Deexcitation Dynamics of Muonic Atoms Revealed by High-Precision Spectroscopy of Electronic K X Rays

We observed electronic K x rays emitted from muonic iron atoms using superconducting transition-edge sensor microcalorimeters. The energy resolution of 5.2 eV in FWHM allowed us to observe the asymmetric broad profile of the electronic characteristic Kα and Kβ x rays together with the hypersatellite K^{h}α x rays around 6 keV. This signature reflects the time-dependent screening of the nuclear charge by the negative muon and the L-shell electrons, accompanied by electron side feeding. Assisted by a simulation, these data clearly reveal the electronic K- and L-shell hole production and their temporal evolution on the 10-20 fs scale during the muon cascade process.

Resistance to visceral obesity is associated with increased locomotion in mice expressing an endothelial cell-specific fibroblast growth factor 1 transgene

Overdevelopment of visceral adipose is positively correlated with the etiology of obesity-associated pathologies including cardiovascular disease and insulin resistance. However, identification of genetic, molecular, and physiological factors regulating adipose development and function in response to nutritional stress is incomplete. Fibroblast Growth Factor 1 (FGF1) is a cytokine expressed and released by both adipocytes and endothelial cells under hypoxia, thermal, and oxidative stress. Expression of Fibroblast Growth Factor 1 (FGF1) in adipose is required for normal depot development and remodeling. Loss of FGF1 leads to deleterious changes in adipose morphology, metabolism, and insulin resistance. Conversely, diabetic and obese mice injected with recombinant FGF1 display improvements in insulin sensitivity and a reduction in adiposity. We report in this novel, in vivo study that transgenic mice expressing an endothelial-specific FGF1 transgene (FGF1-Tek) are resistant to high-fat diet-induced abdominal adipose accretion and are more glucose-tolerant than wild-type control animals. Metabolic chamber analyses indicate that suppression of the development of visceral adiposity and insulin resistance was not associated with alterations in appetite or resting metabolic rate in the FGF1-Tek strain. Instead, FGF1-Tek mice display increased locomotor activity that likely promotes the utilization of dietary fatty acids before they can accumulate in adipose and liver. This study provides insight into the impact that genetic differences dictating the production of FGF1 has on the risk for developing obesity-related metabolic disease in response to nutritional stress.

Observation of threshold effects in positron scattering from the noble gases

Channel coupling is a phenomenon that has been investigated for many scattering processes, and is responsible for the formation of cusps or steps in the cross sections for open scattering channels at, or near, the onset of a new scattering channel. It has long been speculated that the opening of the positronium formation channel may lead to the formation of such cusp features in the elastic positron scattering cross section. In this work, elastic scattering of positrons has been measured in the region of the positronium formation threshold for the noble gases He-Xe. Cusplike behavior is observed and, while the features which are observed appear broad, they represent a magnitude of between 4 and 15% of the total elastic cross section. No evidence is found of any other features in this region, at least within the uncertainty of the present data, discounting the possibility of scattering resonances.

Bone health as a primary target in the pediatric age

Bone tissue is constantly renewed during childhood and adolescence to assure skeleton growth both in size and mineral density: up to 90 percent of peak bone mass is acquired by age 18 in girls and age 20 in boys, which makes youth the best time to "invest" in bone health. The reduction in bone mineral density leading to compromised strength and microarchitecture of bone tissue can favour the occurrence of fragility fractures in the pediatric age. Assessing the normality of bone density measurements in childhood by current methods is hampered by the lack of normative control data. The understanding of factors useful for maximizing peak bone mass, as well as the knowledge of diagnostic tools and therapeutic strategies for managing a state of reduced bone mineral density are crucial to prevent fractures throughout lifetime.

