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Malignant cancer affecting the heart is rare and treatment is problematic. It is most often found in conjunction with cancers of the liver and intestines, and less often with lung cancers. The type of cancer is important in both diagnosis and treatment because the cancers will respond differently. Those associated with the liver and intestines cause an increased production of an enzyme, 5 hydroxyindole acetic acid, that converts a substrate into serotonin, a substance that can decrease production of the hormone somatostatin. The increase in the enzyme can be detected in urine. Lung cancers do not usually cause this increase. Release of a large amount of serotonin during tumor removal can have adverse effects on the patient and somatostatin must be given to counter these effects. When the cancer originates in the lungs, symptoms are often absent. Treatment usually involves complete surgical removal of tumors and surrounding tissues. This case study examined the diagnosis and treatment of a lung tumor that invaded the left atrium in a 63-year-old woman who complained of a persistent cough and flushing of the face. Diagnostic imaging uncovered the tumor. The tumor appeared to have invaded heart tissue, but not to have spread elsewhere. Surgical removal was performed. A urine sample did not test positive for increased enzyme activity. During surgery, the tumor was found to have invaded the left atrium. As removal was attempted, the patient's blood pressure dropped dramatically, and somatostatin had to be infused for the surgery to be completed. Examination of the tumor found it was atypical. It secreted directly into the heart, which caused the blood pressure drop. This case indicates that somatostatin should be available for all tumor operations involving the heart, even when urine sample are negative for 5 hydroxyindole acetic acid. (Consumer Summary produced by Reliance Medical Information, Inc.)

The authors reviewed 59 consecutive patients treated with plasma exchange (PE) for acute, severe attacks of CNS demyelination at Mayo Clinic from January 1984 through June 2000. Most patients had relapsing-remitting MS (n 22, 37.3), neuromyelitis optica (NMO) (n 10, 16.9), and acute disseminated encephalomyelitis (n 10, 16.9). PE was followed by moderate or marked functional improvement in 44.1 of treated patients. Male sex (p0.021), preserved reflexes (p0.019), and early initiation of treatment (p0.009) were associated with moderate or marked improvement. Successfully treated patients improved rapidly following PE, and improvement was sustained.

A prospective study was made of 92 patients who underwent emergency colorectal surgery during a 1-year period. A dedicated emergency theatre allowed half of the patients to be operated on between 09.00 and 17.00 hours with greater seniority of operating surgeons. The overall mortality rate was 14 per cent and the primary resection rate was 79 per cent. The mortality rate was 12 per cent for right-sided resection with anastomosis and 24 per cent for left-sided resection without anastomosis, including those undergoing Hartmann's procedure which had a 35 per cent mortality rate. Immediate left-sided anastomosis was performed safely in all 14 patients in whom it was attempted. Firms headed by consultants with and without a special interest in colorectal disease made differing use of primary resection and immediate anastomosis (67 versus 41 per cent, P< 0·05) and Hartmann's (7 versus 25 per cent, P< 0·05) and non-resectional (15 versus 29 per cent, P not significant) procedures. Retrospective surveys of perioperative deaths examine inadequate management and subsequent mortality rates, but do not reveal the significant morbidity rate that occurs in survivors. This audit revealed significant diferences in the management of patients with colorectal emergencies between, firms headed by specialist and non-specialist consultants. In order to minimize these diflerences we believe that recent advances in colorectal practice should be included in the training of all surgeons.

Faecal bile acid excretion and sigmoid myoelectrical activity were measured on three separate occasions over a 12-month period in 21 patients with diverticular disease and the results were compared with those of 17 age-matched normal subjects. Statistically significantly lower faecal concentrations of both deoxycholic and lithocholic acid were found in patients with diverticular disease (96·7 ± 11·3 mg/100 g, 59·6 ± 6·0 mg/100 g respectively) when compared with normal subjects (219 ± 32·0 mg/100 g and 117·6 ± 14·6 mg/100 g respectively P < 0·001). These values persisted throughout the period of study. Patients with diverticular disease were found to have an abnormally rapid myoelectrical rhythm (frequency 0·2–0·3 Hz [12 – 18 c/min]) which returned towards normal after 1 year's bran treatment. Significant correlatzons were found between lithocholic acid concentrations and activity of 0·2–0·3 Hz (r = 0·67) and deoxycholic acid concentrations and activity of 0·1–0·15 Hz (6–9 c/min) (r = 0·62). It is suggested that increased colonic absorption of bile acids may occur in diverticular disease which may influence the myoelectrical activity.

