Biological aspects of gender disorders.

The scientific community is very interested in the biological aspects of gender disorders and sexual orientation. There are different levels to define an individual's sex: chromosomal, gonadic, and phenotypic sex. Concerning the psychological sex, men and women are different by virtue of their own gender identity, which means they recognize themselves as belonging to a determinate sex. They are different also as a result of their own role identity, a set of behaviors, tendencies, and cognitive and emotional attitudes, commonly defined as "male" and "female". Transsexuality is a disorder characterized by the development of a gender identity opposed to phenotypic sex, whereas homosexuality is not a disturbance of gender identity but only of sexual attraction, expressing sexual orientation towards people of the same sex. We started from a critical review of literature on genetic and hormonal mechanisms involved in sexual differentiation. We re-examined the neuro-anatomic and functional differences between men and women, with special reference to their role in psychosexual differentiation and to their possible implication in the genesis of homosexuality and identity gender disorders. Homosexuality and transsexuality are conditions without a well defined etiology. Although the influence of educational and environmental factors in humans is undeniable, it seems that organic neurohormonal prenatal and postnatal factors might contribute in a determinant way in the development of these two conditions. This "organicistic neurohormal theory" might find support in the study of particular situations in which the human fetus is exposed to an abnormal hormonal environment in utero.

Neoplastic myelopathies and traumatic spinal cord lesions: an Italian comparison of functional and neurological outcomes.

BACKGROUND: Although neoplastic spinal cord injuries (NSCIs) constitute ∼25% of all non-traumatic spinal cord lesions, patients with such pathologies are seldom, if ever, admitted to specialized centers; further, their rehabilitation typically is short because of the perception that rehabilitation prolongs hospital stays unnecessarily and is reserved only for patients with very good prognoses. STUDY DESIGN: This study is a retrospective analysis. OBJECTIVE: The objective of this study is to evaluate the neurological and functional outcomes of patients with NSCIs compared with those of patients with traumatic spinal cord injury (TSCI). METHODS: We evaluated 208 patients with TSCIs and 63 with NSCIs; using a matching cohorts procedure, 43 comparable couples were selected from each group. The measures used to assess these patients were the American Spinal Injury Association standards, the Barthel Index (BI), the Rivermead Mobility Index and the Walking Index for Spinal Cord Injury. RESULTS: In the general population, NSCI patients are older and have longer lesion-to-admission times and more incomplete lesions than TSCI patients. Therefore, the functional status at admission and outcomes differed between the groups. In the matching cohorts, TSCI patients had lower BI scores at admission than NSCI subjects. At discharge, the two groups had comparable functional outcomes. Neurological status was similar at admission and at discharge. CONCLUSIONS: Although they had slightly disparate functional levels at admission, NSCI and TSCI patients had the same outcomes at discharge. Our data suggest that in a selected cohort of NSCI patients, rehabilitation is as successful as that in TSCI subjects and allows most patients to be discharged instead of being institutionalized.

Evaluation of antioxidant systems in pituitary-adrenal axis diseases.

The role of adrenal steroids in antioxidant regulation is not known. Previously, we demonstrated some Coenzyme Q(10) (CoQ(10)) alterations in pituitary diseases, which can induce complex pictures due to alterations of different endocrine axes. Therefore we determined CoQ(10) and Total Antioxidant Capacity (TAC) in pituitary-dependent adrenal diseases: 6 subjects with ACTH-dependent adrenal hyperplasia (AH); 19 with secondary isolated hypoadrenalism (IH), 19 with associated hypothyroidism (multiple pituitary deficiencies, MPH). CoQ(10) was assayed by HPLC; TAC by the system metmyoglobin-H(2)O(2), which, interacting with the chromogenous 2,2(I)-azinobis-(3-ethylbenzothiazoline-6-sulphonate), generates a spectroscopically revealed radical compound after a latency time (Lag) proportional to the antioxidant content. CoQ(10) levels were significantly lower in IH than AH and MPH, with a similar trend when adjusted for cholesterol. Also TAC was lower in IH than in AH and MPH, suggesting that adrenal hormones can influence antioxidants. However, since thyroid hormones modulate CoQ(10) levels and metabolism, when thyroid deficiency coexists it seems to play a prevalent influence.

Hormones and antioxidant systems: role of pituitary and pituitary-dependent axes.

