Castleman's disease presenting as an asymptomatic solitary pulmonary nodule.

We report the case of a 51 year old white woman with an asymptomatic solitary pulmonary nodule, fortuitously discovered on chest radiography. Her physical examination and biochemical tests were unremarkable for pathological findings. Thoracic computed tomography (CT) scan and nuclear magnetic resonance (NMR) spectroscopy confirmed the presence of a dishomogeneous thick lesion of lobular shape, localized between the middle and lower lobe of the right lung. Fibreoptic bronchoscopic examination failed to produce histological diagnosis of the lesion. Surgical removal of the lesion demonstrated intraparenchymal localization of Castelman's disease (giant lymph node hyperplasia). Three years after surgery, no sign of disease recurrence has been recorded.

[Fiber bronchoscopy in old age. Its diagnostic importance, tolerability and safety]. / La fibrobroncoscopia in età geriatrica. Significato diagnostico, tollerabilità e sicurezza.

Fibreoptic bronchoscopic procedure has arisen as fundamental investigation in pneumology. This is of documented value regarding young subjects, however the utility of bronchoscopy in the elderly has not yet been fully evaluated. The aim of this study was to assess the efficacy and safety of fibreoptic bronchoscopy in the elderly. We analyzed both retrospectively and prospectively our experience evaluating the indications, endoscopy findings and tolerance of the procedure in this population. Obviously patients suffering from mental illness or psychotic disease have been not included in this second session of the study. We found that elderly subjects were better compliant than young patients for the bronchoscopic procedure. The analysis showed that no differences were found, between young and elderly patients, for the total number of complications recorded. Analysing the results concerning investigations for haemoptysis we have also observed a high diagnostic value for fibreoptic bronchoscopy even in the aged group, particularly for neoplastic diseases. Our data demonstrate that fibreoptic bronchoscopy is a well tolerated procedure even in elderly patients and is associated with few complications. Fibreoptic bronchoscopy procedure provides useful diagnostic guidelines which enhances the choices of a more appropriate treatment.

Pulmonary function tests in patients with congestive heart failure: effects of medical therapy.

In a group of 13 patients with severe heart failure, both forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) significantly improved after intensive medical therapy (FVC: from 77 +/- 17 to 92 +/- 20%, p < 0.001; FEV1: from 65 +/- 15 to 81 +/- 15%, p < 0.001) in the absence of change in M-mode echo cardiac dimension and left ventricular systolic function; on the other hand, a change of indices of left ventricular filling by Doppler transmitral flow was documented (E/A ratio: from 3.6 +/- 1.2 to 1.65 +/- 1.5, p < 0.01; early filling deceleration time: from 94 +/- 39 to 178 +/- 78 ms, p < 0.01), indicating a reduction of pulmonary capillary pressure; this probably positively affected pulmonary interstitial edema and bronchial wall congestion, thus enhancing pulmonary function.

[Regulation mechanisms in prolactin secretion. Possible role of the hypophyseal renin-angiotensin system]. / Meccanismi di regolazione della secrezione di prolattina. Possibile ruolo del sistema renina-angiotensina ipofisario.

Recent studies have shown a possible role of different factors in the regulation of prolactin secretion. In fact many neurotransmitters (dopamine) and peptides can modulate prolactin release from anterior pituitary lactotrophs. In vitro and in vivo studies, Angiotensin II has been shown to increase prolactin release. On the basis of these data we have studied the effects of enalapril (ACE-Inhibitor) on baseline plasma prolactin in nine hypertensive post-menopausal women. The results indicate that 15-day inhibition of angiotensin-converting enzyme by enalapril significantly reduced serum prolactin levels. These data suggest that the Angiotensin II may play a role in the control of prolactin secretion in hypertensive women.

Multiple mucosal gastrointestinal metastases from primary asymptomatic bronchogenic carcinoma.

