Pachydermoperiostosis and acro-osteolysis

The authors present a case of pachydermoperiostosis (digital hippocratism, periostosis, pachydermia) associated with acro-osteolysis. This is the first association of this type described in Italy, and it is only recently that foreign authors have reported the presence of acro-osteolysis in patients affected with pachydermoperiostosis. The results obtained from studies of the micro and macro circulation in pachydermoperiostosis are reported.

[Ultrasonics of the liver (and bile ducts). The most significant experiences collected at a district hospital (clinical cases)]

The undoubted advantages deriving from the use of abdominal ultrasonography both in diagnosis and medical or surgical treatment are reported. In particular ultrasonography has proved very helpful in the study of pathologies of the liver and biliary tract, especially in a Rural Hospital, where it is not possible to have recourse to more refined diagnostic techniques.

Comparison of serum thyroid microsomal and thyroid peroxidase autoantibodies in thyroid diseases

Recent evidence indicates that human thyroid peroxidase (TPO) has most of the characteristics of the thyroid microsomal antigen. The question of whether TPO accounts for part or all of the antigenic activity recognized by circulating anti-microsomal antigen autoantibody (anti-M Ab) remains to be determined. The availability of an anti-TPO monoclonal antibody and of a highly purified TPO preparation allowed the development of specific and sensitive radioassays for anti-TPO autoantibody (anti-TPO Ab). In this study we compared anti-M Ab and anti-TPO Ab levels in serum from 128 subjects, including patients with Hashimoto's thyroiditis (n = 31), idiopathic myxedema (n = 11), hyperthyroid Graves' disease (n = 45), miscellaneous nonautoimmune thyroid disorders (n = 9), and normal subjects (n = 32). Anti-M Ab and anti-TPO Ab were measured by radioimmunological methods employing two different assay designs: 1) competitive radioassay (CR), based on the inhibition of radioiodinated antibody binding to human thyroid microsomes coated on microtiter wells, using a) [125I]immunoglobulin G (IgG) containing a high anti-M Ab titer (for anti-M Ab determinations), or b) [125I]anti-TPO monoclonal antibody (for anti-TPO Ab); and 2) sandwich immunoradiometric assay (IRMA) using microtiter wells coated with thyroid microsomes (for anti-M Ab determinations) or immunoaffinity-purified TPO (for anti-TPO Ab determinations) and [125I]anti-human IgG antibody. Anti-M Ab also was measured by passive hemagglutination. Anti-M Ab titers by PH closely correlated with anti-TPO Ab levels whether assayed by IRMA (r = 0.905; P less than 0.00001) or CR (r = 0.922; P less than 0.00001). Even closer correlations were found when anti-M Ab and anti-TPO Ab both were measured by the same type of radioassay procedure (IRMA, r = 0.945 and P less than 0.00001; CR, r = 0.957 and P less than 0.00001). No differences in the correlation between anti-M Ab and anti-TPO Ab results were found when the data in patients with different autoimmune thyroid disorders were analyzed separately. Further and more direct evidence for the identity of anti-M Ab and anti-TPO Ab was provided by the ability of purified TPO to completely inhibit the binding to thyroid microsomes of radioiodinated IgG preparations containing high anti-M Ab titers. In conclusion, our results provide strong support for the concept that TPO accounts for virtually all of the antigenic determinants reacting with the autoantibodies commonly termed anti-M antibodies.(ABSTRACT TRUNCATED AT 400 WORDS)

Detection and characterization of autoantibodies blocking the TSH-dependent cAMP production using FRTL-5 cells

Autoantibodies blocking the TSH-stimulated cAMP production (TBkAb) were measured in immunoglobulin G (IgG) preparations from 38 patients with primary autoimmune hypothyroidism, using FRTL-5 cells. TBkAb were detectable in 15/23 IgG preparations from patients with untreated idiopathic myxedema, and in 2/15 IgGs from patients under L-thyroxine treatment. None of the IgG from 22 normal subjects or from 10 patients with nonautoimmune hypothyroidism following total thyroidectomy caused any significant effect on the TSH-stimulated cAMP production. No correlation was found between TBkAb and the thyroid microsomal antibody. Antibodies inhibiting the 125I-TSH binding to TSH receptor were detectable in only 3/20 patients; IgGs from these 3 patients were also positive in the TBkAb assay. One IgG with potent TBkAb activity inhibited the TSH-stimulated adenylate cyclase in a competitive manner, while it had no effect on the forskolin-stimulated cAMP production. The inhibiting action of this IgG was almost completely lost after preabsorption with human thyroid membranes. In conclusion, we describe a new practical and sensitive method for the measurement of TBkAb; TBkAb are distinct from the microsomal antibody, and are probably directed to the TSH receptor.

