[Circadian rhythm of melatonin in liver cirrhosis]

The liver plays an important role in the intermediate metabolism of numerous substances involved in hormonal action. Starting from the presupposition that the pineal has an inhibitory effect on the reproduction system through melatonin (aMT) and that hepatic cirrhosis can be included among the pathologies characterised by sexual disorders, the authors felt that it was interesting to evaluate the light/darkness rhythm of aMT in some patients suffering from hepatic cirrhosis in order to highlight the possible pathogenetic role of aMT in causing the altered sexual activity observed in this pathology. A total of 4 subjects (3 males and 1 female), with a mean age of 60.5 years, suffering from hepatic cirrhosis and a matched group of healthy controls were included in the study. Circadian changes in aMT plasma levels and plasma levels before and after TRH stimulus (200 micrograms) of aMT and PRL were studied in all subjects. The results revealed the presence of a circadian rhythm of aMT with a nocturnal peak secretion in both groups; in patients with cirrhosis, however, the rhythm appeared to be "out of phase" and presented a late and prolonged increase in aMT compared to controls. Responses to TRH did not show any differences in aMT between the two groups, but the response to PRL was higher and longer than in hepatopathic patients. These findings showed an alteration in the secretory pattern of aMT in cirrhotic patients which can be attributed to reduced hormone metabolism at an hepatic level. The altered response to PRL is attributable to an altered neurotransmitter function at the central level.

Dexfentluramine in the treatment of juvenile obesity

BACKGROUND

The aim of this study was to investigate the potential of dexfenfluramine (dF) for reducing cardiovascular risk factors and improving compliance towards diet in a group of young patients hospitalized for essential obesity of high degree (BMI > or = 35).

METHODS

103 adolescents (mean age 15.4 +/- 0.2) participated in a nine-week randomized double-blind study of dF (15 mg bid) versus placebo. All patients received a VLCD (2,512 kJ/day = 600 kcal/day) for two months. In basal conditions, and after 30 and 60 days of treatment, anthropometric variables (height, weight, BMI, and W/H) and cardiovascular risk factors (blood glucose concentration, total cholesterol, HDL-cholesterol, triglycerides, systolic and diastolic blood pressure) were monitored. Modifications in hunger and satiety were also assessed.

RESULTS

During the treatment period, both the dF group and the placebo group presented a similar pattern of weight loss (BMI = dF: 36.7 +/- 0.5 vs 32.5 +/- 0.4 vs 30.1 +/- 0.4; placebo: 37.0 +/- 0.6 vs 33.1 +/- 0.5 vs 30.8 +/- 0.5). No important side-effects were recorded in either group. Blood pressure and metabolic markers decreased significantly in both groups. Earlier reductions in total cholesterol and diastolic blood pressure in dF-treated subjects were the only significant differences observed as compared to the patients receiving placebo (day 30 = total cholesterol: 120 +/- 2 (dF) vs 132 +/- 3 (placebo) mg/dI; p < 0.005; diastolic blood pressure: 73 +/- 1 (dF) vs 77 +/- 1 (placebo) mmHg; p < 0.01). However, after 60 days, these values were similar in the two groups. As far as non-parametric data are concerned, dF determined a reduction in hunger and an increase in satiety in a significantly higher number of subjects than did the placebo, not only after 30 days of treatment (92.8% vs 55.3% and 92.8% vs 45.5%, respectively; p < 0.0001), but also after two months of treatment (97.8% vs 67.4% and 97.8% vs 45.8%, respectively; p < 0.0001).

CONCLUSIONS

These findings demonstrate that dF represents a useful support in the treatment of juvenile obesity and might ensure a better individual compliance towards restrictive diets, particularly in the initial "critical" stages, in the absence of important side-effects.