The absorption of water and electrolytes and intraluminal pressure were measured from Thiry-Vella loops in 4 dogs under basal conditions and during electrical stimulation of the colonic smooth muscle. Pulse wave electrical stimulation via serosal silver | silver chloride electrodes gave rise to significant increases in both intraluminal pressure and percentage motility. Absorption of water, sodium and chloride was significantly increased during stimulation but the transport of ammonia, bicarbonate and potassium was not significantly affected. It is suggested that motility changes result in altered absorption irrespective of transit time.

The effect of different concentrations of sodium cholate, sodium chenodeoxycholate and sodium deoxycholate on colonic myoelectrical activity was studied in 4 dogs. There was no statistically significant difference in percentage motility, motility index, basal pressure or mean slow wave frequency with either cholic or chenodeoxycholic acid (5–15 mm). Deoxycholic acid (15 mm), however, caused a marked increase in percentage motility (median control value 4·1, range 0–23; after installation, median value 27·0, range 20·6–45·0, P < 0·001). This was accompanied by an increase in spike activity, but no alteration in mean slow wave frequency or basal pressure was seen. Cholestyramine inhibited the motor response. It appears that only deoxycholic acid affects both motility and absorption, presumably by different pathways, and may thus assume importance in disorders of colonic motility.

The low affinity IgG Fc receptor, Fc gamma RIII, expressed on circulating neutrophils, natural killer (NK) cells, and tissue macrophages, is involved in effector functions such as cytotoxicity and immune complex clearance by these cells. While Fc gamma RIII is reported to be a phosphatidylinositol (PI)-linked, rather than peptide- linked, protein on neutrophils and NK cells, its membrane linkage in macrophages has not been studied. We examined the sensitivity of Fc gamma RIII to cleavage by PI-specific phospholipase C (PI-PLC) in cultured monocytes and alveolar tissue macrophages and report that this receptor is not PI-linked on these cells. We also observed normal levels of Fc gamma RIII on cultured monocytes of a patient with paroxysmal nocturnal hemoglobinuria, a disease in which PI-linked proteins are deficient. The results suggest that Fc gamma RIII occurs solely in a transmembrane form in cells of the monocyte/macrophage lineage. In addition, we studied Fc gamma RIII on a cloned NK cell line and found it to be resistant to the effects of PI-PLC under conditions that cleaved Fc gamma RIII on neutrophils. Taken together, our results provide evidence for a distinct form of Fc gamma RIII that differs from the neutrophil receptor in its structure and, possibly, in its function.

1. This study examines the effect of chronic cold exposure during pregnancy, induced by winter shearing twin‐bearing ewes 4 weeks before predicted lambing date, on O2 consumption and CO2 production during non‐rapid‐eye‐movement (REM) sleep in lambs maintained for at least 1 h at warm (28‐18 degrees C) and cold (14‐5 degrees C) ambient temperatures at 1, 4, 14 and 30 days of age. This was combined with measurement of the thermogenic activity (GDP binding to uncoupling protein in mitochondrial preparations) of perirenal adipose tissue from lambs immediately after birth and at 33 days of age. 2. Lambs born from shorn (cold‐exposed) ewes were 15% heavier (P < 0.01) and possessed 21% (P < 0.01) more perirenal adipose tissue that contained 40% more protein and mitochondrial protein than unshorn (P < 0.05) controls. Total GDP binding in perirenal adipose tissue was 40% greater (P < 0.05) in lambs born from shorn ewes but there was no difference in lipid content of this tissue between the two groups. 3. At 1 day of age, lambs born from shorn ewes exhibited a 16% higher (P < 0.05) rate of O2 consumption (per kilogram bodyweight) at the warm temperature and a 40% greater metabolic response to the cold ambient temperature. All lambs born from shorn ewes responded to cold exposure without shivering (i.e. via non‐shivering thermogenesis) whilst shivering was measured in four out of seven lambs in the unshorn group. These differences had disappeared by 4 days of age as a result of a 25% increased (P < 0.01) rate of O2 consumption in the warm in lambs born from unshorn ewes and a 20% decrease (P < 0.05) in the response to the cold in lambs from shorn ewes. Shivering during cold exposure was measured in six out of nine lambs born from shorn ewes indicating a rapid alteration in thermoregulatory responses to cold during the first few days of life. 4. The levels of GDP binding and mitochondrial protein in perirenal adipose tissue fell by one‐third in both groups of lambs during the first 33 days of life whereas lipid content either increased or was unchanged. This indicated that brown adipose tissue (BAT) was developing the characteristics of white adipose tissue.(ABSTRACT TRUNCATED AT 400 WORDS)

