Epigallocatechin-3-gallate (EGCG) and green tea polyphenols do not improve stallion semen parameters during cooling at 4°C.

Stallion semen storage for artificial insemination is mainly based on liquid cooled storage. In many stallions this technique maintains sperm quality for an extended period of time (24-72 hr) at 7°C. While this technique is commonly used in the horse industry, there can be a decline in fertility in some stallions, due to an inability of their sperm to tolerate the cool storage process. The aim of the present work was to evaluate the effect of two natural antioxidants (epigallocatechin-3-gallate (EGCG) at 20, 60 and 120 µm and green tea polyphenols, and p at .001, .01 and .1 mg/ml) on some sperm parameters (sperm motility, viability/acrosome integrity and DNA quality) in extended semen immediately after its collection (T0) and after 2, 6, 24 and 48 hr of cool storage. Two ejaculates from three trotter stallions were analysed after 48 hr of storage at 4°C. No beneficial effect on the analysed parameters was observed: the two antioxidants were not able to improve sperm quality after 48 hr of storage. These results are in agreement with previous findings on the effect of different antioxidants reported by other researches, who have demonstrated that stallion semen keeps good antioxidant capacity after dilution for 24 hr. In conclusion, the positive effect exerted by antioxidant molecules in other species is not confirmed in the equine one.

Defining the clinical outcome status (COS) in sarcoidosis: results of WASOG Task Force.

The clinical outcome of sarcoidosis is quite variable. Several scoring systems have been used to assess the level of disease and clinical outcome. The definition of clinical phenotypes has become an important goal as genetic studies have identified distinct genotypes associated with different clinical phenotypes. In addition, treatment strategies have been developed for patients with resolving versus non resolving disease. A task force was established by the World Association of Sarcoidosis and Other Granulomatous diseases (WASOG) to define clinical phenotypes of the disease based on the clinical outcome status (COS). The committee chose to examine patients five years after diagnosis to determine the COS. Several features of the disease were incorporated into the final nine categories of the disease. These included the current or past need for systemic therapy, the resolution of the disease, and current status of the condition. Sarcoidosis patients who were African American or older were likely to have a higher COS, indicating more chronic disease. The COS may be useful in future studies of sarcoidosis.

Quality and fertilizing ability in vivo of sex-sorted stallion spermatozoa.

Little information is available on the quality of stallion spermatozoa after sex sorting. The objectives of the present study were to assess the quality of sex-sorted stallion spermatozoa and determine its fertilizing ability after hysteroscopic low dose insemination. Ejaculates from four stallions were collected and sorted by a MoFlo SX flow cytometer/sperm sorter. Before and after sorting, spermatozoa were evaluated for motility by Computer Assisted Sperm Analysis, viability (SYBR 14-propidium iodide), mitochondrial function (JC-1) and acrosomal status (fluorescein isothiocyanate Pisum sativum agglutinin conjugated). A fertility trial was carried out on four mares (seven oestrous cycles) by hysteroscopic insemination, depositing 5 x 10(6) X-bearing spermatozoa. Sex sorting resulted in a significant decrease (p < 0.001) in all motility characteristics. Sperm viability and percentage of spermatozoa with functional mitochondria were not affected by the sorting process, while the percentage of reacted spermatozoa was higher (p < 0.01) for non-sorted than sorted spermatozoa. Pregnancy rate was 28.6% (2/7) after low dose hysteroscopic insemination. Only one pregnancy was carried to term with the birth of a healthy filly. In conclusion, despite the reduction in sperm motility, sex sorting did not impair stallion sperm viability and mitochondrial activity immediately post-thaw; moreover, the sexed spermatozoa retained the ability to fertilize in vivo.

[Adoptive parental couple: a pilot study]. / La coppia genitoriale adottiva: uno studio pilota.

