Normal age-dependent values of serum insulin growth factor-I: results from a healthy Italian population.

Serum IGF-I levels were measured in 547 non-hypopituitaric, non-acromegalic healthy subjects of both sexes in Italy to develop reference values in relation to age and sex. Participant subjects were stratified in three age classes (25- 39, 40-59 and >or=60 yr) and IGF-I assay was carried out by double-antibody radio immunoassay. Pearson's correlation coefficient between age and IGF-I values was calculated by sex and predefined age ranges. IGF-I levels significantly decreased with age (p<0.001, Kruskal-Wallis test) while sex was not a significant factor. The median IGF-I levels were 206 ng/ml in the 25-39 yr range, 147 ng/ml in the 40-59 yr range and 103 ng/ml in the >or=60 yr range. Pearson's correlation coefficient confirmed the negative correlation between age and IGF-I levels in the total sample of subjects (r=-0.529). The r coefficient between age and IGF-I levels did not differ between sexes (r=-0.570 in males and r=-0.529 in females), thus reflecting no sex-effect on IGF-I levels decline over years. No correlations were found in the 25-39 yr range (r=-0.036) or in the 40-59 yr range (r=-0.080) either, while in subjects aged >60 yr, IGF-I levels tended to further decrease with increased age (r=0.389). Ranges of normal values set at the 2.5th-97.5th percentile in the three age ranges were 95.6-366.7 ng/ml between 25 and 39 yr, 60.8-297.7 ng/ml between 40 and 59 yr and 34.5-219.8 ng/ml in subjects aged >or=60 yr. This study may contribute to the development of age-specific reference ranges for IGF-I determination in serum of normal subjects of both sexes in Italy.

The role of CA 15-3 and MCA monoclonal antibody assays in the detection of primary and recurrent breast cancer.

CA 15-3 and MCA assays were tested in 103 operable patients (preoperative determination) and 100 patients with advanced breast cancer. Normal CA 15-3 and MCA values were determined in a series of 68 healthy women. The negative/positive cut-off was set at 28.8 U/ml and 15.5 U/ml respectively for CA 15-3 and MCA (mean value + 2SD). Results were analyzed in the two groups and with respect to T and N pathological categories in the preoperative series. In pT1 (59 pts), pT2 (30 pts), pT3 + pT4 (14 pts), pNO (58 pts), pN1 (45 pts) and overall preoperative series CA 15-3 and MCA sensitivities were respectively 25%, 40%, 57%, 22%, 42%, 30% and 27%, 30%, 35%, 21%, 33%, 26%. In the patients affected by widespread disease, sensitivity was 92% and 80% for CA 15-3 and MCA. Results were significantly different among normal, preoperative and advanced patients (P less than 0.05). Our results suggest that CA 15-3 and MCA levels are correlated with the tumor mass. Nevertheless, the low sensitivity in pT1 and pNO cases indicates that these two assays have no role in the diagnosis of early breast cancer. In the advanced patients, too, the results can be questioned: in the present study, in fact, recurrent cases were characterized by gross disease with multiple site involvement and cannot be considered as an example of early diagnosis of breast cancer recurrence.

[Comparison between serum ferritin and induced sideruria in the diagnosis of disorders of iron metabolism]. / Raffronto fra ferritinemia e sideruria provocata nella diagnostica dei dismetabolismi marziali.

The A. compare the values of serum ferritin and Desferrioxamine (DFO)-induced sideruria on 73 patients affected by different diseases. The results may be divided into three groups: a first one concerning patients with low serum ferritin and low DFO-induced sideruria, a second one of patients with normal serum ferritin and normal DFO-induced sideruria; in the third group of patients the A. found high values of serum ferritin and high or normal values of DFO-induced sideruria. The different behaviour observed in this III group of patients mostly affected by malignancy may be ascribed, in all those cases with high ferritin and normal sideruria, to a direct production of isoferritins by cancer cells.

