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Insulin and glucagon secretion were studied during an oral glucose tolerance test and arginine infusion in 11 patients with thalassaemia intermedia, who showed laboratory evidence of iron overload. Mean blood glucose concentrations in patients with thalassaemia intermedia were significantly higher than normal and 3 of 11 patients had impaired glucose tolerance. The principal abnormality appears to be a deficiency in insulin and glucagon from the pancreas in response to oral glucose tolerance and arginine stimulation tests. Several factors, such as iron overload, chronic hypoxia, zinc deficiency and increased catecholamine production secondary to anaemia, might play a part in the pathogenesis of these abnormalities. Each of these factors affect individual cases to a varied degree. Our data emphasize the mildness of carbohydrate defect as compared to the degree of insulinopenia and indicate the necessity for prescribing measures which prevent excessive iron deposition and improve iron excretion in thalassaemic patients with iron overload. [ABSTRACT FROM PUBLISHER]

This consensus document has been prepared by a multidisciplinary group of experts (Paediatricians, Radiologists, Paediatric Orthopaedics) and it is mainly aimed at paediatricians, hospitals and primary care providers. We provide recommendations for the early diagnosis and treatment of Developmental Dysplasia of the Hip (DDH) and indications on its management.

Curcumin (CUR) and curcuminoids complexes labeled with fluorine-18 or technetium-99m have recently shown their potential as diagnostic tools for Alzheimer's disease. Gallium-68 is a positron-emitting, generator-produced radionuclide, and its properties can be exploited in situ in medical facilities without a cyclotron. Moreover, CUR showed a higher uptake in tumor cells compared to normal cells, suggesting potential diagnostic applications in this field. In spite of this, no studies using labeled CUR have been performed in this direction, so far. Herein, (68)Ga-labeled complexes with CUR and two curcuminoids, namely diacetyl-curcumin (DAC) and bis(dehydroxy)curcumin (bDHC), were synthesized and characterized by means of experimental and theoretical approaches. Moreover, a first evaluation of their affinity to synthetic β-amyloid fibrils and uptake by A549 lung cancer cells was performed to show the potential application of these new labeled curcuminoids in these diagnostic fields. The radiotracers were prepared by reacting (68)Ga(3+) obtained from a (68)Ge/(68)Ga generator with 1 mg/mL curcuminoids solutions. Reaction parameters (precursor amount, reaction temperature, and pH) were optimized to obtain high and reproducible radiochemical yield and purity. Stoichiometry and formation of the curcuminoid complexes were investigated by matrix-assisted laser desorption ionization time-of-flight mass spectrometry, NMR, ultraviolet-visible, and fluorescence spectroscopy on the equivalent (nat)Ga-curcuminoids (nat = natural) complexes, and their structure was computed by theoretical density functional theory calculations. The analyses evidenced that CUR, DAC, and bDHC were predominantly in the keto-enol form and attested to Ga(L)2(+) species formation. Identity of the (68)Ga(L)2(+) complexes was confirmed by coelution with the equivalent (nat)Ga(L)2(+) complexes in ultrahigh-performance liquid chromatography analyses.(68)Ga(CUR)2(+), (68)Ga(DAC)2(+), and (68)Ga(bDHC)2(+) were highly (87 ± 4, 90 ± 1%) and moderately (48 ± 2%), respectively, retained by synthetic β-amyloid fibrils in vitro. All the Ga-curcuminoid complexes showed an uptake in A549 lung cancer cells, at least equivalent to the respective free curcuminoids, confirming potential applications as cancer-detecting radiotracers.

