Skeletal muscle myosin heavy chain expression in rats with monocrotaline-induced cardiac hypertrophy and failure. Relation to blood flow and degree of muscle atrophy.

BACKGROUND: In congestive heart failure (CHF) the skeletal muscle of the lower limbs develops a myopathy characterised by atrophy and shift from the slow to the fast type fibres. The mechanisms responsible for these changes are not clear yet. OBJECTIVES: We investigated the influence of blood flow and degree of muscle atrophy on the myosin heavy chains (MHC) composition of the soleus and extensor digitorum longus (EDL) of rats with right ventricle hypertrophy and failure. METHODS: CHF was induced in 16 rats by injecting 30 mg/kg monocrotaline. Eight animals had the same dose of monocrotaline but resulting in compensated right ventricle hypertrophy. Two age- and diet-matched groups of control animals (nine and five respectively) were also studied. The relative percentage of MHC1 (slow isoform), MHC2a (fast oxidative) and MHC2b (fast glycolytic) was determined by densitometric scan after electrophoretic separation. The relative weights of soleus and EDL (muscle weight/body weight) were taken as an index of muscle atrophy. Skeletal muscle blood flow was measured by injecting fluorescent micropheres. RESULTS: CHF and Control (Con) rats showed similar degree of atrophy both in soleus (0.40 +/- 0.06 vs. 0.44 +/- 0.06 p = NS), and EDL (0.47 +/- 0.04 vs. 0.45 +/- 0.02, p = 0.09). In CHF rats these two muscles showed a statistically significant MHCs redistribution toward the fast type isozymes. In fact in EDL of CHF rats MHC2a was 30.5 +/- 6.1% vs. 35.8 +/- 8.6% of the Con (p < 0.05). MHC2b was however higher (68.5 +/- 6.6% vs. 61.0 +/- 9.6%, p = 0.017). In the soleus of CHF rats MHC1 was decreased (87.6 +/- 3.4% vs. 91.9 +/- 5.2%, p = 0.02), while MHC2a was increased (12.04 +/- 3.5% vs. 7.9 +/- 5.2%; p = 0.028). Similar changes were not found in the muscles of the compensated hypertrophy animals. No correlation was found between MHC pattern and the relative muscle weight in the CHF animals. Soleus blood flow in CHF rats was significantly lower than that of Con (0.11 +/- 0.03 ml/min/g vs. 0.22 +/- 0.03 p < 0.05), while no differences were found in EDL (0.06 +/- 0.02 ml/min/g vs. 0.08 +/- 0.02, p = NS). CONCLUSIONS: In rats with CHF a skeletal muscle myopathy characterised by a shift of the MHCs toward the fast type isoforms occurs. The magnitude of the shift correlates neither with the degree of atrophy, nor with the skeletal muscle blood flow, suggesting that these two factors do not play a pivotal role in the pathogenesis of the myopathy.

Olive-oil-enriched diet: effect on serum lipoprotein levels and biliary cholesterol saturation.

The effect of diet enriched with a monounsaturated fatty acid (olive oil) on serum lipoproteins, biliary cholesterol saturation index, and gallbladder motility compared with a standard low-fat diet was evaluated in 11 young volunteers admitted to a metabolic ward. A significant decrease of mean total cholesterol (-9.5%), total apo B (-7.4%), LDL cholesterol (-12.2%), and total triglycerides (-25.5%) was observed after the olive-oil-enriched diet. Total HDL- and HDL-subfractions-cholesterol levels as well as serum apo A-I mean levels remained unchanged. Cholesterol saturation index of the bile and fasting and after-meal gallbladder volumes were unaffected by the enriched diet as compared with the low-fat diet. Olive oil may be a natural fat that can be used for the control of plasma and LDL cholesterol as a valid alternative to polyunsaturated fatty acids.

Extensive screening for occult malignant disease in idiopathic venous thromboembolism: a prospective randomized clinical trial.

