Increased levels of the soluble adhesion molecule E-selectin in patients with chronic myeloproliferative disorders and thromboembolic complications.

Patients with chronic myeloproliferative disorders (CMD) show a high frequency of thrombosis. For this reason we evaluated endothelial cell markers, soluble adhesion molecule E-selectin (sELAM), and thrombomodulin (TM) in 25 patients with CMD. Among them nine presented thromboses in their past history. Data were compared with those obtained in a group of healthy subjects and a group of patients with secondary thrombocytosis. The mean plasma concentrations of sELAM were elevated in patients with CMD, as compared with healthy subjects (81.27 +/- 42.8 ng/ml vs. 41.75 +/- 13; P < 0.02). Similarly, the mean plasma concentrations of sTM were increased in CMD patients in comparison with the control group (102.0 +/- 73 ng/ml vs. 16.7 +/- 9.6; P < 0.01). More markedly elevated sELAM levels were observed in CMD patients with thrombosis than in patients without thrombosis (113.16 +/- 29.5 ng/ml vs. 55.11 +/- 19.1 ng/ml; P < 0.001), while no significant difference was found between CMD patients without thrombosis and secondary thrombocytosis (50.72 +/- 10.8 ng/ml). Plasma thrombomodulin values in CMD patients with thrombosis (131 +/- 93.8 ng/ml) were higher than those without thrombosis (65.77 +/- 43.9 ng/ml; P < 0.02). sTM values were also significantly increased in patients with secondary thrombocytosis (P < 0.01). It is speculated that the plasma, sELAM levels may reflect endothelium activation and that it is possibly useful in predicting the thrombotic risk in myeloproliferative disorders.

Circulating levels of intercellular adhesion molecule-1 (ICAM-1) and soluble interleukin 2 receptors (IL-2R) in patients with B cell chronic lymphocytic leukaemia.

The serum concentrations of circulating ICAM-1 (cICAM-1) and soluble receptors for interleukin-2 (sIL-2R) were evaluated on 48 patients with B-cell chronic lymphocytic leukaemia (B-CLL) and on 15 healthy control subjects. The mean +/- SD concentration of cICAM-1 was significantly higher (p < 0.002) in B-CLL patients (407.7 +/- 164.3 ng/ml) than in healthy controls (245.4 +/- 76.7 ng/ml). Patients with progressive disease had higher cICAM-1 levels than patients with "indolent" disease (440.38 +/- 32.3 ng/ml versus 321.36 +/- 14.45 ng/ml; p < 0.0001). Serum levels of cICAM-1 were also significantly higher (p < 0.0002) in patients with advanced stage (III-IV) than in those with early stage (I-II). The increase of cICAM-1 levels was positively correlated to increases of soluble receptors for interleukin-2 (r = 0.9; p < 0.0001). These results seem to show that the measurement of serum levels of cICAM-1 may be an useful tool for monitoring disease activity and tumoral mass in patients with B-CLL. However, further studies are needed to define the functional role of high cICAM-1 levels in the immunological dysregulation of patients with malignancy.

Gas monitoring and uptake.

The breath-by-breath monitoring of anesthetic gases can provide information, beyond the usual safety control. The study of the decay and concentration effects along the circuit can be useful to evaluate their kinetics. The presence of unexpected gases coming from the patient's tissues is another important topic. By means of gas monitoring devices we can study the physiologic changes consequent to the modifications to the patient position, or the respiratory variations due to V/Q mismatching. The end-expired fraction of the anesthetic (FE') is not so close to MAC as first proposed in the 1960s, but it remains the most precise index of the depth of anesthesia. The traditional concept of quantitative anesthesia is still sufficiently actual to be considered in the design of new anesthesia machines.

[Hypertriglyceridemia, IRI and platelet aggregation]. / Ipertrigliceridemia, IRI ed aggregazione piastrinica.

The Authors have studied in 13 patients with type IV hyperlipoproteinemie the behaviour of platelet aggregation and the response of IRI and blood nefa to an oral glucose load. Only two, in whom it has been possible to evidence a basal hypernefemia and a net hyperinsulinism in response to glucose oral load, showed platelet hyperaggregation to all inducers. These findings suggest that type IV hyperlipoproteinemia does not significantly influence platelet aggregation, in which IRI may have a possible role.

[Calcium and endocrine pancreas secretion. I. Effects of an infusion of calcium on plasma levels of insulin and glucagon]. / Calcio e secrezione endocrina pancreatica. -I) Effetti di una infusione di calcio sui livelli plasmatici di insulina e glucagone.

The authors have investigated the behaviour of IRI, IRG and blood glucose levels during a calcium infusion (15 mg/Kg body weight per 90') and during an equivalent saline infusion, in normal subjects. No evident differences were observed between the two infusions; only a slight but not significant decrease of glucagon levels appeared during calcium administration. Further experiences are clearly required, especially during alpha and beta cells stimulation, to better elucidate relationships between calcium and pancreatic endocrine secretion "in vivo".

[Calcium and endocrine pancreas secretion. II. Effects of an infusion of calcium on insulin and glucagon secretion induced by intravenous administration of glucose]. / Calcio e secrezione endocrina pancreatica. II) Effetti di una infusione di calcio sulla secrezione insulinica e glucagomica da glucosio per via venosa.

IRI, IRG and blood glucose levels after I.V.G.T.T. in normal subjects were not significantly modified when I.V.G.T.T. was repeated during a prolonged calcium infusion (15 mg/Kg body weight per 90'). The Authors advance the hypothesis that no closed relationships exist between serum calcium levels and insulin secretion, in these experimental conditions; with regard to glucagon secretion, further experiences are of course required namely during alpha-cell stimulation.

[Circadian variations in glycemia and IRI in normal subjects, young and adult diabetics and in obese subjects]. / Variazioni circadiane della glicemia e dell'IRI in normali, diabetici giovanili e dell'età matura ed in obesi.

Blood sugar and IRI were followed for 24 hr in healthy patients, young and adult diabetics, and in subjects with apparently primary obesity on a standard, normal calorie diet. Morning and nocturnal insulin positivity peaks were noted in the normal subjects, though circadians variations in these parameters were mainly related to meals. This periodicity was altered in young diabetics, for whom insulin responsivity was ruled out, and in the adult diabetics, who displayed deficient insulin secretion in the morning, and delayed secretion after the afternoon meal, and in the obese subjects, the quality of whose response was close to that of the previous group. The usefulness of this type on examination in the planning of diet and drug management, quite apart from diagnosis and prognosis, is stressed.