Spot urinary iodine concentration as a measure of dietary iodine, evaluated in over 3800 young male subjects undergoing medical check-up preliminary to military enrolment in Piemonte and Aosta Valley (Italy).

The aim of the study was to assess iodine status in over 3800 young male subjects aged 18, living in 6 different provinces of Piemonte and in Aosta Valley, Italy. A cross-sectional study on 3837 young male subjects undergoing medical evaluation preliminary to military enrolment was performed. Spot urine samples were obtained in the morning hours and urinary iodine was measured by a colorimetric method. As outcome measure iodine status, based on spot urinary iodine median concentration, categorised as sufficient (>99 microg/l), mild deficiency (50-99 microg/l), moderate deficiency (20-49 microg/l) and severe deficiency (<20 microg/l), was obtained. Median urinary iodine concentration was 101.8 microg/l in our sample. Moderate-to-severe iodine deficiency was found in <10% of all subjects. Mild iodine deficiency was found in <40% of the subjects, with greater variability within the provinces considered. For each geographical area significant differences can be observed in more than 50% of the comparisons of the confidence intervals related to the frequencies of samples with spot urinary iodine concentration below 100 microg/l. The high frequency of mild iodine deficiency found in our sample suggests that dietary sources of iodine in Piemonte, Italy, have improved since the last evaluation 25 yr ago (2) but may still be insufficient. Further population studies are required.

[Intact whole bioactive parathormone: problems arising from comparing different methods]. / Paratormone intatto intero bioattivo: le problematiche emergenti dal confronto.

BACKGROUND: Parathyroid hormone (PTH) has important applications in the nephrological clinical practice. Because assays of Intact PTH (I-PTH) are liable to interferences by N-truncated fragments, a novel method for whole-(1-84) PTH has been proposed. This study is aimed at comparing the latter with some of the previous I-PTH assays. For each method the results are referred to pertinent markers of mineral metabolism. METHODS: We enrolled 171 subjects, including 56 healthy controls (C), 65 calcium stone- formers (CaSF), 40 haemodialysis patients (HD), 10 with primary hyperparathyroidism (PHP). On blood samples we measured: I-PTH by four methods (N-Tact, Advantage, Elecsys, Scantibodies), whole-(1-84) PTH, defined as CAP (Cyclase Activating PTH), total and ionised calcium, phosphate, vitamin D, osteocalcin and Crosslaps. The difference between I-PTH and CAP Scantibodies is defined as CIP (Cyclase Inhibiting PTH). RESULTS: Despite relating to each other (r>0.97) PTH values varied remarkably among methods. For all methods, the reference intervals differed from those provided by the producer. Assuming these new ranges, 10 CaSF had over-range values not always associated with abnormalities of mineral metabolism. One of the PHP patients was normal for I-PTH with 2/4 methods. In HD the differences among methods were even greater, there were inverse (p<0.05) and direct (p<0.001) relationships with ionised calcium and osteocalcin-crosslaps, respectively. The CAP/CIP ratio was lower in low bone turnover patients, but the two subgroups widely overlapped. CONCLUSIONS: This study indicates that the reliability of I-PTH assays is still unsatisfactory, and none of the four methods emerged as the best. Assay for CAP only improves diagnostic efficiency, whereas the CAP/CIP ratio does not exhibit powerful discriminating capacity. Our suggestion is that each Centre should establish its own reference ranges. PTH assay should always be coupled with measurements of other markers of mineral metabolism as well as renal function.

Assessment of quality of care in an oncology institute using information on patients' satisfaction.