International adoption is a phenomenon in constant growth, involving over one hundred countries. In Italy there are approximately two thousand adoptions of foreign minors per year. The needs demonstrated by the families adopting these children, sometimes bearing complex problems, have led to the offer of a combined medical and psychological intervention oriented towards a global and integrated approach to the needs of a family that is changing with the arrival of a new member. Therefore, a clinical evaluation of the health status of the child recently arrived in Italy, targeted at identifying the presence of medical or psychological conditions, is performed during the day spent at the day hospital. The authors present data and considerations emerging from their ongoing experience, which has already involved 113 children and 89 families. The majority of the children evaluated so far show acute physical conditions, requiring major attention and support from their parents. The authors believe that in order to organize an adequate intervention it is useful to consider the parents of these children as caregivers. The function of caregiver is identified at three levels: the care of the child as son/daughter (typical of the parental function), the care of the problems deriving from the specific preadoption experience that accompany the child in the new family, and the care of the sick child. The authors deem that the combined medical and psychological intervention adopted at present with these families constitutes a useful support to the caregiver function.

Effect of cushioned or single layer semen centrifugation before sex sorting on frozen stallion semen quality.

The aim of this study was to compare the effect of presorting centrifugation (cushioned [CC] or single-layer colloid [SLC]), with simple dilution (SD), on the quality of sex-sorted stallion semen before and after sorting and after freezing and thawing. Four ejaculates from each of two fertile stallions were collected 1 week apart and evaluated for percent total sperm motility (TM), percent viable acrosome-intact sperm (VAI), and DNA quality (percentage of DNA fragmentation index). Freezing caused, independently from CC and SLC treatments, a significant decrease of TM (P < 0.05) and VAI (P < 0.05) in both unsorted and sorted semen. On the other hand, sorting did not impair TM and VAI and, interestingly, improved DNA quality in all treatments only before freezing (28 vs 13, 28 vs 10, 22 vs 7 in SD, CC, and SLC for unsorted vs sorted groups, respectively; P < 0.05); this positive effect was lost in the same samples after freezing and thawing, suggesting that the freezing process reduces the DNA quality of sex-sorted sperm. Our results suggest that CC and SLC are not able to select those spermatozoa that possess a better ability to withstand sperm processing associated with sperm sorting and freezing.

Long-term therapy with deflazacort in chronic sarcoidosis.

PURPOSE: To evaluate the long-term action of deflazacort (DF), a new calcium-sparing and bone-saving corticosteroid, in chronic sarcoidosis patients needing prolonged therapy. PATIENTS AND METHODS: 40 patients with chronic histologically proved sarcoidosis requiring long-term corticosteroid therapy were treated with DF and followed for a mean period of 958 +/- 515 days (range 382-2, 068). The indication for giving corticosteroid therapy was pulmonary impairment in most (36), but also other events including hypercalcemia (2), kidney stones (5, 2 with recurrent colic), uveitis (2), lupus pernio (3), suspected heart impairment (5), hypersplenism (1), and other causes. Follow-up examination included serial ACE, chest x-ray, 67Ga lung scan, pulmonary function data, serum and urinary calcium levels. Eleven patients (UT group) were not receiving glucocorticoids when first seen at our clinic; 29 patients (PT group) were on therapy with glucocorticoids (27 wity prednisone, 2 with DF) for 870 +/- 1,128 days (range 27-4,310) RESULTS: In the PT group, DF maintained the good results previously obtained with prednisone; in this group, chest x-ray film showed improvement in 16 patients, 67Ga lung scan was better in 13, while worsening chest x-ray film findings in 1 and 67Ga lung scan in 2 was seen coincident with DF tapering. Respiratory function data showed a mild nonsignificant improvement. SACE decreased significantly from 114.6 +/- 38.7 to 91.5 +/- 37.9 nM/ml/min (p less than .05). In the UT group the results were better, as expected in a population where the action of corticosteroids did not influence the first observation. FVC increased significantly from 76.3 +/- 13.0 to 89.9 +/- 19.5 percent predicted (p less than .01); the 67Ga lung scan and chest x-ray film findings improved in all but 1 patient, and ACE dropped significantly (p less than .01) from 131.8 +/- 46.3 to 83.7 +/- 25.0. In both groups the side effects were mild, and only 2 patients discontinued the treatment, 1 for gastric ulcer, and the other for amenorrhea plus a 14 kg weight gain. CURRENT STATUS: One patient died of cancer, 9 discontinued treatment (5 because therapy was no longer necessary, 2 for the above described side effects, 2 for non-drug-related reasons), 4 dropped out and were last seen when taking DF 22.5, 18, 12 and 6 mg daily respectively. Twenty-six are continuing the drug on a long-term basis at the current mean daily dose of 12.1 +/- 7.3 mg (range 3-30). In a number of these, an attempt to discontinue DF resulted in a sarcoid relapse, and DF was restarted. CONCLUSION: DF is a good and safe approach to the long-term corticosteroid therapy of sarcoidosis.

