Raised serum apolipoprotein (a) in active diabetic retinopathy

Progressive capillary occlusion often leads to severe retinopathy within 15-20 years of the onset of Type 1 (insulin-dependent) diabetes mellitus. Lipoprotein(a), a complex formed by apolipoprotein(a), apo B-100 and lipids, is considered an independent, genetically determined, predictor of cardiovascular disease. It may have antifibrinolytic properties in view of its similarity to plasminogen. To test the hypothesis that circulating lipoprotein(a) is associated with the process that leads to clinically active diabetic retinopathy, we measured the circulating levels of apolipoprotein(a) (which are strictly correlated with those of lipoprotein(a)) in two groups of patients with Type 1 diabetes of at least 15 years duration: 25 with active retinopathy and 27 without clinically detectable retinal lesions. Thirty-eight healthy subjects of the same age and sex served as controls. Serum apolipoprotein(a) was higher in the patients with active retinopathy (36(2-193) U/dl, geometric mean and range) than in those without clinically detectable retinal lesion (17(1-160)) and the control subjects (14(0-115)), p < 0.01 in both cases. The distribution of apolipoprotein(a) levels was skewed to the left, as expected, in the patients without clinically evident retinal lesions and the control groups, but there was a bimodal trend of distribution among those with active retinopathy. The levels of glycated haemoglobin were similar in the two groups of diabetic patients, and no significant differences were found for total and HDL cholesterol, triglycerides or apolipoproteins A1 and B between them and the control subjects. These preliminary results suggest that serum apolipoprotein(a) is elevated in patients with active retinopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Anxiety disorders in the joint hypermobility syndrome

A case-control study was designed to test the association between joint hypermobility syndrome (JHS), an inherited disorder of collagen synthesis, and anxiety and phobic disorders. One hundred fourteen cases of JHS diagnosed at the rheumatology outpatient clinic of the Hospital del Mar (Barcelona) were compared to 59 control subjects randomly selected from patients seen at the same clinic. Both cases and controls were examined by a psychologist who used the Structured Clinical Interview for DSM-III-R and who was unaware of their medical diagnoses. DSM-III-R diagnoses of panic disorder, agoraphobia, and simple phobia, but not generalized anxiety disorder, dysthymic disorder, or major depression were found to be highly associated with JHS (age- and sex-adjusted odds ratio = 10.7). Mitral valve prolapse (MVP) was present only among JHS cases. Among cases of JHS, subjects with MVP were almost three times more likely to suffer from anxiety than subjects without MVP (odds ratio = 2.95), although the association was not statistically significant. The strong association between panic anxiety and JHS appears to occur at a higher level than the association between panic and MVP, and provides a new basis for further studies on the genetic background of panic-anxiety.

The role of endothelium in the pathogenesis of diabetic microangiopathy

Damage caused to the vessel wall by diverse mechanisms may lead to diabetic microangiopathy. Consequently, research work is more and more focusing on the pathophysiology of vascular cells, with particular emphasis on endothelium. This paper reviews the present knowledge on the alterations of small vessel endothelium in diabetes. The most important risk factors for diabetic microangiopathy are the duration of disease and the degree of metabolic control maintained throughout the years. However, genetic factors may also contribute. These are examined first, followed by the presumed roles played by increased protein glycation and the production of Advanced Glycosylation End Products, the "polyol pathway" and free radical generation. Endothelium is a widespread, extremely active organ which regulates complex physiologic functions and its structure and function are discussed in the second section of this review. The third part deals with how diabetes can affect endothelium and describes observations on endothelial metabolism in vitro as well as morphologic and functional alterations in the patients. Unfortunately, the mechanisms leading to progressive degeneration of the microcirculation and organ damage in diabetic patients remain largely unaccounted for.

Pericyte mitogenic activity is reduced in the blood of type 1 diabetic patients with and without retinopathy

Selective loss of capillary pericytes occurs early and specifically in diabetic retinopathy. We have investigated whether blood derivatives from patients with long-term type 1 (insulin-dependent) diabetes and no retinopathy differ from those with retinopathy and/or non-diabetic controls in their ability to stimulate DNA synthesis in cultured bovine retinal pericytes and endothelial cells. As a general trend, whole blood serum, platelet-rich plasma and platelet-free plasma from patients without and with retinopathy stimulated thymidine incorporation in both cell types less than derivatives from controls. Serum, 0.1% v/v final concentration in culture medium, from patients without retinopathy was less active (114.5 +/- 24.5% of a standard stimulus produced by 0.1% fetal calf serum) than that from patients with the complication (132.6 +/- 20.8%, P = 0.003) and both were less potent than control sera (143.6 +/- 28.0%, P < 0.001 and P = 0.013, respectively). Lack of support from circulating factor(s) may contribute to the disappearance of pericytes from the capillary wall in diabetes but further investigations are necessary to clarify the mechanisms that prevent the development of microangiopathy in some patients.

