-7, FCE 20635), in other ways similar to cefotaxime, showed useful levels of activity against cephalosporinase-producing strains resistant to the reference drug. Preliminary in vivo studies demonstrated the therapeutic efficacy of the new compound in the treatment of experimental systemic, subcutaneous and urinary tract infections in mice.

[Compounds with presumable antitumor activity. III. 1-Substituted N,N'-di-2-pyrimidinyl (or pyrazinyl)methylenediamine]

A series of 1-substituted N,N'-di-2-pyrimidinyl (or pyrazinyl)methylenediamines were synthesized as potential antitumor agents. The compounds were tested on lymphocytic murine leukemia P 388. The active 1-(2-chlorophenyl)-N,N'-(2-pyrazinyl)methylenediamine (IX) was also tested on other experimental tumors.

[Compounds with presumable antitumor activity. II. 2-Substituted 3-(2-thiazolyl) and 3-[2-(1,3,4,-thiadizolyl)]-4-thiazolidinones]

2-Substituted 3-(2-thiazolyl) and 3-[2-(1,3,4-thiadiazolyl)]-4-thiazolidinones were prepared and tested for their activity against the leukemic P 388 tumor system in mice. The thiadiazolyl derivatives are generally more active than the thiazolyl ones and some of them showed significant activity.

Pharmacokinetic study of the new sulfamethopyrazine-trimethoprim combination (kelfiprim) in renal insufficiency

The combination of trimethoprim (TMP) and sulfamethopyrazine (SMP) has been successfully used to treat chronic urinary tract infections. Since parenchymal involvement associated with renal insufficiency of varying degree is not infrequent in these patients, it was considered important to study the pharmacokinetics of TMP and SMP in a fixed dose combination. Four groups of patients were studied: 1) 4 patients with endogenous creatinine clearance (CLcR) between 80 and 40 ml/min; 2) 3 patients with CLcR between 40 and 10 ml/min; 3) 3 patients on chronic peritoneal dialysis (CAPD); and 4) 3 patients on haemodialysis. A single oral dose of 250 mg TMP and 200 mg SMP was given to each patient. Multiple samples were collected over 9 days and the following pharmacokinetic parameters were calculated: total area under the plasma level curve, slow disposition rate constant beta and the corresponding t1/2 beta, plasma clearance and the apparent volume of distribution. The results show that the two moieties of the TMP-SMP combination behaved differently in uraemic patients as fas as elimination rate was concerned. TMP was eliminated more slowly both in patients with diminished renal function and in those subjected to haemo- or peritoneal dialysis. The reduction in the rate of elimination of TMP was significantly correlated with the degree of renal impairment. The elimination of SMP, however, was not significantly affected by the reduced renal function; indeed a tendency to increase was noted, at least in dialyzed patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Inhibition of glucagon secretion in the human newborn by glucose infusion

Plasma glucagon, serum insulin, and blood glucose responses during a 30-min glucose (1 g/kg body wt) or saline infusion were reported in 37 full-term and 35 preterm infants. They were studied either on the first day of life before feeding was initiated or during the first week of life. Glucose infusion promptly suppressed glucagon secretion in all infants even from the initial hours of extrauterine life. The mean maximal decrement in percentage in the full-term infants on the day of birth and older was 54 +/- 4% and 61 +/- 6%, respectively, while the maximal decrement in the preterm infants on day of birth and older was significantly lower (44 +/- 3% and 38 +/- 4%, respectively). The insulin response to glucose was variable in all infants and most of them showed a delayed rise of serum insulin. No change in plasma glucagon, blood glucose, and serum insulin was observed during and after saline infusion.

A quantitative immunofluorescent study of the endocrine cell populations in the developing human pancreas

The immunofluorescent cell content of the pancreas of 8--40-wk fetuses and of 1.5--5-mo Caucasian infants was quantitatively evaluated using anti-insulin, anti-glicentin, anti-glucagon, anti-somatostatin, and anti-pancreatic polypeptide antisera. The most significant findings are: (1) the pancreas of 8--10 wk fetuses contains a sizable population of endocrine cells reacting exclusively to anti-glicentin antiserum. This cell population decreases and disappears in later stages and is replaced by the adult type glucagon/glicentin immunoreactive cell; (2) the pancreatic polypeptide-rich region shows a lower relative endocrine cell content as compared with the glucagon-rich region and its islets appear smaller; (3) in the total pancreas, the relative (volume density) and absolute (microliter) insulin cell content increases regularly with age, while the relative volume of glucagon cells peaks in fetal life (wk 17--20) to decrease in infants, although remaining at higher levels than in adults; the relative and absolute volumes of somatostatin cells are elevated in fetal and infant stages studied where they represent the second most abundant cell type, while pancreatic polypeptide cells appear to least abundant cells during prenatal and infant life. These data show several differences with the pattern of the respective endocrine cell populations in the adult pancreas.

Role of thyrotrophin-releasing hormone in the development of pituitary-thyroid axis in four anencephalic infants

Anencephaly provides a unique model for studying endocrine functions in absence of hypothalamic influence. We previously reported that in anencephalic newborns both pituitary TSH-secreting cells and the thyroid were normal and were able to function if adequately stimulated. In order to verify if the normal development of the pituitary-thyroid axis in these infants depends on TRH of extrahypothalamic origin, we measured endogenous TRH levels in the clear fluid of a cyst of the cerebro-vasculosa in 4 anencephalic newborns. In these cysts were also injected 200 micrograms of synthetic TRH and evaluated TSH response in peripheral blood samples. Endogenous TRH was detectable in the cysts of the cerebro-vasculosa in 3 of the 4 infants. In all 4 cases serum TSH sharply increased after TRH administration. Our data suggest that the normal development of the pituitary-thyroid axis in anencephalic infants either requires no TRH or depends on extrahypothalamic TRH. In this latter case TRH produced by other areas of the central nervous system might be secreted into the cysts of the cerebro-vasculosa, actively transported to the hypophyseal vessels, and might thus reach the pituitary to stimulate TSH-cells growth and function.

Glicentin precedes glucagon in the developing human pancreas

A quantitative evaluation of immunofluorescence elicited by anti-insulin, anti-glucagon, anti-glicentin, anti-somatostatin and anti-pancreatic polypeptide antisera has been carried out in the pancreas of 5 human fetuses from 3.0 to 9.6 cm C.R. The data obtained indicate that while insulin and somatostatin-containing cells are approximately in similar proportions with respect to the other endocrine cell types in the five fetuses studied, the glucagon and glicentin immunoreactive cells and the pancreatic polypeptide cells are not : a) pancreatic polypeptide-containing cells increase in proportion as fetuses grow older; b) the youngest fetuses (3.0 to 4.3 cm C.R.) contain a high proportion of cells reacting to anti-glicentin antiserum only (GLI-cells) and a small proportion of cells stained both with the anti-glicentin and anti-glucagon antisera (GLI/GLU-cells). However, the latter cell type which stains similarly as the postnatal and adult pancreatic A-cell (GLI-cells are not detectable in the postnatal and adult pancreas) increases iin proportion in older fetuses, while the proportion of GLI-cells decrease. The data suggest that the definitive adult-type A-cell matures from a GLI-cell type which is not able to convert glucagon precursors GLI(s) into glucagon.