Prevention of aspiration pneumonia during long-term feeding by percutaneous endoscopic gastrostomy: might cisapride play any role? An open pilot study

The risk of aspiration during tube feedings has been reduced but not abolished by percutaneous endoscopic gastrostomy (PEG). This open study was planned to evaluate whether cisapride may play some role in preventing aspiration in long-term enteral feeding via PEG. A group of 29 patients, unable to swallow because of head and neck cancer (14 cases) or neurological disorders (15 cases) entered the study; 7 neurological patients, fed via nasogastric tube before PEG placement, had suffered from aspiration pneumonia during nasogastric feeding. All patients underwent PEG, and 10 mg cisapride was routinely given via PEG before each administration of enteral feeding and 6 h after its initiation when the feeding was continued for 12 h or more. Only 1 minor complication was observed during the acute hospital setting (ileus, spontaneously resolving after 36 h). After hospital discharge, the patients were followed for a total of 4935 days of feeding (range 47-508 days, mean time per patient: 170 days) and assessed weekly for the development of complications. No episode of probable/possible aspiration pneumonia was observed during the follow-up. Two neurological patients with involuntary movements had rupture of the feeding tube, which was replaced without complications. These results support the hypothesis that cisapride might play some role in the prevention of aspiration in patients fed via PEG, and justify the planning of some controlled, double-blind trials to verify such a hypothesis.

Growth and skeletal maturation in children with phenylketonuria

Growth and skeletal maturation was evaluated in 82 children participating in the German Collaborative Study of Children Treated for Phenylketonuria (PKU). Height, weight, head circumference and bone age were recorded at regular intervals for the first 6 years of life. The mean SD score (SDS) for height was not significantly different from zero at study entry, but decreased mainly during the second year of life to a nadir of -0.78 in boys and -0.54 in girls at 2.5 years. During the subsequent years, a significant trend towards a regain of height SDS was noted in both sexes. Weight-for-height SDS was close to zero in both sexes, with a significant continuous increasing trend throughout the observation period. Head circumference SDS decreased in boys during the first year of life from -0.28 to -0.68, whereas girls showed only a minor change. During the further follow-up period, head circumference SDS remained at approximately -0.3 in boys and 0.0 in girls. While the mean verbal and performance IQ of the total study population at 5 and 6 years of age did not differ from a group of 212 healthy non-PKU children, patients with a head circumference SDS less than the population median at 2 years of age exhibited poorer cognitive abilities at school age than those patients with a relative head size greater than the population median. The children with a head circumference less than the median at 2 years had smaller head sizes already at birth; in addition, the change in relative head size during the first 2 years was correlated significantly with cognitive abilities at school age in boys. Mean bone age was identical to chronological age at each time point of observation. The rate of maturation was one year of bone age per year of chronological age. No correlation between phenylalanine intake or phenylalanine concentrations and the rates of body or head growth or skeletal maturation could be established. We conclude that despite adequate weight gain, moderate growth retardation occurred during the first 2 years of life in this group of children treated for PKU. Growth was more compromised in boys than in girls and tended to be compensated during later follow-up. Early infantile head circumference and growth appear to be predictors of cognitive development.

Influence of spontaneous and surgical menopause on atherogenic metabolic risk

We evaluated serum total-, LDL-, HDL-, cholesterol and triglycerides in 858 women. Sixty-seven were in premenopause, 307 in perimenopause, 326 in spontaneous menopause, and 158 women underwent hysterectomy. Of these, 101 had bilateral ovariectomy, 24 with unilateral ovariectomy and 33 with retention of both ovaries. After correcting for chronological age and body mass index by variance analysis, it was found that total-, LDL- and HDL-cholesterol significantly increased during menopause without changes in the total cholesterol/HDL-cholesterol, LDL-cholesterol/HDL-cholesterol and triglycerides/HDL-cholesterol ratio. The changes gradually occurred during the months preceding spontaneous cessation of menses. Atherogenic metabolic risk (as relative risk of high total and LDL-cholesterol, estimated by logistic regression analysis) significantly increased in all groups of women in reference to premenopause. The risk observed in surgical menopause with bilateral ovariectomy was higher than in spontaneous menopause, and conservation of ovaries in hysterectomized women seems to protect only partially against such an increase.

