Gestational diabetes affects platelet behaviour through modified oxidative radical metabolism

AIMS

Patients with Type 1 and Type 2 diabetes mellitus show altered platelet function including decreased nitric oxide synthase (NOS) activity and increased peroxynitrite production. Gestational diabetes mellitus (GDM) is a clinical condition which is ideal for evaluating short-term effects of impaired glucose metabolism, ruling out the possibility that the platelet abnormalities are a consequence of diabetic complications. The aim of the present work was to study NO metabolism in platelets from pregnant women with GDM. The production of peroxides was also studied as it is strongly involved in peroxynitrite formation.

METHODS

Platelet NOS activity and peroxynitrite production, levels of hydroperoxides and thiobarbituric acid reactive substances (TBARS) in platelet membranes in the basal state and after in vitro peroxidative stress with phenylhydrazine were determined in 40 pregnant women with GDM, 40 healthy pregnant women (pregnant controls) of comparable age and gestational age, and 15 healthy non-pregnant women (controls).

RESULTS

NOS activity was significantly increased in both groups of pregnant women compared with non-pregnant ones, and in GDM women compared with pregnant controls. Production of peroxynitrite was higher in GDM women than in pregnant controls, who also had significantly reduced production compared with non-pregnant women. Basal levels of peroxidation of the platelet membranes evaluated either by hydroperoxide content and TBARS levels or the susceptibility to peroxidation were increased in GDM patients in comparison with both control groups.

CONCLUSIONS

We have shown a modification in platelet NO and peroxynitrite production and an increase in platelet indicators of oxidative stress in GDM women compared with healthy pregnant women which might be at the basis of a cellular dysfunction.

Sialic acid content in erythrocyte membranes from pregnant women affected by gestational diabetes

Sialic acid (SA) content, membrane fluidity, and Na(+)/K(+)-adenosine triphosphatase (ATPase) activity were determined in erythrocyte membrane from 10 nonpregnant women (HNPW), 16 pregnant women affected by gestational diabetes mellitus (GDM), and 25 healthy pregnant women (HPW). In GDM patients the membrane erythrocyte SA content was significantly increased compared with HNPW and membrane fluidity was significantly increased in comparison with HPW. Erythrocyte membrane Na(+)/K(+)-ATPase activity was significantly reduced in GDM patients compared both to HNPW and to HPW subjects. A significant inverse correlation was found between 1-(4-trimethylaminophenyl)-6-phenyl-1,3,5-hexatriene (TMA-DPH) anisotropy and erythrocyte membrane SA content in HNPW and in HPW, while this significant correlation was not observed in GDM. The present results indicate that in comparison with normal pregnancy GDM is characterized by deep alterations of the erythrocyte plasma membrane physicochemical properties (increased fluidity) and functional activities (reduced Na(+)/K(+)-ATPase activity). These modifications might be at the basis of the altered blood viscosity and placental perfusion observed under such conditions. Moreover, these results show that in physiological pregnancy and in the nonpregnant state, the erythrocyte surface membrane fluidity is inversely correlated with SA content, while in GDM there is an unbalance of this relation, which might be associated with the microcirculatory abnormality present in this disease.

Penile metastasis secondary to prostate carcinoma: Case report

– The case is reported of a 71-year-old man with penile metastasis from prostate cancer and history of severe penile pain. The patient presented with priapism with repetitive nodular swellings of the whole penile shaft. Drug therapy had failed to relieve the pain and it was decided to denervate the dorsal nerve of the penis. Results were excellent with regard to pain relief, while the cycle of systemic chemotherapy after the operation gave very poor results.

Percutaneous ultrasound-guided treatment of simple renal cysts: Our experience

– Simple renal cysts are often found casually during ultrasound. When they cause flank or back pain, hypertension, renal calyceal or pelvic obstruction or deterioration in renal function, an operation is necessary. Ultrasound-guided percutaneous drainage and sclerotisation are currently considered the least invasive and safest management options compared to open surgery or video laparoscopy. This method was used from January 1993 to February 1997 to treat 60 patients with a success rate of 78% and no significant complications, except for a case of suppuration which was promptly resolved. Our experience showed that best results were obtained when a second alcoholisation was carried out and the catheter-drainage left in situ for three days to help in the collapse of cyst walls.