Trace of metal exposure in hard metal lung disease.

A male subject exposed for many years to metal dusts from grinding and cutting hard metals was investigated four years after the exposure ceased. While chest x-ray films and histologic examinations showed diffuse interstitial fibrosis and severe perivascular and peribronchiolar fibrosis, radiochemical neutron activation analysis (NAA) showed high W, Ta and Co concentrations in the pulmonary specimen compared to the corresponding determinations in 17 control subjects. Tantalum was also found in high concentrations in bronchoalveolar lavage fluid (BAL) and in the blood. In addition other elements such as Ni, Cr, Th and Cd were found in the lung biopsy specimen of the worker in amounts significantly higher than in the control subjects. The results suggest that hard metal origin of pulmonary fibrosis can be detected many years after removal from exposure.

A European survey on the usefulness of 67Ga lung scans in assessing sarcoidosis. Experience in 14 research centers in seven different countries.

Fifty-eight contributors from 12 European and 2 American sarcoidosis centers have collaborated in a survey to define many questions concerning the use of 67Ga lung scan in sarcoidosis. The new quantitative scoring methods based on digital evaluation seem better in detecting lung activity. In 20.1% of untreated patients, the 67Ga lung scan appeared to be the only noninvasive method with which clinical activity could be detected. 67Ga scans may be useful in guiding lung biopsy and in choosing pulmonary segments for BAL. Of 382 patients studied during follow-up (154 patients with three to nine scans at intervals of 2 to 12 months), the 67Ga scan was far more sensitive than chest radiography, both in detecting improvement and in foreseeing relapses. Steroid therapy appears to suppress ACE levels more than 67Ga uptake, and 67Ga uptake more than the alveolitis detectable by BAL. Gallium-67 uptake rebounds to positivity occur in about 40% of patients after steroid discontinuation and in about 20% of patients after steroid reduction to daily doses of 10 mg or less of prednisone. The 67Ga dose of 1.5 mCi seems appropriate for clinical purposes and is recommended for the subjective scoring method in order to reduce the cost and the radiation burden.

The clinical spectrum of the sarcoid peripheral lymph node.

