Amphotericin B-induced depression in the phagocytic function of the isolated rat liver and its prevention by nifedipine

We investigated the effects of the antimycotic agent amphotericin B (AmB) on the phagocytic activity of the isolated perfused rat liver. At a concentration of 5 microM, the drug markedly reduced the clearance of latex beads by the liver as compared to control preparations. Scanning electron microscopy observations showed that latex beads were attached only to Kupffer cells. A liver scan performed infusing 99Tc-colloidal albumin showed that AmB depressed the uptake of the colloid in all hepatic lobes, with no focal defects. Both in control and AmB experiments no trypan blue uptake occurred. The pretreatment of the perfused liver with the calcium antagonist nifedipine prevented the decrease in phagocytosis induced by AmB. In addition, AmB had no effect on livers perfused with a Ca2(+)-free medium. A decrease in the phagocytic capacity of the perfused liver was also observed after the administration of the Ca2(+)-ionophore A23187. The observations suggest that AmB may exert an intrinsic toxicity on the Kupffer cells, which is, at least in part, responsible for the decrease in phagocytosis induced by the drug. This effect may be of relevance to clinical situations and deserves careful consideration.

Influence of HDV infection on clinical, biochemical and histological presentation of HBsAg positive chronic hepatitis

In an attempt to identify some characteristics of HDV infection in the different forms of HBsAg positive chronic hepatitis (CH), we evaluated numerous clinical, biochemical and histological aspects in 203 consecutive HBsAg positive CH patients. The presence of hepatitis delta antigen (HD-Ag) in the liver tissue was the criterion used to identify HDV infection. HD-Ag was observed in none of the 7 patients with non-specific reactive hepatitis, in 14.6% of the 48 with chronic persistent hepatitis (CPH), in 36.4% of the 44 with chronic lobular hepatitis (CLH), in 36% of the 25 with mild chronic active hepatitis (CAH), in 52% of the 36 with severe CAH and in 30.2% of the 43 with inactive or moderately active cirrhosis. Compared with the 139 HD-Ag negative patients in this study, the 64 HD-Ag positive patients more frequently had severe CAH (29.7 vs. 12.2%, p less than 0.01) and less frequently CPH (10.9 vs. 29.5%, p less than 0.01). Of the 139 HD-Ag negative patients, 80 were anti-HD positive and 59 anti-HD negative. The 59 patients with no HD-Ag or anti-HD showed severe CAH less frequently than the 64 HD-Ag positive patients (6.8 vs. 29.7, p less than 0.01) and CPH more frequently (44.1 vs. 10.9, p less than 0.001). Both in CPH and CLH the presence of HD-Ag in the hepatocytes identified subgroups of patients who frequently showed high serum levels of aminotransferases and gammaglobulins and more extended areas of circumscribed lobular necrosis. HD-Ag positive CAH was characterized by a more frequent occurrence of eosinophilic degeneration of hepatocytes without peripolesis (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

HBsAg carriers among blood donors in Italy--a multicentre study in 107 blood banks

We investigated the incidence of HBsAg carriers among blood donors from 107 Italian blood banks during 1986. The overall prevalence of HBsAg carriers was 1.98%. This percentage was higher in Southern (2.69%) than in Northern (1.78%) or Central Italy (0.83%). Notable differences were found in the various regions and in single centres belonging to the same region. In some small areas a prevalence of carriers as high as 10% was recorded. Most carriers had normal aminotransferase values, HBeAg was detected in 8.8% of the carriers and anti-delta in 2.9% of them. The figures from this study still suggest a persistence of an intermediate endemicity level of HBV infection in Italy, with some hyperendemic niches.

Endogenous dopamine (DA) and DA2 receptors: a mechanism limiting excessive sympathetic-adrenal discharge in humans

We studied the effects of presynaptic dopamine (DA) 2 receptor blockade on the sympathetic-adrenal response to graded exercise in seven normal men. DA2 receptor blockade was achieved by means of domperidone (DMP) administration. The exercise consisted of progressive cycling activity, from 30-80% of the predetermined maximal oxygen consumption for each man. Systolic, diastolic, and mean arterial pressures; heart rate; and plasma norepinephrine (NE), epinephrine (E), PRL, glucose, lactate, FFA, sodium, potassium, cortisol, and PRA were measured at rest, during exercise, and during recovery after placebo or DMP administration. Graded exercise caused significant increases in systolic and mean arterial pressures and plasma NE, E, lactate, sodium, potassium, FFA, cortisol, and PRA. DMP administration before exercise caused a significant increase in plasma PRL (P = 0.0009), a greater increase in plasma NE at the end of the exercise (P = 0.002), and an overall increase in plasma E (P = 0.02) and FFA (P = 0.02) concentrations. These results strongly suggest that endogenous DA limits catecholamine release during sympathetic-adrenal stimulation by activating DA2 receptors.

