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The aim of this study was twofold: first, to improve the predictive value of ultrasonography (US) in differentiating benign from malignant thyroid nodules and, second, to investigate whether color Doppler and power Doppler can distinguish different morpho-hemodynamic patterns of hypoechoic thyroid nodules according to their vascularity. Twenty-nine patients with hypoechoic thyroid nodule(s) were entered into this work in progress. Three typical power Doppler patterns were recorded and compared with color Doppler patterns and with cytologic and/or histologic findings. Power Doppler patterns were classified as follows: type A, a perilesional vascular halo; type B, a peri- and intralesional vascular halo, subdivided into: 1) with moderate intralesional vascularization, homogeneous structure and regular vessel caliber and 2) with rich intralesional vascularization, anarchical structure and winding vessel caliber and flow; type C, a perilesional vascular halo with a characteristic peripheral large afferent vessel characterized by winding caliber and flow. Of 29 patients, 21 had type A power Doppler (benign nodular goiter at cytology, in 4 of them with regressive phenomena); seven patients had type B power Doppler patterns-4 had a subtype 1 pattern (3 with nodular hyperplasias and 1 with a papillary adenoma), 3 had a subtype 2 (two had a follicular adenoma and one had a final diagnosis of angioinvasive follicular carcinoma). The patient with undifferentiated carcinoma had a type C power Doppler pattern. In conclusion, according to our early results, PD seems to be more sensitive and reliable than CD in the screening of thyroid nodules, and to yield better vascular information.

The relationship between growth hormone deficiency (GHd) and ventilatory function is not well understood. We studied 7 patients with GHd since childhood who had been adequately treated with replacement therapy until cartilage fusion. Together with 7 well-matched (age and body-type) healthy control subjects, they underwent spirometry including determination of residual volume, and lung diffusing capacity. Also recorded were maximal respiratory muscle pressure during inspiration (PImax) and expiration (PEmax). Patients with GHd showed a significant reduction in total lung capacity and vital capacity while residual volume and lung diffusing capacity remained unchanged. All patients had a significant reduction of both PImax and PEmax. Previously treated adult subjects with GHd present a persistent decrease in lung mobilizing volumes associated with reduced respiratory muscle strength. These alterations may have implications in the management of GHd in adult patients.

To investigate cardiac effects of excess and deficiency of growth hormone (GH) we studied twenty acromegalic subjects and eleven adult patients with GH deficiency by means of a non invasive method, the Doppler echocardiography. The results obtained in the group of patients were compared with those of two groups of twenty and eleven normal subjects, respectively, age and sex matched. The age of the acromegalic patients ranged from 20 to 62 years. Nineteen patients were considered to have active acromegaly at the time of the study. Mean duration of disease since treatment was 12 +/- 5 years (range 5 to 24 years). The age of GH deficient adults ranged from 21 to 33 years. All these patients have been treated with extractive GH over nine years and the therapy withdrawal was performed at least three years before entering the study. In the group of acromegalic patients, a subgroup including nine patients with mild to moderate hypertension was considered. All subjects gave informed consent and the study protocol was approved by the Ethical Committee of the Medical School of Naples. Right ventricular free wall thickness resulted significantly increased in acromegalic patients (8 +/- 2 vs 4 +/- 1 mm; p < 0.001). Left ventricular mass index was augmented both in the whole group and in the subgroups of normotensive and hypertensive acromegalics as compared with normals (134 +/- 33 p < 0.001, 115 +/- 20 p < 0.01 and 156 +/- 31 p < 0.001 vs 80 +/- 18 g.m-2). Ejection phase indices were normal in patient group, while impaired left and right ventricular diastolic filling was found.(ABSTRACT TRUNCATED AT 250 WORDS)