Cellular localization of the microsomal antigen and the thyroid peroxidase antigen

Evidence has been accumulated that human thyroid microsomal/microvillar autoantigen (M) is expressed both in the cytoplasm and on the surface of thyroid follicular cells. The availability of this autoantigen to the immune system, possibly associated with abnormally expressed HLA-DR antigens may be relevant both to the triggering and to maintenance of thyroid autoimmune reactions. Preliminary biochemical characterization of M suggested that it was a glycoprotein with a mol. wt. of about 100-110 kD. recent studies carried out in our laboratories taking advantage of monoclonal antibodies provided evidence that the structure presently referred as M-Ag is represented by thyroid peroxidase (TPO). The identity between TPO and M is further supported by four-layer immunofluorescence analysis showing a complete overlap of the two antigens both in the surface and in the cytoplasm of thyroid cells and by the observation that the expression of M and TPO is similarly modulated by TSH, possibly through a cAMP-dependent mechanism.

Population data on benign and severe forms of X-linked muscular dystrophy

Epidemiological data on Becker muscular dystrophy (BMD) and Duchenne muscular dystrophy (DMD) from a large sample of the Italian population are reported. For BMD the incidence rate was found to be 5.5 X 10(-5) live-born males (lbm) and the prevalence rate, 13.1 X 10(-6); the mutation rate was estimated to be about 6.0 X 10(-6). For DMD the incidence and prevalence rates were found to be respectively 26 X 10(-5) lbm and 31.6 X 10(-6). The DMD mutation rate obtained by the Haldane formula was 86.6 X 10(-6) and by the semi-direct method, 65.6 X 10(-6). The results are discussed in the light of possible allelism of BMD and DMD.

Thyroid-stimulating antibody mimics thyrotropin in its ability to desensitize the adenosine 3',5'-monophosphate response to acute stimulation in continuously cultured rat thyroid cells (FRT-L5)

TSH preincubation induces refractoriness to further stimulation of cAMP accumulation by the hormone in cultured thyroid cells. The question of whether the thyroid-stimulating antibodies (TSAb) present in sera of patients with Graves' disease have the same desensitizing effect as TSH was evaluated in this study using a differentiated strain of rat thyroid cells (FRT-L5) which requires TSH for growth and develops refractoriness to acute TSH stimulation of cAMP accumulation. Cells cultured for 4-5 days in medium deprived of TSH recovered responsiveness to TSH and TSAb. Refractoriness to TSH was reinduced in these cells by a 24-h preincubation with 250 microU/ml TSH. The addition of 100 microM KI or 100 microM methimazole to the medium together with TSH did not modify TSH-induced refractoriness. Four different TSAb preparations all induced refractoriness to TSH-stimulated cAMP accumulation. TSAb preincubation induced refractoriness to acute TSAb as well as TSH-stimulated cAMP accumulation. TSAb-induced desensitization was dose dependent and required prolonged (8-24 h) exposure to TSAb. Furthermore, the desensitization induced by TSAb as well as that caused by TSH were significantly inhibited by cycloheximide, indicating the need for de novo protein synthesis. In conclusion, TSAb mimics TSH in the induction of refractoriness in FRT-L5 cells.

Insulin secretion and insulin sensitivity defects are a common feature of mild, clinically homogeneous, recently diagnosed type II (non-insulin-dependent) diabetics