Summary.A creatine kinase assay based on estimation of creatine liberated from creatine phosphate was accurate and reproducible for use with seminal or prostatic fluid, after allowance was made for acid phosphatase interference. Comparison of this method with one which relies on enzymic coupling of ATP formation to NADP+oxidation shows that the latter under-estimates creatine kinase activity by a factor of about 3. This discrepancy could be due to the high ATPase activity found in prostatic and seminal fluid. Uncritical use of the NADP+assay might account for different seminal creatine kinase values reported in the literature.Interrelationships between ATPase, creatine kinase and zinc suggest that seminal ATPase is a prostatic secretory product while creatine kinase may be multiglandular in origin.

OBJECTIVE: To assess the importance of iron overload as a risk factor for porphyria cutanea tarda (PCT). DESIGN: Prospective study during a 4-month period. SETTING: Departments of emergency care, gastroenterology, and dermatology in a tertiary referral center. PATIENTS: Patients were deemed eligible for inclusion in the study if serum ferritin levels were greater than 500 μg/L (normal range: females, &lt;125 μg/L; males, &lt;325 μg/L). MAIN OUTCOME MEASURES: Porphyrin excretion profiles were analyzed on all patients included in the study, where clinically relevant. A diagnosis of PCT was confirmed biochemically in all cases. The HLA typing was then performed on newly diagnosed cases of PCT. RESULTS: Of 4127 patients tested, 240 patients with an elevated serum ferritin level were identified, of whom 74 had an elevated serum ferritin level of more than 500 μg/L. Of the latter group, 17.5% had hemochromatosis and 6.7% had PCT. The incidence of PCT in the hemochromatosis group was 23%; HLA typing revealed the presence of at least 1 of the hemochromatosis markers. CONCLUSIONS: A high serum ferritin level in the absence of evident cause should prompt investigation for both hemochromatosis and PCT. The HLA heterozygosity for hemochromatosis in some patients with PCT may be a cause of hepatic siderosis.Arch Dermatol. 1997;133:1098-1101

Twenty patients with established irritable colon syndrome were studied at presentation and following a mean period of 14.3 months of bran treatment. An abnormal myoelectrical activity consisting of a high incidence of 3 c/m slow-wave electrical activity was recognised in the rectosigmoid and confirmed by objective automated frequency analysis. After the period of prolonged treatment, the high 3 c/m slowwave activity persisted, but the incidence of 6-9 c/m activity increased. This was associated with an improved stool weight and transit time in patients with predominant constipation but no alteration in patients with predominant diarrhoea.

Prophylactic use of the monoclonal antibody OKT3 has been studied for the prevention of rejection in sensitised renal transplant recipients. Patients receiving a full dose (FD) regimen were compared to a subsequent consecutive group of patients receiving a reduced dose (RD) regimen. The characteristics of the two groups were not significantly different with regard to age, HLA mismatch and panel-reactive antibody (PRA) status. The number of days that OKT3 was given was 12.9±1.8 for the FD regimen and 11.3±2.8 for the RD regimen. The total dose of OKT3 given was 64.4±9 mg (FD) and 38.3±8.5 mg (RD). Patient survival at 12 months was 8/8 for FD and 17/17 for RD. Graft survival at 12 months was 7/8 for FD and 17/17 for RD. Creatinine at 24 months was 185±68 and 201±81 µmol/l for FD and RD, respectively. A reduced dose regimen of OKT3 produced excellent and comparable results to the standard recommended fulldose regimen. The cost per patient was reduced 40% from £5676 for FD to £3344 for RD.

The value of biochemical examination of postprostatic massage (VB3) urine samples has been investigated. Measurement of zinc levels provides a good marker of prostatic secretory function. In the absence of prostatic carcinoma findings of =100 µg zinc in VB3 urines is strong evidence (2% false negatives) of an absence of infectious or inflammatory prostatic disease. Less than 40 µg of zinc is suggestive (14% false positives) of prostatitis. There is little need to consider the endogenous urinary zinc levels. This simple test should be of particular value in cases where an expressed prostatic secretion is not obtained (about 40% of this series of patients), when it would be a valuable adjunct to cytological and bacteriological examination of split urine samples.

