A technique for sorting rat gonadotropes using anti-LH or anti-FSH antibodies covalently attached to magnetic beads

A technique for sorting live LH- and FSH-secreting cells was developed. After enzymatic dispersion, a suspension of pituitary cells from male rats castrated 7 days earlier was incubated in potassium chloride (KCI 50 mmol/l) for 30 min and gonadotropin outflow was provoked. Then, considering either LH or FSH as temporary surface markers, we positively selected the secreting cells by means of antibodies toward either LH (anti-LH beads) or FSH (anti-FSH beads) covalently attached to magnetic beads. The spontaneous secretion of LH and FSH overnight and the release induced by KCI the following morning were calculated. A population enriched in gonadotropes (16% of the total) able to secrete both gonadotropins was selected by means of anti-LH beads; this released 7 times as much LH as non-selected cells. A similar population (14% of the total) was selected by means of anti-FSH-coated beads; this produced 3.3 times as much LH as non-selected cells. In some experiments, the cells not previously sorted with anti-LH-coated beads were further incubated in the presence of anti-FSH beads, in an attempt to isolate a population secreting only FSH. A limited number of cells were sorted (6% of the total cells), able to produce both gonadotropins, but with a lower LH/FSH ratio. Similarly, those cells excluded by the selection with anti-FSH beads were further incubated with anti-LH beads, with a view to obtaining only-LH-secreting cells. However, both gonadotropins were still secreted by these cells (8% of the total), which had the highest LH/FSH ratio. In conclusion, fractions from castrated male rats that are enriched in gonadotropes contain cells that secrete both gonadotropins in vitro. The secretion of LH is prevalent. However, differences in the LH/FSH ratio between the populations sorted and changes from spontaneous to stimulated release are observed. This suggests that some gonadotropes might 'specialize' in releasing LH and others in releasing both LH and FSH.

P0.1 is a useful parameter in setting the level of pressure support ventilation

OBJECTIVE

The purpose of this study was to investigate whether changes in breathing pattern, neuromuscular drive (P0.1), and the work involved in breathing might help to set the individual appropriate level of pressure support ventilation (PSV) in patients with acute respiratory failure (ARF) requiring ventilatory assistance.

DESIGN

A prospective, interventional study.

SETTING

An 8-bed multidisciplinary intensive care unit (ICU).

PATIENTS

Ten patients with ARF due to adult respiratory distress syndrome (ARDS), sepsis or airway infection were included in the study. Chronic obstructive pulmonary disease (COPD) patients with acute exacerbation were excluded. None of these patients was in the weaning process.

INTERVENTIONS

We found a level of pressure support able to generate a condition of near-relaxation in each patient, as evidenced by work of breathing (WOB) values close to 0 J/1. This level was called PS 100 and baseline physiological measurements, namely, breathing pattern, P0.1 and WOB were obtained. Pressure support was then reduced to 85%, 70%, and 50% of the initial value and the same set of measurements was obtained.

MEASUREMENTS AND RESULTS

Flow (V) was measured by a flow sensor (Varflex) positioned between the Y-piece of the breathing circuit and the endotracheal tube. Tidal volume was obtained by numerical integration of the flow signal. Airway pressure (P(aw)) was sampled through a catheter attached to the flow sensor. Esophageal pressure (Pes) was measured with a nasogastric tube incorporating an esophageal balloon. The esophageal balloon and flow and pressure sensors were connected to a portable monitor (CP 100 Bicore) that provided real-time display of flow, volume, P(aw) and Pes tracings and loops of Pes/V, P(aw)/V and V/V relationships. The breathing pattern was analyzed from the flow signal. Patient work of breathing (WOB) was calculated by integration of the area of the Pes/V loop. Respiratory drive (P0.1) was measured at the esophageal pressure change during the first 100 ms of a breath, by the quasi-occlusion technique. When pressure support was reduced, we found that the respiration rate significantly increased from PS 100 to PS 85, but varied negligibly with lower pressure support levels. Tidal volume behaved in a similar way, decreasing significantly from PS 100 to PS 85, but hardly changing at PS 70 and PS 50. In contrast, WOB and P0.1 increased progressively with decreasing pressure support levels. The changes in WOB were significant at each stage in the trial, whereas P0.1 increased significantly from PS 100 at other stages. Linear regression analysis revealed a highly positive, significant correlation between WOB and P0.1 at decreasing PSV levels (r = 0.87), whereas the correlation between WOB and ventilatory frequency was less significant (r = 0.53). No other correlation was found.

