Gynecomastia in two young men with histories of prolonged use of anabolic androgenic steroids

The aim of this report is to highlight the risk of anabolic androgenic steroid-induced gynecomastia in young men involved in nonagonistic sports and the role of ultrasonography in its diagnosis. The authors describe two cases of gynecomastia in nonprofessional weight lifters with histories of AAS use. In both cases, the diagnosis was based on patient history and clinical findings, but the sonographic examination confirmed the clinical suspicion and excluded the presence of other types of disease associated with mammary-gland enlargement in men.

IL-10 production in multiple sclerosis patients, SLE patients and healthy controls: preliminary findings

IL-10 is a cytokine with suppressive effects on (auto) antigen presentation and T-cell-mediated immune reactions, but is also capable of stimulating polyclonal IgG synthesis. Recent evidence suggests its involvement in multiple sclerosis (MS) and systemic lupus erythematosus (SLE). We assessed PBMNC IL-10 release in MS and SLE patients before and after in vivo prednisone or methylprednisolone treatment. The SLE patients showed a high level of IL-10 release by unstimulated PBMNCs, whereas the PHA-stimulated PBMNCs from MS patients produced large amounts of the cytokine.

Prenatal treatment of fetal hypothyroidism: is there more than one option?

Following the diagnosis of fetal goitre at 22 and 24 weeks' gestation in two hyperthyroid pregnant women who underwent treatment with 400-500 mg of propylthiouracil in the first weeks of pregnancy, a total of seven fetal blood samplings were performed to evaluate thyroid function before and after the initiation of two different treatment regimens. L-Thyroxine (600 micrograms) was injected five times intra-amniotically in one woman and continuous maternal administration of the thyroid analogue 3, 5, 3'-triiodothyroacetic acid (Triac) was attempted in the other. Normalization of fetal thyroid function and reduction of fetal goitre were achieved in both fetuses and transplacental passage of Triac was indirectly demonstrated by high levels of free triiodothyronine in fetal blood. In cases of fetal hypothyroidism, direct or indirect prenatal therapy can be adopted successfully and safely.

Resolution of hyperthyroidism in a pregnant woman with toxic thyroid nodule by percutaneous ethanol injection

Overt hyperthyroidism was found in a 35-year-old pregnant woman at the 13th week of gestation who was referred to us for tachycardia, tremors, and weight loss. Clinical signs, symptoms, and laboratory findings led to the diagnosis of toxic thyroid nodule. She was treated with ultrasound guided percutaneous ethanol injection (PEI) and, after 2 weeks of treatment, the woman was completely euthyroid. These findings suggest that during pregnancy PEI appears to be a rapid and safe therapy for toxic nodular goiter and an effective alternative to the administration of antithyroid drugs.

Spinal cord involvement and systemic lupus erythematosus: clinical and magnetic resonance findings in 5 patients

We report the clinical, magnetic resonance imaging (MRI) and laboratory findings in 5 patients with clinical spinal cord involvement with an acute or subacute course; in two of the patients the myelitic episode preceded, in one it was concomitant to, and in two it followed the diagnosis of systemic lupus erythematosus (SLE). The marked clinical and MRI heterogeneity detected in our patients suggests that various factors may be implied in the pathogenesis of spinal cord involvement in SLE. The possibility of a future evolution to SLE should be kept in mind in women presenting spinal cord involvement with no other explanation, and should be assessed by means of extensive and repeated clinical and laboratory evaluations.

Tremor as an early manifestation of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) has been described by many authors as a multisystem disorder involving variable and protean clinical manifestations and with an unpredictable course. We report the case of a 68-year-old woman suffering from SLE in whom tremor appeared ten years before a clinical picture suggestive of SLE and which remained the only clinical neurological sign even during overt disease. Tremor and other SLE manifestations disappeared with corticosteroid therapy.

[Churg-Strauss syndrome: is it a rare disease?]