To investigate cardiac effects of excess and deficiency of growth hormone (GH) 20 acromegalic subjects and 11 adult patients with GH deficiency were studied by means of a non invasive method, the Doppler echocardiography. The results obtained in the group of patients were compared with those of 2 groups of 20 and 12 normal subjects, respectively, age and sex matched. The age of the acromegalic patients ranged from 20 to 62 years. Nineteen patients were considered to have active acromegaly at the time of the study. Mean duration of disease since treatment was 12 +/- 5 years (range 5 to 24 years). The age of GH deficient adults ranged from 21 to 33 years. All these patients have been treated with extractive GH over 9 years and the therapy withdrawal was performed at least 3 years before entering the study. In the acromegalic patient group, a subgroup including 9 patients with mild to moderate hypertension was considered. All subjects gave informed consent and the study protocol was approved by the Ethical Committee of the Medical School of Naples. Right ventricular free wall thickness resulted significantly increased in acromegalic patients (8 +/- 2 versus 4 +/- 1 mm; p < 0.001). Left ventricular mass index was augmented both in the whole group and in the subgroup of normotensive acromegalics as compared with normals (134 +/- 33 and 115 +/- 20 versus 80 +/- 18 g.m-2; p < 0.01). Ejection phase indices were normal in patient group, while impaired left and right ventricular diastolic filling was found.(ABSTRACT TRUNCATED AT 250 WORDS)

Intranasal desmopressin represents the treatment of choice in Central Diabetes Insipidus. Nevertheless, this route of administration bears some practical disadvantage, linked to either difficult delivering technique, or the status of nasal mucose. The antidiuretic effectiveness of oral desmopressin has been recently demonstrated, both in experimental animals and in man. In our study we compared oral vs. intranasal desmopressin efficacy in 13 patients affected by Central Diabetes Insipidus. The results show that the peroral administration of Desmopressin at a mean dose of 500-600 micrograms/die determines an antidiuretic effect comparable to that of intranasal route, without affecting body weight, arterial pressure and chemical analysis. Side effects, generally limited to the first week of treatment, were described (nausea, vomiting, headache, dizziness [corrected], bitter taste, epygastralgia, asthenia, epystassis), inducing 4/13 patients to withdrawal the trial.

A comparative study of 90 post-menopausal osteoporotic women, has been carried out. The patients were divided in 3 homogeneous groups. According to 3 different schemes: Group A = 30 patients received carbocalcitonin i.m. 40 UMRC/day/1 month and 40 UMRC/alternating days/2 months followed by 1 month of wash-out for 11 months; Group B = 30 patients received carbolcitonin nasal-spray 80 UMRC/day/1 month and 80 UMRC/alternating day/2 months followed by 1 month of wash-out for 11 months; Group C = 30 patients received ipriflavone x os (600 mg/day/3 months followed by 1 month of wash-out for 3 times). BMC significantly was increased in all Groups after 7 and 11 months. In conclusion, carbocalcitonin and ipriflavone seem to show a similar improving densitometric effect in post-menopausal osteoporosis.

We describe the association of cerebellar ataxia and hypogonadism in four female patients. Clinical, neurophysiological, neuroradiological and endocrinological features are reported. Post-mortem findings in one case are also described. We show in our patients that, beside the cerebellum, both the supratentorial white matter and the peripheral nerve are involved. We suggest that this association can be considered as a "multiple system atrophy". Furthermore, since hypogonadism is hypergonadotropic in three patients and hypogonadotropic in one, the endocrine pattern appears to be heterogeneous.

Vomiting represents one of the most dangerous complications of general anesthesia. L-sulpiride has been able to control this complication very effectively. We studied the effect on vomiting of two doses of L-sulpiride (50/100 mg). Both these doses have been effective in reducing the episodes of vomiting other than in preventing nausea and retching if considered versus controls and also versus droperidol at the doses of 5 mg (50 mg L-sul = 12%, 100 mg = 4%, droperidol = 20%, controls = 28%). L-sulpiride is an antagonist of dopamine on D2 receptors therefore inhibits the action of dopamine increasing the secretion of prolactin. During the surgical distress per se prolactin levels are increased. Together with the increment of catecholamines, high concentration of prolactin can evoke arrhythmias. In view of this possibility we studied the time course of the administration of the two doses of L-sulpiride and of droperidol on prolactin secretion. Both of the drugs increased the plasma levels of prolactin. Droperidol-induced increase in prolactin secretion was significant already at ten minutes after the administration reaching the peak after 20 minutes. L-sulpiride increased prolactin secretion reaching the maximum increase 20 minutes after the administration of 50 mg of the drug, and 30 minutes after the administration of 100 mg doses. The hyperprolactinemizing action of droperidol lasts for at least 8 hours, whereas L-sulpiride action lasts 4 hours.