Preliminary Observation on the Clinical Tolerance of Interferon-Beta in Cancer Patients

Nine patients with metastatic solid tumors were given IFN-β by i.v. bolus injections. Six escalating doses (from 1 to 9 × 104 IU) followed by 6 additional injections at the dose of 9 × 106 IU were administered every other day (schedule A) in 3 of the 9 patients. IFN dose was also increased to a maximum of 46 × 106 IU, and 12 individual injections of 1, 2, 3.3, 5, 7, 9, 12, 16, 21, 27, 34 and 46 × 106 IU of IFN were given over a minimum of a 24-day period (schedule B) in 6 of the 9 patients. The single maximal tolerated dose ranged from 9 to 46 × 106 IU. The toxicity of IFN-β given as scheduled in this study was significant but acceptable.

Open comparison study of oxidative stress markers between patients with chronic renal failure in conservative therapy and patients in haemodialysis

AIMS

Oxidative stress is defined as tissue damage caused by an imbalance between the excessive production of the oxidant components and an insufficient defence mechanism. It has been observed, as in patients with chronic kidney failure, that there exists a pro-oxidant state characterised by a higher level of reactive oxygen species (ROS), and that oxidative stress in dialysis patients can be aggravated by the activation of neutrophils associated with the production of free radicals. In patients undergoing dialysis even the molecules other than those of cytokines can accumulate and provoke an inflammatory response. This study proposes an analysis based on the total antioxidant capacity (TAC), thiol concentration (TC) and pro-oxidant capacity (POC) in the serum of various groups of patients: one group of dialysis subjects who had been undergoing substitutive treatment for more than ten years at the time of the study; one group of subjects with chronic renal insufficiency in its pre-terminal stage and subjected to conservative therapy; and the control group consisting of healthy volunteers.

MATERIALS AND METHODS

Three types of tests were employed to assess the level of oxidative stress: oxy-adsorbent test, d-ROMS test, and SHp- test. Thirty-three subjects were selected: 11 undergoing haemodialysis for over then years; 14 patients with chronic kidney failure in its pre-terminal stage, and 8 normal subjects. In patients undergoing renal substitutive treatment, the serum levels (mean±sd) of TAC were 272.98±20.54; TC, 249.19±92.48, and POC, 95.06±15.70. In patients with chronic renal insufficiency in its pre-terminal stage and undergoing conservative treatment, the value of TAC was 226.5±27.89; TC, 336.42±102.08; and POC, 80.78±15.69. The levels of TAC in the serum of the controls were 335.62±46.35; TC, 434.09±22.23; and POC, 56.31±7.41.

CONCLUSION

The analysed data suggest that in dialysis the patients with chronic kidney failure, whether undergoing conservative therapy during its pre-terminal stage or in substitution treatment during its terminal stage, there is a reduction in the antioxidant defence (in terms of TAC and thiolic barrier) and an increase in POC compared to the healthy subjects in the control group. Uraemia and haemodialysis increase the inflammatory response: an initial signal provokes the inflammatory state with the production of cytokines and free radicals or reactive oxygen, so that the lack of an antioxidant defence mechanism can bring about a vicious circle with the continual production of other free radicals.

Assessment of the oxidative stress markers in patients with chronic renal insufficiency undergoing dialysis treatment

AIMS

Uraemia is a disease characterised by a significant oxidative stress, and it is a wide agreement that oxidative stress which accompanies uraemia, increases the inflammatory state and promotes the alterations of tiny molecules such as amino acids, proteins, lipids, and carbohydrates. There are numerous records of how ROS are connected to the pathology of end stage renal disease (ESRD). The aim of this study is to assess the Total Antioxidant Capacity (TAC), the Thiolic Capacity (TC) and the Pro-Oxidant Capacity (POC) in the serum of patients undergoing dialysis treatment.

MATERIALS AND METHODS

Forthy-six patients have been recruited (32 men, 14 women; mean age 68.5±15.8) who received hemodialytic treatment triweekly. Three methods have been used: oxy adsorbent test (mmol/l) to determine TAC values; d-ROM test (mg/100 mg/H₂O₂) to determine POC; SHp-test (mmol/l) to determine TC.

RESULTS

In patients who underwent hemodialysis, TAC levels were: pre-dialysis, 265.9±30.5; post-dialysis, 300.0±40.6; TC levels: pre-dialysis, 267.4±59.1; post-dialysis, 303.2±116.7; POC levels: predialysis, 86.2±16.9; post-dialysis, 98.6±17.0; NS: TAC, 335.6±46.3; TC, 434.0±22.2; POC, 56.3±7.4. TAC in both pre- and post-dialysis is reduced compared to the NS (p < 0.05); moreover TAC increases after dialysis (p < 0.05). Pre- and post-dialysis TC is reduced compared to NS (p < 0.05); available TC increases after dialysis, although not statistically significant. Pre- and post-dialysis POC in patients undergoing dialysis is increased compared to the NS (p < 0.05); moreover, POC tends to increase after dialysis ( p < 0.05). The data obtained from our study also show that the TAC is reduced in the patients subjected to hemodialysis compared to the NS, both before and after dialysis treatment; TAC increased after dialysis, even though it did not reach the level of the control group.

CONCLUSION

Our study has demonstrated that exists a profound imbalance between antioxidants and the production of ROS in ESRD patients, which determines oxidative stress and eventually leads to atherosclerosis and cardiovascular complications. This, in turn, represents the major cause of morbidity and mortality in these patients.

Evaluation of oxidative stress in rheumatoid and psoriatic arthritis and psoriasis

INTRODUCTION

The aim of the present study is to discuss the importance of the processes of oxidative stress in the pathogenesis of certain autoimmune diseases, to search for an appropriate assessment marker, and to debate current approaches which have been proposed for the treatment of Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA), and Psoriasis (Ps).

MATERIALS AND METHODS

The total antioxidant capacity (TAC), the thiolic capacity (TC), and the serum hydroperoxide concentration (SHC) were measured in 37 subjects: 13 with RA, 8 with PsA, 8 with Ps, and 8 healthy controls.

RESULTS

SHC levels were significantly higher in patients with RA (p = 0.01), as well as in those with PsA (p = 0.005) and Ps (p = 0.002) in comparison with the control group. However, a significant reduction in the TAC values in the serum of all three groups (RA, p = 0.03; PsA, p = 0.005; Ps, p = 0.001) were observed in comparison with the healthy controls. The thiolic concentration were found to have significantly diminished in patients with RA (p =0.0005) and Ps (p = 0.0005) in comparison with the control group. Our findings have brought out the fact that the therapeutic treatment of RA using biological drugs is more than satisfactory in accord with the considerable increase in the TAC values, although not significantly, compared to those patients treated with DMARDs.

