[Normal ranges of bone mineral content of the distal radius determined with single photon absorptiometry. Study of 1521 cases]

The normal ranges and mathematical equations of bone mineral content (BMC), normalized to radial width (BMC/W) vs. age at the distal radius, were obtained by single photon absorptiometry (SPA), and compared in two different normal populations, one of postmenopausal females and the other of control males. The female population included 1359 postmenopausal women, aged 35 to 75 years; normal control males were 162, of the same age. The results obtained in the two groups of patients show a statistically significant (p less than 0.001) correlation between age and BMC/W, expressed in a polinomial third-degree regression. The slope of the regression curves is quite different between males and females: the mean decrement, evaluated from regression polinomial fits, results 0.5% per year for normal females, and 0.3% per year for normal males. The maximum decrement (1% per year) is observed at the mean age of 51 years, which is the average age of peri-menopausal women in our province (Ferrara). The authors believe SPA to be a simple and reliable technique in measuring peripheral bone loss rate. SPA may be useful in the diagnosis and treatment of postmenopausal women, but is not recommended in the short-term follow-up of osteoporosis.

[Role of triphasic bone scintigraphy in the diagnosis of osteonecrosis of the femur head]

Twelve patients affected by idiopathic osteonecrosis of the femoral head underwent X-ray, triphasic bone scintigraphic (TBS) and CT tests on the femoral head on both sides. TBS revealed arterial hypoperfusion and an area of hypocaptation in the caput femoris in 3 coxofemoral joints which were radiologically "negative" (and of which one was also CT negative); these are scintigraphical signs which are typical of aseptic necrosis. In line with published data, TBS was found to be a more sensitive test in comparison with traditional X-ray techniques and CT, and in the early stages of disease it is more specific in recognising aseptic necrosis of the femoral head. Lastly, it is underlined that magnetic resonance is currently considered to be most sensitive (88%) and most specific (100%) imaging technique in the diagnosis of osteonecrosis of the femoral head.

Atrial natriuretic peptide and urinary sodium balance during physical exercise

Atrial natriuretic peptide (ANP), plasma renin activity (PRA), plasma aldosterone and urinary fractional excretion of sodium (%FENa) were measured in 22 athletes before and after 1 h running. After exercise the hormones increased significantly, while %FENa decreased. In fact, the percent PRA increases resulted higher than the percent ANP increases with a significant inverse correlation. It is concluded that hemodynamic changes during strenuous and prolonged physical exercise lead to the inhibition of the natriuretic properties of ANP by stimulating the renin-angiotensin-aldosterone system, although a feedback mechanism of modulation between ANP and PRA seems to occur.

Plasma levels of atrial natriuretic peptide are increased in normotensive postmenopausal women as a function of age

The aim of this study was to assess the changes in atrial natriuretic peptide (ANP) levels before and after menopause and to test whether they depend on age or are an integral part of the hormonal changes in menopause. We measured plasma ANP, plasma renin activity (PRA), plasma aldosterone, serum estradiol-17 beta and progesterone concentrations in 103 normotensive women, either in premenopause (n = 35; mean age: 24 years), in physiological menopause (n = 34; mean age: 43 years) or surgically induced menopause (n = 34; mean age: 55 years). The last two groups were matched for duration of menopause and were comparable in their estrogen and progesterone status. PRA and plasma aldosterone concentrations decreased in postmenopausal women, whereas systolic blood pressure and ANP increased. These results were not confirmed after adjustment for age by covariance analysis. In all of the groups, plasma ANP concentrations were not significantly correlated with systolic or diastolic blood pressure, nor with plasma aldosterone, estrogen and progesterone concentrations. These correlations were not improved by correction for age. Plasma ANP concentrations were consistently correlated with age. These data suggest that the increase in plasma ANP levels found in postmenopausal women is related with age and that ANP does not play a direct role in the physiological hormonal changes of menopause.