[Effect of sex on the increase of GH induced by galanin, alone or in combination with GHRH with or without pyridostigmine in pubescent subjects]

Growth hormone response to galanin (GAL) and growth hormone releasing hormone have been demonstrated to be higher in females than in males, and moreover the cholinergic system appears to be able to enhance them. On the basis of this presumption, we evaluated the GH response (expressed as area under the curve: AUC-GH) to galanin (GAL, 10 mg/kg i.v.) or GHRH (1 mg/kg i.v.) either alone or associated together and with pyridostigmine (PD, 60 mg p.o.), and to saline infusion as a control, in 5 males and 5 females, in puberty, aged 16 +/- 0.4 years old (mean +/- SD). In females tests were performed during the follicular phase of the menstrual cycle. GAL alone cannot provoke a response from GH unless associated with GHRH. The contemporary administration of PD does not increase the extent of the response. The latter did not differ between sexes. The GHRH-GAL association induced a higher response in GH compared to GAL alone and GAL-PD, without any differences between the sexes. Lastly, the combination GHRH-GAL-PD induced responses that were comparable to GHRH and GAL alone. Therefore GAL does not act alone but enhances the effect of GHRH and the cholinergic system appears to be involved as a modulator. Moreover, the effect of GAL is comparable in both sexes.

[Epidemiology of childhood obesity: prevalence in North-West Italy]

Childhood obesity is currently the most important form of malnutrition in populations with a high socioeconomic status. In Italy the prevalence of this pathology increases steadily every year with differing percentages in the various regions. This paper aims to contribute to epidemiological studies on childhood obesity by analysing the prevalence of this disorder in a relatively large area of north-western Italy. The study examined the childhood population of Verbano-Cusio-Ossola (Piedmont) (12,174 subjects, of which 6,288 males and 5,886 females) aged between 6 and 15 years old. The prevalence of obesity was 9.88% (51.58% in males and 48.22% in females); males showed a peak of prevalence (16.53%) between 13 and 14 years old and females between 8 and 9 (16%). The analysis of our data highlights the importance of this problem in the area studied.

Thyroid-stimulating hormone and prolactin responses to thyrotropin-releasing hormone in juvenile obesity before and after hypocaloric diet

This study was performed on 36 obese subjects aged 8.5-17.4 yr, 14 boys and 22 girls (prepubertal: 5 boys and 5 girls [stage I, according to Tanner]; BMI: 35.5 +/- 1.4 [mean +/- SEM] and 35 +/- 1.3 respectively; pubertal: 9 boys and 17 girls [stage IV-V]; BMI: 36.2 +/- 1.8 and 36 +/- 1.5 respectively) before and after 8 weeks of a 1000 kCal/day diet. The responses of serum TSH and PRL to TRH (200 micrograms iv as a bolus) were evaluated as Area Under the Curve (AUC) and net increase in respect to basal values (delta TSH and delta PRL). Serum T4, fT4 and rT3 were assayed at the baseline and T3 and fT3 at the baseline and 120' after TRH injection. A similar analysis was performed on 14 age- and sex-matched lean subjects as controls. In females at baseline fT4 serum levels were greater than controls and were significantly reduced after weight loss; rT3 increased after weight loss in the whole study group. In patients of both sexes the PRL peak after TRH injection was earlier but not greater (15') than in controls (30'). After weight loss PRL peak after TRH was found at 30' (as controls) in females only. Taking into consideration the stage of pubertal development, the results were the following: a) in puberal girls, after weight loss, TSH and PRL peaks after TRH were delayed with respect to baseline and to the other considered subgroups; b) in prepubertal girls TSH and PRL peaks, delta TSH, delta PRL, AUC-TSH and AUC-PRL were blunted with respect to pubertal ones; c) the other considered variables were unchanged after the period of caloric deprivation. No correlation between BMI and the AUC of TSH and PRL was found. These data suggest that thyroid function is substantially normal in adolescent obese subjects and not influenced by a prolonged period of caloric restriction, even though a reduced hypothalamic dopaminergic tone on pituitary thyreotrophs and lactotrophs could cause subtle alterations on TSH and PRL release, partially influenced by gender and sexual development.

[Blood prolactin patterns in hepatic cirrhosis]

Variations in PRL secretion were observed during chronic hepatic disorders. The aim of our study was to evaluate the behaviour of PRL in patients affected by hepatic cirrhosis. 6 patients (4 males and 2 females) were studied and matched with a group of healthy controls. In all subjects PRL values were evaluated in basal conditions and after TRH stimulation. The results obtained showed higher basal levels of PRL, together with higher and more prolonged TRH responses in patients with hepatopathies than in controls (p < 0.01). These abnormalities in PRL secretion during hepatic cirrhosis could be due to alterations of neurotransmitters at central level.