Receptor binding at two different temperatures to discriminate agonist and antagonist behaviour of adenosine A1 receptor ligands in rat brain

The inhibitory binding constants, Ki, at the adenosine A1 receptor in rat brain have been measured at 0 and 25 degrees C for 25 typical ligands. The Ki ratios at the two temperatures are greater and smaller than unity for adenosine agonists and xanthine antagonists, respectively. These results suggest that two-temperature measurements of in-vitro Ki constants represent a simple method of discriminating between in-vivo agonistic and antagonistic behaviour of A1 adenosine receptor ligands.

Sympathetic and vagal influences on rate-dependent changes of QT interval in healthy subjects

Dependence of QT interval duration on cardiac heart rate has been well established and is considered to be an intrinsic property of ventricular myocardium. Conclusive results of autonomic influences on such phenomena are lacking. To evaluate whether rate-dependent changes of QT interval are conditioned by the autonomic nervous system, 28 normal subjects with no heart disease and a normal QT interval were electrophysiologically assessed. The QT interval was calculated at 6 paced cycle lengths (600, 540, 500, 460, 430 and 400 ms) during the basal state, and after beta blockade (propranolol 0.2 mg/kg) and autonomic blockade (propranolol plus atropine 0.04 mg/kg). Because of atrioventricular nodal conduction limits, intrapatient cross-comparisons were performed in 10 subjects (aged 42 +/- 15 years). Single regression lines, evaluated in each subject, showing correlation between pacing cycle length and QT duration at each of the 3 states were analyzed. The mean slope observed after autonomic blockade (b = 0.10 +/- 0.04) was significantly lower than that seen during the basal state (b = 0.22 +/- 0.12, p less than 0.05) and after beta blockade (b = 0.23 +/- 0.08, p less than 0.05); nonsignificant differences were found between slopes during the basal state and after beta blockade. Results showed that vagal tone increased intrinsic dependence of QT at increasing cycle length, whereas sympathetic tone did not seem to interfere significantly. Since (in each subject) beta blockade was performed--or achieved--before atropine administration, the vagal influences are likely to be directly exerted on the ventricular electrophysiologic substrate.

Coagulation disorders and tumor markers in the diagnosis of pancreatic cancer

Twenty patients (42-80 years old of whom 9 women) affected by instrumentally ascertained pancreatic cancer (7 cases were operated on) were studied. In all of them the following coagulation indices (fibrinopeptide A, FpA; beta-thromboglobulin, BTG; platelet factor IV, PF4; fibrinogen degradation products, XDP) and tumor markers (gastrointestinal cancer associated antigen, GICA; tissue polypeptide antigen, TPA; carcinoembryonic antigen, CEA; alpha-fetoprotein, or AFP) were assessed at the time of diagnosis, and 10 and 30 days after diagnosis, to test whether and which of the above parameters are more sensitive for entertaining the underlying affection. In both operated and nonoperated patients FpA was shown to be the most sensitive index. Lesser sensitivity was shown by XDP, GICA, and BTG. AFP proved to be quite useless as its serum levels constantly fell within the normal range.

Normal phase HPLC as a model system of specific benzodiazepine-receptor binding

The hypothesis that benzodiazepines interact with their receptors in the CNS via hydrogen bonding mediated by the carbonyl and imine groups has been studied by correlating a physicochemical parameter affected by hydrogen bonds potentially accepted or donated by benzodiazepines with their binding constants to synaptosomal rat brain membranes. The reference physicochemical system chosen was normal phase high-performance liquid chromatography on mu-Bondapack NH2 (propylamine groups chemically bonded to porous silica) eluted with mixtures of n-hexane and 2-propanol. A strong correlation has been found for binding of the implicated groups to the column and to the receptor.