Consistent changes in the circadian rhythms of blood pressure and atrial natriuretic peptide in congestive heart failure

We demonstrated in previous works that the circadian rhythms of blood pressure (BP) and atrial natriuretic peptide (ANP) are antiphasic in normal subjects and in essential hypertension. The aim of the present study was to assess the circadian rhythms of BP and ANP in 20 patients with stable congestive heart failure (CHF), divided into two groups of 10 according to their New York Heart Association functional class. A matched control group of 10 normal volunteers was also studied. Noninvasive BP monitoring at 15-min intervals was performed for 24 h. Peripheral blood samples were also obtained at 4-h intervals starting from 08:00 h. The mean (+/- SEM) circadian mesors of ANP plasma levels were 13.4 +/- 1.7 pmol/L in the control group, 28.6 +/- 2.4 pmol/L in the group of 10 patients in class II, and 81.5 +/- 12 pmol/L in the group of 10 patients in class III-IV. In normal subjects, plasma ANP concentration was highest at 04:00 h (21.5 +/- 2.7 pmol/L) and lowest at 16:00 h (8.8 +/- 2.4 pmol/L; p less than 0.01). Both groups of patients with CHF showed no significant circadian change in the plasma levels of ANP and also a significantly blunted circadian rhythm of BP. Cosinor analysis confirmed the loss of the circadian rhythms of ANP and BP in CHF patients. Our findings support the existence of a causal relationship between the circadian rhythms of ANP and BP.

Atrial strain is the main determinant of release of atrial natriuretic peptide

We studied the response of atrial natriuretic peptide to the hemodynamic and renin-aldosterone variations occurring in four patients who developed cardiac tamponade, either occurring in idiopathic fashion in one or secondary to metastatic involvement of the pericardium in three. Right atrial pressure, heart rate and arterial blood pressure were monitored and serial blood samples were taken before and over three hours after pericardiocentesis. During cardiac tamponade, normal levels of atrial natriuretic peptide (mean +/- SEM: 54 +/- 7.4 pg/ml) were observed in the plasma despite increased right atrial pressure (23 +/- 3.8 cm H2O) and heart rates (98 +/- 4.4). Removal of pericardial fluid (540 to 1160 ml) was associated at first with a 200% increase in plasma concentrations of atrial natriuretic peptide (108 +/- 8.8 pg/ml; P less than 0.001), then with a gradual decline toward normal levels, simultaneous with the normalization of right atrial pressure and heart rate. Activity of renin and concentrations of aldosterone in the plasma were increased during tamponade and returned gradually to normal after pericardiocentesis (3.8 +/- 0.9 to 1.2 +/- 0.3 ng/ml/h and 20 +/- 4.2 to 9 +/- 3.2 ng/dl, respectively; P less than 0.01). These data confirm that atrial strain, not intracavitary pressure in itself nor heart rate, is the main determinant of the acute release of atrial natriuretic peptide, which is associated with a suppressing effect on the renin-aldosterone system. In addition, our data indicate that secretion of atrial natriuretic peptide during cardiac tamponade is not stimulated by secondary hyperaldosteronism.

Influence of estrogens on serum free fatty acid levels in women

A relationship between plasma levels of FFA and incidence of hormone-dependent breast cancer has been suggested. This observation has drawn our attention to possible complementary actions of ovarian steroids on circulating FFA levels. Measurements taken in normal women during the menstrual cycle and in ovariectomized women with and without estrogen replacement therapy demonstrate that 1) levels of FFA present in serum are lower during the luteal phase than during the follicular phase; 2) levels of FFA are significantly higher after ovariectomy; and 3) these are again reduced by substitutive estrogen therapy.

[Quantitative analysis of bone density in multiple myeloma]

Bone lesions are the main sign of neoplastic proliferation of multiple myeloma (MM), a disseminated malignant disease which originates in, invades and replaces normal bone marrow. The most characteristic radiographic pattern is a focal lytic lesion, well-defined or "punched-out", generally with no surrounding bone reaction. The association is confirmed between MM and osteoporosis, as reduced bone density (osteopenia) and pathologic fractures (ribs, spine). This paper is aimed at evaluating the importance of osteopenia in both diagnosis and prognosis of MM. Eighteen patients affected with MM were examined with quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DEXA) for bone densitometry in lumbar spine and proximal femur. The patients (12 males and 6 females) were classified according to Durie's clinical criteria and to the radiographic patterns suggested by Merlini. The results indicate the patients with an advanced clinical stage (III) and scintigraphic expansion of bone marrow to have low densitometric values on both QCT and DEXA. There was substantial agreement between the 2 methods, but DEXA had a higher number of false positives. Instrumental diagnostic protocol may be thus planned as follows: 1) conventional radiography; 2) bone marrow scintigraphy; 3) bone densitometry of lumbar spine, with QCT. The patient is then to be followed with conventional and/or digital radiography in symptomatic locations, and with bone scintigraphy.