CONCLUSIONS

During pressure support ventilation, P0.1 may be a more sensitive parameter than the assessment of breathing pattern in setting the optimal level of pressure support in individual patients. Although P0.1 was measured with an esophageal balloon in the present study, non-invasive techniques can also be used.

Delayed puberty in males with beta-thalassemia major: pulsatile gonadotropin-releasing hormone administration induces changes in gonadotropin isoform profiles and an increase in sex steroids

Patients with beta-thalassemia major often have pubertal delay, the etiology of which has not been fully elucidated. We investigated the pituitary-gonadal response to short-term subcutaneous pulsatile gonadotropin-releasing hormone (GnRH) administration (150 ng/kg body weight every 120 min for 7 days) in five young males (aged 13.6-19.0 years) affected by beta-thalassemia major and presenting signs of delayed puberty. Immunoreactive and bioactive gonadotropin levels were determined and their isoform profiles were examined, before and after GnRH treatment, in a pool of samples collected every 15 min for 240 min. Testosterone, androstenedione, 17-hydroxyprogesterone, dehydroepiandrosterone and 17 beta-estradiol were measured as markers of gonadal function on days 0, 1, 3, 5 and 7 of treatment. Five patients (aged 16.9-26.8 years) with confirmed diagnosis of idiopathic hypogonadotropic hypogonadism who were starting pulsatile GnRH therapy were also studied in the same protocol. Increased sex steroid levels were observed in both groups as a result of treatment. On day 7, the thalassemic patients had increased bioactive luteinizing hormone (LH) and follide-stimulating hormone (FSH), although immunoreactive LH and FSH were comparable to day 0. Moreover, fewer acidic and more basic immunoreactive and bioactive isoforms were noted in LH profiles on day 7. Similar results were observed in hypogonadal patients, who also had increased immunoreactive LH and FSH values. We suggest that the early stage of delayed puberty in thalassemia might be characterized by a neuroendocrine dysfunction resulting in an impaired hypothalamic GnRH release, which is inadequate for a proper pituitary stimulation. Pulsatile GnRH treatment seems to re-establish partially the correct pituitary-gonadal function.

The effect of non-steroidal antiandrogen flutamide on luteinizing hormone pulsatile secretion in male-to-female transsexual subjects

We evaluated LH pulsatile patterns before and 4 weeks after the oral administration of flutamide (750 mg/day) in 9 male-to-female transsexuals (age range 17-28 yr) requesting gender reassignment. Flutamide was given to explore the feedback role of androgens on the LHRH-LH unit in LH pulsatility in transsexuals. Seven normal age-matched men served as a control group, without receiving flutamide, due to ethical considerations. LH pulsatility was evaluated on samples collected every 15 min for 360 min. FSH, PRL, cortisol, SHBG and sex steroids were evaluated on pooled samples. LH pulses were analyzed by the Santen and Bardin algorithm, slightly modified. No differences in FSH, PRL, total- or free-testosterone, estradiol and SHBG levels were noted between transsexuals and controls. Normal circadian cortisol decline was observed in all subjects. Mean LH levels (p < 0.05) and LH pulses (p < 0.01) were significantly lower in transsexuals. Flutamide induced an increase in mean LH and testosterone levels (p < 0.01). After flutamide administration there was an increase in LH pulse frequency (P < 0.01) and the frequency and amplitude of LH pulses in transsexuals were restored to levels observed in controls. No differences in FSH, PRL or estradiol levels were found after flutamide. These data suggest that a decrease in LH pulse frequency could be an endocrine marker in male-to-female transsexuals. An increase in endogenous androgen negative feed-back could be speculated in these subjects. However, normal testosterone levels indirectly suggest that a normal that a normal qualitative LH secretion is maintained.(ABSTRACT TRUNCATED AT 250 WORDS)

Sumatriptan does not stimulate PRL and GH secretion in acromegaly

OBJECTIVE

Serotoninergic receptors are involved in the regulation of PRL and GH secretion. We studied the effects of sumatriptan, a new 5-HT1D receptor agonist, on PRL and GH secretion in active acromegaly.

EXPERIMENTAL DESIGN

After their informed consent, all subjects were submitted to sumatriptan or placebo administration in single blind and in a random order. The time interval between the tests was of 7 days.

ENVIRONMENT

We examined all patients in the morning, after 12 hours of fasting. All subjects were in recumbent position during the tests. Pulse rate and blood pressure were monitored during the test.

SUBJECTS

Eight acromegalics (42-65 years) and 10 age-matched (33-63 years) normal subjects.

