Paroxysmal atrial fibrillation after high-dose melphalan in five patients autotransplanted with blood progenitor cells.

Among the drugs used in conditioning regimens for stem cell transplantation, high-dose melphalan (HDM) plays an important role for both its strong myeloablative effect and for its favourable dose-response ratio. Here we report five cases of high frequency atrial fibrillation (AF) developing after HDM. Duration of the arrhythmia was always very short, beginning at variable intervals after the administration of HDM, in the absence of other factors potentially able to trigger AF. In all patients sinus rhythm was restored within 72 h and the follow-up did not show any cardiac damage. To the best of our knowledge, this side-effect has never been reported to occur after HDM.

Ischemia in collateral-dependent myocardium: effects of nifedipine and diltiazem in man.

It has recently been shown that ischemia in collateral-dependent myocardium may develop at a very variable threshold in anginal patients; accordingly, the aim of this study was to assess whether nifedipine and diltiazem can increase blood flow to collateralized myocardium in man. Nine patients with complete coronary occlusion filled by collaterals, with no other coronary stenosis, normal left ventricular function, and reproducibly positive exercise tests were studied. They underwent exercise tests off therapy and after acute randomized administration of nifedipine (10 mg sublingually), diltiazem (120 mg orally), and nitroglycerin (0.5 mg sublingually), the latter a drug known to increase blood flow to collateralized myocardium. Following nifedipine, time to 1 mm ST segment depression increased significantly (from 430 +/- 176 to 576 +/- 205 seconds, p < 0.01), while heart rate and rate-pressure product remained unchanged (115 +/- 16 vs 121 +/- 17 beats/min and 199 +/- 29 vs 204 +/- 44 beats/min.mm Hg.10(2), respectively, p = NS for both). Similarly, diltiazem significantly increased time to ischemic threshold from baseline to 638 +/- 125 seconds (p < 0.01), but did not change heart rate and rate-pressure product at 1 mm ST segment depression. Submaximal rate-pressure products were significantly lowered by both nifedipine and diltiazem. Nitroglycerin not only significantly improved time to ischemic threshold (from baseline to 666 +/- 76 seconds, p < 0.01), but also increased heart rate (from baseline to 137 +/- 16 beats/min, p < 0.01) and rate-pressure product (from baseline to 242 +/- 48 beats/min.mm Hg.10(2), p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Long-term treatment of stable angina pectoris with gallopamil]. / Trattamento a lungo termine dell'angina pectoris stabile con gallopamil.

BACKGROUND: The effects of long-term treatment with gallopamil 50 mg t.i.d were assessed in 8 patients, 7 males and 1 female, aged 47-69 years, with stable angina pectoris, positive exercise tests, coronary artery disease and no previous myocardial infarction. METHODS: Clinical and ECG parameters as well as exercise testing, 24-hour Holter and echocardiography were assessed before treatment, after 3 months, after 1 and 2 years of treatment, and following final wash-out. RESULTS: Comparing each treatment period to baseline, a significant decrease in resting heart rate (from 66 +/- 9 beats/min at baseline to 56 +/- 7 beats/min after 3 months [p < 0.01], 59 +/- 8 beats/min after 1 year [p < 0.05] and 58 +/- 9 beats/min after 2 years [p < 0.05]), systolic (from 162 +/- 19 mmHg at baseline to 147 +/- 12 mmHg after 3 months [p < 0.05], 146 +/- 20 mmHg after 1 year [p < 0.01] and 146 +/- 27 mmHg after 2 years [p < 0.05]), and diastolic (from 89 +/- 6 mmHg to 82 +/- 7 after 3 months [p < 0.05], 82 +/- 4 after 1 year [p < 0.05] and 83 +/- 4 after 2 years [p < 0.05]) blood pressure was observed. Exercise time significantly improved (from 596 +/- 209 seconds to 802 +/- 66 seconds after 3 months [p < 0.01], 710 +/- 167 seconds after 1 year [p < 0.05] and 723 +/- 125 seconds after 2 year [p < 0.05]), while heart rate and rate-pressure product at peak exercise did not change. The number of ischemic episodes and the total ischemic time per 24 hours significantly decreased (from 35 +/- 15 min to 12 +/- 10 min after 3 months [p < 0.05], 10 +/- 8 min after 1 year [p < 0.05] and 11 +/- 9 min after 2 years [p < 0.05]). Ejection fraction increased (from 66 +/- 10% to 77 +/- 7% after 3 months [p < 0.01], 80 +/- 5% after 1 year [p < 0.01] and 80 +/- 3% after 2 years [p < 0.01]), while contractility, as expressed by the end-systolic stress/end systolic volume ratio remained unchanged. No serious side-effects or biochemical abnormalities developed. CONCLUSIONS: Gallopamil appears to be safe, well tolerated and effective in the long term control of angina pectoris; its effects are fully developed at 3 months and persist unchanged after 2 years. For its hypotensive action and the lack of significant effects on myocardial contractility, gallopamil appears to be potentially useful in patients with associated angina and hypertension and in patients with impaired left ventricular function.

