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From January 1999 to today 5 patients have been treated with self-expanding enteral stents for low intestinal occlusion in our General and Emergency Surgery Department. The patients' ages ranged from 75 to 90 years. Their general clinical condition was precarious and the emergency surgical treatment necessary was at very high risk. After a brief period of clinical monitoring the patients were submitted to a colonoscopy which revealed a tight neoplastic stenosis in the lowest portion of the colon. Self-expanding enteral stents measuring 9 by 20 mm were implanted in 4/5 patients, while, in the fifth patient, in view of the extent of the cancer, an oesophageal enteral stent measuring 12 by 23-28 mm was used. Over the following 24 hours we observed canalization and consequent disocclusion of the colorectum. It was thus possible to readjust the altered metabolic parameters, improve the respiratory and circulatory compliance and begin the study and the staging of the malignancy. Only two patients in acceptable general condition were submitted to radical surgery, while the other three were referred to our oncological radiotherapy centre. On the basis of this preliminary study we believe that in given clinical conditions and in a situation of emergency the use of self-expanding enteral stents, when indicated, is the only therapeutic measure capable of avoiding surgery carrying a very high risk and of creating the basis for appropriate, in-depth study of the cancer. In addition, it enables a better balance to be restored in the patient's general condition.

This article reviews research on the growth and nutrient intake of vegan children and provides guidelines for counselling parents of vegan children. Although diets of vegan children meet or exceed recommendations for most nutrients, and vegan children have higher intakes of fiber and lower intakes of total fat, saturated fat, and cholesterol than omnivore children, some studies indicate that they may be low in calcium. In addition, bioavailability of zinc and iron from plant foods can be low. Protein needs are slightly higher for vegan children but are easily met with a varied diet that provides adequate energy. Special attention should be given to dietary practices that enhance absorption of zinc and iron from plant foods. Further, good sources of the omega-3 fatty acid linolenic acid should be emphasized to enhance synthesis of the long-chain fatty acid docosahexanoic acid. Dietetics professionals who counsel vegan families should help parents identify good sources of vitamin B-12, riboflavin, zinc, calcium and, if sun exposure is not adequate, vitamin D. This should not be problematic, due to the growing number and availability of fortified vegan foods that can help children meet all nutrient needs. Therefore, with appropriate food choices, vegan diets can be adequate for children at all ages.

Appropriately planned vegan diets can satisfy nutrient needs of infants. The American Dietetic Association and The American Academy of Pediatrics state that vegan diets can promote normal infant growth. It is important for parents to provide appropriate foods for vegan infants, using guidelines like those in this article. Key considerations when working with vegan families include composition of breast milk from vegan women, appropriate breast milk substitutes, supplements, type and amount of dietary fat, and solid food introduction. Growth of vegan infants appears adequate with post-weaning growth related to dietary adequacy. Breast milk composition is similar to that of non-vegetarians except for fat composition. For the first 4 to 6 months, breast milk should be the sole food with soy-based infant formula as an alternative. Commercial soymilk should not be the primary beverage until after age 1 year. Breastfed vegan infants may need supplements of vitamin B-12 if maternal diet is inadequate; older infants may need zinc supplements and reliable sources of iron and vitamins D and B-12. Timing of solid food introduction is similar to that recommended for non-vegetarians. Tofu, dried beans, and meat analogs are introduced as protein sources around 7-8 months. Vegan diets can be planned to be nutritionally adequate and support growth for infants.