Alteration in insulin secretion and reduced peripheral sensitivity to the hormone have been reported in type II diabetes. In this paper, a comparison is made of basal glucose production (3H-6 glucose), insulin secretion and insulin sensitivity in vivo (hyperglycemic clamp) and in vitro (binding to circulating monocytes) in 24 patients with recently diagnosed type II diabetes, matched for age and fasting glycemia and divided into non-obese (14 subjects) and moderately obese (10 subjects), and in 9 non-obese controls. The non-obese diabetics were slightly hyperinsulinemic during fasting (10.8 +/- 1.0 vs 4.8 +/- 0.8 microU/ml in controls, p less than 0.0005), with a significant reduction in early and late insulin secretion (14.0 +/- 1.5 vs 20.8 +/- 2.0 microU/ml, p less than 0.01 and 24.8 +/- 3.3 vs 34.7 +/- 2.14 microU/ml, p less than 0.025). The insulin sensitivity index MCR/I was significantly reduced (2.30 +/- 0.32 vs 4.14 +/- 0.40, p less than 0.005). Endogenous glucose production was significantly increased (107 +/- 10.2 vs 84 +/- 3.7 mg/m2 per min, p less than 0.025) and displayed a positive correlation with fasting glycemia (r = 0.51, p less than 0.05). Insulin binding to monocytes was significantly lower than in controls (2.36 +/- 0.22% vs 4.06 +/- 0.32%, p less than 0.0005). Moderately obese diabetics also were significantly hyperinsulinemic in the fasting state (18.1 +/- 2.8 microU/ml, p less than 0.0005 vs controls) but, typically, lacked the early secretory phase (20.6 +/- 3.6 microU/ml vs baseline, n.s.). A similar increase of hepatic glucose production (107 +/- 11.2 mg/m2 per min, p less than 0.025 vs controls, n.s. vs non-obese diabetics) and decrease of peripheral sensitivity to insulin (MCR/I = 1.78 +/- 0.31, p less than 0.0005 vs controls, n.s. vs non-obese diabetics) was found in moderately obese diabetics, as well as a significant reduction of insulin binding to insulated monocytes (2.62 +/- 0.4% p less than 0.01 vs controls, n.s. vs non-obese diabetics). These results confirm that common defects of both non-obese and moderately obese type II diabetics are: lack of early phase of glucose induced insulin secretion, increase in hepatic glucose production and decrease of peripheral insulin sensitivity together with reduction of insulin binding to circulating monocytes. The hypothesis of a unique defect as a cause of hyperglycemia in type II diabetes in early clinical phase is not borne out by the results of this study. Moderate obesity, even if able to reduce insulin sensitivity, seems to be less important in determining hyperglycemia.

Prediction of left ventricular function in acute anterior myocardial infarction by serum creatine kinase activity and precordial ECG mapping

Right cardiac catheterization, serial determination of creatine phosphokinase (CPK) and of CPK-MB activities, and precordial 35-lead ECG mapping were performed in 17 consecutive patients with a first anterior acute myocardial infarction (AMI) within 6 hours of the onset of symptoms. Left ventricular function as determined by the stroke index (SI, ml/m2) to mean pulmonary capillary wedge pressure (PCWP, mmHg) ratio inversely correlated either with the total CPK and CPK-MB released and with peak enzymatic activity, or with the entity of early (6th hour ECG) ST-segment elevation. Conversely, a direct correlation was found between the SI/PCWP ratio and the ratio of R to Q+S waves from late (48th hour) ECG. Residual left ventricular function after a first anterior AMI can therefore be estimated noninvasively in the individual patient by early precordial ECG mapping and by peak enzymatic activity.

Thyroid autoimmunity and endemic goiter

The goitrogenic role of autoimmune phenomena in endemic goiter is still uncertain. Scanty and discrepant results have been reported in different areas of the world. This prompted us to evaluate the prevalence of circulating thyroid antibodies in an area of northwestern Tuscany during a survey for endemic goiter. The survey was carried out according to the P.A.H.O. criteria in a stable community. In all schoolchildren (n = 142; age range 7-15 years) and in most of their parents (n = 159), thyroid size was evaluated and urine was collected for iodine determination. Blood was drawn for determination of circulating thyroid microsomal (MAb) and thyroglobulin antibodies (TgAb). TSH binding-inhibiting (TBIAb) and thyroid growth-stimulating antibodies (TGSAb), TT3, TT4 and TSH. Prevalence of goiter in schoolchildren was 77.9% and 94.8% in their parents. Mean (+/- S.D.) urinary iodine excretion was 55.0 +/- 2.1 micrograms/24 h. The overall frequency of TgAB and MAB in the adult population was 14.4, statistically higher than of control subjects matched for sex and age. The frequency in schoolchildren was 4.3%. TBIAb and TGSAb were undetectable in all tested cases. The presence of goiter in children was unrelated with the presence of thyroid antibodies in parents, whether goitrous or non-goitrois. A higher prevalence of goiter was found in children with goitrous parents as compared to children with non-goitrous parents (P less than less than 0.005). In conclusion, the frequency of thyroid autoantibodies in the adult population of the endemic area studies was increased, but showed no relation with the presence of goiter.(ABSTRACT TRUNCATED AT 250 WORDS)

Inflamed eye in Marfan's syndrome with posteriorly luxated lens

A 34-year-old man with Marfan's syndrome complained of redness and pain in the left eye. The right eye had been blind because of untractable retinal detachment. The left eye had had three surgical procedures for retinal detachment, and the lens had been luxated in the vitreous for more than 14 years. Ultrasonography demonstrated the spontaneously luxated lens as the possible cause of the inflammatory reaction. The diagnosis of lens-induced endophthalmitis was confirmed by histopathologic examination of the excised lens.