CONCLUSIONS

The determination of the parameters of oxidative stress utilising these methods may be useful as a quick test, and as routine in monitoring the state of oxidative stress in patients suffering from RA, PsA, and Ps, so that a more effective treatment for ROS can be undertaken accordingly. The administration of biological drugs seems to have a role in increasing the mechanism of the barrier which the body possesses against oxidative stress.

Modern therapeutic approach to ANCA-associated vasculitis

The systemic vasculitis are characterised by an inflammatory process of the blood vessel walls. These may affect any of the vessels and organs, resulting in a diverse range of signs and symptoms. These polymorphic clinical manifestations, combined with the non-specific aetiology of the histological lesions, render the diagnosis for any single form of vasculitis more complicated. The problem lies in the various forms of vasculitis with analogous clinical presentations, requiring very different prognosis and treatment. This review has been realised in order to examine the modern approach to achieve and to maintain the clinical remission and to treat the relapse.

Study of bone metabolism in patients with chronic HIV infection

AIMS

Various studies have confirmed the high incidence of skeletal homeostasis modifications in subjects who are carriers of chronic HIV infections, and specific pharmacological treatments, which modify the metabolism and condition both the weight loss and the reshaping of the bones. The presence of a reduction in body mass index seems to contribute to the progressive deterioration of the skeletal framework. The aim of this study was to see whether the presence of HIV-seropositivity could constitute a risk factor for the development of osteoporosis/osteopenia, even in the light of the fact that our group was composed of patients with a concentrated age span well under the limit for both post-menopausal and senile osteoporosis, and with a median age superimposable for both sexes.

MATERIALS AND METHODS

Our study involved 26 HIV+ patients with an average duration of infection equal to 6.7 +/- 4.8 years, and a range of seropositive duration between 6 months to 16 years. The prominent ultrasonometrical parameters are as follows: Broadband Ultrasound Attenuation, Speed of Sound, Stiffness Index or Quantitative Ultra-sound Index, Bone Mineral Density, and T-score. The biochemical study was carried out by assessing a marker of neoformation such as seric osteocalcine, and uninary pyridinoline and deoxipyridonoline as resorption markers.

RESULTS

The results confirmed the presence of osteoporosis/osteopenia in 46% of the samples (11%, and 35%, respectively), with a progressive reduction in bone mineral density in relation to the duration of HIV infection. Assessment of the marker for bone metabolism showed a significant increase in osteocalcine in the female population compared to the males, without any significant variations in the normal values.

CONCLUSIONS

Extreme variability in the morphological appearance at bone level during the course of HIV infection would lead us to believe that in the genesis of various forms, depending on the mechanisms and the time involved only in the parts defined, other attributable factors are responsible, not only for the progression of the core pathology and the possible interference of hormonal factors (behavioural and/or nutritional) directly correlated with the state of infection, but also for the dismetabolic effects of the antiretroviral drugs.

Functional assessment of patients with systemic sclerosis by the use of 'Six-minutes-walking-test'

AIMS

Systemic Sclerosis (SS) is a chronic inflammatory disease of the connective tissues, characterised by alterations in the functions and structures of the small blood vessels (capillaries and arterioles) and by modifications associated with the disposition of collagen in the tissues. One of the most frequent complication of the SS is the pulmonary arterial hypertension (PAH). Aim of this study was to assess the various pathophysiological relationships betweens SS and PAH in order to establish whether the presence of this systemic disease can represent a risk factor.

MATERIALS AND METHODS

Ten patients affected by SS (9 women and 1 man, with a mean age of 55.7 +/- 11.4 years) were enrolled in our study, as inpatients at Dept. of Internal Medicine and Rheumatology Unit of Perugia University School of Medicine in the "Santa Maria" General Hospital in Terni, Italy. A control group of 10 clinically healthy subjects (CHS, 9 women and 1 man, ranging in age from 35 to 55 years) was also recruited in order to obtain normal clinical data of reference In subjects recruited, we have conducted a functional evaluation, based on physical tests (6-minute-walking-test, 6MWT), equipment and laboratory, on subjects suffering from SS with suspected PAH, in order to calculate the degree of cardio-pulmonary compromission brought on by this disease, taking into consideration important variables such as age and gender.

RESULTS

The 6 MWT showed that the mean value at rest of the O2 saturation (%) was 97.1 +/- 1.20, heart rate (hr/min) 76 +/- 8.8, and respiratory rate (rr/min) 20.4 +/- 2.8. HS had 98.6 +/- 0.52, 75.7 +/- 6.86, and 16.8 +/- 1.61, respectively. After the the test, the results showed that the patients had O2 saturation 93.8 +/- 3.42, hr 113 +/- 20.27, and rr 31 +/- 2.86. HS had 97.6 +/- 0.69, 90.7 +/- 5.67, and 20.1 +/- 1.59, respectively.

CONCLUSIONS

Our study has confirmed the high involvement of PAH and other cardio-respiratory disturbances in patients with SS. In fact, we have verified PAP to be above the normal range in 3 out of 10 patients, while the other 3 patients presented borderline values. Because it is a simple method to conduct at low cost, in addition to being non-invasive, reproducible and well accepted, we must affirm that the 6MWT should be more utilized and exploited, especially during the fi rst phases of diagnosis. This in turn can help us to assess the patients and to determine a course of treatment which is more complex and onerous, as in therapeutic monitoring for verifying efficacy.

Oxidant/antioxidant status in patients with Raynaud's disease

OBJECTIVE

Despite several studies concerning the oxidative stress in Raynaud's phenomenon secondary to systemic sclerosis (secondary Raynaud, SR), little is known regarding the relationship between Raynaud's disease (primary Raynaud, PR) and oxidative stress at present. The aim of the present research was to study the parameters of oxidative stress in PR patients and to compare them to those of SR patients.

MATERIALS AND METHODS

Serum hydroperoxide (Hydrop) level, serum total antioxidant capacity (TAC) and serum total thiol (-SHp) barrier were measured in 19 patients with SR, 15 patients with PR and 14 healthy control subjects (CS). The statistical contrasts were performed via one-way ANOVA.

RESULTS

The serum Hydrop concentrations were significantly higher in SR (p = 0.0043) and PR (p = 0.0038) groups in comparison with CS. A significant decrease in serum TAC level in SR (p = 0.00005) and PR (p = 0.00128) patients in respect to the CS was revealed. No significant change in the -SHp barrier in SR and PR patients in respect to CS has been demonstrated. However, there were no significant differences in serum Hydrop and TAC levels between the groups of patients.

