Effect of treatment with cyproterone acetate on uterine bleeding at the beginning of GnRH analogue therapy in girls with idiopathic central precocious puberty.

BACKGROUND: The flare-up effect of GnRH analogues may cause transient uterine bleeding in girls affected with idiopathic central precocious puberty (ICPP). AIMS: To assess the incidence of endometrial bleeding and verify whether pretreatment with cyproterone acetate could counteract it. METHODS: Fifty-four girls affected by ICPP were divided into 2 groups. The first group (30 girls) was treated with triptorelin (3.75 mg, i.m. injection) every 28 days. The second group (24 girls) was treated with cyproterone acetate and triptorelin: cyproterone acetate (50 mg/m(2)) was administered every day for 8 weeks, and triptorelin (3.75 mg) was commenced 4 weeks after starting the cyproterone, then the intramuscular injection of triptorelin was repeated every 28 days. RESULTS: Eight of 54 girls (15%) had mild withdrawal bleeding. There were no differences in incidence between groups 1 and 2. Girls with pubertal uterus at pelvic ultrasound had a higher incidence of uterine bleeding than girls with infantile uterus (25 vs. 7%), but this difference was not significant. CONCLUSION: Co-administration of cyproterone acetate and GnRH analogues does not significantly decrease the incidence of uterine bleeding.

Ultrastructural mucosal alterations and increased intestinal permeability in non-celiac, type I diabetic patients.

BACKGROUND: Increased intestinal permeability was described in several intestinal auto-immune conditions. There are very few and contradictory reports about type I diabetes mellitus, an auto-immune condition sometimes associated with celiac disease. AIMS: To investigate intestinal permeability in type I diabetes mellitus patients with no concomitant celiac disease, with a comparison to ultra-structural aspects of duodenal mucosa. PATIENTS: 46 insulin dependent diabetes mellitus, non-celiac, patients (18 females and 28 males, mean age 15.8 +/- 5.3 [S.D.] years) were enrolled. The mean duration of the disease was 5.7 years. METHODS: The morphological aspect of the small bowel mucosa, at standard light microscopy and electron transmission microscopy, along with intestinal permeability (by lactulose/mannitol test) were studied. Lactulose and mannitol urinary excretion were determined by means of high performance anion exchange chromatography-pulsed amperometric detection. RESULTS: The lactulose/mannitol ratio was 0.038 [0.005-0.176] (median and range) in 46 patients compared to 0.014 [0.004-0.027] in 23 controls: insulin dependent diabetes mellitus group values being significantly higher than those of the controls (P < 0.0001, Mann-Whitney test). Eight insulin dependent diabetes mellitus patients underwent endoscopy and biopsies were analysed by means of light microscopy and transmission electron microscopy. At the light microscopy level, none of the biopsy samples showed any sign of atrophy nor inflammation, whereas transmission electron microscopy analysis showed remarkable ultra-structural changes in six out of the eight patients. Four parameters were evaluated: height and thickness of microvilli, space between microvilli and thickness of tight junctions. CONCLUSIONS: This alteration of intestinal barrier function in non-celiac type I diabetes mellitus, frequently associated with mucosal ultra-structural alterations, could suggest that a loss of intestinal barrier function can be a pathogenetic factor in a subset of insulin dependent diabetes mellitus patients.

Intestinal permeability is decreased in anorexia nervosa.

Malnutrition and absence of exogenous luminal nutrients in the gastrointestinal tract affect intestinal permeability (IP) leading to an increased penetration of substances that passively cross intestinal epithelium via intercellular pathways. We hypothesised that an increase in IP could occur in patients with anorexia nervosa because of their prolonged fasting and chronic malnutrition. Therefore, we assessed IP in 14 drug-free anorexic women and 19 drug-free age-matched healthy women by means of the lactulose/mannitol (LA/MA) test. To this purpose, after an overnight fast, subjects ingested an oral solution containing 5 g lactulose and 2 g mannitol in 100 ml water. Urine specimens were collected immediately before and 30, 60, 120, 180, 240 and 300 min after the ingestion of the sugar solution. Urinary lactulose and mannitol were determined by high-performance anion exchange chromatography coupled with pulsed amperometric detection. We found that IP, as expressed by the 5-h LA/MA excretion ratio, was significantly decreased in anorexic women because of a lower urinary recovery of lactulose. Moreover, in patients, the time course of lactulose excretion significantly differs from healthy controls. These results do not confirm our hypothesis of increased IP in anorexia nervosa. Since IP reflects the anatomo-functional status of intestinal mucosa, the present findings support the idea that changes in the anatomo-physiology of intestinal mucosa occur in anorexia nervosa.

Effective production of a thermostable alpha-glucosidase from Sulfolobus solfataricus in Escherichia coli exploiting a microfiltration bioreactor.