Hemodynamic and electrocardiographic effects of fructose-1,6-diphosphate in acute myocardial infarction

Acute hemodynamic and electrocardiographic effects of fructose-1,6-diphosphate (FDP), an agent that is supposed to restore anaerobic glycolytic flux in the ischemic myocardium, were studied in 40 patients with acute myocardial infarction who were grouped into 4 subsets: subset 1, normal (15 mm Hg or less) pulmonary artery (PA) wedge pressure and normal (35 g-m/m2 or greater) left ventricular (LV) stroke work index; subset 2, elevated (more than 15 mm Hg) PA wedge pressure and normal LV stroke work index; subset 3, normal PA wedge pressure and reduced (less than 35 g-m/m2) LV stroke work index; subset 4, elevated PA wedge pressure and LV stroke work index moderately reduced to a range between 16 and 34 g-m/m2. Patients were randomized into an FDP (250 mg/kg body weight in isotonic saline solution intravenously in 20 minutes) and into a placebo group. Each subset contained 5 FDP- and 5 placebo-treated patients. After basal measurements, hemodynamic measurements were reassessed at 60, 90 and 120 minutes from the infusions, while a standard 12-lead electrocardiogram was recorded in the basal state and 120 minutes after infusion. Nonsignificant hemodynamic change was observed in the placebo subsets, and FDP failed to exert any effect in subsets 1, 2 and 3. A 24% (p less than 0.02) increase in cardiac index occurred 60 minutes after FDP in subset 4. LV stroke work index also increased, while PA wedge pressure remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Expression of the microsomal antigen on the surface of continuously cultured rat thyroid cells is modulated by thyrotropin

The thyroid microsomal antigen, commonly implicated in thyroid autoimmune diseases, is not confined to cytoplasm, but is also present on the surface of human thyroid cells in primary culture. In this study, a strain of differentiated rat thyroid cells (FRTL5) grown in continuous culture was used to investigate the relationship between functional status of the thyroid cell and expression of microsomal antigen on its surface. Sera from eight patients with Hashimoto's thyroiditis, one with idiopathic hypothyroidism, and three with hyperthyroid Graves' disease were selected for the presence of microsomal antibody, but undetectable thyroglobulin antibody. One additional serum sample from a patient with Graves' disease, which was negative for both thyroid antibodies was used. Sera from eight normal subjects were used as controls. Indirect immunofluorescence was applied to FRTL5 cells that were viable or fixed with acetone in order to expose intracellular antigens. When FRTL5 cells were cultured in Coon's medium containing TSH (300 microU/ml), positive indirect immunofluorescence surface staining was observed with sera containing microsomal antibody, but not with control sera or with the Graves' serum negative for microsomal antibody. A rough correlation was found between the intensity of the surface fluorescence and microsomal antibody titer. After acetone treatment, microsomal antibody-positive sera produced typical cytoplasmic staining. When FRTL5 cells were cultured in the absence of TSH, disappearance of the surface fluorescence and reduction of the cytoplasmic microsomal antigen occurred. Readdition of TSH progressively restored both the surface and cytoplasmic microsomal antigen. The present data indicate that the thyroid microsomal antigen is represented on the surface of FRTL5 cells, and its expression is modulated by TSH.

Decreased number of PGD2 binding sites on platelets from patients with type IIa hyperlipoproteinemia

Platelets from patients with familial hypercholesterolemia (type IIa hyperlipoproteinemia), a condition associated with a high prevalence of atherosclerosis and its ischemic complications, are claimed to be hyperresponsive to aggregating stimuli. We investigated the platelet responsiveness to and the binding of PGD2, a potent endogenous inhibitor of platelet aggregation via stimulation of adenylate cyclase, in a group of 7 patients affected by IIa hyperlipoproteinemia (IIa HLP) and in a control group of 10 healthy subjects. Inhibition by PGD2 of ADP-induced platelet aggregation was significantly lower in IIa HLP patients than in controls. The number of binding sites for PGD2 of platelets from IIa HLP patients was significantly reduced in comparison with that from controls (93 +/- 19 and 232 +/- 23 receptors/platelet, respectively), whereas the affinity for PGD2 was comparable to that of controls (Kd = 68.8 +/- 19.8 nM in patients and 66.1 +/- 15.9 nM in controls). The reduced number of platelet PGD2 binding sites in IIa HLP patients may account for the impaired sensitivity to PGD2 shown in vitro by platelets and may contribute to the increased tendency to thrombotic manifestations observed in IIa HLP.