PROTOCOL

Blood samples were taken after needle insertion kept patent by slow saline solution infusion. PRL and GH secretion were evaluated after sumatriptan (6 mg sc) and placebo. Blood samples were taken before (45, 15 and 0 minutes) and every 15 minutes for 2 hours after sumatriptan or placebo administration.

RESULTS

No significant changes in PRL secretion were observed after sumatriptan in both groups of subjects. A significant increase in GH levels after sumatriptan was observed in controls but not in acromegalics. An age-related negative trend in GH response to sumatriptan was observed in controls.

CONCLUSIONS

Our study indicated that 5-HT1D receptors are not involved in PRL and GH secretion in middle-aged acromegalics.

Treatment of acromegaly with octreotide: effectiveness and tolerability of its pulsatile administration by portable pump

This study was undertaken to evaluate effectiveness and tolerability of octreotide administered in active acromegaly by pulsatile means and compare these data with intermittent three-times-a-day therapy. We studied 13 acromegalics with active disease. All patients received octreotide subcutaneously administered in a pulsatile way using a portable pump delivering 25 micrograms every 120 minutes and in an intermittent way (100 micrograms three times daily) (TID). From pretreatment values (56.5 +/- 13.4 micrograms/L) the 24-h integrated mean GH levels (IC-GH) were significantly reduced both during pulsatile and TID octreotide administration (P < 0.01). IC-GH was significantly lower during pulsatile therapy (17.0 +/- 5.2 micrograms/L) than during TID (22.0 +/- 11.5 micrograms/L; P < 0.05). Before octreotide, IGF-I levels were 669.8 +/- 85.7 micrograms/L; during octreotide therapy they were reduced in 12/13 patients (TID 340.2 +/- 41.5 micrograms/L, pulsatile 338.1 +/- 55.3 micrograms/L; P < 0.01). A correlation between IC-GH and IGF-I levels was observed only during TID administration of octreotide (R = 0.652; P < 0.05). The 24-hour GH pattern fluctuated widely before the start of octreotide therapy. During TID administration, GH levels tended to rise again before the following octreotide injection; this did not occur during pulsatile therapy. Side effects were fewer during pulsatile (15%) than TID (31%) octreotide administration (NS). Asymptomatic gallstones appeared in 1 patient. In conclusion subcutaneous pulsatile octreotide administration in acromegalic patients by means of a small portable pump seems able to produce, a steadier control of GH-IGF-I hypersecretion and fewer side effects than TID administration at same dosage.

[Tracheal intubation in a case of Still's disease]

The authors report the case of a patient with juvenile rheumatoid arthritis (Still's disease) who underwent laparotomic hysterectomy under general anesthesia. Tracheal intubation was performed with the aid of a fibroscope, as recommended in the literature, given that impairment of the cervical spine and the temporo-mandibular joint made it extremely unlikely that direct laryngoscopy could be performed. The authors also report the methods recommended by other authors in order to guarantee a sufficiently deep anesthetic plane together with patency of the airways in patients suffering from Still's disease.

Opioid tonus and luteinizing hormone secretion in anorexia nervosa: priming effect with serotonin precursor L-5-hydroxytryptophan during pulsatile gonadotropin-releasing hormone administration

In anorexia nervosa (AN) luteinizing hormone (LH) release is often impaired during opioid blockade. We investigated whether a restoration of the endogenous sex steroid milieu, together with a rise in central serotonergic tone, could increase LH responsiveness to Naloxone (NAL) in seven young women affected by AN. The spontaneous pulsatility of gonadotropins and their response to gonadotropin-releasing hormone (GnRH) and NAL challenges were tested before and after 13 days of pulsatile GnRH treatment and oral administration of L-5-hydroxytryptophan. Low and unpulsatile gonadotropin levels, responsive to GnRH, but not to NAL, were found before treatment. Pulsatile GnRH brought about a quasi-normal secretory pattern and 17 beta-estradiol increased to preovulatory levels in six of seven patients. On day 13 the lack of response to NAL administration was still present, however. A neuroendocrine disorder seems to be present in AN, which appears more complex than in other forms of hypothalamic amenorrhea.