Patients with symptomatic idiopathic venous thromboembolism and apparently cancer-free have an approximate 10% incidence of subsequent cancer. Apparently cancer-free patients with acute idiopathic venous thromboembolism were randomized to either the strategy of extensive screening for occult cancer or to no further testing. Patients had a 2-year follow-up period. Of the 201 patients, 99 were allocated to the extensive screening group and 102 to the control group. In 13 (13.1%) patients, the extensive screening identified occult cancer. In the extensive screening group, a single (1.0%) malignancy became apparent during follow-up, whereas in the control group a total of 10 (9.8%) malignancies became symptomatic [relative risk, 9.7 (95% CI, 1.3-36.8; P < 0.01]. Overall, malignancies identified in the extensive screening group were at an earlier stage and the mean delay to diagnosis was reduced from 11.6 to 1.0 months (P < 0.001). Cancer-related mortality during the 2 years follow-up period occurred in two (2.0%) of the 99 patients of the extensive screening group vs. four (3.9%) of the 102 control patients [absolute difference, 1.9% (95% CI, -5.5-10.9)]. Although early detection of occult cancers may be associated with improved treatment possibilities, it is uncertain whether this improves the prognosis.

Incidence of cancer after a first episode of idiopathic venous thromboembolism treated with 3 months or 1 year of oral anticoagulation.

BACKGROUND: A prolonged treatment with oral anticoagulants has been claimed to reduce the incidence of newly diagnosed cancer in the long-term follow-up of patients with venous thromboembolism. OBJECTIVES: In a multicenter prospective study we assessed the incidence of newly diagnosed clinically overt cancer in patients with a first episode of idiopathic venous thromboembolism (VTE) treated with oral anticoagulants for 3 months or 1 year. PATIENTS AND METHODS: Consecutive patients with an idiopathic venous thromboembolism who had completed 3 months of oral anticoagulant therapy without having a recurrence, bleeding or newly diagnosed cancer were randomized to discontinue oral anticoagulant therapy or to continue it for nine additional months. Idiopathic venous thromboembolism was defined as thrombosis occurring in the absence of known cancer, known thrombophilia, or temporary risk factors for venous thromboembolism. All patients were followed up for at least 1 year after randomization. RESULTS: A total of 429 patients, 265 patients with DVT and 164 with PE, were followed up for an average of 43.7 months after randomization. A newly diagnosed cancer occurred in 32 patients (7.5%), 13 (6.2%) of the 210 patients treated for 3 months and 19 (8.7%) of the 219 patients treated for 1 year (RR = 0.71, 95% confidence interval 0.36-1.41). CONCLUSIONS: The incidence of newly diagnosed clinically overt cancer is not reduced in patients with idiopathic venous thromboembolism treated with 1-year anticoagulant treatment compared with patients treated for 3 months.

Potential for cholesterol lowering in secondary prevention of coronary heart disease in europe: findings from EUROASPIRE study. European Action on Secondary Prevention through Intervention to Reduce Events.

We have examined the potential for cholesterol lowering in secondary prevention of coronary heart disease based on data from the European Action on Secondary Prevention through Intervention to Reduce Events (EUROASPIRE) study carried out in 1995-1996 in nine European centres (Czech Republic, Finland, France, Germany, Hungary, Italy, The Netherlands, Slovenia and Spain). Consecutive patients aged < or = 70 years in four diagnostic categories--coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, acute myocardial infarction, and acute myocardial ischaemia without infarction--were identified from hospital records and invited for an interview and risk factor assessment at least 6 months after hospital admission. Plasma lipid measurements were carried out in a central laboratory. Combining patients from all centres and diagnostic categories (n = 2749) the medians (interquartile ranges) for plasma lipids were: total cholesterol 5.36 (4.76-6.03) mmol/l, high density lipoprotein (HDL) cholesterol 1.19 (1.01-1.42) mmol/l, triglycerides 1.55 (1.15-2.24) mmol/l, and low density lipoprotein (LDL) cholesterol 3.32 (2.76-3.91) mmol/l. Only 33% of the patients received lipid-lowering drugs. If the therapeutic goal given in the 1998 European recommendations, total cholesterol < 5.0 mmol/l, were applied, 67% of these patients would have needed an intensified cholesterol-lowering action, and with an even stricter goal, total cholesterol < 4.5 mmol/l, this proportion would have been as high as 84%.