Objectives: Biocytin analogues labelled with indium-111, yttrium-90 and lutetium-177 have shown their effectiveness in the imaging of infections/inflammation in patients with osteomyelitis and function as efficient tools in pretargeted antibody-guided radioimmunotherapy. In this study, the labelling of a biocytin analogue coupled with DOTA (1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid), namely, r-BHD, with gallium-68 (68Ga) was optimized, and the quality and stability of the preparations were assessed for clinical use., Materials and Methods: Synthesis of 68Ga-r-BHD was carried out by heating a fraction of the 68Ge/68Ga eluate in a reactor containing the biocytin analogue with the appropriate buffer. The influence of the precursor amount (from 2.5 to 140 nmol), the pH of the reaction (from 2 to 5.5) and the buffer species (1.5 mol/l sodium acetate, 1.5 mol/l sodium formate, 4.5 mol/l HEPES) on radiochemical yield and radiochemical purity was assessed. Studies on stability and binding to avidin (Av) were also conducted in different media., Results: Under the best labelling condition (56 nmol of precursor, 3.8 pH, sodium formate buffer) synthesis of 68Ga-r-BHD resulted in a yield of 64 ± 3% (not decay corrected). Radiochemical purity was around 95% because a 68Ga-coordinated sulfoxide form of the ligand was detected as a by-product of the reaction (68Ga-r-SBHD). The by-product was identified and characterized by liquid chromatography-electrospray ionization tandem mass spectrometry. At the natural 1 : 4 Av/68Ga-r-BHD molar ratio, affinity results were 62 ± 2 and 80 ± 2% in saline and human serum, respectively. Stability of 68Ga-r-BHD and of the radiotracer/Av complex remains almost constant over 180 min. 68Ga-r-BHD appears to be a good candidate for clinical applications.

Objectives: The treatment of tumours expressing somatostatin receptors with yttrium-90 (90Y)-labelled and lutetium-177 (177Lu)-labelled somatostatin analogues is one of the most interesting therapeutic approaches adopted in nuclear medicine in recent years. However, the process of synthesis and fractionation of these radiopharmaceuticals is still mainly carried out manually despite the high radiation exposure to the operators and the need to comply with good manufacturing practices. In this study a semiautomatic synthesizer [automatic dose dispenser (ADD-2)] using only disposable syringes and vials has been presented., Materials and Methods: Small-scale syntheses (185-555 MBq) of 90Y/177Lu-DOTATATE were performed by adding the appropriate amount of peptide to a 90Y/177Lu chloride solution (n=10). The radionuclide/peptide molar ratio was 1 : 17 and 1 : 2 for 90Y and 177Lu, respectively. The solutions were buffered to 4.6 pH by ascorbate buffer and heated at 90°C for 30 min. Radiochemical purity was assessed by two independent radio-thin-layer chromatography systems. The solutions were fractioned to mimic the preparation of patient doses., Results: All synthesis and fractionation steps were performed using ADD-2. The radiochemical yield was 92 ± 3% for 90Y and 97 ± 1% for 177Lu labelling. Radiochemical purity was more than 99.5%. The accuracy and reproducibility of the instrument in transferring and fractionating radioactive solutions were high (maximal error ≈ 5%)., Conclusion: ADD-2 appears suitable for use in clinical preparations of 90Y/177Lu-DOTATATE with therapeutic amounts of precursors (20-30 GBq). The operator's exposure to radiation by using ADD-2 in comparison with manual preparations is under investigation.

Objective: To evaluate an organizational model for neonatal population screening for developmental dysplasia of the hip., Methods: In 4648 neonates born in six hospitals of the Lombardy region, screening for developmental dysplasia of the hip was done using the Ortolani-Barlow maneuver and ultrasonography., Results: The frequency of positive results of clinical and ultrasound examinations carried out in the hospitals varied considerably as a result of difficulties in the Ortolani-Barlow test reproducibility and in the low sensitivity of the clinical examination when compared to ultrasonography. Neonatal screening results implied a large number of subjects with a IIa hip, according to Graf's system; as these subjects require follow-up, the cost of this type of screening is high. Ultrasound findings were normal at 69 days of life in 88% and 75% of subjects, respectively, with unilateral and bilateral type IIa hip., Conclusion: This study evaluated various organizational models for screening (for different time periods and for selected populations) in relation to the cost-benefit ratio and demonstrated the different problems that still impede identification of a correct screening model.