Acute buflomedil intoxication: a life-threatening condition

A 15-year-old girl was admitted to ICU in a comatose state. She presented with mydriasis, areflexia, hypoxemia and seizures. She was immediately intubated and connected to a ventilator. The seizures were reversed with intravenous diazepam. CT scan was negative. EEG showed a diffuse fast activity and theta waves with spikes in the anterior and temporal regions, bilaterally. The gastric lavage was suggestive of drug ingestion. The patient completely recovered after 6 h of mechanical ventilation and supportive management. Mydriasis was still present after the resolution of neurological symptoms. The girl told us she had ingested 10 tablets (3 g-55 mg/kg) of Loftyl (buflomedil) for suicidal intention. The buflomedil concentrations at 2-3 h from ingestion were 24.8 mg/l in the blood, 324.4 mg/l in the urine and 6.9 mg/l in the gastric content. The p-desmethyl metabolite was also identified in the urine. Buflomedil is a rheological agent largely used as a vasodilator in some European countries. Some recent reports have emphasized the risk of acute intoxication with this drug. Relatively low doses (50-60 mg/kg) have been associated with an important neurological toxicity and a high mortality. We suggest that the clinical picture we observed might be related to a neuroleptic-type action of buflomedil. We bring to attention the risk of a large, uncontrolled diffusion of a drug capable to cause serious consequences at relatively low doses.

A cross-over study with the two novel dopaminergic drugs cabergoline and quinagolide in hyperprolactinemic patients

Cabergoline and quinagolide, two new dopamine agonist drugs with long-lasting activity, are currently under investigation for the treatment of hyperprolactinemia. At present, studies comparing these drugs for tolerability and efficacy in the same patients are lacking. It was our aim to make such a comparison in an open randomized cross-over trial. Cabergoline (0.5 mg twice weekly) and quinagolide (75 micrograms once daily) were given orally. Each drug was administered for 12 weeks. Treatment with the second drug was started after the recurrence of hyperprolactinemia. Twelve women with hyperprolactinemia due to idiopathic disease (n = 6), microprolactinoma (n = 5) or postsurgical empty sella (n = 1) were evaluated. Six women were amenorrheic and 6 were oligomenorrheic. Ten had spontaneous or provoked galactorrhea. Baseline characteristics (age, clinical signs and PRL levels) of patients initially allocated to the two treatment groups were similar. Nine patients completed both treatment cycles and PRL levels were lower under cabergoline (10.7 +/- 3.7 micrograms/L) than under quinagolide (25.0 +/- 7.7 micrograms/L; p < 0.05). One patient discontinued cabergoline because of dryness of the eyes after having completed the quinagolide cycle and 2 patients initially treated with cabergoline discontinued quinagolide because of gastrointestinal symptoms. After completion of the first treatment cycle, the time of recurrence of hyperprolactinemia was significantly longer after cabergoline (14 +/- 7 weeks) than after quinagolide (5 +/- 1 weeks; p < 0.05). At week 12, normal PRL levels (< 20 micrograms/L) were observed in 10 and 6 women during cabergoline and quinagolide, respectively. Only one case was resistant to both drugs. The clinical effects of the two treatments were similar.(ABSTRACT TRUNCATED AT 250 WORDS)

Predeposit hemodilution and intra- and post-operative blood salvage in the orthopaedic surgery of brain damaged children

The advantages of autologous transfusion are nowadays well known. It appears so very important to enlarge to the greatest number of kinds of pathologies, trying to overcome all possible problems and studying every counterindication. In this study, through a strict collaboration among orthopaedics, anaesthesia, transfusion medicine, neurological and pediatric specialists, we studied a peculiar protocol, suitable for enlarging the autologous techniques to brain damaged children and, after a regular application lasted globally for about two years, we did an evaluation of the results.

Delta sleep-inducing peptide administration does not influence growth hormone and prolactin secretion in normal women

The aim of this study was to analyze the effects of delta sleep-inducing peptide (DSIP) on growth hormone (GH) and prolactin (PRL) secretion in eight healthy women with normal cycles (aged 17-36 years). GH and PRL secretion was studied in five women after DSIP (25 micrograms/kg bw IV over 30 min), arginine chlorhydrate (0.5 g/kg bw IV over 30 min) and simultaneous DSIP plus arginine chlorhydrate administration. In three other women the circadian rhythm of GH and PRL was studied during DSIP (25 micrograms/kg bw from 2130h to 2230h) and placebo IV infusion. Serum GH and PRL levels were normal under basal conditions and no effects were noted after the infusion of DSIP. The GH and PRL circadian rhythm was not modified by DSIP administration. DSIP did not influence GH and PRL responsiveness to arginine chlorhydrate. We found that at dosages which are known to modify ECG patterns, DSIP is unable to modify spontaneous or arginine chlorhydrate-induced GH and PRL secretion.

