Different responses to chronic somatostatin analogues in patients with central hyperthyroidism

OBJECTIVE: Central hyperthyroidism is mainly due to two different causes, TSH-secreting pituitary adenoma (TSH-oma) and resistance to thyroid hormone in its pituitary variant, i.e. patients presenting with signs and symptoms of hyperthyroidism (PRTH). Because therapeutic approach and the clinical follow-up are extremely different in these two disorders, a correct differential diagnosis is mandatory. Unfortunately, no definite pathognomonic tool is presently available and an extensive biochemical and instrumental workup is frequently needed in order to reach the correct diagnosis. Aim of the present study was to investigate the use of somatostatin analogues in the differential diagnosis between TSH-omas and PRTH, as well as the possible treatment of PRTH with these analogues. DESIGN AND PATIENTS: Eight patients with TSH-oma and four with PRTH underwent the acute test with somatostatin analogue Octreotide (0.1 mg subcutaneously), as well as long-acting Octreotide-LAR (30 mg intramuscularly every 28 days) for two months. MEASUREMENTS: Serum TSH, FT3 and FT4 were evaluated in basal condition, at time 0 and every hour for 6 h during acute test, and every 15 days for 2 months during chronic treatment. RESULTS: During acute test, in both patients with PRTH and TSH-oma, a similar reduction in immunoreactive TSH and FT3 levels was observed, while no variations were found in FT4 concentrations. In contrast, during the administration of Octreotide-LAR, no significant variations of all tested parameters were observed in PRTH group, whereas FT3 and FT4 concentrations normalized or presented a significant reduction (> 30% of pretreatment values) in seven of eight patients with TSH-oma, despite minor variation of immunoreactive TSH levels. CONCLUSIONS: Chronic administration of long-acting somatostatin analogues in patients with central hyperthyroidism caused a marked decrease of FT3 and FT4 levels in all patients but one with TSH-oma, while patients with PRTH did not respond at all. Thus, administration of long acting somatostatin analogues for at least 2 months can be useful in the differential diagnosis in problematic cases of central hyperthyroidism. Furthermore, the present findings exclude the possibility of a beneficial effect of chronic administration of somatostatin analogues in controlling thyrotoxic symptoms in PRTH patients.     

Making a movie on kidney transplantation: a medical school graduation thesis to explain kidney transplantation from students to students

The aim of this study was to report on the production and the opinions of a video movie on transplantation and organ donation. The video was developed by a medical school student with the help of the students and teachers of a high school for applied arts. For this task, the making of the video was included in the high school program of the participating class. The students were tutored by their photography teacher. The video movie lasts about 50 minutes. Each "scene" lasts no more than 5 minutes, to avoid reducing the attention level. The choice of a nonmedical frame helped to have some moments to digest the technical information and to stress the importance of the patient-physician relationship. The video was employed as a part of small-group lessons in the nephrology course. A semistructured anonymous questionnaire gathered the opinion of 65 students at the end of the lessons. Student satisfaction was high; the median score was the highest (8, range 6 to 10) for the lesson based upon the movie, as compared with the conventional ones on chronic kidney disease or dialysis (7, range 5 to 10). As far as the authors know, this is the first experiment of a multimedia approach, dedicated to medical and nonmedical targets, developed as a graduation thesis in an Italian Medical School. In conclusion, the positive opinions of the students, who highly appreciated the peer-developed message, may suggest implementing such nonconventional educational approaches to support human resources and enthusiasm for kidney transplantation among the new generations.     

Tailored dialysis start may allow persistence of residual renal function after graft failure: a case report

BACKGROUND: Restarting dialysis after kidney transplantation is a critical step with psychological and clinical implications. Maintenance of residual renal function a known factor affecting survival in chronic kidney disease, has so far not been investigated after a kidney transplantation. THE CASE: A 54-year-old woman who started dialysis in 1974 (first graft, 1975-1999) received a second "marginal" kidney graft in February 2001 (donor age, 65 years). Her chronic therapy was tacrolimus and steroids. She had a clinical history as follows: nadir creatinine level of 1.5 mg/dL, moderate-severe hypertension, progressive graft dysfunction, nonresponsiveness to addition of mycophenolate, tapering FK levels, and a rescue switch from tacrolimus to rapamycin. From October to December 2003, the creatinine level increased from 2-2.8 to 7 mg/dL. Biopsy specimen showed malignant and "benign" nephrosclerosis, posttransplantation glomerulopathy, and tacrolimus toxicity. Chronic dialysis was started (GFR <3 mL/min). Rapamycin was discontinued. Dialysis was tailored to reach an equivalent renal clearance of >15 mL/min (2 sessions/wk). Blood pressure control improved, nephrotoxic drugs were avoided, and fluid loss was minimized (maximum 500 mL/hr). By this policy, renal function progressively increased to GFR >10 mL/min in May 2004, allowing a once or twice weekly dialysis schedule, with good clinical balance, and obvious advantages for the quality of life. CONCLUSION: This long-term patient, who restarted dialysis with severely reduced renal function, regained sufficient renal function to allow once weekly dialysis. Thus, careful tailoring of dialysis sessions at the restart of dialysis may allow preservation of residual kidney function, at least in individuals for whom a subsequent graft is unlikely.     