Non-invasive diagnosis in a case of bronchopulmonary sequestration and proposal of diagnostic algorithm

The case of a 43-year-old woman with intralobar pulmonary sequestration, Pryce type one, is presented. The medical history was characterised by recurrent bronchopneumonia, productive cough with purulent sputum and hemoptysis in the last three years. Diagnosis was made by CT angiography: multiplanar, maximum intensity projection and volume rendering reconstructions were visualised. A volume reduction of middle and lower lobe with multiple cyst-like bronchiectasis was detected and no evident relationship with tracheobronchial tree was pointed out. Reconstructions aimed at evaluating bronchial structures demonstrated no patency of middle and lower lobar bronchi. The study carried out after contrast medium infusion in arterial phase showed a vascular disorder characterised by an accessory arterial branch arising from the upper portion of thoracic aorta which, after moving caudally to pulmonary hilus with a tortuous course, supplied the atelectatic parenchyma. No anomalous venous drainage was detected. The patient underwent surgery with resection of two pulmonary lobes. CT compares favourably with other alternative imaging technique for pulmonary sequestration as multiplanar reconstructions allow not only the detection of supplying vessel, but also the accurate description of heterogeneous characteristics of the mass and adjacent structures. Finally an imaging-based diagnostic algorhithm is proposed.

Bone mineral density and body composition in a myelomeningocele children population: effects of walking ability and sport activity

Myelomeningocele causes serious locomotor disability, osteoporosis and pathologic fractures. The aim of this study was to investigate the relationship between body composition, bone mineral density, walking ability and sport activity in myelomeningocele children. 60 patients aged between 5 and 14 yrs with myelomeningocele (22 ambulatory and 38 non-ambulatory), were studied. Fat mass and fat-free-mass were calculated by anthropometry. The bone mineral density at lumbar and femoral neck were evaluated. Bone mineral density at the lumbar and femoral neck was lower than in the normal population. In the non-ambulaty group, bone mineral density was approximately 1 SD lower than in the ambulatory one (p < 0.01). Fat mass was greater than expected but without significantly differences between walking group (mean 26%) and wheel-chair users (25%). Patients practised sport activity had a better bone mineral density and body fat compared with other patients with the same disability. Patients with myelomeningocele have decreased bone mineral density and are at higher risk of pathologic bone fractures. All subjects showed an excess of fat as percentage of body weight and are shorter than normal children. The measurement of bone mineral density may help to identify those patients at greatest risk of suffering of multiple fractures. Walk ability and sport activity, associated with the development of muscle mass, are important factors in promoting bone and body growth, to reduce the risk of obesity and of pathological fractures.

A positron trap and beam apparatus for atomic and molecular scattering experiments

An instrument has been designed and constructed to provide new insights into fundamental, low energy positron scattering processes. The design is based on the Surko trap system and produces a pulsed positron beam with an energy resolution of as good as 54 meV. The design and operation of the apparatus is explained, while the first experimental results from this apparatus have been demonstrated in recent publications.

Bone mineral density in survivors of childhood brain tumours

BACKGROUND

Osteopenia has been reported in children surviving acute lymphoblastic leukaemia, apparently as consequence of therapy. Few studies have been published on bone mineral density (BMD) evaluation in children surviving from brain tumours. The endocrine system in these patients is frequently affected as consequence of therapeutic interventions such as cranial irradiation and anti-neoplastic agents: growth hormone deficiency is the most common adverse sequel. The pathogenesis of osteopenia in brain cancer survivors is multi-factorial but still uncertain.

OBJECTIVE

The aim of this study is to examine bone mass in 12 brain cancer survivors and its relationship with their hormonal status.

RESULTS AND DISCUSSION

We observed that most of the patients had a BMD that was lower than normal in both the lumbar column and in the femoral neck. Bone mass loss was higher in the lumbar region rather than in the femoral neck, due to spinal radiation therapy and to the effect of hormonal deficiencies. Particularly hypogonadism, but also multiple hormonal deficiencies, are associated with lower BMD values. Experience in clinical care of these patients suggests the importance of periodic evaluations of BMD, especially in those with secondary hormone deficiencies. Moreover, the periodic assessment of the hypothalamus-pituitary function is essential for an early diagnosis of hormonal insufficiency, primarily hypogonadism, to precociously detect bone mineral loss and to prevent pathological fractures, thus improving the quality of life.