1. Blood flow distribution between the abdominal viscera and the leg muscles of regularly-laying Rhode Island Red hens was measured at rest and immediately following treadmill exercise, using the radioactive microsphere technique.2. Exercise brought about a 150% increase in metabolic rate and this was maintained continuously for 90 min.3. Although there was a small shift in blood flow distribution towards the hindlimb muscles at the expense of the kidneys and reproductive organs, this was not statistically significant.4. There was a significant reduction in blood flow to the preovulatory follicles of the ovary during exercise, relative to the rest of the abdominal viscera.5. It is concluded that exercise of this intensity is insufficient to bring about gross changes in blood flow distribution between the abdominal viscera and the hindlimb muscles. The implications of this finding are discussed in relation to the nutrient and blood flow requirements of the reproductive organs.

To describe the epidemiology of bacteremia in a large, well defined population, the authors reviewed medical records for residents of Charleston County, South Carolina, who had bacteria isolated from blood in the period 1974 to 1976. The incidence was 80 cases per 100,000 population per year. The most common organisms were Escherichia coli, Staphylococcus aureus, Klebsiella, and Streptococcus pneumoniae. The incidence was highest for neonates, infants, and those 70 years of age and older with annualized attack rates of 1,864,250, and 446 cases per 100,000 population, respectively. The incidence was 3.2 times higher for blacks than for whites and, within races, appeared to be independent of family income. Twenty-five per cent of patients had no clinically apparent focus of infection, 26% had urinary tract infection, and 17% had pneumonia. Thirty-nine per cent of cases were nosocomial, and 30% of patients died.

To describe the epidemiology of pneumococcal bacteremia in a large population, this study reviewed medical records for residents of Charleston County, South Carolina, who had pneumococci isolated from blood cultures during the period 1974-1976. The overall incidence of documented pneumococcal bacteremia was 8.5 cases per 100,000 population per year. It was highest for those in the first two years of life (35 per 100,000 per year) and those in their sixties (21 per 100,000 per year). The incidence was more than five times higher in blacks than in whites and within races appeared to be independent of socioeconomic status or population density. Seventy-three per cent of the cases occurred in persons with another medical problem. These data on the incidence of documented pneumococcal bacteremia underestimate the true incidence of bacteremia to the extent that blood cultures were not performed under optimal circumstances for all persons with compatible clinical syndromes. The data suggest that certain groups would benefit from vaccination against pneumococcal disease if the vaccines are shown to be safe and effective for these groups.

Tenckhoff catheters are used widely for the provision of continuous ambulatory peritoneal dialysis. Traditionally these catheters are removed surgically under anaesthesia. We set out to introduce and monitor prospectively a technique for removal of the Tenckhoff catheter by a 'pull' technique. The intention was to avoid the discomfort, risk and cost of traditional surgery.

AbstractMost applied anthropologists will agree that our field should have a greater voice in national and international policy making. But suppose we woke up one day and were invited to every policy making group working in Congress or the United Nations. Could we contribute in a meaningful way? In anthropology’s century of existence we have collected reams of data, generated much information, and certainly produced knowledge in numerous areas. But have we been able to use this data, information, and knowledge to offer wisdom to society? In some cases we have (e.g., see the AAA Website on race [http://www.ameranthassn.org/govafar.htm]). But I think we all would agree that anthropology has not reached its potential to influence the development and implementation of policy.

Forty patients with end-stage renal failure, who had undergone simultaneous bilateral native nephrectomy before a subsequent renal transplant operation, were reviewed with particular reference to the indications and surgical approach for bilateral nephrectomy and to the complications of the procedure. The main indications for bilateral nephrectomy are hypertension resistant to medical therapy, persistent symptomatic renal infection, severe renal protein loss and occasionally polycystic kidneys or bilateral renal tumours. In this consecutive series of 40 patients both kidneys were removed because of chronic pyelonephritis with reflux (n= 28), glomerulonephritis with reflux (n= 9) and uncontrolled hypertension (n= 3). Surgical morbidity was less in patients who had bilateral nephrectomy performed through bilateral vertical lumbotomy incisions. There was no surgical mortality.