99mTc-MAG3 versus 131I-orthoiodohippurate in the routine determination of effective renal plasma flow

99mTc-mercaptoacetyltriglycine (MAG3) has been proposed as an alternative to 131I-orthoiodohippurate (OIH) for the scintigraphic determination of effective renal plasma flow (ERPF). The purpose of this study was to compare the ERPF values determined simultaneously with MAG3 and OIH by a dual channel technique in a large group of subjects with widely ranging renal function. During the last two years, we administered a simultaneous injection of 74 MBq of MAG3 and 0.74 MBq of OIH to each subject who underwent a renal scintigraphic study in our hospital. They were 53 females and 50 males (mean age: 52 years; range: 18-70 years), either normal (30) or with a diagnosis of essential hypertension (53), chronic renal failure (14), renal calculi (5), or renal transplant (1). Plasma clearance and ERPF were calculated with both radiocompounds by using the exponential formula of Tauxe and coworkers and a single plasma concentration determination sampled 44 min after injection of the two tracers. The time-activity curves for kidney and blood were of the same bi-exponential type. The mean ratio between the two plasma clearances was 0.49. The linear regression of the ERPF values obtained with the two radiocompounds was highly significant (r = 0.69; p less than 0.0001) and is expressed by the equation: ERPF (MAG3) = 0.453 ERPF (OIH) + 25.7. These data suggest that the routine calculation of ERPF from MAG3 clearance is consistent with the results obtained from OIH clearance. In conclusion, MAG3 appears to be a good predictor of ERPF in routine clinical practice.

Circadian rhythms of atrial natriuretic peptide, renin, aldosterone, cortisol, blood pressure and heart rate in normal and hypertensive subjects

The occurrence and extent of a circadian rhythm in the circulating concentrations of atrial natriuretic peptide (ANP) are still matters of controversy. Only a few data are available in humans relating the time structure of plasma ANP levels with the circadian patterns of other hormones and cardiovascular variables. In a group of hospitalized normal volunteers (six men and four women, 16-76 years old), and in a group of hospitalized hypertensives (seven men and three women, 18-76 years old), we investigated the circadian variability of ANP and its temporal relationship with the circadian rhythms of blood pressure (BP) and heart rate (HR), and plasma renin activity (PRA), plasma aldosterone (PA) and plasma cortisol (PC) levels, by using a chronobiological inferential statistic method. At the end of a synchronizing period of 1 week (the diet and daily schedule were standardized), the subjects underwent automatic BP and HR monitoring, and blood sampling for 24 h. A statistically significant mean circadian rhythm was demonstrated for ANP, BP, HR, PRA, PA and PC in both normal and hypertensive subjects. The mean circadian acrophase of ANP (calculated to occur at around 04.00 h) anticipated the corresponding acrophases of the other hormones; BP and HR rhythms appeared to be in antiphase with ANP rhythm, i.e. the peak of BP and HR rhythms more or less coincided with the trough in ANP rhythm. A significant increase in the daily levels (assessed by the circadian mesor) of ANP was present in hypertensive subjects when compared with normal controls. In essential hypertension the circadian rhythm of ANP was set at higher circulating levels, but otherwise it was similar to the circadian rhythm found in normals. ANP mesors correlated significantly with renin and aldosterone mesors in normal subjects but not in hypertensive patients. ANP appears to anticipate awakening in its circadian periodic rise. On the basis of the considerable acrophase asynchronism, it seems possible to exclude any causal relations between the periodic changes of ANP and the rhythmic fluctuations of the other hormones that we studied. In contrast, important relations may be hypothesized between ANP levels and BP and HR values, on the basis of their antiphase rhythms.

Modification of number and of affinity of endometrial EGF receptors during the menstrual cycle

We have analysed the distribution and the binding properties of the epidermal growth factor (EGF) receptor in human endometrium during the menstrual cycle to validate the proposal that steroids affect the growth rate of target cells via growth factor-related pathways. The total number of EGF receptors and their affinity for the iodinate exogenous ligand are significantly higher during the proliferative than the secretory phase; the binding kinetics appear to be hyperbolic and sigmoid during the proliferative and the secretory phase, respectively. These results suggest that endogenous sex steroids can regulate the levels and the properties of EGF receptors in vivo, and support the possibility that receptor-coupled events may play a role in estrogen-stimulated growth.