Captopril in elderly hypertensive patients. Results from a multicenter Italian trial.

In this study, 953 patients (48 percent men) more than 60 years old with mild to moderate hypertension (class I or II) were included. After a two-week wash-out period, a starting dosage of captopril--12.5 mg twice a day--was given. Patients were examined after one and three weeks and, subsequently, at monthly intervals for a total period of four months. The dosage was adjusted to a maximum of 50 mg twice a day plus, when needed, 25 mg of hydrochlorothiazide per day. Thirty-two patients were lost to follow-up, 10 withdrew because of inadequate control of blood pressure, and only 21 (2 percent) dropped out because of side effects. Mean blood pressure decreased from 184/104 to 152/87 mm Hg. The lowest dosage (25 mg a day) was sufficient to control blood pressure in 15 percent of patients, 31 percent needed 50 mg a day, and 24 percent required 100 mg a day. Hydrochlorothiazide was added to the captopril regimen in 30 percent. No substantial changes in biochemical variables or electrocardiographic results were observed. "Quality of life" (judged as physical fitness, positive well being, mood, and sexual desire) remarkably improved.

Lack of influence of menopause on blood pressure and cardiovascular risk profile: a 16-year longitudinal study concerning a cohort of 568 women.

OBJECTIVE: To analyse the effect of menopause on blood pressure and cardiovascular risk. DESIGN: From an Italian general population, 568 women (408 pre- and 160 post-menopausal) were screened twice, in 1978 and 16 years later. METHODS: Cross-sectional analyses both in 1978 and in 1994, and longitudinal analysis in the 1978-1994 period. RESULTS: For the general analysis the cohort was reduced to 525 women with paired data in 1978 and 1994. In both cross-sectional studies, unadjusted blood pressure and cardiovascular risk were higher after than they were before menopause, but any difference disappeared after adjustment or matching for age. In 1994 we studied three groups of women: those who were still premenopausal, those who were fertile in 1978 but postmenopausal in 1994 and those who were already postmenopausal in 1978. The 16-year blood pressure increment was similar in all three groups. The incidence of myocardial infarction and angina pectoris was greater in those who were already postmenopausal than it was in those who had their menopause during the study period. An analysis of mortality was performed for all of the 568 women. Forty-three of them died, 14 from cardiovascular causes (six before and eight after menopause), 18 from neoplasia (two before and 16 after menopause) and 11 from other diseases. Menopausal status was rejected from the Cox equations both of overall and of cardiovascular mortality, showing a significantly predictive value only for neoplastic mortality. CONCLUSION: Menopause has no influence on high blood pressure and cardiovascular risk. The greater blood pressure levels, mortality and morbidity observed in postmenopausal women are simply attributable to their older age and are no longer detectable in an age-matched sample.

Specific changes in skeletal muscle myosin heavy chain composition in cardiac failure: differences compared with disuse atrophy as assessed on microbiopsies by high resolution electrophoresis.