Soyfoods have received considerable attention during the past 5 years for their role in disease prevention, especially in relation to heart disease, osteoporosis, and cancer. However, limited research also suggests that soy protein favorably affects renal function. Much of the research interest in soy is aimed at establishing the physiological effects of isoflavones. Isoflavones are diphenolic compounds that have a very limited distribution in nature. Soybeans and soyfoods are, for practical purposes, the only nutritionally relevant dietary sources of isoflavones. Isoflavones are weak estrogens in that they bind to estrogen receptors, but they also have important nonhormonal properties as well. Initial speculation that soyfoods, and in particular isoflavones, might promote bone health was based on the estrogenic properties of isoflavones and the similarity in structure between isoflavones and the osteoporosis drug, ipriflavone, which is a synthetic isoflavone. In ovariectomized rodents, isoflavones retard bone loss almost as effectively as estrogen. Most research, but not all, also indicates that soyfoods rich in isoflavones favorably affect bone turnover and spinal bone mineral density in perimenopausal and postmenopausal women. However, studies conducted thus far have been of short duration and involved small numbers of subjects. Furthermore, no studies have actually examined the effect of soy feeding on fracture risk. Thus, although the data in general are encouraging, no firm conclusions can be drawn about the relationship between soy consumption and bone health. In addition to a possible direct effect of isoflavones on bone tissue, soy protein when substituted for animal protein may indirectly enhance bone strength. Several studies have found that in comparison with animal protein, soy protein decreases calcium excretion, a result of the lower sulfur amino acid content of soy protein. Although the high potassium content of soy is a consideration, the evidence clearly indicates that clinicians should consider recommending that their renal patients incorporate soyfoods into their diet.

The aims of the study were to evaluate the long-term efficacy and tolerability of different doses of interferon-alpha (IFN alpha) and different durations of treatment in chronic hepatitis C by comparing 3 or 6 mega units (MUs) three times weekly given for either 12 or 24 months, and the possibility of obtaining a response in non-responder patients by increasing the dose or by administering IFN daily. A total of 504 patients with non-cirrhotic chronic hepatitis C enrolled in a multicentre study were consecutively assigned to receive either 3 (255 patients) or 6 MU (249 patients) of lymphoblastoid IFN alpha 3 times a week (tiw). At the 12th month of therapy, patients with normal aminotransferase (AMT) in both groups were either given IFN for an additional 12 months with an unmodified or halved dose, or else discontinued therapy. For patients with unmodified AMT levels after 6 months of therapy, the IFN dose was doubled in the 3-MU group, while it was administered at 3 MU daily in the 6-MU group. When no improvement was achieved, therapy was discontinued; otherwise it was prolonged until the 18th month. Patients were followed up for 12 months after discontinuing IFN. Of the 255 patients enrolled at 3 MU, therapy was stopped during the first 6 months in 36 patients (14.1%) because of side effects, and in 24 (9.4%) because of lack of cooperation. Of the remaining 195 patients at the 6th month of therapy, 119 (61%) had normal and 76 (39%) unmodified AMT levels; 14 of the 76 normalized AMT after doubling the dose of IFN, but only 5 (6.6%) had a sustained response. Of the 119 patients with normal AMT, 40 discontinued IFN at the 12th month (schedule A), 39 remained at 3 MU tiw (schedule B) and 40 were given a dose of 1.5 MU tiw (schedule C) for an additional 12 months. At the end of follow-up, 23/40 (57.5%) patients in schedule A, 31/39 (79.5%) on schedule B and 29/40 (72.5%) on schedule C still had normal AMT (A vs. B p = 0.04). In an intention-to-treat analysis, the sustained response rate for patients enrolled at 3 MUs, including the 5 initial non-responders, was 34.5%. Of the 249 patients enrolled at 6 MU, therapy was discontinued during the first 6 months for 39 (15.7%) because of side effects, and for 27 (10.8%) because of lack of cooperation. Of the remaining 183 patients at the 6th month of therapy, 110 (60%) had normal and 73 (40%) unmodified AMT levels. Of the 73 patients, 55 accepted the daily regimen and 8 of them (14.5%) showed a sustained response. Of the 110 patients with normal AMT, 32 (29.1%), despite normalization of AMT, spontaneously discontinued IFN or reduced the dose because of a poor quality of life, while 78 continued with 6 MU until the 12th month, when therapy was discontinued for 28 (schedule A1); 24 patients were given an unmodified dose (schedule B1) and 26 a halved dose (schedule C1) for an additional 12 months. At the end of follow-up, 18/28 (64.3%) patients on schedule A1, 19/24 (79.2%) on schedule B1 and 19/26 (73.1%) on C1 still had normal AMT (p = NS). In an intention-to-treat evaluation, the sustained response rate for patients enrolled at 6 MU, including the 8 from the daily treatment, was 25.7% (64/249). HCV viraemia was undetectable 1 year after discontinuation of IFN in 72.6% of patients with a sustained response. Sustained response was observed in 36.4% of patients with minimal, 46.6% of those with mild, and 33.3% with moderate or severe histological activity (p = NS). The rate of sustained response was lower in patients with genotype 1b (23.6%) than in those with genotype 2a (67.8%, p = 0.002) or genotype 3 (50%, p = 0.03), irrespective of the histological activity. In conclusion, 6 MU IFN alpha are no more effective than 3 MU in inducing a sustained response in treatments of both 12 and 24 months. A 24-month treatment is more effective than a 12-month treatment in maintaining a biochemical response after discontinuation of IFN. In terms of efficacy, compliance and cost, 3 MU for 24 months app