CONCLUSIONS

The study of serum oxidative stress parameters, in terms of Hydro and TAC levels may be used as a routine and rapid test to verify the oxidative stress status in SR and PR patients and to undertake a strategy of treatments by a supplementation of antioxidant molecules.

Intima-media thickness of common carotid as cardiovascular risk factor in rheumatoid arthritis and metabolic disorders

OBJECTIVES

To study the intima-media thickness (IMT) of the common carotid artery and the lipid profile in patients with rheumatoid arthritis (RA), type 1 diabetes mellitus T1DM), and obesity (Ob), against a control group of normal subjects (NS), in order to determine the relationship between cardiovascular risks and pro-atherosclerosis conditions in various inflammatory and metabolic disorders.

MATERIALS AND METHODS

147 subjects, with written consent, were divided into the following categories: 38 patients with RA (6m/32f; average age 51.7+/-4.4 years, range 42-71); 42 patients with T1DM (20m/22f; average age 52.1+/-6.2 years, range 45-65); 37 patients with obesity (20m/17f; average age 53.8+/-5.3 years, range 46-70); 30 normal subjects, age and sex matched, that make up the control group (14m/16f; average age 52.5+/-4.6, range 40-62). The IMT and the plaques were measured (values expressed in mm) according to the guidelines of the GIUV (Gruppo Italiano Ultrasonologia Vascolare, Italian Group of Vascular Ultrasonology).

RESULTS

Our research has revealed the presence of a thickening of the intima-media complex in patients suffering from RA, highlighting, at the same time, that the atherosclerotic risk factor in these patients manifested regardless of the activity of the disease or the serum level.

CONCLUSIONS

The presence of an inflammatory systemic chronic disease such as rheumatoid arthritis, seems to constitute a significant and independent atherosclerosis risk in itself, which apparently does not correlate with the lipid profile.

The therapy of Sjogren's syndrome: a review

The Sjogren's syndrome (SS) is an chronic inflammatory autoimmune disease of the exocrine glands as well as of internal apparatus. The therapy of exocrinopathy is represented by parasympathomimetic drugs such as pilocarpine and cevimeline. The therapy of systemic manifestations, actually is represented by the inhibitors of TNF alfa, as well as leflunomide, methotrexate and cyclosporine-A, but the results are quite insufficient and disappointed. In order to the involvement of B-cell function in the pathogenesis of SS, one of the most important option in the future should be specific inhibitors of that cells.

Definition of adult-onset rheumatoid arthritis from elderly-onset rheumatoid arthritis by studying T-lymphocyte subpopulations, their soluble receptors and soluble receptor of interleukin-2

AIMS

The study of the distribution of T-lymphocyte sub-populations has revealed some immune characteristics of rheumatoid arthritis (RA) as well as polymyalgia rheumatica (PMR). There is much evidence that the subsets of T-lymphocyte subpopulations are well correlated with the age of the patient and the precise diagnosis of RA and PMR. The aims of the study were to evaluate the absolute number and percentage of T-lymphocyte subpopulation subsets in peripheral blood and their soluble receptors and serum soluble receptors of interleukin-2.

MATERIAL AND METHODS

Thirty-six patients with RA were divided into 21 adult-onset RA (AoRA) and 15 elderly-onsets RA (EoRA) patients. They were compared with 48 PMR patients, 21 normal subjects under 45 years and 17 healthy elderly subjects over 65 years. T-lymphocyte subsets were studied by FACSCAN with double stained specific monoclonal antibodies. The EL ISA method was used to determine soluble receptors of CD4+ and CD8+ and IL-2.

RESULTS

The AoRA patients had a significant alteration of T-lymphocyte sub-populations as well as their specific soluble receptors compared to EoRA patients. On the other hand, distribution of T-lymphocyte sub-populations in EoRA patients was quite similar to that in PMR patients.

CONCLUSIONS

This method is probably not applicable for daily routine clinical practice but provides some interesting data for differential diagnosis between RA and PMR.

[Osteoporosis and anorexia nervosa: ultrasonometric and biochemical evaluation--preliminary data]

AIMS

To evaluate the relationship between Anorexia Nervosa (AN) and Osteoporosis (OP) by bone heel ultrasonometric measurement and biochemical bone metabolic data.

MATERIALS AND METHODS

AN, 15 patients (2 males / 13 females; mean age 27.5 yr, range 16-44; mean BMI 15.78, range 13-19.3); normal subjects (NS), 10 (2 males / 8 females; mean age 27.5 yr, range 17-40; mean BMI 26.2, range 25-28). An Hologic Sahara ultrasound heel instrument has been utilized in order to obtain the following parameters: broadband ultrasound attenuation (BUA), speed of sound (SOS), Stiffness' index, bone mineral density (BMD) and T-score. As markers of bone formation osteocalcin (OC, ng/ml) and of resorption pyridinolines (Pyr, pmol/umol creatinine e deoxy-Pyr) have been studied by standardized analytical methods.

RESULTS

(expressed as x+/-SD).

PATIENTS

BUA, 65+/-11.22 (p<0.01); SOS, 1544.14+/-73.5 (ns); Stiffness, 89.8+/-19.4 (p<0.01): BMD, 0.55+/-0.53 (p<0.01); T-score, -1.4+/-1.12 (p<0.01); OC, 4.05+/-2.3 (p<0.01); Pyr, 53+/-21 (ns); d-Pyr, 7.17+/-4.5 (ns). NS: BUA, 88.57+/-8.63; SOS, 1567.72+/-11.88; Stiffness, 108.07+/-4.97; BMD, 0.611+/-0.027; T-score, 0.22+/-0.3; OC, 8.5+/-4.5; Pyr, 60+/-25; d-Pyr, 8.5+/-3.5.

CONCLUSIONS

Our data seem to confirm that AN represents an important risk factor for OP. The ultrasonometric data in AN patients document some statistically significant differences from SN in term of BMD and T-score reduction. The metabolic data show that OC is reduced in AN patients, on the contrary, no differences appear in term of resorption bone markers.

Insulin glargine in patients with severe hepato-gastroenterology diseases and hyperglycemia receiving parenteral nutrition

OBJECTIVE

The aim of this nonrandomized observational study is to verify and confirm whether it is possible to use insulin glargine (Lantus) subcutaneously in patients receiving parenteral nutrition (PN) and whether the analogue is capable of obtaining and maintaining good glycemic control without inducing hypoglycemia.

