Pubblicazioni Altomonte

Specialista in: Gastroenterologia, Endocrinologia, Reumatologia e Medicina Interna.

Dal 1976 al 2001, ricercatore presso la Clinica Medica dell'Università Cattolica di Roma (Policlinico Gemelli) e responsabile dell'Ambulatorio delle Connettiviti Reumatiche, del Servizio di Mineralometria Ossea Computerizzata e del Servizio di Capillaroscopia annessi alla Divisione di Reumatologia.

Dal 2002 primario della UOC di Reumatologia e della UOC di Medicina II dell'Ospedale S.Eugenio di Roma.

Docente di Reumatologia in vari corsi di Laurea e di Specializzazione dell'Università Cattolica e dell'Università di Chieti.

Autore di oltre 360 pubblicazioni scientifiche.

Selezione di 111 articoli fra i più significativi scelti fra gli oltre 360 pubblicati dal 1982 al 2002

Prolactin/cortisol ratio in rheumatoid arthritis.

Zoli A, Ferlisi EM, Lizzio M, Altomonte L, Mirone L, Barini A, Scuderi F, Bartolozzi F, Magaro M.

Istituto di Medicina Interna e Geriatria, Universita Cattolica del Sacro Cuore A. Gemelli, Rome, Italy.

Prolactin (PRL) and glucocorticoids are hormones involved in the regulation of the immune system. Rheumatoid arthritis (RA) is an inflammatory condition that presents a diurnal rhythm of disease activity. PRL/cortisol ratio, and IL-1beta and TNF-alpha levels were determined in patients with RA and in control subjects at 0600, 1000, 1400, 1800, 2200, and 0200 hours. In patients with RA we observed higher PRL/cortisol ratio at 0200 hours, whereas IL-1beta and TNF-alpha reached their highest serum levels at 0200 and 0600 hours. In patients with RA we observed an imbalance in favor of proinflammatory hormones as opposed to levels of antiinflammatory hormones during nocturnal hours together with increased levels of IL-1beta and TNF-alpha of the diurnal rhythm of disease activity.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=12114312&dopt=ExternalLink

Anticardiolipin antibodies in patients with primary antiphospholipid syndrome: a correlation between IgG titre and antibody-induced cell dysfunctions in neuronal cell cultures.

Andreassi C, Zoli A, Riccio A, Scuderi F, Lombardi L, Altomonte L, Eboli ML.

Anticardiolipin antibodies (aCL) of the immunoglobulin (Ig) G isotype have been significantly associated with neurological manifestations of antiphospholipid syndrome (APS). In a previous study we described the direct pathogenic effects of IgG aCL on living neurons in culture. Therefore, we studied the IgG aCL titre as a factor influencing the extent of this effect. Seventeen patients with a history of primary antiphospholipid syndrome were grouped according to their IgG aCL titre into low positive (GPL < or = 40), high positive (40< GPL <100) and very high positive (GPL >100). IgG from these patients were incubated with cerebellar neurons in primary culture for 24h and the effect was evaluated by using the tetrazolium salt (MTT) assay. We found that almost all patients' IgGs reduced cell viability in vitro, but the differences in the extent of the effect were statistically significant only for patients with >40 GPL. Our results reinforce the causal association between increasing level of IgG aCL and clinical features of aPS.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=11642511&dopt=ExternalLink

Craniocervical junction involvement in rheumatoid arthritis: a clinical and radiological study.

Zoli A, Priolo F, Galossi A, Altomonte L, Di Gregorio F, Cerase A, Mirone L, Magaro M.

Division of Rheumatology, Institute of Internal Medicine and Geriatrics, Catholic University of the Sacred Heart, Rome, Italy.

OBJECTIVE: To make a comparative evaluation of different imaging techniques for studying the craniocervical junction involvement in patients with rheumatoid arthritis (RA). Upper cervical spine involvement was compared with clinical and immunological data. METHODS: Patients (n = 47) underwent plain radiographs and computerized tomography (CT) and magnetic resonance (MR) study of the craniocervical junction. Neurological examination following clinical signs of possible atlantoaxial involvement was performed in all patients following the Ranawat classification. RESULTS: Radiographic and MR images showed craniocervical involvement in 41.3% and 61% of the patients, respectively. Immunological data were not correlated with imaging findings, whereas Ranawat class II and III of neurological involvement seem to be predictive of atlantoaxial alteration. CONCLUSION: Conventional radiography allowed us to detect 41.3% of patients with craniocervical involvement, but only in advanced stages of the disease. MR imaging had the unique potential of direct and detailed synovial visualization, especially in the gadolinium enhanced axial images, resulting in the early diagnosis of craniocervical RA.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=10813284&dopt=ExternalLink

Failure of aggressive anticoagulant therapy in catastrophic antiphospholipid syndrome.

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Basal and after-stimuli test for prolactinemia in systemic lupus erythematosus.

Rheumatology Department-Internal Medicine and Geriatrics, Catholic University of Sacred Heart, Rome, Italy.

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Serum zinc and copper in active rheumatoid arthritis: correlation with interleukin 1 beta and tumour necrosis factor alpha.

Zoli A, Altomonte L, Caricchio R, Galossi A, Mirone L, Ruffini MP, Magaro M.

Serum zinc and copper levels and serum interleukin 1 beta (IL1 beta) and tumour necrosis factor alpha (TNF alpha) levels were evaluated in 57 female patients with active rheumatoid arthritis (RA) to investigate a possible role of IL1 beta and TNF alpha on zinc and copper homeostasis in RA. Serum zinc levels were significantly lower and serum copper levels significantly higher in RA patients when compared with osteoarthritis or asymmetrical psoriatic oligoarthritis patients and with normal controls. No differences were observed in serum IgM rheumatoid factor positive and serum IgM rheumatoid factor negative patients as regards serum zinc and copper concentration. In RA patients the erythrocyte sedimentation rate and acute-phase proteins correlated negatively with serum zinc and positively with serum copper. IL1 beta and TNF alpha were found to correlate negatively with zinc and positively with copper in RA patients. Lower levels of zinc may be due to an accumulation of zinc-containing proteins in the liver and in the inflamed joints in RA. Elevated serum copper levels seem to be linked to the increased synthesis of ceruloplasmin by the liver.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=9805181&dopt=ExternalLink

Cerebral blood flow abnormalities detected by SPECT in Behcet's-syndrome-related psychiatric disorders.

Institute of Internal Medicine and Geriatrics, Division of Rheumatology, Catholic University Rome, Italy.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=9586687&dopt=ExternalLink

Neurobehavioural and psychiatric manifestations in a case of ANA-negative SLE with antiphospholipid antibodies.

Institute of Internal Medicine and Geriatrics, Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.

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Serum lipoprotein (a) and lipid pattern in pre-menopausal and post-menopausal patients with active RA.

Zoli A, Altomonte L, Santacesaria GC, Ferlisi EM, Mirone L, Ruffini MP, Magaro M.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=9444433&dopt=ExternalLink

Voluntary oculomotoricity in systemic lupus erythematosus.

Giacomini PG, Zoli A, Bruno E, Alessandrini M, Caricchio R, Mirone L, Magrini A, Altomonte L, Magaro M, Di Girolamo A.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=9307868&dopt=ExternalLink

Autonomic nerve dysfunction in systemic lupus erythematosus: evidence for a mild involvement.

Neurologic manifestations are known to occur in patients with systemic lupus erythematosus (SLE) and significantly affect the clinical course of the disease. Nevertheless, the prevalence, pattern and severity of autonomic impairment in such patients have yet to be defined. In the present study a series of 38 female SLE patients was assessed for the presence of autonomic dysfunction. Five noninvasive standardized cardiovascular reflex tests were used. The grading system proposed by Ewing and Clarke was applied to classifying autonomic impairment according to severity. Seventeen out of 38 patients, that is 44.7%, had evidence of autonomic impairment. Most of the patients had a mild degree of dysfunction. No correlation was found for the duration of the disease while an apparent lack of the commonly described chronological sequence of autonomic involvement was observed. We suggest that in SLE patients the prevalence of autonomic impairment, when investigated, does not significantly differ from that of other SLE-associated neurological events. The contribution of a direct immunological damage to components of neural pathways in the pathogenesis of the autonomic involvement can be postulated. Clinical consequences of autonomic impairment in patients with systemic lupus erythematosus need to be elucidated.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=9229362&dopt=ExternalLink

Behcet's disease and cardiac arrhythmia.

Institute of Internal Medicine and Geriatrics, Catholic University, Rome, Italy.

Only few cases of cardiac conduction disturbances and arrhythmias have been reported in Behcet's disease. We recently observed the case of a 16-year-old woman with Behcet's disease in whom cardiac arrhythmia became the main clinical symptom. This observation and a review of the literature led us to the conclusion that arrhythmia could represent the clinical manifestation of an underlying myocarditis due to Behcet's disease and can be regarded as a feature of cardiac involvement of the disease.

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Undiagnosed polyarthritis with positive anti-Ro/SSA antibodies following a biliopancreatic bypass for morbid obesity.

Zoli A, Altomonte L, Serra A, Santacesaria GC, Caricchio R, Mirone L, Magaro M.

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Rheumatoid factor in patients with systemic lupus erythematosus.

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A study of serum androgen and cortisol levels in female patients with rheumatoid arthritis. Correlation with disease activity.

Divisione di Reumatologia, Istituto di Medicina Interna e Geriatria, Istituto di Chimica Clinica, Universita Cattolica del Sacro Cuore, Roma, Italy.

Androgen status and the role played by androgens in the pathogenesis of rheumatoid arthritis (RA) in female patients are a matter of debate. In the present study serum testosterone (T), DHEAS, sex hormone binding globulin (SHBG) and cortisol levels were determined in 55 RA women, both in pre- and post-menopausal (M) status, and in a group of healthy subjects. Patients were divided into two groups according to disease activity and a correlation analysis of hormonal levels against serum IL1beta levels was performed. No significant differences were found in serum T levels between RA patients and controls, both in preM (1.38 +/- 0.4 vs 1.35 +/- 0.3 nmol/l; p = ns) and in postM status (1.21 +/- 0.2 vs 1.10 +/- 0.2 nmol/l; p = ns). Serum SHBG levels were lower in RA patients than in control subjects, both in pre and in postM status. DHEAS levels were significantly lower in preM RA patients than in controls (2.34 +/- 1.2 vs 5.93 +/- 1.6 mu mol/l; p < 0.001) while cortisol levels were significantly higher in preM active RA patients than in controls (466.2 +/- 30.3 vs 411 +/- 66.2 nmol/l; p = 0.02). IL1beta levels were significantly higher in RA patients than in controls both in pre- and postM subjects (70 +/- 33.8 vs 23.1 +/- 2.9 and 92 +/- 27.4 vs 31.9 +/- 3.1 fmol/l, p < 0.001, respectively). Although androgen status could play a role in the pathogenesis of RA, at present it is not possible to exclude the influence of RA itself on sex hormone profile.

