Lipid profiles and oxidative stress parameters in male and female hemodialysis patients.

To study atherogenesis markers in patients with stage 5D chronic kidney disease (CKD-5D) on hemodialysis to determine which parameters are modified and whether their behavior differ between male and female patients of similar age. Total cholesterol, triglycerides, glucose, total proteins, HDL-cholesterol, LDL-cholesterol, oxidative modification of low-density lipoprotein-cholesterol, autoantibodies against oxidized low-density lipoproteins-cholesterol, homocysteine (Hcy), folate, and vitamin B12 were measured in male and female controls and CKD-5D patients on hemodialysis for >6 months. The CKD-5D patients had significantly lower cholesterol, LDL-c and ox-LDL levels and significantly higher ox-LDL-AB and Hcy levels versus their respective controls. The reduction in ox-LDL in CKD patients does not imply a lower risk of atherosclerosis. In fact, the risk may be higher due to a greater capture of ox-LDL by macrophage scavenger receptors, which are increased in these patients. Elevated Hcy levels may also be a risk factor for atherosclerosis in male and female CKD-5D patients.

Dehydroepiandrosterone sulfate and growth axis hormones in patients with ischemic heart disease.

BACKGROUND: The present study aimed to determine whether decreases in dehydroepiandrosterone sulfate (DHEA-S) and growth axis components precede cardiovascular disease or are a consequence of it. METHODS: We measured the concentrations in serum of DHEA-S, ACTH, cortisol, growth hormone, insulin-like growth factor-1 and insulin-like growth factor-binding protein-3 in 30 male controls and also in 37 male patients on days 0, 2, 5, 7 and 9 after suffering a myocardial infarction (MI). RESULTS: There was no significant variation in any of these parameters between the controls and the patients on day 0. However, we found a significant (p < 0.001) reduction in the DHEA-S concentrations of the patients between day 0 and subsequent days (days 2, 5, 7 and 9). CONCLUSION: We conclude that the decrease in DHEA-S in patients with MI is a consequence and not a cause of the disease.

Relationship between fertilization results after intracytoplasmic sperm injection, and intrafollicular steroid, pituitary hormone and cytokine concentrations.

Previous studies relating hormone and cytokine concentrations in follicular fluid to oocyte fertilizability were flawed by the uncertainty about the actual oocyte maturity status at the time of recovery and by the possible contribution of the male factor to failures of conventional in-vitro fertilization. This is the first study in which oocyte maturity was assessed immediately after recovery and only mature oocytes were selected for treatment by intracytoplasmic sperm injection. Fertilization outcomes were related to follicular fluid concentrations of 17beta-oestradiol, progesterone, follicle stimulating hormone, luteinizing hormone (LH), growth hormone (GH), prolactin (PRL), interleukin-1 (IL-1) and tumour necrosis factor-alpha (TNF alpha). Those oocytes that subsequently showed normal fertilization were harvested from follicles with higher concentrations of progesterone, GH, PRL, IL-1 and TNF alpha as compared with those of oocytes that failed to fertilize. Among the normally fertilized oocytes, low GH concentrations were associated with the failure of cleavage and with poor morphology of cleaving embryos, whereas rapidly cleaving embryos developed from oocytes recovered from follicles with high concentrations of LH and IL-1. These data suggest important roles for GH, IL-1 and TNF alpha, and of residual LH after pituitary suppression, as positive regulators of the final phase of oocyte intrafollicular development.

Effects of human growth hormone on the catabolic state after surgical trauma.