The sensitive innervation of the ostrich nasal mucosa

The sensitive innervation of the ostrich's nasal mucosa, through impregnative gold chloride methods, was investigated. The autonomy innervation, constituted by ganglion cells placed along the course of nerve trunks was particularly represented in the respiratory tract of the nasal cavity. The somatic nerve component, composed by free and capsulated endings, was especially distributed in the vestibular district. The nerve corpuscles were morphologically classified as Pacini, Pacini-like, Golgi-Mazzoni and Herbst. Further investigations must be expected to attribute an effective functional role particularly to this last nerve component.     

Corticospinal excitability during painful self-stimulation in humans: a transcranial magnetic stimulation study

We investigated changes in the corticospinal pattern of activity in healthy volunteers during sustained noxious and non-noxious mechanical stimulation of the first hand digit, resulting from active (self-stimulation) or passive (externally-induced) pressing against a sharp or blunted tip. The results indicate that, in order to press a finger onto a noxious stimulus with the same force generated to press onto a non-noxious one, the motor cortex adopts a peculiar strategy in terms of recruitment of motor units. This is reflected by an increase of corticospinal excitability (as revealed by motor potentials evoked by transcranial magnetic stimulation of the contralateral primary motor cortex) and EMG activity of agonist muscles, possibly related to an increase of motor unit synchronization.     

Contribution of locally grown foods in cumulative exposure assessments

Both laboratory and field studies confirm the importance of vegetation for scavenging semivolatile organic chemicals (SVOCs) from the atmosphere and a number of exposure studies have found that the dietary pathway is often a significant contributor to cumulative exposure for these chemicals. However, little information exists on the atmospheric source-to-dietary intake linkage for SVOCs. Because of higher SVOC emissions to urban regions, this linkage is particularly important for foods that are grown, distributed and consumed in or near urban regions. The food pathway can also contribute to dietary exposure for populations that are remote from a pollutant source if the pollutants can migrate to agricultural regions and subsequently to the agricultural commodities distributed to that population. We use available data, the characteristic travel distance, and the CalTOX multimedia model framework to assess the contribution of local sources of food to cumulative SVOC intake. Based on published concentration data for foods, our exposure calculations indicate that the potential intake through ingestion can be up to 1000 times that of inhalation for certain persistent SVOCs. We use the population-based intake fraction (iF) to determine how SVOC intake can vary among food commodities and exposure pathways, and to determine the contribution of airborne emitted SVOCs to the diet in the Northern Hemisphere. We focus on three representative multimedia SVOCs-benzo(a)pyrene, fluoranthene, and 2,3,7,8-tetrachlorodibenzo-p-dioxin. The approach presented here provides a useful framework and starting point for source-to-intake assessments for the ambient air-to-dietary exposure pathway.     

Radiology and adult celiac disease. Current indications of small bowel barium examinations

PURPOSE: To evaluate the current role of small bowel (SB) radiologic barium examinations in adult celiac disease (ACD). MATERIALS AND METHODS: Retrospective review of 61 SB barium examinations in 280 ACD patients. Sixty-one examinations in 61 patients were performed: 7/61 with small bowel 'follow-through' (SBFT) method, and 54/61 with small bowel double-contrast enteroclysis (SBE). Radiological criteria for ACD diagnosis were divided in four groups: 1) definite ACD (reversal of jejuno-ileal fold pattern); 2) possible ACD (malabsorption pattern and ileal jejunization); 3) malabsorption (fluid, dilatation, 'moulage', flocculation); 4) complicated ACD (irregular, thickened, nodular folds; wall thickening; masses). RESULTS: In 49/61 patients RX examinations were performed before ACD diagnosis. In this group, clinical presentations included one or more of the following: diarrhea, weight loss, malabsorption, anemia, abdominal pain; 7/49 had a SBFT, and 42/49 a SBE. All 7 SBFTs showed pattern 3, and 8/42 SBEs showed pattern 2 (suspected ACD). In 34/42 patients SBE allowed a definite ACD diagnosis (pattern 1); however, 6/34 were also false-positive for complicated ACD (pattern 4). Ten out of sixty-one patients were clinically suspected of having complicated ACD, correctly excluded (8/8) or confirmed (2/2) by SBE. None of these 59/61 patients had a radiologic diagnosis of normal' SB. The last 2/61 patients with ACD, examined for persisting chronic anemia, had a normal SBE. CONCLUSIONS: This study confirm that SB radiology may be of value either in ACD diagnosis or in excluding complications: SBE is currently the most accurate examination. SBE alone is however less accurate in confirming complicated ACD; further imaging techniques are always needed in this clinical context.     