[Comparative scintigraphic functional study of 3 different reconstruction technics following total gastrectomy]

Esophago-jejunal reconstruction, after total gastrectomy, is best performed by one of the following three operations: interposed jejunal loop, Roux-en-Y loop and "omega" loop with Braun anastomosis. To assess the effects of the three mentioned techniques three groups of 15 patients each were examined after total gastrectomy for I, II or III stage cancer. Four to ten months after surgery all patients underwent the following tests: a) esophago-jejunal transit with labeled solid meal; b) cholangio-scintigraphy and c) absorption test of biliary acids. A group of 10 patients, without gastrointestinal pathology, was selected for comparison. The data obtained from the comparative study, in agreement with the opinions held by many Authors and our previous research, demonstrate that the interposition of jejunal loop (Mouchet) is the reconstructive technique closest to the unoperated stomach and, for this reason, is to be preferred after total gastrectomy.

Correlation of MAST chemiluminescent assay (CLA) with RAST and skin prick tests for diagnosis of inhalant allergic disease

The purpose of this study was to compare the new multiple allergosorbent chemiluminescent assay (MAST CLA) system with the RAST and skin prick tests as an adjunct to the diagnosis of inhalant allergies. In this report, MAST CLA and RAST have given similar results, but no technique is as sensitive as skin tests for allergen-specific diagnosis of inhalant allergic disease.

The radiographic appearances following adequate transfusion in beta-thalassaemia

The main lesions of the skull and hand, observed in a group of hypertransfused beta-thalassaemic patients, are compared with a control group of low-transfused patients. Bony abnormalities reflect the relationship between proliferating bone marrow and bone cortex, and hypertransfusion therapy will prevent development of lesions only if established early in life. If this is done, the diploë in the skull may become normal, overgrowth of facial bone is moderate, pneumatisation of the paranasal sinuses is not completely prevented, and the "hair-brush" pattern may disappear completely. A normal appearance of the hand in adequately treated patients differentiates between prepubertal patients and adults.

Studies on amniotic prolactin: chromatographic pattern and correlation with the lecithin content

We have measured the concentrations of prolactin and lecithin in the amniotic fluid from 20 normal pregnant women in the 2nd and 3rd trimester. Prolactin is present totally as a low-molecular-weight form, 'little' prolactin, and appears to correlate negatively with lecithin during the 2nd and positively during the 3rd trimester. On the basis of these results and of the information that prolactin is present as high-molecular-weight isohormones in maternal blood, it is argued that amniotic prolactin is synthesized 'in situ' and that different mechanisms are involved in the regulation of prolactin production.

Circadian rhythms of atrial natriuretic peptide, blood pressure and heart rate in normal subjects

The occurrence and extent of a circadian rhythm in the circulating concentrations of atrial natriuretic peptide (ANP) is still a matter of controversy. In a group of hospitalized normal volunteers (6 men and 4 women, 16-76 years old), we investigated the circadian variability of ANP and its temporal relation with the circadian rhythms of blood pressure (BP) and heart rate (HR), by using a chronobiological inferential statistical method. At the end of a synchronizing period of 1 week (the diet and the daily schedule were standardized), the subjects underwent automatic BP and HR monitoring, and blood sampling for 24 h. A statistically significant mean circadian rhythm was demonstrated for ANP, BP, and HR. The mean circadian acrophase of ANP was calculated to occur around 4 a.m. BP and HR rhythms appeared to be in antiphase with ANP rhythm, i.e. the peak of BP and HR rhythms more or less coincided with a trough in ANP rhythm. ANP appears to be anticipatory in its circadian periodic rise to awakening. Therefore, postural changes cannot fully account for the diurnal variations observed.

Induction of spermatogenesis in thalassaemia

In an attempt to induce or to augment pubertal development and to achieve spermatogenesis, 10 gonadotropin-deficient thalassemic patients 15 to 23 years of age (mean 18.9 years) were treated with exogenous gonadotropins for 1 to 4 years (mean 2.1 years). Seven patients produced sperm during human chorionic gonadotropin (hCG) treatment given for 6 to 14 months. However, full spermatogenesis was achieved only when human menopausal gonadotropin was added to hCG regimen. In one patient, despite cessation of gonadotropin treatment, sexual potency, libido, and spermatogenetic capacity were maintained during the past 2 1/2 years. Our study indicates that it is possible to induce or to restore spermatogenesis in the majority of thalassemic patients and that gonadotrope cells may not be irreversibly damaged by iron deposition.