Immunosuppressive therapy of HBsAg-positive chronic active hepatitis in childhood: a multicentric retrospective study on 139 patients

We analyzed retrospectively the effect of immunosuppressive therapy in 139 children with HBsAG-positive chronic active hepatitis (CAH) observed in four liver units in Italy from 1974 to 1982. All children had been observed for at least 12 months. Of these 139 patients, 38 were treated with steroids (prednisolone or prednisone from 1 to 2 mg/kg daily), 78 with combination therapy (prednisolone or prednisone 1 mg/kg daily in combination with azathioprine, 2 mg/kg daily) and 23 were not treated. The outcome of the disease was assessed by evaluating clinical, biochemical, and histological parameters on the basis of preselected criteria. Untreated patients deteriorated more frequently than those treated with steroids (34.8% versus 13.2%, p less than 0.05) or those receiving combination therapy (34.8% versus 10.3%, p less than 0.01). Remission or improvement was observed more frequently in steroid-treated and combination-treated patients than in the untreated ones (p less than 0.001 and p less than 0.01, respectively). At the end of the study, only one untreated patient had died of liver failure. Remission was observed in about 10% of patients in the two groups of treatment, but in the untreated one, this event never occurred. Although this study is retrospective and presents some shortcomings, the data clearly indicate that steroid and combination therapy are not deleterious, and are possibly helpful, to children with HBsAg-positive CAH.(ABSTRACT TRUNCATED AT 250 WORDS)

Etiological, clinical and laboratory data of post-transfusion hepatitis: a retrospective study of 379 cases from 53 Italian hospitals

Among the 8,604 cases of acute viral hepatitis hospitalized during 1982 in 53 Italian hospitals, we studied 379 cases of post-transfusion hepatitis, 262 cases which occurred after surgery and 4,576 cases with no history of parenteral exposure. The etiological agents of post-transfusion hepatitis were NANB viruses in 57.8%, HBV in 39.0% and HAV in 3.2% of the cases. CMV and EBV accounted for less than 1.5% of the post-transfusion hepatitis cases. HBV was the main etiological agent (62.2% of the cases) in the post-surgical hepatitis group, where HAV accounted for only 6.1% of the cases. In contrast, in the group with no history of parenteral exposure, hepatitis A was most frequent. Percentages of patients with history of transfusion or surgery were always higher in type B and NANB hepatitis than in type A, suggesting that surgery without transfusion also represents a risk of acquiring type B and NANB hepatitis. No regional differences were observed in the etiological patterns of post-transfusion hepatitis and post-surgical hepatitis. The acute phase of type B post-transfusion hepatitis was more severe than that of NANB post-transfusion hepatitis, as shown by higher serum bilirubin and ALT levels and by a higher case fatality rate.

Cyclical Cushing's disease: report of a case cured by conventional cobaltotherapy

Preliminary hormonal studies in a 18-y old man with the clinical features of Cushing's syndrome showed inconclusive and conflicting results both in basal conditions and after metyrapone and dexamethasone administration. Therefore the possibility of a cyclical or acyclical fluctuation of adrenal hypersecretion was suspected and the patient was observed for an extended period of time free of hormonal manipulations. Regular cycles of cortisol hyperproduction, with peaks occurring every 6.0 days were found. Ectopic ACTH production was ruled out and, even in the absence of radiological evidence of a pituitary adenoma, conventional cobaltotherapy was suggested after refusal of transsphenoidal pituitary surgery. About 8 months later a marked clinical improvement was evident as well as normalization of hormonal data with loss of the cyclical pattern. Remission of the disease was still persistent 15 and 28 months later. A recent control, approximately 4 1/2 yr after treatment confirmed the normalization of biochemical data, suggesting a cure of the disease.

