The effect of high intensity combined training on functional capacity, muscle strength, body composition, agility and dynamic balance in patients with coronary artery disease

Funding Acknowledgements

Type of funding sources: None.

Introduction

There is still controversy regarding the exercise characteristics that are more effective for improving peak oxygen uptake (VO2 peak), cardiac and metabolic function. High- intensity interval exercise training (HIIT) has been shown to elicit comparable and/or superior performance on endurance capacity (EC), ventricular function (VF) and quality of life. By other side, there is robust evidence that combined endurance and strength training is significantly more effective than endurance training only for improving EC, muscle mass and muscle strength.

There is no enough information if the combination of HIIT with high strength training (HST) could enhance the physical conditions of these patients.

Purpose

The purpose of our study was to analyze the combination of HIIT + HST and its effect on physical performance compared to different types of combined training: HIIT and MCT with low load resistance training (RT) and HIIT or MCT only.

Methods

We evaluated 140 male patients (p) with CAD documented by angiographic studies, clinically stables with medical treatment and sinus rhythm.

All of them performed a stress testing in treadmill without handrail support using a ramp protocol until maximal effort. VO2 peak (ml/kg/min) was measured indirectly through ACSM formula. We used YMCA´s method of estimating body fat with measurement of skinfolds in four sites (BF %), 30-second chair stand test (CST), 8-foot up and go test (FUGT), six-minute walk test (T6min) and one maximum repetition for quadriceps extension (1RMq) .Training intervention: p were randomly allocated to HIIT + RT (n=30), MCT + RT (n=30), HIIT (n=30), MCT (n=30) and HIIT + HST (n=20) during 3 month period of training.

HIIT: 4 x 4 (85-95% peak heart rate) and 60-70% during active breaks. (36 min)

MCT: 70-75% peak heart rate.(36 min)

RT: 40-50% 1RM for lower body with 12-15 repetitions in 2 sets

HST: ≥ 70% 1RM for lower body with low number of repetitions.

Statistical analysis: all data were analyzed using IBM SPSS V.24. Comparisons were performed by following one-way ANOVA(parametric distribution) with post-hoc Tuckey or Kruskal-Wallis(non parametric distribution). The level of statistical significance was P< 0.05.

Results

Analyzing values pretraining (PRE) vs. postraining (POST), VO2 peak increased significantly by 27,52% for HIIT + HST P< 0,03 vs. HIIT + RT- MCT + RT and MCT. A positive effect in HIIT + HST with FUGT P< 0,001 and CST P< 0,005 between group changes and favourable observations in relation to 1RMq (PRE 60,00 ± 9,07 vs. POST 73,00 ± 9,86) and %BF(PRE 26,60 ± 3,21 vs. POST 24,80 ± 3,72) compared to MCT and HIIT P < 0,05. We didn´t find statistical significant differences with both modalities of combined training (low workloads) and HIIT for T6min.

Conclusions

High intensity combined training (HIIT + HST) had an additional effect related to others aerobic and resistance exercises attributed to neuromuscular adaptations, increased power and muscle strength.

The effects of storage of red blood cells on the development of postoperative infections after noncardiac surgery

BACKGROUND

Prolonged storage of red blood cells (RBCs) is a potential risk factor for postoperative infections. The objective of this study was to examine the effect of age of RBCs transfused on development of postoperative infection.

STUDY DESIGN AND METHODS

In this prospective, double-blind randomized trial, 199 patients undergoing elective noncardiac surgery and requiring RBC transfusion were assigned to receive nonleukoreduced RBCs stored for not more than 14 days ("fresh blood" group, n = 101) or for more than 14 days ("old blood" group, n = 98). The primary outcome was occurrence of infection within 28 days after surgery; secondary outcomes were postoperative acute kidney injury (AKI), in-hospital and 90-day mortality, admission to intensive care unit, and hospital length of stay (LOS). As older blood was not always available, an "as-treated" (AT) analysis was also performed according to actual age of the RBCs transfused.

