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Objective: To assess if androgen decline in physiological aging contributes to the concomitant changes in body composition and lipoprotein levels., Design: Cross-sectional, observational study., Setting: A university-based outpatient center., Subjects: The study comprised 206 healthy volunteers (aged 18-95 years)., Measurements: Blood samples were drawn after an overnight fast for the assay of hormones (free testosterone (FT), estradiol (E2), and sex hormone-binding globulin (SHBG)) and lipids (total cholesterol, triglycerides, high-density lipoprotein cholesterol, and lipoprotein Lp(a)). At the same time, body composition was assessed by both anthropometry (fat mass percentage (FM%) estimated from four measures of skinfold thickness using the Durnin and Womersley equation and the Siri equation) and by bioimpedance analysis (FM% estimated using the Segal or Deurenberg equations, respectively, for subjects younger or older than 62 years)., Results: A significant age-related decline was found for FT and E2 concentrations, whereas SHBG levels were related positively with age. No significant association was apparent between hormonal changes and the concomitant modifications of body composition and lipoproteins. Only SHBG showed a significant inverse association between FM% and the waist-to-hip ratio, independent of age. The comparison between older hypogonadal (with FT levels below the lower limit of the normality range assessed in younger subjects) and eugonadal men did not show any significant differences in body composition or lipid profile., Conclusions: This study suggests that, in men, androgen decline caused by normal aging does not significantly affect some targets of testosterone action, such as body composition and lipid metabolism. Therefore, androgen supplementation in hypogonadal older men cannot be expected to influence nutritional status and body composition to the same extent that it does other main targets of testosterone action, such as sexual activity and muscle strength. However, we cannot exclude that selected subsets of older patients with low testosterone levels, especially if affected by catabolic disease, could benefit from the effects of androgen administration on nutritional status.

Insulin can inhibit dehydroepiandrosterone (DHEA) biosynthesis in humans, as suggested by several studies performed in induced or spontaneous hyperinsulinemia. The increased insulin resistance documented throughout aging, with its accompanying hyperinsulinemia, may contribute to the age-related decline in DHEA synthesis. The aim of this study was to assess if the aging-related differences in DHEA sulfate (DHEA-S) serum levels can be associated with differences in fasting insulin levels, as well as body composition. Two hundred fifty-two healthy subjects of both sexes aged 19 to 90 years with a body mass index (BMI) less than 30 (mean +/- SD, 23.5 +/- 2.4) were studied DHEA-S and insulin serum levels were determined by a radioimmunologic procedure; body composition was assessed by anthropometry (fat mass percentage [FM%] estimated from four skinfold thicknesses by Durnin and Womersley and Siri equations [FM%-SKF]) and by bioimpedance analysis (BIA) (FM% estimated by equations developed by Segal et al and Deurenberg et al for subjects < and > 62 years, respectively [FM%-BIA]). DHEA-S levels were significantly and inversely related to age in both sexes. No significant aging-related differences were found in fasting insulin levels, although a trend toward an increase was apparent in the women on simple regression analysis. No significant associations were found between DHEA-S and insulin levels. As for body composition, a positive relationship to age was apparent for FM%-SKF, FM%-BIA, and waist to hip ratio (WHR), whereas BMI and phase angle ([PA] a bioelectric parameter considered an index of the ratio between intracellular and extracellular water) were inversely related to age. Fasting insulin levels were positively related to FM% as estimated by both BIA and anthropometry, independently of age in both sexes; in addition, a positive correlation with WHR and with the subscapular to triceps skinfold thickness ratio (SS/TS) was found in men and women, respectively. No significant correlation was apparent between DHEA-S and body composition indices in men, whereas in women a slight negative correlation between DHEA-S and WHR was documented, and was still significant after adjustment for age and fasting insulin. Stepwise multiple regression analysis confirmed that DHEA-S levels are not related to fasting insulin, but are independently related to age and, in women only, to WHR. Our study suggests that the DHEA-S decline due to aging is independent of fasting insulin, at least in healthy, non-obese people. In addition, it is not related to the aging-dependent changes in body composition in terms of FM% and fat-free mass (FFM) percentage (FFM%). Only in women could changes in fat distribution be slightly associated with DHEA-S decline, although such a relation cannot be accounted for by changes in insulin levels.

This essay is predicated on two beliefs: (a) that special educators must critically examine the dominant view of reality undergirding the field of learning disabilities to see the false images built into it, and (b) we must seek a new, empowering vision of the purposes of education as we move into the twenty-first century. The purpose of the article is to analyze how the dominant image of reality in the field of learning disabilities is derived from the diagnostic model, and to propose an alternative, normative conception of education that emphasizes the importance of caring, social relatedness, and community participation.