Ciprofloxacin in the treatment of urinary and respiratory tract infections in patients with chronic liver disease

The clinical efficacy and tolerability of ciprofloxacin (Bay o 9867), a new quinolone compound with broad antibacterial spectrum, was evaluated in 28 patients hospitalized in the first Clinic of Infectious Diseases, University of Naples, Italy, for chronic liver disease and affected by respiratory (RTI) or urinary tract infections (UTI). Ciprofloxacin was administered at the dosage of 500 mg twice a day after the isolation of the organism responsible for the infection and after the determination of its sensitivity in vitro to ciprofloxacin. The therapy was carried on for 5-10 days depending upon the severity of infection and clinical evaluation. Bacteriological cultures and hematochemical analysis were always performed during and after the therapy. Ciprofloxacin was very effective in all the treatments of UTI and RTI under examination, both for the disappearance or improvement of clinical signs and for eradication of the responsible microorganisms. No significant side effects or change in the hematochemical tests were observed.

The role of surgery in transmitting "post-transfusion hepatitis"

The role of surgery as an additional risk in transmitting "post-transfusion" hepatitis was investigated in a retrospective study on acute hepatitis occurring in 77 transfused patients, 293 transfused and operated patients and 243 hepatitis cases with history of surgery without transfusion. Hepatitis A patients admitted to the same centres in the same period were utilized as controls. In transfused patients the percentage of NANB hepatitis was higher than that of type B (61.0% vs. 36.4%), while in the operated not transfused group the percentage of type B was twice that of type NANB (63.4% vs. 32.5%). In transfused and operated cases intermediate values were observed. The age-adjusted measures of association between exposures and the different hepatitis types showed a lack of effect of transfusion and a dominant role of surgery in transmitting type B hepatitis. In contrast, NANB "post-transfusional" cases were actually a mixture of post-transfusional and post-surgical cases, since both these exposures were found to be significantly associated with the disease. Our results suggest that studies on the incidence and the etiology of post-transfusion hepatitis should take into account the risk of surgical exposure which might have occurred.

Opioid modulation of normal and pathological human chromaffin tissue

To evaluate whether opioid receptor blockade might modulate sympathetic-adrenal activity, we studied the effects of placebo or naloxone administration on plasma catecholamine (CA) levels in a group of 13 normal subjects and 15 hypertensive patients suspected to have a pheochromocytoma. Diagnostic evaluation confirmed the presence of pheochromocytoma in 9 patients. Among these, 4 had a unilateral epinephrine (E)-secreting tumor, 3 had bilateral E-secreting tumors due to multiple endocrine adenomatosis type IIa, and 2 had a unilateral norepinephrine (NE)-secreting tumor. In each subject studied, CA secretion was evaluated by calculating the area (0-30 min) under the plasma hormone curves after placebo or naloxone administration. In normal subjects naloxone caused a significant increase (P less than 0.005) of E secretion, whereas NE did not change. Similarly, in the group of hypertensive patients, E secretion increased after naloxone (P less than 0.01). In pheochromocytoma patients naloxone caused a significant increase in E (P less than 0.05) and NE (P less than 0.01) secretion from E-producing tumors but no increase in the patients with NE-secreting pheochromocytomas. The study suggests that CA secretion from normal and pathological chromaffin tissue is modulated by endogenous opioids; this modulation seems particularly evident in patients with E-secreting pheochromocytoma.

Treatment of chronic active hepatitis with either prednisolone or corticotrophin: a controlled trial

A total of 54 patients hospitalized for chronic active hepatitis were randomly treated, 29 with prednisolone (maintenance dose 15 mg/day) and 25 with depot synthetic corticotrophin (maintenance dose 1 mg/week, i.m.) and were followed up for 6 to 24 months or longer. In this series, young males predominated, the incidence of serum HBsAg positivity approached 80% in both treatment and no patient had initial evidence of cirrhosis or had autoimmune associated diseases. With either drug SGOT levels showed a decrease during the initial 12 months of therapy (p less than 0.05); initial jaundice, when present, had disappeared by the 3rd month of treatment. With both treatments globulins and gamma-globulins decreased significantly after 12 to 24 months of therapy. Serum HBsAg persisted in all but two cases. Serum liver biopsies showed the following evolutions of histological activity: 12 cases (22%) improved to the "inactive phase" (8 with prednisolone and 4 with corticotrophin); 19 (35%) improved to a lesser extent (8 with prednisolone and 11 with corticotrophin); 17 (32%) remained unchanged (11 with prednisolone and 6 with corticotrophin); 6 (11%) worsened (2 with prednisolone and 4 with corticotrophin). Morphological features of cirrhosis appearently developed in 15 patients (8 treated with prednisolone and 7 with corticotrophin) of whom 7 achieved improvement of histological aggressiveness concurrently. Differences between treatments were not significant. Side effects suggesting drug discontinuation occurred only in 6 cases.

Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies

This paper reviews the complications that arose after 68 276 percutaneous liver biopsies performed from 1973 to 1983. The complications are analyzed in relation to the underlying liver disease and to the type of needle used. Death was infrequent (9/100 000); it was always due to haemoperitoneum and occurred only in patients with malignant diseases or cirrhosis. Complications were less frequent in AVH (44/100 000) than in other liver diseases (from 125 to 278/100 000). Death, serious haemorrhagic complications, pneumothorax and biliary peritonitis were more frequent after biopsy with the Trucut needle than after biopsy with Menghini's needle (3/1000 against 1/1000). Sixty-one percent of complications were discovered within two hours of biopsy and 96% within one day. The data indicate a post biopsy observation period of at least 24 hours. The day-case procedure should be reserved for patients not presenting liver tumour or cirrhosis.

Blind-ending branch of bifid ureter: report of seven cases

Seven cases of bifid ureter with a blind-ending branch are presented: diagnosis was primarily made by excretory urogram. In 1 case the diagnosis was confirmed by retrograde pyelogram. The pelvicalyceal system showed ureteroureteral reflux into the blind-ending branch on photofluoroscopy and cineroentgenography. One rare case of blind-ending branch originating in the upper third of the ureter are described. The clinical aspects, roentgenographic findings, and treatment of these findings are reviewed.

Does endogenous dopamine modulate human sympathetic activity through DA2 receptors?

The effects of placebo and DA2 antidopaminergic agents on basal and stimulated catecholamine (CA) plasma levels in humans have been evaluated by administration either of domperidone or metoclopramide to separate groups of subjects. The latter group was subjected domperidone to sympathetic stimulation by handgrip coldpressor tests, and standing. Pharmacological DA2 receptor blockade, either peripheral by or central and peripheral by metoclopramide, did not modify plasma CA whilst resting or during acute sympathetic stimulation. It is concluded that endogenous dopamine does not seem to play a significant role in modulating NE release in man, at least not under the physiological conditions examined.

Effects of naloxone on catecholamine plasma levels in adult men. A dose-response study

To evaluate a possible role for endogenous opiates in modulating sympathetic-adrenal function in humans, we measured plasma epinephrine and norepinephrine (radioenzymatic method), blood pressure and heart rate in 8 normal men (aged 24-33 years) before and after placebo or different doses (0.4, 4.8, 10 mg) of naloxone. In 6 subjects plasma insulin and glucagon levels were also measured by radioimmunoassay after placebo and 10 mg naloxone. Naloxone had no significant effect upon blood pressure, heart rate, plasma insulin, glucagon or norepinephrine. Placebo, 0.4 and 4.8 mg naloxone caused no significant change in peripheral levels of epinephrine while 10 mg produced an increase in epinephrine concentrations 15 min after iv injection (186 +/- 23 vs 99 +/- 9 pmol/l, P less than 0.01). Since naloxone did not modify plasma levels of insulin and glucagon, an indirect effect of naloxone on adrenal medullary secretion seems to be excluded. These results are in agreement with in vitro experimental data obtained in animals and suggest that endogenous opiates also have a role in modulating adrenal medullary secretion in man.

The incidence of urinary tract malformations in congenital heart disease

A statistically significant number of congenital heart disease patients were evaluated for urinary tract anomalies. Twelve percent (160 cases among 1340 patients) had such associated anomalies. However, no association between a specific congenital heart disease and a particular urinary tract anomaly could be found. The results were very similar to those reported in clinical series, but slightly higher than those found at autopsy. The percentage of urinary tract malformations varied over a wide range, with some congenital heart disease having a much higher association than others. However, the total average incidence of urinary tract malformation was similar to that of the general population.