[Melatonin secretion in Klinefelter's syndrome]

It has been observed that the pineal gland seems to modulate diencephalic neuroendocrine activity through its principal hormone, melatonin. In animals, melatonin inhibits the secretion and release of hypophyseal gonadotropins, probably by inhibiting hypothalamic releasing factors; in man, on the contrary, the administration of LHRH seems to have a stimulating effect on melatonin serum levels. In the light of this, in pathologies characterised by an imbalance in the hypothalamus-hypophyseal-gonad axis, it is possible to hypothesise variations in the secretion of melatonin and/or in its circadian fluctuations. In order to clarify further the relationship between the epiphysis and the hypothalamus-hypophyseal axis, the present study evaluated the pattern of melatonin secretion in a group of 16 patients with Klinefelter's syndrome. The circadian rhythm of melatonin secretion was determined from venous blood samples taken at 9 am, 1 pm, 5 pm, 9 pm, 1 am and 5 am; the same protocol was also followed in two control groups of respectively prepuberal and puberal healthy subjects. During the night samples were taken as rapidly as possible, using a red light source in order to not interfere with melatonin secretion. All of the examinations were performed during the winter period. Serum levels of melatonin were determined, after extractions with diethylether, by means of a double antibody RIA using commercially available kits (Bioscience Product--The Netherlands). Intra- and inter-assay coefficients of variation were respectively 3% and 8%. The data are reported as mean values +/- SD; the results were analysed by means of Student's test for unpaired data and analysis of variance.(ABSTRACT TRUNCATED AT 250 WORDS)

Melatonin response to TRH in prepubertal and pubertal healthy subjects

The current study was carried out to evaluate the influence of thyrotrophin releasing hormone (TRH) on melatonin secretion in healthy subjects. The study included 31 subjects of both sexes (prepubertal subjects: 15; pubertal subjects: 16). They were treated with TRH (0.2 mg i.v. as a bolus) with blood samples being collected at 0, 20, 60, 120, 180 min. after hormone administration; the results were compared with those of subjects infused with saline only. Serum levels of melatonin were measured with a double antibody RIA method. A significant increase in melatonin levels after TRH was seen only in the prepubertal females, with a peak at 120 min. On the contrary, no significant melatonin changes were seen in the prepubertal males or in either pubertal males and females. These results suggest the existence of sex- and age-related differences in melatonin responses to TRH in humans.

[The effect of GH on erythropoiesis in vivo]

It has been demonstrated that the direct and/or indirect stimulation of hematopoiesis is one of the effects of the growth hormone (GH) in vitro. In order to study the effect of GH on erythropoiesis in vivo, the variation of hemochrome in a group of 8 subjects with GH deficiency (GHD) were monitored during a substitutive therapy with biosynthetic GH (rhGH) at dose of 0.4 U/kg/week. Hemoglobin (Hb), hematocrit (Ht), mean corpuscular volume (MCV), number of red blood cells (RBC) were analysed in all subjects at the beginning and after 9 months of treatment. The effectiveness of therapy was demonstrated by statistically significant variations in height, height SDS, growth velocity, serum levels of IGF-I. After 9 months of rhGH therapy, a significant increase was observed in all values considered with exception of MCV. In conclusion Gh would appear to stimulate erythropoiesis, directly or indirectly, and these results would appear to indicate an in vivo confirmation.

[Social integration in adulthood in a group of subjects with Turner syndrome]

The aim of the present study was to evaluate social integration in adulthood in a group of 48 subjects with Turner's syndrome. This was done by asking subjects to fill in a multi-choice questionnaire concerning their personal, social and working situation. The mean age (+/- SD) of the group was 24.8 +/- 1 and the reported stature was 142.2 +/- 1.4. The results obtained were compared with those formulated by ISTAT in 1990 for the entire Italian population. As far as regards education it was seen that 100% of subjects had completed primary school, 52% had attended secondary school, 29% had been to high school and 6% had attended university. It was therefore concluded that educational status, at least in this group, was higher than that of the Italian population in general. The cultural level of these subjects meant that most had found appropriate employment and only 6% were unemployed. 90% of the subjects were unmarried and only 5 were married (10%); the majority of those unmarried lived with their parents (83%). This underlines a prolonged dependence on the family nucleus and probable disorders regarding the subjects' own sexual identity and affective capacities. Among the parameters examined no substantial differences were found between subjects with a 45,X karyotype and those with chromosomic mosaicism. In the light of these findings it is apparent that efficacious medical and psychological strategies should be developed to enable a greater realization of interpersonal relations in the familial and social field.