[Prolactin after baclofen in healthy subjects and prolactinoma patients]. / Prolattina dopo baclofene in soggetti normali e con prolattinoma.

Serum prolactin (PRL) levels in basal conditions (two samples) and 30, 60, 90, 120, 150 e 180 minutes after oral administration of baclofen (20 mg) were evaluated in 6 healthy subjects and in 10 patients with prolactinoma. The effect of baclofen (20 mg by mouth) on the PRL secretion cimetidine (400 mg i.v.) or domperidone (20 mg i.v.) induced were evaluated in 9 healthy women by administration of baclofen 60 minutes before cimetidine or domperidone. Baclofen was unable to significantly rise serum PRL levels in healthy subjects and in patients affected by prolactinoma and furthermore did not interfere with PRL rise domperidone induced. On the contrary baclofen decreased PRL rise cimetidine induced. It was concluded that: in basal condition, GABAb receptor don't play an obvious role in modulation of PRL secretion; when H2 istaminergic inhibition on PRL secretion is blocked (at an hypothalamic site), a GABA inhibition, b receptor mediated, on PRL secretion became more clear; the domperidone blockade of hypophysial dopaminergic receptors suggests that GABAb modulation of prolactin secretion don't obtain itself by dopaminergic pathways.

[Neurohypophyseal diabetes insipidus. Anatomo-clinical correlations]. / Diabete insipido neuroipofisario. Correlazioni anatomo-cliniche.

Eighteen patients aged between 14 and 60 years suffering from diabetes insipidus were studied. Diabetes insipidus was diagnosed by means of Robertson's test. All patients underwent C.T. scanning and evaluation of PRL basally and after TRH (200 mcg e.v.). Twelve patients (66%) showed neurological lesions (secondary central diabetes insipidus). Six of these patients had hyperprolactinaemia. Our data suggest that most of central diabetes insipidus are associated with central system nervous (S.N.C.) damage. In same cases the presence of hyperprolactinaemia suggests a brain damage. Therefore neuroradiological study is very important in all cases of neurohypophyseal diabetes insipidus.

[Evaluation of TSH secretion after GnRh in patients with primary hypothyroidism]. / Valutazione della secrezione di tsh dopo GnRH in pazienti con ipotiroidismo primario.

6 women (mean age 38 years) with high Thyroid Stimulating Hormone (TSH) serum levels because affected from primary hypothyroidism were studied. 6 healthy women (mean age 31 years) represented the control group. All subjects underwent evaluation of serum TSH, Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), basally and 20, 30, 60, 120 minutes after administration of Gonadotropin Releasing Hormone (GnRH: 100 meg. IV). Seric FSH and LH show a large increase 30 minutes after GnRH either in healthy or in hypothyroid subjects. TSH is unresponsive to GnRH in normal condition, while shows a clear decrease (-78%) 30 minutes after GnRH in primary hypothyroidism. Rarely the hypothalamic releasing hormones possess an inhibitory effect on anteipophyseal secretions. Previously a GnRH inhibitory effect on prolactin (PRL) release from PRL secreting tumors in rat. The GnRH inhibitory effect on TSH release in pathological conditions such as primary hypothyroidism is difficult to explain: it may be that GnRH acts on Central Nervous System or at pituitary level: in the last case it could bind sites which are not quite different in the different glycoprotein secreting cells.

[GH after baclofen and diazepam]. / GH dopo baclofene e diazepam.

