[Replacement therapy in adrenopause. Dehydroepiandrosterone and aging]. / Terapia sostitutiva nell'adrenopausa. Deidroepiandrosterone e invecchiamento.

Dehydroepiandrosterone (DHEA) and its sulfated ester DHEAS are the most abundant circulating adrenal steroids but their function remains to be elucidated. DHEAS secretion and serum levels decrease with age and this is parallel to the development of a number of the problems of ageing (immunosenescence, increased incidence of osteoporosis, atherosclerosis and cancer, decrease of cognitive functions and/or well-being). For these reasons a growing interest in replacement of DHEA in elderly people has been developed. The findings from recent studies of replacement of DHEA in elderly are reviewed here. Although we have some positive data about benefit results of this therapy on muscle, bone and well-being, at present it is premature to recommend the routine use of DHEA replacement because most of its aspects remains controversial.

Cochlear dysfunction in type 2 diabetes: a complication independent of neuropathy and acute hyperglycemia.

The effects of type 2 diabetes on evoked otoacoustic emissions (e-OAEs) elicited by clicks in subjects with normal hearing and the involvement of the central (CNS) and peripheral nervous system and acute hyperglycemia were investigated. In study 1, 110 type 2 diabetic patients and 106 control subjects matched for age and gender were investigated by e-OAEs. Central and peripheral neuropathy were evaluated respectively by auditory brainstem responses (ABRs) and according to San Antonio Consensus Conference criteria. In study 2, 10 healthy and 10 type 2 diabetic men matched for age, all with normal e-OAEs, underwent a 5-hour hyperglycemic clamp study. e-OAE tests were performed before and during the hyperglycemic clamp. In study 1, e-OAEs were impaired in 51.8% (57 of 110) of the diabetic subjects, in comparison to 4.7% (five of 106) of the control group (P < .0001). Diabetics with impaired e-OAEs (e-OAEs-), in comparison to those with normal e-OAEs (e-OAEs+), were older (51.0+/-5.8 v 45.1+/-6.0 years, P < .001), had diabetes longer (11.5+/-4.4 v 7.0+/-3.9 years, P < .001), achieved poorer metabolic control as judged by hemoglobin A1c ([HbA1c] 6.9%+/-0.4% v 6.5%+/-0.3%, P < .001), and had more peripheral neuropathy (46% v 23%, P < .02). No difference was observed between e-OAEs- and e-OAEs+ subjects for retinopathy or nephropathy. Nevertheless, when the duration of diabetes was corrected by multiple regression analysis, the correlation between sensorineural damage and peripheral neuropathy lost significance (P = .12). Diabetic groups (e-OAEs+ and e-OAEs-) showed greater latency in waves I, III, and V and greater interwave latency for waves I to V than the control group, but there was no significant difference in ABRs between e-OAEs+ and e-OAEs- subjects. In study 2, there were no significant changes in e-OAE intensities compared with basal values during the entire hyperglycemic clamp in either type 2 diabetic or control subjects. No difference was observed between the two groups at each time of the clamp. Thus, type 2 diabetic subjects show a higher rate of compromised e-OAEs than healthy individuals. The e-OAE dysfunction does not associate with either an injury to the auditory nervous pathway or diabetic microvasculopathy. The apparent interference of peripheral neuropathy in e-OAEs loses significance when corrected for the duration of diabetes.

[Benign thyroid nodules in the elderly. Medical treatment]. / I noduli tiroidei benigni nell'anziano. Trattamento medico.

BACKGROUND AND AIM: Benign thyroid nodules are a frequent pathology in the general population and in particular in the aged, but their treatment is still controversial. The percentage by which volume and/or the number of nodules is reduced using L-thyroxine treatment reported in the literature varies widely: from 9 to 68%. The aim of this study was to study the therapeutic efficacy of thyroxine treatment in the aged. METHODS: A retrospective study was performed in 105 elderly out-patients (mean age 68 +/- 6 years) suffering from thyroid nodules forming part of a population of 7452 thyroid patients from central Italy attending the 2nd Medical Clinic at "La Sapienza" University of Rome from 1986 to 1994. Other diseases which might influence treatment were excluded in all subjects. Thyroid hormones, TSH and antithyroid antibodies were assayed using RIA techniques; patients also underwent ultrasonography of the gland, 131I thyroid captation with scintigraphy and cytological analysis using fine needle aspiration. Patients were treated with L-thyroxine (75-150 micrograms/day) and controlled after 6, 12 and 24 months. No collateral effects were reported. RESULTS: The majority of patients (some 85%) remained stationary; just under 10% improved and only a few showed a deterioration of symptoms. CONCLUSIONS: Medical therapy continues, in the authors' opinion, to be the first choice in the treatment of benign thyroid nodules also in elderly patients owing to its easy management, low cost and scarce collateral effects.

Idiopathic hemothorax.

Development of spontaneous hemothorax without predisposing conditions is extremely rare. We report a young man with a history of a seizure disorder who presented to the emergency department with spontaneous hemothorax. Exploratory thoracotomy evacuated 2,000 ml of old blood. No source of hemorrhage was identified. To our knowledge, this is the first report of spontaneous hemothorax proved by thoracotomy.