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[Quantitative ultrasonography in the evaluation of postmenopausal osteoporosis. Comparison with dual energy x-ray absorptiometry]

Magaro M, Zoli A, Caricchio R, Angelosante S, Mirone L, Altomonte L, Palazzoni G.

Istituto di Medicina Interna e Geriatria, Universita Cattolica del Sacro Cuore di Roma.

In order to compare the capacities of quantitative ultrasonography and dual energy X-ray absorptiometry to measure bone mineral density (BMD) in postmenopausal women, 45 postmenopausal patients were studied. They were divided into two groups on the basis of the results of absorptiometry: Group A (20 patients) had BMD values within normal limits, and Group B (25 patients) had BMD values lower than 1 standard deviation (SD) of the average for an age and sex matched population. Ultrasonography of the non-dominant heel was carried out on both groups to determine broadband ultrasound attenuation (BUA), speed of sound (SOS) and bone velocity (BV). A negative correlation between age and BMD, BV, SOS, and BUA was observed in all subjects. A positive correlation between BMD and BV and between BMD and SOS was found. In Group A, age correlated negatively with BMD, BUA, SOS and BV, and BMD correlated positively with BV. In Group B, age correlated negatively with BMD, and BMD correlated positively with BV and SOS. BV values were significantly elevated in Group B. The study evidenced a relationship between ultrasonography and absorptiometry in determining bone density in postmenopausal women. As ultrasonography and absorptiometry provided comparable information on bone density, we point out that ultrasonography can be used as a simple and sensitive indicator for postmenopausal osteoporosis.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=8718655&dopt=ExternalLink

Posture in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a connective autoimmune disease that may involve many organ systems and neural function impairment. Postural apparatus dysfunction in SLE may develop in the case of central and peripheral neural involvement. We studied the presence of postural abnormalities in SLE patients with different degrees of disease activity. Twenty-eight subjects (18 SLE patients and 10 normal controls) underwent postural evaluation by means of Static Computerised Posturography. Disease severity or specific clinical problems did not form selection criteria. Lupus activity was assessed using the Systemic Lupus Activity Measure (SLAM). A statistically significant (p < 0.05) increase in the parameters of trace length, trace surface, trace velocity, standard deviation in velocity, and Fast Fourier trX and Y (FET), were found in both the closed and opened eyes tests, when lupus patients were compared to controls subjects. No significant pattern variation in posture was observed between more active and less active SLE patients. Postural control alterations in SLE may be considered a complication of the chronic autoimmune inflammatory process, independent of disease activity as evaluated by the SLAM index. The site of the neuropathy remains uncertain, although we believe it to be peripheral rather than central in origin due to the absence of symptoms or clinical signs of CNS involvement or vascular degeneration.

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Platelet lactate dehydrogenase activity in systemic lupus erythematosus: correlation with anticardiolipin antibodies.

Zoli A, Zappacosta B, Altomonte L, De Sole P, Caricchio R, Pellegrino M, Mirone L, Giardina B, Magaro M.

OBJECTIVE. To evaluate lactate dehydrogenase (LDH) activity in platelet subpopulations in systemic lupus erythematosus (SLE) and to correlate platelet LDH activity with concentrations of anticardiolipin antibody (aCL). METHODS. Twelve female patients with SLE and 12 age matched female control subjects were studied. Platelets were separated on the Percoll gradient, their density values controlled by density marker beads. LDH activity was measured after platelet lysis, expressed as nU/fl. ELISA were used to measure levels of IgG and IgM aCL. RESULTS. A significant increase of LDH activity with a significant correlation to IgG and IgM aCL were found in small, light platelets with a volume < 5 mu 3 compared to large, dense platelets and to controls. LDH activity did not correlate with immunoglobulin classes, anti-DNA antibodies, and complement fractions in small and large SLE platelets. CONCLUSION. Our data suggest a possible chronic activation of subpopulations of small platelets in patients with SLE independent of thrombotic process. Low levels of aCL can mediate small platelet activation. Quantitative and qualitative analysis of the small, light platelets can serve a clinical diagnostic purpose as an in vivo platelet activation index in SLE.

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[Keratoconjunctivitis sicca in rheumatoid arthritis: correlation with the autoantibody pattern]

Istituto di Medicina Interna e Geriatria, Universita Cattolica del Sacro Cuore di Roma.

In order to evaluate the autoantibody pattern of subjects affected by rheumatoid arthritis (RA) with clinical features of keratoconjunctivitis, we studied 32 out- and in-patients (26 women, 6 men, average age 52 years, average disease duration 5.5 years) at the Division of Rheumatology, Catholic University of Rome. We found keratoconjunctivitis sicca and xerostomia in 22 (68.75%) patients with RA. Rheumatoid factor was present in 17 (53.1%) patients, antinuclear antibodies (ANA) were observed in 15 (48.4%) patients, and anti-rheumatoid arthritis nuclear antigens (RANA) in 22 (68.7%) patients; anti-SSA antibodies were confirmed in 3 (9.4%) patients and anti-SSB antibodies in 2 (6.2%) patients. None of the patients evidenced anti-U1RNP. Although keratoconjunctivitis sicca and xerostomia correlated significantly with the presence of rheumatoid factor, we found no relationship between these two conditions and ANA or anti-RANA antibodies. The high frequency of keratoconjunctivitis sicca and xerostomia in our RA patients is the expression of extra-articular involvement in this disease and is correlated with the presence of rheumatoid factor. ANA and anti-RANA antibodies may represent aspecific polyclonal activation in RA.

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Microvascular capillaroscopic abnormalities in rheumatoid arthritis patients.

Altomonte L, Zoli A, Galossi A, Mirone L, Tulli A, Martone FR, Morini P, Laraia P, Magaro M.

Institute of Internal Medicine and Geriatrics, Catholic University of the Sacred Heart, Rome, Italy.

Microvascular circulation was investigated by nailfold capillaroscopy in 32 patients affected by rheumatoid arthritis (RA). In all the patients elongated and tiny capillaries as well as tortuousity were the main shape abnormalities of the capillary loops. Higher subpapilar venous plexus (SPVP) visibility was evidentiated in patients presenting antinuclear and anti-RANA antibodies. No differences in the capillaroscopic pattern were found between rheumatoid factor positive and rheumatoid factor negative patients. In conclusion, elongated and tortuous capillaries seem to be the main alterations in RA, although they are not specific to the disease and are not correlated with the presence of rheumatoid factor. Higher SPVP visibility may be an expression of the endothelial damage induced by antinuclear antibodies in vessel walls.

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Clinically silent inflammatory gut lesions in undifferentiated spondyloarthropathies.

Altomonte L, Zoli A, Veneziani A, Mirone L, Santacesaria G, Chiarelli C, Federico F, Massi G, Magaro M.

Divisione di Reumatologia, Istituto di Medicina Interna e Geriatria, Universita Cattolica del Sacro Cuore, Roma, Italy.

Gastrointestinal inflammation or infection can be associated with various forms of arthritis, such as, acute reactive arthritis triggered by enteritis due to gram-negative bacteria or ankylosing spondylitis and peripheral arthritis in relation to Crohn's disease and ulcerative colitis. Using colonoscopy, we have found a high prevalence of clinically silent inflammatory lesions in 38 patients (24 males and 14 females) affected by undifferentiated spondyloarthropathies (SpA). Microscopic inflammatory lesions were present in all the patients. Three patterns of nonspecific chronic inflammatory alterations were observed. No difference was noted between patients taking or not taking nonsteroidal anti-inflammatory drugs. Direct immunofluorescence demonstrated the presence of IgG, IgA, IgM, C3, C4 and fibrinogen in 75% of the specimens examined. The finding of chronic inflammatory gut lesions hypothesizes that a local activation of the immune system depending on the persistence of intestinal microbial antigens or toxins, due to impaired elimination or increased exposition, may have a part in the pathogenesis of SpA.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=7697956&dopt=ExternalLink

Serum transferrin receptors in rheumatoid arthritis.

Zoli A, Altomonte L, Mirone L, Magaro M, Ricerca BM, Storti S, Candido A, Bizzi M.

OBJECTIVE--Serum transferrin receptors (sTfR) were determined in patients affected by rheumatoid arthritis (RA) to verify a possible relationship with the degree of anaemia and with the severity of the inflammatory disease. METHODS--sTfR, IL1-b, TNF-a and common parameters of iron metabolism were studied in 72 patients with active RA. Anaemia (Hb < 12 g/dl) was present in 51 patients. Twenty normal healthy subjects and 40 iron-deficient anaemic patients without chronic inflammatory, infective or malignant diseases were studied as controls. RESULTS--In patients with RA sTfR levels were significantly higher than in the normal group but lower than in iron-deficient anaemic patients and correlated positively with ESR and IL1-b and negatively with Hb. Anaemic patients with RA were divided into two groups. Group A (56%) showed a possible iron deficiency (TSI < 16 and ferritin < 50 ng/ml); group B did not show iron deficiency (TSI > 16 and ferritin > 50 ng/ml). No significant difference in sTfR was observed in the two groups. CONCLUSION--sTfR appear to be elevated and related to the degree of anaemia and to the inflammatory process in RA. Reduced sTfR levels in patients with RA compared with patients with iron-deficiency anaemia may indicate a reduced erythropoietic activity in RA.

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[Antiphospholipid antibodies in systemic lupus erythematosus: study of a caseload of 120 patients]

In order to evaluate the presence of antiphospholipid antibodies (aPL) in patients with systemic lupus erythematosus (SLE), we measured IgG and IgM anticardiolipin antibodies (aCL) in a group of out- and in-patients of the Rheumatology Division at the Catholic University of Rome. Lupus anticoagulant and VDRL were also measured in 30 patients. One hundred thirteen women and 7 men (mean age 38.5 years, mean disease duration 4.27 years) were studied. The control group consisted of 60 age and sex matched healthy subjects. aCL IgG and IgM were positive in 48 (40%) and 49 (40.8%) patients respectively. aCL IgG correlated positively with the activated partial thromboplastin time. aCL IgM correlated positively with immunoglobulins of the G and M classes and with circulating immune complexes, and negatively with the C4 fraction. aCL antibodies did not correlate with spontaneous abortion or neurologic and psychiatric disturbances, although in women with a history of abortion, aCL IgG concentration was correlated with the number of spontaneous abortions. The presence of aPL does not seem to indicate a subgroup of SLE patients. The occurrence of abortion and/or neurologic and psychiatric disturbances in SLE seems to point to a complex pathogenesis with aPL as one of the causative agents.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=7893573&dopt=ExternalLink

Lactic dehydrogenase activity of platelet subpopulations in a group of patients with systemic lupus erythematosus.

Zappacosta B, De Sole P, Fresu R, Caricchio R, Zoli A, Altomonte L, Giardina B.

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Effect of fish oil on neutrophil chemiluminescence induced by different stimuli in patients with rheumatoid arthritis.