[The TRH test in Turner syndrome]

In order to evaluate the functionality of the hypothalamic-hypophyseal-thyroid axis in Turner's syndrome (TS), 27 subjects, aged between 5.1 and 16.1 years old, were studied, 14 of whom were karyotype 45,XO and 13 affected by mosaicism. The TRH test (200 mcg i.v.) was performed in all subjects using a single bolus. TRH titers were assayed in serum samples collected at 0, 15, 30, 60 and 90 minutes, and anti-microsome and anti-thyroglobulin, T4 and T3, were assayed in the basal sample; the latter were also assayed in the blood sample collected at 120 minutes. These results were compared with those obtained using the same test in a group of age- and sex-matched controls. Anti-thyroid antibodies and basal levels of T3 and T4 were within the norm in 26 subjects; a high basal value of TSH was only found in one patient with chromosomic mosaicism with an elevated response to TRH and a high titer of anti-microsomic antibodies. Apart from this no statistically significant differences were found in patients compared to control subjects in relation to TSH values at all stages of the test and between the two groups of TS; no significant results were found in the comparison between the areas below the curves (AUC). On the basis of these results the Authors conclude that it is not possible to reveal alterations in thyroid function attributable to hypothalamic and hypophyseal anomalies in this group of patients either with karyotype 45,XO and mosaicism.

[Tolerability to terizidone (TZ) in the treatment of pulmonary tuberculosis in dialyzed patients]

Six dialysed patients affected by tuberculosis involving the respiratory apparatus were included in the study. Antimycobacterial treatment consisted of polychemiotherapeutic combinations using terizidone (TZ). The need to resort to this drug may be explained by the need to exclude normally used drugs (R/AMP, INH, SM) due to resistance, allergy or organ meiopragia. Five patients received terizidone at a dose of 600-900 mg/day for the entire course of treatment, whereas it was necessary to abandon treatment in one patient due to the onset of depressive symptoms which then rapidly regressed following the suspension of TZ therapy. The good level of tolerance demonstrated in the 5 remaining cases confirm the inclusion of this drug in the treatment of a limited number of cases of tuberculosis in dialysed patients.

[Growth in stature in infantile-juvenile obesity]

The study aimed to assess the effect of juvenile simple adiposity on growth. The height (measured using a Hapenden stadiometer) of 1443 subjects (799 boys and 644 girls) aged from 6 to 16 was measured. The Quetelet index (QI) of adiposity was used; all subjects examined exceeded the 95th centile of the standard Cronk and Roche scale. Heights are expressed as standard deviation scores (SDS) and are compared to the British Standard. Adipose boys are taller than British boys up to the age of 12, then the difference lessens and the average heights of 15-year-old adipose boys are below the 50th centile of British growth charts. Female subjects showed a higher SDS from 6 to 8 years, after which the difference lessens gradually, and after 13 years the average height is below the 50th centile of British standards. Adipose boys are taller than normal boys during childhood; in prepuberty and puberty this difference lessens and during puberty they are shorter than British boys. This growth model is probably due to advanced skeletal maturity in adipose subjects with the result that at puberty growth lessens because it is exhausted. The wide epidemiological cross-sectional study confirms that growth is favourable in juvenile adiposity but does not alter adult height.