BACKGROUND: The finding of sarcoid-type granulomas in a peripheral lymph node (PLN) without clinical evidence of changes suggestive of sarcoidosis elsewhere poses a diagnostic problem. The long term follow-up of these patients has never been described in adults. AIMS OF THE WORK: 1. To describe in the above population whether and when a definite diagnosis of sarcoidosis was eventually made, and the time required to make the diagnosis. 2. To study the percentage of peripheral lymph node presentation in sarcoidosis. PATIENTS: A peripheral lymph node presentation, with lymph node biopsy demonstrating sarcoid granulomas, was seen in 127 patients over the last 20 years. Detailed investigation permitted the early diagnosis of sarcoidosis in 76, and of sarcoid reaction in 8 patients. The other 43-patients with granulomatous lymph node and no clinical evidence of changes outside the lymphatic system at the onset are the subject of the present study. METHODS: Periodic examination at our Sarcoid Clinic every 2 to 4 months, in a long term median follow-up of 36 months (range 1 to 203) and workup according to clinical need, including chest X ray and Computed Axial Tomography (CAT), pulmonary function tests, total body 67Ga scan, Broncho Alveolar Lavage (BAL) studies, blood cell counts, 24 h calciuria and urine analysis, serological tests for liver function, calcaemia, Angiotensin Converting Enzyme (ACE). RESULTS: The diagnosis of sarcoidosis (chronic in all) could be made in 33 patients (25 pulmonary, 8 extrapulmonary), after a median time from presentation of 5 years (range 3-288 months). In the other 10, in spite of a median duration of the illness of 62 months (range 20-487), our diagnosis has been idiopathic granulomatous disease of peripheral lymph nodes. Thus, we observed 109 patients in 20 years presenting with lymph nodes that were surgically removed and provided the diagnosis of sarcoidosis sooner (76 patients) or later (33 patients). CONCLUSIONS: 1. In patients presenting only sarcoid granulomas in peripheral lymph nodes, sarcoidosis may be diagnosed months or years later, but a subpopulation of them still exists where granulomatous lesions remain unexplained. 2. In our series of patients, peripheral lymph node presentation occurred in 11.7% of cases of sarcoidosis.

Nephrolithiasis as a presenting feature of chronic sarcoidosis: a prospective study.

BACKGROUND AND AIM OF THE WORK: The presentation of sarcoidosis with renal stones has never been evaluated in a prospective study. DESIGN: We have studied 110 consecutive patients with histologically proven sarcoidosis, first seen in the years 1993-1994 in the Milan Sarcoid Clinic. Those who had renal stones preceding or suggesting the diagnosis of sarcoidosis, and those who had evidence of renal calculi at presentation, were studied up to 31 December 1995 with serial evaluation of calcaemia, calciuria and serum 1,25 (OH)2D3 and are the basis of this report. RESULTS: Four patients had had calculi a long time ago and probably unrelated to their sarcoidosis. Three patients had a previous history of recurrent colic with calculi. In one further patient the occurrence of calculi suggested the diagnosis. In three other patients pyuria or microscopic haematuria at the presentation of pulmonary sarcoidosis led to the diagnosis of asymptomatic calculi. All the above seven patients had features of chronic disease and required long term corticosteroid therapy. Four of them required lithotripsy or pyelotomy before starting steroid therapy. Another had further calculi during the follow-up, and an episode of hydronephrosis requiring lithotripsy, due to poor compliance to corticosteroid therapy. Another patient had a single stone during follow-up in spite of proper therapy. In all the others prednisone was useful to control the disease. Summing up the results of a previous similar but retrospective study from our clinic, we can describe the full spectrum of nephrolithiasis at presentation of sarcoidosis, as it appears from the examination of 729 consecutive patients seen over 17 years (1978-1994), with a further follow-up of at least one year (see Conclusions). CONCLUSIONS: 1. Renal stones may be the presentation of sarcoidosis in 3.6% of cases, but the etiology may go unrecognized for many years in most of them. 2. There are asymptomatic renal stones at presentation in a further 2.7%: pyuria or microscopic haematuria may suggest such an occurrence. 3. Renal calculi appear to be a marker of chronicity, with long term corticosteroid therapy required in most cases. 4. A diagnosis of sarcoidosis should always be considered when patients present with renal calculi of unknown origin.

The late follow-up of chronic sarcoid patients previously treated with corticosteroids.

