Growth hormone, insulin-like growth factor-I and somatostatin in human fetus, newborn, mother plasma and amniotic fluid.

During pregnancy, organism development and its differentiation are stimulated and modulated by fetal and placental hormones. However the exact role played by all the different growth factors has not been explained yet. This study summarizes knowledge about secretion, regulation and role of GH, IGF-1 and SRIF during perinatal age. It also reports the results of researches into GH, IGF-1 and SRIF in amniotic fluid, in mothers and in newborns at delivery and at four days of age. Amniotic fluid GH levels proved significantly higher during middle pregnancy that at delivery (p < 0.001); a significant difference was also found between mean GH concentrations observed in amniotic fluid collected at delivery in preterm and full-term pregnancies. In amniotic fluid, significant reductions of SRIF and IGF-1 concentrations correspond to a sudden decrease of GH concentration during the last months of pregnancy. Fetal serum GH levels resulted higher than venous cordonal GH concentration at birth (p < 0.001). High levels of IGF-1 were found in the amniotic fluid and in the maternal plasma. These values were higher than those observed in cord blood during pregnancy or at delivery. Preterm and full-term newborns showed similar serum GH levels at birth and at the age of 4 days. Mean GH values in newborns, both at birth and at the age of 4 days, proved to be significantly higher than the values of their mothers (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Pharmacological and clinical research on the interaction of digitalis and amiodarone in heart disease patients with varying degrees of cardiac insufficiency]. / Ricerca farmacologico-clinica sull'interazione digitale-amiodarone in pazienti cardiopatici con insufficienza cardiaca di vario grado.

The increasing use of amiodarone as antiarrhythmic drug has raised the possibilities of dangerous effects from amiodarone-digitalis interaction. We have studied twelve patients who were taking digitalis and to whom amiodarone was administered because of arrhythmias. We found a 75,42% increase of digitalis plasma levels (p less than 0,001) in the early days of amiodarone therapy, and a 52,1% increase (p less than 0,001) in the medium term. An inverse correlation was found (r = -0,65; p less than 0,05) between the plasma levels of digitalis during the steady-state control period and during the following 2-to-6 months evaluation. Acute episodes of cardiac failure caused in our patients an abrupt increase of digitalis plasma levels: in three patients digitalis toxicity occurred. Based on our experience, we recommend that the dose of digitalis be halved when the two drugs are given together in patients with various degree of cardiac failure; moreover digitalis plasma levels should be frequently monitored in these patients. On the other hand digitalis administered according to age, sex, weight, kidney function, together with amiodarone, can be given at full dosage in patients without cardiac failure.

[Digitalis therapy used according to the "rational" method. Techniques of application and clinical advantages (author's transl)]. / La terapia digitalica attuata con metodo razionale. Tecnica di applicazione e vantaggi clinici.

Digitalis therapy in cardiac failure is used by physicians according to conventional dosages; we call this type of digitalization "empiric". With this method digitalis intoxication in hospitalized patients is likely to occur in 8 to 20% of the cases. Another method of digitalization which we call "rational" is based upon an initial dosage of 0.015 mg per Kilo of digoxin, followed by a maintenance dosage determined by the relationship between initial dosage and daily rate of elimination. The latter depends upon the individual value of endogenous creatinine clearance (determined by age, weight and sex). Blood level of digoxin during steady state was measured in 454 patients divided randomly in four groups, each of whom following a different protocol of digitalization: 31 patients were treated with the rapid "empiric" digitalization (group I), 249 patients with the slow "empiric" digitalization (group II), 81 patients with the "rational" digitalization (group III), and 93 patients after a initial "empiric" dosage were treated with a maintenance dosage calculated by the "rational" method. An excessive initial dosage (blood level of digoxin > 2 ng/ml) was observed in 47.9% of patients of group I, in 15.9% of patients in group II, in 9.8% of patients of group III and in 14.7% of patients of group IV. manifestations of digitalis intoxication occurred in 30% patients of group I, in 10% of patients of group II, in 4.9% of patients of group III, and in 2.1% of group IV. Blood value of digoxin below therapeutic levels (under 0.5 ng/ml) was observed in only 13.1% of patients of group II, in 8.6% of patients of group III, and in 8% of patients of group IV. The lower percentage of digitalis intoxication observed in patients treated with "rational" method of digitalization is highly significant if compared with that observed in patients treated with empiric digitalization. The use of the "Lanoxin-rulex" makes the rational digitalization easier to handle, and gives the physicians the habit of considering the more important determinants of digoxin blood level. Conditions more likely to determine a wrong digitalis dosage are discussed in detail.

[Automatic method for the evaluation of the extent of myocardial infarct from the serum of CPK curve]. / Sistema automatico per valutare l'estensione dell'infarto miocardico dalla curva del CPK serico.

An off-line system for calculating the extent of infarct from serial serum CPK determinations based on Sobel et al.'s compartmental model is presented. Results in 40 patients with acute infarct in a coronary unit showed that the index of infarct extent had an appreciable prognostic significance. Employment of the MB isoenzyme in the calculation could, it is felt improve the sensitivity of the method.

[Hyperglycemia in acute myocardial infarction (author's transl)]. / Sull'iperglicemia della fase acuta dell'infarto miocardico.

50 non-diabetic patients, less then 70 y.o. and with fasting blood sugar (FBS) subsequently proved to be normal, consecutively admitted to the Coronary Care Unit by the 10th hour of acute myocardial infarction (AMI), have been studied. Blood sugar (BS) and white blood cell count (WBC) on admission and serum CPK every four hour until the 36th hour, have been determined. Oral glucose tolerance test (OGTT) has been performed at least one week later, when FBS has been determined. In 16 patients with normal OGTT the test has been repeated twice, 4 to 15 months later, before and after a cortisone load. Data have been statistically computed. Mean blood sugar on admission was significantly higher then mean FBS. No correlation was found between BS and WBC neither between BS and maximal CPK. No significant difference has been found between the mean BS on admission among 25 patients with normal OGTT and the one among the remaining 25 patients with abnormal OGTT. The OGTT was confirmed to be normal in the 16 patients belonging to the former group, who had the test repeated, with a single exception as far as the cortisone-OGTT is concerned. The above results are consistent with the opinion that the hyperglycemia usually observed during the first hours of AMI, is related to the acute medical stress and in no way indicates subclinical and/or latent diabetes.