[Impaired glucose tolerance in obesity in children and adolescents]

The incidence of impaired glucose tolerance (IGT) in obese juvenile has not yet been well defined. Glycemic and insulin responses to OGTT were evaluated in 398 obese juveniles (and 70 healthy control subjects) to investigate possible correlations with age, body mass index (BMI) and obesity duration. Subjects were subdivided into two groups according to OGTT results: obese with normal glucose tolerance (OB-NGT) and obese with impaired glucose tolerance (OB-IGT). IGT was found in 11% of subjects but no correlations were observed in relation to age, BMI and obesity duration. There was no difference in the glycemic response to OGTT in terms of the biological parameters examined. Insulin plasma levels were twice as high in OB-NGT in comparison to control subjects and OB-NGT. Basal insulinemia increased with BMI in OB-IGT but not in OB-NGT.

[Correlation between lipid pattern and body mass index in obesity]

Lipid plasma levels were measured in a group of 519 obese subjects, aged 7-66 years, divided according to age, sex and BMI. Lipidemia and total cholesterolemia increased both with age and BMI, irrespective of sex; LDL and VLDL increased in relation to age and, with less evident differences, to BMI. Triglycerides increased in the age bracket from adolescent to adult, especially in males, whereas their increase in relation to BMI showed no difference between the sexes. Chylomicron plasma levels remained steady both in relation to age and BMI.

[Contribution of the serum anti-mycobacterial IgG measurement to the diagnosis of tuberculosis. Personal cases]

Data of a transversal research on 36 suspected tuberculosis (tb) inpatients of St. Luigi Hospital are reported. Serum antimycobacterial antibodies Class IgG to A60 were measured by means of ELISA. Final diagnosis was tb in 19 subjects, while 9 had a tb history over different years. Sensitivity was 78.94% and specificity 75%. According to with other recent reports, our results are poorly discriminating. However, the test, if valued with other clinical data, can contribute to the ascertainment of tb.

[Assessment of final body height of a group of persons with juvenile obesity]

Essential adiposity positively influences growth during childhood, but little is known about its effects on final height. A study was performed in 39 subjects (20 males and 19 females, mean age 10.7 for males, and 8.2 years for females) affected by essential adiposity to assess height during and at the end of the developmental age. During childhood the height of adipose subjects included in the study exceeded the mean values for matched chronological ages from the British reference sample (0.716 SDS for males, 0.587 for females). In adulthood, this advantage was completely reversed: the height of males in the study was in line with mean values (0.069 SDS), whereas the females were slightly under the mean height of the reference group (0.165 SDS). Since height is known to be heavily influenced by genetic factors, the results have been corrected for genetic bias. Improved results are obtained following correction for genetic influence: males (0.890 SDS), females (0.584 SDS). In conclusion, childhood adiposity has a positive influence on growth during the developmental age, and also appears to have a positive influence on genetic potential, as may be deduced from the height of the parents, thus improving final height.

[The importance of glycosylated plasma protein determination in the diagnosis of carbohydrate intolerance in obesity]

To evaluate the possible interest of the dosage of glycated plasma proteins in the diagnosis of glucidic intolerance, OGTT with determination of glycaemia and insulinaemia, HbA1c and fructosamine was determined in 6 normal and 35 obese subjects. On the basis of OGTT the subjects were subdivided into 20 obese with normal glucose tolerance, 7 with IGT and 8 with DM. In the comparison between all the subjects there was a significantly higher plasma fructosamine concentration in the obese with DM (p less than 0.001). No difference was noticed between the normal subjects and the other two classes of obese patients. This suggests that the evaluation of glycated plasma proteins is scarcely sure in a screening plan.

[The current epidemiologic profile of the drug resistance of Koch's bacillus to antitubercular antibiotic chemicals]

The study was conducted on patients with initially diagnosed tuberculosis encountered in 1986-87. A series of 269 bacterial antibiograms performed on sputum [correction of excreate] and other materials was examined in order to ascertain the resistance of Koch's bacillus to R/AMP, INH, SM and EMB. Primary drug resistance was found in 64 cases (23.79% of the total) and was isolated in 32 (11.89%), multiple in the rest. The response to the individual antibiotics was a follows resistance to INH was isolated in 11 cases (4.08%), combined with resistance to other drugs in 27 (10.03%); resistance to SM was isolated in 13 cases (4.81%) multiple in 24 (8.92%); resistance to R/AMP was isolated in 4 cases (1.48%), multiple in 14 (5.2%); resistance to EMB was isolated in 4 (1.48%) multiple in 19 (7.06%). Comparison with earlier studies in the Turin area highlights that the incidence of TB, in decline up to 1979, significantly increased in the period considered.