To detect HIV antigens in circulating complement fixing immune complexes (ICs) we assessed an ELISA using wells of microtitre plates coated with F(ab)2 anti-C3b and monoclonal antibodies anti-HIV gp120 and anti-HIV p24. We tested 24 anti-HIV positive subjects (Group A), 10 anti-HIV negative subjects at risk of acquiring HIV infection (Group B), 20 normal controls (Group C) and 2 seroconversion panels. We found HIV antigens in ICs in all sera from seroconversion panels, in 25.5% of sera from subjects in Group A, in 28.6% of sera from subjects in Group B and in no serum from subjects in Group C. A subject in Group B acquired HIV infection during the observation. HIV antigens in ICs by our assay were detected 8 months before Anti-HIV and Ag by commercial ELISA.

Although increasing the levels of phytochemicals in foods via traditional breeding or genetic engineering would appear to pose less of a risk, there is still the possibility of over consumption given the ease with which phytochemical content can be increased. According to the recent position paper by the American Dietetic Association on phytochemicals, "the dietetics professional ... is the specialist who should make recommendations concerning appropriate dietary intake to optimize the potential benefits of phytochemical-rich or functional foods in overall health." For dietitians to make these recommendations, it will be necessary for the nutrition community to make a concerted effort to incorporate information on phytochemicals into nutrition manuals and professional resources. As it is, most of the research and discussion of phytochemicals is conducted by professionals not related or only peripherally related to the field of nutrition. This is truly an exciting time to be involved in the nutrition field. We have moved a head from thinking that only a relatively small number of dietary factors possess biological activity to recognizing that there are hundreds and perhaps thousands of such factors. It will be many years before our understanding of phytochemicals approaches our knowledge of vitamins and minerals- and it is worth nothing that our knowledge of vitamins and minerals is still incomplete. But it does appear that the phytochemicals help explain why plant-based diets, in general, are associated with a reduced risk of many chronic diseases. And in fact, his may be the most important outcome from use of phytochemicals. The nutrition community now has more reasons for encouraging consumers to eat plant-based diets.

The aim of the study was to evaluate arterial distensibility, intimal-medial thickening of the common carotid artery, left ventricular mass and the eventual correlations among these parameters in the hypertensive state. Our study population consisted of 89 hypertensive patients aged 35 to 80 years (mean age 60.8 +/- 10.6 years), and 76 normotensive subjects aged 45 to 85 years (mean age 61.2 +/- 11.1 years). Those patients constantly presenting systolic blood pressure values > or = 160 mmHg or diastolic blood pressure > 90 mmHg were diagnosed as hypertensive. Each patient underwent a B-mode echotomographic examination of the extracranial carotid tract performed with a Vingmed CFM 750 echotomographer with a 7.5 MHz probe and M-mode echocardiography with a Vingmed CFM 750 device equipped with a 3.0 MHz transducer. The results show the intimal-media thickness value in hypertensive patients (0.90 +/- 0.22 mm on the right and 0.92 +/- 0.22 mm on the left), was significantly greater than that in normotensive subjects (0.64 +/- 0.13 mm on the right and 0.64 +/- 0.13 mm on the left, p < 0.001); in hypertensive subjects, interventricular septum thickness (12.1 +/- 1.25 mm) was significantly greater than that in normotensive patients (9.1 +/- 0.77 mm, p < 0.001). In conclusion, we can say that hypertensive subjects have higher values of common carotid artery intimal-medial thickness than normotensives and that this finding is associated with the presence of left ventricular hypertrophy and with a reduction in arterial compliance. Vascular ultrasonography, as well as echocardiography and arterial mechanography can show, in hypertensive subjects, cardiac and vascular abnormalities in a non invasive way.

