Search

Non disponibile.

Osteoporosis is a common complication in children with chronic rheumatic diseases (CRD). Although dual energy X-ray absorptiometry (DXA) is increasingly being used to determine bone mineral density (BMD) in children, it exposes the subject to ionizing radiation and does not provide a measure of true bone density; in fact, in growing bones the increase in BMD is mainly caused by the increase in bone size. In recent years, quantitative ultrasound techniques (QUS) have been used in radiation-free assessment of bone density and ``bone quality'' by measurement of the ultrasound waves attenuation by bone (BUA). In the present study we made a direct comparison of BUA in the calcaneum, determined by the pediatric contact ultrasound bone analyzer (CUBA) with lumbar BMD measured by DXA, in a group of 6–18-year-old patients with CRD. The study group consisted of 53 patients affected with juvenile rheumatoid arthritis (n = 29), systemic lupus erythematosus (n = 13), and juvenile dermatomyositis (n = 11). Mean age was 13.02 ± 2.69 years. In 22 patients (19 girls, 3 boys) both DXA and CUBA were repeated after 1 year in order to assess the mean percentage rate of BMD and BUA change over this time. Both lumbar spine BMD and calcaneal BUA measurements were lower in the CRD patients compared with a control group (P < 0.001). Calcaneal BUA was significantly correlated (r = 0.83, P < 0.001) with lumbar spine BMD. Age and sex correction (Z-score) did not change the relationship between BUA and BMD (r = 0.80, P < 0.001). A significant correlation between the mean percentage of variation (Δ%) of BMD and BUA (r = 0.76, P < 0.001) was also demonstrated in the 22 patients who were evaluated prospectively. Portability, ease of use, lower cost, and absence of radiation make CUBA a promising means of evaluating BMD in children.

A recent paper touched on some important aspects of residual stress measurement by the blind hole drilling method in the presence of an intense stress field. This technical note discusses some significant issues raised in that paper, and presents a different viewpoint. The issues concern the problems regarding a yield condition of the material near the drilled hole. In the presence of plasticity effects, we discuss the dependence of the calibration constants A and B on the biaxiality ratio (Ω) between the principal stresses and on the angle (β) between the principal direction of stress and the direction of the strain gauge.

We evaluated lung function in a group of patients affected by juvenile rheumatoid arthritis (JRA), without clinical and/or radiological signs of respiratory involvement. We compared the effects on pulmonary function of methotrexate (MTX) therapy combined with non-steroid anti-inflammatory drugs (NSAIDs) to those of NSAIDs alone and correlated lung function to subtype onset, disease duration and disease activity. Our patients were 27 JRA children, subdivided into two groups according to the therapy (group A = 14 patients, treated with a low dose of MTX and NSAIDs; group B = 13 patients, treated with NSAIDs alone). Clinical evaluation, haematological data and pulmonary function tests (PFTs) were obtained in each group at baseline (time 0) and at 1 year (time 1). At time 0 and time 1 PFTs were altered in 51.8% of JRA patients. The restrictive pattern (reduced forced vital capacity, FVC) was the most frequent feature, observed in 22.2% of patients. In group A the mean values of FVC, FEV1 (forced expiratory flow in 1 s), FRC (functional residual capacity), TLC (total lung capacity) and DLCO (diffusing lung capacity of carbon monoxide) were significantly lower compared to those of group B, at time 0 and at time 1. No functional parameter was correlated to subtype, duration or activity of the disease. Our study confirms that abnormalities in PFTs may be detected in JRA patients, even in the absence of clinical and/or radiological signs of lung disease; MTX in combination with NSAIDs does not seem to affect lung function at 1 year more than NSAIDs alone.

Rheumatoid nodules are a rare extraarticular manifestation of juvenile rheumatoid arthritis (JRA), usually detected in patients with polyarticular-onset disease and positive rheumatoid factor (RF). To date, there has not been a published report of rheumatoid nodules in systemic-onset JRA. Low-dose methotrexate (MTX) is generally considered to be the most useful second-line drug in the treatment of polyarticular JRA. In adult RA, MTX has been shown to be associated with appearance and progression of rheumatoid nodules. This report describes a 3-year-old girl with RF-negative, antinuclear antibody-negative systemic JRA who developed multiple rheumatoid nodules on the scalp and trunk during MTX therapy. The first nodule developed on the scalp 6 months after MTX treatment was initiated. Previous treatment with azathioprine was not associated with nodulosis. This represents an atypical case of MTX-associated accelerated nodulosis in systemic JRA, and raises the problem of treatment plan modification in the presence of this side effect.