[Beta-pancreatic function in adult patients with GH deficiency]

We investigated the beta-pancreatic function in response to a standard oral glucose tolerance test (OGTT) and a tolbutamide test in a group of GH-deficient adult subjects and in a group of control subjects. Fasting plasma glucose levels were normal in all subjects; the insulin levels, basal (0.19 +/- 0.02 vs 0.99 +/- 0.08) and, as n-AUC, after OGTT (195.2 +/- 23 vs 520.5 +/- 69) and tolbutamide test (33.6 +/- 4.4 vs 177.7 +/- 12.1) (means +/- ES), were significantly lower (p less than 0.001) in the GH-deficient subjects compared to controls. These data indicate a reduced beta-cell activity, secondary to absence of trophic effect of GH on pancreatic beta-cells, in GH-deficient adults.

[Different rates of theophylline clearance. A statistical study of a group of asthmatics]

In standard clinical practice the pharmacokinetic profile of theophylline is monitored by measuring blood levels of the drug. However a more accurate picture of the metabolic pattern over time can be obtained by monitoring theophylline clearance. This technique was applied to 40 lung disease patients most (55%) of them slow metabolisers as described in the literature. In the light of this findings, cautious dosing is advisable when no data are available or clearance (difficult to apply outside a strictly specialist environment).

[No correlation between insulinemic levels and arterial hypertension in obese females]

High blood pressure and impaired glucose tolerance are frequently associated with obesity: it has been suggested that hyperinsulinemia could represent one of the possible pathogenetic connections between obesity and systodiastolic hypertension. In order to verify this hypothesis we examined fasting and post-load insulin and glucose levels in a group of 102 obese females, 58 hypertensive and 44 normotensive. All of the subjects underwent standard OGTT in order to measure their glycemic and insulinemic levels. No differences were found between two groups, as regard age and degree of obesity; blood pressure values were significantly different (p less than 0.01). No significative differences were detected for glycemic and insulinemic levels between hypertensive and normotensive subjects. These results indicate that hyperinsulinemia is not the prominent link between obesity and arterial hypertension; the relationship between these two conditions may be indirect.

[Clinical aspects of respiratory pathology in scleroderma. Case reports]

Six cases of scleroderma with pulmonary involvement, either isolated or accompanied by other visceral signs, observed between 1985 and 1987 have been examined. Patients were undergoing treatment with cortisone drugs in 4 cases and azathioprine in 2. Chest X-ray documented a picture of nodular opacities in 3 cases, reticular in 2 and miliariform in 1. B.A.L. revealed a picture of prevalently neutrophil alveolitis in all subjects, while transbronchial biopsy showed a finding of macrophagic infiltration in 2 cases, and one of fibroblastic proliferation in 4. The anatomoclinical damage was reflected adequately by spirometric tests and above all by the DLCO, while Gallium 67 scan and measurement of the A.C.E. were not very sensitive.

The release of thromboxane B2 and 6-keto-PGF1 alpha following pulmonary embolism

It has been shown in animals that acute obstruction of pulmonary artery branches is followed by an early but shortly lived increase in blood levels of thromboxane B2 and a subsequent longer-lasting increase in blood levels of 6-keto-PGF1 alpha. Our study was conducted on twelve patients with acute pulmonary embolism. Nine were treated with urokinase; three could not be given thrombolytic or anticoagulant drugs due to bleeding peptic ulcer (2 cases) or recent cerebral hemorrhage (1 case). HPLC and RIA tests were performed on arterial blood samples at diagnosis and after 1, 6, 12 and 24 hours. Findings were compared with those in a control group of 6 healthy subjects. There was a difference in prostanoid behaviour between the untreated and urokinase treated patients. Among the former mean TxB2 was significantly raised at clinical onset and began to decline after 6-12 hours, approaching the mean level found among the controls after 24 hours. In contrast 6-keto-PGF1 alpha was raised after 1 hour and gradually declined thereafter. In the subjects treated with urokinase TxB2 was already close to the mean control level after 1 hour; 6-keto-PGF1 alpha had increased after 1 hour but had returned near the control level after 12. The behaviour of prostanoids appears to match the clinical course.