OBJECTIVE: To evaluate the feasibility of conducting a patient satisfaction survey in the oncology hospital setting, using a multidimensional patient satisfaction questionnaire to be completed at home. METHODS: Socio-demographic and clinical data were collected for 133 consecutive patients. Patients were asked to complete the European Organisation for Research and Treatment of Cancer QLQ-C30 (version 2.0) just before hospital discharge and the Comprehensive Assessment of Satisfaction with Care at home 2 weeks after discharge. RESULTS: Respondents (73% of patients approached) were younger, hospitalized for a shorter time and presented less appetite loss, nausea and vomiting and better physical and role functioning than non-responders. The aspects of care for which patients wanted the most improvement were associated with the provision of medical information. In multivariate analyses, longer hospital stay was associated with higher satisfaction with all aspects of medical and nursing care, most probably because patients discharged early were not assured of continuity of care and lacked information regarding self-care at home. Higher global quality of life was associated with higher satisfaction with all aspects of care, suggesting the potential contribution of patient satisfaction to the patients' well-being. CONCLUSIONS: Conducting a patient satisfaction survey in an oncology hospital setting proved feasible; however, further surveys should attempt to obtain the opinion of patients with more severe physical conditions. The assessment of the patients' satisfaction provided indications for improvement of care in a particular hospital. Although the results of this study are specific to one hospital, the methods could be reproduced in other hospital settings, but may possibly lead to other conclusions.

Psychological distress in cancer patients attending the European Institute of Oncology in Milan.

BACKGROUND: The determination of the extent and specific features of the psychological distress to be expected in a cancer centre may influence the choice of interventions to be implemented for addressing these problems. This study was aimed at estimating the prevalence of psychological distress in patients attending a second reference cancer centre in Milan (Italy), and at identifying associated factors. PATIENTS AND METHODS: 190 consecutive patients were assessed within 3 days of hospital discharge using the Hospital Anxiety and Depression Scale. RESULTS: Major depressive disorders or generalised anxiety disorders were estimated in 16% of the patients. Only 2 of these patients were referred to the psycho-oncology unit, hence the psychological distress of many patients was not considered during their hospital stay. In the multiple regression analysis, independent predictors of psychological distress were female gender, experience of disturbance in family and social life due to illness, nausea and vomiting, and perception of being in a poor state of health (R(2) = 0.31, p value < 0.001), while physical functioning, fatigue and pain, significant factors in univariate analysis (p < 0. 05), sociodemographic and clinical factors were not predictors. CONCLUSIONS The psycho-oncology team should focus on helping doctors and nurses identify the patients' psychological problems, dealing with them or making a referral.

Association between an R338L mutation in the thyroid hormone receptor-beta gene and thyrotoxic features in two unrelated kindreds with resistance to thyroid hormone.

Resistance to thyroid hormone (RTH) is a rare syndrome characterized by reduced sensitivity to thyroid hormone due to thyroid hormone receptor-beta (TRbeta) gene mutations or deletion. RTH has been classified on the basis of clinical features into generalized (GRTH) and pituitary (PRTH) resistance. There is, however, overlap of clinical and biochemical findings in patients with the two forms of resistance, and similar TRbeta gene mutations have been identified in both. The 2 subtypes of RTH, therefore, are considered to be different manifestations of a single genetic entity. We report a mutation of the TRbeta gene, an arginine to leucine substitution at codon 338 (R338L), in 2 unrelated RTH kindreds of northern Italian ancestry. The same mutation was already reported in a single unrelated kindred affected by PRTH. Five individuals, 3 in the first and 2 in the second family, were clinically evaluated and followed for 3-11 years. During the long-term follow-up, the patients manifested symptoms and signs of hyperthyroidism including palpitations, fine tremors, heat intolerance, increased sweating, increased deep tendon reflexes, moist and warm skin, cardiac rhythm abnormalities, reduced body weight, and reduced bone mineral density. The clinical features of these kindreds are consistent with a predominant PRTH phenotype.

Bovine ferritin iron bioavailability in man.

The bioavailability of ferritin iron was evaluated in human subjects using radiolabelled [55Fe]ferritin isolated from bovine spleen and liver. Preliminary studies with bovine spleen ferritin labelled in vitro demonstrated an inappropriately high absorption compared with ferritin labelled in vivo, and the latter was therefore used in all subsequent absorption studies. In 10 subjects, geometric mean absorption from 5 mg of ferritin iron was 3.8% when taken without and 3.2% when taken with food (P > 0.05). These values were significantly lower than absorption from the same dose of iron given as ferrous sulphate, which averaged 24.1% without and 8.2% with food. When the iron dose was increased 10-fold, absorption of ferritin iron averaged only 0.6-0.7% with or without food as compared with 7.9% without and 2.6% with food when the iron was given as ferrous sulphate. In a further study, mean absorption from bovine spleen ferritin of 4.0% did not differ significantly from the mean of 2.7% observed with bovine liver ferritin. These findings confirm previous studies indicating that ferritin iron is poorly absorbed. Furthermore, its use as a pharmaceutical iron preparation cannot be advocated.