A new case of familial partial generalized resistance to thyroid hormones: study of 3,5,3'-triiodothyronine (T3) binding to lymphocyte and skin fibroblast nuclei and in vivo conversion of thyroxine to T3

A clinically euthyroid 30-yr-old man with high serum levels of both total (T4, 14.5 micrograms/dl; T3, 272 ng/dl) and free (FT4, 33 pg/ml; FT3, 9.7 pg/ml) thyroid hormones and inappropriately normal TSH levels, both basally and after TRH stimulation, is described. Peripheral indices of thyroid hormone action and the patient's clinical status were not modified by the prolonged administration of supraphysiological doses of both T4 (up to 900 micrograms/day) and T3 (up to 80 micrograms/day), which decreased but did not completely abolish the TSH response to TRH. However, the TSH response to TRH was normally blunted by dexamethasone administration, which also reduced serum T4 and T3 levels to normal. T3 binding to nuclei of mononuclear leukocytes and cultured skin fibroblasts was normal. The overall pattern demonstrates that the patient was affected by partial peripheral resistance to thyroid hormone action. Study of the patient's family revealed the same hormone pattern in the patient's father, suggesting an autosomal dominant mode of inheritance. An in vivo study performed after the iv injection of tracer doses of [125I]T4 and [131I]T3, demonstrated increased production rates (PR) of both T4 [PR, 113.0 micrograms/day X m2; normal subjects, 55.4 +/- 12.3 (mean +/- SD); n = 13] and T3 (PR, 41.1 micrograms/day X m2; normal subjects, 16.3 +/- 2.7). In vivo conversion of T4 to T3 was also evaluated in the patient; a nearly normal T4 to T3 conversion factor was found (0.3108 vs. 0.2576 +/- 0.0422 in normal subjects). In four hyperthyroid patients, the T4 to T3 conversion factors were similar (0.2932 +/- 0.0600), while the PRs of T4 and T3 were increased (PR of T4, 308.6 +/- 85.6; PR of T3, 110.3 +/- 35.0 micrograms/day X m2) compared to those in the normal subjects.

Immunosuppressive therapy in chronic active hepatitis (CAH). A multicentric retrospective study on 867 patients. A report from a study group for CAH of the Italian Association for the study of the liver

We retrospectively reviewed the clinical, biochemical and histological features of 867 patients with biopsy-proven CAH observed in 12 Italian Liver Units for at least one year. Either HBsAg positive or HBsAg negative patients (473 and 394 patients, respectively) were left untreated, or were treated with one of the following regimens: a) prednisolone or prednisone 10 to 30 mg daily, referred to as Steroids; b) azathioprine 50 to 100 mg daily; c) prednisolone or prednisone 10 to 20 mg daily associated with azathioprine 50 to 100 mg daily, referred to as Combination. The outcome was evaluated on the basis of clinical, biochemical and histological parameters. Among the 473 patients with HBsAg positive CAH those treated with combination, as compared to those untreated, more frequently, improved (P less than 0.001), and less frequently deteriorated (P less than 0.001). Under Steroids or Azathioprine improvement was more frequent than in untreated patients, but deterioration was not prevented. The results were similar among the 394 HBsAg negative patients. The data indicate that combination is effective in treating either HBsAg positive CAH or HBsAg negative CAH.

Effects of pharmacological doses of testosterone and dihydrotestosterone on the hypothalamic-pituitary axis function of Klinefelter patients

Six patients affected by Klinefelter's syndrome (KS) were treated with testosterone propionate (TP) 100 mg im daily for 4 days and one month later the same patients received dihydrotestosterone propionate (DHTP) 100 mg im daily for 4 days. Plasma levels of LH, FSH, PRL, testosterone (T) and dihydrotestosterone (DHT) have been measured in these patients for 8 days during and after TP and DHTP treatment. TP administration reduced LH levels only transiently, while a more prolonged reduction was observed for FSH. DHTP administration produced a late and transient reduction of LH and a very late reduction of FSH. PRL levels increased significantly during and after TP administration. Our data suggest that in Klinefelter patients: i) DHT is less effective than T in suppressing gonadotropin concentrations, ii) the increased PRL levels observed during and after TP administration are not due to a pure androgenic effect, but are probably related to an increased conversion rate of T to estradiol.

