[Prothrombotic and prethrombotic markers in obese diabetic and non-diabetic subjects]. / Indici protrombotici e pretrombotici in soggetti obesi diabetici e non diabetici.

The Authors studied the behaviour of some prothrombotic (fibrinogen, factor VII, antithrombin III and tissue plasminogen activator) and prethrombotic (beta thromboglobulin, D-dimer) markers in a group of obese subjects in relation to various physiopathological parameters. The series consist of 93 obese subjects (29 m, 64 f, mean age 55 +/- 6 yrs, BMI 33 +/- 1), of whom 62 suffering from type 2 diabetes in good metabolic control obtained by oral hypoglycemic (42 cases) or insulin (20 cases) treatment. For each subject the Authors determined the plasmatic levels of glucose, total cholesterol, triglycerides (enzymatic method, Boehringer kits), fibrinogen (coagulometric method, Organon kit), factor VII (chromogenic method, IL kit), antithrombin III (chromogenic method, IL kit), tissue plasminogen, beta thromboglobulin and D-dimer (ELISA method, Boehringer kits). The results were examined in relation to sex, age, overweight degree, waist/thigh ratio, total cholesterol, triglycerides and, for diabetics, to the therapeutical treatment. The fibrinogen plasma levels proved statistically (0.05) increased proportionally to the overweight degree (BMI over 35), cholesterol levels (over 250 mg%) and age (51-65 yrs); factor VII showed a significant increase (0.05) related to the cholesterol levels, the overweight degree and, surprisingly, to female sex; as regards antithrombin III, its sharp reduction was related with ageing and with the "gynoid type" waist/thigh ratio; tissue plasminogen activator showed a statistically significant reduction (0.05) in the group with older age (over 65 yrs); the beta thromboglobulin levels were obviously increased (0.05) in the hypercholesterolemic and hypertriglyceridemic subjects (over 250 mg%), the D-dimer values increased proportionally with age (0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of nitrendipine in mild or moderate essential hypertensive subjects with type II diabetes.

The antihypertensive effect of nitrendipine, 20 mg once daily was studied in 30 patients with mild or moderate hypertension and type II diabetes mellitus under metabolic control. Blood pressure was measured at the end of a 15-day washout period from previous antihypertensive treatment and on the 15th, 30th, 60th, and 90th day of treatment. Systolic blood pressure and diastolic blood pressure were significantly reduced by nitrendipine. The reduction involved lying and orthostatic blood pressure and was maintained throughout the treatment period. Heart rate, fasting and postprandial glycemia, and lipid profile were not significantly affected by nitrendipine. It is concluded that this drug effectively lowers blood pressure in diabetic hypertensive subjects with no alteration of lipid and glucose metabolism.

[Fibrinogen and antithrombin III in obese subjects]. / Fibrinogeno e antitrombina III in soggetti obesi.

The study aimed to evaluate the behaviour of two pre-thrombotic markers (hyperfibrinogenemia and hypoanti-thrombinemia) in obesity which is considered a factor of atherogenous risk. Ninety-three obese subjects were included in the study (29 M, 64 F, mean age 55 +/- 6, BMI 33 +/- 1), including 62 Type 2 diabetics. The following were assayed in each subject: glucose, total cholesterol, triglycerides (enzymatic method), fibrinogen (coagulometric method) and anti-thrombin III (chromogenic method). Results were assessed in relation to sex, age (0-50, 51-65, over 65), BMI (upto 30, 31-35, over 35), waist/hip ratio (upto 0.95, 0.96-1.02, over 1.02), cholesterolemia (upto 200, 201-250, over 250 mg%) and triglyceridemia (upto 150, 151-200, over 200 mg%). A significant increase (0.05) in fibrinogenemia was observed in the subjects aged between 51-65, with BMI above 35, with an intermediate waist/hip ratio (0.96-1.02) and with cholesterolemia over 250 mg%; reduced values of anti-thrombin III were found in subjects over 65 years old and with the lowest waist-hip ratio (upto 0.95); no significant data were obtained for the other parameters and for the correlation between fibrinogen and anti-thrombin III. The pro-thrombotic importance of hyperfibrinogenemia is underlined in obese subjects; this is proportional to age, to the degree of overweight and levels of cholesterolemia, even if equivocal results emerge with regard to the "android" variety. The reduction of anti-thrombin III is correlated to senility and, surprisingly, to the gynoid-type waist/hip ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of naloxone on prolactin, growth hormone and cortisol response to insulin hypoglycemia in obese subjects.

Recent studies suggest that opioid peptides may influence the secretion of pituitary gland hormones. Since obese patients often show impaired growth hormone (GH), prolactin (PRL) and cortisol responses to stimuli and raised beta endorphin levels, the opioid regulation of such hormone secretion could be different from that in normal weight subjects. In order to verify this hypothesis we studied the effect of iv naloxone, an opiate receptor antagonist, on GH, PRL and cortisol response to insulin-induced hypoglycemia in 9 obese female subjects. Seven normal weight females were used as control group. A control test using saline showed that the PRL and GH responses to insulin stress were impaired in obese subjects, whereas no difference was seen in the cortisol response. Naloxone did not modify the PRL and GH response but provoked a rise in the cortisol response in both obese and normal weight subjects. These findings suggest that while the opioid peptides do not play an important role in regulating the GH and PRL response to insulin hypoglycemia, they influence the cortisol response. In obese patients the impairment in GH and PRL response to stimuli cannot be related to alterations in opioid peptide regulation.