MATERIALS AND METHODS

The sample is made up of 25 patients with severe hepato-gastroenterology diseases receiving parenteral nutrition, diagnosed diabetics and non-diabetics, who had previously been prescribed traditional insulin therapy. All were to be given subcutaneous insulin glargine at a dosage equal to the average of insulin/day administered in the preceding days spent receiving PN.

RESULTS

Twenty-five consecutive patients, not stratified in any way, were judged eligible in the last six months of 2004 and first eight months of 2005. Four out of these 25 cannot be evaluated, either because (2/4) they did not begin or complete the treatment with Lantus or because the proper number of glycemic tests were not done (2/4); 21/25 patients, 84% of the sample with a mean age of 65.9 years (range 46-93 yr), finished the study and can be evaluated. The mean glycemic values after treatment with glargine were already better on the second day, and on the seventh day the difference was statistically significant. No hypoglycemias occurred which required medical intervention.

CONCLUSIONS

This study confirms the possibility of using insulin glargine in patients receiving parenteral nutrition with hyperglycemia diagnosed diabetics or not diabetics.

Osteoporosis prevention: a reasoned examination of food habits and physical activities in a schoolchildren population in central Italy

OBJECTIVE

The dietary intake of calcium is fundamental for prevention of osteoporosis, especially in the first three decade of age to gain a valid peak bone mass; moreover physical activity is important for the same reason. The objective of our research is to examine the food habits and the way to practice sport in a homogenous population of schoolchildren.

MATERIALS AND METHODS

Data were collected by an original questionnaire in 500 schoolchildren (238 males, 262 females, 9-12 yrs) living in the centre of Italy.

RESULTS

Data show that the calcium intake decreases while the age increases. According to the recommended daily calcium dose, the percentages of insufficient calcium intake were 21% in the 6 years old group, 35% in the 7 to 10 years old group and 52.5% in the 11 to 14 years old group. Milk and dairy products cover 57% of the calcium needs (17% and 40% respectively), water covers 24% and the other foodstuffs 19%; moreover most children (43.5%) practice non competitive sports with a preference (58.3%) for no-weightbearing sports (mainly cycling) over weightbearing sports (mainly football). CONCLUSIONS. This survey suggests that a high percentage of young people do not take the recommended daily dose of calcium (especially interesting that becoming older with consequent lower parental control over the diet, the higher the incidence of poor calcium intake increases), then it would be recommendable to establish a national health program promoting appropriate physical exercise plus a correct calcium intake as early as the primary school.

Short term efficacy of intra-articular injection of hyaluronic acid in osteoarthritis of the first carpometacarpal joint in a preliminary open pilot study

OBJECTIVE

The use of hyaluronic acid (HA) in osteoarthritis (OA) is based on the findings that viscoelasticity of the synovial fluid is entirely due to its HA content and that HA itself may influence the disease by interacting with components of the synovial fluid. The aim of this pilot study was to evaluate the efficacy of HA in OA of the first carpometacarpal joint.

MATERIALS AND METHODS

This study was performed on 43 patients with 56 total joints. Five parameters were been relieved: spontaneous pain; provoked pain; joint performances and related pain; algofunctional index of Dreiser; assumption of drugs. The administrations of HA have been performed with 0.5 ml of HA at each injection.

RESULTS

The behaviour of pain shows a significant (p < 0.0005 for all the comparisons) reduction from base time to the end of the study and the Dreiser Index decreased as well. At base time 81.4% of the patients assumed NSAIDs and only 13.8% analgesics. During the following weeks a smaller requirement of NSAIDs (from 81% to 23%) and a greater number of patients without analgesic therapy were observed.

CONCLUSIONS

Intra-articular HA seems to be effective in OA of CMC joint. This short term study suggests to observe and to treat these patients during a longer period of time in order to evaluate not only the efficacy but also the clinical safety.

Proposal of a questionnaire to evaluate the foot in the rheumatic diseases

OBJECTIVE

To compile a simple questionnaire, named 'Foot Health Questionnaire-1' (FHQ1), which would evaluate the state of the foot in rheumatic diseases, such as osteoarthritis (OA) and rheumatoid arthritis (RA).

MATERIALS AND METHODS

Sixty-three consecutive subjects entered the study: 25 with RA; 14 with OA; 10 with CTD and 14 healthy control subjects.

RESULTS

It was possible to establish that the highest mean value of FHQ1 refers to RA patients (median FHQ1 value, 41) and OA patients (median FHQ1 value, 37) whereas for CTD patients the mean value was 14 and for healthy subjects was = 0, as expected. It results that 72% of RA patients and 65% of OA patients enter classes III and IV of FHQ1, whereas 70% of CTD patients were in class I.

CONCLUSIONS

An evaluation questionnaire regarding the algo-functioning of the foot could be a useful tool in routine rheumatologic clinical practice.

Use of insulin glargine in patients with hyperglycaemia receiving artificial nutrition

The purpose of this study was to verify whether it is possible to use insulin glargine (Lantus) subcutaneously in patients receiving artificial nutrition (AN) and if the analogue is capable of obtaining and maintaining good glycaemic control without inducing hypoglycaemia. The sample considers 25 patients receiving AN, diagnosed diabetics and non-diabetics, who had previously been prescribed traditional insulin therapy. All were to be given subcutaneous insulin glargine at a dosage equal to the average of insulin/day administered in the preceding days spent receiving AN. Twenty-five consecutive patients, not stratified in any way, were judged eligible in the last six months of 2004 and first two months of 2005. Four out of these 25 could not be evaluated, either because they did not begin or complete the treatment with Lantus (3/4) or because the proper number of glycaemic tests were not carried out (1/4); 21/25 patients, 84% of the sample with a mean age of 68.7 years (range 46-91 years), finished the study and could be evaluated. The mean glycaemic values after treatment with glargine were already better on the second day, and on the seventh day the difference was statistically significant. No hypoglycaemia requiring medical intervention occurred. This study confirms the possibility of using insulin glargine in patients receiving AN with hyperglycaemia regardless of the type of nutrition and whether or not the patient is diabetic.

[Study of lymphocyte subpopulations in chronic autoimmune inflammatory rheumatic diseases. II. Polymyalgia rheumatica: behaviour of lymphocyte subpopulations during treatment with two different corticosteroids]

AIM

The aim of this paper was to study the distribution of CD8+ subsets, of soluble receptors of CD8 and IL-2 during a steroid treatment with prednisone and deflazacort.

METHODS

Forty-eight patients (9 males and 39 females, mean age 69.4(6.5 years) with active polymyalgia rheumatica (ESR 74 (18 mm, 1(st) h) were studied. In order to determine the distribution of lymphocyte subpopulations a panel of monoclonal antibodies was utilised. Flow cytometry with a FACSCAN machine and ELISA method were utilized.