Osteoporosis, a common clinical feature in children affected with Juvenile Rheumatoid Arthritis (JRA), is generally divided into two forms, a localized juxta-articular osteoporosis of the single joints and a generalized reduction of bone mass due to the disease itself, joint involvement and steroid treatment. Recently Dual Energy X-ray Absorptiometry (DEXA) has been suggested for Bone Mineral Density (BMD) measurement. In the present study DEXA has been used to investigate the lumbar spine BMD in JRA patients as compared to healthy children. Our results showed that BMD is reduced in JRA patients (BMD 0.685 g/cm2) when compared to healthy children (BMD 0.722 g/cm2), and it is significantly lower in the group of patients treated with steroids (BMD 0.623 g/cm2) when compared to those treated with nonsteroidal antiinflammatory drugs (BMD 0.710 g/cm2). The analysis of all risk factors of bone loss indicated that steroids represent the only parameter of significant negative correlation with BMD.

Systemic lupus erythematosus can produce disturbances in the CNS, characterized by seizures, headache, encephalopathy, chorea, cerebral infarction and psychosis. We used magnetic resonance and spectroscopy, in order to provide anatomical and metabolic information on the direct involvement of the CNS in LES. This study shows how these non-invasive techniques are well tolerated by children and young adults and how the levels of N-acetylaspartate correlate with the severity of the disease.

An efficient algorithm for the analysis and computer aided design of slotted waveguide arrays is presented. This algorithm is based on the generalized admittance matrix method. The use of analytical or semianalytical expressions for calculating the modal reaction integrals for both the waveguided and radiating regions results in extreme speed-up of the overall procedure. Furthermore, the algorithm provides a fast evaluation of conducting losses, useful when low cost materials are employed for a mass-production. An applicative example of a slotted waveguide array is also presented.

The aim of the present study was to assess and monitor brain damage in patients with pediatric onset systemic lupus erythematosus (SLE) using non-invasive techniques such as magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (H-MRS).Twenty-four SLE patients, both symptomatic or asymptomatic for central nervous system (CNS) involvement, and 20 controls were examined. Each individual underwent a diagnostic MRI using a 1.5 T Philips ACS-NT scanner including transverse T2-weighted (T2W) spin echo, transverse FLuid Attenuated Inversion Recovery (FLAIR), and sagittal T2W turbo spin echo 5 mm slices. In addition, single voxel proton MR spectroscopy localized on the supraventricular region was performed in all patients and controls. Patients were re-examined after one year.75% of SLE patients had clinical CNS involvement; 46% showed abnormal MRI (3 of them, in the absence of neurologic signs); 4 SLE patients showed N-acetylaspartate/Creatine (NAA/Cr) ratios significantly lower than the controls. Among 5 SLE patients examined at the onset of the disease, 1 had MRI alterations and another showed a decrease of NAA/Cr values. Three patients with relapses showed a correlation between the course of the disease and the NAA/Cr ratios.MRI and H-MRS are non-invasive techniques that might be useful, in some cases, in detecting CNS involvement in SLE patients and monitoring the disease course and efficacy of pharmacological treatment.

Pleuropulmonary involvement in adult spondyloarthropathy (SpA) has been thoroughly investigated. SpA is usually detected by conventional radiology as fibrosis of the upper lobes in about 30% of asymptomatic patients. Pulmonary function tests (PFT) reveal decreased vital capacity and total lung capacity, as well as increased residual volume. Juvenile SpA (JSpA) is a rare clinical condition, and no extensive investigations have been carried out on pulmonary involvement in JSpA. We studied prevalence and features of PFT alterations in patients with JSpA over a 2 year followup and analyzed the relationship between PFT and disease duration, disease activity, and chest and spine mobility.Eighteen patients with JSpA, with no clinical signs of lung disease and normal chest radiographs, underwent PFT--static and dynamic volumes, diffusing capacity for carbon monoxide (DLCO), at enrollment (T0), at 12 months (T1), and at 24 months later (T2). Disease activity was defined at each investigation by clinical and hematological data.Significant functional lung impairment was detected in 33% of patients (reduced forced vital capacity in 22% and DLCO in 11%). No significant change in the prevalence and features of PFT alterations was detected at T1 and T2; no relationship was found between PFT and duration, activity, and clinical scores of the disease.Thirty-three percent of JSpA patients without clinical symptoms and no radiological findings of lung involvement show PFT alterations, mainly characterized by a restrictive pattern. No progression or modification in PFT developed over 2 years. No correlation was found between PFT and disease duration, activity, and clinical scores.