[Clinical experience in patients with chronic peripheral obliterating arteriopathy: defibrotide versus definite molecular weight heparan sulfate (MW 7500-15000 dalton)]

In a controlled study of 100 patients, mean age 65 years old, suffering from chronic peripheral obliterative arterial disease, Leriche's stage II, were randomised in two groups treated respectively with defibrotide (400 mg bid) or heparan-sulfate (40 mg bid) by the oral route for a period of 6 months. At basal and after 30, 90 and 180 treatment days, patients were assessed for pain, paresthesias, rigidity and or tiredness in the leg, Winsor index (WI) relative and absolute walking distance (RWD, AWD), and time of recovery from pain. In order to evaluate microcirculation the following parameters were tested: resting flow (RF), standing flow (SF), veno-arteriolar reflex (VAR) and a capillaroscopy study was conducted. All patients showed an improvement in the clinical and instrumental parameters but more pronounced in the defibrotide group; the difference between the beginning and the end of the therapy was significantly better for defibrotide (p < 0.01). The tolerability observed was good, no side-effects were reported during the study.

Modulation of human lymphoblastoid interferon activity by melatonin in metastatic renal cell carcinoma. A phase II study

BACKGROUND

Numerous attempts to identify active cytotoxic agents for the treatment of metastatic renal cell carcinoma (RCC) have proved disappointing. However, several recent developments in biologic therapy of neoplastic disease have substantially improved the prospects for the treatment of advanced RCC. Melatonin (MLT), a hormone regulated by the pineal gland, has been shown to act on the immune system by causing the release of cytokines from activated T-cell populations.

METHODS

A series of 22 patients with documented progressing RCC entered a trial in which the authors studied the effect of a long term regimen (12 months) with human lymphoblastoid interferon (IFN), 3 mega units (MU) intramuscularly 3 times per week, and MLT, 10 mg orally every day.

RESULTS

Twenty-one patients were evaluable for response and toxicity. There were seven remissions (33%): three complete, involving lung and soft tissue and four partial, with a median duration at the time of this writing of 16 months. Nine patients achieved stable disease, and five progressed. General toxicity was mild. Fever, chills, arthralgias, and myalgias occurred rarely. Leukopenia and hepatic enzyme elevation were modest and always reversible.

CONCLUSIONS

Response rate and toxic effects observed during this study warrant additional randomized studies to define the role of MLT's concomitant administration in the clinical response to IFN in metastatic RCC.

Retroperitoneal germ cell tumor in postmenopausal woman

A fifty-four-year-old woman presented with right renal colic and three months later a retroperitoneal tumor was diagnosed. After explorative laparotomy with biopsy, which showed a germ cell tumor, the patient received external beam radiotherapy, but died of metastatic diffusion nine months later. We believe this is a rare occurrence of a germ cell tumor in a postmenopausal woman.

[Posttraumatic functional exclusion of the kidney of nonvascular origin. Description of a case and review of the literature]

A review of published series about 56 cases with unilateral nonvisualization on excretory urography after external trauma have been described: the renal injury causing the nonvisualization was contusion in 8 patients, laceration in 13, rupture in 12 and renal pedicle in 19. The acquisition of the most important methods has allowed a total view as about minimal lesions (contusion, laceration), as rupture or fragmentation of the kidney and renal pedicle. We have evaluated 32 cases of renal traumatic injuries and we have studied one case with unilateral nonvisualization stressing the diagnostic, etiopathogenetic and therapeutic problems.

Therapeutic value of citicoline in the treatment of glaucoma (computerized and automated perimetric investigation)

The favourable neurotrophic effects obtained by means of the intramuscular administration of citicoline, one of the intermediate compounds of phospholipids, on the visual field of patients suffering from open-angle glaucoma are referred. The drug was administered at the dose of 1 gm for ten consecutive days. Visual field was examined by means of central computerized perimetry and automated perimetry. All patients had well controlled intraocular pressure through beta-blockers, but presented characteristic glaucomatous perimetric defects. It is suggested that citicoline might be administered as a useful complement to conventional hypotensive therapy, since it acts positively on the glaucomatous optic nerve damage.