Lipid composition plays an important part in the structural and metabolic functions of cell membranes. In particular the production of inflammatory mediators such as prostaglandins and leukotrienes is dependent on polyunsaturated fatty acid precursors. Neutrophil leucocytes participate in inflammatory processes by their phagocytic and killing activities which can be monitored by measuring the photon emission (chemiluminescence). Chemiluminescence was measured in a luminol dependent system after stimulation by either particulate (zymosan) or soluble (phorbol myristate acetate) stimulus in a group of 10 patients with rheumatoid arthritis before and 21 and 45 days after treatment with a diet supplemented with eicosapentaenoic and docosahexaenoic acids. Ten patients with rheumatoid arthritis continuing their usual diet were used as control subjects. A progressive reduction of chemiluminescence stimulated by zymosan and phorbol myristate acetate was found in the patients treated with fish oil supplementation. This result correlated well with the reduction in erythrocyte sedimentation rate and an improvement of clinical parameters. The effects of fish oil derived lipids on neutrophil chemiluminescence are probably due to a change of the lipid composition of the cell membrane which is dependent on the esterification of eicosapentaenoic acid and docosahexaenoic acid in cellular membrane phospholipids. The modification of membrane lipid composition seems to interact in a non-specific way with the metabolic activation of neutrophils during phagocytosis.

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Serum levels of interleukin-1b, tumour necrosis factor-a and interleukin-2 in rheumatoid arthritis. Correlation with disease activity.

Cytokines are potent immunoregulatory factors and may be directly involved in the disordered immunoregulation found in chronic rheumatic diseases. Interleukin-1b (IL-1b), Interleukin-2 (IL-2) and Tumour Necrosis Factor-a (TNF-a) have been implicated in the pathogenesis of rheumatoid arthritis (RA) as mediators of chronic inflammation. Serum levels of IL-1b and TNF-a measured by radioimmunoassay were significantly higher in patients with RA than in healthy controls of similar sex and age while serum levels of IL-2 were significantly lower in the same patients. Further IL-1b and TNF-a were significantly elevated in RA patients with active disease and IL-2 was significantly reduced when compared with patients with low active disease. Serum IL-1b and TNF-a appear to correlate with systemic inflammation, and systemic features of RA may result from dissemination of cytokines produced in the synovium. The role of IL-2 in RA remains controversial. Reduced levels of IL-2 may be an expression of a deficiency of T-cells to produce IL-2 in the active phases of RA or may be due to a possible absorption of IL-2 by lymphocyte receptors.

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Lack of correlation between anticardiolipin antibodies and peripheral autonomic nerve involvement in systemic lupus erythematosus.

The presence of anticardiolipin antibodies has recently been related to a clinical complex in which both central and peripheral neurologic damage is included. A series of 27 female patients affected by systemic lupus erythematosus (SLE) was tested for the presence of peripheral autonomic neuropathy and serum anticardiolipin antibody (ACA) levels were determined in each patient by ELISA. Peripheral autonomic impairment was detected in 40.7% of SLE patients and a large number (77.7%) of patients had elevated levels of ACA. No relationship was found between presence of ACA (both for IgG and IgM classes) and the autonomic neuropathy.

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The association of silent thyroiditis with active systemic lupus erythematosus.

Autoimmune thyroid disorders have been shown to occur in patients with connective tissue diseases. Hypothyroidism and thyrotoxicosis have been recognized in systemic lupus erythematosus (SLE). Moreover, a high prevalence of antithyroid antibodies has been found in patients with SLE. We studied thyroid function in a group of SLE female patients without a history or clinical diagnosis of thyroid disease and then correlated the prevalence of abnormal function test results with the laboratory indexes of active disease and with the presence of antithyroid antibodies. The SLE patients had significantly lower T4 levels than the controls. Basal TSH and TSH concentrations after TRH stimulation were significantly higher in patients with active SLE in comparison to both patients with inactive SLE and to controls. 45.5% of patients with active SLE presented antithyroid antibodies. Antithyroglobulin and antimicrosomal antibodies were not found in patients with inactive SLE nor in controls. Our results confirm the existence of a mild hypothyroidism in SLE that is clinically silent. The altered thyroid function appears to be dependent on the activity of the systemic autoimmune process.

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[Mucocutaneous lichen planus with esophageal involvement. A clinical case]

Istituto di Clinica Medica Generale, Universita Cattolica del Sacro Cuore, Roma.

The paper reports the case of a 58-year-old woman suffering from mucosal and cutaneous lichen planus (LP) with esophageal and oral involvement, who had complained of dysphagia for approximately the past two years. The diagnosis of esophageal LP was made using esophagoscopy with mucosal biopsy. The differential diagnosis between LP and progressive systemic sclerosis is discussed; a cold-test, plethysmography of the limbs, an anti-ENA Sci-70 antibody assay, X-rays of soft tissues and esophagomanometry were performed for this purpose, and all proved normal. The presence of conditions implicated in the etiopathogenesis of LP (psychic disorders and the administration of psychoactive drugs, anti-hypertensives and FANS) were observed, together with an already known association with arterial hypertension. Altered hepatic function (with an increase in cholestasis enzymes) was also noted which is probably attributable to the prolonged use of psychoactive drugs (hepatic biopsy showed severe steatosis).

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=1545925&dopt=ExternalLink

Growth hormone secretion in diffuse idiopathic skeletal hyperostosis.

Divisione di Reumatologia, Istituto di Clinica Medica, Universita Cattolica del Sacro Cuore, Roma.

Serum insulin and C-peptide response to an oral glucose tolerance test (OGTT) and serum growth hormone (GH) response to an intravenous insulin tolerance test (IVITT) were investigated in six non-obese patients, with normal glucose tolerance, affected by diffuse idiopathic skeletal hyperostosis (DISH). Basal serum insulin, C-peptide and GH values were similar in DISH patients and in controls. After OGTT, insulin and C-peptide values were not significantly different in the two groups at any time interval. In contrast, after IVITT, a significant increase in GH concentrations was noted at 30 and 45 minutes in DISH patients when compared to controls. Growth hormone either acting alone or through somatomedin intermediaries results in new bone growth in acromegaly, and the same may be true for DISH. Recent reports suggest that GH promotes tissue growth by stimulating precursor cells in various tissues including cartilage and bone. The increased GH response to IVITT corroborates the hypothesis that GH may act as a bone growth-promoting factor in DISH.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=1524945&dopt=ExternalLink

Serum lipid pattern and apolipoproteins (A1 and B100) in active rheumatoid arthritis.

Cardiovascular diseases and atherosclerotic manifestations have been reported to be the most common causes of death in rheumatoid arthritis (RA). In the present investigation the levels of serum lipids, apolipoproteins (A1 and B100), total proteins, and albumin were studied in 35 female patients affected by active RA. Apolipoproteins A1 and B100 were significantly lower in RA patients than in controls. No significant difference was observed in total cholesterol, LDL cholesterol, or triglycerides. In contrast, HDL cholesterol and serum albumin were significantly lower in RA patients compared to controls. The finding of reduced apolipoproteins and HDL-cholesterol levels may represent an important factor in the etiology of cardiovascular and atherosclerotic disease in RA. Reduced levels of albumin in active RA may indicate a reduced rate of proteins like lipoproteins in the liver.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=1927062&dopt=ExternalLink

Generalized osteoporosis in non-steroid treated rheumatoid arthritis.

Department of Internal Medicine, Catholic University of Sacred Heart, Rome, Italy.

To investigate the presence of reduced bone mineral density (BMD) and to assess determinants of bone loss in rheumatoid arthritis, 45 female patients suffering from non-steroid treated rheumatoid arthritis were submitted to dual photon absorptiometry of the lumbar spine and to laboratory tests for calcium metabolism. The rheumatoid arthritis patients were divided into two groups according to anatomic grade and functional class; no abnormalities in calcium metabolism were detected whereas BMD was significantly lower in the third and fourth grade and in the third and fourth class patients (P less than 0.005 versus controls, versus grades I and II and versus classes 1 and 2). BMD was significantly correlated with age (P less than 0.001) and years postmenopausal (P less than 0.01), but not with duration of disease. By multiple linear regression we derived an equation predictive of BMD. Osteoporosis in rheumatoid arthritis is observed even in non-corticosteroid treated patients; articular lesions with subsequent reduction in physical activity appear to play an important role in axial bone loss in rheumatoid arthritis.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=1947672&dopt=ExternalLink

[Circadian rhythm of the heart rate and autonomic nervous system stimulation tests in patients with systemic lupus erythematosus]

Lanza GA, Scabbia EV, Mancuso P, Magaro M, Mirone L, Altomonte L, Zoli A, Angelosante S, Manzoli U.

We studied 19 women (mean age 35 +/- 13 years) with systemic lupus erythematosus (SLE), in order to evaluate whether or not alterations in the circadian rhythm of heart rate (HR) occur in patients with pathologic responses to stimulation tests of the autonomic nervous system (ST-ANS). The duration of SLE was 5.3 +/- 5 years. None of the patients had clinical signs of cardiopathy or dysautonomy, nor were any of them taking drugs with known effects on the heart or ANS. Nine patients (47%, group A) had normal ST-ANS and 10 (53%, group B) had an abnormal response to at least 1 ST-ANS (5 to sympathetic ANS, 3 to parasympathetic and 2 to both ST-ANS). Age, duration of disease and therapy were not different between the 2 groups. All patients underwent 24-hour ambulatory ECG monitoring, and chronobiologic analysis of hourly HR was carried out by single and mean cosinor methods. A significant circadian rhythm was found both in the total sample (mesor 80 b/min, acrophase h 13:12; p less than 0.01), and, separately, in group A (mesor 82 b/min, acrophase h 13:11; p less than 0.01) and group B (mesor 78 b/min, acrophase h 13:12; p less than 0.01). No difference existed between the HR circadian rhythms of the 2 groups. Thus, our data show the possibility of ANS involvement in SLE patients without clinical signs of dysautonomy; the analysis of the HR circadian rhythm does not appear to be a sensitive method to identify early involvement of the ANS in these patients.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=1892727&dopt=ExternalLink

Vertebral involvement in tertiary syphilis.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=2224422&dopt=ExternalLink

Sensorineural hearing loss in rheumatoid arthritis.

Magaro M, Zoli A, Altomonte L, Mirone L, Corvino G, Di Girolamo S, Giacomini P, Alessandrini M.

Hearing function was tested in 20 patients affected by rheumatoid arthritis. Audiological examination was performed by pure tone audiometry thresholds, tympanometry, a stapedial reflex threshold test and auditory brainstem responses (ABR). Hearing impairment was observed in 55% of patients. Conductive hearing loss and the absence of stapedius reflex were never recorded. Five patients with abnormal audiograms had normal ABR and normal stapedial reflex thresholds while 6 patients showed abnormalities in their audiograms, stapedial reflex thresholds test and ABR. Abnormal audiometric results associated with normal ABR are compatible with cochlea involvement, while abnormal audiometric results associated with an altered ABR and stapedial reflex test may be due to retrocochlear involvement. Sensorineural hearing loss appeared to significantly correlate with active disease and with the presence of rheumatoid factor.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=2261709&dopt=ExternalLink

Eosinophilic fasciitis associated with inflammatory neutrophilic vasculitis.