A study of the effects of human blood derivatives and individual growth factors on [3H]thymidine uptake in bovine retinal pericytes and endothelial cells

Pericytes disappear early, selectively and specifically from retinal capillaries in diabetic microangiopathy, but little is known of their growth and turnover in health and disease. We have studied the effects of human blood derivatives and of a panel of individual growth factors on [3H]thymidine incorporation in bovine retinal pericytes and endothelial cells. Human serum and platelet-rich plasma stimulated incorporation of the nucleotide in a dose-dependent manner in both cell types, and did so more potently than platelet-free plasma. Consistent and significant stimulation of DNA synthesis in pericytes was observed with basic fibroblast growth factor (ED50 = 1.8 x 10(-13) mol/l), acidic fibroblast growth factor (7.4 x 10(-12) mol/l), insulin-like growth factor 1 (8.6 x 10(-10) mol/l), insulin (158 microU/ml) and endothelin-1 (6.1 x 10(-10) mol/l). Transforming growth factor beta 1 inhibited DNA synthesis (ID50 = 3.6 x 10(-10) mol/l) and so did heparin (1.4 x 10(-6) mol/l) and low molecular weight heparin (2.9 x 10(-6) mol/l). Retinal endothelial cells were stimulated by basic fibroblast growth factor (3.2 x 10(-13) mol/l) and acidic fibroblast growth factor (1.3 x 10(-9) mol/l), and inhibited by transforming growth factor beta 1 (1.6 x 10(-12) mol/l). Neither cell type was stimulated by platelet-derived growth factor (A + B chain heterodimer), epidermal growth factor, growth hormone, or nerve growth factor (7S complex). The characteristics and active concentrations of the above growth factors suggest that none is solely responsible for the pericyte mitogenic activity of platelets, serum or plasma.(ABSTRACT TRUNCATED AT 250 WORDS)

Epidemiology of prostatic disorders in the city of Barcelona

Although disorders of the prostate are among the most prevalent problems in elderly males, little is known about their epidemiological characteristics. The 1986 Barcelona Health Interview Survey (BHIS), a cross-sectional study of a random sample of the noninstitutionalized population of the city, was used to estimate the prevalence of prostatic disorders (PD) and to analyse sociodemographic characteristics, self-perceived health, and use of health services among males reporting PD. Ninety-eight out of 1218 males over 45 years old (8%) reported having PD, the prevalence increasing substantially with age. A pattern of increasing prevalence with decreasing occupational class was found. As compared to subjects not reporting PD, individuals reporting PD reported slightly more restricted activity days (prevalence odds ratio [POR] = 1.28; 95% confidence interval [CI]: 0.52-2.80), more chronic disorders (POR = 4.75; 95% CI: 2.04-13.53), and worse self-perceived health (POR = 1.55; 95% CI: 0.92-2.58). Medical visits and hospitalizations were also higher in the prostatic group (P < 0.05). Men reporting PD appear to constitute a subgroup with increased morbidity and health services use.

Myelodysplastic syndromes and malignant solid tumors: analysis of 21 cases

We studied the association between myelodysplastic syndromes (MDS) and malignancies in a cohort of 155 patients with MDS, 21 of whom presented malignant solid tumors. Myelodysplasia was present after the diagnosis of cancer in eight patients (interval between the diagnosis of both conditions 18 months, median survival 49.5 months), simultaneously with diagnosis in 11 (median survival 8 months), and before malignancy in two patients (interval between the diagnosis of both conditions 47 and 7 months). One patient was given chemotherapy for lung cancer, and three patients received radiotherapy for adenocarcinoma of the kidney and cancer of the prostate. At the time of diagnosis of MDS, nine patients already presented metastatic spread. Fourteen patients died, ten as a result of tumor-related complications and four because of transformation to acute nonlymphocytic leukemia. The analysis of the incidence of malignancy in patients with MDS was statistically significant for males, and the relative risk was significant in both sexes. The results of this study show that MDS patients present a higher incidence of malignant tumors than the general population, that MDS may be of real paraneoplastic significance, and that the occurrence of MDS in cancer patients may be considered to be related to the malignancy rather than an independent phenomenon.