OBJECTIVE: In congestive heart failure (CHF) the skeletal muscle of the lower limbs develops a myopathy with atrophy and shift from the slow type to the fast type fibres. The aim was to test the hypothesis that this myopathy is specific and not simply related to detraining, by comparing patients with different degrees of CHF with patients with severe muscle atrophy due to disuse. DESIGN: Case-control study involving 50-150 micrograms needle biopsies of the gastrocnemius muscle. By an electrophoretic micromethod, the three isoforms of myosin heavy chains (MHC) were separated. PATIENTS: Five patients restricted to bed for more than one year because of stroke with disuse atrophy and normal ventricular function, and 19 with CHF were studied. There were seven age matched controls. MAIN OUTCOME MEASURES: The percentage of MHC1 (slow isoform), MHC2a (fast oxidative), and MHC2b (fast glycolytic) was determined by densitometric scan and correlated with indices of severity of cardiac failure. RESULTS: Ejection fraction was 42.5 (SD 15.2)% in CHF, 59.5 (1.0)% in disuse atrophy and 60.3 (1.4)% in controls (P < 0.001 v both). The degree of muscle atrophy as calculated by the body mass index/gastrocnemius cross sectional area, showed a profound degree of atrophy in patients with muscle disuse [0.94 (0.39)]. This was worse than in the controls [4.27 (0.16), P < 0.0005] and the CHF patients [2.60 (1.10), P < 0.005]. Atrophy in CHF patients was also greater than in controls (P < 0.005). MHC1 was lower in CHF than in disuse atrophy [51.83 (15.04) v 84.5 (17.04), P < 0.01] while MHC2b was higher [23.5 (7.4) v 7.25 (7.92), P < 0.001]. There was a similar trend for MHC2a [24.83 (15.01) v 8.25 (9.12), P < 0.05]. Within the CHF group there was a positive correlation between NYHA class and MHC2a (r = 0.47, P < 0.05) and MHC2b (r = 0.55, P < 0.01) and a negative correlation between NYHA class and MHC1 (r = -0.74, P < 0.001). Similarly, significant correlations were found for ejection fraction, diuretic consumption score, exercise test tolerance, and degree of muscle atrophy. CONCLUSIONS: The CHF myopathy appears to be specific and not related to detraining. The magnitude of MCH redistribution correlates with the severity of the disease. The electrophoretic micromethod used is very sensitive and reproducible. Biopsies are so well tolerated that can be repeated frequently, allowing thorough follow up.

Blood pressure and metabolic profile after surgical menopause: comparison with fertile and naturally-menopausal women.

In 1978 a random sample (367 men and 568 women aged 18-65 years) taken from the general population of a north-eastern Italian town was screened for cardiovascular risk; 16 years later, the women were invited to a second screening. Three groups were identified at the initial screening (fertile, naturally menopausal and surgically menopausal) and four in the longitudinal study (137 remained fertile during the whole study, 205 became naturally menopausal, 56 were ovariectomised and 127 were already going through the menopause). The protocol included a questionnaire, blood pressure (BP) measurement, and blood exams. Continuous variables were adjusted for confounders. Systolic BP, prevalence of hypertension, cholesterol, glycaemia and uricaemia were similar, whereas diastolic and triglycerides (TG) were lower in surgically-menopausal than in fertile women (P < 0.001). No significant difference in 16 years' variation from baseline was observed between the four groups, although women who remained fertile showed the smallest increases. In particular, neither systolic or diastolic BP increases differed between the women who were oophorectimised and those who remained fertile. 'Fertile status' was rejected from the logistic equation of incidence of hypertension, and 'age of menopause' was also rejected when this analysis was repeated in ovariectomised women. New coronary artery disease (angina pectoris or myocardial infarction) was observed in one ovariectomised woman, in three naturally menopausal, and in 13 already menopausal women which seemed to reflect the age trend. No new cases were observed in women who remained fertile. In conclusion, in Italian women surgical menopause, similarly to natural menopause, is devoid of any negative prognostic effect. Journal of Human Hypertension (2000) 14, 799-805

[The use of color Doppler sonography in the diagnosis of thyroid pathology]. / L'impiego dell'ecocolor Doppler nella diagnostica della patologia tiroidea.

Color Flow Doppler Sonography (CFD) is a technique that gives us useful information related to blood flow and consequently about some organs or tissues physiology and morphology. The purpose of this paper is to discuss some new developments on CFD's role in the diagnosis of thyroid disease, an application that has recently been put forward. Some studies using CFD have described, as in the case of other organs and tissues, the main qualities of gland's parenchyma vascularity both in physiological conditions and in the instance of diffuse and/or focal thyroid diseases. A large part of these studies have dealt with the aspects of hypervascularity in malignant thyroid neoplasms, focusing on the meaning of the intranodular hypervascularity in the differential diagnosis between benign and malignant thyroid lesions. CFD, although reported as having high sensibility and specificity, is not yet in a position to improve much on the current limits of fine-needle aspiration biopsy (FNAB), in particular in the case of "follicular proliferation" where the distinction between benign adenoma and thyroid carcinoma is still a frequent problem. Further studies are required to evaluate if CFD can reduce the percentage of patients to be operated upon because of unclear cytological pattern.

