Endocrine evaluation of patients with benign lumps of the breast.

We studied 39 women with benign breast disease in order to evaluate their endocrine status. Two groups of women were distinguished: premenopausal (n = 22) and postmenopausal (n = 17). We determined basal concentrations of the following: follicle-stimulating (FSH) hormones, luteinizing hormone (LH), prolactin (PRL), estrone (E1), estradiol (E2), testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEAS). We also assayed sex hormone-binding globulin (SHBG) and calculated the free androgen index (FAI). The samples in premenopausal subjects were collected in the follicular phase. There was no significant difference between the groups considered and normal control subjects for any of the hormones tested; there was no significant correlation between T concentration or E2/T ratios and SHBG levels; the FAI was not significantly different compared to normal subjects. In conclusion, even if basal steroid, gonadotropin, and SHBG levels do not indicate an unequivocal alteration, it is not possible to exclude subtle alterations in transport and local metabolism of steroids. The balance between steroids and SHBG seems to indicate small dysregulations, which could be of some importance.     

The Rett syndrome: progress report on studies at the Kennedy Institute

Clinical, biochemical and pathological studies in patients with the Rett syndrome (RS) are presented. The neuropathological changes and alterations in neurotransmitter markers are particularly interesting and provide valuable information that may be helpful in understanding the behavior and neurological phenotype of RS.     

The Neuman Systems Model: application to a patient with a cervical spinal cord injury

Neuman's Systems Model provides a framework for holistic neuroscience nursing practice. Utilizing Neuman's assessment format, results are presented for a patient who sustained a cervical spinal cord injury. Nursing diagnoses are identified and a sample plan of care is included.     

Folic acid and vitamin E supplementation effects on homocysteinemia, endothelial function and plasma antioxidant capacity in young myocardial-infarction patients.

We examined the effects of folate (either alone or co-supplemented with Vitamin E) on endothelial function in hyperhomocysteinimic patients and correlated results with serum antioxidant capacity. A randomized trial was carried out in 30 young patients with recent acute myocardial infarction (AMI) and high plasma homocysteine concentrations. Intervention consisted of high doses of folate, either alone (group A) or in combination with Vitamin E (group B), for three months. Main outcome measures were endothelial function, serum antioxidant capacity, and homocysteinemia. Folic acid treatment reduced plasma homocysteine concentrations in both groups by 41% and, as compared with baseline values, was associated with a significant (P<0.001) improvement of endothelial function (from 0.322 (0.03) to 0.450 (0.02)mm in group A and from 0.338 (0.03) to 0.584 (0.04)mm in group B). However, there was no difference in endothelial function improvement between folic acid and folic acid plus Vitamin E group. Plasma antioxidant capacity significantly (P<0.001) increased in both groups. In conclusion, beneficial effects of folic acid on vasomotion appear to be independent of antioxidant action but, rather, seem to be strongly associated with reduction of homocysteinemia. Confirming previous reports, the effects of Vitamin E are still equivocal.     

Aneurysm of the subrenal aorta. Comments on 25 cases seen]

The authors report their experience in the diagnosis and treatment of subrenal aortic aneurysms. The incidence of the abdominal aortic aneurysms, in aged population, is increasing, linked, in 95% of cases, to atherosclerotic disease. The diagnosis is essentially clinical with help of various examination techniques, that provide an accurate preoperative morphological assessment, like direct X-ray of the abdomen, echography, angio computerized axial tomography and arteriography. The moment for operating aneurysms of the subrenal aorta is discussed. The rate of operative deaths following elective replacement of abdominal aortic aneurysms is less than 4% and it increase to 40-80% in emergency replacement for rupture. Rupture remains a catastrophic life-threatening complication for cardiovascular, respiratory and renal failure, in spite of improved surgical techniques and postoperative intensive care.     

RESPONSE TO ORTHOSTATIC STRESS PREDICTS OFFICE-DAYTIME BLOOD PRESSURE DIFFERENCE, BUT NOT NOCTURNAL BLOOD PRESSURE FALL IN MILD ESSENTIAL HYPERTENSIVES: RESULTS OF THE HARVEST TRIAL

1. The aim of the present study was to evaluate whether postural blood pressure (BP) change could predict office-daytime BP disparity and the nocturnal BP fall in young, mild essential hypertensives. We investigated 411 males aged between 18 and 45 years with never treated borderline to mild hypertension. BP was measured three times after a 5 min rest in the supine position and thereafter three times after 2 min of standing. The mean of six BP measurements obtained during two visits in the lying position was defined as office BP. 2. Twenty-four hour ambulatory BP monitoring was performed with either the A and D TM-2420 model 7 or the ICR Spacelabs 90207. BP values were averaged for day—and nighttime periods. The nocturnal BP fall was defined as the difference between the average day—and night-time BP. 3. The standing-lying difference was significantly inversely correlated with the office-daytime difference for both systolic blood pressure (SBP) (r = -0.34, P 0.001) and diastolic blood pressure (DBP) (r = -0.24, P 0.001). These correlations did not change when the obese subjects (body mass index > 30 kg/m²) were excluded from the analysis. No significant correlation between standing-lying difference and nocturnal BP fall was found. 4. Our results indicate that white coat hypertension assessed as the office-daytime BP disparity is partially related (in a negative fashion) to the BP reaction to standing. The postural BP change does not predict nocturnal BP fall in young, mild essential hypertensives.     

Relative influence of different disulphate disaccharide clusters on the HCII-mediated inhibition of thrombin by dermatan sulphates of different origins

Besides the major monosulphated disaccharide sequences (IdoA-GalNAc4SO₃), dermatan sulphates (DS) contain the oversulphated sequences (IdoA2SO₃-GalNAc4SO₃) and (IdoA-GalNAc4,6SO₃), the concentration of which is correlated with the HCII-mediated inhibition of thrombin by DS. The effect of the chemical removal of the sulphate groups on the HCII-mediated activity was studied. The base-catalyzed sulphate group displacement from IdoA2SO₃ residues, leading to formation of the epoxyde aGulA, is a 1st order reaction. When the content of sequences (IdoA-GalNAc4,6SO₃) is higher than that of sequences (IdoA2SO₃-GalNAc4SO₃), removal of the sulphate groups from Ido2SO₃ reduces the HCII activity less than when the latter sequences prevail. (IdoA-GalNAc4,6SO₃) cooperates with (IdoA2SO₃-GalNAc4SO₃) in the activation of the HCII. Also the removal of 6-SO₃ groups from GalNAc4,6SO₃, in absence of IdoA2SO₃-GalNAc4SO₃, considerably reduces the activity. A low molecular mass natural fraction rich in IdoA2SO₃ as well as glucuronic acid, having higher electrophoretic mobility than the higher molecular mass DS which contains less glucuronic acid, is remarkably active.