Correlations between spondylarthropathic inflammatory troubles and gonadal (androgenic) troubles in men. Study on 30 cases with a new methodological analysis.

Ankylosing spondylitis (AS) and spondylarthropathies (SAP), proposed immune diseases, present sexual preponderance: men are mostly affected. It is known that androgens are decreased in systemic immune disorders. We have investigated two aspects: gonadal--with 13 parameters, and entheso-osteoarthritic--with 10 parameters, by an original methodological semiquantitative analysis. All the parameters were divided into five degrees; each degree was pointed from 0 to 5, and the total and final scores were obtained. In this way differences and correlations could be performed between all 23 parameters. We have studied 30 SAP patients in inflammatory attack, 4 SAP patients out of the inflammatory attack and 16 control subjects; all were men and in fertile age. Between the gonadal status of SAP patients vs the control group there is a significant difference concerning: the degree of testosterone (1.81 vs 0.22, p < 0.005) and testes trophicity (1.5 vs 0.35, p < 0.01); marked differences have been recorded for integrative scores: total (12.18 vs 6.21, p < 0.02), final (1.07 vs 0.57, p < 0.01) and general degree score (1.7 vs 1.18, p < 0.01). Testosteronemia has been different, too: 7.38 vs 23.25 nmol/l, p < 0.01. Between SAP patients in and out of the inflammatory attack there are no significant differences. A significant positive correlation between gonadal axis status degree and entheso-osteoarthritic status degree has been obtained by Spearman rank test: r = 0.41, p < 0.05. Our new methodological analysis allows to change qualitative criteria in mathematical used quantitative data, for performing correlations between so different fields: rheumatological and endocrinological. SAP patients (in inflammatory attack, and out of the inflammatory attack) have a certain degree of hypogonadism, which does not represent a specific disease but suggests a specific spondylarthropathic background.

Determination of serum myoglobin by the reverse passive hemagglutination assay (RPHA) and radioimmunoassay (RIA).

Serum myoglobin (Mb) is an important biological marker in the early diagnosis of the acute myocardial infarction (AMI). In a previous paper we showed that RPHA, which consists in the agglutination of anti-Mb antibody--coated erythrocytes by solutions containing Mb, is a simple, rapid and highly sensitive assay (approx. 1 ng/ml). 42 sera from AMI patients and 20 sera from healthy subjects were investigated by RPHA. The geometric mean (x/divided by SD) of serum Mb titers in AMI patients was 362 x/divided by 3.94, in the range of 64-8192 (the reciprocal dilutions) and in normal sera was 19 x/divided by 1.36, in the range of 16-32. The difference between the mean values was statistically significant at p < 0.001. Subsequently, serum Mb concentration was determined by RPHA and RIA in 51 AMI sera prelevated at various stages of the disease. A high degree of correlation was found between the two methods. Log Y (RPHA titers) = -0.9174 + 1.5879 log X (RIA); ESE: +/- 0.1947; r = 0.9601. In four AMI patients successive determinations were made at every 6 hours: serum Mb curves determined by RPHA and RIA had a parallel evolution and this was an additional argument for the validation of RPHA. Being quite simple and easy of execution RPHA is the most suitable method by which an early AMI diagnosis can be made.

Bone scintigraphy in acromegaly. Preliminary report on 10 cases.

The present study investigates if bone scintigraphy could be used as a diagnostic and prognostic tool in acromegaly. Bone scintigraphy (99m Tc-diphosphonate) was performed in 10 acromegalic (7 active and 3 inactive acromegaly) vs 12 control patients. Isotope uptake (in counts/cell) was assessed in the area of interest 3-4 hours after diphosphonate administration. Three views were chosen: cranium lateral (I)/frontal (II), and the hands (III). Between the acromegalic and control patients there were significant differences (x = p less than 0.001; xx = p less than 0.05) for the following areas: I-parietal: 66.5 vs 24.82x; I-occipital: 58.4 vs 23x; I-mediosphenoidal temporal: 55.2 vs 21.36x: I-nasal: 55.9 vs 38.73 xx; II-frontal: 46.8 vs 16.64 x; II-nasal: 59.8 vs 40.27 xx; III-left metacarpal: 21.67 vs 15.36 xx; III-right metacarpal: 21.78 vs 16.18 xx. Surprisingly, bone isotope uptake at the mandibular level, both in lateral and frontal view, showed no significant differences between acromegalic and control patients (55.2 vs 45 and 59.8 vs 44.5). Between the active and nonactive acromegalic patients there were no significant differences in any area. Bone scintigraphy, therefore, does not represent a useful index for disease activity. However, the results gave rise to two interesting problems: the acromegalic bone seems to have the same metabolic activity irrespective of the disease status; why is bone isotope uptake the same in acromegalics with pronounced prognathism as in the controls with normal mandible?

[Severe arterial hypertension due to chronic constitutional hyperadrenalism. Splanchnic sympathectomy and left adrenal medulla sclerosis with 40 percent sodium salicylate (result after 3 years--genetic chemosurgery)]. / Hipertensiunea arteriala severa prin hiperadrenalinism cronic constitutional. Spanhnicosimpatectomie si meduloscleroza suprarenala stînga cu salicilat de sodiu 40% (rezultat dupa 3 ani--chimiochirurgie genetica).

The case is presented of a male patient hospitalized for severe arterial hypertension determined by chronic constitutional hyperadrenalism. Splanchnic-sympathectomy was performed, associated to medullar sclerosis of the left adrenal with 40% sodium salicylate (genetic chemical surgery). The results after 3 years were good, both clinically and paraclinically. The constitutional background was normo-hypoadrenergic and the ecologic balance of the patient became normal after surgery.