RESULTS

At base-time in comparison with normal subjects: reduction (P<0.05) of CD4(-)/CD8(+) (356+/-112/mL vs 564(132/mL), due to reduction (P<0.001) of CD8(+)bright (224(86/mL vs 426+/-124/mL) and CD8(+)bright/CD57(-) (123+/-44/mL vs 256(58/mL); increasing (P<0.001) of sCD8 (514+/-123 U/mL vs 312+/-102 U/mL) and (P<0.005) sIL-2r (984(346 U/mL vs 244+/-58 U/mL). Group-PDN: significant (P<0.001) reduction of CD4(-)/CD8(+) (466+/-102), CD89(+))bright (302(74), CD8+bright/CD57- (186+/-51), sCD8 (418+/-96) and of sIL-2r (450+/-163) at 1(st) week, and toward the normal range at 1(st) month. Group-DFZ: normal values at 6th month: CD4(-)/CD8(+) (497+/-133), CD8(+)bright (401+/-98), CD8(+)bright/CD57(-) (240+/-64), sCD8 (317+/-82), while sIL-2r è (P<0.0005) higher vs group-PDN. Group-PDN: VES <50 at 1st week, normal value (14+/-7) at 3(rd) month; PCR, 2.2+/-1.2 at 3(rd) month and 1(0.8 at 6th month. Group-DFZ: VES >20 (24+/-5) at 6th month e PCR increased.

CONCLUSIONS

PDN shows a faster action vs DFZ. DFZ does not seem to be able in reducing sIL-2r probably showing a persistent inflammation and immune activation status.

[Evaluation of the peak bone mass by quantitative heel ultrasound in young women of the centre of Italy]

OBJECTIVE

To measure the reference young adult mean values in healthy women of the centre of Italy by Quantitative heel UltraSound (QUS).

METHODS

The study group was composed by 70 caucasian women: mean age was 25.4 years (Standard Deviation 4.7), mean weight was 58 Kg (SD 8.2), mean height was 166 cm (SD 5.8), mean BMI was 20.9 kg/m 2 (SD 2.5). Every subject was evaluated firstly with an original questionnaire to discover risk factors (like for example steroids consumption, recent fractures of the lower limb), then was measured by quantitative heel ultrasonometry Hologic Sahara.

RESULTS

Mean extimated Bone Mineral Density (BMD) 0.588 g/cm 2 (SD 0.124) mean Quantitative Ultrasound Index (QUI) 105.0 (SD 19.6), mean Speed of Sound (SOS) 1564.2 m/s (SD 31.4), mean Broadband Ultrasound Attenuation (BUA) 84.8 dB/MHz (SD 17.4). No significant correlation was found between QUS parameters and anthropometric data. A correlation was found between every QUS parameters. No significant differences were found about QUI and extimated BMD, between our results and Hologic normative data for European women.

CONCLUSIONS

It is very important to develop specific reference values for any measurement device and site of skeleton especially in the age of reaching the peak bone mass because the T score is then measured referring to these data. Usually the normative data are supplied by manufacturer and are based on large multicentric study. In our opinion it could be helpful to verify if these data are compatible with the population examined in every region.

[Study of lymphocyte subpopulations in chronic autoimmune inflammatory rheumatic diseases. I) Polymyalgia rheumatica]

AIM

The polymyalgia rheumatica (PMR) is a chronic autoimmune inflammatory rheumatic disorder, characterised by pain and stiffness on the shoulder and pelvic girdles, increasing of erythrocyte sedimentation rate (ESR) and good clinical and laboratory recovery by steroid therapy with a good outcome of the disease. There is now a wide agreement about an alteration of the distribution of lymphocyte subpopulations, characterised by a decreasing of CD8+ subset, at the onset of PMR. The aim of this paper is to study the distribution of lymphocyte subpopulations and their soluble receptors and the distribution of CD4+ and CD8+ subsets in patients with active PMR.

METHODS

Forty-eight patients (9 males and 39 females, mean age 69.4+/-6.5 years) with active PMR (ESR 74+/-18 mm, 1st hour) were studied. In order to determine the distribution of lymphocyte subpopulations a panel of monoclonal antibodies was utilised. Flow cytometry was performed with a FACSCAN machine.

RESULTS

The absolute number of CD4-/CD8+ cells were reduced (p<0.05) in comparison to normal subjects (356+/-112/ml vs 564+/-132/ml); the reduction was due to a decrease (p<0.001) of CD8+bright cells (224+/-86/ml vs 426+/-124/ml) and of CD8+bright/CD57- subset (123+/-44/ml vs 256+/-58/ml); an increase (p<0.001) of sCD8 (514+/-123 U/ml vs 312+/-102 U/ml) and an increase (p<0.0005) of sIL-2r (984+/-346 U/ml vs 244+/-58 U/ml) were also observed in comparison to normal subjects. No alterations of CD4+/CD8, CD8+bright/CD57+, CD8+dim/ CD57+/- cells and sCD4 were observed.

CONCLUSION

Our study seems to confirm that in early and active PMR there are significant alterations of lymphocyte subpopulations and their subsets as well as of soluble receptors.

[The usefulness of the quantitative ultrasound to diagnose glucocorticoids induced osteoporosis]

BACKGROUND

The aim of this study was to evaluate the utilization of heel ultrasonometry in the diagnosis of glucocorticoid induced osteoporosis.

METHODS

The study group included 108 caucasian women, ranging in age from 30 to 81 years. They were all affected by inflammatory disorders (rheumatoid arthritis and other connective tissue diseases) and had been in chronic glucocorticoid therapy for at least 8 months, at an average daily dosage of not less than 7.5 mg of prednisolone. The control group was composed of 112 women. Every subject was evaluated by a heel ultrasonography (Hologic Sahara).

RESULTS

The ultrasonometry data average values noted were: QUI (Quantitative Ultrasound Index) 71* (86); SOS (Speed of Sound) 1324 m/sec* (1541); BUA (Broadband Ultrasound Attenuation) 61 dB/MHz (62). The asterisk shows a statistically significant difference in comparison to the value in brackets. QUI/Stiffness and SOS had reached a significant statistic value in all the age groups, with regard to average values of patients not on glucocorticoid therapy. The BUA values did not demonstrate a significant difference, even if they always appeared inferior to the average observed (except in the range 60-70 years age group).