Dietary behaviour in psoriatic patients.

Two hundred and nineteen psoriatic in-patients and 747 non-psoriatic subjects were asked to report in a semiquantitative, self-administered questionnaire on the frequency of consumption of different foodstuffs and cooking and seasoning fats and the daily intake of alcohol (glasses/day) and coffee (cups/day). According to this a definite score was assigned to each of the 46 food items, which were divided into five groups: carbohydrates (CH), low-fat foods (LFF), high-fat foods (HFF), saturated fats (SF) and polyunsaturated fats (PUF) and the alcohol consumption in grams/day was calculated. The mean scores for each food group and the means of alcohol (grams/day) and coffee (cups/day) intake were compared in the two groups, after age-adjustment through ANOCOVA. Psoriatic patients showed higher scores for HFF and SF in males and for CH, HFF, SF and PUF in females and a higher intake of alcohol in both sexes. These dietary habits could explain the higher prevalence of metabolic abnormalities in psoriatic patients.

[Initial experience with clotiapine in the treatment of heroin addiction]. / Prima esperienza con clotiapina nel trattamento dell'eroinomane.

Experience in treating heroin addicts with a major neuroleptic, Chlothiapin (Entumin Sandoz) is described. Treatment was begun on 16 cases and completed on 12. Slight signs of asthenia appeared in three cases. All patients completing the treatment achieved a normal sleeping pattern and reduced anxiety. Thus after a 7 day course patients could be transferred to a specialist drug addiction centre.

[Using a structural alternative (non-medical) in the "capillary" screening of arterial hypertension in a community. Means of intervention and evaluation in preventive cardiology]. / Utilizzazione di strutture alternative (non sanitarie) per uno screening "capillare" dell'ipertensione arteriosa nel territorio. Un mezzo di intervento e valutazione in cardiologia preventiva.

A "Community Control Programme of Hypertension" has been implemented in a Northern Italian population as part of an international co-operative pilot project promoted by World Health Organization. The programme was planned to last five years. Three years after the start we performed what we called a "capillary" screening in the community involved in the project. In fact a team of physicians and medical students moved about in the villages of the area where extemporary ambulances were set up with the aim of identifying new hypertensives, evaluating the state of the control of hypertension as compared with the situation at the outset of the study and, more generally, as a means of strengthening the ties between the project organization and the community. In doing so we also evaluated the feasibility of an alternative approach, based upon the cooperation with an organization outside the health service system, namely the Catholic Church, to achieve the set aims in a very religious population as ours. The parish priests of the villages did eagerly cooperate with our work both in the form of propaganda and in making available the parish buildings in which the ambulances were set up. We examined 1306 subjects (47.3% males), of whom 39.5% were hypertensives ("casual" blood pressure at or above 160 or 95 or treated). Of all the hypertensives, 28.6% were new hypertensives ("unaware"), 45.3% were being treated and 13.7% had a blood pressure lower than 160/95 mmHg while under treatment "effectively treated"); 16%, though, had blood pressure values at or above 200 or 120 mmHg. The state of control of hypertension was better in women and with increasing age. As compared with the findings at the outset of the study, 27,6% more "aware", 23.9% more treated and 9.6% more "effectively treated" hypertensives were found. Using the support of an alternative (non-medical) organization in a programme of preventive medicine in the community has proved to be, in our experience, a feasible, valuable and very cheap approach.

[Evaluation of the safety and efficacy of the lisinopril + hydrochlorothiazide and captopril + hydrochlorothiazide combinations in the treatment of essential arterial hypertension]. / Valutazione della sicurezza e dell'efficacia delle associazioni lisinopril + idroclorotiazide e captopril + idroclorotiazide nel trattamento dell'ipertensione arteriosa essenziale.

