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Objective: This study aimed to assess the long-term outcome of patients with acromegaly. Design: This is a multicenter, retrospective, observational study which extends the mean observation period of a previously reported cohort of Italian patients with acromegaly to 15 years of follow-up. Methods: Only patients from the centers that provided information on the life status of at least 95% of their original cohorts were included. Life status information was collected either from clinical records or from the municipal registry offices. Standardized mortality ratios (SMRs) were computed comparing data with those of the general Italian population. Results: A total of 811 patients were included. There were 153 deaths, with 90 expected and an SMR of 1.7 (95% CI 1.4–2.0, p< 0.001). Death occurred after a median of 15 (women) or 16 (men) years from the diagnosis, without gender differences. Mortality remained elevated in the patients with control of disease (SMR 1.3, 95% CI 1.1–1.6). In the multivariable analysis, only older age and high IGF1 concentrations at last available follow-up visit were predictors of mortality. The oncological causes of death outweighed the cardiovascular ones, bordering on statistical significance with respect to the general population. Conclusions: Mortality remains significantly high in patients with acromegaly, irrespectively of disease status, as long as the follow-up is sufficiently long with a low rate of patients lost to follow-up. Therapy strategy including radiotherapy does not have an impact on mortality. Oncological causes of death currently outweigh the cardiovascular causes.

Summary:Limiting total mixed ration (TMR) availability from 24 to 19 h/d changed the eating patterns of lactating dairy cows. Availability of ad libitum hay also made a significant difference in dry matter intake (DMI) patterns, as shown by the 95% confidence limits in the shaded bands. Rumen pH pattern throughout the day was modified in restricted-fed cows, but ranges in values were similar to those of ad libitum-fed cows. The changes in intake patterns over time indicate that when feeding TMR diets, cows can adjust to the changes in feed availability and access to long hay.

A convenience sample of 20 farms in the geographic bounds of the Parmigiano Reggiano cheese producing region of northern Italy were studied. All farms used a TMR feeding system consisting of all dry hay (primarily alfalfa and grass) diets and adhering to the specific limitations of feeds as described by the Parmigiano Reggiano cheese consortium. Farms were visited twice for a survey of general farm characteristics and feeding management practices and collection of feed intake and samples at 0, 8, and 24 h after feeding to measure particle size characteristics of TMR in the feed bunk at each time. Many farms added 1 to 10 L of water per cow to the TMR in an attempt to reduce sorting and enhance intake. Based on particle size analysis it appeared that cows were not sorting diets to any great degree either with or without added water. However, it is likely that adding water to the TMR enabled cows to eat faster, thereby producing less saliva per kilogram of feed, and helped to create a situation for more slug feeding in the warm summer months of this study when the water-added TMR heated due to molding several hours after feeding. There was a positive correlation (r = 0.41) between the amount of added water and the percentage of cows on a farm that had an inversion of milk fat and protein or low fat percentage. Farms using pelleted concentrates also had less milk fat (r = −0.41). Overall there appeared to be no advantage of adding water to reduce TMR sorting on these farms.

The role of indigestible NDF is essential in relation to OM digestibility prediction, total tract digestibility, rumen fill, passage rate, and digestion kinetics. Moreover, the truly indigestible NDF (iNDF) represents a core point in dynamic models used for diet formulations. However, despite its wide possible applications, few trials have been conducted to quantify iNDF and even fewer to investigate whether or not it is consistent among different forage sources. The objective of this study was to predict the iNDF by measuring the residual NDF after 240-h in vitro fermentation to determine the unavailable NDF (uNDF240) within and among various forage types. Finally, a mathematical approach was investigated for the estimation of the uNDF240fraction. In all, 688 forages were analyzed in this study. This pool included 122 alfalfa hays, 282 corn silages, and 284 grass hays. Values of uNDF240varied among different forages and within the same type (22.7% ± 4.48%, 20.1% ± 4.23%, and 11.8% ± 3.5% DM for grass hay, alfalfa hay, and corn silages, respectively). The relationship among uNDF240and ADL was not constant and, for grass hay and corn silage, was different (P <0.05) from the 2.4 × lignin value applied by the traditional Chandler equation. The observed uNDF240:ADL ratio was 3.22 for grass hay and 3.11 for corn silage. Relationships among chemical and biological parameters and uNDF240were investigated via simple and multiple regression equations. The greatest correlation with a single variable was obtained by ADL and ADF when applied to the whole data set (R2= 0.63). Greater coefficients of determination resulted from a multiple regression equation for the whole data set (R2= 0.80) and within each forage type (R2= 0.65, 0.77, and 0.54 for grass hay, alfalfa hay, and corn silage, respectively). In conclusion, a regression approach requires specific equations and different regression coefficients for each forage type. The direct measurement of uNDF240represented the best approach to obtain an accurate prediction of the iNDF and to optimize its specific purpose in dynamic nutrition models.