External quality assessment scheme in Tuscany, Italy.

According to the Regional Law n. 44 of 6/6/1988, all public and private laboratories in Tuscany, Italy, are obligated to carry out internal quality control and participate in external quality assessment programmes. The external quality assessment schemes are directly managed by "Regione Toscana" by means of the "Centro regionale di riferimento per la sicurezza di qualità". The programme for clinical chemistry (comprising cholesterol, glucose, urea, creatinine, sodium, potassium, calcium, uric acid, total proteins, ALT, AST, GGT) started in 1990 by sending two lyophilized serum samples from eight pools, each containing a different analyte concentration. In 1992 the analytes were increased to eighteen, chloride, phosphate, bilirubin, triglycerides, iron and alkaline phosphatase being added. At the same time the first cycle of the EQAs dedicated to the blood coagulation (including PT, APTT and fibrinogen) was started. In every cycle each laboratory must perform 16 analyses, by testing 8 pairs of samples from 8 different pools. The samples from different pools are sent by separate dispatches and in random order. Thus the participating laboratories receive and analyze the samples in a different sequence.

External quality assessment in therapeutic drug monitoring: an Italian experience.

Pharmacontrol is an external quality assessment (EQA) for therapeutic drug monitoring initiated in Italy in 1986 on regional basis. Since then, interest and involvement being on a national level, participation has expanded to some 180 laboratories currently. The EQA concerns assays for the drugs most frequently monitored in Italy (seven drugs until 1989, 13 at present). The results obtained in 1989, reported in this paper, indicate a generally satisfactory level of both precision and accuracy.

High variability in results of semen analysis in andrology laboratories in Tuscany (Italy): the experience of an external quality control (EQC) programme.

We report the results of the first three trials of an external quality control (EQC) programme performed in 71 laboratories executing semen analysis in Tuscany Region (Italy). At the end of the second trial, participants were invited to attend a teaching course illustrating and inviting to adhere to procedures recommended by WHO (V edition). Results of the first three trials of the EQC documented a huge variability in the procedures and the results. The highest variability was found for morphology (CV above 80% for all the trials), followed by count (CV of about 60% for all the trials) and motility (CV below 30% for all the trials). When results of sperm count and morphology were divided according to the used method, mean CV values did not show significant differences. CV for morphology dropped significantly at the third trial for most methods, indicating the usefulness of the teaching course for morphology assessment. Conversely, no differences were observed after the course for motility and for most methods to evaluate count, although CV values were lower at the second and third trial for the laboratories using the Burker cytometer. When results were divided according to tertiles of activity, the lowest mean bias values (difference between each laboratory result and the median value of the results) for count and morphology were observed for laboratories in the third tertile (performing over 200 semen analysis/year). Of interest, mean bias values for concentration dropped significantly at the third trial for low activity laboratories. In conclusion, lack of agreement of results of semen analysis in Tuscany is mainly because of the activity and the experience of the laboratory. Our study points out the importance of participating in EQC programmes and periodical teaching courses as well as the use of WHO recommended standardized procedures to increase precision and to allow the use of WHO reference values.

Frecuencia de trastornos mentales en adultos que concurren a un centro de salud de un barrio de la ciudad de Córdoba / Frequência dos transtornos mentais em adultosatendidos em um centro de saúde de um bairroda cidade de Córdoba / Frequency of mental disorders in adults who attend a health centre in a neighborhood, in the city of Cordoba

Estudios previos revelan que una proporción importante de losconsultantes del primer nivel de atención de salud presentanalgún tipo de Trastorno Mental y del Comportamiento, por loque este nivel ofrece una oportunidad en el manejo oportunode esta problemática.Objetivo: Caracterizar la prevalencia de TMyC enconsultantes de un centro de salud de un barrio de la ciudadde Córdoba.Material y Método: Se utilizó CIDI 3.0, en una muestraprobabilística de 100 consultantes adultos del primer nivelde atención.Resultados: El 96,4% de los entrevistados fueron mujeresy la media de edad de 35±2,6. La frecuencia de TMyC a lolargo de la vida fue del 33,33%. 7,1% de los entrevistadospresentó Trastornos Generalizados de la Ansiedad, 3,6%Desorden Obsesivo Compulsivo y 22,22% algún episodio deDepresión. A partir de estos primeros resultados, el equipode salud local podrá orientar estrategias y políticas públicasque aborden integralmente al consultante.