AIM OF THE STUDY: The aim of the study was to evaluate, in a white population with chronic sarcoidosis, the rate and pattern of relapses, the correlated factors, and the course of disease after prednisone withdrawal. METHODS: We have retrospectively examined the charts of 702 consecutive patients with histologically proven sarcoidosis, first seen in the Milan Sarcoidosis Clinic in the period October 1978-October 1994. 239 patients required corticosteroid therapy; in 82 it was possible to discontinue prednisone therapy and to have a follow-up of at least 18 months after withdrawal. RESULTS: A relapse, requiring a new course of steroids, was observed in 30 (36.6%) of the 82 patients (R group). The other 52 patients (No-R group) did not relapse during a mean follow-up of 36.8 +/- 24.8 months (range 18-125). There were no relapses after 3 asymptomatic years of prednisone withdrawal. Extrapulmonary sarcoidosis was a reason for giving therapy in 46.6% of patients in the R group, vs 23.0% in the No-R group (P < 0.05). The first course of therapy lasted 22 months [median time; i.q. 11.5 to 34.5] in R group vs 26 months [i.q. 18 to 41] in No-R group (P > 0.05). The mean daily prednisone dose was higher in the R group: 17 mg [median value; i.q. 8.9 to 23.2] vs 10.6 mg [i.q. 8.1 to 13.8] in the No-R group (p < 0.05). Logistic regression confirmed the prognostic significance of mean daily prednisone dose and of extrapulmonary sarcoidosis at presentation (P < 0.01). A mild sarcoid activity at the time of withdrawal was still present in 51.9% of patients who did not relapse, and in 66.7% of patients who relapsed (p > 0.05). Relapse in the first year after withdrawal of prednisone therapy occurred in twenty-five of the 30 patients. The pattern of relapse was different from the initial manifestation in 5. Nine of the 30 patients could ultimately be weaned successfully from prednisone. CONCLUSION: Relapses occurred in 36.6% of cases, and their pattern was the same as the initial manifestation in the majority of cases. A mild sarcoid activity at the time of withdrawal is not a reason for continuing steroids when the disease is abating. In our white population severe irreversible pulmonary impairment is rare, and even patients requiring chronic therapy need low prednisone dosage, usually around 10 mg daily, to control the disease in the late course.

The long-term efficacy and safety of two different corticosteroids in chronic sarcoidosis.

Deflazacort (DFZ) is claimed to have fewer adverse bone effects than prednisone (PDN) at doses with equivalent anti-inflammatory activity (5 mg PDN = 6 mg DFZ). However, its safety over the long-term has never been tested in a controlled trial. The aim of the present study was to assess prospectively the safety and efficacy of DFZ compared with PDN in previously untreated patients with chronic, histologically proven sarcoidosis needing long-term (> or = 2 yr) corticosteroid therapy. Thirty-six patients were treated with PDN for 32 +/- 18 months and 36 patients were treated with DFZ for 42 +/- 18 months, and followed-up with periodic chest X-ray, 67Gallium lung scan, angiotensin converting enzyme (ACE), serum and urinary calcium levels, spirometry, alveolar diffusion (DLCO) arterial oxygen tension (PaO2), bone mineral content (BMC) (by computed tomography), and a complete biochemical and haematological profile. The two groups were similar as regards sex, age, pulmonary and extrapulmonary involvement, parameters of activity and impairment, and initial BMC. Daily starting doses were 23.2 +/- 11.4 mg DFZ and 22.3 +/- 6.9 mg PDN. One year of trial was completed by 69 patients, 2 yr by 59 patients, 3 yr by 46 patients and 4 yr by 24 patients. Some patients were followed-up for 5-7 yr. The mean daily dose over the whole period was 15 +/- 10 mg DFZ and 10 +/- 6 PDN, starting from 21 +/- 9 and 15 +/- 8 mg in the first year, and progressively declining to a mean of 9 +/- 6 mg in both groups in the fourth year. Chest X-ray, 67Ga score, ACE and forced vital capacity improved significantly in both groups. Urine total calcium improved significantly in the PDN group (345 +/- 27 to 186 +/- 47; P < 0.05) with a similar but non-significant pattern in the DFZ group (270 +/- 28 to 207 +/- 39). Non-significant improvements were observed in DLCO, PaO2 and forced expiratory volume in 1 s in both groups. Drug-related adverse events were more frequent in the PDN group, causing discontinuation of the drug in four PDN patients. Body weight increased mainly in the PDN group [69.9 +/- 0.4 to 73.6 +/- 0.8 kg vs 70.1 +/- 0.4 to 70.0 +/- 0.6 kg in the DFZ group (P < 0.01)]. Bone mineral content dropped under the fracture threshold in most PDN patients, who thus appeared at higher risk for fractures. In fact, six atraumatic skeletal fractures were observed in this group but only one in the DFZ group. Two further patients in the DFZ group and eight in the PDN group were obliged to start corrective measures for bone loss and/or bone pain. At the end of the study, 21 patients (12 DFZ, nine PDN) no longer needed corticosteroids, and the others were taking a maintenance daily dose that controlled the disease adequately. In conclusion, DFZ appeared as effective as PDN in the long-term treatment of chronic sarcoidosis, and it may have fewer side-effects, especially on bone.