Background: The aim of this study was to evaluate the effects of nicardipine, at the dosage of 80 mg/day in two administrations, on blood pressure, intimal-media thickness of the common carotid artery and on arterial distensibility after 6 months of therapy. The study population consisted of 23 patients, 13 male and 10 female, mean age 61.7 +/- 10.1 years, with systolic blood pressure 170.4 +/- 14.5 mmHg and diastolic blood pressure 98.3 +/- 5.7 mmHg, affected by essential arterial hypertension of slight to moderate degree. Twenty-three subjects underwent high resolution B-mode echotomography of the common carotid artery, performed twice by the same operator within a one-week period. Treatment for 6 months with slow release Nicardipine at a dosage of 80 mg in two daily administrations was seen to be efficient in reducing systolic and diastolic blood pressure values. It also reduced the carotid-femoral pulse wave velocity. The results of our study show that 6 month's treatment with slow-release Nicardipine at 80 mg in two daily administrations, in effective reducing systolic and diastolic blood pressure values, and, to a slightly significant degree, in reducing the value of the intimal-medial thickness of the common carotid. Naturally the data which emerge from our study are preliminary and require a definitive analysis at the end the study, which is foreseen after a two year period from the enrolment of at least one hundred patients.

We studied a series of 268 chronic hepatitis C patients (31 chronic persistent hepatitis CPH, 69 mild chronic active hepatitis CAH, 125 severe CAH, and 43 active cirrhosis) enrolled from 1988 to 1991 in different therapeutic protocols using lymphoblastoid or recombinant interferon (IFN) at a dosage of 3 mega units (M.U.), three times a week for 12 months. Of these patients 54.8% showed a complete response (normalization of aminotransferases), 14.2% a partial response (decrease in aminotransferases of over 50%), 27.6% no response, and 3.4% a substantial progressive increase in the liver enzymes during IFN (becoming worse). The prevalence of non responders was lower in CPH (9.7%) than in CAH patients (31.9% in the mild form and 20.8% in the severe), and significantly higher in patients with cirrhosis (53.5%). No correlation was observed between non response and the baseline aminotransferase level or the patient's sex. Patients under 35 had a better response to IFN when compared with patients 36-50 years. This is probably due to the higher prevalence of CPH patients with a good response to IFN in the youngest group. No effect was gained in non responders by increasing the dose or shifting from recombinant to lymphoblastoid IFN; three patients were then treated with steroids, but only one benefitted. For 5 of the 9 patients who became worse, steroids were started after discontinuation of IFN therapy, and they induced a favorable response only for the 3 who had developed autoantibodies during IFN treatment.