Secondary skeletal involvement in Sanfilippo syndrome

BACKGROUND

Sanfilippo syndrome, or mucopolysaccharidosis (MPS) type III, is a rare lysosomal storage disease, resulting from errors in the catabolism of heparan sulphate.

AIM

To evaluate bone turnover and bone mineral density (BMD) in MPS type III patients.

DESIGN

Clinical and observational study.

METHODS

We evaluated serum markers of bone formation or resorption, and measured BMD using dual-energy X-ray absorptiometry (DEXA), in three patients with MPS type III.

RESULTS

Serum vitamin D were low, and BMDs greatly reduced at lumbar and femoral sites, indicating the possibility of osteoporosis and osteomalacia.

DISCUSSION

These skeletal effects probably result from nutritional deficiencies and inability to walk, rather than from the genetic defect itself. Secondary skeletal involvement in patients with MPS type III may represent a considerable cause of morbidity, and requires interventions to reduce the risk of pathological fractures.

Correlates of osteoporosis in chronic obstructive pulmonary disease

The aim of this study was to analyse the correlates of reduced bone mineral density in patients with chronic obstructive pulmonary disease (COPD), with special regard to a possible protective role of hypercapnia. One hundred and four consecutive COPD inpatients in stabilized respiratory conditions underwent a comprehensive assessment of their health status. Bone mineral density was measured by X-ray absorptiometry at the lumbar site and at the femoral neck site. Differences in health-related variables between patients with (group O, n=62) and without (group N, n=42) lumbar and/or femoral neck osteoporosis were assessed first by univariate analysis and then by logistic regression analysis aimed to identify independent correlates of osteoporosis. Group O was characterized by worse nutritional status, as reflected by indices exploring either lean or fat mass, and by a trend towards lower forced expiratory volume in 1 sec/forced vital capacity ratio. Arterial tension of carbon dioxide lacked any correlation with bone mineral density. According to the logistic regression analysis, body mass index < or = 22 kg m(-2) qualified as the only and positive independent correlate of osteoporosis (odds ratio=4.18; 95% confidence intervals=1.19-14.71). In conclusion, malnutrition characterizes COPD patients with osteoporosis, while mild to moderate hypercapnia lacks either a positive or negative effect on bone mineral density. Longitudinal studies are needed to identify predictors rather than correlates of bone mineral density.

[Hypersplenism in surgery]

We studied 86 patients suffering from hypersplenism, associated with portal hypertension (39 patients), hematologic disease (45 patients) and with Gaucher's disease (2 patients). Inclusion criteria were the presence of thrombocytopenia < 100.000 x mm3 and leucopenia < 4.000 x mm3. No meaningful differences about the improvement of hypersplenism in portal hypertension were observed between the patients submitted to shunt and splenectomy and those submitted to shunt only. On the contrary, splenectomy caused a quick normalization of the leukothrombocytopenia in the patients suffering from hematologic disease, which, moreover, allowed to perform radio- and chemotherapy in those suffering from malignancies. We reported absence of mortality and a low and aspecific morbidity.

Prospective study of bone loss in pre- and post-menopausal women on L-thyroxine therapy for non-toxic goitre

OBJECTIVE

Hyperthyroidism is associated with increased bone turnover and bone resorption, but the effects of suppressive doses of thyroxine in treating non-toxic goitre remain unclear. We carried out a longitudinal study to evaluate the effect on bone of L-thyroxine (L-T4) therapy in women with non-toxic goitre.

SUBJECTS

Forty Caucasian women, 19 of whom were pre-menopausal and 21 post-menopausal, were studied before and after 12 months' L-T4 therapy for non-toxic goitre; 40 women matched for age, body mass index and menopausal status were used as controls.

DESIGN

The minimal dosage of L-T4 (mean +/- standard error = 1.5 +/- 0.1 micrograms/kg-1 day-1) was given to each patient to obtain subnormal but detectable serum TSH (< or = 0.2 mU/l). Patients and controls were assessed for minor determinants of bone loss rate, such as genetic and behavioural factors.

