Prolactin and thyrotropin pituitary response to thyrotropin releasing hormone in young female heroin addicts.

Prolactin (PRL) and thyrotropin (TSH) serum levels were determined in a group of young female heroin addicts treated in hospital with methadone in tapered doses. At admission, from 24 to 3 h after the last dose of 'street' heroin, basal PRL values were 21 +/- 2.6 ng/ml, i.e. significantly higher (P less than 0.001) than in controls: 9.8 +/- 0.7; there was no significant differences of basal TSH values between heroin addicts and normal subjects: 2.5 +/- 0.2 vs. 2.2 +/- 0.1 mu units/ml, respectively. The day after admission, when methadone treatment was begun, the PRL and TSH pituitary response to thyrotropin releasing hormone (TRH) 200 micrograms i.v. in 12 patients was studied. The PRL response was significantly reduced (P less than 0.001) in heroin addicts vs. controls, the mean values of highest percent increments over basal were 368 +/- 41.8 and 847 +/- 80.7, respectively. The TSH response in the two groups was similar, the mean highest per cent increment over basal 393 +/- 53.4 in heroin addicts vs. 367 +/- 39.2 in controls. The increase of the PRL basal concentration and its decreased pituitary response following TRH were probably related to a change in the tuberoinfundibolar dopaminergic system (TIDA) because of a chronic intake of opiates whereas the impaired function of the dopaminergic system did not alter the thyrotropin pituitary secretion.

Sepsis score and acute-phase protein response as predictors of outcome in septic surgical patients.

In a series of 135 patients with severe surgical infections, we determined the sepsis score and the plasma level of the acute-phase proteins alpha-1-acid glycoprotein, alpha 1-antitrypsin, complement factor B, and C3. The initial sepsis score was a strong determinant of survival: in survivors it was significantly lower than in nonsurvivors. Only 8% of patients with a sepsis score above 20 survived. At the onset of severe sepsis, the plasma levels of all four acute-phase proteins were significantly lower in nonsurvivors. A significant elevation of C3a levels in the plasma of both surviving and nonsurviving patients indicated marked consumption of complement components in all patients with severe sepsis. A linear equation was developed to predict survival: sepsis index of survival (SIS) % = 121 + 0.26 (complement factor B) + 0.36 (alpha-1-acid glycoprotein)-6 (sepsis score). Based on our analysis, at the onset of severe sepsis, an SIS of 50% or more can correctly predict 88% of survivors and an SIS less than 50% can correctly predict 86% of nonsurvivors several days in advance of clinical outcome.

Effects of malnutrition on the acute phase response of plasma proteins in patients undergoing total gastrectomy.

The serum level of six acute phase proteins (APP) has been evaluated preoperatively and for a few days in the postoperative period. Thirty patients undergoing total gastrectomy for gastric cancer have been studied in two subgroups according to their nutritional status. Those with gastric cancer had significantly higher baseline serum levels of alpha 1 acid glycoprotein (alpha1AGP) and C-reactive protein (CRP) than a control group. Malnourished patients also had reduced acute phase response for alpha1AGP and alpha 1 antitrypsin (alpha1AT) a higher increase of CRP and fibrinogen, and a lower decrease for transferrin and retinol binding protein (RBP).

[Possible causal factors in postoperative immunodepression]. / Studio di alcuni possibili fattori causali dell"immunodepressione postoperatoria.

The relationships between postoperative immunodepression and duration of general anesthesia, volume of blood transfusions, cortico-steroid administrations and amount of surgical trauma have ben studied, in cancer patients undergoing radical operations. Postoperative depression of cellular immunity, assayed by the lymphocyte blastogenic response to phytohemagglutinin, was significantly correlated with the amount of surgical trauma and did not correlate with blood transfusions and corticosteroid administrations, nor with the duration of anesthesia.

[Physiopathology and therapy of foreign bodies in the upper digestive tract]. / Fisiopatologia e terapia dei corpi estranei delle prime vie digerenti.

Fibroendoscopy is the treatment of choice for foreign oesophageal and gastric bodies. Whereas the presence of objects in the oesophagus demands immediate endoscopic removal, gastric localization does not require any emergency treatment except for cases of perforation or incarceration, as most foreign bodies (80-90%) are eliminated naturally. Only two weeks after ingestion, in the case of failed expulsion, is it necessary to proceed to endoscopic removal so as to prevent decubitus or perforation erosions. Endoscopic extraction is made difficult by the length and weight of the object, on by its smallness and lack of texture, which make it hard to get hold of. In the case of suture stitches, it may be hard to cut them because of the presence of a gastric mucosa reactive granulomatous inflammatory process. Contraindications to endoscopic extraction are the failure of the patient to cooperate, acute oesophagitis (peptic and due to caustics) and perforating in the stomach, due to congenital or acquired malformations, means that surgery is necessary. The elimination of foreign bodies depends on the correlation between shape and size of object and the anatomo-functional components of the digestive ways. With reference to an approximate geometric schematization of transit organs, the physiopathology of foreign bodies may be expressed by means of mathematical formulae whose manifold variables sometimes make the natural elimination of the bodies unpredictable.