RESULTS

The median [interquartile range] storage time of RBCs was 6 [5-10] and 15 [11-20] days in fresh blood and in old blood groups, respectively. The occurrence of postoperative infection did not differ between groups (fresh blood 22% vs. old blood 25%; relative risk [RR], 1.17; confidence interval [CI], 0.71-1.93), although wound infections occurred more frequently in old blood (15% vs. 5%; RR, 3.09; CI, 1.17- 8.18). Patients receiving older units had a higher rate of AKI (24% vs. 6%; p < 0.001) and, according to AT analysis, longer LOS (mean difference, 3.6 days; CI, 0.6-7.5).

CONCLUSION

Prolonged RBC storage time did not increase the risk of postoperative infection. However, old blood transfusion increased wound infections rate and incidence of AKI.

Panitumumab for the treatment of metastatic colorectal cancer: a review

In recent years, the treatment of metastatic colorectal cancer (mCRC) has evolved significantly with the increase of new therapeutic options, leading to an improved median survival for these patients. In particular, the identification of molecular targets in tumor cells has led to the introduction of biological drugs for the treatment of mCRC. Panitumumab is a fully human monoclonal antibody that binds the EGF receptor of tumor cells and inhibits downstream cell signaling with antitumor effect on inhibition of tumor growth. Its use has been approved by randomized clinical trials as monotherapy in chemorefractory patients or combined with chemotherapy in the treatment of RAS wild-type mCRC, where it demonstrated a significant improvement in survival and response rate. The purpose of this review is to analyze the use and efficacy profile of panitumumab, particularly focusing on recently reported data on its use, and future perspectives in patients with mCRC.

Neutrophil-to-lymphocyte ratio may be associated with the outcome in patients with prostate cancer

Purpose

Evidences have shown that neutrophil-to-lymphocyte ratio (NLR) has a prognostic value in patients with cancer. We wanted to test the prognostic significance of NLR in prostatic cancer of patients who are candidate to radical prostatectomy.

Methods

We have considered 731 patients. Complete demographic data including age, tumor stage, Gleason score, complete blood count and serum biochemical profile were collected. Pre-treatment percentage of neutrophils and NLR were considered, and correlated with patients data and recurrence free survival.

Results

389 patients were evaluated, mean age 65 years, mean follow-up 51.5 months, mean recurrence free survival 51.3 months. Total neutrophil count does not correlate with biochemical recurrence and disease free survival. Patients with a value higher of 60% of neutrophils are more likely to have a recurrence. Patients with a total lymphocyte count <1,500 have a higher rate of relapse. NLR was not correlated with baseline total PSA, with Gleason score and with pathological stage; patients with a NLR >3 has a higher incidence of recurrence. In multivariate analysis including age, total PSA and NLR, NLR is the most important factor able to predict recurrence. There are some limitations to this study; first, this is a retrospective study, and the total number of patients analyzed is relatively small.

Conclusions

Our study suggests that pre-treatment NLR may be associated with disease free survival in patients with prostate cancer, and could be introduced in clinical practice. NLR has the advantage of low economic cost and wide availability.

Electronic supplementary material

The online version of this article (doi:10.1186/s40064-015-1036-1) contains supplementary material, which is available to authorized users.

Step-index optical waveguide produced by multi-step ion implantation in LiNbO3

The refractive indexes, material attenuation and damage fractions of a multi-step ion implanted Lithium Niobate (LiNbO3) waveguide were analyzed as functions of the annealing temperatures. An almost flat damage depth profile was designed to reduce the uncertainties related to the indexes profile shape, thus providing a better test-case for the characterizations. The measurements performed on the fabricated optical waveguides confirmed the predicted step-index profiles showing that the light is confined inside the damaged layer. The low measured attenuation (less than 0.8 dB/cm @ 632.8 nm) makes the obtained waveguide attractive for device fabrication.