The aims of our studies were: (1) to determine if the protein catabolic response after a major or moderate surgical trauma can be restrained by the administration of exogenous human growth hormone (hGH); (2) to determine if the administration of hGH can improve systemic host defenses, thus reducing the risk of infection, and (3) given that the postoperative fatigue syndrome (POF) is mediated by the endocrino-metabolic response to surgery we attempt to determine if the administration of hGH can prevent or reduce POF. Therefore, we performed three placebo-controlled randomized double-blind trials on 216 patients. Major gastrointestinal surgery was treated only with total parenteral nutrition (TPN; n = 20) or TPN plus 4 IU hGH (n = 18). Patients with moderate surgical trauma received either hypocaloric parenteral nutrition (HPN; n = 93) or HPN and 8 IU hGH (n = 87). In this study, we also determined the evolution of the systemic host defenses and thereby the risk of infection. In 48 patients who underwent cholecystectomy treated (n = 26) either with HPN or HPN plus 8 IU hGH, we measured the protein catabolic response, postoperative fatigue and anthropometric modifications. The treatment with hGH together with HPN or TPN (1) overcomes the protein catabolic effects of the trauma response induced by major or moderate surgery by increasing protein synthesis, (2) improves humoral and cellular systemic host defenses, thus reducing the risk of infection, (3) preserves or increases lean body mass and reduces adipose tissue and (4) minimizes POF.

Can the use of growth hormone reduce the postoperative fatigue syndrome?

Convalescence after surgery is characterized by a period of fatigue (POF). If we assume that the POF syndrome has a multifactorial etiology, it is clear that the aim of therapeutic measures should be to reduce the response to surgical stress. The purpose of the present study was to determine if administering exogenous human growth hormone (hGH) can prevent the development or reduce the duration of the POF. We carried out a placebo-controlled randomized double-blind trial with 48 patients after elective cholecystectomy (placebo, or control group, n = 26; hGH-treated group, n = 22). Eligibility criteria were strict so as to introduce as few variables as possible. The results obtained in the study show that for moderate surgical injury (cholecystectomy in metabolically healthy subjects) the administering of low doses of hGH (8 IU/day) minimized the POF syndrome (Christensen score). Furthermore, a positive nitrogen balance was achieved in the hGH-treated group during the postoperative period from the first 24 hours onward. This finding correlates with the significant increase in serum levels of hGH (p < 0.05) and insulin-like growth factor 1 (IGF-1) (p < 0.001). On the other hand, anthropometric measurements in the hGH-treated group revealed a slight but continuous decrease in body weight and thickness of the triceps skinfold; however, arm muscle circumference did not significantly change during the postoperative period. These findings are related to the effects of the application of exogenous growth hormone, which preserves or increases lean body mass and reduces adipose tissue mass. The serum transferrin level proved to be a reliable biochemical indicator of POF.

Exogenous growth hormone: effects on the catabolic response to surgically produced acute stress and on postoperative immune function.

The first purpose of the present prospective randomized study was to determine if the protein catabolic response after operation could be restrained by administration of hypocaloric parenteral nutrition (HPN) plus human growth hormone (hGH). Our second aim was to determine if the administration of hGH could improve the systemic host defenses, thereby reducing the risk of infection. We performed a placebo-controlled randomized double-blind trial in 180 patients after elective cholecystectomy with or without choledochoduodenostomy (placebo = control group, n = 93; hGH-treated group, n = 87). The results obtained in this study show that positive nitrogen balance can be achieved during the postoperative period from the first 24 hours onward, with a combination of HPN support (1.0-1.5 g protein/kg/day and 900 kcal/day) together with the administration of small doses (8 IU) of hGH. The potassium balance tended to follow the same positive balance as the nitrogen balance. Our study shows that in the control group, treated only with HPN, a significant decrease in serum levels of some acute-phase proteins (retinol-binding protein, transferrin, prealbumin), albumin, total proteins, and immunoglobulins occurs by the 5th postoperative day. In the GH group the values of all the above-mentioned proteins do not change or tend to rise if compared to preoperative levels. In the GH-treated group liver function appeared to improve at the start of the study. GH and somatomedin C levels were similar in the two groups and had not changed significantly in the control group by the 5th postoperative day.(ABSTRACT TRUNCATED AT 250 WORDS)