CONCLUSIONS

The concept that osteoporosis is a disease characterized exclusively to a reduction in bone density, now leaves room for consideration that corresponds with the concepts of quantitative and quality elements. Chronic glucocorticoid therapy is one of the major causes of osteoporosis. The use of glucocorticoids increases the risk of fractures, independently from the bone ùineral BMD in the various ages, which therefore cannot be explained solely by the reduced BMD. Ultrasound may provide information on the bone structure, and so its eventual modification, after chronic glucocorticoid therapy. Our results show that bone ultrasonometry is able to detect a population in chronic glucocorticoid therapy in comparison with those not treated. BUA and SOS are reduced in all the patients. Our experience derives that in the chronic glucocorticoid therapy patients, a major prevalence is noted of SOS which may provide information on the modification of the bone structure.

Circadian rhythm of hunger sensation in obese patients: effects of a short-term, moderately hypocaloric diet with a substitutive meal

This investigation deals with the circadian rhythm (CR) of hunger sensation (HS) in obese patients before and after a four-week, moderately hypocaloric diet with a substitutive meal. The study was performed on 25 non-diabetic obese patients (5 males and 20 females, mean age: 39.7 +/- 7, mean BMI: 27.9 1.4 Kg/m2), whose obesity was not associated with impaired glucose tolerance (IGT), binge eating, nor endocrine diseases. Their daily HS profile (orexigram) was analysed chronobiometrically. The moderately hypocaloric diet with a substitutive meal reduced the daily HS by about 10% by the fourth week. This reduction was apparently due to a tonic and amplitude modulation of the HS CR and was not accompanied by its disruption. No conclusions, however, could be drawn with regard to its orectic and clinical effects beyond four weeks.

Diffuse idiopathic skeletal hyperostosis in diabetes mellitus, impaired glucose tolerance and obesity

BACKGROUND

Diffuse idiopathic skeletal hyperostosis (DISH) is a rheumatic disease characterized by a significant association with metabolic alterations, such as an impaired lipidic profile.

METHODS

One-hundred-thirty consecutive patients and 40 normal subjects were studied. The patients were affected by type 1 and type 2 diabetes mellitus, impaired glucose tolerance and obesity. The diagnosis of DISH was performed by clinical examination and X-ray study of the thoracolumbar spine. The determination of total cholesterol, triglycerides, HLD-cholesterol and LDL-cholesterol was realized by routine biochemical methods; an oral glucose tolerance test was performed in order to determine the levels of C-peptide and blood glucose.

RESULTS

We demonstrate a high incidence of the disease in a cohort of patients affected by overt and non-overt diabetes mellitus (T1DM and T2DM) as well as in obese subjects and a correlation between this disorder and hypertryglyceridemia (T1DM, obese-T2DM and obese patients), hypo-HDL-cholesterolemia (obese-T2DM, non-obese-T2DM and obese patients) and hyper-LDL-cholesterolemia (obese patients). In obese-T2DM patients, as well as in obese patients, we observed 40% of DISH, in non obese-T2DM patients the presence of DISH was 30%, while in T1DM patients and impaired glucose tolerance 26.6% and 22.2, respectively. However, a correlation between DISH and the relative hyperinsulinemia in obese patients during an oral glucose tolerance test is not documented.

CONCLUSIONS

Our study confirms the prevalence of DISH in diabetes mellitus and obesity, the association with an impaired lipidic profile and the low percentage of symptomatic patients.

Impaired cutaneous cell-mediated immunity in newly diagnosed rheumatoid arthritis

BACKGROUND

Rheumatoid arthritis is characterized by an impaired immune response and a defective cutaneous cell-mediated immunity has been reported. This study was realised in order to determine the characteristics of cutaneous cell-mediated immunity in patients affected by recent-onset and untreated rheumatoid arthritis.

METHODS

Forty-eight patients affected by newly diagnosed rheumatoid arthritis were studied by skin testing with seven common recall antigens. The skin tests were performed before the administration of disease modifying anti-rheumatic drugs (methotrexate, cyclosporine-A, hydroxychloroquine) and were repeated after four months of therapy.

RESULTS

43.75% of the RA patients (21 out of 48) were defined as anergic compared with 2% of the normal control subjects and the rate of depression of cutaneous cell-mediated immunity was not related either with the markers of disease activity or with the clinical assessment. The impaired cutaneous cell-mediated immunity shows a slight improvement after methotrexate therapy, while cyclosporine-A and hydroxychloroquine were not able to achieve the same result.

CONCLUSIONS

Rheumatoid arthritis shows a defective cutaneous cell-mediated immunity when the patients are studied in the early phase of the disease and before a second-line of therapy with disease modifying anti-rheumatic drugs. The anergy does not correlate either with the disease activity or with the short-term response to treatment. The prognostic significance of these data remains uncertain.

Onset of myasthenia gravis in a patient affected by rheumatoid arthritis never treated with disease-modifying anti-rheumatic drugs

We describe a patient affected by rheumatoid arthritis (RA) that developed myasthenia gravis (MG) after 20 years of illness. The peculiarity of this case concerns both the rare association between these diseases and the fact that the patients had never assumed disease modifying antirheumatic drugs. These treatments have been associated in some clinical reports with the onset of MG during the clinical course of RA. To our knowledge this is the first case described in medical literature up to now.

[Intra-articular administration of galactosaminoglucuronoglycan sulfate in moderate primary gonarthritis. A pilot study]

BACKGROUND

The present study has been carried out in order to assess the clinical and functional efficacy and tolerability of galactosa-minoglucuronoglycan sulphate (GGGS). The molecule has been intra-articularly administered in patients affected by moderate primary gonarthritis, according to clinical and functional parameters.

METHODS

At the beginning and at the end of each period of treatment the following parameters have been evaluated: spontaneous pain, provoked pain, pain during active movement, pain during passive movement, pain at rising (7-8:00 a.m.) pain at bed time (10:00 p.m.), execution time (expressed in seconds) of up-down from a chair (five times), execution time (expressed in seconds) to walk 15 meters. Fifty patients affected by osteoarthritis of the knee were treated weekly, during one year, for two periods of six weeks each with a total amount of 12 injections.

RESULTS

Treatment with Galactosaminglucuronoglycan sulphate (GGGS) seems to be effective in the therapy of osteoarthritis of the knee. The pain scores decreased and the functional levels significantly (p < 0.01) improved in a large proportion of patients and GGGS was very well tolerated.

CONCLUSIONS

This study suggests that intra-articular treatment is a substantially new way for GGGS administration in the therapy of osteoarthritis of the knee.