Anorectal motility measurements have been performed on 19 patients with adult megacolon and the results compared with 12 normal subjects. Adult Hirschsprung's disease (4 patients) was recognized by the absence of anal canal inhibition on rectal distension (normal mean inhibition 21·9 ± 2·3 mmHg).Seven patients with non-Hirschsprung's megacolon (idiopathic) had an elevated anal canal pressure (mean 90·4 ± 7·0 mmHg). These patients were treated with repeated anal dilatation. Eight further patients had normal anal canal pressures (mean 33·2 ± 11·7 mmHg) and were treated with enemas and regular suppositories. Little overall clinical improvement resulted in this group and 1 patient underwent subtotal colectomy.Measurements of anorectal motility have been found to assist in the management of adult megacolon.

Abstract: The degradation of electrophysiological signals by electrostatically and electromagnetically induced interference is discussed. An instrument is described which reduces the adverse effects of electrical interference on electrophysiological recordings.

Summary: Two cases of immunodeficiency with increased IgM are reported. Patient 1 was a black male 3.5 years old who had recurrent pyogenic infections, failure to thrive, oral thrush, and systemic cryptococcal infection. Patient 2 was a 9-year-old white female who had recurrent cervical abscesses. Serum immunoglobulin determinations by radial immunodiffusion in both patients showed marked depression of IgG and IgA and marked elevation of IgM. A low molecular weight circulating monomeric IgM was demonstrated by immunoelectrophoresis and gel filtration in the second patient; this was not present in the first case. In vitro impairment of cellular immunity was observed in both patients. Administration of dialyzable leukocyte extracts (transfer factor) led to improvement of cell-mediated immunity in patient 1. The etiology of this syndrome apparently has several different genetic bases. These patients demonstrate heterogeneity in genetic, ethnic, immunologic, and other features of the syndrome.Speculation: The cause of hyper-IgM syndrome with depressed synthesis of IgA and IgG immunoglobulins is unknown. Deficiency in the function of T cells1or a subpopulation thereof could have a causal relation to this syndrome, since there is increasing evidence that normal cellular immunity is necessary for the IgM-to-IgG “switch” in immunoglobulin production; whether it is also necessary for the formation of normal polymeric IgM from monomeric IgM is unknown, but this possibility merits speculation. In the present study, the occurrence of monomeric IgM in one patient but not the other, along with the differences in clinical manifestations, raises the possibility that the presence of monomeric IgM may be an index of a distinct subcategory of this syndrome with certain clinical features present only when the monomeric molecule is found. Our two patients, and all eight previously reported patients in whom isohemagglutinins were studied, had isohemagglutinins for A and B cells (i.e., were blood type O). In addition, two other hyper-IgM patients seen by us subsequently have been found to be blood type O (unpublished observation). If this phenomenon is universal, it would suggest a very close association between the blood group O antigen and this syndrome.

Abstract As part of an ongoing study, 80 patients undergoing cadaveric renal transplantation were randomised to receive either Prograf [PTT (patients receiving Prograf); n = 40]- or Neoral [NTT (patients receiving Neoral); n = 40]-based immunosuppression as part of a triple therapy regimen. Prograf was commenced at a dose of 0.2 mg/kg per day and Neoral at 8 mg/kg per day. Both groups received identical azathioprine and corticosteroid regimens. Trough levels for Prograf were maintained between 5 and 15 ng/ml and for Neoral between 100 and 200 ng/ml. During the 3-month follow up 40 % of PTT and 33 % of NTT experienced biopsy-proven acute rejection. In each group 81 % of rejection episodes were classified as either borderline or grade 1. The median 3-month serum creatinine levels were 128 μmol/l and 135 μmol/l, respectively, for PTT and NTT. Six grafts were lost in the NTT group including three deaths with functioning grafts whilst none were lost in the PTT group (χ², P &lt; 0.02). The prevalence of other complications was similar for the two groups. We conclude that Prograf represents an effective and safe therapy as a primary immunosuppressive agent following cadaveric renal transplantation and appears to have a similar side-effect profile to Neoral.

AbstractThe articles presented in this volume were prepared for the 1997 Society for Applied Anthropology Meetings held in Seattle, Washington. The purpose of the session was to convey what is happening in the world of cultural resource management in Indian country today. There is a change underway, due primarily to the direct involvement of Native Americans in cultural resource management. The field is changing from viewing cultural resources as sources of scientific information to understanding cultural resources as important parts of indigenous cultural systems.

