Beta-thalassaemia intermedia: evaluation of endocrine and bone complications.

OBJECTIVE: Data about endocrine and bone disease in nontransfusion-dependent thalassaemia (NTDT) is scanty. The aim of our study was to evaluate these complications in ß-TI adult patients. METHODS: We studied retrospectively 70 ß-TI patients with mean followup of 20 years. Data recorded included age, gender, haemoglobin and ferritin levels, biochemical and endocrine tests, liver iron concentration (LIC) from T2*, transfusion regimen, iron chelation, hydroxyurea, splenectomy, and bone mineralization by dual X-ray absorptiometry. RESULTS: Thirty-seven (53%) males and 33 (47%) females were studied, with mean age 41 ± 12 years, mean haemoglobin 9.2 ± 1.5 g/dL, median ferritin 537 (range 14-4893), and mean LIC 7.6 ± 6.4 mg Fe/g dw. Thirty-three patients (47%) had been transfused, occasionally (24/33; 73%) or regularly (9/33; 27%); 37/70 (53%) had never been transfused; 34/70 patients had been splenectomized (49%); 39 (56%) were on chelation therapy; and 11 (16%) were on hydroxyurea. Endocrinopathies were found in 15 patients (21%): 10 hypothyroidism, 3 hypogonadism, 2 impaired glucose tolerance (IGT), and one diabetes. Bone disease was observed in 53/70 (76%) patients, osteoporosis in 26/53 (49%), and osteopenia in 27/53 (51%). DISCUSSION AND CONCLUSIONS: Bone disease was found in most patients in our study, while endocrinopathies were highly uncommon, especially hypogonadism. We speculate that low iron burden may protect against endocrinopathy development.

[Epidural electrostimulation in the treatment of refractory angina pectoris in elderly patients: preliminary results]. / L'elettrostimolazione epidurale nel trattamento dell'angina pectoris refrattaria nel paziente anziano: esperienza preliminare.

The spinal cord stimulation is an antalgic technique which has been used since 1967 for the treatment of several painful syndromes. More recently it was employed in the cardiology field to treat refractory angina, not suitable for revascularization. We applied spinal cord stimulation as alternative therapy in 7 clients older than 70 years who, for different reasons, could not undergo revascularization. We obtained good short- and long-term clinical results, without complications. On the basis of our preliminary experience with this technique in a small group of elderly patients and after a critical review of the literature, we conclude that spinal cord stimulation can be used without significant risks, in elderly patients with refractory angina pectoris.

Technical and clinical problems in patients with simultaneous implantation of a cardiac pacemaker and spinal cord stimulator.

Spinal cord stimulators are used to relieve pain associated with peripheral ischemia and angina pectoris. In patients with both permanent pacemaker (PPM) and a spinal cord stimulator (SCS), electromagnetic signals from the SCS may inhibit the PPM. A bipolar PPM configuration is preferred to minimize myopotential or electromagnetic interference but patients have safely had unipolar devices implanted. We report ten patients (six males and four females; median age 73.3 years) with both a SCS and a PPM implanted between 1987-1991. Intermittent interference with one PPM (Ela Medical Model Opus 3001) was noted after an increase in the output voltage of the SCS for continued clinical efficacy. Inhibition was output voltage dependent, and reversion to the noise mode was frequency dependent. Sensitivity to both could be managed by changing the pacemaker sensitivity. Interference with pacemaker function occurred if the SCS output was set above a voltage and pulse duration which resulted in a product of these values above 1.9-2 mVs. Seven VVI, one VDD, and two DDD PPM had been implanted. In five patients both PPM and SCS were unipolar. In two patients the SCS was bipolar and the PPM unipolar, in two patients a bipolar PPM was associated with a bipolar SCS and with one patient, a unipolar SCS. Multiprogrammable and/or bipolar PPMs should be implanted in a patient with a SCS to allow reprogramming of the PPM and to minimize the risk of inter-device interference. Inhibition of the PPM may occur at different SCS stimulation frequencies. The frequency at which inhibition occurs varies with different models of implanted pacemaker.

A black adrenocortical adenoma causing Cushing's syndrome not imaged by radiocholesterol scintigraphy.

In a 33-year-old female patient with left adrenal tumour and Cushing's syndrome, adrenocortical scintigraphy with radiocholesterol did not image the tumour nor the suppressed contralateral gland. Histology showed a black adrenocortical adenoma composed only of compact cells; there was no evidence of malignancy. This demonstrates that non-visualization of the adrenal glands in a patient with Cushing's syndrome is not invariably due to adrenal carcinoma. The literature on black adrenal adenomas causing Cushing's syndrome is reviewed.

Selenium intake with diet in Italy: a pilot study.

Selenium is an element essential to man. The main environmental pathway of Se-exposure for the general population is through food. As is true for all essential elements, not only deficient but also excessive exposure results in adverse health effects. Between these extremes there is a range of safe and adequate Se intakes. In 1980 the Italian National Research Council recommended 50-200 micrograms/day as an interval adequate to meet nutritional requirements, being at the same time below the threshold of toxic effects. Therefore the evaluation of dietary Se intake has become very important. The purpose of this work is the estimation of dietary intakes of Se using data on the amount and composition of an average Italian diet. Complete meals from a factory canteen were analyzed and calculations of weekly intake of Se carried out. Analyses were performed by means of Inductively-coupled Plasma Atomic Emission Spectrometry. The results obtained, related to the average and indicative food consumption of Italian people, showed that the daily intake is well within the recommended range.