MEASUREMENTS

Bone mineral density (BMD) of the lumbar spine, femoral neck, trochanter and Ward's triangle was measured by dual-energy X-ray absorptiometry at baseline and 12 months; serum and urine markers of bone turnover was measured at baseline, 3, 6 and 12 months.

RESULTS

No significant difference was detected in BMD values between patients and controls either at presentation or at the 12-month follow-up. Pre-menopausal patients showed a significant decrease in femoral neck BMD (-1.7 +/- 0.6%, P < 0.05) while controls showed no change +0.2 +/- 0.9%, P = NS). Post-menopausal patients showed a significant decrease in BMD of the lumbar spine (-1.3 +/- 0.6%, P < 0.05; controls +0.0 +/- 0.4%, P = NS), femoral neck (-1.5 +/- 0.6%, P < 0.05; controls -1.2 +/- 0.8%, P = NS) and trochanter (-2.1 +/- 0.8%, P < 0.05; controls -1.4 +/- 0.9%, P = NS). In both pre- and post-menopausal patients the serum markers of bone turnover, alkaline phosphatase and osteocalcin, showed an early and progressive increase. A linear relationship was found only between the 3-month values of serum osteocalcin and the urine hydroxyproline/creatinine ratio in both pre-menopausal (r = 0.87, P < 0.01) and post-menopausal (r = 0.72, P < 0.05) patients. No correlation was found between bone loss or changes in bone turnover markers and L-T4 dose or thyroid hormone levels.

CONCLUSIONS

This longitudinal study suggests that TSH-suppressive therapy with L-thyroxine for non-toxic goitre significantly increases the bone mineral turnover and might contribute to a BMD reduction, more marked on cortical bone, in both pre- and post-menopausal women.

[Rare causes of serious digestive hemorrhages]

The rare causes of massive hemorrhage in the gastrointestinal tract are not completely classifiable. They are characterized by high variability, as shown in several isolated reports. In our experience of 17 cases, clinical and endoscopic features were sometimes typical of a rare pathology, others were referable to common pathologies and exactly diagnosed only by angiography or surgery. Our experience points out the difficulties in the surgical prescription and timing, when the endoscopic diagnosis was lacking or unsure, or when a massive haemorrhagic recurrence forced diagnostic laparatomy. The role of endoscopy and the advantages of intraoperative enteroscopy have been compellingly demonstrated. Diagnostic and therapeutic angiography has been the main method in vascular hemorrhage.

Recurrence of acute colonic pseudo-obstruction in selective adrenergic dysautonomia associated with infectious toxoplasmosis

BACKGROUND

Acute colonic pseudo-obstruction is a life-threatening condition associated with several pathologic conditions, whose pathophysiology is still uncertain.

CASE

Autonomic function in a young patient operated on for acute colonic pseudo-obstruction was carefully evaluated; none of the common clinical conditions described in the literature was found to have caused the syndrome. Selective adrenergic failure was suggested by the presence of severe orthostatic hypotension, low basal plasma catecholamine level, and absence of the expected increase on standing and by the findings of provocation tests, cardiovascular tests, and acetylcholine sweat spot test. Biopsy specimens from the colon and small-bowel wall did not show any morphologic or immunohistochemical alteration either in muscle layers or in the autonomic plexus, testifying to the possible occurrence of extrinsic denervation in the presence of an intact plexus. Infectious toxoplasmosis was proved through indirect and direct hemagglutination assays, enzyme-linked immunosorbent assay IgG, IgM, and IgA, immunosorbent agglutination IgM assay, and the protozoa were demonstrated in a biopsy specimen from the rectus abdominis muscle.

CONCLUSIONS

Selective adrenergic denervation of the gut resulted in recurrent episodes of colonic pseudo-obstruction, probably by direct toxicity or a cross-reaction between the immune process and a toxoplasmic antigen, stressing the importance of sympathetic inhibitory modulation on colon motor activity.