AbstractWe have been fortunate over the last few years to work alongside Native Americans in conducting cultural resource management activities. These experiences have helped us appreciate the importance of cultural resources to the Indian people. We are convinced that Native Americans must be directly involved in cultural resource management activities for two main reasons: they understand the cultural resources in ways that non-Indians probably never can, and because these sites are an integral part of their past, present, and future, they care more about them than non-Indians do. Thus, if the resources are to be protected and made available to future generations of Native Americans, Native Americans must take an active role in managing the resources.

IntroductionThe diagnosis of colorectal cancer (CRC) in primary care can be challenging as symptoms are variable with poor specificity. We investigated the diagnostic accuracies of faecal immunochemical test for haemoglobin (FIT) and faecal calprotectin (FCP) in symptomatic patients referred from primary care for urgent lower gastrointestinal investigations via the two-week wait colorectal pathway.Method1016 patients were prospectively recruited between January 2015 and September 2016. In total 612 patients returned stool samples, completed colonic investigations and were included in the final statistical analysis (51% women, median age 68 years, IQR: 57–76). FIT was performed on HM-JACKarc analyser (Kyowa Medex), and FCP by EliA Calprotectin immunoassay (Thermo Fisher Scientific). Any detectable FIT (detection limit 7 µg Hb/g faeces) and a cut-off of 50 µg/g for FCP were considered positive.Results37 (6%) patients were diagnosed with CRC. The negative predictive value (NPV) of FIT vs. FIT plus FCP was the same at 99% (95% CI 98% to 100%). The sensitivity and specificity of FIT was 84% and 89%, respectively. Whereas, it was 89% and 86% for FIT combined with FCP. The ROCs for FIT, FCP and both faecal biomarkers combined showed AUC 0.90, 0.73 and 0.91, respectively. Faecal ćhaemoglobin measurements were significantly higher in left-sided colonic lesions compared ćwith the right side; 490 µg Hb/g faeces vs. 90 µg Hb/g faeces; p=0.007).[Figure]ConclusionUndetectable FIT is sufficiently sensitive to exclude colorectal cancer, with higher values in left-sided lesions. FCP in combination does not appear to provide additional diagnostic information. Further studies to determine the health economic benefits of implementing FIT in primary care are required.Disclosure of InterestM. Widlak: None Declared, C. Thomas: None Declared, M. Thomas: None Declared, C. Tomkins Conflict with: Educational lectures on behalf of Thermo Fisher Scientific Ltd., S. Smith: None Declared, C. Darby: None Declared, N. O’Connell: None Declared, S. Wurie: None Declared, L. Burns: None Declared, C. Harmston: None Declared, C. Evans: None Declared, C. Nwokolo: None Declared, B. Singh: None Declared, R. Arasaradnam Conflict with: Educational lectures on behalf of Thermo Fisher Scientific Ltd.

PREMESSE: La malattia di Cushing è una patologia ad alta morbidità e mortalità per la quale oggi non vi è una terapia medica di provata efficacia. Il pasireotide, un ligando multirecettoriale per i recettori per la somatostatina (SS), ha dimostrato di possedere nell’animale in vitroe in vivoun significativo effetto inibitorio sulla funzione corticotropa con conseguente riduzione della secrezione glucocorticoide in tumori ACTH-secernenti. SCOPO:Valutare l’efficacia di un trattamento a breve termine con pasireotide in pazienti affetti da malattia di Cushing. METODI: È stato valutato l’effetto del trattamento per 15 giorni con pasireotide (600 mg/bid) in 39 pazienti con malattia di Cushing, de novo, persistente o recidivata dopo trattamento neurochirurgico. RISULTATI: Dei 29 pazienti in cui si è potuta eseguire l’analisi di efficacia, il 76% (N=22) ha dimostrato una significativa riduzione dei livelli di cortisoluria, con normalizzazione nel 17% (N=5), in associazione a una riduzione dei livelli di ACTH e cortisolo, più pronunciata nei soggetti responder. I livelli plasmatici steady statedi pasireotide sono stati ottenuti entro 5 giorni dall’inizio del trattamento. I pazienti responderhanno dimostrato livelli plasmatici di pasireotide più elevati rispetto ai non responder. CONCLUSIONI: Il trattamento a breve termine con pasireotide ha dimostrato un significativo effetto inibitorio sui livelli di cortisoluria nella maggior parte dei pazienti studiati con malattia di Cushing, associato a una riduzione della secrezione corticotropa, suggerendo una potenziale nuova prospettiva terapeutica in tale patologia.