Factors predictive of patient satisfaction with anesthesia

BACKGROUND

In this multicenter prospective study, we identified factors associated with satisfaction with anesthesia in patients staying in hospital at least 24 h after surgery.

METHODS

The study was performed in six centers. Inpatients aged more than 18 yr, who underwent a wide range of common surgical procedures, were asked to answer a 10-item instrument to measure patient satisfaction with anesthesia (mean score range, 0-10) and some specific questions, and to rate their perceived health (score, 0-10). Anesthesia staff members were invited to self-compile a Maslach Burnout Inventory.

RESULTS

The satisfaction evaluation questionnaire was returned by 1290 patients (mean age, 61 +/- 16 yr; males, 54.4%). The mean global satisfaction score was 8.7 (95% CI: 8.7-8.8), being <9 in 632 (49%) and > or =9 in 658 (51%) patients. The Maslach Burnout Inventory was returned by 55 anesthesiologists and 68 nurses. Multivariate regression identified five variables as significant predictors of a mean global satisfaction of >/=9: 1) having been treated in a service with perioperative nurses specifically dedicated only to anesthesia; 2) having been treated where anesthesia information leaflets were provided preoperatively; 3) having received more than two anesthesiologist visits after surgery; 4) having a perceived health score >8.5; and 5) being older that 70 yr. No relationship was found between staff burnout and patient satisfaction.

CONCLUSIONS

Inpatient satisfaction can be improved by an organization in which surgical suite nurses are dedicated only to anesthesia, a written anesthesia information leaflet is given during the preoperative visit and postoperative visits are enhanced.

Successful salvage of a relapsed high risk gestational trophoblastic neoplasia patient using capecitabine

BACKGROUND

Although most patients at high risk of Gestational Trophoblastic Neoplasia (GTN) respond to standard treatments, there is a group of patients that will die because of it. The use of new single or combination drugs in this population has become a priority.

CASE REPORT

We present the case of a relapsed high risk choriocarcinoma patient who did not respond to several chemotherapy treatments nor to PET guided salvage surgery. Because of treatment toxicity, the patient was started on Capecitabine, with which she achieved total remission, still present after 15 months of starting treatment.

CONCLUSIONS

The use of Capecitabine and the multidisciplinary management of this population should be taken into account for patients at high risk of relapsing to EP/EMA because of its efficacy and little toxicity.

Hospital discharge analysis of oncology patients from thirteen acute general hospitals which belong to the City of Buenos Aires Government (CBAG)

21183

Background: Statistical report which considers the discharge of oncology patients from thirteen acute general Hospitals from the CBAG in order to determine how to allocate founds and propose epidemilogy, preventive and/or therapeutics trials. Methods: Review of the information given by the HSD of the CBAG Ministry.The variables taken into account were: type of cancer (CIE-10-OMS), sex, age and area of residency. Results: During 2005, in the 13 acute care hospitals of CBAG there were 132,431 disc; among these 6,896 were oncology patients (5%). From the total number of hospital beds used that year (1,074,495), 90,352 were oncology patients (9%). The malignant tumor diagnosis were; Gynecologic 23% (cervix 689 + in situ 134, ovarian 479, uterine 120 and other 188); digestive 15% (colorectal 529, pancreatic 149, stomach 134, esophagus 188 and others 34); hematologic 15% (lymphomas 500, leukemias 410, myelomas 77 and others 46); breast 12% (849); lung 10% (681); urologic 9% (bladder 228, prostate 187, kidney 115, testicle 43 and others 22); miscellaneus 15% (1,065). Sex: Female (F) discharges were 4,158 and male (M) 2,738; the relationshionship F/M was 1.5/1. The group mean age was 56.1± 16.6 years. Area of residence: 53% belonged to the City of Buenos Aires and 40 % to suburban areas. Conclusions: The diagnosis of the pathologies found could help determine epidemiology and therapeutic trials. Hospitalizacions due to cancers that can be ‘prevented by screening‘, such as breast, cervical and colon cancer, support the need to redefine prevention campaigns.