It has been proposed that GABAergic receptors possess two functionally distinct, but strictly co-operating binding sites, one for GABA itself, another for benzodiazepines. The activation of GABA receptor is followed by opening of the Cl- channels. This action is strengthened if both binding sites of GABA receptor are contemporaneously engaged by their respective agonists. Baclofen, a GABAergic drug, is able, in acute administration, to determine an increase of serum GH in man. The aim of this work was to control if benzodiazepines can strengthen this metabolic effect of Baclofen in vivo. Five healthy voluntary women were studied. Blood samples for serum GH evaluation were collected basally and 30, 60, 90, 120, 150, 180, 210 minutes after oral administration of 20 mg. of Baclofen. This test was repeated one week after oral administration of 12 mg. die of Diazepam. The results were analyzed for paired data. The finding show that the metabolic effect of Baclofen on GH secretion are prolonged in time after Diazepam premedication and suggest that GABA-benzodiazepines interaction is effective at hypothalamo-hypophyseal level in man.

[Plasma cortisol levels after acute administration of baclofen]. / Cortisolemia dopo somministrazione acuta di baclofene.

Plasma cortisol levels after acute administration of Baclofen, a Gaba agonist drug, were evaluated in eight healthy volunteer subjects. After 10 mg. of such drug, cortisol levels did not change appreciably. On the contrary after 20 mg. Baclofen elicited a rise in cortisol plasma levels. Baclofen increases striatal levels of dopamine. Therefore it is possible that metabolic effects of the drug are a consequence of increased levels of dopamine.

[Hypophyseal gonadotropins after GnRH in patients with pituitary tumors]. / Gonadotropine ipofisarie dopo GnRH in pazienti con tumori ipofisari.

The effects of exogenous GnRH on plasma FSH and LH concentrations were evaluated in 12 patients with pituitary macroadenomas and in 11 patients with pituitary microadenomas. In patients of the former group the mean values of FSH were not increased as compared with healthy controls, while LH was significantly lower. In patients of the latter group FSH was strongly greater than in normal controls, while serum LH concentrations were included in the normal range. These findings suggest that the exaggerated response of FSH can be useful to the diagnosis of the pituitary microadenomas.

[Hypophyseal gonadotropins after GnRH in patients with hypophyseal tumors and after hypophysectomy]. / Gonadotropine ipofisarie dopo GnRH in pazienti con tumori ipofisari prima e dopo ipofisectomia.

The effects of GnRH administration on serum FSL and LH concentrations were evaluated in 6 patients with pituitary tumors before and after surgical ablative treatment. After surgical therapy LH is suppressed, while FSH concentrations are not statistically different before and after surgical procedure. These data suggest that FSH and LH may be controlled by two different physiological mechanisms of their secretion.

[Glycemia and insulinemia after oral administration of Nomifensine]. / Glicemia ed insulinemia dopo carico orale di Nomifensina.

Blood glucose and immunoreactive insulin (IRI) were evaluated in 8 healthy subjects after mg 200 of Nomifensina per os. 5 subjects underwent an oral glucose challenge before and after mg 200 of Nomifensine and their glucose and IRI were evaluated in both conditions. Nomifensine inhibits basal IRI but does not inhibit IRI levels after an oral glucose challenge. It is possible that nervous dopaminergic endings are present at the level of B cells.

[HbAlc in diabetic subjects in progressive deterioration of the metabolic situation]. / HbAlc in soggetti diabetici in progressivo peggioramento della stuazione metabolica.

Five subjects with type I and type II diabetes mellitus under worsening diabetic control were studied and their HbAlc levels were monitored over three months. There was a strong rise of HbAlc paralleling plasma glucose, while serum cholesterol and triglyceride levels do not rise significantly. These findings confirm that the glycosylation of haemoglobin in vivo reflects the mean blood glucose levels over the previous few weeks and suggest that the trouble of lipid metabolism in diabetes is a slower and more indirect expression of the derangement in diabetic control than HbAlc.

[Case of Pelger-Huet anomaly in its exceptional homozygotic variant]. / Su di un caso di anomalia di Pelger-Huet nella sua eccizionale variante omozigotica.

After briefly recalling the cytomorphological aspects of Pelger-Huet anomaly, its statistical occurrence, the modalities of hereditary transmission and its differentiation from pseudo-Pelger, a case of the homozygotic variant is reported. The practical and theoretical importance of the anomaly is commented on briefly.