Arterial hypertension is considered an independent atherosclerotic risk factor. In hypertensive patients it increases cardiovascular morbidity and mortality risk. The aim of the study was to emphasize the presence of atherosclerotic lesions at the level of extracranial carotid tree in patients with essential arterial hypertension. In 110 hypertensive patients (63 males, 47 females) mean age 66 +/- 16 years, and in 100 normotensive patients (66 males, 34 females) mean age 65 +/- 15 years, high-resolution B-mode pulsed wave Doppler echotomography of internal, external and common carotid artery of both sides was performed. The value of the intimal-medial complex thickness of common carotid was measured, and the stenosis percentage evaluated by B-mode pulsed wave Doppler echotomography. Atherosclerotic plaques were classified according to their echogenic characteristic and surface; their localization was then evaluated. In hypertensive patients we observed the presence of common carotid intimal-medial thickening in 75.4%, atherosclerotic plaques in 60.9% and stenosis in 17.9%; 58.3% of these ones were localized at internal carotid, 33.3% at common carotid and 8.3% at external carotid. We observed that 36% of the 100 normotensive patients presented common carotid intimal-medial thickening (p < 0.001 versus hypertensives), 25% atherosclerotic plaques (p < 0.001 versus hypertensives) and 8% stenoses; 50% of these stenosis were localized at internal carotid, the second half at external carotid. In conclusion, high-resolution B-mode echotomography study with pulsed wave Doppler spectral analysis represents a necessary method to evaluate the condition of the extracranial carotid tree in patients with hypertension.

The United States produces approximately half of the world's soybeans. Although most of what is produced is used as animal feed, soy-protein products (eg, soy-protein flour, concentrates, and isolates) are used extensively by the food industry, primarily for their functional characteristics, such as emulsification. During the past decade, however, there has been a marked increase in the use of both traditional soyfoods, such as tofu and soymilk, and second-generation soyfoods, products which generally simulate familiar American dishes. Recently, attention has focused on the possible role of soybean consumption in reducing cancer risk. Soybeans contain, in relatively high concentrations, several compounds with demonstrated anticarcinogenic activity. Two of these compounds--protease inhibitors and phytic acid--have traditionally been viewed as antinutrients. The scientific community has begun to appreciate the potential importance of nonnutritive dietary compounds (phytochemicals) in foods such as soybeans. Dietitians need to become more aware of the phytochemical content of foods and the possible effect of phytochemicals on health and disease.

Eight adult male patients suffering from hydrocephalus of differing aetiologies were investigated in order to detect the existence of diurnal variations of prolactin (PRL) concentration in human cerebrospinal fluid (CSF). Blood and ventricular CSF samples were taken every 2 h during the day (0800-2200 h) and every hour during the night (2300-0700 h). CSF mean PRL levels showed significant nyctohemeral variations with low levels (2.1 +/- 0.3 ng/ml) during day-time and higher levels at night (3.3 +/- 0.1 ng/ml), similar to that observed in serum (PRL values: 16.4 +/- 5.2 and 24.8 +/- 4.3 ng/ml during day and night periods respectively). The presence of a 24 h CSF PRL secretory profile similar to that in serum was shown in six patients with normal 24 h mean PRL values and normal diurnal changes in serum. In two patients with an altered serum 24 h secretory pattern no significant nyctohemeral variations in CSF PRL levels were found. Present data show the existence in man of nyctohemeral variations in CSF PRL content related to the 24 h changes of PRL levels in serum.

The effect of suckling on plasma vasoactive intestinal polypeptide (VIP) values was evaluated in 6 nursing women on the 3rd to 4th day postpartum. Plasma prolactin (PRL) concentrations were also measured. Plasma VIP values (20.6 +/- 3.2 pg/ml in baseline) significantly (p less than 0.05) increased, reaching a maximum (53.5 +/- 10.9 pg/ml) 20 min after the starting of suckling. A possible role of VIP in the suckling-induced PRL release in humans cannot be excluded.

In the present multicenter, randomized and double-blind study, performed on 127 hospitalized patients, we compared the effects of three antibiotics (cephemic cofosfolactamine, cephalexin and fosfomycin) in the treatment of acute or recurrent systemic infections. Results show that the percentage of recoveries of clinical symptoms and of bacterial eradications were significantly higher, and associated with a lower rate of side effects in the patients treated by cephemic cofosfolactamine than in those treated by cephalexin or fosfomycin.