The aim of this study was to assess the efficacy and tolerability of the combinations of lisinopril (LIS) 20 mg + hydrochlorothiazide (HCTZ) 12.5 mg and captopril (CAP) 50 mg + HCTZ 25 mg in moderately hypertensive patients not adequately controlled by LIS or CAP alone. The study was multicentre (11 centres), open, random and carried out in parallel groups. After two weeks' placebo run in patients were randomly assigned to LIS 10-20 mg/o.d. or CAP 25-50 mg/b.i.d. treatment for 6 weeks. After this, patients with supine diastolic blood pressure (SDBP) greater than 90 mmHg were treated with the combinations LIS 20 mg + HCTZ 12.5 mg/o.d. or CAP 50 mg + HCTZ 25 mg/o.d. for 4 weeks; this dose was doubled if DBP was found to be greater than 90 mmHg after 2 weeks' combined therapy. A total of 175 patients were enrolled (92 females and 83 males) of which 153 completed the study. The LIS + HCTZ association caused a significant reduction of DBP in comparison to the other combined treatment (88.1 +/- 0.7 vs 90.3 +/- 0.7; p = 0.026). The statistical analysis of mean SBP values showed no significant difference between the two groups (144.0 +/- 1.3 vs 146.8 +/- 1.3; p = 0.15). At the end of the study 79.5% of patients treated with LIS + HCTZ presented normal results (DBP less than or equal to 90 mmHg), whereas the percentage of similar results in the comparison group was 72%. The percentage of "responder" patients to therapy (DBP reduced by 10 mmHg or more in relation to basal values) was 96.3% in the LIS + HCTZ group and 86.7% in the CAP + HCTZ group. In the CAP + HCTZ group 0.6% of patients reported adverse reactions, while only 0.3% were observed in the LIS + HCTZ group.

[Vascularization of single thyroid nodule as an indicator malignant neoplasm: a study using echo-color-Doppler]. / La vascolarizzazione del nodo tiroideo singolo come indice di neoplasia maligna: uno studio con eco-color-Doppler.

A number of studies done with color-flow Doppler (CFD) sonography have disclosed intense vascularization of malignant thyroid nodules. As this method might be able to provide important reference data to enable differentiation between benign and malignant nodular pathology, a study of the vascularization of single thyroid nodules using CFD sonography was done at the Endocrinology Out-Patient Clinic of the Combined Units of the University of Padua and the City Hospital of Venice, 1st Medical Division. Its aim was to verify the utility of CFD in the diagnosis of solitary and scintigraphically "cold" thyroid nodules, particularly to distinguish benign from malignant nodular pathology. One hundred nineteen patients were examined with hormonal dosage, scintigraphy, fine-needle aspiration biopsy (FNAB), echography and CFD sonography of the thyroid, and, in some cases, histological examination. Nineteen patients underwent histological examination: 17 follicular adenomas and 2 papillary carcinomas were found. Color-flow Doppler sonography indicated intense intranodular vascularization in both cases of malignant neoplasm (sensitivity 100%) and in 2 cases of the 17 benign lesions (specificity 88.2%). Moreover, intralesional hypervascularization was not observed in the 2 false positive FNAB cases. Although limited by the scarcity of histological material and the absence of cases of follicular carcinoma, this study has demonstrated that CFD sonography is a highly sensitive (no false negatives) and specific (only 2 false positives) method to diagnose scintigraphically "cold" single thyroid nodules.

[Secondary prevention of myocardial ischemia. From theory to clinical reality: preliminary results of the EUROASPIRE study in Italy. European Action on Secondary Prevention through Intervention to Reduce Events]. / Prevenzione secondaria della cardiopatia ischemica. Dalle premesse teoriche alla realtà clinica: risultati iniziali dello studio EUROASPIRE in Italia. European Action on Secondary Prevention through Intervention to Reduce Events.

EUROASPIRE study has been carried out in 9 European countries with the aim of assessing coronary risk factors in high-risk patients admitted to hospital to undergo coronary revascularization procedures (coronary angioplasty or coronary artery bypass grafting) or because of angina or myocardial infarction. The results of the initial stage of the study in Italy, investigating the data from 691 hospital medical records, showed that management of risk factors in these patients was inferior than expected. In particular, the prevalence of hyperlipidaemia (63%), hypertension (40%) and diabetes (27%) was remarkably high. These results suggest that there is still a need for secondary prevention of coronary heart disease.