[Chronic treatment of dilated cardiomyopathy by beta blocking agents. Clinical and hemodynamic follow-up]. / Trattamento cronico della cardiomiopatia dilatativa con betabloccanti. Controllo clinico ed emodinamico a distanza.

symptomatic dilated cardiomyopathy were studied in order to evaluate the effect of long term sympathetic beta-blockade with metoprolol. Clinical evaluation, stress test, two-dimensional echocardiography, 24 hour ambulatory electrocardiography and hemodynamic assessment with Swan-Ganz catheter were performed before enrollment in the study. Patients were randomly assigned to the relative placebo (8 pts) or metoprolol group (12 pts) in a single-blind fashion. The placebo group received standard therapy (digitalis, diuretics, vasodilators and anticoagulants as needed), while the metoprolol group, along with standard therapy received low-dose beta-blockade, starting with 6.25 mg twice daily and then doubling every 4 days on the two daily administrations. The therapeutic end-point was 100 mg. Patients received less than 100 mg if their systolic blood pressure was less than 100 mmHg or if their resting heart rate was less than 55 beats/min. Patients were clinically assessed every month and a 24-hour electrocardiography, echocardiography and hemodynamic control was repeated after six months. In the metoprolol group there was one sudden death and two drop-outs.(ABSTRACT TRUNCATED AT 250 WORDS)

[Early changes in ventricular function in diastolic phase in the resting coronary patient]. / Precoci alterazioni della funzione ventricolare in fase diastolica nel coronaropatico a riposo.

The aim of this study is to test left ventricular diastolic function in coronary artery disease patients with preserved systolic performance. Two groups of patients (25 coronary artery disease patients with angiographic proved coronary artery stenosis, but with normal hemodynamic and angiographic indices of systolic phase, first group; and 14 normal subjects for control, second group) were tested comparing their systolic and diastolic ventricular function indices, obtained by using a Millar microtip catheter and a computerized program. Systolic ventricular function was similar in the two groups (EF: 0.61 +/- 0.05 vs 0.62 +/- 0.03, p: n.s.; Vmax:120 +/- 28 vs 112 +/- 24 sec-1, p: n.s.), while diastolic indices were significantly different (lowest diastolic pressure: 3.7 +/- 2.4 vs -1.72 +/- 1.45 mmHg, p less than 0.01; end-diastolic pressure: 11.2 +/- 4.2 vs 6.5 +/- 2.8 mmHg, p less than 0.05; T constant: 45 +/- 8 vs 35 +/- 6 mmHg, p less than 0.001; end-diastolic compliance: 2.79 +/- 0.3 X 10(-2) vs 5.68 +/- 0.4 X 10(-2) mmHg-1, p less than 0.001; Kp: 0.041 +/- 0.006 vs 0.003 +/- 0.004 p less than 0.001). In conclusion, impairment of left ventricular diastolic phase may be one of the earliest manifestations of functional alterations of ischemic ventricle.

[Effect of propafenone on the pharmacokinetics of digoxin administered orally: a study in healthy volunteers]. / Influenza del propafenone sulla farmacocinetica della digossina somministrata per via orale: studio su volontari sani.

It is well known that many cardiovascular drugs affect digoxin kinetics, but nothing is defined on propafenone-digoxin interaction. To clarify this problem, we studied digoxin kinetics in 8 healthy men, who received digoxin oral dose (0.50 mg) in the control state and again during maintenance therapy with propafenone (150 mg q.i.d.). Statistically significant changes were observed during propafenone in a number of digoxin kinetic indexes: a rise in peak serum digoxin concentration (4.30 vs 3.07 ng/ml - p less than 0.005), in area under the serum-digoxin concentration curve (4 h: 520.4 vs 368.9; 10 h: 789.6 vs 621.3 ng X min/ml - p less than 0.005; 24 h: 1187.6 vs 954.7 ng X min/ml - p less than 0.05) and urinary excretion of digoxin (277.7 vs 203.5 mcg - p less than 0.005). Renal digoxin clearance was not affected by propafenone. We conclude that propafenone interact kinetically with digoxin in healthy subjects, perhaps increasing digoxin bioavailability.

Effects of cyclic somatostatin on insulin, C-peptide and immunoreactive glucagon response to oral glucose loading in obese patients.

The effects of somatostatin (SRIF) infusion on blood sugar, immunoreactive insulin (IRI), immunoreactive glucagon (IRG) and C-peptide after administration of oral glucose load (100 g) to 23 obese subjects were examined. The latter were divided in two groups according to oral glucose tolerance (OGTT): (1) normal OGT; (2) impaired OGT. During SRIF infusion IRI and C-peptide response to oral glucose was significantly reduced in both groups as compared with the response under saline infusion. Blood sugar values fell markedly in the second group. After SRIF infusion ended a marked increase in C-peptide, IRG and blood sugar was observed. The results suggest that SRIF infusion is only able to inhibit the release of IRI and IRG temporarily. They do not demonstrate if the behaviour of blood sugar is influenced by variations of these hormones or by the direct effect of SRIF infusion on absorption of the glucose load.

Moral development and perceptual role-taking egocentrism: their development and interrelationship across the life-span.

Moral judgments and perceptual role taking egocentrism were assessed in seventy-two middle-class people whose age range encompassed a significant portion of the life span. Findings support the anticipated curvilinear relationship between moral development and age, and egocentrism and age. However, the close conceptual development and age, and egocentrism and age. However, the close conceptual relationship between moral development and egocentrism throughout life received only slight statistical support, which attained significance only in the fifteen- to nineteen-year-old age group. The existence of "self-involving" egocentrism was postulated to be an important determinant or moral development during adulthood.