[Thalassemia today. The radiologic evolution of lesions of the skull and hand with reference to transfusion therapy]

The main abnormalities of the hand and skull in a group of patients who underwent hypertransfusion regimen were reviewed and compared to the lesions observed in a control group of low-transfused patients. The results are reported, and a possible correlation with transfusion regimen is discussed: since bone lesions are explained on the basis of relationship between proliferating bone marrow and bone cortex, hypertransfusion regimen will prevent the development of abnormalities, only if established early in life. For this reason, skeletal lesions in Cooley's anaemia have changed their "classical" radiographic patterns. In the skull, the diploic space may become normal, and the overgrowth of facial bones moderate; the pneumatization of paranasal sinuses may not be completely impeded by the swelling of the jaws, the "hair-brush" pattern may disappear completely. The normalized picture of the hand is and remains a typical differential sign of prepuberal and adult patients.

[A computerized manual for assessing the dosage absorbed by breast tissue in mammography]

The computerized translation of "Handbook of glandular tissue doses in mammography" (HHS publication FDA 85-8239) is presented. It is registered on floppy disk and suitable for use in MS-DOS on IBM personal computer, Olivetti or compatible. The manual collects data published by many authors and suggests a method to estimate the dose released to the glandular tissue (considered at risk for breast cancer) in the most commonly used conditions for mammography. Besides translation manual, the program holds an algorithm developed by the authors, which allows the dose to the glandular tissue to be evaluated, given the following data: projection: craniocaudal or mediolateral; compression level: firm or moderate; breast size: small, medium or large; breast composition: percentage of glandular tissue content (by weight); X-ray beam quality: HVL mm Al. The algorithm is obtained from a bidimensional fit of the original data and is based on the terms contained in the manual. The program flow is guided by menus that make the procedure suitable for inexperienced operators too, both for consulting and printing and for computing program.

Hypothalamic-pituitary-gonadal axis in thalassemic patients with secondary amenorrhea

Eight thalassemic patients, aged 24-35 years, who developed amenorrhea 2-15 years after menarche, were studied. Mean basal serum LH and FSH levels and the peak levels after gonadotropin-releasing hormone were significantly less than corresponding values in normal controls. All patients showed low basal serum levels of estradiol and six had a poor or absent response to human menopausal gonadotropin. One subject had intact pituitary-gonadal function and one patient had an impaired LH and FSH response to gonadotropin-releasing hormone in the presence of a significant increase of estradiol after human menopausal gonadotropin stimulation. The findings regarding pituitary hormones other than gonadotropins suggest that iron overload damages tropic cells unequally and inconsistently. We conclude that both pituitary and gonadal damage may be responsible for the secondary amenorrhea in thalassemic patients.

[Bone marrow scintigraphy in multiple myeloma. A comparison with bone scintigraphy and skeletal radiology]

The radiographic patterns of the skeleton of 73 patients affected by multiple myeloma (MM) were compared to the correspondent scintigraphic findings. Whole body scans were performed using 99m Tc-diphosphonates (bone scintigraphy), and 99m Tc-microcolloids (bone marrow scintigraphy). The results indicate that: a) radiography is more sensitive and accurate than scintigraphy in detecting typical myeloma-related bone lesions; b) bone scintigraphy is useful in detecting alterations in particular locations--i.e., sternum, ribs, scapulae, etc.--which are difficult to demonstrate by plain X-rays; moreover, the recovery of the fractures can be visualized; c) bone marrow scintigraphy is employed to demonstrate the presence of marrow expansion, of cold/hot spots, and relative marrow uptake, related to phagocytic activity. Since in adult men red marrow is confined to the epiphysis of long bones and to the spine, all the diseases affecting bone marrow cause medullary expansion/reduction, which are both easily detected by specific radiopharmaceuticals. The peripheral expansion is clearly documented especially in distal humeri and femora since marrow uptake is included, in healthy adults, in the axial and proximal appendicular skeleton. In spite of its yielding unique information, bone marrow scintigraphy remains an additional technique of bone scan, because of its low diagnostic accuracy.

Gonadal function in patients with beta thalassaemia major

Endocrine studies were made on 23 female patients aged 13 to 29 years, with delayed puberty or primary amenorrhoea and beta thalassaemia major, and 12 healthy controls, of whom six were prepubertal and six were in Tanner's stage 3-4. Each patient and control received a single intravenous dose of 100 micrograms gonadotrophin releasing hormone (GnRH), and one week later, 10 U/kg body weight of human menopausal gonadotrophin (hMG) to stimulate ovarian function. The patients had decreased gonadotrophin reserves when compared with those of normal controls, only one of 23 patients had an intact luteinising hormone and follicle stimulating hormone response. Most of the thalassaemic patients with delayed puberty showed normal gonad response to human menopausal gonadotrophin (hMG), but three had very low responses, when compared with that of controls. The gonadal failure was even more severe in four of six patients with primary amenorrhoea. It is important to assess hypothalamic-pituitary-gonadal function in young women with beta thalassaemia major, so that those with glandular dysfunction may be started on replacement therapy.