Iron excretion following subcutaneous administration of deferrioxamine (DFO) was measured between two transfusions of packed red cells in 6 patients with beta-thalassaemia major on the high level Hb transfusion regime; and in a single 3-day period in 2 other patients, 1 with transfused beta-thalassaemia major and the other with haemolytic anaemia due to PK deficiency. The pattern of iron excretion did not change significantly during the period between the two transfusions and was found to be related to serum ferritin levels. The proportion of iron excreted in the stools was inversely related to the serum ferritin level. These observations on iron excretion are of practical importance in relation to DFO administration, especially when evaluated in thalassaemics with normal haemoglobin levels and low iron stores.

The main abnormalities of the hand and skull in a group of patients who underwent hypertransfusion regimen were reviewed and compared to the lesions observed in a control group of low-transfused patients. The results are reported, and a possible correlation with transfusion regimen is discussed: since bone lesions are explained on the basis of relationship between proliferating bone marrow and bone cortex, hypertransfusion regimen will prevent the development of abnormalities, only if established early in life. For this reason, skeletal lesions in Cooley's anaemia have changed their "classical" radiographic patterns. In the skull, the diploic space may become normal, and the overgrowth of facial bones moderate; the pneumatization of paranasal sinuses may not be completely impeded by the swelling of the jaws, the "hair-brush" pattern may disappear completely. The normalized picture of the hand is and remains a typical differential sign of prepuberal and adult patients.

Gonadotrophin releasing hormone (GRH) was administered to 54 patients (39 prepubertal and 15 pubertal) with beta-thalassaemia major to assess pituitary gonadotrophin secretory reserve. Human chorionic gonadotrophin (HCG) was also administered to 10 of the prepubertal boys to assess gonadal endocrine function. Many patients, some with and some without pubertal changes and including prepubertal children aged from 7 to 12 years, had evidence of pituitary hypofunction. A normal pituitary response to GRH stimulation, with decreased gonadal hormone response to the HCG test, found in 3 subjects, demonstrated that gonadal endocrine failure may also occur.

In order to investigate the pancreatic function in patients with thalassaemia major, plasma glucose and immunoreactive C-peptide levels were determined in 9 diabetic thalassaemic patients and in 7 controls after arginine infusion. Mean basal and peak values and C-peptide areas in thalassaemic patients did not differ significantly from those of the controls. However, in the thalassaemic group there was a greater variation in values, since pancreatic beta-cell function was found either normal, reduced or increased. These findings could suggest that different factors may lead to diabetes which complicates thalassaemia, i.e. insulin-resistance, probably due to liver damage subsequent to iron deposition and infectious hepatitis, and insulinopenia, probably due to beta-cell lesion following iron storage in the pancreas.

The Authors list the results obtained from a tuberculin survey carried out on students of the Faculty of Medicine of the University of Ferrara (school year 1977/1978) and on enlisting soldiers. A different skin positivity is here confirmed: a higher percentage in males (27.41%) than in females (17.91%). A higher frequency of positive responses is noted in students originating from the centre-south of Italy. Such tendency is principally due to the greater differences in skin positivity found in females. Students over 26 years of age show a skin positivity of more than 40%, whilst for 17 to 20 years old skin positivity ranges between 22% to 25%. The frequency of skin positivity in soldiers confirms the data found in male students of the same age group. Post vaccine control, although limited to a smaller group of students, shows a definite turn towards positivity with an average figure in both sexes of 63%. The Authors, although admit having carried out their survey on a small population, believe to have contributed with useful information on the epidemiological situation of tuberculosis in age groups with scarce statistical data.

The skull in homozygous beta-thalassemia (Cooley's anemia) may present with several abnormalities, such as osteopenia, widening of the diploic space, and a "hair on end" appearance. In some cases it presents also a particular stratified aspect owing to a variable number of osseous lamellae, arranged so as to be parallel to the inner table. This "lamellated skull" was observed in 16 patients, selected from 150 patients with Cooley's anemia (10.6%). The possible mechanisms are discussed. The pluristratified lamellar osseous production could be brought about by repeated periosteal osteoblastic reaction to the sinusoidal neovascularization associated with marrow hyperplasia in poorly or not at all transfused patients.

Prolactin release following breast pump aspiration is less than that following suckling. The long-term effects of this decreased prolactin response are not yet known and therefore the use of the breast pump should be limited to selected cases and for the shortest possible time.