Previous studies have shown that an important proportion of the patients in first levelhealth care present some kind of Mental and Behavioral Disorder (MBD); thus, this leveloffers a possibility to timely deal with this problem.Objective: To characterize the prevalence of MBD in patients who attend a health carecenter in a neighborhood in the city of Cordoba.Material and Method: CIDI 3.0 was used in a probability sample of 100 adult consultantsat primary level of care.Results: Out of the patients interviewed, 96.4% were women and the mean age was35±2.6. The frequency of MBD along lifetime was 33.33%. A 7.1% of the interviewedpatients presented Generalized Anxiety Disorders, 3.6% Obsessive Compulsive Disorderand 22.22% some Depressive episode. Using these first results, the local health team willbe able to direct strategies and public policies to deal with the patients comprehensively.

Atención primaria y trastornos mentales y del comportamiento: una mirada exploratoria / Primary careand mental and behavior disorders: an exploratory view

Objetivo: Identificar la prevalencia de los problemas de comportamiento y salud mental que se relacionan con el primer nivel de atención a partir del análisis de las estadísticas de mortalidad a nivel nacional y el la provincia de Córdoba. Metodología: La fuente analizada fue la Base de Datos de Mortalidad 2005-2006 del Ministerio de Salud de la Nación. Se calcularon tasas de mortalidad bruta (TMB) y específica (TME) según sexo, edad y causa por trastornos mentales y de comportamiento (TMyC), Mortalidad proporcional (MP) y la razón de tasas para país y provincia de Córdoba. Software SPSS e InfoStat. Resultados: En el año 2005, la TMB fué similar entre país y provincia de Córdoba, mientras que la TME por causa y por sexo fueron inferiores en Córdoba. Los TMYC representaron el 0.74 % de MP en Argentina, valores similares se registraron en el 2006. Conclusión: La prevalencia de los TMyC observados en los registros de estadísticas virtuales de Argentina y provincia de Córdoba se relacionan a patologías que están incluidas como necesidades en el primer nivel de atención.

The role of lithium carbonate in the management of hemolymphoblastosis: estimation of plasmatic and erythrocyte lithium levels.

Twelve patients affected by hemolymphoblastosis were treated with lithium carbonate in order to attenuate neutropenia induced by anticancer drugs. Controls were chosen among patients who had not received lithium treatment after cytostatic therapy. We estimated plasmatic and erythrocyte lithium levels and determined the Erythrocyte lithium rate (ER), i.e., erythrocyte lithium levels expressed as a percentage of plasmatic levels. A significant correlation was found between granulocyte increase at one week (GIW) and ER. No significant correlation was found between GIW and the other two estimation procedures. Therefore, ER seems to be a reliable index of the efficacy of the treatment, and could be used to monitor lithium administration.

[Variations in serum myoglobin due to physical exertion]. / Variazione della concentrazione della mioglobina sierica nello sforzo fisico.

We studied the behaviour of serum myoglobin and of serum enzymes in 25 young men, before and after physical stress. The stress appeared to markedly increase myoglobin, aldolase and CK activity and to a lesser extent GOT. Myoglobin, aldolase return to normal levels within 24 hours but CK appeared to decrease more slowly. The simultaneous determination of some organic-specific enzymes (CK-MB, gamma-GT, GPT) permitted us to state that the myocardium and liver are not involved in the increase of tests following muscular stress.

A new approach to the quality control of steroid receptor assays.