Chronic pancreatitis prevalence in liver cirrhosis. Morphological and functional study

Ductal pancreatic changes and functional exocrine assessment have been studied, in a group of 60 cirrhotic patients. In these patients the aetiology of cirrhosis was alcoholism in 35, hepatitis B virus-hepatitis C virus infection in 19, primary biliary cirrhosis in 2 and not determinable in 4. Eighteen patients (30%) showed an endoscopic retrograde pancreatography picture consistent with chronic pancreatitis (14 mild, 2 moderate and 2 severe). Mild pancreatographic changes were present in 7 alcoholic (20%) and in 7 non-alcoholic cirrhosis patients (28%). Moderate and severe abnormalities were present only in alcoholic cirrhosis (4 patients, 11.4%). No correlation was found between presence or pancreatopathy degree and Child-Pugh score or cirrhosis duration. Functional exocrine tests were abnormal only in severe endoscopic retrograde pancreatography picture. Mild type ductal lesions can mimic either age-dependent changes or chronic pancreatitis. The absence of impaired functional tests makes it impossible to discriminate between these two possibilities. These findings emphasize that in our cirrhotic group the prevalence of chronic pancreatitis (with a moderate or severe endoscopic retrograde pancreatography picture) is low (6.6%) and alcoholism is always present. Possibly, cirrhosis with secretion of high-volume low protein concentration juice confers a protective effect on the pancreas.

Pancreatic juice 90K and serum CA 19-9 combined determination can discriminate between pancreatic cancer and chronic pancreatitis

OBJECTIVES

Differential diagnosis of pancreatic cancer versus chronic pancreatitis may be difficult. The aim of this study is to determine whether a group of tumor-associated antigens could differentiate between the two pathologies.

METHODS

CA 19-9, TAG-72, CAR-3, and a newly discovered antigen termed "90K" were determined in the serum and in the pancreatic juice of 19 patients with pancreatic cancer, 20 patients with chronic pancreatitis, and seven controls with lithiasis of extrapancreatic bile ducts.

RESULTS

The serum antigen levels of all three markers except 90K were significantly higher in pancreatic cancer than in chronic pancreatitis. High correlations were found between serum CA 19-9 and both TAG-72 and CAR-3. 90K did not correlate with other markers. In pancreatic juice, only 90K values were significantly higher in chronic pancreatitis than in pancreatic cancer, and only 90K and CA 19-9 were significantly correlated. At the stepwise discriminant analysis, serum CA 19-9 and pancreatic juice 90K had independent diagnostic roles. Used in combination, they correctly identified 84.2% of pancreatic cancer and 90% of chronic pancreatitis.

CONCLUSIONS

These data suggest that pancreatic juice 90K and serum CA 19-9 can discriminate between chronic pancreatitis and pancreatic cancer. The data further support the complementary use of tumor-associated antigens along with other diagnostic tools.

Glucose-induced thermogenesis in postobese women who have undergone biliopancreatic diversion

We evaluated the metabolic response to a standard (75-g) oral-glucose-tolerance test (OGTT) in eight post-obese women (PO) who underwent biliopancreatic diversion and in eight healthy control women (C). All subjects had been weight-stable for > or = 2 y. Blood samples for glucose, insulin, C-peptide, and nonesterified free fatty acids were taken at baseline and during 180 min after the glucose load. Plasma glucose and insulin concentrations at baseline and during the OGTT were similar in the two groups, suggesting the absence of an insulin-resistant state in the PO. Continuous indirect calorimetry was performed throughout the test. Glucose-induced thermogenesis (GIT) was higher in PO than in C (8.6 +/- 2.6 vs 4.3 +/- 1.9%; P < 0.01). These data indicate that GIT and insulin-glucose metabolism are not impaired in postobese patients when a near ideal body weight is reached and maintained after weight loss; this suggests that thermogenic deficiencies and hyperinsulinemia-insulin resistance are alterations secondary to obesity.