Hemodynamic effects of digoxin in acute myocardial infarction in man: a randomized controlled trial

Hemodynamic effects of digoxin in acute myocardial infarction (AMI) have been acknowledged to depend on the basal cardiocirculatory state. In the present study, the effects of digoxin in patients with AMI were evaluated in four hemodynamic subsets, based on the relationship between mean pulmonary capillary wedge pressure (PCWP, in mm Hg) and left ventricular stroke work index (LVSWI, in g-m/m2): subset 1: normal (less than or equal to 15 mm Hg) PCWP and normal (greater than or equal to 35 g-m/m2) LVSWI; subset 2: elevated (greater than 15 mm Hg) PCWP and normal LVSWI; subset 3: reduced (less than 35 g-m/m2) LVSWI and normal PCWP; and subset 4: elevated PCWP and LVSWI moderately reduced to a range between 16 and 34 g-m/m2. Forty patients were admitted to the study and were randomly assigned to one of two groups in each subset: control group (19 patients) and treated group (21 patients). Five patients were randomized into each of the subsets 2, 3, and 4 in both the control and treated groups, while in subset 1 there were four control and six digoxin-treated patients. Control patients were administered a placebo saline solution and digoxin-treated patients received 0.50 mg of the drug intravenously in 20 minutes. The effects of the placebo and of the drug were evaluated at 30, 60, and 90 minutes from the end of the infusion. Hemodynamic data did not vary in the control group, and digoxin did not exert any relevant effect in subsets 1 and 2. After drug infusion, cardiac index (Cl, in L/min/m2) significantly increased in subset 3 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Reduction in prostacyclin platelet receptors in active spontaneous angina

The number and affinity of binding sites for tritiated prostacyclin (PGI2) in platelets were investigated in twenty-eight patients with spontaneous angina (fourteen in the active and fourteen in the inactive phase) and in nine healthy controls of similar age. Active-phase patients had significantly lower numbers of both classes of platelet PGI2 receptors (high affinity and low affinity) than controls or inactive-phase patients. In contrast, the affinity for PGI2 was not significantly different in the three groups. In six active-phase patients restudied in the inactive phase the previously low number of PGI2 receptors had returned to normal. These results suggest that the instability of angina is associated with functional changes not confined to the coronary vasculature.

Hyperglycaemic clamp and insulin binding to isolated monocytes before and after glibenclamide treatment of mild type II diabetics

The therapeutic action of 3.5 mg glibenclamide (HB 420) once a day for six weeks was evaluated in ten mild NID diabetics previously treated with diet only. Stable HbA1, insulin secretion during hyperglycaemic clamp (100 mg/dl over the baseline in the first study, and at the same level in the second one), peripheral sensitivity expressed as the amount of dextrose infused per Kg per min (M-coefficient), the glucose metabolic clearance rate (MCR) and the M/I ratio were measured. Circulating monocytes were separated to assess insulin binding before and after treatment. The results included a significant decrease in HbA1 (7.5 +/- 0.3 against 8.4 +/- 0.4%, P less than 0.005), increased steady-state (100-120 min.) plasma insulin (31 +/- 4.4 against 25.7 +/- 3.9 microU/ml), a significant increase in M-coefficient (4.02 +/- 0.62 against 2.49 +/- 0.31 mg/Kg/min, P less than 0.01), and MCR (1.90 +/- 0.34 against 1.18 +/- 0.18 ml/Kg/min, P less than 0.025) and an increase in the M/I ratio (14.6 +/- 1.9 against 11.2 +/- 1.7). All subjects displayed an increase in total insulin binding (4.03 +/- 0.31% against 2.79 +/- 0.34%, P less than 0.001) and affinity constants (Ke = 8.3 +/- 0.6 against 6.6 +/- 0.4 X 10(7) M-1, P less than 0.05). Since the M/I ratio increased in only 7/10 subjects and since there was no significant correlations between the percentage increase in M and MCR and the plasma insulin increase, whereas the increase in R0 was significant, it is felt that the euglycaemizing action of low doses of glibenclamide is primarily peripheral.(ABSTRACT TRUNCATED AT 250 WORDS)