A chronobiological study was carried out in 10 elderly male subjects (78-83 years) to evaluate the 24-hour thyroid-stimulating hormone (TSH) secretory pattern. 10 young adult males (26-35 years) made up the control group. Hourly blood samples were drawn from each subject for a 24-hour period. TSH levels in elderly subjects showed blunted circadian fluctuations compared to those seen in young adult subjects. Mean 24-hour TSH values in elderly (3.1 +/- 0.3 microU/ml) and young adult subjects (3.5 +/- 0.1 microU/ml) did not differ statistically, but nighttime TSH values observed in elderly subjects (3.2 +/- 0.3 microU/ml) were lower (p less than 0.05) than those recorded in young adults (4.1 +/- 0.1 microU/ml).

The incidence of malnutrition and the effect of hospitalization was evaluated in 100 consecutive admissions to the Clinical Pathology R Department of the University of Genoa. Nutritional deficiencies were evaluated at the time of admission and discharge from the Hospital, among patients hospitalized 2 weeks or longer, using the following nutrition-related parameters: body fat, muscle proteins, weigh, rate of weight loss plasma proteins level, vitamin B12 and folic acid plasma level, plasma iron and ferritin. We also considered the nutritional alterations in malnourished patients with relation to appetite decrease and to pathological status. At the admission to the hospital, the findings showed a high incidence (79%) of alterations in some nutritional parameters. In patients with nutritional impairments we observed a worsening of most of the nutritional parameters during hospitalization, especially in patients with severe appetite decrease and those affected by sepsis, neoplastic, gastric and renal diseases.

Basal and TRH-stimulated TSH secretion was evaluated in six patients suffering from prostatic cancer, before and after antiandrogenic treatment performed using a long-acting LHRH analogue, D-Trp-6-LHRH. Although serum testosterone values dropped to minimal levels after treatment, TSH secretion remained unchanged. Observed results suggest that pharmacological castration does not affect the regulatory mechanisms involved in the control of TSH secretion.

The result of a study of 100 cases of arterial hypertension with various aetiology is presented from a phonomechanocardiographic viewpoint. Findings suggest that irregularities in the apicocardiographic curve recorded in Pachon position, and particularly the "a" wave and the "a" index, are highly sensitive and provide an early warning of contractile deficiency of the left ventricle. The mechanism leading to the pathological appearance of the "a" wave is discussed.

Plasma somatostatin levels were determined during a 24-hour period and after a meal test in 7 and 5 elderly subjects (76-90 years), respectively. The data obtained were compared with those recorded in young adult subjects (22-30 years). Increased basal somatostatin values were found in elderly subjects (20.0 +/- 1.5 pg/ml) when compared to young adults (14.1 +/- 0.6 pg/ml; p less than 0.01). Also, the mean 24-hour somatostatin levels were higher in the elderly (21.3 +/- 0.8 pg/ml) than in young adults (16.7 +/- 0.5 pg/ml; p less than 0.01), and minor diurnal variations were found in the former group. The response to the meal test was less evident in the elderly than in the control group. The data obtained indicate an increased basal somatostatin production associated with a diminished variability throughout the 24-hour period and in relation to meals.

The effect of thyrotropin-releasing hormone (TRH) on the release of growth hormone (GH) was investigated in 16 elderly male subjects aged 74-88 years. Intravenous injection of 200 micrograms TRH induced a clear-cut GH rise (greater than or equal to 10 ng/ml) in 7 of 16 subjects. TRH administration did not raise plasma GH in 10 adult subjects aged 36-58 years. The results suggest disorders in neurobiochemical mechanisms regulating hypothalamopituitary function in elderly men.

The i.m. administration to 6 healthy adult male volunteers of 2 mg butorphanol, a potent synthetic opiate analgesic, resulted in a significant rise in serum PRL level, without affecting GH, LH, FSH, TSH or cortisol secretion. These effects indicate that in man butorphanol exerts an opiate agonist rather than an opiate antagonist effect at the hypothalamic and/or pituitary level.