[Sequential nimodipine-reduced glutathione treatment in alcoholic abstinence syndrome. Preliminary experience]

Alcohol abstinence syndrome (AAS) occurs in alcohol dependent patients a few hours after ceasing to drink, first in the form of gastrointestinal and dysvegetative signs, then with the involvement of neurological functions. The results obtained in 15 patients selected according to DSM III criteria, treated with nimodipine (calcium entry blocker) in the acute phase and with reduced glutathione in the subacute phase are presented. All patients who, during treatment, did not take other drugs, showed a definite, fast improvement in symptoms, especially in neurovegetative symptoms. Administration of nimodipine, which seems capable of reducing the catecholaminergic drive, was very well tolerated. Treatment with reduced glutathione is justified by the fact that the inadequate intake of alcohol is responsible for liver changes and, particularly, for a significant reduction in liver levels of glutathione, a condition that makes the cell more exposed to attack on the part of substances that activate lipoperoxidation processes. The results obtained seem to confirm a protective action on the part of reduced glutathione.

Sjögren's syndrome: a stepwise approach to the use of diagnostic tests

One hundred and forty two patients (62 with definite Sjögren's syndrome, 24 with probable Sjögren's syndrome, and 56 in whom Sjögren's syndrome was finally ruled out) were studied. Schirmer's test and rose bengal staining for the diagnosis of keratoconjunctivitis sicca and salivary scintigraphy and a labial biopsy sample for the diagnosis of xerostomaia were studied in all patients. Rose bengal staining showed high specificity (98%) but low sensitivity (55%). All patients with positive rose bengal staining results had associated xerostomia. In the rose bengal staining positive patients, scintigraphy had 100% specificity. A labial biopsy sample showed high sensitivity in the rose bengal staining, salivary scintigraphy positive group, and high specificity in the rose bengal staining positive, salivary scintigraphy negative group. In patients with negative rose bengal staining, salivary scintigraphy showed 96% specificity and 36% sensitivity. A labial biopsy sample had a sensitivity and specificity greater than 90% in rose bengal staining negative patients. Only 29 biopsy samples were needed to achieve a diagnosis of Sjögren's syndrome in 142 patients (20%). Hence the suggested approach may make it unnecessary to take biopsy samples in approximately 80% of patients with suspected Sjögren's syndrome. Using the stepwise approach of first rose bengal staining, then salivary scintigraphy, and eventually a labial biopsy sample in patients with suspected Sjögren's syndrome, the diagnosis is relatively simple.

Clinical assessment of hypermobility of joints: assembling criteria

We carried out a prospective study to determine the validity of different sets of criteria to define the hypermobility syndrome (HMS), as well as the frequency, reliability and clinical features of HMS items. All consecutive cases of HMS attending the rheumatological outpatient clinic of Hospital del Mar (Barcelona, Spain) constituted the index group (n = 114). A control group of non-HMS rheumatological patients (n = 59) was randomly selected to assess suitable cutoff points and particular HMS item prevalences. Beighton's, Carter's and Rotés' HMS scores correlated very highly among them. Both the correlation coefficients obtained between each pair of sets of HMS criteria and the predictive efficiencies were uniformly high, suggesting high concurrent and predictive validity. All but 2 of the major items were more frequent among women. A basic set of criteria to define HMS is proposed. In relation to previous criteria the new scale shows better internal reliability and homogeneity. Results suggest that it may be suitable for screening studies and in clinical rheumatological settings.

Influence of "diagnostic delay" upon cancer survival: an analysis of five tumour sites

STUDY OBJECTIVE

The aim was to assess the relationship between survival, tumour stage, and the interval from first symptom to diagnosis (SDI, or duration of symptoms).

DESIGN

This was a retrospective follow up study of a cohort of patients registered in the tumour registry of the Hospital del Mar (Barcelona).

SETTING

Hospital based tumour registry, with patients derived mainly from the City of Barcelona.

PARTICIPANTS

1247 cases of lung, breast, stomach, colon, or rectal cancer were analysed using survival curves and Cox proportional hazards regression. Subjects (mean age 63.6 years) were followed for a median length of 12.9 months after diagnosis. At the time of diagnosis one fourth of patients had disseminated disease.

MEASUREMENTS AND MAIN RESULTS

Based on clinical records, a physician registered the onset time of the first symptom attributable to cancer (from which the SDI is computed), as well as the tumour stage at diagnosis. Other measurements followed standard tumour registry procedures. Overall, the crude mean SDI was 5.15 months (SD 8.03, median 2.03); only 24.5% of cases had an SDI less than a month. Crude mean SDIs by anatomical site were as follows: lung cancer 3.07 months; breast 7.44; stomach 5.34; colon 5.74; rectum 5.03. Tumour extension did not appear to be significantly influenced by SDI, only breast cancer showing a distinct pattern of increased extension with increasing SDI. As expected, the probability of survival decreased monotonically with increasing stage in all sites. Tumour site was also a significant predictor of survival, which at one year ranged from 93% for breast cancer to 28% for lung cancer. However, a longer SDI tended sometimes to be associated with a better chance of survival, a fact that was most apparent in colon cancer. All Cox proportional hazards models showed a consistent picture: SDI was not a significant predictor of survival (age and sex adjusted hazard ratios ranging from 0.97 to 1.01), neither was sex; age did predict survival, and so did site and stage.