Pleuro-pulmonary involvement has been well recognized in adults affected with systemic lupus erythematosus (SLE), but few studies have been carried out in children. A longitudinal study on a group of 15 children affected with juvenile SLE (JSLE), asymptomatic for lung disease, was performed, and the prevalence and the features of respiratory function alterations, over a period of 12 months, were analysed. Moreover, a possible correlation between any pulmonary function test (PFT) and disease duration, disease activity, visceral involvement and immunological pattern was evaluated. At baseline, a significant functional lung impairment was present in 40% of patients, with a significantly reduced FVC, VA and DLCO in 26% of them; in 60% of patients at 6 months and in 33% of patients at 12 months. At 6 and 12 months, our data did not show any significant modification in PFTs and the restrictive pattern, observed at baseline, remained unchanged. No correlation between altered PFTs and disease duration, activity and/or immunological findings was found. At baseline, the presence of neurological involvement was the only extra-pulmonary feature correlated to reduced FVC

Peak bone mass is an important determinant of future bone mass and of the risk of osteoporosis and subsequent fractures. Although some information concerning bone mineral density (BMD) in adults affected with systemic lupus erythematosus (SLE) is available, few data on children and adolescents have been reported. Many variables, such as duration and activity of the disease, reduced sun exposure, and steroid therapy have been suggested as risk factors in the pathogenesis of osteoporosis in SLE. In this study, we longitudinally evaluated, by dual energy X-ray absorptiometry (DEXA), the BMD of 20 young patients affected with juvenile SLE (JSLE), in order to establish the degree of osteoporosis and the influence of steroid treatment, among other clinical variables. At baseline, the mean BMD in JSLE patients was 0.978 g/cm2 and in controls 1.038 g/cm2 (P = 0.31). At 1 year (time 2), this value became 0.947 g/cm2 in JSLE children; the mean individual difference was 0.28 g/cm2 (3.4%). Only in those patients aged 19-25 years BMD was significantly lower than in controls, both at baseline and at time 2. Considering the steroid treatment, no significant difference between the two groups was found either at baseline or at time 2; however, the mean yearly BMD loss in the steroid patients was 0.031 g/cm2 (3.5%) vs. 0.005 g/cm2 (0.5%) in those who had not taken steroids. A significantly inverse correlation between BMD and the cumulative dosage of corticosteroids has been detected. BMD produced a significantly inverse correlation to the cumulative dosage of corticosteroids; no significant correlation has been found between BMD and disease activity or duration.

Juvenile Rheumatoid Arthritis (JRA) is frequently associated with osteoporosis. In order to determine if JRA osteoporosis is related to reduced formation or to increased bone resorption or both, serum levels of calcium (Ca), phosphorus (PO4), magnesium (Mg), alkaline phosphatase (ALP), parathormone (PTHi), 25-hydroxyvitamin D3 (25-OHD) and 1,25-dihydroxyvitamin D3 (1,25-(OH)2D), osteocalcin (OT), carboxyterminal propeptide (P-coll-1-c), and carboxyterminal telopeptide of type I collagen (ICTP) were evaluated in 47 JRA children, 33 with active disease and 14 in remission. The therapy consisted of nonsteroidal antiinflammatory (NSAIDs) drugs in pauciarticular subset, NSAIDs and Methotrexate (MTX) in polyarticular, NSAIDs and steroids in systemic onset. OT reflects bone formation, P-coll-1-c reflects collagen production and bone formation, ICTP, marker of collagen degradation in bone, indicates bone destruction. Serum levels of Ca, PO4, Mg, ALP, PTHi 25-OHD and 1,25-(OH)2D were comparable in JRA children and in controls. OT (8.7 +/- 3.7 ng/ml vs 9.6 +/- 5.1), P-coll-1-c (301.2 +/- 118.4 ng/ml vs 264.1 +/- 100.1) and ICTP (15.7 +/- 5.7 ng/ml vs 16.1 +/- 6.1) did not differ statistically in the whole group of JRA children vs controls. OT (8.0 +/- 3.5 vs 10.4 +/- 3.8) and ICTP (14.4 +/- 5.4 vs 18.8 +/- 5.4) were significantly lower in active than inactive group. In polyarticular and systemic onset OT and ICTP were significantly lower than in pauciarticular. No difference was found in active patients treated with steroids vs active patients treated with NSAIDS and NSAIDs plus MTX. The lower serum levels of OT and ICTP in active disease support the hypothesis that both bone formation and resorption are reduced in JRA bone turnover.