Ultrastructural changes of Leydig cells in prepubertal varicocele

Testicular biopsies from 25 boys, aged 11-17, with left clinically evident varicocele were studied. Electron microscopic observations documented diffuse histological changes of smooth endoplasmic reticulum, Golgi apparatus and mitochondria of Leydig cells. Ultrastructural modifications of these subcellular structures related to steroid hormone synthesis may impede the normal growth and maturation of the testis and impair fertility potential.

Periurethral neurofibroma

A periurethral neurofibroma presenting as a midline perineal mass was removed in a three-year-old boy. An immunohistochemical study of S-100 protein distribution within the tumor tissue was performed.

Fertility in unilateral cryptorchidism: review of 104 cases

Testicular maldescent adversely affects spermatogenesis, therefore the primary purpose of its correction is to preserve subsequent fertility. However, many patients, even with unilateral cryptorchidism, are infertile in spite of successful prepubertal orchidopexy. Out of our 104 patients treated for unilateral cryptorchidism before puberty, a decreased sperm density (spermatic concentration less than 20 X 10(6)/ml) was observed in 64 cases (61.54%), a normal sperm count in 32 cases (30.77%) and azoospermia in the remaining 8 cases (7.69%). Both congenital and acquired abnormalities may be associated with development of bilateral testicular impairment in unilateral cryptorchid males.

Varicocele in adolescents: ultrastructural aspects

Twenty-four boys age 11-17 with moderate to large sized varicocele were studied. The duration of varicocele ranged from 11 to 20 months prior to surgery. Histological and ultrastructural studies of testicular specimens demonstrated bilateral abnormalities and the detrimental effect of varicocele on the future fertility of these young patients. These findings strongly support the necessity of an early surgical treatment of varicocele.

Pyelovesicostomy: an alternative to ureteropelvic junction-plasty in pelvic ectopic kidneys

Pyelovesicostomy was performed in 2 cases of hydronephrosis in pelvic kidneys secondary to ureteropelvic junction obstruction. In the first patient, who presented with a solitary kidney, the procedure was done after failure of a dismembered pyeloplasty, while in the second patient the procedure was performed electively. Both patients had sterile urines and stable renal function, although some dilatation persisted in the first case. The indications and the functional aspects of this surgical solution are discussed.

[Cystic renal disease in childhood]

In the last five years, in the Surgery Pediatric Department and in the Pediatric Nephrology and Dialysis Service of the Florence University, have been observed 13 patients with cystic renal diseases. In every single case, for the diagnosis we have considered the age of the patients and the examinations made to them. We payed attention mostly to the echography considered the main diagnostic examination, even in prenatal age.

Recurrent reflux caused by vesicoureteral fistula

We present an unusual case of recurrent reflux on the right side after bilateral vesicoureteroplasty with modified Hutch I technique.

Polyorchidism and seminoma in a child

A case is reported of a neoplasm involving a supernumerary testicle in a 9-year-old boy. The histologic diagnosis was anaplastic seminoma. We have not been able to find a similar case in the literature.

[A rapid method for the isolation of Salmonellae from faeces (author's transl)]

A rapid and simple method for detecting Salmonellae in faeces was developed. It was based on the motility of Salmonellae through a semi-solid medium in a U-tube. The migration of other intestinal bacteria was retarded by means of a magnesium salt concentration. 474 stool specimens were examined for Salmonellae in parallel with the usual isolation method. A total of 39 Salmonella strains were isolated, 37 (94.9%) by means of the selective migration procedure, 26 (66.7%) when the routine method was applied. Two strains of patients in chemo-therapy were missed by the rapid method, which was moreover inefficient in detecting S. typhi, due to its slow motility. However, the rapid method is recommended in addition to conventional mediums in screening of carriers for its higher frequency of positive isolations compared with multistep procedure (+27.3%).