Thyroid cancer histotype changes as observed in a major general hospital in a 21-year period.

The existing registries of thyroid carcinoma are seldom comparable as far as epidemiological data, diagnostic criteria and histopatological description are concerned. Epidemiological studies report a progressive increase in the incidence of thyroid carcinoma in the last twenty years and in both sexes this increase of incidence has been referred to papillary histotype. Data collected from surgical series show a rate of thyroid carcinomas from 7 to 20% of total thyroid surgeries. The present study was designed in order to obtain a retrospective review of the distribution of thyroid carcinoma's different histotypes in the last 21 years in a major General Hospital. Detailed analysis of patients with histologically confirmed thyroid carcinoma admitted between 1974 and 1994 to the Surgery Department of Mauriziano Hospital of Torino, Italy showed an overall 11.8% prevalence of thyroid cancer out of the total thyroid surgeries. The rate of papillary carcinoma was the highest (54.3%) followed by follicular carcinoma (27.6%), anaplastic carcinoma (11.1%), medullary carcinoma (4.6%) and others (2.4%). The papillary-to-follicular ratio varied from 0.60 in 1974-76 to 6.88 in 1992-94. Female to male ratio of all thyroid carcinoma histotypes was 2.0 or more; papillary and follicular histotypes had the highest ratio. The variations of the histotype rate observed may be consequence of the silent increase of daily iodine intake throughout the subsequent years, while improved diagnostic tools available and increased experience of the medical staff have probably increased the number on thyroid ablations performed. Our data confirm the changing epidemiology of thyroid carcinoma, reported by international literature.

[Pancreatic beta-cell hyperplasia in adults. A clinical case]. / L'iperplasia delle beta-cellule pancreatiche nell'adulto. Caso clinico.

The author describe a rare case of pancreatic beta-cell hyperplasia. The patient was referred to us because of serious hypoglycemic crises. During hospitalization, endogenous hyperinsulinism was confirmed by hematochemical and instrumental tests. AngioCT of the pancreas evidenced a small lesion of the corpus, suspected of insulinoma. The patient underwent a corpus caudalis pancreatectomy: a small nodule with histologic neuroendocrine traits was ablated. A few days after the operation, new symptomatic hypoglycemia appeared. The hormonal tests confirmed a recurrence of endogenous hyperinsulinism. The patient underwent a new operation for pancreaticoduodenectomy: histological examination confirmed a pancreatic beta-cells hyperplasia. This condition has to be taken into account in the differential diagnosis of post prandial hypoglycemia. Besides, the observation of an insulinoma doesn't exclude the presence of a diffused disorder of islet cells as in the case above described.

[Diabetes, obesity, hypertension and the autonomic nervous system]. / Diabete, obesità, ipertensione e sistema nervoso vegetativo.

Functional changes of the autonomic nervous system may represent a common pathophysiologic factor in the association between non insulin-dependent diabetes, obesity, and essential hypertension. In all these conditions a number of sympathetic and/or parasympathetic dysfunctions consistent with autonomic neuropathy or simply with functional adaptations to haemodynamic changes have been reported. Autonomic neuropathy is a well known diabetic complication which is responsible for some clinical aspects of different severity. Subtle sympathetic and parasympathetic abnormalities possibly affecting thermogenesis have been shown in obese people. An increased sympathetic activity has been proposed as one of the pathogenetic mechanisms of essential hypertension. Finally, the association between diabetes, obesity, hypertension and sympathetic overactivity could be explained by a common trans-membrane ionic disturbance with an increase of intracellular calcium and a decrease of both intracellular magnesium and pH.

Changes in autonomic nervous function over a 5-year period in non-insulin-dependent diabetic patients.

