[Current role of angiography in the diagnosis of hepatic cavernous hemangioma]

46 cases of cavernous hemangioma of the liver, studied by angiography, are reported. Part of them were studied with echotomography and CT too, and 28 with angiotomography. In author's opinion based on experience, angiographic diagnosis of the lesion is, in presence of typical angiographic patterns, always confirmed, while echotomography and CT are not specific, especially in differential diagnosis with neoplastic malignant, primitive or secondary, hepatic lesions. Diagnostic algorithm needs, in their opinion, an initial echotomographical phase and, in presence of positive pictures for expansive hepatic mass with clinical suspicion for haemangioma, angiography and angiotomography for complete and specific diagnosis.

Effect of long-term treatment with sodium valproate on gonadotrophin and prolactin secretion in paediatric patients

1 Luteinizing hormone (LH), follicle stimulating hormone (FSH) and prolactin levels were measured in twenty paediatric patients receiving sodium valproate (30 mg/kg body weight daily) and in ten control subjects under control conditions and following LRH-TRH administration. In addition, baseline GH levels were measured in the two groups. 2 No significant differences were observed between the basal and stimulated hormone levels in the two groups. Although sodium valproate may act as anticonvulsant by increasing GABA levels in the central nervous system, the present data indicate that a central GABAergic pathway is probably not involved in the control of gonadotrophin and prolactin secretion.

The unreliability of mean corpuscular volume and mean cellular hemoglobin determinations in the diagnosis of alpha-thalassemia in newborn infants

Mean corpuscular volume (MCV) and mean cellular hemoglobin (MCH) were determined by means of a Hemalog 8/90 electronic counter in 51 full-term newborn infants with alpha-thalassemia-2 and 15 with alpha-thalassemia-1, as well as in 150 normal newborn infants. The mean MCV and MCH values were 92 fl +/- 06 and 33.26 pg +/- 2.22 in the normal newborn infants, 82 fl +/- 07 and 29.40 pg +/- 2.60 in the alpha-thalassemia-2 subjects, and 73 fl +/- 06 and 26.7 +/- 2.05 in the alpha-thalassemia-1 subjects. Four of the 150 normal newborn infants had MCV's < 79 fl and MCH's < 29.00 pg whereas 5 of the alpha-thalassemic subjects had MCV's > 90 fl and MCH's > 32.00 pg. We conclude that MCV and MCH determinations are unreliable in the diagnosis of alpha-thalassemia in the neonatal period.

Pituitary responsiveness to gonadotrophin-releasing and thyrotrophin-releasing hormones in children receiving phenobarbitone

The effect of long-term treatment with phenobarbitone on pituitary responsiveness to gonadotrophin-releasing hormone and thyrotrophin-releasing hormone was studied in 20 boys being treated with the drug to prevent febrile convulsions. Baseline concentrations of luteinising and follicle-stimulating hormones were reduced as well as the responses of these hormones to stimulation with gonadotrophin-releasing hormone. Baseline prolactin concentrations were raised in comparison with those in normal children. The response of prolactin to thyrotrophin-releasing hormone, however, was impaired only in the children who had been receiving the drug for a long time. Phenobarbitone had no effect on the secretion of growth hormone. Further studies should be carried out to ascertain how long these effects on pituitary function last after phenobarbitone is withdrawn and whether this interference with pituitary function modifies the child's subsequent development.

Genetic heterogeneity of glucose 6-phosphate dehydrogenase deficiency in Sardinia

Glucose 6-phosphate dehydrogenase (G6PD) activity was assayed quantitatively in red cells from 100 consecutive G6PD-deficient newborn male babies born in a city hospital in Sassari, Sardinia. In four cases G6PD activity was between 30% and 45% of normal: these appeared on electrophoresis to be identical with G6PD Seattle-like. In 65 cases G6PD activity ranged from 2% to 14% of normal, while in the remaining 31 samples no activity could be detected in crude hemolysates. G6PD was partiall purified from 39 samples having activity below 14% of normal (including 20 with zero activity). G6PD activity could now be determined in all, and it was fully characterized in nine samples. These were shown to belong to two distinct classes on grounds of the Michaelis constant for glucose 6-phosphate and the elution profile from DEAE-Sephadex columns. These properties were compared with those of G6PD-deficient samples from Greece and from Israel. We conclude that there are at least three polymorphic G6PD-deficient variants in Northern Sardinia: G6PD Seattle-like, G6PD Mediterranean, and a new variant, which we designate G6PD Sassari. The GdMediterranean and GdSassari genes have been shown to breed true in family studies. We also produce evidence that the definition of G6PD Mediterranean must be carefully reassessed.

beta-Thalassemia trait and hyperbilirubinemia in G-6-PD deficient newborn infants