The authors report a case of eosinophilic fasciitis with an histopathological pattern of inflammatory neutrophilic vasculitis associated with the typical inflammatory infiltrate. The presence of this type of vasculitis which may be observed in the initial forms of scleroderma supports the hypothesis of a considerable overlap between these two entities.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=2322770&dopt=ExternalLink

Iron chelation in rheumatoid arthritis: clinical and laboratory evaluation.

Magaro M, Zoli A, Altomonte L, Mirone L, Corvino G, Storti S, Marra R, Ricerca BM, Pagano L, Di Cesare L.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=2187420&dopt=ExternalLink

Effect of oral gold salt therapy on bile acid absorption in rheumatoid arthritis patients.

Several studies pointed out an altered stool pattern as the most common side effect of auranofin therapy. The major mechanism in the aetiology of auranofin-induced impairment in bowel habit seems to be the inhibition of Na+/K+ ATPase in the gut. In vitro experiments proved that auranofin can affect active bile acid (BA) reabsorption in rat terminal ileum; this action, due to the ability of the drug to reduce Na+ pump activity by inhibiting Na+/K+ ATPase, may make a significant contribution to the auranofin-induced diarrhoea. The ability of auranofin to reduce the Na+ gradient necessary for active BA reabsorption, however, could cause a decrease of serum BA levels in patients taking auranofin before or without the development of an overt diarrhoea. We measured fasting and postprandial serum conjugated BA levels in 10 female rheumatoid arthritis patients before and after one month and two months' auranofin treatment. No patient developed diarrhoea during the chrysotherapy. When oral gold salt therapy was started, we observed a slight decrease in serum BA levels, but difference was not statistically significant. We can conclude that auranofin therapy does not cause BA malabsorption in patients who do not develop diarrhoea during the treatment.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=2335051&dopt=ExternalLink

[Yellow nail syndrome: description of a case and review of the associated pathology]

The AA. report a case of yellow nail syndrome associated with rheumatoid arthritis and monoclonal gammopathy (IgG-lambda). Because of the great variety of the diseases associated with this syndrome, the AA. suggest to control patients periodically to verify the probable appearance of other clinical manifestations.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=2113700&dopt=ExternalLink

[Changes in esophageal motility in patients with systemic lupus erythematosus: an esophago-manometric study]

Impairment of esophageal motor function is well recognized in connective tissue disease. We have investigated esophageal function, by manometric studies, presence of symptoms of esophageal involvement and antibodies pattern, in 18 female patients affected by systemic lupus erythematosus (SLE). Esophageal manometry showed motor abnormalities in 72.3% of the patients, especially hypokinetic abnormalities (hypotony of lower esophageal sphincter pressure, low amplitude or alterations of peristaltic waves) or, rarely, an increase of amplitude of peristaltic contractions. No significant correlation were found between antinuclear antibodies, esophageal symptoms and manometric findings. Hypoperistalsis or aperistalsis, may be due to an inflammatory reaction in the esophageal muscles or to an ischemic vasculitic damage of Auerbach plexus. High amplitude of peristaltic esophageal waves may be due to an early stage of reflux esophagitis: we have found gastro-esophageal reflux symptoms in more than half of our patients.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=2336165&dopt=ExternalLink

Serum osteocalcin as an index of bone turnover in active rheumatoid arthritis and in active psoriatic arthritis.

Juxtaarticular osteoporosis is a recognized clinical feature in both rheumatoid arthritis (RA) and psoriatic arthritis (PA), while generalised osteopenia seems to be characteristic of RA only. To assess differences in bone turnover in the two forms of disease, we measured serum osteocalcin levels and other parameters of bone metabolism in two groups of female, ambulant, age-matched patients suffering from active RA or active PA and never treated with steroid therapy. Serum osteocalcin levels were significantly higher in RA patients than in PA patients (13.05 +/- 1.27 ng/ml vs 4.83 +/- 0.88 ng/ml; p less than 0.001), with a significant positive correlation between osteocalcin and serum alkaline phosphatase in both groups. These data suggest that bone turnover is higher in active RA than in active PA. Juxtaarticular osteoporosis could be mediated by local disease mechanisms both in RA and in PA, while factors specifically related to active RA seem to determine a more generalized impairment of bone turnover.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=2612118&dopt=ExternalLink

[Nimesulide in the treatment of osteoarthrosis and extra-articular rheumatism]

Nimesulide is a new non-steroidal anti-inflammatory drug which seems to be characterized by a low inhibitory action on prostaglandin synthesis and a high inhibitory action on oxygen free radicals production. The aim of this trial was to determine the effect of Nimesulide on degenerative joint disease and on non-articular rheumatism. One hundred and forty, 64 females and 76 males aged 51.9 +/- 1.2 years, affected with osteoarthritis or non-articular rheumatism (fibromyalgia, periarthritis, tendinitis, tenosynovitis, bursitis and enthesitis) were studied. Nimesulide was administered at a daily dosage of 200 mg. A significative improvement in the clinical parameters studied was observed in all the patients, but a more remarkable progress was noted in the group with non-articular rheumatism. The incidence of adverse reactions was irrelevant: 2 patients complained of epigastralgia that subsided reducing the daily dosage to 100 mg.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=2812475&dopt=ExternalLink

Bone GLA protein (BGP) levels and bone turnover in rheumatoid arthritis.

Bone GLA protein (BGP) and other biochemical indices of bone turnover were measured in 42 female patients with rheumatoid arthritis (RA) and in a group of normal subjects matched for sex and age. Mean serum BGP concentrations were significantly higher in patients with active arthritis than in patients with mild activity (p less than 0.01) and controls (p less than 0.01). No significant difference was found in serum BGP levels and in other parameters of bone turnover when the patients were stratified according to functional class or duration of disease. There was a correlation between BGP and alkaline phosphatase levels only in RA patients with high activity of disease. Our data suggest an accelerated bone turnover in patients with active RA. We infer that in such patients the impairment of bone metabolism is a determinant of RA-associated osteopenia. Disease activity rather than functional impairment or duration of arthritis should be regarded as a factor in the bone loss of RA.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=2786438&dopt=ExternalLink

C-1 inhibitor activity levels in active rheumatoid and psoriatic arthritis.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=2743717&dopt=ExternalLink

Asymptomatic and symptomatic gastroduodenal patients affected by rheumatic disease treated with non-steroidal anti-inflammatory drugs.

Magaro M, Altomonte L, Zoli A, Mirone L, Berchicci MC, Tricerri A, Corvino G.

It is becoming more apparent that the common gastritis and ulcer complications associated with non steroidal anti-inflammatory drugs (NSAID's) are distinct from classic peptic ulcer disease. To assess the incidence of gastrointestinal lesions and the existence of correlation with gastrointestinal symptoms, patients affected by rheumatic diseases treated with NSAIDs were carefully questioned to evaluate gastrointestinal symptoms and then underwent an esophagogastroduodenoscopic examination. The study demonstrates a relevant absence of gastrointestinal symptoms with an high incidence of gastric mucosal lesions in this patients. Asymptomatic lesions seem to be a characteristic feature of NSAID gastropathy. The blockade of synthesis of prostaglandins, due to the inhibition of cyclooxygenase by NSAIDs, may create an environment conducive to gastritis or ulcer disease and may be responsible of the absence of gastrointestinal symptoms.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=2786181&dopt=ExternalLink

Prevalence of diabetes mellitus in common rheumatic diseases.

Association between diabetes and some rheumatic diseases have been proposed. The aim of our work is the evaluation of the prevalence of diabetes mellitus (DM) in a population of patients affected by some common rheumatic disease. We evaluated 356 consecutive out-patients [205 (71.66%) women and 101 (28.34%) men] attending the Rheumatology Unit of the Dept. of Internal Medicine of the Catholic University of Rome. The control group consisted of 200 out-patients, age and sex matched, who were examined in the Dept. of Surgery. The diagnosis of rheumatic patients were osteoarthritis (OA) (45.5%), rheumatoid arthritis (RA) (34%) and periarthritis (PA) (20.5%). The prevalence of diabetes mellitus in our rheumatic population was 5.78% in RA, 6.17% in OA, 10.9% in PA. The prevalence of DM in the control group was 4%. Our data suggest that the prevalence of DM in OA and RA patients is similar to that of general population, while it is significantly higher in PA patients probably for an active role of microangiopathy and hyperglycemia in the genesis of such disease.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=2786180&dopt=ExternalLink

[Sulglicotide in the prevention of gastric disease induced by NSAID. Double-blind controlled study versus placebo]

Magaro M, Altomonte L, Zoli A, Mirone L, Wielmarin A, Massari M, Destito G, Nazzari M, Psilogenis M.

Non-steroidal anti-inflammatory drugs, essential for the treatment of rheumatic diseases, are frequently associated with significant adverse effects on the integrity of the gastrointestinal mucosa. Sulglicotide (S), a natural product, has been found to possess gastromucosal protective properties. Aim of the present study was to evaluate whether (S) 200 mg t.i.d prevented or reduced the severity of gastric and/or duodenal mucosal injury induced by Diclofenac. A total of 30 patients with either rheumatoid arthritis (RA) or osteoarthritis (OA) who required NSAID therapy for at least 8 weeks were enrolled into a double-blind randomized placebo-controlled study. The main criteria for entry into the trial was the absence of gastrointestinal symptoms, and gastric/duodenal lesions assessed by endoscopy. At the end of the treatment endoscopy and relative symptoms were assessed. Six out of 15 patients, in both groups of treatment developed mucosal injury, but only in the placebo group the gastric damage was important (ulcer and petechiae) while in the group (S) we observed only hyperemia of the gastric mucosa. These preliminary data indicate the usefulness of Sulglicotide in preventing or reducing mucosal injury from NSAID treatment.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=2725926&dopt=ExternalLink

Impaired growth hormone response to clonidine in obesity.

Altomonte L, Zoli A, Mirone L, Berchicci M, Travaglini R, Pellicano P, Greco AV.

Clonidine, an imidazoline derivative, is an antihypertensive agent which reduces sympathetic tone by acting in the central nervous system to stimulate alpha-2 adrenoceptors. There is evidence that dopamine and norepinephrine modulate the secretion of GH. Stimulation of GH release is a well-known effect of clonidine in man. Obesity is characterized by an impairment of GH release in response to various stimuli. The aim of this work is to study GH release in response to alpha-2 adrenoceptors stimulation by clonidine in obesity. 12 volunteer obese subjects were studied. 10 normal weight subjects, sex and age matched, were controls. The GH responsiveness was tested with a single oral dose of clonidine (0.15 mg). Blood was sampled for GH radioimmunoassay at 0', 30', 60', 90', 120', 150', 180'. Serum GH basal levels were not significant different in obese subjects compared to controls. In obese subjects, no significant changes occurred in blood GH concentration after clonidine. In normal weight controls, instead, a significant increase of GH values was reached at 90' (P less than 0.05) and at 120' (P less than 0.05) after clonidine. The impairment of GH release after clonidine in obese subjects might be in a reduced serotonin release or in a failure of the hypothalamic-pituitary system to stimulate plasma GH caused by a diminished GH releasing factor stimulatory effect or by an excessive endorphin or somatostatin secretion in obesity.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=3243343&dopt=ExternalLink

Influence of diet with different lipid composition on neutrophil chemiluminescence and disease activity in patients with rheumatoid arthritis.