The arginine vasopressin (AVP) concentrations were determined in plasma and in cerebrospinal fluid (CSF) during a 24-hour period in 7 male patients suffering from hydrocephalus of differing etiologies. Blood and ventricular CSF samples were simultaneously collected every 2 h during the day (08.00-22.00) and every hour during the night (24.00-07.00). In both plasma and CSF, the AVP levels did not show significant time-related circadian variations. No significant correlation was found between the plasma and CSF AVP values during the 24-hour period. The data obtained indicate the absence of the plasma and CSF AVP circadian rhythm in hydrocephalic patients and suggest that in these patients, and possibly in healthy humans, physiological stimuli which are able to induce variations in the plasma AVP concentration during daily life do not alter the CSF AVP content.

Serum and cerebrospinal fluid (CSF) prolactin (PRL) concentrations were determined in fourteen patients of both sexes suffering from hydrocephalus, in basal conditions and after i.m. administration of 10 mg metoclopramide or 10 mg morphine. A significant increase in both serum and CSF hormone values was found after administration of both drugs. Serum and CSF PRL values after metoclopramide administration increased earlier and to a greater extent than after morphine. Furthermore, the metoclopramide induced CSF PRL increase immediately followed the serum peak, whereas after morphine administration an evident delay in the CSF hormone peak with respect to the serum increase was found. These data suggest that PRL entry in the CSF compartment is subject to a controlling mechanism which acts at the blood/brain barrier.

We studied 39 nursing home patients and proxies to assess their decision-making capability and preferences regarding advance directives (ADs) or "living wills." Most patients willingly stated preferences; over half opted to forego burdensome measures when death appeared imminent. Patients perceived as decisionally capable were more likely to forego life-sustaining measures than those of questionable capability. The vast majority of proxies disapproved of using life-sustaining measures, even in some cases with limited knowledge of patients' preferences.

The im administration in 6 healthy subjects of buprenorphine, a derivative of the morphine alkaloid thebaine with agonist-antagonist properties, resulted in a significant rise of serum Prl within 45-240 min, a small and transient increase in serum GH and a significant fall in serum cortisol values. Conversely, no appreciable changes in the serum levels of the other hormones studied were found. The observed hormonal effects indicate that, in man, buprenorphine exerts an opiate agonist rather than an opiate antagonist effect.

The effect of a single oral dose of 400 mg fipexide on pituitary secretion was investigated in 10 elderly non-endocrine patients. Fipexide induced significant decrease (P less than 0.05) in serum prolactin (PRL) values at 90 and 120 min after drug administration, without affecting serum growth hormone (GH), gonadotropin (LH and FSH), thyrotropin (TSH) and cortisol values. Fipexide was unable to modify metoclopramide-induced PRL release in five of these patients. Our results show that this drug acts as a mild dopamine (DA) agonist, probably not directly affecting hypothalamic and/or pituitary DA receptors but indirectly via a reduced DA re-uptake at the pre-synaptic level.

Infusion of a mixture of branched-chain 1-amino acids (BCAA; isoleucine, leucine, and valine) in six male patients suffering from hepatic cirrhosis led to an increase in serum GH, while serum PRL was not affected. In the same patients arginine infusion stimulated GH and PRL release. These findings demonstrate that hypothalamo-pituitary responsiveness to amino acid stimulation is preserved in cirrhosis and that administration of these amino acids has some endocrine effect.

A chronobiological study was carried out in seven elderly male subjects (78-84 years) to evaluate the 24-h beta-endorphin secretory pattern. Seven young adult males (28-37 years) made up the control group. Blood samples were drawn every four hours from 08.00 to 20.00 h and every two hours from 24.00 to 06.00 h. ACTH and cortisol levels were also determined in the same plasma samples. Mean 24-h beta-endorphin values in the elderly (32.6 +/- 1.1 ng/l) and in the young adult male subjects (29.5 +/- 1.4 ng/l) did not differ statistically, but the circadian rhythm was absent in the elderly subjects. In the elderly, plasma ACTH and cortisol concentrations showed a circadian rhythm similar to that observed in the adult subjects. However, in the elderly patients, in contrast to that in the adult subjects, the multilinear regression analysis did not show any statistically significant correlation between the beta-endorphin, ACTH and cortisol 24-h plasma concentrations.