Ovarian steroids modulate the action of calcitonin in women

Slow i.v. infusion of salmon calcitonin into normal women led to a transient increase in plasma concentrations of cyclic AMP and to a decrease in plasma calcium, which was maintained for at least 2 h. These responses were significantly reduced in the same patients after hysterectomy and ovariectomy. In contrast, maintenance of the ovaries at the time of surgery, or substitutive hormonal therapy, seemed to restore the sensitivity to exogenous calcitonin, suggesting a permissive role of ovarian steroids in the effect of calcitonin. The most likely explanation for this phenomenon is that these hormones influence either the number of calcitonin receptors or the coupling of the receptors to the functional unit of bone adenylate cyclase.

[Serum level of the tumor marker CA 125 in ovarian pathology]

The tumor marker CA-125 is an embryonal glycoprotein detectable in tissues derived from celomatic epithelium. Serum CA-125 was determined by RIA in 66 patients with various ovarian pathologies (16 malignant at stage III-IV and 50 benign). Six patients with ovarian carcinoma were monitored during the first week after surgery and chemotherapy for a total of 150 days of treatment. We observed that CA-125 serum level is consistently above the normal range (greater than 35 U/ml) in all malignant diseases. In benign pathology, levels above the normal were found to be represented almost exclusively by ovarian endometriosis. Furthermore, the results demonstrate that chemotherapy alone is capable of lowering CA-125 serum levels. This tumor marker may be of great advantage in diagnosis and follow-up of ovarian malignancy.

[Radioisotope evaluation of splenic hemocatheretic activity in a group of thalassemic patients after embolization]

Seven patients with thalassemia major underwent splenic embolization in order to assess splenic mass and function before and after treatment. Red blood cells, marked "in vitro" and chemically denatured with BMHP were also used to assess the blood parameters related to splenic function i.e. pretransfusional haemoglobin (Nb) and mean blood consumption (BC). The results show a statistically significant difference (p less than 0.01) for Hb and erythrocyte clearance before and after embolization. Before embolization no statistically significant correlations were found between the parameters examined, whereas after embolization there was a linear correlation at the limit of significance between BC and clearance half-time. The radionuclide method is proposed as safe and reproducible. Unlike blood chemical tests it also provides immediate information on the effects of embolization and a reliable parameter for follow-up.

Effect of the hormonal contraception on serum reverse triiodothyronine levels

Thyroid hormones and the thyroxine-binding globulin are increased during hormonal treatment with oral contraceptives without changes in the thyroidal economy. Now we report that even reverse triiodothyronine, the main peripheral catabolite of thyroxine, is significantly increased during therapy with oral contraceptives.

Prolactinemia during the menstrual cycle. A possible role for prolactin in the regulation of ovarian function

We measured the concentration of circulating prolactin (PRL) in the serum during ovulatory and anovulatory cycles of normoprolactinemic menstruating women. The results demonstrate that during the luteal phase of ovulatory cycles a significant increase of PRL is observed together with that of progesterone. On the contrary, in menstruating women with anovulatory cycles we could not detect these increases. These data, analyzed together with the concomitant changes of gonadotrophins secretion, suggest a possible luteotrophic action of PRL in humans during the menstrual cycle.

Serum CA 125 in ovarian pathology and its variation in ovarian carcinoma after integrated therapy

Serum CA 125 was detected by RIA in a total of 66 patients with various ovarian pathologies (16 malignant and 50 benign). Six patients with ovarian carcinoma were monitored during the 1st week after surgery (2 patients underwent only explorative laparatomy) and during chemotherapy for a total of 150 days of treatment. We observed that CA 125 serum level is consistently above the normal range (greater than 35 U/ml) in all malignant diseases. In benign pathology, levels above the normal were found to be represented almost exclusively by ovarian endometriosis. Furthermore, the results demonstrate that the chemotherapeutic regime alone is capable of lowering CA 125 serum levels.