Examination of 41 cases of laryngeal tuberculosis observed between 1975-1985

Forty one cases of laryngeal tuberculosis, accounting for 0.8% of all cases of tuberculosis observed in 1975-1985, are evaluated. The mean age was 53 yrs, the male/female ratio 9:1. In all cases current or earlier pulmonary tuberculosis was noted. The laryngeal sites affected were, in order of frequency: true vocal cords, epiglottis, false cords and laryngeal ventricles, arytenoid and interarytenoid area, subglottic area. The patients were usually treated with isoniazid, rifampicin, ethambutol for 6-12 months. Two cases required excision of laryngeal lesions. The results of chemotherapy were good.

[Lung diseases associated with silicosis. Study of 618 cases]

Retrospective research has been carried out on the clinical reports of 618 cases of patients suffering from silicosis admitted to the S. Luigi Gonzaga Hospital in 1973-1987 (1.4% of all pneumopathy admittances). A comparative evaluation of the five-year periods 1973-77, 1978-82, 1983-87 showed a steady reduction in the percentage of silicosis to total cases (from 1.62% to 1.55% and 1.16%). Among the 618 cases assessed, the following pneumopathies were associated with silicosis either alone or in combination: chronic obstructive bronchopneumopathy (89.4%), pulmonary tuberculosis (22.2%), bronchogenic carcinoma (8.4%), acute aspecific infections (26.1%), mycosis (0.6%), sarcoidosis (0.3%), other pneumopathies (1.1%). Comparison between the three five-year periods shows an increase in the frequency of the silicosis-carcinoma association and a fall in the silicosis-tuberculosis and silicosis-COLD associations.

Examination of 41 cases of laryngeal tuberculosis observed between 1975-1985

Forty one cases of laryngeal tuberculosis, accounting for 0.8% of all cases of tuberculosis observed in 1975-1985, are evaluated. The mean age was 53 yrs, the male/female ratio 9:1. In all cases current or earlier pulmonary tuberculosis was noted. The laryngeal sites affected were, in order of frequency: true vocal cords, epiglottis, false cords and laryngeal ventricles, arytenoid and interarytenoid area, subglottic area. The patients were usually treated with isoniazid, rifampicin, ethambutol for 6-12 months. Two cases required excision of laryngeal lesions. The results of chemotherapy were good.

Tuberculosis of the larynx. Today

Forty-one cases of laryngeal tuberculosis accounting for 0.79% of the TB cases observed in 1975-85 are examined. The M/F ratio was 9.2:1; the mean age 52 years 9 months. In all cases current or earlier tubercular lesions on the pulmonary parenchyma were also noted. The laryngeal sites affected were as follows, in order of frequency: true vocal cords, epiglottis, false cords and laryngeal ventricles, arytenoid and interarytenoid area, subglottic area. The patients were treated with R/AMP, INH, EMB or SM, EMB with satisfactory results. Two cases required exeresis of laryngeal lesions and 3 tracheotomy.

[Histo-radiological and histo-bronchoscopic correlates in neoplastic pathology of the lung. Personal case series]

Data are presented on a series of 100 lung cancer patients, diagnosed histologically and encountered in 1984-87. The percentage distribution of the various histotypes and their relationship with radiological and endoscopic aspects were examined. The data obtained are then compared with those reported in the literature.

[Post-actinic pulmonary fibrosis. Longitudinal study of 279 cases]

The incidence and extent of postactinic pulmonary fibrosis was investigated in relation to the different types of radiation therapy. For this purpose, 131 patients treated with fast electron (for breast cancer) and 148 patients treated with TCT (for breast cancer and cancer of other nature) observed in the period 1976-1987 were followed up (from 13 months to 7 years). The frequency of postactinic fibrosis was much less in the first group of patients than the second (6.61% vs 18.99%); further, the functional damage in these patients proved less and developed in a less unfavourable way.