A microfiltration (MF) membrane bioreactor was developed for an efficient production of a recombinant thermostable alpha-glucosidase (rSsGA) from Sulfolobus solfataricus MT-4. The aim of the membrane bioreactor was to improve the control of the concentration of key components in the growth of genetic engineered microorganisms, such as Escherichia coli. The influence of medium composition was studied in relation to cell growth and alpha-glucosidase production. The addition of components such as yeast extract and tryptone resulted in a higher enzyme production. High cell density cultivation of E. coli BL21(DE3) on semidefined medium, exploiting a microfiltration bioreactor, was studied in order to optimize rSsGA production. In addition to medium composition, the inducer employed (either isopropyl beta-D-thiogalactopyranoside or lactose), the induction duration, and the cultivation mode influenced both the final biomass and the enzyme yield. The MF bioreactor allowed a cell concentration of 50 g/L dry weight and a corresponding alpha-glucosidase production of 11,500 U/L. The improvement obtained in the enzyme production combining genetic engineering and the microfiltration strategy was estimated to be 2,000-fold the wild-type strain.

The influence of starvation and Eurytrema coelomaticum infection on the nitrogenous products of degradation in the hemolymph of Bradybaena similaris

The urea and uric acid contents in the hemolymph of Bradybaena similaris were analyzed under starvation and Eurytrema coelomaticum infection during 30 days. The urea and uric acid contents in the uninfected and fed snails were 15.090 mg/dl and 9.399 mg/dl, respectively, being the urea/uric acid ratio 1.6. The urea content in starved snails increased to a maximum of 363.237 mg/dl at 15 days, and the uric acid varied to a maximum of 11.470 mg/dl. The urea content in infected snails was reduced to a minimum of 2.123 mg/dl at 30 days of infection and the uric acid increased significatively at 25 days post exposure, being 13.820 mg/dl. A significative relation was not observed between the time of starvation and time of E. coelomaticum infection and the uric acid content in the hemolymph of B. similaris.

O conteúdo de uréia e de ácido úrico na hemolnfa de Bradybaena similaris foi analisado em função da inanição e da infecção com Eurytrema coelomaticum ao longo de 30 dias. O conteúdo destas substâncias em moluscos não infectados e alimentados foi, respectivamente, 15.090 mg/dl e 9.399 mg/dl, sendo a relação uréia/ácido úrico 1.6. A concentração de uréia nos moluscos em inanição aumentou até um valor máximo de 363.237 mg/dl, aos 15 dias de inanição e o conteúdo de ácido úrico variou até um valor máximo de 11.761 mg/dl, aos 10 dias de jejum. A concentração de uréia em moluscos infectados foi reduzida até um valor mínimo 2.123 mg/dl, aos 30 dias de infecção, e o conteúdo de ácido úrico aumentou significativamente aos 25 dias de infecção, sendo 13.820 mg/dl. Não foram observadas relações significativas entre o tempo de inanição e o tempo de infecção com estágios larvais de E. coelomaticum e o conteúdo de ácido úrico na hemolinfa de B. similaris.

Serum and urine somatomedin B in pediatrics.

Somatomedin B was determined by the radioimmunological method in the serum and urine of 104 normal subjects divided into seven age groups. The serum and urine of each patient were divided into two fractions of which one was heated at 60 degrees C for 30 min. SmB serum levels were significantly higher in heated than in unheated samples in all age groups. Moreover, SmB levels in unheated samples increased slowly, but significantly, up to the age of four years, then decreased until nine years of age, when they started increasing again. In heated serum, however, a rapid and significant increase occurred from the age of six months; later SmB levels showed slight, not significant variations. In urine no significant difference was shown in SmB levels either between unheated and heated samples or between age groups. The difference in the behavior of SmB in serum and urine may be explained by assuming the presence of carrier proteins in the blood.

[Arterial blood-gases and acid-base balance in acute diseases of the lower respiratory tract in infancy (author's transl)]. / Gas respiratori ed equilibrio acido-base nelle broncopneumopatie acute nel lattante.

A group of 31 infants, aged 1 month to 13 months, recovered at the Pediatric Institute of the University of Florence for acute diseases of the lower respiratory tract, were analyzed for paCO2, paO2, pH and BE. Samples of arterial blood were obtained in the first, second, fourth and eighth day of recovery. Hypoxia occurred in all the infants and metabolic acidosis was found in almost every case. The paCO2 value resulted high in some of the babies, normal in others and below normal in the remaining. pH showed a lower value in patients affected with metabolic and respiratory acidosis. paCO2 returned to normal value on the eighth day in all the infants, while pH remained slightly below normal value, due to persisting metabolic acidosis. paO2 registered only a small increase during the stay, remaining on the eighth day still below normal level.

[Extracardiac malformations in infants with congenital heart diseases: clinical research and statistics covering period 1969-79 (author's transl)]. / Malformazioni extracardiache nei lattanti con cardiopatie congenite: indagine clinico statistica nel periodo 1969-79.

The authors have examined the statistics of extracardiac malformations in infants with congenital heart disease, aged between birth and 12 months. Cases have been registered and studied within a period ranging from 1969 to 1979 at A. Meyer Hospital of Florence (Pediatric Institute of the University, Divisions of Medical Pediatrics and of Pediatric Surgery). Extracardiac abnormalities occur in 23,05% of infants seen during the first year of life for significant cardiac disease. Sometimes the extracardiac malformations are multiple and 66,3% of the affected infants have some established syndrome, especially chromosomal. The most frequent associated cardiac malformations are: ventricular septal defect (29,3%), complex heart disease (18,5%), non cyanotic heart disease with increased pulmonary blood flow (16,3%) and endocardial cushion defect (10,8%).