Hb A2 was determined in 50 subjects with erythrocyte G-6-PD deficiency who presented with hyperbilirubinemia in the neonatal period and in 100 non-hyperbilirubinemic G-6-PD deficient newborn infants, at the age of 12 months or more. Six subjects in the first group and 13 in the second were found to be carriers of the beta-thalassemia trait. Statistical analysis of the data did not show any significant difference between the two groups. It seems that the beta-thalassemia trait does not provide any protection against neonatal hyperbilirubinemia associated with G-6-PD deficiency.

alpha-Thalassaemia and hyperbilirubinaemia in G-6-PD-deficient newborns

53 newborn infants with both G-6-PD deficiency (29 male hemizygotes and 24 female heterozygotes) and alpha-thalassaemia, and 120 newborn infants with only the enzymatic defect (60 male hemizygotes and 60 female heterozygotes) were studied. 12 of those with both G-6-PD deficiency and alpha=thalassaemia, and 32 of those with only G-6-PD deficiency showed hyperbilirubinaemia. alpha-Thalassaemia does not seem to be implicated in the development of hyperbilirubinaemia in G-6-PD-deficient newborns.

Coexistence of three hemoglobins with different alpha-chains in two unrelated children (with family studies indicating polymorphism in the number of alpha-globin genes in the Sardinian population)

In each of two families from Sardinia, Italy, we have found segregation for two alpha-chain hemoglobin variants, which we have identified as G Philadelphia [alpha 68 (E17) Asn leads to Lys] and J Sardinia [alpha 50 (CE8) His leads to Asp], respectively. One family also shows segregation for the beta-thalassemia trait. One subject in one family and two subjects in the other family have in their red cells both hemoglobin variants, G and J, in addition to HbA. One of the subjects, a newborn baby, has six major hemoglobin components; alpha 2A beta 2, alpha 2A gamma 2, alpha 2G beta 2, alpha 2G gamma 2, alpha 2J beta 2, alpha 2J gamma 2. These three cases are to be added to three previous cases in the literature in whom three different alpha-chains have been found in the same blood. These findings prove that the alpha-chain locus is duplicated in the Sardinian population, as it is in other populations. The relative amounts of the various hemoglobin species found in members of our two families, through three and four generations respectively, suggest that chromosomes with and without duplication may coexist in the same population.

gamma chain composition in five Italian newborns heterozygous for Hb F Malta G gamma-117 His leads to Arg

The percentage of Hb F Malta G gamma-177 His replaced by Arg and the gamma chain composition have been evaluated at birth and at different times after birth in five Italian newborns heterozygous for this variant. The percentage of Hb F Malta ranged at birth from 24% to 31% of the total Hb F, while the average G gamma/A gamma chain ratio was about 7/3, overlapping the values observed in normal newborns. T gamma chains were detected in three out of five newborns, with a percentage of about 10% of the total Hb F. After birth the Hb F Malta declined faster than the total Hb F; thus, the Hb F decrease during the first 45 d of life is mainly due to the switch-off of the G gamma locus containing the Hb F Malta gene.

Favism: erythrocyte metabolism during haemolysis and reticulocytosis

The reduced activity of glucose-6-phosphate dehydrogenase (D-glucose-6-phosphate; NADP+ 1-oxidoreductase; G6PF) in Mediterranean erythrocytes explains the precarious equilibrium of the hexose monophosphate pathway (HMP) and the susceptibility of these cells to haemolytic agents. G6PD-deficient erythrocytes, in steady-state conditions, have a low NADPH/NADP+ ratio, thus allowing the HMP to operate at its maximal intracellular rate and to compensate the intrinsic erythrocyte enzyme deficiency. Studies started soon after accidental intake of fava beans by sensitive G6PD-deficient subjects demonstrate a decrease of both NADPH/NADP+ ratio and reduced glutathione. The metabolic effects induced by fava beans may be attributed to oxidative stress probably associated with an inhibitor effect of some unknown metabolite on the HMP. The availability of erythrocytes from subjects recovering from haemolysis with high reticulocyte counts and increased G6PD activity, provides new information on the rate of synthesis as well as on the in vivo decay of the mutant enzyme. Correlation of G6PD activity to reticulocyte count and extrapolation to an ideally homogenous population of reticulocytes reveal that the mutant enzyme is synthesized at a nearly normal rate. Furthermore, the present correlation allows an estimate of the in vivo half-life of Mediterranean G6PD. The rate of decline of about 8 d observed in this study well correlates to the intracellular metabolic aspects of G6PD Mediterranean erythrocytes.