Alpha and beta cell evaluation in patients with thalassaemia intermedia and iron overload

Insulin and glucagon secretion were studied during an oral glucose tolerance test and arginine infusion in 11 patients with thalassaemia intermedia, who showed laboratory evidence of iron overload. Mean blood glucose concentrations in patients with thalassaemia intermedia were significantly higher than normal and 3 of 11 patients had impaired glucose tolerance. The principal abnormality appears to be a deficiency in insulin and glucagon from the pancreas in response to oral glucose tolerance and arginine stimulation tests. Several factors, such as iron overload, chronic hypoxia, zinc deficiency and increased catecholamine production secondary to anaemia, might play a part in the pathogenesis of these abnormalities. Each of these factors affect individual cases to a varied degree. Our data emphasize the mildness of carbohydrate defect as compared to the degree of insulinopenia and indicate the necessity for prescribing measures which prevent excessive iron deposition and improve iron excretion in thalassaemic patients with iron overload.

Multiple molecular forms of prolactin during pregnancy in women

The distribution of isomorphic forms of prolactin in the serum of pregnant women was studied by gel filtration chromatography. Using this technique we were able to resolve three peaks, detected by radioimmunoassay: they were termed 'big-big', 'big' and 'little' prolactin in order of decreasing size, with approximate molecular weights greater than 100 000, 50 000 and 21 000 respectively. They displayed a comparable immunoreactivity to the antiserum employed in the radioimmunoassay, as determined in competition experiments. The relative amount of each hormone form in serum changed during the third trimester of pregnancy. At week 33 of pregnancy, 'little' prolactin accounted for 63.2 +/- 7.7% of the total circulating hormone present in the serum of five normal pregnant women. During the progression of pregnancy, there was a gradual increase in the low molecular weight prolactin, so that, at the time of delivery, the larger forms of the hormone were present only in small amounts.

Hormonal sensitivity of adenylate cyclase from human endometrium: modulation by estradiol

In human endometria, a membrane-bound adenylate cyclase is present, which is recovered in high yield in a low-speed particulate fraction. Neither the specific activity of the enzyme nor the response to modifiers that act through the regulatory subunit of the complex, are modified during the proliferative or secretory phase of the cycle. Surprisingly, we found that in vitro treatment of secretory endometrial membranes with 17 beta-estradiol stimulates 3- to 4-fold the activity of adenylate cyclase. However this response does not occur on proliferative membranes. The activation by estradiol is independent of the presence of guanylylimidodiphosphate and is additive to that of the nucleotide. Possibly, as the consequence of the phenomenon, the concentration of cyclic AMP is significantly higher in curretage samples obtained from patients during the secretory rather than in the proliferative phase of the cycle. To our knowledge this is the first evidence of a target-cell membrane-directed effect of sex steroids in humans.

Short-term effect of oophorectomy on lipoprotein metabolism

The influence of steroid hormones on lipoprotein metabolism has been investigated in menstruating women undergoing oophorectomy; indeed, by this procedure, it is possible to alter selectively the secretion of the hormones and thus to determine the influence of their withdrawal on blood lipids. Within 3 months of surgery we observed significant rapid changes in cholesterol levels of total and HDL-bound components (early decrease and subsequent increase) without alteration of the triglyceride component of the lipoproteins. Similar biphasic changes were observed for the apolipoproteins A and B, determined by immunological methods. These results are suggestive of an action of sex hormones on the lipoprotein metabolism, both on the lipid and the protein moieties. They can be explained by a primary action of the hormones on the apolipoprotein metabolism and a secondary apoprotein-mediated effect on the lipid component of the lipoproteins.

Sex steroid hormones influence the cAMP content in human endometrium during the menstrual cycle

The measurement of the tissue concentrations of cyclic adenosine monophosphate (cAMP) in human endometrium shows that the levels of the nucleotide vary during the menstrual cycle, being 11.4 +/- (SE) 2.5 and 37.7 +/- (SE) 10.1 pmol/mg protein in the proliferative and secretory phase, respectively. The individual determinations of cAMP are significantly correlated to the estradiol/progesterone blood concentration ratio: by this means we obtained a superimposable distribution with the results of histologic examination suggesting that the hormones have a direct action in determining the cAMP levels in this tissue. The relevance of these observations for the physiology of the endometrium is discussed.

