Thyrotoxicosis: clinical and laboratory assessment.

Thyroid hormones are triiodothyronine (T3) and thyroxine (T4). The hypophysial thyrotropic hormone, thyroid stimulating hormone (TSH) is their physiologic regulator. Thyrotoxicosis is characterized by clinical symptoms caused by high thyroid hormone concentrations. The commonest forms are: 1) toxic diffuse goiter (Basedow-Flajani-Graves disease), 2) toxic multinodular goiter, 3) toxic adenoma. Other less frequent forms are the iodide-induced, that during Hashimoto thyroiditis, that from inappropriate TSH secretion. The diagnosis is predominantly clinical and confirmed by hormone level determination associated in some cases to functional and morphofunctional tests (TRH test, scintigraphy, thyroid I uptake) and antithyroid antibody assay.

[Intravenous versus inhalation anesthetics in anesthesia for bone marrow harvest for transplantation]. / Anestetici endovenosi versus inalatori nell'anestesia per il prelievo di midollo osseo a scopo di trapianto.

It is well known that nitrous oxide and many volatile anaesthetic drugs possess a certain degree of myelodepressive activity. The authors' aim has been to evaluate the degree of proliferative activity after exposure to forane or propofol. Bone marrow samples have been cultured after general anaesthesia induced and maintained by the same agents; cultures have also been performed after samples exposure to forane and propofol. The results have not shown significative differences in the haemopoietic colonies growth of bone marrow harvested from patients underwent intravenous or inhalatory anaesthesia. In vitro study has shown a significative variation of the colonies growth at the forane higher concentration. Intravenous anaesthetic may be safer for bone marrow harvest for transplantation.

[Anesthesiologic management for lower pulmonary lobectomy intervention in patients with heart transplant. A clinical case]. / Condotta anestesiologica per intervento di lobectomia polmonare inferiore in paziente cardiotrapiantato. Caso clinico.

The Authors describe the case of a patient who had undergone human allograft cardiac transplant seven months before inferior pulmonary lobectomy for neoplasia. The pulmonary neoplasia had been revealed by X-rays during the periodic check-up examinations. Because of the high risk of infection following corticosteroid and immunosuppressive therapy, sterile equipment for invasive monitoring and oro-tracheal intubation has been used. The denervated heart presents peculiar haemodynamic and pharmacological aspects that the anaesthetist must pay attention to in the conduction of a general anaesthesia; moreover, arrhythmias are common in the recently transplanted heart. Anaesthesia has been induced and maintained by an association propofol-fentanyl that showed a good cardiocirculatory stability; neither arrhythmias have happened, nor the need for drugs different from those of anaesthesia and resuscitation have occurred.

MR 714, a new aryloxypropionic non-steroidal antiinflammatory agent. Chemical and pharmacokinetic properties and preliminary pharmacotoxicological data.

2-(4-(2',4'-Difluorophenyl)-phenoxy)propionic acid (MR 714) is endowed with an interesting analgesic and antiinflammatory activity, while any remarkable gastro-ulcerogenic action is virtually absent. From a toxicological point of view, MR 714 orally administered to mice showed a LD50 of 848 mg/kg; an observation of general behaviour proved that the drug is free of any remarkable effect on general behaviour, food and water intake, or diuresis after single or repeated administration. An autoptic examination after single oral doses (25, 50, 100 and 200 mg/kg) or repeated oral doses (100 mg/kg/day over 5 days) did not show any adverse modification and also the Ames test didn't allow any mutagenic action to be detected. From a pharmacokinetic point of view, MR 714 given p.o. to rats was absorbed excellently and plasma levels showed a peak after 4-6 h, followed by a plateau lasting 24-36 h at a dose of 50 or 100 mg/kg and considerably less at a dosage of 25 mg/kg. This lower dose allowed a dominant half-life (t1/2) of plasma levels of 13 h to be determined. Excretion occurred only via the bile in conjugated form (acylglucuronide) which reverted easily into the parent drug. The resultant enterohepatic circulation contributes to a substantial maintenance of plasma levels and hence long-lasting activity. Among the organs examined, the uterus showed the highest ratio of organ/plasma concentration; this evidence points to a possible clinical application of MR 714 in the treatment of dysmenorrhoea. From a chemical point of view, the aryloxypropionic structure may be regarded as an interesting novelty in the field of structure-activity relationship studies on non-steroidal antiinflammatory agents.