Oxidative stress, a condition defined as unbalancing between production of free radicals and antioxidant defenses, is an important pathogenetic mechanism in different diseases. Despite the abundant literature, many aspects of hormone role in regulating antioxidant synthesis and activity still remain obscure. Therefore, we reviewed experimental data, in vivo and in vitro, about the effects of the different pituitary- dependent axes on antioxidant levels, trying to give a broad view from hormones which also have antioxidant properties to the classic antioxidants, from the lipophilic antioxidant Coenzyme Q10, strictly related to thyroid function, to total antioxidant capacity, a measure of non-protein non-enzymatic antioxidants in serum and other biological fluids. Taken together, these data underline the importance of oxidative stress in various pituitary-dependent disorders, suggesting a possible clinical usefulness of antioxidant molecules.

A case of forearm amputation after ovarian stimulation for in vitro fertilization-embryo transfer.

OBJECTIVE: To report a case of forearm amputation after ovarian stimulation for IVF-ET. DESIGN: Case report. SETTING: A university hospital. PATIENT(S): A 41-year-old woman, who had coagulation disorder as a result of an ovarian hyperstimulation syndrome (OHSS) for IVF-ET. INTERVENTION(S): Retrospective evaluation of angiographic studies and surgical treatment. MAIN OUTCOME MEASURE(S): Medical follow-up after forearm amputation due to OHSS. RESULT(S): The patient underwent many cycles of IVF-ET with administration of purified FSH (75 IU 10 times per day, for 12 days) and chorionic gonadotropin (5,000 IU). The patient had a coagulation disorder as a result of OHSS, with thrombosis of the axillary vein, recurring after thromboarterectomy and leading to the paradoxical result of the amputation of an arm. CONCLUSION(S): An ethical evaluation of this case is mandatory, since the desire for pregnancy, the role of medical science, health, and human life itself are all factors involved.

[Pulmonary silicosis associated with MacLeod syndrome: a case report]. / Silicosi polmonare associata a sindrome di MacLeod: nota su un caso.

The paper reports a case of silicosis associated with idiopathic unilateral hyperlucent lung--MacLeod's disease (ML)--in a 65-year old miner. ML had not been diagnosed before this clinical observation and the patient had been exposed to silica dust for about 15 years as a truck operator in water supply tunnelling work in central Italy. Impaired ventilatory function due to left pulmonary dystrophy was the favouring or even the causal factor of dust accumulation in the functionally active right lung and of the tissue reaction to the dust, leading to interstitial fibrosis. A radiological diagnosis of p 1/0 pneumoconiosis was made according to the 1980 International Labour Office classification. Clinical, radiological and functional findings indicated the presence of respiratory failure as a result of the sum of silicotic and dystrophic lesions. Two combined pulmonary scintigraphic examinations with Tc99 perfusional and mTc-DPTA inhalatory methods revealed peculiar alterations: absence of ventilation associated with severe vascular impairment in the left lung, inequality of the ventilation/perfusion rate, due to pneumoconiosis, in the right lung. MacLeod's disease is rare, but must be considered as a mandatory contra-indication for work involving dust exposure risk since it is one of the predisposing factors which can cause an occupational disease even if environmental exposure standards are observed.

Neurological and functional outcome in traumatic central cord syndrome.

STUDY DESIGN: Retrospective analysis of in-patient stay and prospective follow-up. OBJECTIVES: To study neurological and functional outcomes after traumatic central cord syndrome (TCCS). SETTING: Regional Spinal Unit of Florence, Italy. METHODS: In total, 82 patients, admitted for acute rehabilitation to our Centre (1996-2002) with a diagnosis of TCCS entered the study. Data on admission and discharge were collected for assessments performed at 18 months of injury or later. Data included: cause of injury, gender, type of vertebral lesion, treatment, time of hospitalisation (LoS), ASIA/ISCOS Impairment Scale, neurological examination, functional independence measure (FIM) on admission and discharge. Additional measures included the walking index for spinal cord injuries (WISCI), bladder management, FIM, spasticity on discharge/follow-up and neuropathic pain at follow-up. Correlations were performed on outcome measures in relation to age, treatment, LoS, spasticity and neuropathic pain. RESULTS: Average age was 52 (16-82) years. Causes included falls (47%), road traffic accidents (36%) and sport (7%). Of patients, 45% were treated surgically and 55% conservatively. LoS was 120 days (24-390), but less for those treated without surgery. Patients under 65 years had better outcomes with less neuropathic pain. Neurological and functional recovery was observed on discharge from rehabilitation, which continued in the period following discharge. Spasticity was equally present in all age groups. No difference in outcome was found as a result of spine surgery. CONCLUSIONS: Patients with TCCS are older than other spinal cord injured patients, but often show improvement after discharge. Improvement in subjects under 65 years was significantly better than for those over 65 years.