Clinical efficacy and tolerance of nabumetone in articular and non-articular rheumatic disorders: personal experience during 12 weeks of treatment

BACKGROUND

We evaluated the clinical efficacy and the tolerance of Nabumetone (N), in comparison with a pool of non-steroidal anti-inflammatory drugs (NSAIDs), in a cohort of patients affected by rheumatoid arthritis, osteoarthritis, non-articular rheumatisms and primary fibromyalgic syndrome.

METHODS

One hundred and seventy patients were observed in an open-non randomized study. The patients have been recruited alternatively and subdivided into two groups: 84 patients that received N and 86 patients that received one of the other NSAIDs. All the patients affected by rheumatoid arthritis received a disease-modifying anti-rheumatic drug (OH-chloroquine, d-penicillamine, auranofin, cyclosporine-A); while benzodiazepines are administered in the patients suffering from primary fibromyalgic syndrome. A follow-up not inferior to 12 consecutive weeks was realized and the following clinical parameters were studied: spontaneous pain, provoked pain, pain on active movement, pain on passive movement, pain at rising, pain at bed time, morning stiffness, limited joint mobility, number of tender points, number of affected joints and number of swollen joints. All the patients were monitored for hematological, biochemical, urinary and clotting tests.

RESULTS

The results revealed an excellent tolerability of nabumetone with a clinical efficacy not inferior to the NSAIDs' pool. Moreover, the number of drop-outs in the N-group were significantly inferior in comparison to the NSAIDs'-pool group.

CONCLUSIONS

We conclude that N can be considered as effective as other NSAIDs. Moreover it seems to be better tolerated that the other NSAIDs utilized in our study.

Galactosaminoglucuronoglycan sulphate in the treatment of osteoarthritis: clinical efficacy and tolerance of oral and intra-articular administrations

The clinical efficacy and the tolerance of galactosaminoglucuronoglycan sulphate (GGGS), administered both orally and intra-articularly were evaluated for the treatment of generalized and localized osteoarthritis (OA). The study included 154 patients: 52 treated orally with GGGS, observed during three periods of three consecutive months of therapy followed by eight weeks of withdrawal, 52 treated only with non-steroidal anti-inflammatory drugs (NSAIDs), and 50 patients treated two times in a year with a total of twelve (6 x 2) knee intra-articular weekly injections. The tolerance to GGGS was excellent, and the monitoring of the clinical measurements revealed a significant improvement of the articular data with a decreasing of NSAID's consumption.

Hunger sensation in patients with compensated and and uncompensated type 1 and type 2 diabetes mellitus

OBJECTIVE

Diabetic patients (DP) refer increased hunger sensation (HS) when hyperglycemic but not yet ketogenic. As HS shows a within-day (ultradian cyclicity) and intra-day (circadian cyclicity) repetitivity, its recursive pattern was investigated in patients with type 1 and type 2 diabetes mellitus (DM), in compensated and uncompensated metabolic stage.

METHOD

HS was approached in its cyclic structure by means of spectral analysis (SA), and in its circadian rhythmicity by means of Single Cosinor analysis (SCA), applied to self-rated scores of HS given every 30 min to their HS (orexigram) by DP.

RESULTS

Exaggerated periprandial, interprandial, and/or nocturnal peaks of HS were seen in the orexigram of both the type I and type II DP. Specific alterations in HS periodogram were detected, structurally denoting a relative prevalence of the ultradian components along with the deamplification and loss of the circadian harmonics.

DISCUSSION

The increase of HS (hyperorexia) in nonketotic DM may be formally attributed to a mechanism of frequency multiplication and amplitude demodulation in the multifrequency bioperiodic structure which physiologically regulates the recursive pattern to the daily HS in human beings.

Rifaximin in the treatment of chronic hepatic encephalopathy

A study was performed to assess the efficacy and tolerability of rifaximin in the treatment of encephalopathy during cirrhosis of the liver. Fifty-five patients suffering from grade 1, 2 and 3 portosystemic encephalopathy, with a mean age of 58.9 years (range 30 to 86 years) were evaluated. The patients were treated for 15 consecutive days with rifaximin, an antibiotic which is not absorbed by the intestinal wall, at a dosage of 1200 mg/day in association with sufficient lactulose to induce 2 or 3 evacuations per day. Combined use of the 2 drugs proved an efficient means of controlling the majority of signs and symptoms. After just a few days, an improvement in the signs of encephalopathy was noted in all patients. The treatment was well tolerated and the patients completed the trial without any drug-related side-effects. The results of our trial, although in the context of an open assessment, confirm the clinical efficacy of rifaximin in association with a non-absorbable disaccharide such as lactulose. The 2 compounds have a synergetic effect in reducing ammonia-producing flora. Its efficacy and good tolerability make rifaximin a valid alternative to the use of aminoglycoside antibiotics associated with disaccharides in the treatment of patients with liver disease, particularly in the case of prolonged therapy.

[Obesity among patients admitted to a medical department at the Terni Hospital]

The Authors report the results of a study intended to asses the prevalence of obesity in Terni's medical department. Body mass index (BMI) was used as a measure of obesity: it can easily be calculated from weight and height (W/H2) for any individual. A sample of 1195 patients (569 males and 626 females) was studied; obesity was found in 30% of the females and in 10% of the males.

[The presence of nucleotide sequences of the hepatitis B virus in the serum of HBsAg-negative blood donors in Sardinia]

The presence of HBV DNA was assessed in the serum samples from 878 HBsAg negative Sardinian blood donors. They were composed of 481 (55%) donors selected because of abnormal serum alanine aminotransferase (ALT) levels during routine testing of their blood donation, and of 397 donors (45%) selected on the basis of normal serum ALT activities. HBV DNA sequences were detected in 37 (7.7%) out of 481 subjects with abnormal ALT and in 2 (0.5%) out of 397 subjects with normal ALT. Anti-HBc was detected in 199 (41%) of the 481 subjects with abnormal ALT and in 81 (20%) out of 397 subjects with normal ALT. Among the 39 subjects positive for serum HBV DNA, 12 (31%) were positive for anti-HBc, while 27 (69%) were negative for all serological HBV markers. These data show in Sardinia, where HBV infection is endemic, there is a high frequency of HBsAg negative HBV DNA positive individuals in whom multiplication of HBV may occur without conventional serological HBV markers, suggesting the possible existence of HBV-like viruses which may be responsible for some of the presumed non-A non-B hepatitis.