Steroid secretion by the prepubertal human testis

It has been demonstrated that the human testis secretes testosterone and, to a smaller extent and less constantly, also androstenedione. Testosterone, progesterone, 17 alpha-hydroxyprogesterone and 20 alpha-dihydroprogesterone have been measured in the spermatic and peripheral venous blood of prepubertal boys undergoing surgery for undescended testis or inguinal hernia repair. The spermatic plasma levels of testosterone and progesterone were significantly higher than peripheral levels. A significant spermatic-peripheral gradient was not found for 17 alpha-hydroxyprogesterone and 20 alpha-dihydroprogesterone. These studies demonstrate that the secretory pattern of the human prepubertal testis is different from that of the adults.

A study on human adrenal secretion. Measurement of epinephrine, norepinephrine, dopamine and cortisol in peripheral and adrenal venous blood under surgical stress

Epinephrine (E), norepinephrine (NE), dopamine (DA) and cortisol (F) were measured in samples drawn simultaneously by direct venepuncture from the brachial and the adrenal vein of 12 patients undergoing surgery for left kidney diseases. In 7 patients the influence of anesthesia on peripheral plasma levels was also assessed. Catecholamines were measured by a radioenzymatic assay and F by radioimmunoassay. Compared to basal values (mean +/- SE) (E: 53.6 +/- 6.2 pg/ml; NE: 209.4 +/- 24.4 pg/ml; DA: 24.5 +/- 3.3 pg/ml; F: 12.9 +/- 1.2 micrograms/dl) only NE peripheral levels were significantly modified by anesthesia (NE: 343.7 +/- 67.4 pg/ml p less than 0.05), whereas under surgery a significant increase in the peripheral levels was found for every substance measured (mean +/- SE) (E: 332.5 +/- 46.6 pg/ml p less than 0.001; NE: 633.6 +/- 114.2 pg/ml p less than 0.005; DA: 85.8 +/- 15.7 pg/ml p less than 0.005; F: 21.3 +/- 1.9 micrograms/dl p less than 0.01). Catecholamine and F levels in adrenal vein showed a high variability suggesting an intermittent secretion. In the adrenal venous blood E levels were, in the mean, 381 times higher, NE levels 45 times, DA levels 27 times and F levels 23 times higher than in peripheral blood. E, NE and DA concentrations in the adrenal vein were all significantly correlated to the others but not to cortisol, suggesting that the medulla secrets E, NE and DA in rather constant ratios and that the cortex and the medulla respond differently to surgical stress.

Treatment of chronic active hepatitis (CAH): a retrospective review of 130 patients

The authors review the course of disease in 130 patients (87 HBsAg-positive and 43 HBsAg-negative) with chronic active hepatitis (CAH) observed in the last six years. Patients were treated with prednisone (36 HBsAg-positive an 8 HBsAg-negative), azathioprine (7 HBsAg-positive and 12 HBsAg-negative) or a combination of prednisone and azathioprine (23 HBsAg-positive and 14 HBsAg-negative), or remained untreated (21 HBsAg-positive and 9 HBsAg-negative). Among HBsAg-positive patients improvement was observed in 54% of the 66 patients treated, and in none of the 21 untreated patients (P less than 0.001). Treatment did not modify the course of the disease in HBsAg-negative patients with CAH; this is probably related either to the small number of patients in each treatment group, or to geographical differences. Furthermore treatment was not effective in patients older than 40 years, whether HBsAg-positive or HBsAg-negative. Three out of 87 HBsAg-positive patients, and two out of the 43 HBsAg-negative patients had died by the end of the observation period irrespective of treatment. Full remission with clearance of HBsAg was observed only in one patient after 4 years of treatment with steroids.

Spermatic and peripheral oestradiol levels in patients affected by azoospermia due to seminiferous tubular damage

Plasma levels of testosterone, androstenedione and oestradiol were determined in the spermatic venous blood of both testes of 17 patient affected by azoospermia due to tubular damage (Group I). The results were compared with those found in 5 patients affected by azoospermia of obstructive origin and 5 patients with an inguinal hernia (Group II). Mean spermatic levels of testosterone and androstenedione were not significantly different in the two groups, while the mean (+/- SE) oestradiol spermatic level was significantly higher in patients of Group I (5.02 +/- 0.75 nM/l vs. 2.20 +/- 0.365 nM/l; P less than 0.05). Moreover, while the testosterone/androstenedione and the androstenedione/oestradiol ratios were not significantly different in the two groups, the mean (+/- SE) testosterone/oestradiol ratio was significantly lower in patients of Group I (552.71 +/- 80.94 vs. 939.86 +/- 129.45; P less than 0.025). Peripheral testosterone and androstenedione mean levels were not significantly different between the two groups while the mean peripheral oestradiol level (+/- SE) was significantly higher in Group I (0.107 +/- 0.021 nM/l vs. 0.038 +/- 0.05 nM/l; P less than 0.025). Peripheral oestradiol was not significantly related to peripheral FSH, nor to spermatic oestradiol in both groups. These results suggest the possibility that oestradiol may be involved in the pathogenesis of some cases of male infertility.