The incidence of serum organ and non-organ specific autoantibodies, the peripheral blood lymphocyte blastogenic response to phytohaemagglutinin, concanavalin A and pokeweek mitogen, and the surface markers of peripheral T and B lymphocytes were studied in 15 patients affected by coronary artery disease and in 21 patients with dilated cardiomyopathy. In the latter group there was a significantly impaired blastogenic response to concanavalin A with respect to both the normal control group and patients with coronary artery disease (P less than 0.01). The percentage of peripheral blood lymphocytes with cytotoxic/suppressor activity was also reduced in patients with dilated cardiomyopathy in comparison to normal subjects and patients with coronary artery disease (P less than 0.01 and P less than 0.05, respectively). These data may reflect an in vivo defect in suppressor cell function in patients with dilated cardiomyopathy.

Ten obese and 10 control subjects were studied in basal conditions and after ingestion of a standard mixed test meal. Blood glucose, insulin, somatostatin (SLI) and vasoactive intestinal polypeptide (VIP) concentrations were determined before and 30, 60, 90, 120, 180 and 240 min after the start of the meal. Basal SLI levels in the obese (14.4 +/- 0.7 ng/l) were not significantly different from those in the controls (15.5 +/- 0.8 ng/l), whereas after the meal a blunted secretory response was recorded. Baseline plasma VIP levels were higher in the obese (29.7 +/- 1.5 ng/l) than in the control subjects (19.8 +/- 1.3 ng/l) and, similarly to the controls, were unaffected by meal ingestion. Data suggest that in the course of obesity an enhanced VIP secretion in association with a diminished SLI responsiveness to meals occurs.

After a 4-week wash-out period, picotamide was administered to 25 patients affected by chronic arteriopathy of the lower limbs (scale 2 according to Fontaine) at a dose of 900 mg/die for 90 days, and then at a dose of 600 mg/die for a further 90 days, in order to assess its efficacy according to the following parameters: duration of gait, residual pressure index (RPI) resting the ankles, hematochemicals, electrocardiogram. At the end of the study a statistically significant increase was observed in the duration of gait and RPI at the ankles and, of the hematochemical parameters, in an increase in fibrogenic degradation products. Adverse reactions were only observed in 3 patients and regressed spontaneously. In conclusion, picotamide was found to be efficacious in patients affected by chronic obliterating arteriopathy of the lower limbs with the possibility of reducing the dose after 3 months of therapy.

Serum growth hormone (GH), prolactin (PRL), cortisol, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and thyroid-stimulating hormone (TSH) levels were evaluated before and after a bicycle ergometer exercise test in 8 male competitive volleyball players and in 8 sedentary healthy males of the same age. Increased serum GH and cortisol values after exercise in both groups were found, whereas an exercise-induced PRL release was observed in athletes only. Serum levels of LH, FSH and TSH were unaffected by the test in all subjects. A possible role of training in conditioning the hypothalamopituitary exercise-induced secretion is suggested.

Plasma and cerebrospinal fluid (CSF) beta-endorphin levels were determined by a RIA method in seven hydrocephalic male patients. The samples were simultaneously collected every two hours from 8 AM to 12 midnight and every hour from 1 AM to 7 AM. In both plasma and CSF beta-endorphin levels showed significant time-related variations during the 24 hour period. These results suggest the existence of diurnal CSF beta-endorphin variations analogous to those observed in plasma.

A study of the behaviour of the a and telediastolic indices and systolic times in patients presenting the sequelae of myocardial infarction is reported. It is pointed out that the earliness of a and t index variations with respect to those of systolic times is an indication of the sensitivity of the investigation which offers invaluable pointers to subsequent treatment. It is also stressed that previous hypertension and/or coronaropathy are more important than the infarction itself in creating dyskinetic zones of the myocardium and, consequently, the haemodynamic changes observed with phonomechanocardiography.