Influence of acute estrogenic withdrawal on blood calcitonin

As a model to investigate the pathogenesis of postmenopausal osteoporosis and the involvement of calcitonin in the bone alterations, we chose surgical menopause, studying the influence of castration on blood calcitonin. After surgery, the hormone and calcemia were raised significantly over preoperative values in castrated women, but not so in a control group of patients undergoing hysterectomy without oophorectomy. The elevated concentration of calcitonin was maintained during at least 4 months. It is speculated that this mechanism of control of calcitonin secretion by gonadal hormones might be activated in the pathogenesis of postmenopausal osteoporosis.

[Determination of cerebral blood flow using non-diffusible tracers]

A program for the evaluation of cerebral blood flow based on the analysis of the time activity curves is presented. The method is based on the Meier and Zierler formula, applying the partition coefficents suggested by Lassen et al. for the corrections deriving from the use of non-diffusible indicators (99Tcm-DTPA). Particular attention is given to the smoothing of the time-activity curve (using Legendre's polynomials) and to the correction function for reflux. The computation procedures and their validity is discussed.

Blood prolactin levels: influence of age, menstrual cycle and oral contraceptives

The relationships between the serum levels of estradiol, progesterone and prolactin have been analysed in normal women in relation to age, to menstrual cycle, and in oral contraceptives users. We have been able to detect significant differences between the prolactinemia values during the cycle in different age groups as well as following oral contraceptives. A word of caution is presented for the evaluation of the prolactin blood level which should always be related to the physiological phase of the cycle and to the age of the subjects.

Beta-cell function assessed by plasma C-peptide evaluation in diabetic thalassaemic patients

In order to investigate the pancreatic function in patients with thalassaemia major, plasma glucose and immunoreactive C-peptide levels were determined in 9 diabetic thalassaemic patients and in 7 controls after arginine infusion. Mean basal and peak values and C-peptide areas in thalassaemic patients did not differ significantly from those of the controls. However, in the thalassaemic group there was a greater variation in values, since pancreatic beta-cell function was found either normal, reduced or increased. These findings could suggest that different factors may lead to diabetes which complicates thalassaemia, i.e. insulin-resistance, probably due to liver damage subsequent to iron deposition and infectious hepatitis, and insulinopenia, probably due to beta-cell lesion following iron storage in the pancreas.

Folic acid deficiency in beta-thalassaemia heterozygotes

Plasma and red cell folate mean contents have been found to be significantly lower in 41 symptom-free beta-thalassaemia heterozygotes than in 21 controls. Such decreases must be considered as effects of an increased folate utilization caused by the enhanced total, both effective and ineffective, erythropoiesis. Since no close correlation has been found between packed cell volume and plasma or red blood cell folate levels, it seems that in 'healthy' beta-thalassaemia subjects, the degree of anaemia is not influenced by folate body reserves. However, the frequent finding of reduced red cell folate contents suggests that further folate imbalance might lead to clinically significant degrees of folate deficiency.

Primary hypothyroidism and the low T3 syndrome in thalassaemia major

Basal thyroid function was assessed from the serum thyroxine, triiodothyronine, and thyroid-stimulating hormone concentrations in 114 patients (mean age 13·6 years), designated group 1, with thalassaemia major. Forty of these patients were further evaluated (group 2) for serum-free thyroxine, and free and reverse triiodothyronine concentrations. The response of thyroid-stimulating hormone to thyrotrophin-releasing hormone was measured in 25 patients from this subgroup. Results were compared with those from 53 control subjects. Primary hypothyroidism, defined by a raised thyroid-stimulating hormone level above the upper range limit of 6·5 μIU/ml of the controls, was present in 17·5% of the 114 patients. In group 2 patients, a spectrum of thyroid disease spanning uncompensated and compensated primary hypothyroidism and decreased thyroid reserve was evident. The presence of primary hypothyroidism (uncompensated and compensated) was associated with an age of at least 10 years, an increased incidence of iron toxicity-related systemic complications, and an increased transfusion iron load, but not with an increased serum ferritin level. In the total 114 patients there were 9 who had the low triiodothyronine (sick euthyroid) syndrome. Primary hypothyroidism occurs in a significant proportion of thalassaemia major patients in the absence of obvious clinical signs of hypothyroidism; the low triiodothyronine syndrome associated with non-thyroidal disease is not uncommon.

[Study of intestinal transit using a radioisotope method]

Intestinal transit patterns were studied in 20 normal volunteers. It was found that small changes in transit time occurred in the passage from the caecum to the sigmoid and rectum, and that most subjects evacuated the capsule 38 hr after its ingestion.