HBsAg carriers among blood donors in Italy; a retrospective survey of data from 189 blood banks

Data of occasional or periodic blood donors from 189 banks scattered throughout Italy were retrospectively surveyed for the period between 1974 and 1977. The prevalence of HBsAg positive subjects (PHA or RIA) among occasional donors during 1975-1977 was about 3% with no appreciable annual variation. The rate of HBsAg positivity in southern Italy (i.e. Campania, 4.32%) was higher than in northern Italy (i.e. Trentino, 0.30%). Only 0.27% of the occasional donors showed both HBsAg positivity and elevated serum transaminases levels. Among periodic donors the rate of infection, as indicated by the appearance of HBsAg in serum subsequent to the last donation, was approximately 0.5% per year. Only one-tenth of the periodic donors who acquired HBsAg also had hypertransaminasemia.

Hormonal studies in a male with a 47,XXX chromosome constitution: comparison with the hormonal pattern of a 46,XX male and patients with Klinefelter's syndrome

Chromosome analysis in peripheral blood lymphocytes and skin fibroblasts of a 18 year old chromatin-positive man showed a 47,XXX karyotype. The following hormonal studies were performed: 1) FSH and LH response to GnRH; 2) hypothalamic-pituitary responsiveness to short-term testosterone administration; 3) plasma levels of testosterone, dihydrotestosterone, 17-hydroxyprogesterone, estradiol before and after hCG stimulation. Results were compared with similar studies performed in a 46,XX male and in a group of patients with Klinefelter's syndrome. Our data support the hypothesis that this rare cytogenetical disorder can be considered, from the endocrine point of view, as a variant of the Klinefelter's syndrome.

Seminal plasma levels of testosterone and 5 alpha-dihydrotestosterone in azoospermic patients

Testosterone (T) and 5 alpha-dihydrotestosterone (DHT) have been measured in seminal plasma of sixteen azoospermic patients with tubular damage (germinal cell arrest or Sertoli cell only syndrome) and five patients affected by azoospermia of obstructive origin. In both groups T values were not significantly different from controls, while DHT was significantly lower in patients affected by azoospermia of obstructive origin.

The growth-hormone in long-term steroid-treated patients with chronic active hepatitis

To determine whether the hypothalamo-pituitary axis (HPA) became suppressed in patients with chronic active hepatitis (CAH) treated with prednisone or long-activity synthetic corticotrophin (L.A.S.C.) for at least 12 months 36 patients with CAH were assessed for growth hormone release following insulin hypoglycemia test (IHT). Sixteen out of the 36 patients were treated with steroids, 11 with L.A.S.C. and 9 were untreated. Sixteen patients were less than 12 years old of whom 8 were treated with prednisone and 5 with L.A.S.C. and 3 untreated. Suppression of HPA was observed only in two patients of whom one was treated with prednisolone for 24 months and the other one received L.A.S.C. for 23 months. Normal HPA was observed in all the other 34 patients. Two patients aged 6 and 8 years were treated with steroids for 3 and 6 years respectively and showed impairment of the growth in height and remained permanently stunted even when steroids had been discontinued. Our data suggest that both steroids and L.A.S.C. treatment does not impair HPA in patients with CAH when administered for less than two years.

Abnormal steroid sulfate in plasma of women with intrahepatic cholestasis of pregnancy

Concentrations of numerous sulfate steroids were checked in the plasma of 10 women in normal pregnancy (NP), 21 women with intrahepatic cholestasis of pregnancy (ICP) and 10 pregnant women suffering from viral hepatitis with jaundice (VHP). A considerable increase in 5 alpha pregnane and 5 beta pregnane 3 alpha, 20 alpha diols, mono- and disulfates and in 5 alpha pregnane 3 beta, 20 alpha diols disulfates was observed only in ICP and not in VHP. This observation permits us to hypothesize that these hormone changes can have a causative role in the pathogenesis of ICP.