Magaro M, Altomonte L, Zoli A, Mirone L, De Sole P, Di Mario G, Lippa S, Oradei A.

Neutrophil chemiluminescence was determined in patients with active rheumatoid arthritis. Twelve patients were randomly assigned either to a diet high in polyunsaturated fatty acids supplemented with eicosapentaenoic and docosahexaenoic acids or to a diet high in saturated fatty acids. A correlation with clinical and laboratory parameters is also reported. No statistical difference was observed in neutrophil chemiluminescence and in clinical parameters in the group of patients treated with a diet high in saturated fatty acids. Fish oil ingestion resulted in subjective alleviation of active rheumatoid arthritis and reduction of neutrophil chemiluminescence. This study corroborates the hypothesis of an anti-inflammatory role for polyunsaturated fatty acids in patients with chronic inflammatory diseases.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=3196080&dopt=ExternalLink

Seronegative spondarthritis associated with Takayasu's arteritis.

A young woman presented with an aortic arch syndrome a few years after the onset of ankylosing spondylitis. Tissue typing showed HLA-B27. The possibility of an association between ankylosing spondylitis and Takayasu's arteritis is suggested.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=2899992&dopt=ExternalLink

Glucagon and glucose tolerance in liver cirrhosis.

Greco AV, Altomonte L, Ghirlanda G, D'Anna LM, Manna R, Caputo S, Uccioli L.

The present study was undertaken in order to establish the significance of glucagon in glucose intolerance in liver cirrhosis. The plasma glucose response to an oral glucose load (75 g) was determined in 10 control subjects and in 10 cirrhotic patients, after infusions of: glucagon (3 ng.kg-1.min-1) or saline (154 mmol/l); somatostatin (SRIH) (500 micrograms/h); and SRIH plus glucagon (3 ng.kg-1.min-1). Glucagon infusion did not impair glucose tolerance, neither in normal subjects nor in patients with cirrhosis. On the other hand, in both groups glucose tolerance was impaired by SRIH infusion, presumably owing to an absolute insulin deficiency. Both in normal subjects and in cirrhotic patients, SRIH plus glucagon infusion further impaired glucose tolerance, presumably as a result of excess glucagon and concomitant insulin deficiency. In conclusion, our data show that hyperglucagonemia is not an important factor in the development of the glucose intolerance in patients with hepatic cirrhosis.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=2899368&dopt=ExternalLink

Acute rheumatoid factor positive (IgM) polyarthritis associated with a Klebsiella pneumonitis.

Divisione Di Reumatologia, Istituto di Clinica Medica, Universita' Cattolica S. Cuore Rome, Italy.

The authors report a case of a patient suffering from acute polyarthritis with a high rheumatoid factor titre, associated with a Klebsiella pneumonitis. A polyclonal B lymphocyte activation or a possible cross reaction between rheumatoid factor and an antigen related to Klebsiella may explain the elevated production of rheumatoid factor observed.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=3046829&dopt=ExternalLink

Effect of fenfluramine on insulin/growth hormone ratio in obese subjects.

Obesity is characterized by increased levels of insulin and by subnormal growth hormone (GH) release. Insulin/GH ratio is significantly higher in obese than in lean individuals. Fenfluramine, an anorectic drug, may have some effects on hypothalamic-pituitary function and on insulin secretion, possibly through a serotonergic stimulation. The aim of this work was to study the effects of fenfluramine on the insulin/GH ratio after arginine in obese subjects. Ten volunteer obese females were studied; 10 volunteer women were the normal weight controls. All subjects were given placebo and fenfluramine (60 mg p.o.) in a randomized order and after 120 min underwent arginine infusion (25 g i.v. for 30 min). Blood samples were taken every 30 min until 270 min for GH and insulin radioimmunoassay. In the obese group the GH response to arginine was significantly lower than in controls. Fenfluramine administration restored the subnormal GH response to arginine in obese subjects. Arginine infusion provoked a greater insulin secretion in obese subjects than in lean individuals. Fenfluramine administration diminished the insulin response to arginine. Fenfluramine did not modify the insulin/GH ratio in controls while it significantly lowered the insulin/GH ratio in obese subjects. Because insulin promotes fat and carbohydrate storage while GH stimulates lipolysis, the combination of high insulin and low GH concentrations may worsen the obese condition. A lower insulin/GH ratio can be useful in the treatment of obesity.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=3281173&dopt=ExternalLink

Serum C4 concentration and diabetic microangiopathy in insulin dependent diabetes. A study of an Italian group of insulin dependent diabetic patients.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=3431891&dopt=ExternalLink

Effect of fenfluramine on growth hormone and prolactin secretion in obese subjects.

Obese subjects show a subnormal growth hormone (GH) and prolactin (PRL) release in response to a variety of stimuli. Fenfluramine, an anorexiant drug used in obesity therapy, may have some effects on hypothalamic-pituitary function mediated by serotoninergic stimulation. The present investigation in obese subjects was carried out to study the effects of fenfluramine (60 mg orally) on GH and PRL secretion after intravenous arginine infusion. Ten volunteer obese females were studied and compared with 10 volunteer normal weight controls. In the obese group the GH response to arginine was significantly lower than in control group. Fenfluramine administration restored the subnormal GH response to arginine in obese subjects. The PRL response to arginine in obese women was subnormal. Fenfluramine administration restored the response of PRL to arginine infusion to normal. In conclusion, fenfluramine--under acute circumstances--enhances the hypothalamic-pituitary response to arginine in obese subjects. The decreased GH and PRL output in obese subjects is not due to an absolute hormonal deficiency and this effect of fenfluramine on GH secretion may--due to its lipolysis stimulation--be useful in obesity treatment.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=3436616&dopt=ExternalLink

Stimulatory effect of pentagastrin on growth hormone and prolactin secretion in normal subjects.

Gastrin-like immunoreactive substances have been reported as occurring in both digestive tract tissues and nervous system, including the hypothalamus and the anterior and posterior pituitary. The carboxyterminal tetrapeptide shared by gastrin and cholecystokinin, which represents the bioactive site of both hormones, has been shown to be a secretagogue for insulin and glucagon and it might have a neurotrasmitter function. As small gastrin-like peptides may also play a role in the regulation of anterior pituitary hormones, the present study deals with the in vivo effect of pentagastrin on the release of growth hormone (GH) and prolactin (PRL). Six healthy volunteer males and six healthy volunteer females were studied. All females subjects were in the early follicular phase of the normal menstrual cycle and all subjects were not taking or had been taking any drug known to affect GH or PRL secretion. A continuous intravenous infusion of pentagastrin (1.5 micrograms/kg/h) was administered to all the subjects for a time of 3 hours. In males pentagastrin infusion resulted in a significant increase in GH concentration from basal values (P less than 0.01 at 60 min). In females pentagastrin infusion did not affect GH levels. PRL levels were not affected at all by intravenous pentagastrin infusion both in males and females. The exact understanding of pentagastrin action on GH release awaits further investigation. The different pattern between male and female subjects suggests a sexual hormone influence on the hypothalamic-pituitary sites of action of pentagastrin in vivo. Our data did not confirm a stimulatory effect of pentagastrin on PRL secretion in normal subjects.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=3556418&dopt=ExternalLink

The effect of lysine acetylsalicylate on somatostatin inhibition of insulin secretion induced by arginine.

The inhibitory effect of somatostatin (SRIF) on immunoreactive insulin release and on many other hormonal secretions has been widely studied in both animal and man. However, the mechanism by which SRIF acts on these functions remains poorly defined. Aim of this study is to determine the inhibitory effect of SRIF on insulin secretion induced by arginine after the administration of lysine acetylsalicylate (LAS) in a dose which inhibits the endogenous synthesis of prostaglandins. Ten healthy informed volunteer subjects were studied. Four studies were carried out in randomized order, each one separated by a three day interval. The first study was a test of arginine (25 g i.v. in 30 min). The second study was a test of arginine with SRIF infusion (150 micrograms bolus followed by 100 micrograms/h for 120 min). The third study was a test of arginine with an infusion of SRIF and LAS (66 mg/min for 120 min). The fourth study was a test of arginine with LAS infusion. Plasma insulin levels were determined by radioimmunoassay. After arginine administration the typical biphasic insulin response was observed with a precocious peak at 3 min and a late peak at 30 min. This response is not significantly modified under LAS infusion. With the infusion of SRIF at a dose of 100 micrograms/hr after arginine administration only a very modest insulin response was observed. The addition of LAS does not modify the inhibitory effect of SRIF on insulin secretion induced by arginine. This result demonstrates that the inhibitory action of SRIF on the secretion of insulin is not dependent upon the activation of the endocellular prostaglandin system.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=2880743&dopt=ExternalLink

Thromboxane production in diabetes mellitus.

A correlation between increased platelet adhesiveness and aggregation and the development of angiopathy in diabetes mellitus can be made. Thromboxane produced by platelets represents a potent platelet aggregation factor. We studied the platelet TXB2 production during blood coagulation in carefully selected patients with type II diabetes mellitus in good metabolic control and the results were correlated with the presence or absence of microangiopathy, fasting blood glucose levels, type of therapy, age, duration of diabetes and the most important hematochemical parameters. No statistically significant differences were found between serum TXB2 concentrations in diabetic patients and control subjects, in diabetics with or without microangiopathy and in diabetics on insulin therapy or on oral hypoglycemic agents. We did not observe any correlation between TXB2 production and age, duration of diabetes, sex, basal blood glucose levels, total and HDL-cholesterol, triglycerides, blood creatinine and blood electrolytes. The thromboxane production may be a not important factor for determining the increased platelet aggregation which is at the origin of the angiopathy in diabetes mellitus.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=3576051&dopt=ExternalLink

Evidence of extragastric gastrin release in postoperative ulcer patients.

The principal sites of gastrin production in man are localized at the level of the gastric antrum; both the oral glucose load and the protein meal stimulate the gastrin secretion. The aim of this study was to verify the gastrin response in patients with gastric resections presented with various stimuli. In the operated patients, the behavior of serum gastrin after a protein meal was different with respect to that observed in control subjects. After glucose, on the contrary, a very similar result was seen when compared to controls. The increase in serum gastrin of patients with Billroth II provides a further confirmation of an extragastric origin of gastrin.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=3758196&dopt=ExternalLink

The role of cAMP and prostaglandins in gastric acid secretion after pentagastrin administration.