Acute myopathy associated with chronic licorice ingestion: reversible loss of myoadenylate deaminase activity

A patient with acute rhabdomyolysis and absence of myoadenylate deaminase (MADA) associated with chronic licorice intoxication is presented. Clinical and laboratory examination of the patient and morphologic study over skeletal muscle were performed. The major effect of licorice intoxication is hypokalemia, which may explain most of the observed clinical symptoms and morphological changes. The absence of MADA may be a consequence of the direct toxic effect of licorice glycosides. To our knowledge, this is the first report in which a lack of MADA and chronic licorice intoxication has been shown to be associated with clinical, histochemical, biochemical, and morphological changes, which were completely reversed with potassium supplementation and licorice withdrawal.

Delayed hypersensitivity to diltiazem in two patients

We report two cases of cutaneous adverse reactions during treatment with diltiazem. Both patients developed wide-spread, pruriginous, erythematous, maculopapular eruptions with fever and facial angioedema, 48 to 72 hours after starting diltiazem. Delayed hypersensitivity to diltiazem was suspected and the diagnosis was confirmed by skin patch tests followed by cutaneous biopsy.

[Familial Mediterranean fever and electroencephalographic changes. A clinical case]

The Authors describe the case of a non-Hebrew Italian girl suffering from short-lasting fever episodes, associated with abdominal colic, since the age of 3. The occurrence of acute arthrosynovitis during the last episode, at 12 years of age, clinically confirms the diagnosis of familial mediterranean fever, as previously supposed. The increase in urinary coproporphyrins, with normal values of delta-aminolevulinic acid and porphobilinogen poses the problem of the differential diagnosis between hereditary coproporphyria and secondary coproporphinuria. The importance of this case lies in the presence of electroencephalographic alteration since the first years of life, suggesting a temporal epilepsy for which the patient was at length submitted to anti-epileptic treatment. Electroencephalographic alterations, of different type and uneasy interpretation, are described in the literature with a frequency which does not seem accidental. Renal biopsy does not show amyloid, nor the RMN reveals cerebral abnormalities. The anti-epileptic therapy being withdrawn, the patient was treated with daily administrations of colchicine (1 mg/die); 18 months after, she is disease free.

Malignant fibrous histiocytoma of sternum: an unusual cause of pyrexia of undetermined origin

Malignant fibrous histiocytoma of the bone is a very rare tumour mainly affecting long bones, and the most common presenting symptom is local pain. A case of malignant fibrous histiocytoma presenting with pyrexia of undetermined origin and arising in the sternum, a localization not previously described, is reported. The patient died with septic shock after multi-drug chemotherapy including high dose methotrexate treatment with citrovorum factor rescue.

Megaloblastic anaemia due to sulphasalazine responding to drug withdrawal alone

A 60 year old man with ulcerative colitis since 1975 and treated with sulphasalazine, presented with severe megaloblastic anaemia caused by folate deficiency. The drug was stopped, and the anaemia recovered promptly. There was no relapse one year later.

Determination of the non-enzymatic glycation of hemoglobin by isoelectrofocusing of its globin chains

Micro cation exchange chromatography determination of HbA1c does not provide a complete picture of Hb glycation, for it does not determine all the glycated forms of hemoglobin. For the determination of total glycation, we describe here a rod IEF method, which allows the simultaneous quantitation of glycation on alpha and beta globin chains. The method exhibits good sensitivity; it is not affected by artifacts deriving from temperature, hypertriglyceridemia, Hb variants or labile HbA1 (aldiminic Hb). The results obtained indicate that in a normal population approximately 18% of the beta chain and 8% of the alpha chain are glycated. These mean percentages increase in the diabetic to 28% and 12%, respectively. The beta chain is glycated on both valine and lysine residues, while the alpha chain is glycated only on the latter. HbA1 values from micro cation exchange chromatography are significantly related to both alpha and beta glycation. Thus, valinic or lysinic glycation have roughly the same clinical significance.