Multiple humoral and cellular abnormalities in Kawasaki disease (KD) have already been described. In this study an analysis of immunological findings in a cohort of 34 Italian children affected with KD is reported, and the potential clinical significance of such alterations in predicting the development of coronary aneurysm and the prognosis of the disease is evaluated.Levels of circulating immune complexes (CIC), antinuclear antibodies (ANA), anticardiolipin (aCL), antineutrophil cytoplasmic antibodies (ANCA), and anti-endothelial cells (AECA) and the T cell profile were determined in both the acute and the convalescent phases, and were compared to febrile, sex- and age-matched children.CIC were present in 66% of the patients, 18 of whom were in the acute phase and 13 in the convalescent phase. In the control group CIC were detected in 47% of the children. ANA were negative in both the KD and in the febrile group. ANCA were present in 8%, AECA in 26%, and aCL in 30% of KD patients (IgG aCL antibodies were found in 14 patients, IgM aCL in, 1 and 1 had both). Among the controls, aCL antibodies were found in 5 patients (22%); in particular 1 (4.4%) had IgG and 4 (17.4%) had IgM aCL. An altered T cell profile, with an inverted CD4/CD8 ratio, was found in all KD children. All of the immune alterations showed a lower incidence in the convalescent than in the acute phase. No significant relationship between any of these immune findings and cardiac involvement or any other clinical manifestations was found.Our data confirms the previously reported immunological anomalies in KD both in the acute and the convalescent phases, with a decreased incidence of such alterations in the convalescent phase. No prognostic significance for the occurrence of aneurysm could be demonstrated.

Cessation of ovarian activity is accompanied by a more or less marked and more or less accelerated reduction in bone mass; the degree and speed of the process--which occurs in all women--depends on individual (genetic factors influencing peak bone mass, duration of child-bearing period), iatrogenic (treatment with corticosteroids or thyroid hormones) or accidental factors (post-traumatic immobilization). Whatever the factor that triggers off the process, the end result is the destruction of bone tissue. This process may be documented by hematochemical (Nordin's test) and instrumental parameters (MOC and similar techniques). Oestroprogestin (and to a lesser extent calcitonin) hormone replacement therapy has been demonstrated to be highly efficacious in countering this involutive process. The authors report data obtained following the evaluation of 35 women in menopause undergoing. Nordin's test and measurement of the plasma level of estradiol using RIA, before and after twelve months after the start of osteoprotective treatment. Of the 35 patients 9 received only progestin, 22 an oestroprogestin combination (of these 18 patients received estrogen transdermally and 4 orally), and 4 calcitonin administered parenterally. A statistically significant positive correlation with Nordin's test was only found in the group receiving oestrogen therapy. In conclusion, it may be affirmed that in the absence of contraindications oestrogens represent the elective form of treatment for menopausal osteoporosis. Acceptable results have been reported in the literature also using calcitonin, but this treatment could not be evaluated in this study owing to the reduced number of the sample treated.

During menopause the number of cardiovascular attacks increases parallel to the elimination of estradiol production. The administration of the latter reverses this tendency owing to a compound mechanism (improved HDL) cholesterol/total cholesterol ratio, diminished vasal resistance).The authors present a study performed in 34 patients in menopause receiving oestroprogestinic replacement therapy using an oral or transdermal route. Metabolic status (serum concentrations of total cholesterol (TC) and HDL cholesterol (C.HDL) was evaluated in all patients before treatment and after 12 months.A statistically significant positive correlation (p0.0001) was found between the use of oestrogen and serum levels of HDL. This correlation appeared to be more evident in patients using transdermal treatment compared to the oral form.The authors conclude that in the absence of contraindications, hormone replacement therapy in menopause exercises a beneficial effect on the lipid status, contributing to diminishing the risk of cardiovascular attacks. The possibility of an increased incidence of breast cancer is now being evaluated, whereas effective protection of the endometrium against the risk of hyperplasia and cancer was shown using the doses of progestin used in this study, which coincide with those currently prescribed in the literature.

Catastrophic antiphospholipid antibody syndrome, reported in a minority of patients with circulating antiphospholipid antibodies, is characterized by widespread vascular occlusions. The term "catastrophic" has been used to describe the severity of symptomatology, sometimes leading to death. We describe a girl aged 11 years, fulfilling diagnostic criteria for systemic lupus erythematosus, with recurrent episodes of thromboembolic phenomena involving lung and skin, complicated with disseminated intravascular coagulation. Treatment with warfarin ultimately resulted in effective control of the disease.

To investigate the serum levels of nerve growth factor (NGF) and their possible relationship with disease activity in Kawasaki disease.Twelve children with Kawasaki disease, 12 healthy children (afebrile controls), and 12 children with high fever related to upper respiratory tract viral infections (URTVI) were enrolled in the study. Serum NGF levels were measured by an ELISA method before and after therapy. In addition, angiotensin converting enzyme (ACE), and erythrocyte sedimentation rate (ESR), complete hemochrome, and C-reactive protein were tested as indicators of endothelial injury and disease activity, respectively.NGF levels were strikingly increased in the acute phase of Kawasaki disease (1219.54 +/- 1660.29 pg/ml) and decreased in the inactive phase of the disease (277.08 +/- 245.64 pg/ml), while remaining significantly higher than controls (6.5 +/- 2.03 pg/ml). In febrile patients with URTVI, NGF levels (30.18 +/- 44.70 pg/ml) were moderately but significantly increased compared to afebrile controls, but remarkably lower in respect to active and inactive Kawasaki disease. In active Kawasaki disease, ACE values were significantly lower than in healthy children (2.8 +/- 1.7 vs 10.1 +/- 4.2 pmol/ml/min; p0.001) and increased during the inactive phase, but remaining lower than in controls (4.8 +/- 2.7 pmol/ml/min); ESR, hemoglobin level, and platelet count showed significant correlation with NGF, while ACE levels showed a significant inverse correlation with ESR and NGF.In Kawasaki disease, NGF increased together with decreased ACE may be linked to a diffuse vascular inflammatory process. NGF and ACE levels remained abnormal even when there was no clinical sign of disease activity. This may indicate that the disease process is not in complete remission and suggests careful and prolonged cardiac followup until their normalization.