The differential diagnosis of hard metal lung disease.

Hard metal lung disease is usually easy to diagnose, on the basis of occupational history, chest X-ray appearance of interstitial lung disease and, if necessary, by bronchoalveolar lavage (BAL). However, other interstitial lung diseases may affect patients with an occupational history of exposure to cobalt. In hard metal disease, the hylar lymphnodes may enlarge due to high draining of hard metals from the lung tissue via lymphatic vessels. Also, the presence of Giant Cells (even if Langhan's type) in the BAL fluid of sarcoid patients may be high. We present four patients with a history of exposure to hard metals and whose chest X-rays suggest sarcoidosis, stage II; in each, a pulmonary biopsy was necessary to confirm the diagnosis. Final diagnosis was sarcoidosis in one (showing typical granulomata in the lung tissue), and hard metal disease in three: two of these had foreign body-type granulomata in the lung tissue. Neutron activation analysis (NAA) study was carried out on these four patients using specimens of BAL fluid, blood, urine, toenails, pubic hair and sperm. In the light of available data, the concentration of elements may not be useful in differentiating between sarcoidosis and hard metal pneumoconiosis. However, NAA on BAL fluid or other specimens may be helpful in confirming the presence of the offending agent in suspected cases when the occupational history is not clear.

Trace metal lung disease: in vitro interaction of hard metals with human lung and plasma components.

Hard metal pneumoconiosis is an occupational pulmonary disease caused by long-term exposure to dust produced in the hard metal industry. In vitro experiments have been carried out to study the solubility and metabolic behaviour in human lung tissue and plasma of hard metal alloy constituents such as cobalt, tungsten, tantalum, titanium and niobium. The experiments were carried out using 60Co, 187W, 182Ta, 44Ti and 95Nb radiotracers in combination with neutron activation, radio-release tests and gel filtration techniques. Leaching experiments from neutron-irradiated hard metal dust showed that cobalt was highly soluble, especially in the lung cytosol and plasma, in comparison with tantalum and tungsten. The gel filtration experiments showed three biochemical pools of cobalt in both lung and plasma components, in accordance with the hypothesis that cobalt represents the allergic factor in the development of hard metal disease. High affinity for proteins was observed for Nb, Ta and Ti, but not for W, in agreement with the dissimilar biological half-lives of these elements in the body. The different ability of the metals to interact with biochemical components and to be solubilized in biological media may explain the various degrees of retention in the lung, which would influence the metabolic pathways. This would explain the presence of Co, Ta and W in body fluids, as well as in the public hair and toenails of hard metal workers.

Correlation between tracheal pressure and pulmonary artery pressure in healthy dogs.