One hundred and eight non-insulin-dependent diabetic patients who had been tested for autonomic dysfunction in 1984/85 were re-evaluated 5 years later. Autonomic function was assessed by means of four cardiovascular tests (heart rate variation during deep breathing and standing, and blood pressure variation after standing and sustained handgrip). Eighteen subjects were lost to follow-up; in the 90 patients who completed the study, both the deep breathing and the handgrip test significantly worsened (respectively from 13.7 +/- 7.8 to 11.6 +/- 6.3 beats min-1 p < 0.01, and from 16.9 +/- 8.2 to 12.7 +/- 7.1 mmHg, p < 0.001), whereas both the 30:15 ratio and the variation of blood pressure on standing did not change. The impairment of a comprehensive evaluation score (from 2.5 +/- 1.7 to 3.0 +/- 1.5; p < 0.05) also confirmed the gradual deterioration of autonomic function over the study period.

[Libido-related changes in the elderly]. / Le modificazioni della libido nell'anziano.

Sexual desire can be influenced in elderly men by a number of factors such as hormonal abnormalities, socio-cultural conditions, chronic diseases, drugs. Testosterone decrease per se is not sufficient to impair sexual function in the elderly; social and psychological factors are probably of relevance as it can be observed in people living in nursing homes. Diabetes may have a major impact on sexual desire. Drugs usually associated with impairment of libido (psychotropic drugs, anti-hypertensives) are frequently used by elderly people; alcohol is a leading cause of sexual dysfunction, particularly in unfavourable social conditions.

[ACE inhibitors and vagal activity: the effect of captopril and lisinopril on cardiovascular reflexes]. / ACE-inibitori e attività vagale: effetto di captopril e lisinopril su alcuni riflessi cardiovascolari.

The influence of the ACE-inhibitors captopril and lisinopril on parasympathetic activity in normotensive subjects was evaluated. Three cardiovascular tests which explored chiefly parasympathetic function (deep breathing, lying to standing and Valsalva test) were performed in 10 normotensive volunteers (mean age 26.1 years) in both basal conditions and after four days of treatment with either captopril (25 mg twice a day) or lisinopril (20 mg once a day). Mean blood pressure was not influenced by captopril, whereas it was significantly lowered with lisinopril (from 94.4 +/- 6.8 to 88.7 +/- 5.7 mmHg; p < 0.05). Neither drug interfered with heart rate or with the results of the deep breathing and Valsalva tests. The 30/15 ratio, an index of heart rate variability during the lying to standing test, significantly worsened after assumption of both captopril (from 1.37 +/- 0.18 to 1.21 +/- 0.14; p < 0.05) and lisinopril (from 1.31 +/- 0.17 to 1.20 +/- 0.11; p < 0.05). Although our subjects had a lisinopril-induced drop in blood pressure, their heart rate remained steady. This finding confirms previous studies reporting the lack of reflex tachycardia during ACE-inhibition. The slight effect of ACE-inhibitors on the results of deep breathing and Valsalva tests suggests that such drugs do not directly stimulate vagal activity; the significant decrease of the 30/15 ratio may be due to a functional impairment of the baroreflex mechanism.

[Is it possible to prevent andrological complications in the diabetic patient?]. / Si possono prevenire le complicanze andrologiche nel paziente diabetico?

Sexual impotence is the main andrological complication of diabetes mellitus and is the consequence of nervous, vascular and psychological factors which act either separately or in association. An attempt to prevent this complication will be successful if performed early before impotence has became irreversible. Neuropathy-induced impotence can be prevented by obtaining a good metabolic control of diabetes and/or by using some specific drugs such as gangliosides and aldose reductase inhibitors. The vascular causes of erectile failure can be prevented by reducing or removing associated risk factors such as smoking, hypertension, obesity, hypercholesterolemia, sedentariness and insulin-resistance. Finally, correct information and reassurance of the patient and his partner can prevent the negative role played by psychological factors on the sexual dysfunctions complained by the diabetic subject.

[Analysis of seminal fluid: modern aspects of an old examination]. / L'analisi del liquido seminale: moderni aspetti di un vecchio esame.