Delayed puberty in uremia: pituitary-gonadal function during short-term pulsatile luteinizing hormone-releasing hormone administration

Pubertal development is frequently delayed or disordered in children with chronic renal failure. Both neuroendocrine and peripheral alterations due to uremia have been hypothesized to explain the impairment in the pituitary gonadal axis. The aim of the present study was to evaluate quantitative (immunological) and qualitative (biological) LH secretion, as well as FSH and sex steroids, before and during 7 days of sc LHRH administration (136-150 ng/kg bw every 120 min) in 5 uremic children (13.1-14.8 yr) with delayed puberty. Six nonuremic children (13.2-17.8 yr) with delayed puberty underwent the same schedule and served as control group. On day 0 mean immunoreactive LH (I-LH) levels were higher in uremic (4.5 +/- 0.9 mIU/ml) than in nonuremic (1.9 +/- 03 mIU/ml; p < 0.05) subjects while no differences were observed in bioactive LH (B-LH) levels (2.9 +/- 0.7 mIU/ml vs 2.4 +/- 0.3 mIU/ml). In both groups of subjects testosterone was at prepubertal levels. Spontaneous I-LH and B-LH pulses were observed sporadically in both uremic and nonuremic subjects. Short-term pulsatile LHRH administration induced significant increases in B-LH, I-LH, FSH and testosterone. The B/I LH ratio increased from day 0 (0.7 +/- 0.2) to day 7 (1.3 +/- 0.4; p < 0.05) in uremics while it showed wide fluctuations in nonuremic subjects. On day 7, 4 uremic and 5 nonuremic subjects showed a pulsatile release of B-LH after exogenous LHRH pulses. Our data document that in uremia there are qualitative as well as quantitative abnormalities in pituitary gonadal secretion.(ABSTRACT TRUNCATED AT 250 WORDS)

Therapeutic strategies in a male with delayed puberty

Therapeutical strategies in male with delayed puberty. Delayed puberty (absence of pubertal modifications after 14-15 years of age) due to transitory deficit of LHRH secretion often constitutes a difficult differential diagnostic problem for conditions of permanent LHRH deficit which can be identified only after 18 years of age in the idiopathic hypogonadotropic hypogonadism. After a period of clinical observation short-term therapy with pulsatile LHRH administration may take place. Therapy can be necessary: to document the functional integrity of the pituitary-gonadal axis; to promote pubertal modification such as to improve and physiologically sustain the patient; to tray a neuroendocrine activation of endogenous LHRH-LH secretion. Also delayed puberty linked to uremia seems to respond to short-term pulsatile LHRH administration. Pulsatile LHRH administration is the most physiological therapeutical approach to subject with delayed puberty. It seems to constitute a valid alternative to the therapy with testosterone or gonadotropins.

Effect of cholinergic tone on growth hormone-releasing hormone-induced secretion of growth hormone in normal aging

Aging is associated with an impairment in the GH response to GHRH and to several other stimuli of GH secretion. We evaluated the effect of pyridostigmine (PD) or placebo pretreatment (Protocol A: placebo or 120 mg PD orally at 8 a.m.; Protocol B: placebo or 60 mg PD twice orally at 9 p.m. and 7 a.m.) on GH responsiveness to GHRH (1 micrograms/kg BW bolus i.v. at 9 a.m.) in 15 normal elderly males (65-92 years) and in 14 normal young adults (20-37 years). GH response to GHRH was significantly reduced in elderly subjects compared to young adults (p < 0.05). PD (Protocol A) increased GH release in both elderly and young subjects. In elderly men, PD enhanced GH response to GHRH. The phenomenon was more evident when PD was administered according to Protocol B (p < 0.01). The area under the curve of GH was significantly greater after PD plus GHRH than it was after placebo plus GHRH (p < 0.01). In young adults, PD induced an increase in GH responsiveness to GHRH when administered according to Protocol A (p < 0.05) but not Protocol B. Both GH peak and AUC of GH after PD plus GHRH (Protocols A and B) in elderly subjects were not significantly different from the same parameters found in young subjects after placebo plus GHRH. Our data confirm that pituitary somatotrophin responsiveness to GHRH in man changes with aging. PD restores GH responsiveness to GHRH in elderly subjects. The effect of PD on GH secretion suggests that cholinergic mechanisms may be involved in GH control in normal aging.(ABSTRACT TRUNCATED AT 250 WORDS)

Differential lung ventilation with a double-lumen tracheostomy tube in unilateral refractory atelectasis