CONCLUSIONS

The results provide further evidence of a very weak relationship between SDI and tumour stage at diagnosis (except for breast cancer), and between SDI and survival, thus emphasising some limitations within which early clinical detection operates. They also suggest that in addition to reflecting patient and physician behaviour, as well as the functioning of the health system, SDI may be influenced by the biological behaviour of the tumour.

Emerging strategies for the prevention and treatment of diabetic eye disease

Diabetic retinopathy (DR) is the major cause of blindness in the working age groups of industrialized countries, and a programme has been launched by the World Health Organization (WHO) and the International Diabetes Federation (IDF) to reduce its morbidity in Europe. Retinopathy progresses slowly, and even when it becomes sight-threatening, may not present visual symptoms. When symptoms do occur, it is often too late to restore full vision or to stop further deterioration by retinal photocoagulation. For photocoagulation to be maximally effective, treatable sight-threatening retinopathy must be identified while still asymptomatic by means of regular fundus examination of all diabetic patients. Given the absence of effective medical treatment, prevention of retinopathy depends on mass screening. The WHO and IDF recommend that internists in charge of diabetic patients perform a fundus examination at least every two years if retinopathy is absent, or as frequently as necessary otherwise. Patients at risk should be referred for assessment and treatment to ophthalmic facilities. Either direct ophthalmoscopy or retinal photography are suitable methods. The setting up of nation-wide screening programmes is essential for coordinated action. Pilot studies have proven that screening is an effective means for decreasing diabetes related blindness and the human and social costs attached to it.

von Willebrand factor and endothelial abnormalities in diabetic microangiopathy

We briefly summarize current knowledge on 1) the abnormalities of von Willebrand factor (vWF) as an indicator of endothelial cell (EC) dysfunction in diabetes and 2) the modifications induced in the growth of cultured ECs by high glucose in the incubation media. A MEDLINE search (1986 through Sept. 1989) was performed to update previous relevant references on vWF and ECs in healthy and diabetic subjects. Main data in the literature and personal contributions were scrutinized. Study quality, information, and relevance to the subject were assessed. vWF is synthesized and stored mainly in ECs. Its plasma levels are increased in diabetic microangiopathy but are not influenced by circulating glucose, insulin, or growth hormone, nor do they acutely affect platelet function in diabetes. Supraphysiological concentrations of glucose inhibit the replication of cultured ECs from large vessels via different possible mechanisms but appear to stimulate pathways involved in the activation of capillary ECs. vWF is a possible marker of EC damage in diabetes, and prospective studies will ascertain its role as a predictor for the development of microangiopathy. The possible dichotomy in the response of cultured ECs from large and small vessels to high glucose in the culture media may help explain some of the lesions observed in the walls of arteries and capillaries in diabetes.

Cytokine stimulated endothelin release from endothelial cells

Endothelin release from bovine endothelial cells of the aorta, pulmonary artery, and retinal microvessels was measured in response to various cytokines. Transforming growth factor beta (0.05-5 ng/ml) was found to be a potent stimulator (3-4 fold increase) of endothelin secretion in all three cell types. Tumour necrosis factor alpha (0.1-10 ng/ml) and interferon gamma (8-800 U/ml) had a small (1.5-2 fold increase) but significant effect on endothelin secretion from endothelial cells of large vessels but not the retinal microvessels. Interleukin-1 beta, Interleukin-6 and interleukin-8 at various doses did not affect endothelin secretion. These effects were observed at various time points from 6-24 hrs and indicate that of the cytokines tested, only transforming growth factor beta has a potent effect on endothelin release from endothelial cells of different organs.

Production of endothelin by vascular smooth muscle cells

Endothelin (ET) production by cultured vascular smooth muscle cells isolated from rat and rabbit aortae was measured by a specific radioimmunoassay. Vascular smooth muscle cells released ET at a rate of 0.6 (range of 0.1-1) fmol/10(5) cells/24 h compared to 45 (range of 10-80) fmol/10(5) cells/h for endothelial cells. ET immunoreactivity was confirmed as ET-1 by fast protein liquid chromatography. Calcitonin gene-related peptide (CGRP) and vasoactive intestinal polypeptide (VIP) suppressed basal release of ET by 24-66% from both rat and rabbit vascular smooth muscle. Forskolin and dibutryl-cAMP similarly suppressed ET release by 33-86%, suggesting that increased intracellular cAMP may account for the mechanism of action of CGRP and VIP. In contrast, CGRP and VIP did not have any effect on ET release from endothelial cells. The characteristics and regulation of ET binding sites on vascular smooth muscle cells were measured using [125I]ET-1 as the radioligand. Pretreatment with CGRP, VIP, forskolin, and dibutryl-cAMP increased the ET receptor density on both smooth muscle cell types. The low level production of ET-1 by vascular smooth muscle cells may have an important autocrine function and may be under regulation of neuropeptides localized to perivascular nerves.