Immunorestorative properties of thymostimulin (TS) in patients with Hodgkin's disease in clinical remission

Fifteen Hodgkin's disease patients (8 male, 7 female) aged 19-72 years, who had been in complete unmaintained remission for 1 year or more when the study was initiated, were given 50 mg thymostimulin (TS) IM daily for 60 consecutive days. When compared with 26-30 age- and sex-matched controls, as a group the patients' circulating ENR+, OKT+3, and OKT+4 cells were depressed (0.001 less than or equal to P less than or equal to 0.06), whereas their OKT+8 cell population was not. Low (greater than 1 SD or greater than 2 SD below mean in controls) or borderline (mean value of two subsequent tests greater than 1 SD below mean in controls) values of ENR+, OKT+3, and OKT+4 cells were seen in nine (group I) of the 15 patients tested, while the remaining six patients (group II) had normal T-cell proportions. Following TS treatment, the proportions of ENR+, OKT+3, and OKT+4 cells increased to normal in all group I patients. The T-cell levels, however, decreased to pretreatment values 60-70 days after completion of TS therapy. TS had no effect on the group II patients whose T-cell percentages had initially been normal. Spontaneous cell-mediated cytotoxicity (SCMC) was assessed in 11 patients, and irrespective of the baseline values, there was a significant enhancement (P less than 0.005) by day 15 of TS administration, which was maintained during treatment. SCMC, however, returned to pretreatment levels 60-70 days after TS was discontinued. The delayed skin test reactivity to DNCB was significantly depressed in all cases. Although TS restored the T-cell proportions, it failed to reverse DNCB reactivity from negative to positive in any of the patients tested. TS can thus restore defective T-cell frequencies and can enhance cytolytic functions that are potentially important in host immunosurveillance, but it apparently failed to improve the skin reactivity to neoantigen.

[Beta thalassemia: motivation for screening in Terni]

There are no definitive data on the frequency of beta-thalassaemia in the Province of Terni; a mass screening programme has not been carried out. Preliminary studies confirm that there is a strong incidence of beta-thalassaemia heterozygotes. A theory can be put forward for the presence of beta-thalassaemia trait, based on the notion of the multicentric genesis of the disorder: the malaria may have been the dominant selective factor.

Erythrocyte concentration of glycolytic phosphorylated intermediates and adenosine nucleotides in subjects with diabetes mellitus

We determined erythrocyte concentration of phosphorylated glycolytic intermediates and adenosine nucleotides in 9 non-ketotic diabetics under different conditions of glycemic control. We showed a significant increase of G6P, F6P and FDP levels in the 9 diabetics with poor glycemic control, whereas other phosphorylated glycolytic intermediates were in the normal range. After achieving fair glycemic control G6P, F6P and FDP fell to normal value. G6P, F6P and FDP were well correlated with simultaneously determined plasma glucose. Another 5 diabetics with poor glycemic control were connected to Biostator in order to determine the time relationship between blood glucose and erythrocyte levels of G6P, F6P and FDP. We demonstrated a prompt decrease to the normal values of the phosphorylated glycolytic intermediates where blood glucose fell to normal 60-90 minutes after automatic insulin delivery. Finally, we determined RBC glycolytic intermediates in 5 subjects with normal OGTT and in 5 subjects with normal fasting plasma glucose but abnormal OGTT. In this group we observed a prompt and persistent increase of G6P, F6P and FDP levels over the three hours hyperglycemia phase which has been induced by glucose load. No significant increase was found in subjects with normal OGTT. Our results demonstrate that erythrocyte glycolytic metabolism in abnormal in diabetics, depending strictly on the degree of glycemic control.

[Early diagnosis of pheochromocytoma in pregnancy]

The authors report a case of pheochromocytoma revealed by a de novo appeared hypertension in a young female patient at her 3rd trimester of pregnancy. An early diagnosis and an appropriate medical management allowed a successful maternal outcome. Since maternal and fetal prognosis of pheochromocytoma associated with pregnancy is strictly related to an antepartum diagnosis, the importance of suspecting pheochromocytoma as underlying cause of de novo appearing hypertension (or hypertension of unknown origin) during pregnancy is emphasized. Biochemical tests (plasma and/or urinary catecholamine or metabolite determination) are recommended as the most suitable approach to the screening of pheochromocytoma in pregnancy.

Modification of glycosylated haemoglobin concentration during artificial endocrine pancreas treatment of diabetics. Evidence for a short-term effect on HbA 1 (a+b+c) levels

In order to verify whether or not insulin-induced blood glucose control can acutely lower glycosylated haemoglobin levels, HbAI (a+b+c) (HbAI) was measured in 11 diabetics before, during and after 3 days of treatment with an "artificial endocrine pancreas" (Biostator). Initially 5 patients were in fair glycaemic control (group A), while the other 6 showed poor control (group B). HbAI levels decreased significantly after 3 days in both groups A (from 9.6 +/- 0.2% to 8.5 +/- 0.3%, mean +/- SEM, p less than 0.05) and B (from 13.7 +/- 0.2% to 12.6 +/- 0.3%, p less than 0.05). A further HbAI decrease was observed until day 60 following Biostator treatment, during which period glycaemic control improved, as assessed by fasting and post-lunch plasma glucose values and daily glycosuria determined every 10 days. These results suggest that increased HbAI levels may be reversed early by strict blood glucose control during a 3 day period. It is concluded that HbAI levels not only reflect long-term glycaemic control, but also recent acute variations in mean blood glucose values.

Red cell 2,3-DPG levels in diabetic vasculopathy

RBC 2,3-DPG resulted statistically increased versus normal subjects in 22 insulin-dependent diabetics affected by arterial vasculopathy and in 19 vasculopathic non-diabetic patients. RBC 2,3-DPG, on the other hand, did not differ from the normal mean in 16 insulin-dependent diabetics without vascular involvement. The increase of RBC 2,3-DPG represents principally a consequence of the vasculopathy.

Urinary excretion and plasma levels of norepinephrine and epinephrine during diabetic ketoacidosis

Sympathetic activity was determined in 13 ketoacidotic diabetics by evaluation of plasma and urinary catecholamines, before and in the course of medical management. Patients were divided into two groups. Group A (severe ketoacidosis, n = 5) and Group B (moderate ketoacidosis, = 8), depending on plasma glucose, pH and plasma bicarbonate levels. The results showed an enhanced sympathetic activity in all patients before treatment, with significant decrease during therapy. In Group A plasma catecholamines were higher than in Group B, both before and in the course of therapy. A significant correlation was found between basal plasma catecholamines and initial plasma glucose, plasma bicarbonate, hours of therapy and insulin dosage required to obtain plasma glucose levels below 150 mg/100 ml .These results, suggesting a close correlation between glycometabolic control and adrenergic activity, emphasize the role of the sympathetic nervous system as a powerful contrainsular factor in the pathogenesis and metabolic derangement of diabetic ketoacidosis.