Two patients with refractory hypoxemia due to unilateral lung atelectasis were treated with differential lung ventilation (DLV) through a Robertshaw-type, double-lumen tracheostomy tube. DLV was applied using two non-synchronized ventilators and maintained for 6 and 3 days, respectively. Ventilator settings were chosen in accord to the clinical, laboratory and chest X-rays results. Particularly, tidal volume and PEEP were set to avoid excessively high alveolar pressure and to obtain the highest possible value of compliance. We investigated the mechanical properties of the two lungs separately by measuring airway pressure and compliance of each lung before the beginning of DLV and at 0, 5, 24, and 48 h after. Initially we observed in both patients very low values of compliance (7-9 cm H2O/l) and a significant level of PEEPi (12-8 cm H2O) of the diseased lung, whereas PEEPi in the healthy lung was negligible. The clinical improvement was assessed by sequential chest X-rays and by significant improvement of arterial blood gas and PaO2/FiO2 ratios and was associated with a progressive increase of compliance (24-22 cm H2O/l) and by a fall of PEEPi levels (5-4 cm H2O) of the diseased lung. We also observed an improvement of SvO2, O2AVI, PVRI and Qva/Qt values (Case 1). The tracheostomy tube used to apply DLV was very reliable, allowing easy nursing care and selective bronchial aspirations. We conclude that DLV is a very useful technique in unilateral lung pathology, and it can be a life saving procedure in selected patients, by supplying volume and PEEP more efficiently to the affected lung.

Interaction between thiopentone and subhypnotic doses of ketamine

The hypnotic effects of thiopentone and ketamine were studied in ASA Grade I female patients aged 20-30 without premedication. The dose-response curves of ketamine 0.4 mg kg-1 and thiopentone following ketamine 0.4 mg kg-1 were determined by probit analysis. The interaction between ketamine and thiopentone was found to be an antagonistic one. This effect can be interpreted as a consequence of the different neurophysiological spectra of action of the two drugs.

Growth hormone secretion in aging. Effect of pyridostigmine on growth hormone responsiveness to growth hormone-releasing hormone

Recent studies in adults have shown that cholinergic enhancement by pyridostigmine (PD) has a stimulatory effect on growth hormone (GH) response to GH-releasing hormone (GHRH). PD probably reduces somatostatin release from the hypothalamus by increasing the central cholinergic tone. The aim of this study was to evaluate the effect of PD (120 mg orally) or placebo pretreatment on GH responsiveness to GHRH (1 micrograms/kg b.w. i.v.) or placebo in 10 normal elderly males (68-92 years). PD induced a significant increase in GH secretion (GH peak 7.3 +/- 1.8 micrograms/L, mean +/- SEM) over the basal value (0.9 +/- 0.2 micrograms/L; P less than 0.01) and enhanced GH response to GHRH (peak after GHRH: 17.0 +/- 3.8 micrograms/L; after PD plus GHRH: 42.6 +/- 12.2 micrograms/L; P less than 0.05). There was a significant difference in the secretory areas of GH among tests (P less than 0.05). The secretory area was greater after PD plus GHRH (2722 +/- 801 micrograms/L/120 min) than after GHRH (1185 +/- 206 micrograms/L 120 min; P less than 0.01). The effect of PD on GH secretion suggests that cholinergic mechanisms may be involved in GH control in normal aging. During the life-span cholinergic neurons and/or the somatostatin pathways could exert a differential effect on GH control.

[Effectiveness and tolerance of a new molecule with secreto-dynamic activity: nesosteine]

232 patients with acute or chronic respiratory disorders characterized by increased secretion, were included in an open multicentre trial to evaluate the tolerability and the activity of a new molecule with secreto-dynamic action, nesosteine. The drug was administered orally at the dose of 900 mg/day for two consecutive weeks. The incidence of side effects (11.6%) was comparable to that observed in studies carried out on molecules with similar activity. Undesirable reactions were found mainly at the gastrointestinal level. Side effects were slight/moderate in most cases; only 3 patients abandoned treatment. Nesosteine therapeutic activity was highly valid; cough and expectorate were favourably affected by treatment. The drug, by restoring the natural characteristics of excreate viscoelasticity, favored a better mucociliary clearance and a more incisive cough expelling action. The activity/tolerability ratio was judged excellent/good by the investigator in 83% of the patients treated.

Italian multicenter study on the treatment of chronic obstructive lung disease with bromhexine. A double-blind placebo-controlled trial

237 out-patients suffering from chronic obstructive lung disease (COLD) were selected from 7 Italian clinical centers. They were randomly allocated to either placebo or bromhexine 30 mg b.i.d. p.o., in a double-blind fashion. Sputum volume and quality, facility of expectoration, cough, dyspnea, auscultatory thoracic symptoms, forced expiratory volume, peak expiratory flow rate and residual volume were evaluated. Bromhexine showed a statistically significant therapeutic activity in comparison to placebo. This action was rapid, marked and effective in determining a modulation of bronchial secretions.