Recordings of the myoelectrical activity have been obtained from the small intestine of 4 dogs by means of serosally implanted electrodes. The occurrence of the activity front (phase III) of the migrating myoelectrical cycle (MMC) in the recordings obtained each day after abdominal surgery have been compared. No activity fronts were seen on postoperative days 1 and 2. From days 3 to 6 there was a slightly reduced incidence, but from day 7 onwards an activity front was observed in each recording. It is concluded that the normal pattern of cyclic myoelectrical activity in the small intestine is disrupted for at least 2 days following a laparotomy, and the view that small bowel motility returns to normal soon after routine abdominal surgery may be inaccurate.

Hypertension control rates (BP <140/90) vary from 6 in the UK to 27% in the U.S. (NHANES III). Retrospectively, we analyzed 63,335 blood pressure measurements in 8,735 patients managed in the Division of Hypertension from 1997-2000. Using the nurse-physician clinic model for hypertension management, overall control rates were stable (49.3-51.4%) over the four years. Control was defined as the mean of the last two readings <140/90-mm Hg in each year for each patient. When control rates were analyzed by 20-year spans of age, control rates for patients > 60 years of age were markedly lower than for younger patients (Table 1). The differences in control rates between patients > 60 years of age and those less than 60 years were also seen when control was defined as: 1) the mean of all visits in a year was < 140/90 mm Hg for each patient, or 2) more than 50% of visits in each year during which the patients BP was < 140/90 mm Hg. Failure to achieve blood pressure goals was almost always due to failure to reduce systolic BP to less than 140 mm Hg. TABLE 1 Number (%) BP < 140/90 By 20-year spans of Age Yrs. of Age199719981999200020-3960/89 (67%)67/94 (71%)80/107 (75%)87/110 (79%)40-59320/480 (67%)394/616 (64%)368/584 (63%)325/491 (66%)60-79557/1182 (47%)650/1395 (47%)639/1422 (45%)572/1212 (47%)80+53/207 (26%)84/290 (29%)72/239 (30%)54/206 (26%) Conclusion: For patients less than 60 years of age, the nurse-physician model of hypertension management results in control rates higher than reported elsewhere. Control rates for patients > 60 years are better than reported worldwide but still poor, this is due to persistent systolic hypertension. New treatment paradigms are necessary to improve control rates in the elderly.

We examined the oxidation of different chain length fatty acids in the leukocytes and the quantity of lipid peroxides in the plasma of Reye syndrome patients. We have found that the oxidation of [1-14C] octanoic acid in homogenates of leukocytes from a patient with Reye syndrome (1.25 ± 0.09 nmol/mg protein/hr) was only 38 percent of the control (3.34 ± 0.07 nmol/mg protein/hr), whereas oxidation of [1-14C] palmitic and [1-14C] lignoceric acids was slightly increased. The rates of oxidation of [1-14C] lignoceric and palmitic acids in Reye's Syndrome were 0.885 ± 0.004 and 0.032 ± 0.002 nmol/mg protein/hr respectively and for their controls were 0.661 ± 0.05 and 0.02 ± 0.004 nmol/mg protein/hr respectively. The level of lipid peroxides in the serum of two Reye syndrome patients in stage III was 4.42- and 3.04 times higher than the control level. Lipid peroxides and ammonia levels were higher in one patient during the period of active disease and subsequently came back to normal levels as the patient improved. These results suggest that impaired oxidation of octanoic acid and higher levels of lipid peroxides may contribute to the pathogenesis of cellular toxicity in Reye syndrome. Supported by grants from National Reye's Syndrome Foundation and NS 22476 from National Institutes of Health.

4 patients with male karyotype, two of whom have an uterus and ovarian stroma while the other two have “vanishing” testes (1 patient) and a small testes (1 patient) have been treated with local testosterone cream in an attempt to enlarge their penis so as to make operative correction of their perineal or scrotal hypospadias easier.The results of pre- and post-operative clinical and laboratory measurements are presented, including the results of human chorionic gonadotrophin tests and of plasma testosterone levels.