No significant financial relationships to disclose.

A New Miniaturised Optical System for Chemical Species Spectroscopic Detection Based on a Scanning Integrated Mach–Zehnder Microinterferometer on LiNbO3

Absorption or emission spectroscopy is a powerful tool for detecting chemical compounds, diluted in fluid media: the sensitivity of this technique depends on the optical path of the source radiation, on the spectral window used for analysis and on the spectrometer performances. In this view, we designed and produced the first prototypes of an integrated scanning Fourier Transform Microinterferometer with Mach-Zehnder geometry, by using MEOS (Micro Electro Optical Systems) technologies. The microdevice, obtained by fabricating integrated optical waveguides on LiNbO(3) (LN) crystals, is electrically driven, without moving parts, by exploiting the electrooptical properties of the material. The microdevice operates the Fourier Transform of the input radiation spectral distribution, which can be reconstructed starting from the output signal by means of Fast Fourier Transform (FFT) techniques. The microinterferometer weights few grams, the power consumption is of a few mW and, in principle, can operate in the LN transmittance range (0.36-4.5 microm). The microinterferometer performances were preliminary tested in the (0.4-1.7 microm) spectral window. In the Visible region (0.4-0.7 mum) this microsystem demonstrated a spectral resolution suitable for detecting the characteristic lines of the solar spectrum together with the absorption bands of common gases present in Earth's atmosphere. In a further experiment we tested its performances for gas trace detection by using a calibrated NO(2) optical gas cell, showing the possibility to reveal up to 10 ppb, when suitable optical paths are used. Finally, colorimetry tests for the titration of an organic dye (E131) in alcohol solution are presented.

The Pharmacokinetics and Efficacy of Ropivacaine Continuous Wound Instillation After Spine Fusion Surgery

Because local anesthetic continuous wound instillation has not been evaluated after spine fusion surgery, we designed this study to determine whether this technique could enhance analgesia and improve patient outcome after posterior lumbar arthrodesis. Thirty-eight patients undergoing spine stabilization were randomly divided into two groups. The M group received a postoperative baseline IV infusion of morphine plus ketorolac for 24 h, and the R group received IV saline. In both groups, a multihole 16-gauge catheter was placed subcutaneously; in the R group, the wound was infiltrated with a solution of ropivacaine 0.5% 200 mg/40 mL, and infusion of ropivacaine 0.2% 5 mL/h was maintained for 55 h. In the M group, saline infusion was given at the same rate. Pain scores were taken at rest and on passive mobilization by nurses blinded to patient analgesic treatment. The total plasma ropivacaine concentration was evaluated. Pain scores and rescue medication requirements (diclofenac and tramadol) were significantly less in the R group than in the M group. Postoperative blood loss was less and the length of hospital stay was shorter in the R group. The ropivacaine peak total plasma concentration occurred at 24 h during infusion and was within safe limits; no toxic local anesthetic side effects were observed. These results suggest that wound infiltration and continuous instillation of ropivacaine 0.2% is effective for pain management after spine stabilization surgery.

IMPLICATIONS

Postoperative pain after lumbar arthrodesis is related to soft tissue and muscle dissection and to manipulations and removal at the operation site. By blocking noxious stimuli from the surgical area, infiltration and wound perfusion with ropivacaine were more effective in controlling pain than systemic analgesia.

Pharmacokinetics and efficacy of ropivacaine continuous wound instillation after joint replacement surgery † †Declaration of interest. This work was supported by AstraZeneca, Basiglio, Milano, Italy. Presented in part at the Third European Congress of Orthopaedic Anaesthesia, 31 May–2 June 2001, London, UK

BACKGROUND

As continuous wound instillation with local anaesthetic has not been evaluated after hip/knee arthroplasties, our study was designed to determine whether this technique could enhance analgesia and improve patient outcome after joint replacement surgery.