OBJECTIVE: To determine the circulating serum concentrations of nerve growth factor (NGF) and compare them with indices of disease activity in juvenile chronic arthritis. METHODS: NGF concentrations were evaluated with a two site immunoenzymatic assay (ELISA), in 17 children with systemic, 39 with polyarticular, and 24 with pauciarticular onset juvenile chronic arthritis. Each subset was divided according to different variables, appropriate to each subset, reflecting active and inactive disease. RESULTS: NGF concentrations were significantly higher in children with systemic [254 (SD 256.1) pg ml-1; P < 0.001], polyarticular [165.2 (300.8) pg ml-1; P < 0.05], and pauciarticular [106.8 (111.8) pg ml-1; P < 0.005] onset juvenile chronic arthritis than in controls. In all subsets, NGF concentrations were higher in the active than in the inactive phase of the disease. A significant direct correlation between NGF concentrations and erythrocyte sedimentation rate was found both in the systemic and in the polyarticular onset juvenile chronic arthritis. CONCLUSIONS: The increase in NGF concentrations in all juvenile chronic arthritis subsets and the correlation with disease activity suggest that NGF may take an active part in joint inflammation.

The purpose of the investigation was to test the use of alendronate in the therapy of children affected by chronic rheumatic diseases and symptomatic drug-induced osteoporosis. Two courses of alendronate were intravenously administered to four girls with vertebral fractures that were glucocorticoid induced. Improvement of back pain and bone mineral density increase evaluated by DXA and conventional spine X-rays were observed. Our study supports the ABD-induced improvement of the negative effects of long-term therapy on bone mineral density in children with chronic rheumatic diseases.

As al.ready described [1], Kawasaki syndrome is an acute mucocutaneous, self-limited febrile illness characterized by a systemic vasculitis of small-and medium-sized vessels involving the coronary arteries [2]. Untreated it may lead to coronary aneurysms and myocardial infarction which are responsible for death either in the acute phase of the disease or subsequently. Intravenous gammaglobulin has been shown to reduce the risk of coronary artery abnormalities when administered during the first 10 days of the disease [3].

to investigate the effects of treatment with low dose of cyproterone acetate and ethynyl-estradiol on chemical and hormonal parameters in female hyperandrogenism.twenty patients, affected by clinical manifestations of hyperandrogenism, were studied basally and during treatment with 10 mg of cyproterone acetate associated with ethynyl-estradiol (20 m g) in an inversal sequential scheme for six months. Safety parameters were assessed throughout the study. Hirsutism was graded by Ferriman and Gallway score, and hormonal parameters were evaluated basally and after six months of therapy.after six months of therapy all patients showed a significant decrease of clinical and biochemical signs of hyperandrogenism, and normalization of ovarian parameters in seventeen women affected by PCOS.this treatment is an effective and well tolerated therapy. It is reasonable to consider this treatment as a safe procedure especially in view of a long-term administration.

Over a period of four years 18 children seen in our clinic have been diagnosed as suffering from Yersinia enterocolitica reactive arthritis: this group constitutes one third of the total reactive arthritides seen by us. The diagnosis was based on elevated specific antibody titres and the outcome has always been good with anti-inflammatory therapy, symptoms disappearing within a few weeks without any complications or recurrences. This positive outcome could be due to the absence of the HLA B27 haplotype. Yersinia has been described as the most frequent agent causing reactive arthritis, a common complication in an otherwise benign infection in children. It seems that Yersinia may trigger in predisposed hosts an immunological reaction leading to arthritis.