We describe four patients with Churg-Strauss syndrome admitted to the hospital in 1988. Some clinical and histological features of particular relief are present in these cases. All patients had been treated with corticosteroids and they are now in remission. Our work suggests that Churg-Strauss syndrome is not a rare disease and that an early diagnosis and appropriate therapy may influence favourably at least long term survival.

In vitro and ex vivo effect of RU41740 on human polymorphonuclear leukocyte function

We investigated the effect of RU41740, a glycoprotein extracted from Klebsiella pneumoniae and possessing immunomodulating properties, on human neutrophil functions in vitro and ex vivo. Our in vitro results showed that RU41740 increased complement- and Fc receptor-dependent phagocytosis. Moreover, the drug enhanced the oxidative metabolism (assessed by chemiluminescence) both in resting and stimulated cells; in the latter case the RU41740-induced enhancement was observed when neutrophils were stimulated with opsonized particles of N-formyl-methionyl-leucyl-phenylalanine (FMLP) but not when phorbol myristate acetate was used. Using otherwise effective experimental conditions, RU41740 did not affect spontaneous or FMLP-induced neutrophil migration. For the ex vivo experience we tested neutrophils of ten elderly subjects with a previously demonstrated phagocytic defect. These subjects were treated orally with RU41740 at a daily dose of 2 mg for 1 week during the first month, and of 1 mg for 1 week in the second month. In this population, RU41740 was able to restore the impaired phagocytic activity and to induce a significant increase of spontaneous chemiluminescence (CL); stimulated CL was also positively influenced. These effects on neutrophils provide new explanatory bases for the immunostimulatory activity of RU41740.

Inhibition of neutrophil oxidative metabolism by nimesulide

Oxygen derived free radical release from activated neutrophils may be in part responsible of tissue damage in the acute phase of inflammation. We have shown that the methane sulfonanilide antiinflammatory agent nimesulide inhibits the respiratory burst of phagocytosing neutrophils without affecting their phagocytic or chemotactic responsiveness. In fact, chemiluminescence and superoxide anion generation by polymorphonuclear leukocytes (PMN) stimulated with zymosan particles or with the synthetic peptide FMLP are inhibited by nimesulide and its 4-OH metabolite in a dose dependent fashion without affecting cell viability. The control of the extracellular flux of radical species by pharmacological compounds may affect the course of inflammation reducing tissue damage. Our data suggest that the inhibition of superoxide anion production by neutrophils is an additional mechanism of action of the antiinflammatory agent nimesulide.

Chronic granulomatous disease in a 23-year-old female

A 23-year-old girl with clinical and laboratory findings characteristic of chronic granulomatous disease is described. The patient was admitted to hospital because of severe disseminated aspergillosis. Studies of neutrophils showed normal phagocytosis but impaired microbicidal killing and a failure of the respiratory burst activity as measured by NBT-reduction, superoxide generation, chemiluminescence and antibody-dependent cell mediated cytotoxicity. Patient's neutrophils had normal chemotactic responsiveness but a marked impairment in the level of serum chemotactic activity was observed. Neutrophils from the parents and 2 maternal aunts showed normal values for all the determinations. The lack of evidence for a carrier state in all the family members studied together with the inability to detect a mixed population of neutrophils in our patient are in contrast with the Lyon's hypothesis of X-chromosome inactivation. Our findings suggest an autosomal recessive inheritance in this female with chronic granulomatous disease.

Evidence for differing dopaminergic activity in childhood- or adult-onset obesity

In order to investigate dopaminergic activity in two types of human obesity, childhood- and adult-onset, we have studied the responses of plasma TSH and prolactin to domperidone, a dopamine receptor antagonist, in 12 patients obese since early childhood, 12 patients with adult-onset obesity, and in 12 lean controls. All subjects were females. In childhood-onset obese patients the responses of plasma prolactin and TSH to antidopaminergic stimulation were lower than those of adult-onset obese patients and lean controls. Conversely, the stimulus elicited a normal response of plasma prolactin and an exaggerated response of plasma TSH in adult-onset obese patients. These data indicate the presence of differing dopaminergic tone in the two types of human obesity.