Nimodipine in human alcohol withdrawal syndrome--an open study

The aim of this study was to evaluate the efficacy and tolerability of the DHP Ca2+ antagonist nimodipine in human AWS and post-AWS. Ten hospitalized alcoholics of both sexes with a diagnosis of AWS according to the DSM-III criteria were treated for 3 weeks in monotherapy with nimodipine p.o. at flexible daily dosages. Evaluation of AWS symptoms was performed at baseline and after 3, 5, 7, 10, 14 and 21 days. A statistically significant improvement of AWS was seen at evaluation on day 3, particularly in neurovegetative and psychopathological symptoms, and lasted up to the end of the study. The treatment was well tolerated and no side effects were observed or reported. In this pilot, open study nimodipine proved effective in the treatment of mild-to-moderate AWS. If these data are confirmed in a double-blind study nimodipine could be a rational alternative to benzodiazepines in the treatment of AWS.

Efficacy of clonidine, guanfacine and methadone in the rapid detoxification of heroin addicts: a controlled clinical trial

The efficacy of clonidine, methadone, and guanfacine in rapid detoxification of heroin inpatients was assessed in a randomized controlled clinical trial. Signs and symptoms of abstinence and of side effects were analysed in 90 heroin addicts successfully completing a 12-day inpatient trial. All patients fit DSM-III criteria for opioid dependence, the age range being 18 to 36 years. All three drugs were effective in controlling abstinence; however, the course of abstinence was different in the methadone group as compared to the adrenergic agonists, the latter showing limitations in their ability to suppress withdrawal manifestations. While mean number of withdrawal signs and symptoms was significantly lower during days 2 to 5 in the methadone group (p less than 0.01), adrenergic agonists were slightly more effective at the end of the trial. Incidence of side effects was closely related to the dose administered. Hypotensive action of adrenergic agonists was more marked in orthostatic position. The present results suggest that methadone is superior to adrenergic agonists. Between these drugs clonidine appears to be less effective than guanfacine in controlling some withdrawal manifestations, and causes more side effects, mainly of cardiovascular nature.

Antibiotic prophylaxis with cefotaxime in gastroduodenal and biliary surgery

In a multicenter prospective, randomized study, the efficacy of a single preoperative dose of 1 g of cefotaxime for avoiding wound infections was compared with four 2-g doses of cefoxitin. In the study, 1,451 patients with infection risk factors who underwent gastroduodenal or biliary surgery were included, of whom 722 received cefotaxime and 729 cefoxitin. The characteristics of both groups were comparable. The frequency of wound infections in the cefotaxime group was 3.3 percent and in the cefoxitin group, 7.6 percent. The difference was statistically significant. The lowest rate of wound infection (0.63 percent) was achieved when cefotaxime was administered during the last hour before surgery. In both groups, the frequency of infections was directly related to the duration of operation. Hospital stay was, on average, 3 days longer in patients with wound infections. After cost-benefit analysis, we have concluded that cefotaxime treatment results in substantial reduction of costs derived from antibiotic prophylaxis.

[Results of long-term follow-up of patients with ureterosigmoidostomy]

The late results of ureterosigmoidostomy (US) have been known for many years; however, the incidence rates of second neoplasms that have been reported for the foregoing procedure are in disagreement with our own findings. A comprehensive review we had undertaken demonstrates that although it is a risk factor, its true incidence is much lower than that widely-accepted and published. Its very long latency period make it a currently valid surgical procedure in some adult conditions.

[Sipple's syndrome. Review of the literature and personal case load]

A family with Sipple's syndrome was studied over three generations. The syndrome is transmitted as a dominant autosomic hereditary trait with high penetrance and varying expressiveness. Our series include 13 patients of three generations: 1) husband and wife who were 1st degree cousins; 2) 4 sisters and 1 brother; 3) 5 sisters and 1 brother. In the first generation we did not find any sign that could be related to the syndrome, in the second generation 2 thyroid carcinomas and a pheochromocytoma were present, and in the third one 2 sisters had these neoplasias, one pheochromocytoma and the other thyroid cancer, another one had marfanoid habitus and the fourth one had pheochromocytoma. This series includes 11 subjects of the second and third generation; the Sipple's syndrome was present in 7 females. The incidence of the syndrome was 63.8% and present only in female subjects. The high incidence rate could be caused by the strict relation between the grandparents. The diffusion of this pathology may be related to the high penetrance of the gene(s) involved whereas the clinical variations may be interpreted to the variable expressiveness and, even more so, as evidence that the other manifestations of the syndrome may occur later in time.