The limited and controversial data available regarding endocrine function in adults treated for acute lymphoblastic leukemia (ALL) prompted us to study the influence of chemotherapy on gonadal, adrenal androgen and thyroid function. Forty-eight ALL adults (30 men and 18 women) in first complete remission (CR) were investigated.Severe reproductive function impairment was detected in 10/12 males receiving treatment, while endocrine function was affected in only 1 case. All but one off-therapy male showed normal reproductive function; moreover, endocrine function was impaired in only one male. Eight of 10 females receiving treatment showed hypergonadotropinemia and decreased estrogen levels. All off-therapy women reported regular menses, even though mild hypergonadotropinemia persisted in only 2 cases. Adrenal androgen function was depressed in 12/22 on-therapy patients in both sexes, and in 6/17 off-therapy males. All off-therapy females recovered completely. Dihydroepiandrosterone-sulfate (DHEA-S) serum levels were significantly correlated to the length of time-off therapy (p = 0.003), and inversely correlated to the age at diagnosis (p0.0001) in off-therapy males. All patients remained euthyroid, although 4 patients showed subclinical impairment of thyroid function.Our experience suggests that long-term prospective studies for ALL adults are necessary in order to better define the magnitude and duration of influence the chemotherapy has on endocrine function.

The gonadal function of 38 patients with Hodgkin's disease (HD) treated with MOPP chemotherapy (12 patients), ABVD (9 patients) and alternating MOPP/ABVD (17 patients) has been retrospectively investigated with semen analysis. Median age of patients was 25 years (range 16-41 years). Azoospermia was found in all patients from the MOPP group (100%), in 3 of the ABVD group (33%) and in 13 of the MOPP/ABVD group (76%). After temporary oligospermia full recovery of spermatogenesis was observed in 67% of patients treated with ABVD, versus 25% of MOPP-treated patients following a prolonged period of azoospermia and oligospermia. Patients receiving MOPP/ABVD scheme had complete recovery of testicular function after oligospermia in 24% of cases. These results confirm the higher gonadal toxicity of the MOPP regimen as compared to others such as ABVD without alkylating agents.

Nel 30–60% dei soggetti con LES ad esordio pediatrico è stato descritto un coinvolgimento del SNC. In studi precedenti sono state riscontrate alterazioni metaboliche tramite indagine con SPECT cerebrale. Sono stati studiati con Risonanza Magnetica (Imaging e Spettroscopia 23 soggetti (18 F e 5 M; età media 15, 4 anni; range 8–27) con LES, 20 controlli di età e sesso adeguati, 5 soggetti con forma giovanile di dermatomiosite (5 F), 2 con sclerosi sistemica (1 F e 1 M) e 1 con malattia di Behçet (1 F). Altre 2 ragazze con LES erano state sottoposte all'esame RM, ma sono state escluse dallo studio per il rilievo di grossi artefatti dovuti alla presenza di apparecchio metallico ortodontico fisso. Gli esami sono stati effettuati con apparecchio Philips ACS-NT (Best, Olanda) 1,5T. Sono state eseguite scansioni assiali spin eco T2 e FLAIR, scansioni sagittali turbo T2 (5mm di spessore) e spettroscopia dell'idrogeno di un singolo volume 70times50times20mm (TE 272ms, TR 2000ms) posizionato sulla sostanza bianca sopraventricolare. 16 pazienti affetti da LES presentavano dati anamnestici e clinici di coinvolgimento del SNC: tra questi soltanto 9 hanno mostrato alterazioni all'esame di Imaging preliminare (atrofia e/o piccole lesioni focali della sostanza bianca). Anche in 2 dei pazienti senza sintomi neuropsichiatrici il quadro neuroradiologico è risultato alterato. L'indagine spettroscopica ha evidenziato una correlazione tra l'attività della malattia e la diminuzione dell'N-acetilaspartato espresso come rapporto NAA/Cr. 11 pazienti sono stati esaminati durante la presenza di sintomi neuropsichiatrici: tra questi 5 pazienti sottoposti a un prolungato periodo di trattamento con corticosteroidi per un coinvolgimento sistemico della malattia più marcato hanno mostrato il più basso valore del rapporto NAA/Cr. 2 tra essi hanno mostrato il quadro neuroradiologico nella norma. Dunque la Risonanza Magnetica per immagini e la Spettroscopia possono essere indagini non invasive da utilizzare in soggetti con LES pediatrico sia per rilevare un coinvolgimento precoce dell'encefalo sia per monitorizzare la gravità della malattia.

This investigation was designed to produce in the human female antibodies capable of neutralizing hCG, but not hLH. Two women were immunized with the beta subunit of hCG, used as carrier, coupled to diazotized sulphanilic acid through diazo bonds. Control cycles of both subjects were clearly indicative of normally ovulatory patterns. These patterns were not influenced by the immunization procedure, either before the humoral antibodies were detectable, or after their levels rose to more than 300 pg of ( 125 I)-hCG bound/ml of human plasma. In each cycle, there was a clear LH peak followed by the rise of progesterone to full luteal levels. The IgGs of the two patients' plasmas were precipitated by ammonium sulphate and tested for their ability to neutralize the biological activity of hLH and hCG. Using the rat uterine weight assay, the IgG, given intraperitoneally, strongly reduced the rat uterine weight induced by hCG administered subcutaneously. On the contrary, the IgG from both patients were unable to reduce the increase in rat uterine weight induced by hLH.