Hormonal changes and hair growth during treatment of hirsutism with cimetidine.

The effects on hair growth by treatment with cimetidine have been studied. This drug has been given orally to 4 women with simple hirsutism and 3 women with peptic ulcer as controls for a period of 9 months. Hair growth slowed down in all of the treated women but the results were not statistically significant. A significant decrease in urine 17-ketosteroids has been observed, while plasma levels of testosterone, 17-beta estradiol, progesterone, FSH, LH and prolactin, did not change substantially. It is concluded that, on the whole, cimetidine doses not seem to induce such results on hair growth as to claim a role in the treatment of hirsutism in other current regimes.

Testosterone, 17 Ks, 17 beta E2 FSH-LH variations and hirsutism modifications during spironolactone therapy.

The research here reported concerns 9 hirsute women, four of them with PCO and five with idiopathic hirsutism, who underwent treatment with spironolactone. 4 non hirsute hypertensive cases served as control. For one year hair growth, testosterone, 17 Ks, estradiol and gonadotropins behaviours were studied in all of the patients. Results clearly show that the peripherical response (the hair) to the therapy is only just sufficient, and corresponds to a good reduction of the androgenic hormones in blood. However, there is also an LH gonadotropin secretion reduction which is statistically scarcely significant. If the therapeutic response of hair were good, fetal risk could be prevented with safe and contemporaneous contraception. However, since the response is scarcely sufficient, we do not think this therapy is more advisable than other ones.

Psychological effects of hypertension labelling during a community survey. A two-year follow-up.

The possibility that subjects examined during a population screening programme may develop psychological disturbances as a consequence of being labelled as hypertensives has been investigated. The Symptom Rating Test (SRT) for the assessment of neurotic symptoms was completed by 210 screenees. Aware hypertensives were excluded from the study. It was subsequently found that 81 subjects had raised BP (systolic greater than or equal to 160 or diastolic greater than or equal to 95 mmHg; group 1), and 129 subjects were 'normotensive' (group 2). The total SRT score was significantly higher in group 2 than in group 1. After screening, all subjects were returned to their GPs, and 82% of them were re-examined 2 years later. SRT scores were significantly lower than the initial ones in both groups. At re-examination 35% of 'hypertensives', were found to have 'normal' BP values. The SRT scores of these falsely-labelled subjects were similar to those of the subjects found still to be hypertensive. These findings suggest that subjects with raised BP at screening have lower neuroticism scores than normotensives. More importantly still, hypertension labelling, whether 'true' or 'false', does not have any negative long-term psychological consequences.

Intra-erythrocytic sodium content in normotensive offspring of normotensive and hypertensive subjects: an epidemiological study.

An increase in intra-erythrocytic sodium (IENa) content has been proposed as a genetic marker of essential hypertension. Intra-erythrocytic sodium was studied using hypotonic lysis and flame photometry after four washings with isotonic MgCl2 in 240 normotensive subjects (aged 10-45 years) on a free diet with (F+, 121 patients) or without (F-, 119 patients) hypertensive parents, recruited from a random sample of the general population. Systolic blood pressure was significantly higher in males F+ than in males F- (130 +/- 2 versus 125 +/- 2 mmHg, mean +/- s.e.m., P < 0.05), while IENa did not differ. In contrast, intra-erythrocytic potassium content (IEK) was significantly lower and red cell sodium potassium (Na:K) ratio significantly higher in F+ than F-. This might reflect decreased NaK pump activity, or increased membrane permeability to cations which causes increased K leakage. No differences in blood pressure, IENa or IEK showed in female F+ versus F-. It is concluded that IENa is not a genetic marker of hypertension, and that it is probably influenced by exogenous factors. Being associated with differences in blood pressure, the abnormalities of IEK and Na:K ratio might be pathogenetically linked to an early increase in blood pressure.