Background:Hyponatraemia is the most frequent electrolyte disorder in hospitalized patients and has been associated with increased morbidity, mortality and length of hospital stay. There is evidence that also mild chronic hyponatraemia may have clinical consequences, such as gait disturbances, attention deficits, falls, increased risk of fractures and reduced bone mineral density. Nevertheless, this condition appears to be rather often not taken into consideration, or inappropriately managed and treated, thus negatively affecting patients’ outcome. Aim:The aim of this study was to investigate the awareness and management of hyponatraemia secondary to SIAD, a common cause of hyponatraemia, among Italian physicians (endocrinologists, nephrologists, internists) commonly involved as consultants. Methods:A questionnaire, covering definition, diagnosis, management, treatment and prognosis of hyponatraemia secondary to SIAD, was developed with the support of the Italian Society of Endocrinology. Results:Among the respondents (n=275), the majority was aware of the negative implications of hyponatraemia or of an inappropriate treatment. Nevertheless, the answers indicated that SIAD is still underdiagnosed and incorrectly managed in clinical practice. In particular, only 47% of respondents used the validated biochemical parameters to diagnose hyponatraemia secondary to SIAD. The survey also indicated a rather satisfactory knowledge of the therapeutic options, including the currently available vasopressin receptor antagonists. Conclusions:One of the main findings of the survey was that the diagnostic work-up of hyponatraemia still represents a critical issue. Therefore, there is urgent need of educational programs in order to improve the management of this condition and reduce morbidity, mortality and costs.

OBJECTIVE: We describe an unusual case of ectopic TSH-secreting pituitary adenoma arising from the vomerosphenoidal junction. CLINICAL PRESENTATION: A 52-Year-old man with a long-standing history of hyperthyroidism was referred to the University Hospital in September 2001 because of increasingly disabling symptoms of nasal obstruction. For the past 18 Years the patient had complained of palpitations, hypertension, weight loss, and nervousness. A presumptive diagnosis of Graves' disease was made. Treatment with methimazole was begun, but the patient was lost to follow-up. On admission, physical examination revealed signs of hyperthyroidism and a large diffuse goiter. Tests of thyroid function showed inappropriate secretion of TSH with hyperthyroidism. Both a TSH-secreting pituitary adenoma and resistance to thyroid hormone could be taken into account. There was no evidence of pituitary tumour by magnetic resonance imaging (MRI), but a large space-occupying lesion involving the nasal cavity and the nasopharynx was incidentally discovered. INTERVENTATION AND TECHNIQUE: Using an endoscopic endonasal approach, the tumour was removed en bloc together with the sphenoid floor, sphenoid rostrum, bony septum, and part of the soft palate mucosa. Histological features and immunophenotype were those of a TSH-secreting tumour. CONCLUSION: Although exceedingly rare, ectopic TSH-secreting pituitary tumour should be borne in mind in cases of inappropriate secretion of TSH with hyperthyroidism and no evidence of pituitary tumour by computed tomography and/or MRI when a mass located along the migration path of the Rathke's pouch is demonstrated by radiological examination. To our knowledge, this is only the second reported case in the literature.

AbstractTwo homogeneous groups of dairy cows were fed the same base diet added with a concentrate containing 10 % of soybean meal or 10.1 % of faba bean and 10.1 % of pea. The substitution of soybean meal with faba bean + pea reduced dry matter intake (−0.83 kg/head/day equivalent to 3.5%) and milk yield (−1.29 kg/head/day equivalent to 3.9%), but increased fat and casein concentrations in milk and, as a consequence, cheese yield at 32 hours (P>0.01). The present data show that is possible feed a GMO free diet to dairy cows, without using soybean meal.