The role of cAMP and prostaglandins as specific intracellular effectors of gastrin action at the level of the parietal cells has not been sufficiently clarified. For this reason we studied the responses of the parietal cells to stimulation with pentagastrin (6 micrograms/kg i.m.) during theophylline infusion (which causes an increase in the intracellular cAMP) and during acetylsalicylic acid infusion (which inhibits the prostaglandin synthesis) in 28 healthy volunteers. Both theophylline and acetylsalicylic acid provoked a significant increase of gastric acid secretion after pentagastrin. Our results suggest that: 1. an increase in intracellular cAMP may be the basis of the stimulatory effect of gastrin on gastric acid secretion 2. a decrease in the synthesis of prostaglandins may lead to a greater gastric acid response after pentagastrin.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=3019744&dopt=ExternalLink

[Clinical experience with thymostimulin (TP-1) therapy. Preliminary findings]

In order to verify the immunostimulant effect of thymus humoral factors, a bovine thymic extract (TP 1-Thymostimulin) was given to 9 patients affected by primary immunodeficiency (mild deficit T/B combined) and to 8 patients affected by acquired immunodeficiency because of old age, lung neoplasm or with recurrent herpes simplex labialis. 6 patients affected by chronic hepatitis HBsAg+ and 1 patient affected by Behcet's syndrome were also studied. At the end of the study, after six months, all the patients with primary or acquired immunodeficiency showed a normalization of their immunological parameters and a clinical improvement. A clinical improvement was also observed in the patients affected by lung neoplasm. Instead, patients suffering from chronic active hepatitis HBsAg+ showed unsatisfactory results; the study did not reveal any clinical or immunological improvement in these cases. The patient affected by Behcet's syndrome showed a decreased recurrent uveitis.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=3725151&dopt=ExternalLink

[Gold salts in the therapy of rheumatoid arthritis. Experience with an oral preparation]

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=3764073&dopt=ExternalLink

[Insulin receptors in type II diabetes treated unsuccessfully with oral hypoglycemic agents. Preliminary results]

Bertoli A, Caputo S, Santini S, Ghirlanda G, Altomonte L, Manna R, Greco AV.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=3785114&dopt=ExternalLink

Thrombosis, recurrent abortions and intrauterine foetal death in a patient with lupus anticoagulant.

The authors describe a case report of a patient suffering from thrombosis and recurrent abortions. Routine coagulation screening was abnormal and investigation showed the presence of a circulating anticoagulant. High titres of anticardiolipin antibodies were demonstrated. Antinuclear antibodies were slightly positive and antinative DNA antibodies were present. Lupus anticoagulant activity and anticardiolipin antibodies seem to be strong markers of a thrombotic tendency.

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[Behavior of GH and prolactin during enflurane anesthesia and neuroleptoanesthesia in man]

The present study was designed to investigate the effects of neuraleptanesthesia (NLA) and enflurane (Ethane) anesthesia on plasma levels of growth hormone (GH) and prolactin (PRL) in man. A total of 18 patients aged between 20 and 65 years scheduled for elective open-heart surgery were divided in two groups. In the first group (9 patients) general anaesthesia was induced with sodium thiopental (TPS) (3-5 mg/kg) and was maintained with enflurane administered with an inspired concentration of 1.5% in nitrous oxide (2 litres/min) and oxygen (2 litres/min). In the second group (9 patients) anaesthesia was induced with dihydrobenzopyridol (BPS) (0.1-0.2 mg/kg), fentanyl (5-8 gamma/kg) and TPS (3-5 mg/kg) and was maintained with fentanyl (0,65 mg in average). The patients had neither hepatic, renal or endocrine disease nor did they have a history of steroid therapy. All subjects received atropine (0.01 mg/kg) and diazepam (0.2 mg/kg) i.m. 2 hours before induction of anaesthesia. Blood samples for GH and PRL was collected before induction of anaesthesia (0) and at 30, 60, 90 and 120 minutes after induction: the 90' sample was taken immediately after sternal incision. The sampling was stopped at the start of the cardiopulmonary by-pass. A significative reduction of GH at 60' and of PRL at 30' was observed in both groups. Surgical stress at 90' does not evoke a significant increase of PRL and GH levels in both groups. In conclusion NLA and enflurane induced a decrease of GH and PRL plasma levels; in both groups the anaesthetic agents, at the dosage used during anaesthesia, blocked the response of these hormones to the surgical stress likely due to a block of the hypothalamic-pituitary response.

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[Gastroenterologic aspects of connective tissue diseases]

The connective tissue disorders are a protean group of acquired diseases which have in common widespread immunologic and inflammatory alterations of connective tissue. The acquired connective tissue diseases generally include the following clinical entities: rheumatoid arthritis, systemic lupus erythematosus, polymyositis, polyarteritis nodosa, scleroderma, mixed connective tissue disease, Sjogren's and Behcet's sindromes. These entities have certain features in common which include sinovitis, pleuritis, myocarditis, endocarditis, pericarditis, peritonitis, vasculitis, myositis, changes in skin, alteration of connective tissue and nephritis. Gastrointestinal and hepatic involvement in connective tissue disorders are not the most important features, nevertheless appear almost regularly. Anorexia, nausea, vomiting, abdominal pain, malabsorption may affect patients suffering by rheumatoid arthritis, systemic lupus erythematosus and other collagenophaties. In some cases mesenteric vasculitis may cause intestinal ischemia which may result in bowel infarction, mucosal ulceration, hemorrhage, perforation. After an extensive review of the existing literature the Authors make an accurate evaluation of gastrointestinal and hepatic alterations in connective tissue diseases.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=2862608&dopt=ExternalLink

Amniotic fluid content of glucose, C-peptide and insulin in normal and diabetic pregnancies.

Glucose, C-peptide and insulin concentrations in amniotic fluid were measured in 63 women, 19 of whom had insulin-dependent diabetes. The amniotic fluid glucose concentration was higher in the diabetic (37.4 +/- 4.1) than in the normal women (19.4 +/- 5.1 mg/dl; P less than 0.01). The amniotic fluid insulin concentration was higher in diabetic than non diabetic women (15.9 +/- 3.1 versus 8.9 +/- 2.1 microU/ml; P less than 0.01). The C-peptide concentration was also higher in the amniotic fluid of diabetic women than normal (1.60 +/- 0.66 vs 0.26 +/- 0.15 nmol/l; P less than 0.001). The lecithin/sphingomyelin (L/S) ratio in the amniotic fluid was greater than 2 in 61 mothers; only two diabetic patients had an L/S ratio lower than 2. Five neonates of diabetic mothers were macrosomic and three of these were also hypoglycaemic. A negative correlation was observed in diabetic women between insulin and C-peptide concentrations in the amniotic fluid and Apgar score of the newborn infants both at 1 and 5 minutes; no correlation was found on the contrary with the amniotic glucose. In the prognostic evaluation of the fetus with a diabetic mother one must consider many parameters. Among these more consideration must be given to the levels of C-peptide and insulin in amniotic fluid than to glucose level.

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Does secretin control insulin secretion?

The effect of secretin on insulin release has been studied in normal subjects after prestimulation with arginine. In order to make a comparison a pulse of glucose with arginine prestimulation was given. A pulse of 1 U/kg b.w. of secretin provokes a secretion of insulin that is weak and brief compared to that provoked by glucose; thus secretin fails to potentiate arginine-induced insulin secretion. Such a result does not support the hypothesis of secretin as the central hormone in the enteroinsular axis.

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Concentration of serum bile acids as an index of hepatic damage in systemic lupus erythematosus.

The aim of this work is to evaluate the concentration of serum bile acids (SBA) as an index of impaired liver function in systemic lupus erythematosus (SLE) patients versus usual laboratory tests of hepato-biliary system diseases. In patients with SLE the mean fasting SBA concentration was 9.6 +/- 1.4 mumol/L; in normal subjects the concentration was 2.9 +/- 0.6 mumol/L (P less than 0.01). In patients with SLE, mean gamma-glutamyl transpeptidase (GGTP) concentration was 31.5 +/- 5.9 mU/ml versus 10.05 +/- 1.1 mU/ml in controls (P less than 0.01). The bromsulphalein (BSP) excretion test, 45 minutes after injection, was 6.8 +/- 1% in SLE patients versus 2.8 +/- 0.4% in controls (P less than 0.02). No significant difference was found between these two groups of subjects with respect to leucine aminopeptidase (LAP), alkaline phosphatase (AlPh), glutamic-oxalacetic transaminase (SGOT), glutamic-pyruvic transaminase (SGPT), bilirubin serum rates. SBA rate was abnormal in 50% of the SLE patients; GGTP rate and the BSP excretion test were abnormal in 38% and 27% respectively. Our findings show the presence of an actual liver impairment in SLE patients, significantly demonstrated by fasting SBA concentration, GGTP rate and BSP excretion test. Other liver function tests are less useful in evaluating hepatic damage in SLE.

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[Serum bile acids in dyslipidemic patients]

The sensitivity of total serum bile acid concentration as an index of hepatic damage has long been recognised. In addition serum bile acid measurement is significantly more specific than conventional hepatic function tests. However the concentration might be affected by factors other than hepatic dysfunction. Several authors have reported variations in the synthesis of serum bile acids in dyslipidaemic patients. This might potentially reduce the value of concentration measurement in the diagnosis of hepatic diseases especially considering the relative prevalence of hyperlipidaemia. The present article reports on radioimmunological serum bile acid measurement before and after meals in 10 patients with dyslipidaemia and in 22 controls. No difference was revealed between the two groups. Therefore dyslipidaemia appears not to affect the specificity of the test nor does it invalidate the use of radioimmunological measurement of total serum bile acids in the study of hepatic function.

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[Arterial hypertension with hypopotassemia and hypochloremic metabolic alkalosis caused by abuse of a nasal spray]

The case of a young woman, using a nasal spray containing corticosteroids, presenting hypertension systodiastolic, hypokalemia and hypochloremic metabolic alkalosis is presented. Clinical findings, similar to hyperfunction of the adrenal cortex, recovered quickly after discontinuation of the drug. The principal causes of hypertension associated with hypokalemia and hypochloremic metabolic alkalosis, are discussed and the importance of nasal spray, containing glucocorticoids and sympathetic agonists, as a cause of high blood pressure syndromes with different clinical expression and of difficult diagnosis is stressed. The importance of systemic absorption of drugs administered by nasal route is also emphasized.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=6197683&dopt=ExternalLink

Decreased insulin binding to red blood cells in liver cirrhosis.

eleven male cirrhotic subjects, all with impaired glucose tolerance (IGT), were studied. Insulin binding to circulating erythrocytes was evaluated. The specific bound fraction was decreased compared to normals (5.95 +/-0.76 vs 7.08 +/- 0.84%; p less than 0.005). An negative correlation was found between fasting insulin and bound fraction (r = -0.68; p less than 0.05). We suggest that serum insulin may be chronically augmented as a consequence of liver damage. This induces a down-regulation of insulin receptors that is responsible for insulin resistance and at least in part for the impairment of glucose tolerance.