Transplacental passage of Pt after treatment with the new triamine complex cis-diaminechloro-[2-(diethylamino) ethyl 4-amino-benzoate,N<Superscript>4</Superscript>]-chloride platinum (II) monohydrochloride monohydrate

Cis-diaminechloro-[2-(diethylamino) ethyl 4-amino-benzoate, N⁴]-chloride platinum (II) monohydrochloride monohydrate (DPR) is a monofunctional Pt triamine complex synthesized starting from cisplatin and procaine hydrochloride, characterized by a good antitumor activity coupled with low toxic effects and able to impair prenatal development of mice but at doses outside or just in the upper range of therapeutic doses. In the present paper the transplacental passage of DPR-derived Pt was investigated in CD1 mice on days 9, 13, 16 and 18 of pregnancy, 24 h after ip administration of 21 mg/kg DPR. For comparison, groups of mice were treated with an equivalent Pt-containing dose of cisplatin (10.7 mg/kg). Similarly to cisplatin, small amounts of Pt were detected in fetuses on day 9. From day 13 of gestation the concentration of DPR- and cisplatin-derived Pt increased up to the highest fetal concentrations detected on day 16. On day 18 the concentration of Pt decreased. Most importantly, on days 13–18 of pregnancy cisplatin-derived Pt was always significantly higher than that assayed after DPR administration. In addition, on day 13 of pregnancy Pt exposure of fetuses was significantly higher when dams were treated with cisplatin (AUC_0.5–24= 3.40 vs. 4.95 g·h/g). Finally, it is worth noting that serum decay of Pt after DPR or cisplatin administration in adult female mice was similar with AUC_0.13–2h s of 7.5 and 6.6 g·h/ml, respectively. When we determined the concentration of Pt into the main organs of fetuses from dams treated with either DPR or cisplatin on day 18 of gestation, we observed a different organ distribution. In fact, while the concentration of DPR-derived Pt was greater in the heart (1.08±0.30 vs. 0.78±0.35 g/g, p <0.10), an opposite situation was found in the kidney (0.51±0.20 vs. 0.69±0.22 g/g, p <0.05). In conclusion, our data show that DPR may pass through the placenta with an efficiency significantly lower than that of cisplatin. This finding may represent one of the possible causes of the lower embryotoxic/teratogenic effect of DPR as compared to cisplatin.     

Locomotor behaviours and respiratory pattern of the Mediterranean fin whale (Balaenoptera physalus)

Twenty-four Mediterranean fin whales were tracked in open sea with a method based on the assessment of the animal differential position in respect of the observer's absolute position aboard a vessel, with the concomitant recording of the respiratory activity. Short distance video recording was also performed in two whales, permitting the simultaneous determination of single breath expiratory (T_E) and inspiratory (T_I) durations. In the 24 whales swimming at an average velocity of 1.39 (0.47) m·s^–1 [mean (SD), range: 0.62–2.44 m·s^–1], 2068 breaths organized in 477 respiratory cycles were observed. Each cycle entailed a prolonged apnoea dive phase [225 (91) s, T_dive) followed by a period near the surface [62 (28) s, surfacing], during which a series of breaths [4.6 (1.8)] was performed at short intervals. On the basis of track length and swimming velocity, two groups of animals were devised differing for convolution of the course (p<0.001), extension of ranging territory (p<0.01) and horizontal swimming velocity (p<0.05), which may represent two distinct behaviours. A possibly general mechanism of control of breathing in cetaceans was found, consistent with a model of constant tidal volume and variable respiratory frequency. Coherently with this model, T_E was independent of T_I or T_dive, in line with a passive expiration, while T_I appeared to be negatively correlated with T_dive (p<0.05), otherwise suggesting, similarly with terrestrial mammals, a significant role of hypercapnic stimulation. The estimated O₂ consumption of about 150 l·min^–1 is in line with the general allometric regression for mammals and corresponds to an energetic expenditure of 85–95 kJ·kg^–1·day^–1.Partially presented as a poster at The World Marine Mammal Science Conference and 12th Annual Conference of the European Cetacean Society, Monaco (Montecarlo), 20–24 January 1998.Angelo Colombini provided technical assistance.