Physiopathologic aspects of Leydig cell function in varicocele patients

Leydig cell function was studied in 108 varicocele (V) patients with a mean age of 30.9 years, and a control group (C) of 46 men with a mean age of 30 years. Plasma gonadotropin levels were determined before and after GNRH stimulation. Testosterone (T), 17-OH-progesterone (17-OH-P), dihydrotestosterone (DHT) and estradiol (E2) were also assayed. Mean plasma T levels were significantly decreased in varicocele patients (V = 416 +/- 12.9, n = 106; C = 487 +/- 19.9, n = 40; P less than 0.01), while the basal 17-OH-P/T ratio was significantly increased (V = 0.38 +/- 0.02, n = 56; C = 0.28 +/- 0.02, n = 40; 0.02 greater than P greater than 0.01) and remained higher after hCG stimulation (P less than 0.01). No significant differences in mean sex steroid levels were observed when comparing varicocele patients with normal sperm counts (VN) and those who had oligozoospermia (VO). There was a significant negative linear correlation between age and 17-OH-P (n = 56; r = -0.47; P less than 0.01) and T values (n = 106; r = 0.27; P less than 0.01) in varicocele patients, which contrasted with the absence of any significant correlation with age in the controls. These data suggest that the duration of idiopathic varicocele influences testicular hormone secretion.

The influence of age on Leydig cell function in patients with varicocele

In a large group of patients with varicocele (n = 108, mean age: 30.9 years) Leydig cell function was investigated by determining the plasma levels of gonadotrophins under basal conditions and after GnRH stimulation, and by measuring the plasma levels of 17-OH-progesterone (17-OH-P), testosterone (T), dihydrotestosterone (DHT) and oestradiol (E2). There was a significant positive correlation between age and the peak plasma LH values after GnRH stimulation (n = 48, r = 41, P less than 0.01). Conversely, an inverse correlation was observed between age and the basal plasma levels of 17-OH-P (n = 56, r = 0.47, P less than 0.01) and T (n = 108, r = 0.27, P less than 0.01). In normals controls of the same age range (n = 46, mean age: 30 years) such correlations were absent. In patients with varicocele, the 17-OH-P/T ratio was increased significantly in peripheral plasma under basal conditions (P less than 0.01) and after hCG stimulation (P less than 0.05), and a similar increase was found in spermatic venous blood. This suggests that in varicocele patients there is some enzymatic impairment involving the last steps of T biosynthesis. In order to verify the influence of ologozoospermia on plasma steroid levels we divided the patients into 2 groups according to sperm count (more than or less than 10 X 10(6)/ml). Three analyses of variance were then carried out between these 2 groups of patients: 1) analysis of peripheral plasma T levels; 2) analysis of peripheral plasma levels of 17-OH-P and 3) spermatic vein levels of these 2 steroids. However, none of these analyses revealed any significant difference between the 2 groups of patients. When we re-grouped the patients according to age (15-30 and 30-45 years) the same analyses of variance revealed significant differences. These results therefore suggest that the duration of idiopathic varicocele per se influences Leydig cell activity.

Binding of low-molecular-weight heparin to aortic endothelium in rabbits

The ability of a low-molecular-weight heparin to bind in vivo to the aortic endothelium in rabbits, compared with that of unfractionated extractive sodium heparin (UHEP), was investigated. For this purpose a low-molecular-weight heparin (LMWHEP) fraction (CY 216 A, 4,000-5,000 daltons) and an extractive UHEP (average 17,000 daltons) were labeled with 99m Tc and injected (0.2, 0.6, and 1.2 mg/kg) intravenously in groups of 6 rabbits. The binding to endothelium was then measured by counting the radioactivity of samples of abdominal aorta. Both heparins bound to endothelium with a fast, saturable, and reversible binding. No significant difference in the total bound radioactivity was found between the two heparins, suggesting that the investigated LMWHEP retains the ability to bind to the endothelium, contributing to its athrombogenic properties.

Effect of a single Ditazole dose on platelet aggregation and prostaglandin formation

The in vitro activity of the non-steroidal anti-inflammatory agent Ditazole was investigated in a group of 20 male patients at thrombotic risk in comparison with placebo in a completely randomized cross-over design. A single Ditazole administration was able to induce a significant decrease in the number of circulating platelet aggregates (CPA), platelet aggregability by ADP and in thromboxane production by platelets. No significant changes were found in platelet cAMP concentration and in plasma 6keto-PGF1 alpha levels. Present results indicate that Ditazole affects platelet aggregation in a double way, by decreasing both the reversible and the ADP-induced aggregation. The lack of effects on plasma 6keto-PGF1 alpha concentration suggests that Ditazole can reduce platelet aggregation without affecting prostacyclin production.