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[Changes in thyroid hormone metabolism in subjects with liver cirrhosis]

The behaviour of the serum levels of thyroxine (T4), 3,5,3' tri-iodothyronine (T3), TSH and of the free binding sites of the thyroid hormones binding globulins in 23 patients affected by hepatic cirrhosis, is described in function of the severity of the disease. The values obtained have been statistically compared to those of a group of 14 healthy subjects. A decrease of the serum levels of T3 directly related to the severity of the disease has been remarked in the cirrhotic patients, while no significant differences in the serum levels of T4 and TSH and in the number of free binding sites on the thyroid hormones binding globulins have been noted between the two groups.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=6835552&dopt=ExternalLink

[Hyperosmolar diabetic coma. Case reports and review of the literature]

The physiopathology and clinical picture of hyperosmolar diabetic coma are described, and four personal cases are presented. This form of coma is a rare, but particularly serious complication of diabetes mellitus. Since its prognosis is poor, even when suitable treatment is provided, the greatest possible care should be devoted to preventing its main cause, namely dehydration.

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[Somatostatin]

Ghirlanda G, Uccioli L, Manna R, Altomonte L, Bertoli A, Raimondo S, Greco AV.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=6135246&dopt=ExternalLink

Epidermal growth factor, somatostatin, and psoriasis.

Ghirlanda G, Uccioli L, Perri F, Altomonte L, Bertoli A, Manna R, Frati L, Greco AV.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=6129392&dopt=ExternalLink

[Serum gastrin in rheumatoid arthritis]

Since 1973 some Authors reported a high prevalence of raise serum gastrin levels in rheumatoid arthritis. In our study of 37 subjects with classic or defined RA, 29 (78%) had serum gastrin levels significantly higher than controls (mean 156.3% pg/ml versus 58.8 pg/ml) and 8 (22%) had normal levels. Basal acid output (BAO) and maximal acid output (MAO) of all affected patients did not differ from controls. We found no correlation among gastrinaemia, BAO, MAO, inflammation indexes and RA test. According to the normal acid output of our RA patients, hypergastrinaemia should be caused by factors different from hypochlorhydria. It is possible that immunoreactive, but non biologically active, peptides could interfere with RIA of gastrin, or that other factors, such as prostaglandins or antigastrin antibodies, could modify the activity of endogenous hormone.

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[Serum concentration of bile acids as an index of liver lesions in rheumatoid arthritis]

Many Authors reported an impairment of liver function tests in Rheumatoid Arthritis (R.A.) No study can be found on Serum Bile Acids (S.B.A.), which are a specific index of liver dysfunction. In a series of 20 patients, affected by R.A. and without other causes of hepatic damage, we found S.B.A. elevated in 80% (mean value 14,1 muM/l versus 2,6 muM/l in controls), bromosulphalein retenction (BSP) elevated in 60% and glutamyltranspeptidase (GT) in 55%. These results confirm BSP and GT frequent impairment, as found by others, and give evidence to S.B.A. reliability in evaluating liver function in R.A.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=6123967&dopt=ExternalLink

[Glucose and insulin in the blood and ascitic fluid after oral administration of glucose in hepatic cirrhosis]

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=7048132&dopt=ExternalLink

Effect of somatostatin on lower esophageal sphincter (les) pressure and serum gastrin in normal and achalasic subjects.

Serum gastrin and lower esophageal sphincter (LES) responses to somatostatin infusion were evaluated in ten normal subjects and in nine achalasic patients in order to determine evidence of hormonal (presumably gastrin)control of LES pressure. After somatostatin infusion, a significant decrease of serum gastrin was observed in normal subjects at 30 min (81.6 +/- 3.2 versus 40.0 +/- 4.7 pg/ml; p less than 0.01) and a rapid increase of LES pressure was also observed (26.0 +/- 1.3 versus 34.1 +/- 1.6 mmHg; p less than 0.01). In achalasia no change was observed in serum gastrin concentration after somatostatin infusion. LES pressure at 20 min however significantly decreased (45.8 +/- 7.6 versus 31.6 +/- 2.3 mmHg; p less than 0.05). Endogenous gastrin is not a major control factor for LES pressure in either normal or achalasic subjects.

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Prolactin release in liver cirrhosis with impaired glucose tolerance (IGT).

The effects of acute TRH and cimetidine administration on the plasma prolactin (PRL) response have been studied in cirrhotic patients with impaired glucose tolerance (IGT). I v. TRH administration stimulates PRL release both in cirrhotics and controls; i.v. cimetidine did not induced a significant rise of PRL in liver cirrhosis. Present findings demonstrate that PRL is not responsible for the deterioration of glucose handling in alcoholic cirrhotic patients examined.

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[Gastrointestinal changes in mixed connective tissue disease. Apropos of a clinical case]

A case of mixed connective tissue disease is described. It began as chronic juvenile arthritis and progressed to acquire the typical features of SLE, PSS and PM. Dyspepsia and the patient's poor general condition, by focussing attention on the digestion and absorption functions, revealed the presence of the gastrointestinal alterations that often accompany SSP.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=7279257&dopt=ExternalLink

[Endocrine changes in hepatic cirrhosis]

Greco AV, Ghirlanda G, Altomonte L, Manna R, Palumbo P, Modugno I, Bertoli A.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=7034080&dopt=ExternalLink

[Waldenstrom's macroglobulinemia; observation of 13 clinical cases]

Thirteen immuno-electrophoretically diagnosed cases of Waldenstrom's macroglobulinemia are presented in 11 women and 2 men aged 57-60 yr. Abdominal plain (53.34%), asthenia and weariness (46.15%), anorexia (38.46%), weight loss (38.46%), intercurrent infections (38.46%), haemorrhage (30.76%), and loss of vision (30.76%) were the most frequent symptoms. One patient presented intercostal neuritis with burning pains that only responded to cortisones. Mean survival from the date of observation was between 3.5 and 14 yr.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=6789253&dopt=ExternalLink

[Clinical aspects and therapy of diabetic coma]

Greco AV, Ghirlanda G, Altomonte L, Manna R, Ucciolo L, Caputo S, Bertoli A.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=6115458&dopt=ExternalLink

Somatostatin and insulin infusion in the management of diabetic ketoacidosis.

The effect of low-dose insulin infusion (4.8 U/h) in diabetic ketoacidosis was compared to that of low-dose insulin infusion (4.8 U/h) plus somatostatin (500 microgram/h IV). Treatment with insulin only in 20 patients caused normalization of blood glucose levels within 6 hours and resolution of ketoacidosis within 5 hours. During insulin plus somatostatin infusion in 7 patients, blood glucose levels returned to normal within 4 hours and acidosis was reduced within 3 hours. Correction of acidosis is the most important problem in diabetic ketoacidosis: in the severest cases cardiovascular and cerebral complications may ensue. The data presented show that addition of somatostatin to treatment with low doses of insulin reduces and resolves acidosis in a shorter time while plasma levels of glucagon and GH were concomitantly reduced.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=6114915&dopt=ExternalLink

[Lactic acidosis associated with fenformin therapy]

Irreversible lactic acidosis occurred in two phenformin-treated diabetics. In the first case, blood creatinine was 3 mg % ml, arterial blood pH was 7,12 and ketostix was negative; in the second case, blood creatinine was 1,3 mg% ml, arterial blood pH was 7,22 and ketostix was negative. Diabetic patients to be treated with phenformin must always be carefully selected and this treatment should be reserved for cases where there is a precise indication. Lactic acidosis may occur even in the presence of almost normal serum creatinine concentrations.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=7219798&dopt=ExternalLink

[Double-blind study of the therapeutic activity of a new hypolipemic drug: etofibrate]

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=7016409&dopt=ExternalLink

Comparative effects of chenodeoxycholic acid and ursodeoxycholic acid on lipid synthesis in rat liver.

Chenodeoxycholic and ursodeoxycholic acids reduce significantly the hepatic synthesis of lipids in rats. The present study has been carried out using (1-14C)acetate and evaluating its incorporation into different lipidic fractions of the liver by thin-layer radiochromatography. Ursodeoxycholic acid proved to be more active than chenodeoxycholic acid: in addition to a significant decrease of the hepatic incorporation of the acetate into cholesterol and triglycerides an increase of the hepatic incorporation of the acetate into phospholipids has been observed. The exogenous administration of bile acids diminishes the hepatic synthesis of cholesterol and therefore its biliary excretion; it enriches the bile acid and phospholipid pool in the liver and bile. By this way the action of bile acids establishes in the liver a condition which induces such an increase of availability of mixed micelles in the bile as to make it unsaturated in cholesterol.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=7333363&dopt=ExternalLink

Insulin resistance in liver cirrhosis: decreased insulin binding to circulating monocytes.

Hyperinsulinemia and insulin resistance have been reported in patients with liver cirrhosis. Since insulin receptor decrease has been demonstrated in some conditions of insulin resistance, we have studied insulin binding to circulating monocytes in eleven patients with alcoholic liver cirrhosis. Specific insulin binding at tracer concentration was lower in cirrhotics than in control subjects (p < 0.005). Insulin binding to monocytes was correlated with basal plasma insulin level in cirrhotics (r = -0.76; p < 0.01). The inhibiting effect of native insulin on 125I-insulin binding was similar in cirrhotics and controls suggesting that concentration rather than affinity of the binding sites is affected in cirrhosis of the liver. These findings suggest that decrease in insulin receptor concentration exists in liver cirrhosis, probably as a consequence of chronic hyperinsulinemia.

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[Serum biliary acids in hepatic cirrhosis]

Radioimmunological measurement of serum bile acids has shown that they increase in alcoholic cirrhosis of the liver. In normal subjects, the fasting value of serum bile acids averaged 2.5 +/- 0.41 microM/l, whereas in cirrhotics it was 37.8 +/- 7.9 microM/l (p < 0.001). This technique has proved more specific than routine liver function tests. Measurement of fasting serum bile acids is a sensitive, specific, reproducible index of liver bile function. A quality investigation of primary and secondary bile acids requires the adoption of more sensitive techniques which are not, however, readily adaptable to routine use.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=7432673&dopt=ExternalLink

[Celiac disease: association with rheumatoid arthritis and diabetes mellitus. Apropos of a clinical case]

Mingrone G, Negrini AP, Principi E, De Cunto F, Vecchio FM, Altomonte L, Magaro M.

A case of coeliac disease accompanied by serum-negative rheumatoid arthritis and (subsequently) by diabetes mellitus is described. The appearance of a similar clinical and sympatomatological enteric and articular picture in one of the patient's brothers is seen as evidence that the link between the components of the three-fold syndrome is to be found in common genetic factors, with an onset in the form of a cellular and biohumoral immunological disorder.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=7432643&dopt=ExternalLink

Somatostatin infusion in liver cirrhosis: glucagon control of glucose homeostasis.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=6102941&dopt=ExternalLink

[Bile lipid composition in subjects with blood lipid disorders (types II and IV). Effect of a new hypolipemic drug (Etofibrate)]

Altomonte L, Mingrone G, Ghirlanda G, Manna R, Rebuzzi A, Pala MA, Greco AV.

The biliary lithogenous index before and after treatment with Etofibrate, a new hypolipaemizing substance, has been assessed in dyslipidaemic subjects (ypes II and IV). Etofibrate is the result of the association of a molecule of clofibrate and one of nicotinic acid. An analysis of relative molar concentrations of biliary lipides showed that subjects with type IV and IIb dyslipidaemia produced lithogenous bile in base condition, unlike subjects with type IIa dyslipidaemia. After 28 days of treatment with Etofibrate (900 mg/die) a clear-cut increase was observed in the biliary lithogenous index in all types of dyslipidaemia examined.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=7354946&dopt=ExternalLink

Fetal origin of amniotic fluid insulin in the human mother.