The relationship between mean pulmonary artery pressure (PAP) and alveolar pressures, at varying tidal volumes and opposing variable pressure to expiratory flow, was studied in 14 healthy dogs at the end of inspiration and at the end of expiration. Pulmonary blood flow was also studied in 4 dogs. Through the analysis of multiple regression, the equations which show the relation between PAP, tracheal pressure and tidal volume during phases of zero flow were obtained. Our study shows that the co-relation between PAP and tracheal pressure is always highly significant and that, in our experimental conditions, the parameter having the greatest influence on PAP is tracheal pressure, while tidal volume is negligible.

Can pulmonary artery pressure be predicted without right heart catheterization in chronic obstructive lung disease?

We have investigated the dependance of observed pulmonary artery mean pressure (PAP) on body surface, age, PaO2, pH, PaCO2, hematocrit, and spirometric data (VC, FEV1/VC, RV/TLC) in 70 patients with chronic obstructive lung disease (COLD). After elimination of all variables that failed to correlate with PAP, multifactorial analysis showed that only two of nine independent variables, namely PaO2 and body surface, correlated significantly with PAP. According to our calculations, 28.9% of total PAP is predictable by PaO2, 1.5% by H+ concentration, 2.8% by RV/TLC, and 2.5% by body surface. Fully 64.2% of total variability was not accounted for by our regression analysis; thus the error of predicted PAP was so great (+/- 17 mm Hg for P = 0.05) as to invalidate the method. We also recalculated our subjects' PAP values by applying Enson's and Grassi's equations to our own lung function and biochemical data, and compared the predicted PAP values thus obtained with those measured directly in our subjects. Both equations proved imprecise and/or inaccurate in the individual case. From this we conclude that whereas available equations may be suitable for predicting the mean PAP value of a large population sample, the same equations cannot give a reliable prediction in individual cases.

Can pulmonary hypertension be predicted by non-invasive approach? Echocardiographic and haemodynamic study.

41 patients suffering from Chronic Obstructive Lung Disease (COLD) and 44 with Sarcoidosis were studied. Said patients underwent respiratory function tests, echocardiography (M.mode) to assess the right ventricular index ( RVI = diameter of the right ventricular cavity corrected by body surface) and the thickness of the right ventricular anterior wall ( RVAWT ); patients also underwent right heart haemodynamics (Swan-Ganz catheter). These data were further statistically studied by means of multiple regression in order to assess the eventuality of a non-invasive prediction of pulmonary artery mean pressure (PAP): variables taken into consideration were: age, body surface (BS), RVI , RVAWT , arterial oxygen pressure (PaO2), arterial carbon dioxide pressure (PaCO2) and PAP dependence according to each case group and the interaction of each group itself on the variables. RVI appeared to be the most reliable, in fact, when PaCO2 is also available, the standard error of estimation (SEE) was only 3.84 mmHg and the coefficient of determination was equal to 85.5% with a notable improvement when compared to results seen in previous studies. This behaviour was observed both in patients with early sarcoidosis and in COLD patients with mild pulmonary hypertension. This might be due to the fact that we took the right ventricle into consideration which inevitably feels the increase in pulmonary hypertension.

Bone loss in prednisone treated sarcoidosis: a two-year follow-up.

We followed up 35 sarcoid patients treated with prednisone for two years in order to evaluate bone mineral loss over time. Vertebral cancellous mineral content was detected by quantitative computed tomography and calibration phantom before beginning prednisone therapy and monitored two more times at yearly intervals. The percent mineral loss (ML%) averaged -13.9 +/- 2.1 at the end of the first year and -15.3 +/- 2.6 at the end of second year. We conclude first, that the time course of mineral loss in prednisone treated sarcoidosis is similar to that of other diseases such as asthma and rheumatoid arthritis. In a separate group of 10 early postmenopausal females, we observed a greater ML% averaging -21.9 +/- 16.6 and -26.2 +/- 18.5, at the end of the first and second year respectively. Our second conclusion was thus that the synergic effect of postmenopausal status and prednisone therapy results in an ML% far more significant than expected from the two single conditions.

