[The hospital medical director: his role and professional qualification in Modena (Italy) health care system]. / II Direttore di Presidio Ospedaliero: ruolo e requisiti professionali nell'esperienza dell'Azienda U.S.L. di Modena.

The development of health care system in Italy, from 1968, have changed the hospital medical director function and have put him in conflict with the desired physicians involvement in health care management. In Modena the health care system organisation, the self government and the responsibility decentralisation, promoted the achievement of an organisation model tempering every competence because the success of everyone's task depends on the other one's. Therefore, Italian laws are suitable of getting more efficiency and effectiveness in health care system without new rules, if the clinical governance becomes a way to involve the physicians in management and not an instrument to leave out managers and hospital medical directors.

Isocratic reversed-phase liquid chromatography of all-trans-retinoic acid and its major metabolites in new potential supplementary test systems for developmental toxicology.

An isocratic reversed-phase high-performance liquid chromatographic procedure for the determination of all-trans-retinoic acid (all-trans-RA) and its metabolites, all-trans-4-oxo-RA, 5,6-epoxy-RA, 9-cis-RA and 13-cis-RA, in mouse plasma and embryo and in new in vitro potential test systems for developmental toxicology has been developed. These compounds, their biological precursor retinol (vitamin A) and the internal standard were resolved on a Spherisorb ODS-2 (5 microns) column (250 x 4.6 mm I.D.) with acetonitrile-water-methanol-n-butyl alcohol (56:37:4:3, v/v) containing 100 mM ammonium acetate and 70 mM acetic acid as the elution system, with a total run time of 23 min. The assay was linear over a wide range, with a lower limit of quantitation of 50 ng/ml or 10 ng/mg of protein for all-trans-RA, 13-cis-RA and 9-cis-RA and of 25 ng/ml or 5 ng/mg protein for the 4-oxo- and 5,6-epoxy-metabolites. At these concentrations, intra-assay coefficients of variation (C.V.) of the retinoids were 3-9%. Mean intra-assay C.V. averaged 5-7% in the tissues studied. Its use is discussed for RA measurements in some of the new test systems--Drosophila melanogaster, sea urchin embryos and cultured human keratinocytes--that have to be evaluated in toxicological testing, supplementary to standard assays in mammals.

Effects of prolonged treatment with diltiazem on pituitary secretion of luteinizing hormone, follicle-stimulating hormone, thyrotropin and prolactin.

In previous studies it has been observed that acute administration or short-term treatment with calcium channel blockers can influence the secretion of some pituitary hormones. In this study, we have examined the effect of the long-term administration of diltiazem on luteinizing-hormone (LH), follicle-stimulating hormone (FSH), thyrotropin (TSH) and prolactin (PRL) levels under basal conditions and after gonadotropin-releasing hormone (GnRH)/thyrotropin-releasing-hormone (TRH) stimulation in 12 subjects affected by cardiovascular diseases who were treated with diltiazem (60 mg 3 times/day per os) for more than 6 months and in 12 healthy volunteers of the same age. The basal levels of the studied hormones were similar in the two groups. In both the treated patients and the control subjects, a statistically significant increase (p < 0.01) in LH, FSH, TSH and PRL levels was observed after GnRH/TRH administration. Comparing the respective areas under the LH, FSH, TSH and PRL response curves between the two groups did not present any statistically significant difference. These findings indicate that long-term therapy with diltiazem does not alter pituitary hormone secretion.