[Anesthesia and nanism. Apropos of 2 cases]

The authors describe the favourable outcome of general anaesthesias in a female patient with achondroplastic dwarfism and in another patient with dystrophic dwarfism. In the first patient the gall-bladder was removed and a plastic reconstruction of the diaphragm was carried out. In the second patient a Girdlestone's operation was performed. The difficulty of intubation of the dystrophic dwarf due to stiffness of the cervical spine suggested a procedure of intubation under fibroscopy. The doses of agents and the size of the tracheal tubes were calculated on the basis of the patients weight and the controlled ventilation was carried out after determining the current volume and the respiratory frequency in the awaken patient.

Electrophysiologic effects of cigarette smoking in patients with and without chronic beta-blocker therapy

After refraining from smoking for at least 8 hours, 22 adult male habitual smokers underwent baseline electrophysiologic study including atrial and ventricular burst pacing and programmed premature stimulation with single extrastimuli. After smoking 2 of their usual brand of cigarettes in rapid succession, the electrophysiologic protocol was repeated. Nicotine, catecholamine and carbon monoxide concentrations all increased significantly. Smoking increased heart rate and improved atrioventricular conduction in the 13 patients receiving chronic beta-blocker therapy (mostly for angina pectoris); increases in heart rate and improvement in atrioventricular conduction were not different statistically from those seen in patients not receiving beta-blocker therapy, suggesting the possibility of a direct effect of nicotine or other components of tobacco smoke. Ventricular refractoriness was not altered and atrial and ventricular arrhythmias were not increased by smoking. Persistent sympathomimetic actions of cigarette smoking may explain in part the failure of beta-blocking drugs to reduce cardiac mortality risk in smokers after myocardial infarction.

Bioavailability and pharmacokinetics of a new controlled-release theophylline preparation in the form of capsules containing pellets

The bioavailability and pharmacokinetics of a new controlled-release theophylline preparation in the form of capsules containing pellets of coated drug were studied in 10 healthy subjects. Results showed that the bioavailability of this preparation is complete after oral intake of a single dose, while after repeated administrations (300 mg b.i.d.) theophylline serum levels are constantly within the therapeutic range (10-15 mg/l) with small fluctuations over 12 h. Side effects were not observed.

Bronchial provocation tests with RAST-standardized allergens and dosimetric technique

58 patients with proven allergic asthma (positive prick and RAST) were challenged with allergen extracts dosed in RAST arbitrary units; 14 of them were rechallenged after some months to evaluate the reproducibility of results; 41 underwent also a nonspecific challenge with methacholine. The results of the specific bronchial provocation test were well reproducible, with similar coefficients of variation for both early and late reactions. The specific bronchial provocation test was found to be more related to the allergic status, as reflected by specific IgE levels, than to nonspecific bronchial hyperreactivity, as reflected by response to methacholine.

Bronchoalveolar lavage and transbronchial lung biopsy in sarcoidosis and extrinsic allergic alveolitis

Bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB) in the same endoscopic session were performed in 44 patients: 20 were affected by active sarcoidosis (AS), 15 by inactive sarcoidosis (IS) and nine by extrinsic allergic alveolitis (EAA). Compared with 12 healthy controls, in EAA and AS patients the total number of cells and the percentage of lymphocytes were increased both in smokers and non-smokers. TBLB showed sarcoid granulomata in 15 AS and six IS patients, interstitial fibrosis in four AS and seven IS patients, and normal lung tissue in two IS patients. In EAA, TBLB revealed granulomata or mononuclear infiltrates in four patients and fibrosis in a further four. Regarding the correlation between TBLB and BAL, sarcoid granulomata were more frequently found in patients with AS, as reflected by the increased number of lymphocytes in BAL. The procedure produced no significant complications.

The influence of thiopentone and alfathesin on succinylcholine-induced fasciculations and myalgias

Thiopentone doses corresponding to 5.238 mg x kg-1, that is 2UD95 (UD95:unconsciousness dose 95) inhibit the intensity of succinylcholine-induced fasciculations compared with UD95. Alfathesin doses corresponding to 0.570 mg x kg-1, also 2UD95 (calculated as alphaxalone at a concentration of 9 mg/ml in alfathesin), do not have any greater effect on the degree of fasciculations compared to UD95. Furthermore, neither induction agent influences the incidence, distribution and duration of succinylcholine-induced myalgias. The inhibition of the degree of fasciculations caused by thiopentone is believed to be a consequence of a postsynaptic depressant effect of thiopentone at the neuromuscular junction. The evaluation of the degree of succinylcholine-induced fasciculations must take into consideration the dose of thiopentone administered at induction of anaesthesia.