Lyophilized cytosols prepared from calf uterus and human breast tumor tissue are commonly used to assess the reliability of routine steroid receptor assays. However, preanalytical error (sample preparation, storage, homogenization) cannot be detected in this way. Participating laboratories were asked to mail us all their receptor results obtained over a four-month interval, and to include some information about the patients involved (age, menopausal status, nodal status). After verifying the homogeneity of the populations investigated, we computed consensus means for the percentages of positive samples and for their absolute value. Despite the homogeneity of the characteristics of the populations studied, results from some laboratories systematically differed from the consensus mean. This approach to the quality control of steroid receptors allows evaluation of the whole procedure, from sample preparation to analysis, and thus may be helpful as an addition to the usual practice of distribution of cytosols and tissue powders for assay.

[Glycosylated hemoglobin in normal pregnancy]. / L'emoglobina glicosilata nella gravidanza normale.

The Authors studied the trend of HbA1 values in 215 normal pregnant women and in 31 normal non-pregnant women (control group). HbA1 values appeared to decrease in the course of pregnancy, according to a parabolic regression. A minimum value was reached near 25 weeks. The levels of HbA1 in the last weeks were not different from the control group ones. HbA1 did not change significantly during post-partum period.

Serum angiotensin-I-converting enzyme and lysozyme levels in untreated and unsplenectomized patients with Hodgkin's disease.

Serum angiotensin-I-converting enzyme (S-ACE) is elevated in active sarcoidosis. In Hodgkin's disease (HD) there are few reports with different and contrasting results. We studied S-ACE in 23 healthy controls and in 18 untreated and unsplenectomized patients with HD. In the same cases we studied also serum lysozyme. Lysozyme concentration was significantly higher in HD patients compared with normal controls (p less than 0.01) and was independent of stage, systemic symptoms and presence of mediastinal involvement. S-ACE activity in HD patients was lower than in healthy controls, but not significantly. The correlation coefficient between the two enzymes showed that there was no significant correlation both in controls and in patients.

[Changes in the serum protein picture in viral hepatitis. II. Evaluation of the proteins in the acute phase]. / Modificazioni del quadro sieroproteico nell'epatite virale. II. Valutazione delle proteine della fase acuta.

A few of the best known acute phase reactants have been followed in 30 patients suffering from acute viral hepatitis during the first four weeks of illness. Increased levels of alpha-1 antitrypsin and prevailing low levels of haptoglobin were the main findings, while the other proteins showed only little changes. As a whole the determination of acute phase reactants does not seem of any particular significance in viral hepatitis.

Folate deficiency in operated terminal ileitis (Crohn's disease).

In a series of 39 subjects previous results for serum folate levels were confirmed while intraglobular folate did not differ from those in a control group. To verify the hypothesis that SASP administration could be responsible for serum folate deficiency three different sub-groups were considered. 11 patients had never taken SASP (sub-group I), 16 patients had taken SASP in the past but the treatment had been withheld at least 2 months before (sub-group II), 12 patients were still taking the drug at the time of the study (sub-group III). Differences in serum folate levels between each one of the three sub-groups and the control group were significant. The same was not true for the differences between each one of the three sub-groups and the other. These findings seem to confirm that SASP treatment is not the major cause of serum folate deficiency, but a multifactorial pathogenesis might account for it.

[Changes in the serum protein picture in viral hepatitis. III. Evaluation of immunoglobulins]. / Modificazioni del quadro sieroproteico nell'epatite virale. III. Valutazione delle immunoglobuline.

Serum IgG, IgA and IgM were determined sequentially during the first four weeks of illness in 30 patients suffering from acute viral hepatitis. Initially increased levels of IgM, and to a lower extent of IgG were the most characteristic findings. Two patients showed increased levels of IgA. The determination of immunoglobulins is not contributory to the diagnosis of viral hepatitis, though it may have a significant value in detecting the activity of the disease.