[Measurement of cutaneous evaporation. 4. Cutaneous water loss in heart disease]. / L'evaporimetria cutanea. Nota IV. La coutaneous water loss (CWL) nelle cardiopatie.

The purpose of this research is the measurement of the cutaneous water loss in not influenced by very specific therapies. Ep I in order to compare it with the values of normal people. We found a statistical significant increase of the CWL that is 23 cardiopathic patients by the evaporimeter.

[Measurement of cutaneous evaporation. 5. Cutaneous water loss in peripheral vascular disease]. / L'evaporimetria cutanea. Nota V. La coutaneous water loss (CWL) nelle angiopatie periferiche.

The purpose of this research is the measurement of the cutaneous water loss in 19 angiopathie patients by the Evaporimeter. Ep I in order to compare it with the values of normal people. We found a statistical significant increase of the CWL without difference between the normal and pathologic limb.

[Cutaneous evaporimetry. IX. Cutaneous water loss in old age]. / L'evaporimetria cutanea. nota IX. La coutaneous water loss (CWL) nell'età senile.

The cutaneous water loss (CWL) were investigated in 15 old human subjects by Evaporimeter Ep-1. The mean value of the CWL resulted 11,9 +/- 4,3 g/h. This result is significantly lower compared with the value of normal people equal to 17, 5 +/- 4,0 g/h as reported in foregoing notes.

[Spontaneous grade I bundle of His block. Clinical, electrocardiographic and electrophysiological studies in 37 patients]. / Il blocco intrahisiano di I grado spontaneo. Osservazioni cliniche, elettrocardiografiche ed elettrofisiologiche in 37 pazienti.

The clinical, ECG and electrophysiological data of 37 patients (28 males and 9 females) with spontaneous intra-hisian block are reported. Of these patients, 11 had hypertensive heart disease and 5 had ischemic heart disease with previous myocardial infarction; in 21 patients, clinical signs of heart disease were not evident. In 18 patients, a single or recurrent episode of syncope had occurred. One patient had junctional rhythm and 36 sinus rhythm; among these, 12 patients presented PR greater than 200 msec (7 with a narrow and 5 with a wide QRS); 12 patients had a single or bilateral bundle branch block; 12 had a normal ECG. The electrophysiological study showed a split H-H1 in 22 patients, a wide His deflection (H greater than 25 msec) in 4 and HV greater than 65 msec with narrow QRS in 11. In 17 patients a more or less marked sinoatrial node and/or atrioventricular node dysfunction was present. Atrial pacing, performed in all, induced 2nd degree Mobitz 2 intra-hisian block in 9 patients. Ajmaline was used in 16 patients but induced a complete intra-hisian block in only one. In 28 patients a preventive pacemaker was implanted after electrophysiological study. During the follow-up (mean 25 months/pt.), 38% of the patients developed complete atrioventricular block. No recurrence of syncope occurred in the paced patients. Comparison of patients who developed atrioventricular block and those who maintained normal atrioventricular conduction did not show differences as far as heart disease, previous syncope, ECG pattern and results were concerned.(ABSTRACT TRUNCATED AT 250 WORDS)

[Variations in plasma protein components during extracorporeal circulation]. / Variazioni delle componenti proteiche plasmatiche durante circolazione extracorporea.

In this research we have determined the behaviour of proteic plasmatic pattern and some enzymes during extracorporeal circulation and we noted a constant increase of albumin and of the ratio Alb/Glob. We observed also variations of some enzymes. Our opinion according other AA. is that this changes are determined principally by the large dose of heparin necessary during the C.E.C.

[Plasma variations of pituitary hormones during extracorporeal circulation]. / Variazioni plasmatiche degli ormoni ipofisari durante circolazione extracorporea.

In this research we have determined the behaviour of hypophisary hormones determined by radioimmunoassay. We have noted a constant increase of GH and HPrL. In one case we have seen also the decrease of LH and FSH. This changes are determined by the large dose of heparin necessary during C.E.C.

[Cutaneous lipid excretion]. / Escrezione lipidica cutanea.

In this research we have studied the lipids excretion of skin by comparison of three groups of subjects at first age, young age and old people. We evidence the amount of the lipidic fractions and the differences between the ages in the lipids of skin and their components. We have also underlined the great significance of the skin as an important factor in the homeostasis.