METHODS

Thirty-seven patients undergoing elective hip/knee arthroplasties under spinal block were randomly assigned to two analgesia groups. Group M received continuous i.v. infusion of morphine plus ketorolac for 24 h. Then, a multi-hole 16 G catheter was placed subcutaneously and infusion of saline was maintained for 55 h. Group R received i.v. saline. Thereafter the wound was infiltrated with a solution of ropivacaine 0.5% 40 ml, then a multi-hole 16 G catheter was placed subcutaneously and an infusion of ropivacaine 0.2% 5 ml h(-1) was maintained for 55 h. Visual analogue scale scores were assessed at rest and on passive mobilization by nurses blinded to analgesic treatment. Total plasma ropivacaine concentration was measured.

RESULTS

Group R showed a significant reduction in postoperative pain at rest and on mobilization, while rescue medication requirements were greater in Group M. Total ropivacaine plasma concentration remained below toxic concentrations and no adverse effects occurred. Length of hospital stay was shorter in Group R.

CONCLUSION

Infiltration and wound instillation with ropivacaine 0.2% is more effective in controlling postoperative pain than systemic analgesia after major joint replacement surgery.

Analgesia, sedation, and memory of intensive care

PURPOSE

The purpose of this article was to investigate the relationship between analgesia, sedation, and memory of intensive care.

PATIENTS AND METHODS

One hundred fifty-two adult, cooperative intensive care unit (ICU) patients were interviewed 6 months after hospital discharge about their memory of intensive care. The patient was considered to be cooperative when he/she was aware of self and environment at the interview. The patients were grouped as follows: A (45 patients) substantially no sedation, B (85) morphine, and C (22) morphine and other sedatives.

RESULTS

The patients having no memory of intensive care were 38%, 34%, and 23% respectively, in the three groups. They were less ill, according to SAPS II (P <.05), and had a shorter ICU stay (P <.01). Group C patients were more seriously ill according to SAPS II, duration of mechanical ventilation, and length of stay in ICU and in hospital (P <.001). The incidence of factual, sensation, and emotional memories was not different among the three groups. Females reported at least one emotional memory more frequently than males (odds ratio 4.17; 95% CI 10.97-1.59).

CONCLUSIONS

The patients receiving sedatives in the ICU are not comparable with those receiving only opiates or nothing, due to the different clinical condition. The lack of memory of intensive care is present in one third of patients and is influenced more by length of stay in ICU than by the sedation received. Sedation does not influence the incidence of factual, sensation, and emotional memories of ICU admitted patients. Females have higher incidences of emotional memories than males.

[Analysis of quality of life. Development of an evaluation instrument]

OBJECTIVE

To develop a questionnaire about quality of life (QV) suitable for Intensive Care Unit (ICU) patients.

DESIGN

Two prospective studies by direct interviews; in the first one the questionnaire was answered before and after surgical intervention and in the second during ICU stay and six months after hospital discharge.

SETTING

Surgical ward and surgical-medical ICU.

MATERIALS AND METHODS

Adult, co-operative patients, resident near the hospital, who gave informed consent have been interviewed. The following items of QOL were investigated: residence, physical activity, social life, perceived QV, oral communication and functional limitation, considering age. The last two items were assessed by the interviewer.

RESULTS

Inter-observer reliability on oral communication and functional limitation, assessed by two interviewers in 87 surgical patients, was good (p = 0.68 and p = 0.72 respectively). Validation of the questionnaire in 37 surgical cases showed worsening in all the items, consistent with theoretical prediction. In the 152 ICU consecutively admitted eligible patients, physical activity, social life, functional limitation and global QV (sum of all the investigated items) significantly changed. Residence, perceived QV and oral communication did not change. Internal consistency of the instrument was good (p < 0.05).

CONCLUSIONS

The evaluative instrument studied shows good reliability and validity. The authors suggest a shorter questionnaire could be tested in future investigations.

[Memory for postoperative pain six months after discharge from the hospital]

OBJECTIVE

To investigate memory for postoperative pain in Intensive Care Unit (ICU) admitted patients after hospital discharge.