Serum glutamic oxalacetic transaminase, glutamic pyruvic transaminase, gamma-glutamyl transpeptidase and glutamic dehydrogenase levels in favism

Serum GOT, GPT, gamma-GT and GLDH were determined in 15 G-6-PD-deficient subjects during a hemolytic crisis and hemoglobinuria due to ingestion of fresh fava beans. The same G-6-PD-deficient subjects were studied again 2 months after the crisis, when they were asymptomatic. 15 normal healthy children served as controls. A statistically significant increase, above normal, in serum GOT, GLDH and gamma-GT was observed in the favic subjects during the crisis. All the values reverted to normal in the asymptomatic period.

Dynamic evaluation of prolactin secretion during the early hours of life in human newborns

PRL secretion was evaluated in 30 human newborns during the early hours of life. Both levodopa and pyridoxine administration failed to suppress PRL release in all subjects. Synthetic TRH elicited a constant, prompt increase in PRL levels. No significant changes were observed after somatostatin injections. These results demonstrate normal pituitary PRL reserve in newborns. The failure to respond to levodopa and pyridoxine administration might reflect partial immaturity of the pituitary dopaminergic receptors.

Effect of LRH on gonadotropin secretion in newborn male infants

The concentrations of LH and FSH were measured in eight male newborn babies, aged 4-6 h, before and after the administration of 25 micrograms synthetic LHR. A comparison was performed with six control newborns receiving normal saline. Both LH and FSH rose significantly in all subjects after LHR administration. Their values were significantly higher than those observed during the control study. These data demonstrate sensitivity of the pituitary gonadotropes to synthetic LHR and a pubertal-type response to LH in the early hours of human life.

Action of somatostatin, levodopa and pyridoxine on growth hormone (GH) secretion in newborn infants

We studied the effect of i.v. levodopa, pyridoxine and synthetic somatostatin in 28 normal babies during the first hours of life. Somatostatin caused a decrease in GH levels in all infants; in addition, both levodopa and pyridoxine infection paradoxically suppressed GH secretion in all subjects. It is concluded that in the first hours of life GH secretion can be suppressed by synthetic somatostatin as well as by levodopa and pyridoxine administration.

Thyrotropin, prolactin and growth hormone response to synthetic thyrotropin-releasing hormone in newborn infants

The effects of 50 microgram synthetic thyrotropin-releasing hormone (TRH) intravenously on thyrotropin (TSH), prolactin (PRL) and growth hormone (GH) levels were studied in 8 normal male newborns during the first hours of life. Mean plasma GH concentrations were similar to baseline values during the period of study; on the contrary, plasma PRL and TSH values increased in all infants after TRH administration. These data demonstrate a normal pituitary reserve of PRL and TSH in the early period of human life.

Salicylamide glucuronide formation in newborn babies with G-6-PD deficiency

Salicylamide glucuronide formation has been studied in 23 newborn babies with erythrocyte G-6-PD deficiency and in 15 normal newborns on the first day of life. Glucuronide formation was significantly lower (p less than 0.001) in the former in comparison with the controls. In the newborns with G-6-PD deficiency who subsequently became hyperbilirubinemic an even lower mean glucuronide formation was observed (p less than 0.01) in respect to the non-jaundiced G-6-PD-deficient newborns.

Agar in control of hyperbilirubinemia of full-term newborn infants with erythrocyte G-6-PD deficiency

40 full-term newborn infants with erythrocyte glucose-6-phosphate dehydrogenase (G-6-PD) deficiency were used for a study concerning the effectiveness of agar per os in preventing severe hyperbilirubinemia. 20 randomly selected neonates were given agar (1 g/kg/day) orally in 4 daily doses from their 1st to their 5th day of life. 20 infants were not treated and served as controls. Three exchange transfusions were performed in the experimental as well as in the control group. According to these results, agar does not seem to be effective in preventing severe hyperbilirubinemia, which frequently occurs in newborn infants with erythrocyte G-6-PD deficiency.

[Concentrations of the IgM and antibodies for the TORCH complex in the umbilical blood (author's transl)]

The Authors have found both IgM and antibodies for the TORCH complex in the umbilical blood of 1500 newborns. In 119 (7.9%) there was an increase of IgM. In 23% of these newborns there were present antibodies for rubella, in 21% antibodies for toxoplasma, in 15.9% antibodies for cytomegalovirus, and in 19.2% antibodies for herpes simplex. However there was no statistical correlation between the antibodies for the TORCH complex and the increase of IgM.

Salicylamide-Glucuronide formation in children with favism and in their parents

Salicylamide-glucuronide formation has been determined in 27 children who underwent a favism crisis, 25 parents, and in 25 normal children who served as controls. A highly significant mean lower glucuronide formation was observed in the favism group in respect to the controls. The difference between fabic children and their parents was significant, and between parents and controls there was no significant difference.