Volatile halogenated hydrocarbons in urban atmosphere and in human blood

Atmospheric concentrations of volatile, halogenated hydrocarbons (VHH) can be correlated with intensity of industrial or commercial activities and with demographic density. Measurements of VHHs were performed in Turin, Italy. The VHH indoor/outdoor contamination ratio was calculated, and VHH blood concentrations were measured during 1 yr in Turin, Italy. The results showed a typical primary pollutant trend: 18.1 micrograms/m3 during winter and 12.02 micrograms/m3 during summer. During the winter, the VHH indoor/outdoor contamination ratio showed a greater indoor presence (p = .0006) and a higher VHH blood concentration (0.71 vs. 0.22 micrograms/l). The indoor and outdoor atmospheric VHH concentrations provide the major sources of human daily intake, especially during winter.

[Collective exposure to secondary pollutants. Origin, chemistry, environmental cycles, impact on urban and rural atmospheric contamination, criteria for prevention]

Consequently to a bibliographic review, the Authors confirm that aliphatic aldehydes are ubiquitous constituents of rural and urban atmospheres and that they are certainly important by-products in many kind of antropogenic combustions (primary sources) as well as important intermediates in a wide variety of tropospheric chemical processes (secondary sources). The results of the monitoring of atmospheric aliphatic aldehydes in Turin city (north western Italy), during one year, are reported. The dynamic presence and concentration of aldehydes (mainly formaldehyde and acetaldehyde) is always limited below 100 ppb, however variable in the time. The results of our work point out the main role of photochemical processes during the summer, since the summer data well correlate with solar irradiation, ground temperature and relative humidity. During the winterthough it has not been possible to compare our data with other atmospheric pollutant (CO; NMHC), it is presumable a major role of primary sources in generating the atmospheric aldehydes. Without forgetting the irritant, mutagenic and cancerogenic properties of some aldehydes, we can assume that the next qualitative gasoline modification in 1991, according to the E.E.C. directive (8/5210/E.E.C. 20/3/1985), could cause an atmospheric aldehyde increase followed by a human risk increase.

[Acid fog: hygiene and health observations correlated with an aspect of atmospheric pollution]

In the last years the interest about acid depositions has been shifted to heterogeneous phase reactions and, particularly, to occult precipitations (fog, mist, ecc.). It is very improbable that some kind of human health hazards could derive from acid rain exposure. Instead, the human exposure to acid fog could represent a possible respiratory vehicle for the assumption of acid pollutants as well as of many other pollutants. This last assertion can be supported by the following considerations: 1) Fog may represent an important chemical reactor that can modify the nature of pollutant material in the atmosphere (acidification and other events). 2) Fog is formed near the ground where pollution sources are located so that pollution is the heaviest. The fog water droplets coalesce around preexisting aerosol which is most highly concentrated near the ground (cities and industrial areas). Since fog water droplets contain muc less water than rain drops, they do not dilute the acidity as much as rain. 3) Finally, fog is partially inhalable. In certain areas of the world, wet deposition by fog can be important to the human health, even if the acqueous concentrations of fog droplets, the acidity per volume of air and the acid deposition rate are all important factors to consider. Particularly the pH of fog does not tell the whole story, but it represents a sufficient information about the severity of the atmospheric situation that can be correlated to seriousness of human risk.