DESIGN

Prospective study by direct interviews.

METHODS

Six months after hospital discharge, we interviewed adult, postoperative, co-operative patients consecutively admitted to ICU for more than 24 hrs, resident near the hospital, who gave informed consent. We investigated intensity of postoperative pain and recollections of critical care reported by patients. The following data were collected from medical records: type and duration of surgical intervention, type of anaesthesia and fentanyl dose, severity of illness at ICU admission, ICU and hospital (after ICU) length of stay and postoperative administration of morphine.

RESULTS

Of 130 patients interviewed, 82 (63%) reported no pain, 27 (21%) low and 21 (16%) more than low pain. Among these 3 groups of patients, there was no statistically significant difference in all the variables collected from medical records. Patients who remembered more than low pain recorded emotional distress more frequently (p < 0.001) and physical discomfort less frequently (p < 0.01) than patients whose pain was absent or low.

CONCLUSIONS

Most patients report that postoperative pain, during their ICU stay, was absent or low. Emotional distress seems to be related to memory for postoperative pain.

Survival and quality of life after intensive care

OBJECTIVE

To determine survival and changes in quality of life (QOL) after hospital discharge in patients who had stayed in an intensive care unit (ICU).

DESIGN

Prospective study by direct interviews during ICU stay and 6 months after hospital discharge.

SETTING

Surgical-medical ICU.

PATIENTS AND METHODS

We interviewed cooperative, adult patients admitted consecutively to the ICU for more than 24 h, living near the hospital, who gave informed consent. The following QOL domains were investigated: residence, physical activity, social life, perceived QOL, oral communication and functional limitation.

RESULTS

One-year survival was 82.4% (predicted 84%). Mortality was 36.3% after urgent neoplastic surgery, 19.4% for medical admissions and 4.9% after non-neoplastic surgery. Of 160 patients studied, eight cases, older and already deteriorated at the first interview, could not respond to the perceived QOL item after ICU discharge. In the other 152 patients, physical activity was reduced in 31% (usually slightly), social life had worsened in 32% and functional limitation increased in 30%. The perceived QOL did not change.

CONCLUSIONS

After hospital discharge, the survival of ICU-admitted patients is comparable to that of the general population and not related to ICU treatments. Most patients maintain their physical activity and social status at the preadmission level. Any worsening, if present, is slight and does not influence perceived QOL.

Excimer Laser Amorphous Silicon Film Crystallization: A Study of Time Resolved Reflectivity Measurements

Time Resolved Reflectivity during XeCl pulsed laser irradiation of amorphous silicon films deposited on glass was measured. Simulation of the process by a Heat Flow Calculation in which explosive crystallization was not forced to occur, predicts the coexistence of partial bulk nucleation and a traveling molten layer. Optical simulation of Time Resolved Reflectivity was used to critically examine the Heat Flow Calculation results, substantially confirming the existence of a mixture of thermodynamical phases.

[The empty sella syndrome. Clinical, radiological and endocrinologic analysis in 20 cases]

Empty sella syndrome is an anatomical entity in which the pituitary fossa is enlarged and partially filled with cerebrospinal fluid owing to the arachnoid herniation, while the pituitary gland is compressed against the posterior rim of the fossa. This condition can be due to an inherent weakness of the diaphragm sella and/or to an increase in intracranial pressure which promote the herniation of the arachnoid membrane into the pituitary fossa (primary empty sella) or it can results following surgery, radiation or vascular and tumorous pituitary diseases (secondary empty sella). Empty sella can be associated with neuroradiological and endocrine symptoms. This study reports the clinical, endocrine, and roentgenographic features in 20 patients with primary empty sella syndrome. Disturbances of hypothalamic-pituitary function were detected in 6 patients (hyperprolactinemia, hypopituitarism, central diabetes insipidus, hypothalamic hypothyroidism). Three patients exhibited hypergonadotropic hypogonadism. This report supports the following conclusions: a) there is no correlation between size of pituitary fossa, type an extension of arachnoid herniation and the degree of hypothalamic-pituitary dysfunction; b) endocrine alterations are frequent in the empty sella syndrome; c) the association of empty sella and primary diabetes insipidus is not a very rare event.