Regular estrous cycles can be reinitiated in old acyclic female rats by pharmacologic, hormonal, and environmental manipulations. The most responsive acyclic states are persistent vaginal cornification (PVC) and spontaneous pseudopregnancy (SP). However, it is not known if the irregular cyclicity that precedes acyclicity during aging can also be alleviated. We found that transient shortening of estrous cycles follows smear sequences indicative of pseudopregnancy in C57BL/6J mice, aged 9-15 mo, suggesting a role for progesterone. This phenomenon was investigated through a limited model of pseudopregnancy in which intact aging mice with lengthened cycles were given progesterone implants (yielding 70 ng progesterone/ml plasma) that suppressed estrous cycles; upon removal of the implants, cycles were transiently shortened in aging mice. Therefore, we hypothesize that withdrawal from the progesterone elevations associated with SP is the mechanism in shortening subsequent estrous cycles. Effects of central-acting drugs, similar to those used to reinitiate cyclicity in acyclic old rats, were also examined. Hydergine, an ergot mixture with partial dopaminergic and serotonergic agonist activities, suppressed SP when fed to 10- to 12-mo-old, middle-aged mice. Hydergine did not otherwise affect estrous cycle length, prevent PVC, or reinitiate cycling in acyclic PVC mice. Feeding L-dihydroxyphenylalanine to middle-aged mice did not suppress SP, affect estrous cycle lengths, or reinitiate cycles from PVC.

Comparison between young and old rats confirmed that, in old age, the phosphocreatine (PC) of muscle decreases. Parallel to this, the adenine nucleotides of muscle were estimated and it was found that the restoration of ade nosine triphosphate (ATP) is diminished in old age. The relationship Q = ATP/ADP (adenosine diphosphate) decreases from 6.7 to 2.2. The role of the carbohydrate metabolism for the recovery of muscle was controlled by glycogen estimations in muscle and liver. In both, the glycogen content during rest is diminished in old age. Succinate dehydrogenase (SDH) activity decreases in muscle of old animals. Aldolase (ALD) activity does not change significantly. This confirms the conclusion that, in old age, the aerobic part of the carbohydrate metabolism, i.e. the recovery process of muscle, is diminished.

1. After removal of tropomyosin and troponin from the ;natural' actomyosin complex, the adenosine triphosphatase activity of the resulting ;desensitized' actomyosin is stimulated to the same extent by various bivalent cations with an ionic radius in the range 0.65-0.99å when tested at optimum concentration of the metal ion in the presence of 2.5mm-ATP at low ionic strength and pH7.6. Under identical conditions the adenosine triphosphatase activity of myosin alone is stimulated to an appreciable extent only by Ca(2+) (ionic radius 0.99å). 2. Tropomyosin narrows the range of size of the stimulatory cations by inhibiting specifically the adenosine triphosphatase activity of ;desensitized' actomyosin when stimulated by Ca(2+) or the slightly smaller Cd(2+) (ionic radius 0.97å). Tropomyosin has no effect on the adenosine triphosphatase activity of ;desensitized' actomyosin when stimulated by the smaller cations, nor on the Ca(2+)-activated adenosine triphosphatase activity of myosin alone. 3. The adenosine triphosphatase activity of the ;natural' actomyosin system (containing tropomyosin and troponin) stimulated by the smallest cation, Mg(2+) (ionic radius 0.65å), is low when the system is deprived of Ca(2+) but high in the presence of small amounts of Ca(2+). This sensitivity to Ca(2+) seems to be a unique feature of the Mg(2+)-stimulated system. 4. The changes in specificity of the myosin adenosine triphosphatase activity in its requirement for bivalent cations caused by interaction with actin, tropomyosin and troponin primarily concern the size of the metal ions. The effects on enzymic properties of myofibrils due to tropomyosin and troponin can be demonstrated at low and at physiological ionic strength.

Determination of radioactivity in urine and faeces was used to monitor absorption of labelled 6-methyl-17α-acetoxypregna-4,6-diene-3,20-dione from polydimethylsiloxane implants. Based on previously determined in vitro diffusion rates, mean absorption was 60% in hamsters, 80% in rabbits, and 85% in rats during the first month after implantation. Thereafter, excretion of radioactive material has slowly decreased. After six months, the rate declined to 40% of the original value.