Comparison of acute and subacute effects of deflazacort and prednisone on glucose metabolism in man

Corticosteroid treatment produces glucose intolerance with insulin resistance. Recent reports have indicated that deflazacort (DF) is significantly less diabetogenic than prednisone (PN). A euglycaemic hyperinsulinaemic (100 microU/ml) glucose clamp ( EHGC ) and 3H-glucose infusion for 240 min were performed in 6 healthy volunteers (HV) after administration of 15 mg PN or 18 mg DF, 12 h and 2 h before test. The glucose metabolic clearance rate (MCR) was significantly (p = 0.02) higher after DF (4.75 +/- 0.58 ml/min X kg) than after PN (3.31 +/- 0.27 ml/min X kg). Basal hepatic glucose production (HGP) was significantly (p = 0.003) lower after DF (3.58 +/- 0.33 mg/kg X min) than after PN (4.44 +/- 0.23 mg/kg X min). A similar pattern was obtained for glucose volume (GV) and glucose pool (GP). The kinetic parameters of insulin were not significantly different after the two drugs. After 7 day of PN 30 mg/day or DF 36 mg/day, EHGC and 3H-glucose infusion for 240 min were performed in 10 HV. Glucose MCR values were significantly (p = 0.03) higher after DF (5.03 +/- 0.91 ml/min X kg) than after PN (2.80 +/- 0.26 ml/min X kg). HGP values did not different significantly after the two drugs. GV (p = 0.001) and GP (p = 0.002) were significantly lower after DF than after PN. Insulin kinetics were not significantly different after the two drugs. It is concluded that on acute and 7-day administration to healthy subjects DF, in an anti-inflammatory dose equivalent to PN, shows significantly less influence on glucose metabolism.

Testosterone and dihydrotestosterone seminal plasma levels in varicocele patients

Testosterone (T) and Dihydrotestosterone (DHT) were measured in seminal plasma levels of forty-four varicocele patients and in seventeen normal men. T values were not significantly different from controls, while DHT values were significantly lower in varicocele patients. When we grouped the patients according to the sperm count, we observed a decrease of DHT similar to that reported by other authors in oligozoospermic patients. However in the patients with normal sperm count, where the motility was the only parameter significantly lower, DHT in the ejaculate showed again a marked decrease. In contrast to that observed in the normal subjects, in the latter group, with normal sperm count, we observed a negative correlation between the age of the patients and DHT in the ejaculate. This suggests that the duration of varicocele per se could affect DHT seminal plasma levels.

Plasma levels of 17-OH-progesterone and testosterone in patients with varicoceles

In order to study Leydig cell function in patients with varicoceles, we determined plasma levels of the most important testicular steroids, 17-OH-progesterone (17-OH-P) and testosterone (T) in the basal condition and after hCG stimulation. There was a significant inverse linear correlation between age, plasma testosterone, and 17-OH-P (n = 65, r = 0.316, P = 0.01, n = 48, r = 0.532, P = 0.01). This was in contrast to the absence of such correlations in normal men in the same age range. Following hCG stimulation in 16 patients the 17-OH-P/T ratio was significantly increased with respect to normal controls. No correlation was been observed between sperm count and age in varicocele patients. Analysis of variance of 17-OH-P plasma levels between the patients with a sperm count less than 10 million/ml and that of more than 10 million/ml did not reveal any significant difference. These results suggest that the deleterious effects of varicocele on seminiferous tubules and Leydig cells are unrelated. Moreover the increased 17-OH-P/T ratio after hCG stimulation suggests that some enzymatic impairment involving the last steps of testosterone biosynthesis exists in patients with varicoceles. This is evident in middle aged varicocele patients with a premature decrease of plasma levels of testosterone.

Testosterone and dihydrotestosterone seminal plasma levels in varicocele patients

Testosterone (T) and 5-a-Dihydrotestosterone (DHT) was measured in seminal plasma levels of forty-four varicocele patients and in seventeen normal men. T values were not significantly different from controls, while DHT values were significantly lower in varicocele patients. When grouped the patients according to the sperm count, we observed a decrease of DHT similar to that reported by other authors in oligozoospermic patients. However in the patients with normal sperm count, where the motility was the only parameter significantly lower, DHT in the ejaculate showed again a marked decrease. In contrast to that observed in the normal subjects, in the latter group, with normal sperm count, we observed a negative correlation between the age of the patients and DHT in the ejaculate. This suggests that the duration of varicocele per se could affect DHT seminal plasma levels.