Gastrointestinal metastases from bronchogenic carcinoma are considered very unusual. We report a case of a 62-years-old man with a primary asymptomatic bronchogenic carcinoma who developed symptomatic multiple mucosal metastases to gastrointestinal tract. The following case is presented to draw attention to the unusual clinic presentation with a variety of differential diagnostic considerations.

[Recent progress in dopaminergic control of aldosterone secretion]. / Recenti progressi nel controllo dopaminergico della secrezione di aldosterone.

The role of dopamine on the aldosterone secretion-regulation mechanism has been confirmed by the identification of dopaminergic receptors on adrenal glomerulosa cells. Though the renin-angiotensin system plays an important primary role in the regulation of aldosterone secretion it has recently been suggested that dopamine has direct inhibitory influence on aldosterone release. Dopamine has no effect on basal plasma aldosterone levels, while it inhibits the aldosterone response in a sodium-depleted state or upright posture. Furthermore, in vitro studies have shown that dopamine modulates the activity of zona glomerulosa enzymes regulating the biosynthesis of aldosterone. The use of dopamine agonist and antagonist substances has shown that dopamine inhibits aldosterone biosynthesis by activating DA2 dopaminergic receptors identified in adrenal glomerulosa cells.

[Effects of calcium antagonist drugs on glucide metabolism]. / Effetti dei farmaci ca-antagonisti sul metabolismo glucidico.

The extension of the clinical use of Calcium entry Blockers (CEBs) indicates the need for a careful evaluation of possible adverse effects. Recently, contrasting data have been reported in some studies on the effect of CEBs on oral and i.v. glucose tolerance tests. The aim of the present study was to evaluate the potential diabetogenic properties of CEBs in normal subjects and their activities in diabetic patients. The data present in literature and also personal observations outline the safety of CEBs. In fact, there is a low possibility to derange the balance between insulin and glucagon secretion after acute and chronic administration of CEBs at conventional dosages.

Inhibition of the aldosterone response to sodium depletion in man by stimulation of dopamine DA2 receptors.

In this study we have investigated the effect of co-dergocrine, a selective DA2-agonist, on plasma aldosterone concentrations (PAC) in twelve patients with essential hypertension both in basal conditions and during sodium depletion. Sodium depletion resulted in an increase of PAC from 38 (13) pg/ml to 297 (21) pg/ml. The PAC response to sodium depletion was reduced to 155 (29) pg/ml by co-dergocrine. No significant PAC changes were found in patients maintained on a normal sodium intake. In addition the drug did not significantly modify plasma renin activity (PRA) in either experimental group. These results suggest that the dopaminergic inhibition of aldosterone secretion in man is mediated by DA2 receptors in the adrenal cortex.

Reversal by the selective D-2 dopamine receptor blocker sulpiride of the hypotensive effect of co-dergocrine in elderly hypertensives.

The aim of the study was to define the role of peripheral dopaminergic mechanisms in the regulation of blood pressure. The data suggest that the hypotensive effect of the dopaminergic agonist co-dergocrine in elderly hypertensive patients is mediated by interaction with peripheral DA-2 receptors, since it was reversed by the selective antagonist sulpiride in a dose that does not significantly cross the blood brain barrier. The findings suggest the possible therapeutic use of dopamine DA-2 agonists in elderly hypertensive patients.

Long-term treatment with oral nifedipine plus theophylline in the management of chronic bronchial asthma.

The effect on bronchial smooth muscle of slow release theophylline plus placebo and theophylline plus slow release nifedipine administered for a prolonged period to 12 asthmatic and hypertensive patients has been studied. Both combinations led to a significant improvement in respiratory function parameters when compared to baseline values. No additional improvement in pulmonary function was found on long term treatment with theophylline plus nifedipine. A reduction in the number of asthmatic attacks, in the use of inhaled beta 2-agonists and better control of arterial blood pressure resulted from use of theophylline plus nifedipine. That drug combination is safe and valuable in patients with chronic bronchial obstruction and cardiovascular disease.