High levels of lipoprotein Lp(a) are related to cerebrovascular disease clinical manifestations, as well as to the severity of extracranial carotid atherosclerosis assessed by ultrasonography. In order to investigate the relationship of Lp(a) to the severity of carotid atherosclerosis in the elderly, 100 subjects, aged 78.5 +/- 0.6 yrs underwent an echo-color-doppler scanning of carotids; atherosclerosis severity, assessed as maximum percentage stenosis, presence of complicated plaque and Intima-Media Thickness (IMT), was related to Lp(a) levels, assayed by an immunoenzymatic procedure. A slight association between Lp(a) and CVD clinical manifestations was apparent only in subjects under 78 yrs and for Lp(a) values above 25 mg/dL. Lp(a) levels were not related either to the degree of stenosis, the presence of complicated plaque, or IMT. As for other selected risk factors, while no relationship was found for clinical CVD and IMT, the maximum percentage of stenosis and the presence of complicated plaques were positively related to LDL-cholesterol in subjects under 78 yrs. We can conclude that Lp(a), albeit unrelated to the severity of extracranial vessel atherosclerosis, maintains a role as cerebrovascular risk factor in the elderly, being slightly related to clinical manifestations; however its discriminant power is lower than in middle-aged people and further decreases throughout ageing.

High concentrations of lipoprotein Lp(a) have been related to atherosclerotic disease, both at coronary and cerebrovascular levels. Although Lp(a) levels are under a strict genetic control, being inversely related to the molecular weight of apo(a) isoforms, an interference of endogenous sex steroids on Lp(a) metabolism has been hypothesized. The aim of this study was to investigate the interrelationship between plasma Lp(a) and sex hormone concentrations in 98 healthy males, controlled as for their nutritional status by anthropometric measurements. Statistical evaluation was performed employing simple and multiple stepwise regression analysis. No significant correlation was found between Lp(a) levels and fT, E2 and gonadotropins, while they were positively and independently related to LDL-cholesterol and DHEA-S. As for the other lipoproteins, a positive correlation between HDL-cholesterol and E2 and an inverse correlation between triglycerides and SHBG were observed. These data suggest that endogenous testosterone and estradiol do not affect Lp(a) metabolism in males, at least in physiological concentrations. However Lp(a) might be affected by DHEA-S, the most abundant product of the adrenal gland. The positive correlation of HDL-cholesterol to E2 suggests that estrogens play a major role in lipid metabolism also in males, in spite of their low concentrations; more complex to be explained is the finding of an inverse relationship between Tg and SHBG. Further studies are needed in order to clarify the influence of sex steroids on lipid metabolism, mainly on Lp(a), under physiological conditions; population samples homogeneous in terms of apo a isoforms could be the ideal objects of such studies, in order to avoid the great interindividual variability of Lp(a) concentrations.

The basal and GH-releasing hormone-stimulated secretion of GH declines in the elderly. We tested the ability of cytidine 5'-diphosphocholine, a drug used in the treatment of stroke and Parkinson's disease, to alter GH secretion in 11 healthy elderly volunteers, aged 69-84. Each subject received an iv infusion of 2 g of cytidine 5'-diphosphocholine or normal saline. GHRH and TRH were also administered during cytidine 5'-diphosphocholine infusions. The infusion of cytidine 5'-diphosphocholine induced a 4-fold (p less than 0.05) increase in serum GH levels over basal values. A small increase in GH was seen after GHRH administration. However, the addition of GHRH to the cytidine 5'-diphosphocholine infusion resulted in a GH response which was significantly greater than that seen after GHRH alone; the integrated concentration of GH was more than 2-fold greater in the cytidine 5'-diphosphocholine treated group (706.85 +/- 185.1 vs 248.9 +/- 61.4 micrograms.l-1.(120 min)-1; p = 0.01). The PRL and TSH responses to TRH were not significantly affected by cytidine 5'-diphosphocholine infusion, indicating that dopaminergic mechanisms are not involved. These studies demonstrate that cytidine 5'-diphosphocholine can enhance basal and GHRH-stimulated GH release in the elderly, but the mechanism of action of the drug remains unclear.