Cholinergic mediation in dermorphin-induced growth hormone secretion in man

The effects of pirenzepine (P), a cholinergic muscarinic antagonist, on growth hormone (GH) and prolactin (PRL) response to dermorphin (D) were studied in a group of 7 healthy men. D produced clear elevations in GH and PRL levels. P completely blocked the GH-releasing activity of D, whereas it did not alter the PRL-releasing activity. These results indicate that GH-releasing action of D is mediated via the central cholinergic nervous system in man.

Dermorphin reduces the metyrapone-evoked release of adrenocorticotropin, beta-endorphin, and beta-lipotropin in man

The aim of this study was to investigate further the influence of dermorphin (D), a new potent opioid peptide (H-Tyr-D-Ala-Phe-Gly-Tyr-Pro-Ser-NH2), on the functional activity of the pituitary-adrenocortical system in man. Six normal men were treated with oral metyrapone to stimulate the secretion of ACTH, beta-lipotropin, and beta-endorphin. In these subjects, significant suppression of metyrapone-evoked release of ACTH and related peptides occurred during D infusion (5.5 micrograms/kg X min for 30 min) compared with that during saline infusion. These results indicate that D can induce a significant decline in plasma levels of ACTH, beta-lipotropin, and beta-endorphin, the major circulating peptides from the C-terminal part of proopiocortin, and suggest that opioid peptides may be involved in the control of the functional activity of pituitary-adrenocortical activity in man.

Prolactin and growth hormone responses to dermorphin in patients with prolactin-secreting pituitary adenoma

We have recently shown that dermorphin (D), a new potent opioid peptide (H-Tyr-D-Ala-Phe-Gly-Tyr-Pro-Ser-NH2) stimulates prolactin (PRL) and growth hormone (GH) secretion in humans. In 11 patients with a PRL-secreting pituitary adenoma (eight microprolactinomas and three macroprolactinomas with suprasellar extension), diagnosed by pituitary dynamic function tests, and radiological evidence with confirmation at surgery, the PRL and GH responses to D were studied to evaluate the effect of pathological hyperprolactinemia on the opioid-induced secretion of GH and PRL. No PRL response to D was observed in all 11 patients. Plasma GH increased after D in all patients, except in three patients bearing a macroprolactinoma. This study shows that the effect of D on PRL and GH secretion can be dissociated in patients with PRL-secreting pituitary adenoma, perhaps for a different derangement in the hypothalamic-pituitary mechanism(s) underlying the opioidergic regulation of GH and PRL secretion. In addition our data indicate that D can be employed as a useful opioid probe in humans.

Dermorphin, a new opioid peptide, stimulates thyrotropin secretion in normal subjects

The effect of a recently described, potent opioid peptide, dermorphin (DER), on TSH secretion in euthyroid subjects has been studied. DER infused at a rate of 5.5 micrograms/Kg/min for 30 min induced a significant increase in serum TSH concentration at 60, 90, and 120 min after the infusion was begun. Treatment with naloxone administered 30 min before the DER infusion with a bolus dose of 4 mg, followed by a constant infusion of 1 microgram/Kg/min for 150 min, prevented the rise in serum TSH. Naloxone administered alone did not induce any change in TSH concentration. The present findings suggest that DER has a stimulatory effect on TSH secretion, probably mediated by opioid receptors. These results, however, do not solve the question as to whether opioids have a physiological role in the control of pituitary TSH secretion.