[Presence of aflatoxin in products intended for human consumption: the choice of methods and the results obtained]

The contamination of food resources by aflatoxin is a major problem for those countries where the meteorological and sanitary conditions allow the growth of Aspergillus Flavus and the contaminated food is not discarded because of the critical economical and social situation. However this phenomenon is also recorded in those Nations where the environmental and meteorological conditions are not favourable to Aspergillus Flavus growth. In Europe it has been possible to measure low aflatoxin (M1) concentrations in milk destined to humans. This kind of contamination may represent a source of chronic exposure to an important risk factor for hepatocancerogenesis. In Italy an appropriate law regulating the maximum aflatoxin concentration in the food destined to human nutrition is lacking, therefore the purpose of this paper is to contribute to the knowledge of a possible human exposure from the milk consumed in the Turin area (north western Italy). The results obtained display a lower (but more diffused) contamination in milk sampled after processing treatments (1.9-15 ppt), than in raw milk (5.3-94 ppt). Moreover it has been possible to show a positive relationship between dry animal feed and aflatoxin concentrations in milk.

Relationship between atmospheric lead concentration and blood lead level in Turin (Italy)

On July 1, 1981 the Italian government received and implemented an E.E.C. directive dated 1978 calling for the reduction of lead in fuels from 0.6 to 0.4 g/L. The effectiveness of this legislative measure is evaluated here by comparison of data on atmospheric lead levels in the city of Turin, and blood lead levels in A.V.I.S. (Italian Association of Blood Donors) donors in Turin and the countryside (control group), before (1977) and after (1986, 1987) the enforcement of the law. The results show that the implementation of the law has contributed to a decrease in the atmospheric lead levels. The analysis of blood lead concentration revealed an evident biological response to this environmental change: there was a decrease in blood lead level between 1977 and 1987, in both the countryside (control group) and, to a lesser extent, in the city.

Temperature dependence of the binding of mu, delta and kappa agonists to the opiate receptors in guinea-pig brain

Membrane preparations from guinea-pig brain were used to study the effects of temperature on the interaction of [3H][D-Ala2-MePhe-Gly-ol5] (DAGO), a selective mu agonist, [3H][D-Ala2,D-Leu5]enkephalin (DADLE), a nearly selective delta agonist and (+/-)[3H]ethylketazocine (EKC), a selective kappa agonist when binding was measured in the presence of an excess of DAGO and DADLE. Binding was endothermic (delta H0 = 10-17 kJ mol-1) and thus driven by the large increase in entropy (delta S0 = 200-230 J mol-1 K-1) for all ligands under examination. Van't Hoff plot for DAGO and DADLE showed a breakdown beyond 303 K which could have been due to lower in vitro stability of the proteins to conformational changes in the receptor proteins and/or to phase changes in the membranes. The present results do not agree with the hypothesis that agonist binding is associated with very small or negative delta S0 (in opposition to antagonists) in view of the information transfer involved (the biological effect).

[Carbon monoxide: environmental and biological aspects]

We retrospectively reviewed the MR examinations of 20 patients with surgically documented sequestered lumbar disks (free fragments). Sixteen of 20 cases demonstrated extradural masses that were distinct from the interspace of origin and had intermediate signal on T1-weighted images but increased signal on T2-weighted images. In 12 cases there was migration of the sequestered fragment. Sequestered disks that migrated away from the interspace had an irregular, oblong appearance, while those near the interspace were round in configuration. Additionally, the interspace of origin consistently demonstrated loss of signal on T2-weighted images when compared with intact lumbar disks. Sagittal 12-weighted images best depicted the absence of a high-signal pedicle contiguous with the interspace of origin in sequestered disks. These findings were applied to a prospective group of 20 patients undergoing lumbar diskectomy. There was an 89% sensitivity, 82% specificity, and 85% accuracy for MR in distinguishing sequestered disks from other forms of lumbar disk herniation.

We conclude that high-resolution MR imaging is sensitive in detecting disk disease and specific in characterizing various subtypes of extradural defects. MR uses morphology as well as changes in signal intensity to make these distinctions.

Growth disparity in monozygotic twins discordant for chronic renal disease

Growth data in seven pairs of monozygotic twins only one twin affected by renal disease are given. The data suggest that renal disease not only retards normal growth and sexual maturation but also affects growth potential. Therefore evaluation of the effect of renal disease and its treatment on growth should include estimation of the genetic potential for growth.