To investigate the effects of aging on the secretion of the common alpha-subunit of the glycoprotein hormones, we measured basal levels of luteinizing hormone (LH), testosterone (T) and alpha-subunit in 176 normal men aged 19 to 89 years. In addition, in two groups of young (less than 65 years; n = 25) and old (greater than 65 years; n = 15) subjects, the effects of luteinizing hormone-releasing hormone (LHRH) on LH and alpha-subunit secretion were determined. Age-related increases in serum alpha-subunit and LH were noted only in the oldest men while T levels decreased progressively with advancing age. LHRH stimulation resulted in significantly greater secretion of alpha-subunit in the old subjects while no difference in LH release between young and old men was observed. Moreover, there was a delay to peak LH and alpha-subunit levels after LHRH in the old subjects. These data suggest that the aging process in males involves deficits in both testicular and gonadotroph functions as demonstrated by (1) the relative hypogonadotropic hypogonadism seen until the ninth decade; (2) the hypergonadotropic hypogonadism apparent in men greater than 80 years; (3) the delay in the timing of peak responses of LH and alpha-subunit after LHRH administration; and (4) the disproportionate increase in the secretion of alpha subunit relative to intact LH.

Gonadotropin patterns were evaluated in a group of 70 patients of both sexes with Graves' disease or primary hypothyroidism. Significant variations were found only in hyperthyroidism where increased basal and stimulated values of both gonadotropins, but particularly LH, occurred. Qualitative and quantitative recovery was seen when euthyroid states were achieved after treatment of hyper- and hypothyroid patients. Interactions with gonadotropin behavior were found in both sexes and in women of different ages. Direct interference on the hypothalamo-pituitary system rather than through the modulation of peripheral estrogen metabolism is suggested as the possible pathogenetic mechanism.

In all the patients was performed angiography, while only 11 were studied by the means of Abdominal Ultrasonography. The Authors' aim is to evaluate the accuracy of these two methods and to define a correct diagnostic procedure. The results obtained with Angiography were 15 correct diagnosis and 1 false positive, whereas those obtained with Sonography were 7 correct diagnosis, 2 indicative diagnosis and 2 false negative. Therefore, when a patient is clinically suspected of having a traumatic spleen injury, the Authors suggest to perform an Abdominal Sonography at first. In case of evident spleen lesion, laparatomy will be directly carried out. However, if the sonographic result is negative or aspecific, it will be necessary for the patient to undergo Angiography in order to rule out possible false negative or establish the origin of endoabdominal bleeding correctly.

For many years pathologists have argued about the definition and the biologic reasons of what is "early", "minimal" and "occult" breast cancer. Whether these terms really identify entities which today can be meaningful to clinicians and whether the prognostic significance of breast cancer measuring 1 cm or less in diameter should have implications in the treatment decision making will form the subject of this review.

This article describes a 5-year effort to integrate special and regular students on a campus where special and regular education students are housed in separate but adjacent facilities with separate administrators. Observational data and questionnaires revealed almost total segregation at the end of 3 years. An intensive intervention program, Project L.E.A.D., generated promising short-term movement toward integration, but there were few enduring effects. Physical, social, and psychological barriers created by the two-roof school erect almost insurmountable obstacles to integration. Future efforts should concentrate on building one-roof schools with a single facility and administration.

In a group of 30 obese male patients (160.2% of ideal body weight), an impaired function of the pituitary-gonadal axis has been demonstrated. Decreased testosterone and increased estradiol basal levels, increased LH and FHS responsiveness to gonadotropin-releasing hormone, and increased basal prolactin (PRL) levels are the most significant findings. The overweight factor seems to account for the documented decreased testosterone and increased estrogen levels through a modulation of peripheral steroid metabolism. These peripheral steroid patterns might affect gonadotropin and PRL secretions as well; nevertheless an interference with the metabolism of cerebral neurotransmitters, perhaps related to a nutritional component (impaired glucose tolerance), cannot be completely excluded.

Calcitonin has been shown to modulate pituitary hormone secretion in a variety of ways. In this study we examined the effects of a salmon calcitonin infusion on GHRH-induced GH secretion in 5 normal men. In addition, in vitro experiments were performed using primary cultures of rat anterior pituitary cells in order to examine whether there is a direct pituitary effect of CT. Infusion of CT significantly blunted the GH response to GHRH in all subjects without affecting basal GH secretion or plasma calcium levels. Infusion of CT was accompanied by significant increases in ACTH, beta-endorphin, cortisol and free fatty acid levels, and by a significant decrease in serum insulin levels. The addition of CT to primary cultures of rat pituitary cells did not alter basal or stimulated secretion of GH or ACTH. These results indicate that: 1) CT blunts the GH response to GHRH; 2) CT infusion results in the stimulation of the hypothalamic-pituitary-adrenal axis, and 3) this effect is probably exerted at the hypothalamic level, since no direct activity of CT was documented in vitro on either GH or ACTH secretion.