Responses of plasma renin activity, aldosterone, adrenocorticotropin, and cortisol to dermorphin, a new synthetic potent opiate-like peptide, in man

This study was designed to investigate the effect of dermorphin (D), a new synthetic potent opiate-like peptide (H-Tyr-D-Ala-Phe-Gly-Tyr-Pro-Ser-NH2), on PRA, plasma aldosterone (PA), plasma cortisol (PC), and plasma ACTH levels in normal men. D infusion (5.5 micrograms/kg X min for 30 min) significantly increased PRA (P less than 0.01) and decreased PC levels (P less than 0.02). D produced a small decrease in ACTH and a small increase in PA. Pretreatment with the opioid receptor antagonist naloxone (N) blunted the D-induced PRA increase and completely prevented the D-induced PC decrease, but enhanced PC and ACTH levels. These data indicate that the action of D is mediated through opioid receptors, and are consistent with the conclusion that 1) D, a new opioid peptide, increases PRA levels, perhaps via activation of the sympathetic nervous system, providing evidence that opioid peptides may exert an influence on renin secretion; and 2) D suppresses PC levels, perhaps by affecting ACTH secretion, corroborating previous observations that opioid peptides might affect the function of the pituitary-adrenocortical axis.

Stimulatory effect of dermorphin, a new synthetic potent opiate-like peptide, on human growth hormone secretion

Two new related heptapeptides (dermorphins) with potent central and peripheral opiate-like activity have been isolated from the skin of South American frogs, and have been chemically characterized as H-Tyr-D-Ala-Phe-Gly-Tyr-Pro-Ser-NH2 (dermorphin) and H-Tyr-D-Ala-Phe-Gly-Tyr-Hyp-Ser-NH2 (Hyp6-dermorphin). The response of GH to infusion of a synthetic dermorphin (5.5 micrograms/kg/min for 30 min) was studied in 9 healthy men. Dermorphin (D) significantly increased plasma growth hormone (GH) concentrations. The GH response to D was blunted by prior administration of naloxone, suggesting that D interacts with mu-type opiate receptors. However, the evaluation of the physiological significance of D-induced GH release in humans requires further study.

Prolactin-releasing activity of dermorphin, a new synthetic potent opiate-like peptide, in normal human subjects

Dermorphins (D) are heptapeptides (H-Tyr-D-Ala-Phe-Gly-Tyr-X-Ser-NH2; X, Pro or Hyp) with powerful central and peripheral opiate-like activity, originally isolated from the skin of South American frogs. To study the effect of a synthetic D on PRL secretion in man, either D (5.5 micrograms/kg . min for 30 min) or D-placebo (0.9% saline) infusion over 30 min was administered iv in random sequence to 11 volunteers (6 women and 5 men). In all the subjects, D induced a significant increase in the levels of PRL, more consistently in women than in men. To investigate whether the increase in PRL was due to the opiate agonist properties of D, the study was repeated in the same subjects during naloxone infusion. The PRL response to D was completely suppressed, suggesting that the peptide exerts its effect on PRL release via an opiate receptor stimulation of the mu-type. These data allow us to conclude that D may affect PRL release in humans; however, further investigation is necessary before any physiological significance might be attributed to D in man.

Effect of ketanserin, an inhibitor of 5-HT2 receptors, on the aldosterone-stimulating action of metoclopramide

To estimate the possible involvement of a peripheral serotonergic pathway in the mechanism of the aldosterone-stimulating effect of metoclopramide (M) the plasma aldosterone (PA), renin activity (PRA) and prolactin (PRL) response to M was studied in 6 normal subjects before and after administration of ketanserin (K), a pure, specific, and selective blocking agent of 5-hydroxytryptamine type 2 (5-HT2) receptors. With K preadministration the M-induced increase of PRL was similar to that observed in control conditions, in accordance with the specific and peripheral antiserotonergic action of the drug. K potentiated the PA and PRA elevation in response to M. These data suggest that the PA response to M is not related to M's agonist activity at the peripheral 5-HT2 receptors level. The results further indicate that K can induce an enhancement of the activity of renin-angiotensin-aldosterone system with an higher PRA and PA response to stimulatory action of M.