Ketoalkalosis as a result of triple derangement of acid-base equilibrium in a diabetic patient

A diabetic patient presented with weight loss, ketosis, and hyperventilation, thus mimicking the clinical picture of diabetic ketoacidosis. Laboratory investigations revealed alkalemia and a pattern consistent with a triple derangement of acid-base equilibrium: respiratory alkalosis, metabolic acidosis and metabolic alkalosis. High cortisol level suggested a genesis of ketosis different from diabetes mellitus. The patient died suddenly from acute gastrointestinal bleeding. Autopsy showed a carcinoma of the head of the pancreas with secondary portal hypertension and rupture of varices. Pulmonary micrometastases were demonstrated. It is suggested that stress hormones were the main cause of the 'ketoalkalotic' pattern observed.

Analysis of the globins from fast human haemoglobins by isoelectrofocusing on polyacrylamide gel rods

The globins from all fast haemoglobin (Hb) components obtainable by Bio-Rex 70 cation-exchange chromatography were examined by isoelectrofocusing on polyacrylamide gel rods with 8.0 mol/l urea. From this analysis HbA1a1 and HbA1a2 seem to be very heterogeneous components. HbA1b is separable into two components, one of which is varied in both the beta chains. Between HbA1b2 and the well-known HbA1c components two chromatographic peaks are separated, one with a noticeable percentage of glucosylated beta chain and one that probably contains HbF. HbA1c has both beta chains glucosylated, while HbA1x seems to be a beta monoglucosylated Hb form. Finally, the early part of the HbAo peak has a large amount of glucosylation on both alpha and beta chains.

The chromatographic separation of glycosylated haemoglobins: a comparison between macro- and micromethods

The microchromatographic determination of "fast haemoglobins" is currently used in long-term control of diabetes: its use is made easier by commercially available kits, that are impaired by some analytical variables. For a good standardization of these kits a comparison with an accurate method of analysis is necessary. The macrochromatographic column allows the determination of each fast component with a good precision, and reveals the great complexity of human haemoglobin. Comparison of the two methods shows that the most appropriate temperature of elution for the kit is 20 degrees C and that the increase in the fraction of "fast haemoglobins" in diabetic samples is only related to the HbA1c component.

Investigation of the heterogeneity of hemoglobin by cation-exchange chromatography on Bio-REX 70

The use of Bio-Rex 70 cation-exchange resin for chromatography of normal and diabetic hemoglobin provides a reproducible pattern of the "fast components". Particular attention to the choice of sample preparation, pH of elution, and the increase of ionic strength by sodium chloride linear gradients results in the separation of Hb-A1b into two components and in the isolation of a new component eluting between Hb-A1c and Hb-A0. Experiments with [3H]glucose and the colorimetric test (thiobarbituric acid) normally used to determine the extent of non-enzymatic glycosylation, as well as an increase of this component in diabetic samples compared with normoglycemic ones and a significant linear correlation with Hb-A1c, indicate that this component should be a part of the hemoglobins glucosylated on the epsilon-NH2 group of the lysines of both chains and/or the hemoglobin glucosylated on the alpha-NH2 of the valine of the alpha-chain. We propose to call this component Hb-A1x, pending confirmation of its identity. Normally Hb-A1x accounts for about 3% of Hb-A, but up to 5-7% of glucosylated hemoglobins should be confined to the early part of Hb-A0. In diabetics, the percentage of Hb-A1x rises to 4-5% and that of the other glucosylated hemoglobins increases to 12-16%.

[Hepatic hemangioma: limitations of echo-scintigraphic diagnosis]

The Authors report a case of percutaneous liver biopsy of a solitary hepatic lesion complicated by a serious haemorrhage. By a timely surgical operation an hepatic hemangioma has been detected. The lack of diagnostic accuracy of the echo-scintigraphic detection in assessing a solitary hepatic lesion is analyzed.

[Wegener's granulomatosis. Clinical and radiologic considerations and description of 3 cases]

The clinical, radiological and pathological findings, natural history and response to treatment are investigated in 3 patients. They represent the only examples of W.G. who were seen over a 15 year period at our University Hospital and are characteristic of generalize and limited form. The role of immune complexes in the pathogenesis of W.G. and diagnostic importance of pulmonary radiological pattern are described.