Semen analysis stands as the most widely employed test for the diagnosis of male infertility. Subjectivity of evaluation and intra-individual variations of sperm concentration and motility are major limitations of this technique. Intra-individual variations are due to spontaneous circannual rhythmicity, to collection artifacts or to several environmental, physiological and pathological factors. The diagnostic and prognostic usefulness of semen analysis is related to strict compliance with the guidelines recently suggested by the World Health Organization. In recent years, the development of computerized systems provides an objective and rapid method for semen analysis, suitable for the study of more sophisticated parameters of sperm motility. Electron microscopy should be performed for the evaluation of ultrastructural abnormalities of spermatozoa in men with infertility of uncertain origin.

Autonomic nervous activity in obese subjects before and after caloric restriction.

The heart rate response to deep breathing (DB test) and standing (30:15 r test) and the blood pressure response to standing (LS test) and sustained handgrip (HG test) were assessed in 19 obese subjects and 15 age matched lean controls. The results of DB, 30:15 r and LS tests were not significantly different in both groups. The diastolic blood pressure increase during handgrip was significantly higher in obese than in control subjects. After a period of caloric restriction the tests were repeated in 9 patients who had obtained a weight loss of at least 5 kg: a significant decrease in heart rate, diastolic blood pressure and 30:15 r results was observed, whereas the caloric restriction did not cause significant variations in the results of DB, LS and HG tests. Our results suggest that in obese patients some autonomic nervous changes can occur before and after weight loss.

Autonomic neuropathy in non-insulin-dependent diabetic patients: correlation with age, sex, duration and metabolic control of diabetes.

The aim of this study has been to assess the prevalence of autonomic neuropathy among non-insulin dependent diabetic patients, and to determine whether a correlation could be found between autonomic impairment and the following: age, sex, duration of diabetes, body mass and metabolic control. Two hundred and twenty one non-insulin dependent patients were submitted to four cardiovascular tests: heart rate response to deep breathing and to standing up; blood pressure response to handgrip and to standing up. Sixty six percent of patients showed at least one abnormal cardiovascular response. The prevalence of autonomic impairment was higher in non-insulin dependent than in insulin-dependent diabetics. Patients were grouped according to the extent of autonomic impairment: absent (33.5%), early (27.6%), definite (3.6%), severe (4.5%). An atypical pattern (abnormality of blood pressure responses in absence of a definite abnormality of heart rate responses) was found in 30.8% of patients. Heart rate responses correlated significantly with age (p less than 0.001). No correlation between test results and duration was found in the multivariate analysis. The tests' results did not correlate with metabolic control or body mass index. Patients with symptoms of autonomic neuropathy had values for heart rate response to deep breathing and to standing significantly lower than those without (p less than 0.05).

Autonomic neuropathy and sexual impotence in diabetic patients: analysis of cardiovascular reflexes.

Four cardiovascular tests exploring autonomic nervous function (Deep Breathing, 30:15 ratio, Lying to Standing, Hand Grip) have been performed in 38 diabetic patients with erectile failure (mean age 53.2 years, range 34.5-60.5) and in 35 diabetic subjects without sexual dysfunctions (mean age 52.8 years, range 45-60.5). In our study Deep Breathing test was abnormal in 21 patients with erectile failure (55.3%) and in 9 patients without sexual dysfunction (25.7%) (P less than 0.05). Seven patients with sexual impotence (18.4%) and 2 subjects without sexual dysfunction (5.7%) showed abnormal results of 30:15 ratio test. The Lying to Standing test was not abnormal both in impotent and in non impotent subjects, while the Hand Grip test was abnormal in 7 patients with impotence (18.4%) and in 8 patients without sexual dysfunction (22.9%). Results obtained from Deep Breathing test were significantly lower (P less than 0.01) in impotent (10.25 +/- 6.10 beats/min) than in non impotent patients (14.63 +/- 6.85 beats/min). Lower 30:15 ratios were also found in patients with erectile failure (1.09 +/- 0.10 vs 1.12 +/- 0.09). The tests exploring the sympathetic function did not show any difference between the two groups of patients. The present study confirms the major role of parasympathetic impairment in the pathogenesis of sexual dysfunctions in diabetic men. Cardiovascular tests can be a first-step diagnostic tool in the assessment of diabetic impotence.