Greco AV, Rebuzzi AG, Bellati U, Serri F, Altomonte L, Manna R, Ghirlanda G.

To investigate the origin of insulin in amniotic fluid amniocenteses were carried out in pregnancies with live, dead and anencephalic fetuses. Amniotic fluid insulin of pregnant women bearing live fetuses was 9.0 +/- 2.1 microU/ml; in six women with dead foetuses amniotic fluid insulin was not detected. A significant positive correlation was observed between gestational age and the amniotic fluid concentration of insulin. In the amniotic fluid of the four women bearing anencephalic fetuses, the amount of hormone was within normal limits (10.0 +/- 1.4 microU/ml). Intravenous glucose administration (0.33 g/kg body weight) to the mother doses not influence levels of insulin in amniotic fluid, but brought about changes in amniotic fluid glucose concentration. These findings support the conclusion that human amniotic fluid insulin is of fetal rather than maternal origin.

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[Budd-Chiari syndrome in the course of polycythemia rubra vera. Presentation of a clinical case]

An unusual case of Budd-Chiari syndrome during erythraemia is presented. Acute thrombosis of the suprahepatic veins became chronic with progressive improvement, shown clinically and radiologically in the form of partial recanalisation of thromboses of these veins and the porta. The pathogenetic relationship between polycythaemia and the Budd-Chiari syndrome is also discussed.

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Glucose, insulin and somatostatin infusion for the determination of insulin resistance in liver cirrhosis.

Twelve patients with liver cirrhosis and ten normal subjects were studied. Using a constant intravneous infusion of glucose, insulin and somatostatin over 2 1/2 hours we determined the stteady state plasma glucose level (SSPG) in order to measure insulin resistance. The results demonstrated that the cirrhotic patients were insulin resistant compared to normals and that plasma glucagon does not account for the insulin resistance in these patients.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=521009&dopt=ExternalLink

Insulin and glucagon concentrations in portal and peripheral veins in patients with hepatic cirrhosis.

Greco AV, Crucitti F, Ghirlanda G, Manna R, Altomonte L, Rebuzzi AG, Bertoli A.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=467851&dopt=ExternalLink

Gastrin response to insulin in patients with cirrhosis of the liver.

Fasting gastrinemia in cirrhotics (48.35 +/- 2.77 pg/ml) was higher than in normal controls (32.93 +/- 0.75 pg/ml; P less than 0.001). After insulin-induced hypoglycemia, the mean increase of gastrin above basal level was 42.29 +/- 1.92 pg/ml in controls and 10.85 +/- 5.05 pg/ml in cirrhosis (P less than 0.001). BAO was 2.53 +/- 0.36 mEq/h in controls and 0.42 +/- 0.004 mEq/h in cirrhotics (P less than 0.001). After i.v. insulin, TAO was 8.42 +/- 0.72 mEq/h in controls and 3.06 +/- 0.26 mEq/h in cirrhotics (P less than 0.001). The authors suggest that the lack of an adequate gastrin and acid response to the hypoglycemic stimulus in cirrhotics might be accounted for by a decreased insulin sensitivity.

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Effect of somatostatin (SRIF) on plasma glucose and insulin response to glucagon in liver cirrhosis.

The present study was performed in order to evaluate the plasma glucose pattern in cirrhotic patients who, in the course of a continuous somatostatin infusion (500 microgram/h), were given pulses of glucagon (1 mg i.v.). In normal as well as in cirrhotic subjects somatostatin infusion provoked a marked reduction of the IRI plasma level and this was uninfluenced by subsequent glucagon administration. The rise in plasma glucose level in response to i.v. glucagon administration during somatostatin infusion was less marked in cirrhotics compared to normal subjects. This can be attributed to a variety of factors such as reduced number of liver cells or quantitative or qualitative changes of the liver cell glucagon receptors. Glucagon does not seem to contribute to the pathogenesis of carbohydrate intolerance in liver cirrhosis.

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Serum gastrin in portal and peripheral veins after arginine in man.

Immunoreactive serum gastrin from portal and peripheral veins was determined in five controls and in five cirrhotic patients with indwelling portal catheters in basal conditions, during and after 30 min arginine infusion, in order to assess whether the human liver is involved in gastrin metabolism. A significant difference was found between portal and peripheral gastrin concentrations in controls at 0, 60 and 90 min; no significant differences were found in cirrhotics. Our findings support the hypothesis of an at least partial breakdown of endogenous gastrin in the human liver.

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Early insulin and glucagon response to subsequent pulses of arginine, glucose, and tolbutamide in normal man.

To determine the dynamics of insulin and of glucagon secretion in response to several sequential stimuli administered shortly after an arginine pulse (5 g), 20 nonobese, apparently healthy volunteers were given arginine (5 g), glucose (5 g), and tolbutamide (1 g) by rapid intravenous injection. The early insulin and glucagon area 0-8 min was studied. At the intervals and with the dosages used in this study, different stimuli with and without prestimulation with arginine did not lead to changes in early secretion of insulin. There was no exhaustion of the pool of insulin released after multiple sequential pulses. These results suggest a pattern in which stimulation induces a rapid release of insulin and activates the interchange between the stored and labile insulin pool; the 8-min interval is sufficient for the rapid return of the two compartments to a state of equilibrium. Also for glucagon, subsequent different stimuli did not exhaust glucagon release; nevertheless, glucagon is immediately suppressed by a submaximal glucose pulse.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=369391&dopt=ExternalLink

GH secretion in open-angle glaucoma.

Open-angle glaucoma is frequently observed in patients with acromegaly suggesting that the somatotropic hormone might facilitate a condition of glaucoma. The open-angle glaucoma patients studied, displayed higher plasma human growth hormone (HGH) levels than control subjects 60 min (30.3 +/- 1.7 against 16.8 +/- 2.7 ng/ml; p less than 0.001) and 90 min (19.0 +/- 1.9 against 9.3 +/- 1.2 ng/ml; p less than 0.001) after intravenous administration of arginine (25 g in 30 min). The authors support the hypothesis that the increased plasma HGH level may interfere with the regulation of ocular pressure by modifying the flow of aqueous humor from the eyeball via changes in the sclero-corneal trabecular meshwork; these changes are also found in diabetic subjects. The interplay between HGH and changes of carbohydrate metabolism (frequently occurring in glaucomatous patients) may be at the root of the variations of intraocular pressure in open-angle glaucoma.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=548853&dopt=ExternalLink

Urinary kallikrein excretion and plasma DBH activity in hypertension.

Many factors are to be considered in maintaining normal blood pressure. Authors study the behavior of urinary kallikrein (U.K.) and plasma dopamine-beta-hydroxylase (DBH) activity in various forms of hypertension. The values of U.K. excretion in normals were 20.5 +/- 1.8 E.U./24 h. In essential hypertensive patients (9.4 +/- 2.0 E.U./24 h) U.K. decreased, while in secondary hypertension it was significantly higher (33.8 +/- 3.0 E.U./24 h). Plasma DBH activity in essential hypertensive patients (17.72 +/- 2.33 I.U./ml) was similar to controls (20.22 +/- 1.39 I.U./ml); in secondary hypertension the mean values of plasma DBH were decreased (12.31 +/- 2.55 I.U./ml). No correlation between U.K. and plasma DBH activity was observed in normals and in various forms of hypertensive patients. U.K. seems a more reliable factor than plasma DBH in defining the different types of hypertension.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=742555&dopt=ExternalLink

[Behavior of plasma/insulin, somatropin and NEFA after intravenous administration of tolbutamide in hepatic cirrhosis]

Cirrhotics presented higher insulin production, in the presence of a drop in glycaemia significantly less than controls, following 1 g of tolbutamide i.v. The drug also brought on a rapid drop in NEFA and a rise in plasma growth hormone. The pathogenesis of altered glucose tolerance in liver cirrhosis is discussed.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=995300&dopt=ExternalLink

[Changes in plasma insulin and growth hormone after intravenous glucagon in hepatic cirrhosis]

Decreased increases in blood sugar by comparison with control subjects was noted in patients with cirrhosis of the liver after i.v. administration of 1 mg glucagon. Insulin secretion was similar to that observed in the controls. Basal GH values were higher in the liver patients, whereas after glucagon they displayed a gradual and progressive increase with a peak at 60'. No significant differences in GH pattern were noted in the two groups, however.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=995278&dopt=ExternalLink

[GH secretion after L-dopa administration in hepatic cirrhosis]

A 500 mg L-Dopa administration in normal and cirrhotic subjects does not determinate a significant varation of plasma glucose and insulin level, while a peak plasma GH level in both cirrhotic and normal subjects occurred at 90' with a significantly greates values in cirrhotics. It is doubtful to affirm that a high plasma GH level is the only one factor which responsable of glucose intolerance in cirrhotic subjects, when there are many others factors contribute to it in synergic way. In order to elucidate the hypothesis on possible pathogenetic mechanism it is discussed some of our own experience and observations.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=967366&dopt=ExternalLink

[Secretion of GH and diabetic retinopathy]

Recently it has been studied a possible pathogenetic role of GH in diabetic angiopathy. The purpose of the present study was to verify whether the diabetic retinopathy is associated or not with a high plasma GH level. In an attempt to answer this question we did the dosage of plasma GH after a oral glucose load (110 g), Insulin (0,1 U/Kg) i.v., and arginin i.v. (25 g/30'). The plasma GH measurements were approximately the same as in normal patients. The Authors underline the importance of GH in pathophysiology of diabetic angiopathy and report all recent literature on this argument.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=967359&dopt=ExternalLink

[Plasma insulin and GH during oral glucose load in liver cirrhosis]

Blood sugar, insulin and GH values were examined in two groups of cirrhosis of the liver patients, with and without ascites, after the administration of 100 g glucose per os. No significant differences between the two groups were observed. Insulin values were higher than those in the controls, with a pattern similar to that noted in subjects with chemical diabetes. GH values were higher than in normal subjects and secretion was not suppressed.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=951048&dopt=ExternalLink

Letter: Insulin in the management of diabetic ketoacidosis.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=55669&dopt=ExternalLink

[Urinary kallikrein excretion in hepatic cirrhosis]

Measurements of urinary kallikrein using an esterolytic assay revealed higher levels in patients with liver cirrhosis than in a control population. The range of excretion in 33 patients with cirrhosis was from 18.68 to 85.20 E.U. per 24 hours with a mean excretion of 39.42 plus or minus 2.84 E.U. Kallikrein excretion in the control group ranged from 13.20 to 39.50 E.U. per 24 hours with a mean of 24.44 plus or minus 1.66 E.U.

Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=1143688&dopt=ExternalLink

MEDICINA ON LINE

AGGIORNAMENTI IN REUMATOLOGIA

Prof. Lorenzo Altomonte