[Controlled clinical study on the effect of quazepam versus triazolam in patients with sleep disorders]

Quazepam (QZP), a new long half-life benzodiazepine, seems to have a more specific hypnotic activity and a "physiological" mechanism of action. This study assessed its clinical efficacy and any withdrawal symptoms occurring after the treatment with QZP and triazolam (TRZ). Sixty-five patients (mean age 41.4 yrs +/- 12.43 SD) with sleep disorders were included in the study. The patients were treated with placebo for 4 days (run-in period) and if no amelioration of insomnia was observed, were then randomly allocated to 15 mg QZP (33 patients) or TRZ (32 patients) for 8 weeks and finally placebo for another week. Sleep quality, efficiency, side-effects and withdrawal effects were assessed by specific rating scales. In comparing data obtained from the two treatments, the following conclusions were drawn: 1) both drugs showed a hypnoinductive efficacy but patients treated with QZP had significantly fewer night awakenings; 2) at the end of treatment only patients treated with TRZ had longer awakenings and rebound symptoms; 3) a lower withdrawal symptom incidence was observed in patients treated with QZP. Therefore, QZP seems to have a good hypnotic effect without inducing withdrawal symptoms. In contrast TRZ turned out to be a merely hypno-inducing drug presenting higher risks of rebound effects after withdrawal.

Water permeability in the human amnion: pH regulation of the paracellular pathway

Human amnion was mounted, immediately after delivery, as a diaphragm between two lucite chambers and the net transepithelial water movement (Jw) was recorded minute by minute. When Jw was plotted against the applied transepithelial hydrostatic pressure (fetal side positive), in the absence of any other gradient, a linear relationship was observed (Phydr = 0.32 +/- 0.05 cm/s, n = 10). A linear relationship was also found when Jw was measured in the presence of an osmotic gradient, generated by adding (to the maternal side) different concentrations of poly(ethylene glycol) (Mr approximately equal to 3600; reflexion coefficient (sigma) = 1; Posm = 0.015 +/- 0.001 cm/s, n = 10). When sucrose, a paracellular marker, was used as the osmotic probe, the observed sigma was 0.5. Medium acidification in the presence of bicarbonate reduced in the same proportion both the hydrostatic and osmotic permeabilities. The effect was fully reversible, but was not observed when bicarbonate was replaced by Tris. To test the comparative role of transcellular versus paracellular paths, Jw and the [14C]sucrose permeability (Psuc) were simultaneously recorded minute by minute, in the presence of an osmotic or an hydrostatic gradient. In both cases, the percentage reductions in Jw and Psuc induced by medium acidification were similar. Quantification of theoretical and observed values for Jw and Psuc strongly suggests that effects of pH on both the osmotic and hydrostatic flux reflect a modification of the paracellular path.

Reductions of body weight and blood pressure in obese hypertensive patients treated by diet. A retrospective study

A retrospective survey was carried out in a group of 39 previously obese and hypertensive subjects to evaluate: the rate of blood pressure reductions achieved by dietary treatment, the smallest weight reduction accompanied by a significant decrease in blood pressure, and the mean weight reduction associated with normalization of pressure. Significant decrease in weight, systolic and diastolic pressures were observed after 15 days of treatment in 21 patients who had never assumed antihypertensive drugs and 9 who were on medication. Blood pressure normalization was achieved in 19 of the former with a weight reduction of 7.63 +/- 4.29% kg and in 7 of the latter after losing 8.63 +/- 2.20% kg; in 3 patients the medication was reduced and in 1 was withdrawn. In 4 patients weight but not pressure had decreased and in 5 neither did. Reduction, often normalization, of blood pressure can be obtained through relatively minor weight loss in most obese hypertensive patients.

Success and failure at inpatient heroin detoxification

Predictors of either detoxification success or failure were evaluated during an inpatient trial that compared the efficacy of methadone, clonidine and guanfacine for rapid heroin detoxification. The analysis of such predictors was stimulated by the fact that in order to achieve 90 patients who completed the study (30 in each group), a total of 170 patients had to be included. Of 80 detoxification failures, 10 occurred in the methadone group, 32 in the guanfacine group, and 38 in the clonidine group. Voluntary request for discontinuation of the detoxification schedule was the first cause of failure. There were not statistically significant differences with regard to sociodemographic characteristics and pattern of drug consumption among patients in the three groups who completed detoxification with success or failure. The treatment drug, the type of schedule and the score obtained from the Symptom Checklist-90/Revised (SCL-90/R) were the only predictors of either detoxification success or failure. Inpatient opioid detoxification would be a useful strategy for patients with more severe psychological symptoms.