Acute effect of prednisone and deflazacort on glucose tolerance in prediabetic subjects

The diabetogenic effect of deflazacort (DF), an oxazolinic synthetic corticosteroid, was studied in 12 healthy adult subjects with a positive family history of diabetes mellitus. Three oral glucose tests (oGTT) were performed at 9.00 a.m., after a 12 h fast, following randomized administration of Placebo (PL), or Deflazacort (DF 36 +36 mg) or Prednisone (PN 30 + 30 mg) 12 and 2 h before the test. Plasma glucose (BG), insulin (IRI), non-esterified fatty acids, (NEFA), total cholesterol (CL), HDL-cholesterol (HDL-CL) and triglycerides (TG) were measured at time 0, and BG, IRI, NEFA were again measured 30, 60, 90 and 120 min after oGTT. PN was followed by a significant increase in BG over the PL values in accordance with the prediabetic state of these subjects, and there was also an increase in IRI values. No change in CL, HDL-CL and TG was found. AFter DF administration, there was a small increase only in BG and IRI over PL values. The differences between DF- PL were not significant, but those between PL-PN and DF-PN were significant at p less than 0.05 (Scheffe's test). The lesser metabolic effect of DF on glucose balance by comparison with PN, as shown by these results, is consistent with previous reports of its lower osteopaenic effect. Thus, DF may be more suitable than PN and similar corticosteroids for corticosteroid therapy in prediabetic and diabetic subjects.

[Exchange transfusion in the newborn infant]

Total transfusion practice in hospitals is examined and reference is made to the methods regarded as indispensable in avoiding damage to the newborn.

Diurnal variations in insulin secretion and insulin sensitivity in aged subjects

Glucose tolerance tends to decrease in healthy aged subjects without family history of diabetes. Either reduced insulin secretion or insulin resistance may be responsible. Insulin secretion and insulin sensitivity were studied in 7 aged subjects (68-75 years) and 8 young controls (21-27 years). A 1-mg i.v. glucagon and a 5-U/m2 body area i.v. insulin test were run in each subject at 07(00) and at 19(00) on two different days to detect diurnal variations. An arginine test was also performed to evaluate pancreatic glucagon behavior. In the evening, young subjects presented a glucose tolerance impairment with significantly decreased plasma insulin levels, and a reduced hypoglycemic effect of exogenous insulin. Resistance to both endogenous and exogenous insulin in the aged was observed in the morning without significant morning/evening variations. Since the response to contra-insular hormones (GH in the insulin test, glucagon in the arginine test) was the same in both age groups, their role in the phenomenon could be ruled out. It is suggested that in the aged a stable reduction in number and/or a change in affinity of insulin receptors may occur. In addition, since aging is seen to be associated with the disappearance of diurnal variations in glucose tolerance and insulin secretion and sensitivity, and since a reduction in the receptor level of young healthy subjects in the evening has been reported by some authors, it is suggested that aged subjects may be less able to modulate the binding of insulin to its peripheral receptors in the course of the day.

[New trends in the clinical use of platelet transfusions]

Reference is made to the indications for platelet transfusions, the way in which they are prepared, and the criteria used in assessment of their therapeutic results.

[Usefulness of transaminase determination in transfusional practice]

The usefulness of determining G.O. and G.P. transaminase is examined and techniques described. Such studies take on particular importance for the selection of particular importance for the selection of donors, some with preclinical viral hepatitis.

[Valve of detection of the Du blood group factor in hospital transfusion practice]

Following a description of factor Du, a variant of factor D, a personal series of about 3% is described and the technique using indirect Coombs test is indicated. Identification of factor Du takes on importance in the prophylaxis of post-transfusional isoimmunization as donors of Rh negative blood with Du positive must be considered Rh positive donors.

[Relations between immunological and enzymatic parameters in viral hepatitis]

The results of a study showing correlations between the behaviour of complement serum level, the presence of antigen Au, variations in serum immunoglobulin and the behaviour of transaminases in the cases of hepatitis examined are reported. It was found that the reduction in complement level during the initial stage of the disease coincides directly with antigenaemia positivity, increased IgM production, large increases in transaminase activity and inversion of the SGOT/SGPT ratio.