[Skin reactions with ubiquitous multiple antigens as a test of survival in patients with inoperable bronchogenic carcinoma]

Fifty-three patients suffering from inoperable, non-microcytoma, bronchogenic carcinoma in which a skin reaction with ubiquitous antigens (tetanus, diphtheria, streptococcus, tuberculin, proteus, tricophyton, candida) had been carried out were followed up to check on the possible relationship between skin reactivity and survival period. A significant correlation was found between the degree of positivity and duration of survival, with mean survival values greater than 69.1 weeks being observed in patients positive to five or more antigens. Among preliminary tests, it would therefore appear that skin reaction with ubiquitous may provide indications for predicting survival.

[Double-blind study on the effects of famotidine on bronchial tone and on expectoration]

A double blind test using famotidine and a placebo was conducted on 14 patients with hypersecretory, chronic bronchitis. No other drug treatment was given during the test or in the ten days preceding it. VC, FEV1, Sgaw and daily excrete volume were measured before the test and 7, 14 and 21 days after it began. The data collected indicate that H2 receptors have no influence on bronchial calibre or secretions.

[Ultrasonic spray protection against bronchospasm. Comparison of fenoterol and a combination of salbutamol and ipratropium bromide]

Nine patients with clinically stable bronchial asthma who had received no drug treatment in the preceding 48 hours were examined. The patients were subjected to 5 minutes ultrasound spray after the double blind administration of either fenoterol or salbutamol + ipratropium bromide. Respiratory function was assessed before and 30, 60 and 90 minutes after cessation of the stimulation. The results showed no significant difference in the protection against the ultrasound spray provided by fenoterol and the combination of salbutamol + ipratropium bromide.

[Comparison of the bronchodilating activity of procaterol and nicardipine in chronic forms of bronchial asthma]

The bronchodilatory activity of one beta 2-stimulation (procaterol) and one calcium antagonist (nicardipine) both recently introduced was compared in a group of chronic asthmatics in the clinical remission phase. The experiment took the form of the randomised double blind administration of procaterol or nicardipine or a placebo twice a day for 15 days with spirometric tests being performed before, during and after the experiment. The results show that nicardipine does have a bronchodilatory effect though less than the beta 2-stimulant.

[Data on cellular subpopulations in bronchoalveolar lavage in silicosis and asbestosis patients. Case contribution]

Data on the cytology of BAL performed on 8 silicosis and 5 asbestosis patients with different degrees of radiological profusion and functional impairment are examined. The prevalently neutrophilic alveolitis reported in the literature in these forms of pneumoconiosis is confirmed, while differences were found between the percentage of lymphocyte subpopulations in the two diseases.

[Scintigraphic findings with a positive marker in generalized lymphadenopathy syndrome (L.A.S.)]

The behaviour of gallium scintigraphy in a group of 15 drug addicts suffering from LAS is examined. The examination was positive in 11 patients with no pleuro-pulmonary lesions that could be demonstrated by clinical or radiological examination. This is in line with similar observations in AIDS cases and may reflect the preactivation of monocytes and macrophages documented in HIV infection.

[Use of miocamycin in the acute exacerbation of chronic obstructive bronchopneumopathy. Case material contribution]

18 patients with chronic obstructive bronchitis were treated with 900 mg myomycin a day. The clinical parameters examined were the quantity and organoleptic characteristics of the expectoration, coughing, and body temperature. These parameters were studied immediately before and 7.14 and 21 days after the start of treatment. Myomycin was found to be satisfactorily effective with minimal toxicity and well tolerated.

[Radioscintigraphic correlation in interstitial pneumopathy. Case presentations]

Radiological and scintigraphic findings in 82 patients (58 male, 24 female) were compared. The patients were hospitalised in 1981-86 with sarcoidosis (43 cases), silicosis (26), asbestosis (9) extrinsic allergic alveolitis (3), lung disease caused by hard metals (1). Gallium scintigraphy was positive in 61 patients (74.39%). More precisely, the response was positive in 57 cases in both analogic and quantitative terms and in 4 only quantitatively. The radiological (radiography and stratigraphy) finding was significant in 42 of the 61 gallium-positive cases and negative in the remaining 19. In the 21 gallium-negative cases (25.61%) the radiological finding was significant in 9, negative in 12. The study confirms the real value of gallium scintigraphy in the diagnosis and follow-up of interstitial lung disease in line with views presented in the recent literature.