Lumbar myelography with iopamidol: a methodological approach to the investigation of side effects

Pathophysiology of adverse reactions occurring during myelography with non-ionic contrast agents, such as iopamidol, seem related to their direct action on the nervous system. The authors try a multivariate approach, involving neurophysiological, neuropsychological and neurochemical parameters on a pilot group of twelve subjects. Any possible change in the above examinations is thoroughly analyzed and correlated to the postulated neurotoxic properties of contrast media.

[Endothelium and its morphofunctional changes in the pathogenesis of diabetic microangiopathy]

Recent advances in our knowledge of endothelial function in health and in the presence of generalized microvascular damage, such as found in diabetic microangiopathy, are discussed in this review article. In microangiopathy there are no typical morphological signs of endothelial stress, apart from ubiquitous thickening of the basement membrane and the finding of both hyper- and acellular capillaries, whereas important derangements of endothelial function may occur in the early stages of the disease, like accelerated turnover, intracellular accumulation of potentially toxic intermediate metabolites, hyperpermeability of the vessel wall, altered synthesis of some haemostatic factors, expression of angiogenetic potentialities in inappropriate situations. The possible pathogenetic mechanisms underlying such alterations are reviewed, with special emphasis on the shortcomings of the experimental models available for laboratory investigation and on the in vivo situation.

A survey of patients acceptability of diabetes education programmes in Italy

When planning diabetes education programmes it would be useful to know in advance the patients' demands and expectations. To this purpose, a questionnaire was circulated throughout Italy. Eight hundred and forty-five forms were returned from 487 men and 358 women of age 49 +/- 18 (SD) residing in all regions of Italy. Fifty percent were on insulin, 37% on oral agents and 13% on diet only. Forty-seven percent believed they had a satisfactory knowledge of diabetes, 49% thought it fair or poor and 4% judged it non-existent. Such knowledge derived from diabetic clinics, mass media, specialized publications and family doctors. Only 11% had previously attended education programmes. The vast majority (83%) believed that better information would help to improve their diabetes care and were willing to attend education courses. Printed material and group learning were preferred to audiovisual aids and individual education. Doctors were preferred as teachers (83%) to other patients or paramedical staff. Patients were mostly interested in learning about complications (84%), diet (74%), control (63%), intercurrent illnesses (61%) and inheritance (59%). The least requested subjects were CSII (20%), the artificial pancreas (22%), insulin preparations (22%), pancreatic transplant (26%) and oral agents (31%).

High glucose concentrations inhibit DNA synthesis and replication without causing death or impairing injury repair in cultured human endothelial cells

Endothelial cells are directly exposed to the metabolic derangements of diabetes mellitus and may be damaged early, if not primitively, in the pathogenesis of diabetic microangiopathy. Cultured human umbilical vein endothelial cells were subjected to equimolar concentrations of glucose or mannitol for the evaluation of 3H-thymidine uptake, cell replication, cell death and repair of standard mechanical lesions. 3H-thymidine uptake was inhibited dose-dependently and to a similar extent by both glucose and mannitol. The former reduced cell replication whereas the latter did not (p less than 0.01 at 27.8 mmol/l, p less than 0.001 at 50.0 mmol/l). Neither caused excess cell death nor interfered with lesion repair. These results suggest that supra-physiological amounts of glucose inhibit DNA synthesis with osmotic mechanisms, delay cell replication through at least partially non osmotic effects, do not cause excess cell death and do not impair local injury repair. The above effects may play a role in the pathogenesis of long-term complications of diabetes.

Intracellular Ca2+ concentration and the antidiuretic hormone-induced increase in water permeability: effects of ionophore A23187 and quinidine

The hydroosmotic responses induced by oxytocin and 8-bromo-cyclic AMP, in frog and toad urinary bladders, were recorded minute by minute. 3HHO and 45Ca unidirectional fluxes as well as prostaglandin B2 liberation were also measured. It was observed that: (1) Addition of the calcium ionophore A23187 or quinidine to the serosal bath inhibited the response to oxytocin, but not to 8-bromo-cyclic AMP, while increasing prostaglandin E1 liberation into the serosal but not into the mucosal bath. (2) Addition of A23187 to the mucosal bath induced a transient and temperature-dependent inhibition of the response elicited by 8-bromo-cyclic AMP. The time-course of this reduction in water permeability and its sensitivity to medium temperature were similar to those observed after the withdrawal of agonist, but clearly different of those observed after intracellular acidification. (3) The hydroosmotic response was also transitorily inhibited when the Ca2+ concentration was step-changed in the mucosal bath. (4) When added to the mucosal or to the serosal baths, the ionophore increased either the apical or the laterobasal Ca2+ permeabilities. It is concluded that manipulation of intracellular Ca2+ interferes with the hydroosmotic response at two different levels. (1) A first target point located 'pre-cyclic-AMP production'. This effect would be mediated by prostaglandin liberation. (2) A second target point located after cyclic AMP production and before the 'temperature-dependent rate-limiting step'. This effect is probably related to the mechanism controlling the insertion and removal of water channels.