First report of the Italian register for diffuse infiltrative lung disorders (RIPID).

RIPID was established in 1998 as a joint project of the major Italian scientific societies for Respiratory Medicine, with the aim to create an Italian Register on diffuse infiltrative lung disorders that can provide the basis for epidemiological and clinical studies of adequate sample size. In the period from May 1998 to December 2000, 1,382 cases were submitted from 54 Centers in 15 regions of Italy, 54.2% males (mean age +/- SD 50.5 +/- 16.8 years) and 45.8% females (50.2 +/- 15.3 years). A current smoking habit emerges in 18% of subjects; former smokers and never-smokers represent 26% and 56% of the total case series, respectively. The most frequent disease registered is idiopathic pulmonary fibrosis (37.6%), followed in decreasing order by sarcoidosis (29.2%), and Langherans' cell hystiocytosis (6.6%). High resolution computed tomography (HRCT) was considered as the most important tool for final diagnosis in the majority of cases (74.4%); 39.4% of patients underwent transbronchial biopsies, 39.2% bronchoalveolar lavage (BAL). A surgical biopsy was performed in 20.5% of patients. A web site has been activated from December 2000 (www.pneumonet.it/ripid), allowing prompt access to all information and scientific material concerning the project and to an electronic form for data collection that can be completed on-line.

Effects of repeated transvaginal ultrasound-guided aspirations performed in anestrous and cyclic mares on P4 and E2 plasma levels and luteal function.

The aim of the present study was to verify how repeated ovum pick-up (OPU), performed in anestrous and cyclic mares, affect ovarian activity, measured by progesterone (P4) and 17ß-estradiol (E2) plasma levels. Ovum pick-up of all visible follicles was performed every 9 to 12 days, and four sessions were carried out during anestrous (A) and breeding season (BS). The number of aspirated follicles per mare at each session was not significantly different between the two periods (BS: 6.1 ± 2.4; A: 7.5 ± 4.4; P > 0.05), but the mean follicular diameter was significantly higher during BS (16.0 ± 7.1 vs. 10.2 ± 5.1 mm; P < 0.05); during A the number of aspirated follicles less than 15 mm in diameter resulted significantly higher than that registered in BS (5.1 ± 2.7 vs. 3.0 ± 1.8; P < 0.05). The total mean value of P4 was higher in BS than in A (6.3 ± 4.4 vs. 0.3 ± 1.8 ng/mL; P < 0.05), whereas the total mean level of E2 was not different between the two periods (3.8 ± 3.4 vs. 2.5 ± 2.7 pg/mL; P > 0.05). Estradiol plasma values resulted positively correlated, in A and BS, with diameter of follicles detected on the ovaries (R = 0.345 and R = 0.331, respectively), whereas a negative correlation was observed between P4 and follicular diameter in BS (R = -0.162). Both E2 and P4 presented a high individual variability during BS; in particular, in three of seven mares, P4 trend was compatible with a normal estrous cycle, and the interval between two consecutive peaks was 21 days. In two of seven mares, with CL at first OPU, P4 concentrations remained more than 3 ng/mL throughout the entire treatment period. Finally, in two of seven animals, P4 levels initially showed a similar pattern to that of a normal estrous cycle, then, after the second aspiration, they remained consistently higher than 3 ng/mL. When the procedure was carried out in cyclic animals, the influence of this technique on ovarian activity seemed to be related to individual variability although, according to progesterone values, structures observed on the ovaries after aspirations presented luteal function. Furthermore, the resumption of normal ovarian activity, after repeated OPU sessions, occurred in a period not much longer than the duration of a normal estrous cycle (25.4 ± 5.2 days). Data recorded during nonbreeding period showed that repeated OPU in anestrous mares do not affect ovarian activity and do not anticipate the resumption of ovarian cyclicity. However, based on the number of aspirated follicles in anestrous and cyclic mares, both types of subjects could be considered as oocyte donors.