Influence of acupuncture on the postoperative complications following ketamine anesthesia. The importance of manual stimulation of point R and shen menn

The Authors have investigated the antihallucinogenic and sedative effects of auricular points R and shen menn during surgery under ketamine anesthesia. The results demonstrate that the insertion of the needle in point R is very efficient in reducing hallucinations of ketamine emergence, while the insertion of needle in auricular point shen menn causes only a brief period of sedation in the beginning of the emergence period. The acupunctural technique employed by the Authors has been shown to increase considerably approbation of ketamine anesthesia.

[Comparison of the effect of premedication with diazepam and trazodone on anesthesia induced with althesin]

Interference on the part of premedication with diazepam and trazodone with althesin anaesthesia was investigated and compared by means of variance analysis according to Fisher, and the X2c test according to Yates, in 150 patients aged 35-45 yr in three groups of 50 during examination of the uterine cavity. No marked difference between the effects of the two drugs were noted, with two exceptions: 1) trazodone was better able to potentiate the hypnotic action of althesin, so that less was needed for the induction of anaesthesia; 2) patients pretreated wih diazepam displayed a marked increase in postoperative somnolence, this being an expression of the drug's hypnotic effect.

[Clinical experience with althesin]

On the basis of the clinical records of experiments on 110 patients treated with Althesin as induction and maintenance anaesthetic in association or otherwise with other anaesthetics, it is concluded that Althesin possesses good hypnotic power and is compatible with other anaesthetics. It also offers fair stability of cardiocirculatory and respiratory values with slight incidence of unwanted side-effects. Althesin is therefore classed among the safest anaesthetics.

[Althesin in cesarean section]

The effects of Althesin (group A) and thiopentone (group B) in mother and newborn were compared after their use in the induction of narcosis in 80 patients undergoing Caesarean section. The mean doses of Althesin (0.072 ml/kg i.v.) and thiopentone (4.1 mg/kg i.v.) proved sufficient to guarantee rapid onset of sleep (about 20 seconds) in both groups. As of cardiovascular effects on the mother in the induction-extraction period, greater stability of cardiac frequency (c.f.) was noted with thiopentone, while Althesin produced rapid, frequent variations in c.f. The reverse phenomenon was observed with respect to arterial pressure variations. The clinical condition of the newborns at 1st, 3rd and 5th minutes after extraction, assessed by means of the Apgar index, was excellent in both groups of patients. Results obtained were assessed by analysing variance with the Fisher test.

Comparison between intracutaneous and prick tests in detecting sensitizations to common Mediterranean allergens

The role of the intracutaneous test (IC) in clinical allergy routine was evaluated comparing its results with those from the prick test, the radioallergosorbent test (RAST), and the specific bronchial provocation test (BPT). The study was carried out making an a posteriori survey of 384 patients suffering from symptoms of perennial and seasonal rhinitis and/or bronchial asthma. They were tested with the most common allergens in the Mediterranean countries; 681 prick tests and 489 IC tests were compared with RAST and 69 with BPT. The IC tests showed disagreement with RAST and BPT more frequently than prick tests: this is attributable to a lesser degree of specificity of IC test performed with the usual concentrations, and depends on the nature of the allergens. On the other hand the prick test is no less sensitive than the IC test, being the occurrence of RAST positivity in patients with negative skin tests similar for the prick and IC tests. These results support the concept of the prick test as preferable with respect to the IC test because of its specificity and sensitivity.

Transbronchial lung biopsy with fiberoptic bronchoscope

Transbronchial lung biopsy (TBB) was performed during fiberoptic bronchoscopy under fluoroscopic guidance in 133 patients with diffuse or peripherally localized lung diseases without endobronchial lesions. Histological diagnosis consistent with the clinical course and roentgenographic appearance was obtained in 96 patients (72%). In four cases specimens were inadequate for histological evaluation (3%). In 33 cases a diagnosis was not possible even though the specimens were adequate for histological examination. The low complication rate in this series seems due to the selection of patients and the technique used.

[Primary malignant tumors of the pleura. Pleural Mesothelioma (P.M.)]

The clinical overture, symptomatology and morphoradiological picture of a personal series of primary pleural tumours (70 mesothelioma and 1 fibrosarcoma) are described. Conventional and more recent instrumental, cytohistological and bioptic methods of diagnosis are explained, with particular reference to pioneering experience gained with fibropleuroscopy in the Genoa Clinical Department. While dependable diagnosis can now be virtually assured, surgical and pneumological management holds out few prospects of success.