Initial treatment of thyrotoxic Graves' disease with methimazole: a randomized trial comparing different dosages

We evaluated the efficacy of different doses of methimazole (MMI) as the initial therapy for Graves' disease. Fourteen patients were treated with 15 mg/die of the drug (group A) and 14 with 30 mg/die (group B). Blood samples for T3, T4, FT3 and FT4 were obtained before beginning therapy, every 48 h during the first 12 days and on the 45th day of treatment. All these hormonal parameters fell significantly from the 2nd day of therapy in both groups. All the patients, except for one in group B, had normal or subnormal levels of thyroidal hormones on the 45th day of treatment. The comparison between the two groups of regression coefficients over the first 12 days showed no significant differences. The absolute decrease of each examined parameter on day 12 was positively correlated with the relevant pretreatment value. These results demonstrate that doses of MMI (15 mg/die) much lower than those commonly recommended are able to rapidly control thyroidal overproduction as effectively as 30 mg/die.

Levels of serum angiotensin-converting enzyme before and after forearm venous stasis in diabetic microangiopathy

The levels of angiotensin-converting enzyme and Factor VIII-related antigen, 2 endothelial synthesized glycoproteins, were measured in basal conditions and after forearm venous stasis in 12 healthy controls and 12 patients with diabetic microangiopathy. Angiotensin-converting enzyme levels were similar in the controls and in the patients both basally (185 +/- 17 nm/ml/min (SEM) and 192 +/- 15, respectively) and after stasis (238 +/- 17 and 220 +/- 15), whereas Factor VIII-related antigen was lower in the former basally (101 +/- 13% vs 184 +/- 16%, p less than 0.001) and after stasis (140 +/- 21% and 243 +/- 21%, p less than 0.01). It is concluded that Factor VIII-related antigen is a more sensitive indicator of endothelial cell damage in diabetic microangiopathy than angiotensin-converting enzyme.

A study of the possible interactions between human platelets and the antibiotic MDL-507 (teicoplanin)

Teicoplanin, a new glycopeptide antibiotic, was tested for its ability to induce agglutination and/or aggregation of fresh and fixed human platelets in vitro. Two chemically related substances, ristocetin and vancomycin, were used as controls in the same experimental conditions, as they are known to be active and, respectively, nonactive on platelets. The studies with fresh platelet rich plasma (PRP) taken from 10 healthy volunteers and the studies with fixed washed platelets (FWP) were carried out at the final concentrations of teicoplanin and vancomycin of 10, 100, 2000 and 5000 mg/l. Unlike ristocetin, teicoplanin did not exhibit any agglutinating or aggregating activity, even when tested for concentrations 50 times as high as those measured in vivo during the peak time. At high concentrations it induced protein precipitation, albeit to a lesser extent than vancomycin.

Follow-up study of pseudoephedrine users

A follow-up study of over 100,000 persons below age 65 years who filled a total of 243,286 prescriptions for pseudoephedrine indicated that there were no hospitalizations among users that could be attributed to the drug. There were no admissions within 15 days of filling a prescription for pseudoephedrine for cerebral hemorrhage, thrombotic stroke, or hypertensive crisis. There were a small number of hospitalizations for myocardial infarction, seizures and neuropsychiatric disorders, but the rate of such admissions among the pseudoephedrine users was close to the expected rate in the population at large.

[Lactic acidosis]

Lactic acidosis is a metabolic disturbance characterized by an increase of the production/clearance ratio of lactate. Lactate is a catabolite of glycolysis when this takes place under anaerobic conditions. Clinically LA is characterized by: signs of acidosis, venous blood lactate greater than 5 mMol/l, arterial pH less than 7.25. LA is classified in type A, due to shock, and type B which, in turn, can be divided according to its pathogenesis in B1 correlated to particular pathologies, B2 due to exogenous substances and B3 caused by congenital metabolic diseases. LA is of particular interest in type II diabetes mellitus treated by phenformin. Current therapeutic directions, although suboptimal, are: to eliminate the causes of lactate hyperproduction by maintaining a sufficient efficiency of the cardio-vascular apparatus, to correct acidosis by using alkalinizing solutions, to remove pharmacologically or by dialysis the excess of lactate.