Tritium labelled testosterone and carbon-14 labelled testosterone sulphate were administered into the intact foeto-placental circulation in two subjects at laparotomy and the principal conjugated metabolites present in the placenta and various foetal tissues, as well as unconjugated testosterone were isolated and identified. More than 99% of the carbon-14 labelled material recovered from the various sources was in a water-soluble (conjugated) form, whereas water-soluble metabolites accounted for some 42% of the tritium labelled material. More than 70% of the carbon-14 labelled material isolated from all tissues studied, except the liver, was present in the form of testosterone sulphate; in the liver it amounted only to some 30%. Exclusively tritium labelled unconjugated testosterone was isolated in a radiochemically homogeneous form from the placental and liver extracts, and from the combined extract of all other foetal tissues. In addition, three exclusively tritium labelled conjugated metabolites were isolated: 5α-androsterone sulphate (placenta, lungs and carcass), 5β-androsterone sulphate (placenta, liver, gastro-intestinal tract, lungs and carcass) and 3β,5β-androsterone sulphate (liver). In addition to double labelled testosterone sulphate, which was isolated from every tissue studied, double labelled 5β-dihydrotestosterone sulphate was isolated from the liver. Moreover, 5β-androstane-3α,17β-diol was isolated from the liver following solvolysis of the monosulphate fraction and 11β-hydroxytestosterone sulphate from the adrenals following solvolysis and conversion of the product to 11β-hydroxyandrostenedione. The testosterone sulphate isolated from the adrenals exhibited the highest, and that isolated from the placenta, lungs and liver the lowest tritium to carbon-14 ratio. It is concluded that significant quantities of testosterone are converted to testosterone sulphate by the foetal adrenals and that neither the foetus nor the placenta is capable of hydrolysing testosterone sulphate. The foetal metabolism of testosterone sulphate seems to be characterized by the formation of 5β-oriented conjugated reduction products in the liver and by the formation of 11β-hydroxytestosterone sulphate in the adrenals.

Three midgestation placentas were perfused at laparotomy during fifteen minutes with tracer amounts of [1,2-3H] testosterone [35S] sulphate sodium salt, and metabolites present in the placentas, perfusates and maternal urine specimens were analyzed. Most of the radioactive material administered was present in the placentas and perfusates; approximately 2% of it was recovered from the urine. More than 99.5% of the radioactive material recovered from the placentas and the perfusates was in a water soluble (conjugated) form. No unconjugated testosterone was found in these sources. Radiochemically homogeneous [1,2-3H] testosterone [35S] sulphate was isolated from the placentas, perfusates and urine specimens collected during the first 24 hours of experiment. The isotopic ratio of the conjugate isolated from these sources was very similar to that of the perfused material. Seventy per cent of the double labelled radioactive material recovered from the Day 1 urine samples was radiochemically homogeneous testosterone sulphate. The relative amounts of testosterone sulphate present in the Day 2 and Day 3 urine specimens showed a gradual decrease. This decrease was associated with an increase in tritium to sulphur-35 ratio. From the pooled extracts of all urine specimens, small amounts of exclusively tritium labelled conjugated 5α-androsterone and 5β-androsterone were also isolated. No 17β-oestradiol 17-sulphate was detected in any of the sources studied. It is concluded that little, if any, testosterone sulphate is hydrolyzed by the midgestation human placenta, and that a considerable part of the testosterone sulphate secreted by the foetus is transferred across the placenta to the mother in an unchanged form. The major part of the transferred testosterone sulphate is excreted in the urine; a smaller part of it undergoes hydrolysis with a subsequent metabolism of the steroid moiety.

The content of phosphocreatine and of the adenin nucleotides, ATP, ADP and AMP in the white skeletal muscle of rats of different ages has been determined.

The activity of aldolase and succinatdehydrogenase (SDH) in white and red skeletal muscle of young (3–7 months) and old (20–30 months) rats has been determined. In addition also the SDH of liver was measured. The activity of aldolase is higher in white than in red muscles, while SDH shows a higher activity in red than in white muscles. The activity of aldolase is not influenced by ageing in white muscles, but decreased in red muscles by 23%. In old animals the activity of SDH is 34% less in white and 52% less in red muscles. In liver the activity is 44% less. The significance of these changes for the energy metabolism of skeletal muscle is discussed.

Die Fahigkeit des Skelettmuskels, in der Ruhe Kreatin-Phosphat (KP) zu restituieren, wird an der Ratte, gesondert an weisser und roter Muskulatur, untersucht. Das Gesamt-Kreatin ist in beiden Muskelarten zwischen jungen, erwachsenen (6–9 Monate) und alten Tieren (25–37 Monate) nicht verschieden. Dagegen ist die Restitution von KP nach gleich langer Ruheperiode bei jungen erwachsenen grosser als bei alten Tieren; in weissen Muskeln 50,1 gegenuber 17,6%, in roten Muskeln 23,6 gegenuber 12,5%.