Neuroendocrine response to diclofenac in healthy subjects: a pilot study.

PURPOSE: The precise effects of non-steroidal anti-inflammatory drugs on the neuroendocrine hydro-electrolytic regulation are not precisely understood. The aim of this pilot study was to evaluate, in healthy subjects, the neuroendocrine response of the antidiuretic system to intravenous diclofenac infusion. METHODS: For this single-blinded, cross-over study, we recruited 12 healthy subjects (50% women). Test sessions were divided into three observation times (pre-test; test; 48 h post-test), which were repeated equally on two different occasions, with the administration of diclofenac (75 mg in saline solution 0.9% 100 cc) on 1 day, or placebo (saline solution 0.9% 100 cc) on another day. The night before the test the subjects were asked to collect a salivary cortisol and cortisone sample, which was repeated on the night of the procedure session. Serial urine and blood samples were collected on the test day (for osmolality, electrolytes, ACTH, cortisol, copeptin, MR-proADM, MR-proANP; the last three represent more stable and analytically reliable molecules than their respective active peptides). Moreover, the subjects were evaluated with the bioimpedance vector analysis (BIVA) before and after the test. Forty-eight hours after the end of the procedure urine sodium, urine potassium, urine osmolality, serum sodium and copeptin were revaluated together with BIVA. RESULTS: No significant changes in circulating hormone levels were observed; anyway, 48 h after diclofenac, BIVA showed a significant water retention (p < 0.00001), especially in extracellular fluid (ECF) (16.47 ± 1.65 vs 15.67 ± 1.84, p < 0.001). Salivary cortisol and cortisone tended to increase only the night after placebo administration (p = 0.054 cortisol; p = 0.021 cortisone). CONCLUSION: Diclofenac resulted in an increased ECF at 48 h, but this phenomenon seems to be associated with a greater renal sensibility to the action of vasopressin rather than with an increase in its secretion. Moreover, a partial inhibitory effect on cortisol secretion can be hypothesized.

Information technology in a dialysis department.

The use of information technology in a peritoneal dialysis service, as in any facility, poses the problem of the choice of the data to be stored. It is important to define the whole range of information which may be of use and to assess the costs and benefits involved. These will depend on how complete and reliable the stored information is, how well the management process (filing and processing) is integrated with its day to day use by the Department. It is essential to both safeguard work efficiency and guarantee processing which will be useful in routine operations, including checking the quality of work carried out, and in study and research.

A case of dysembryogenesis of the aortic arches.

A medico-legal necropsy conducted on a stillborn child revealed certain abnormalities of the heart and the large vessels. Both the pulmonary artery and the aorta issued from the right ventricle, while the left ventricle communicated with the right superiorly and below the crest. There was no ductus arteriosus. As far the vessels were concerned, it was found that the aortic arch was directed rightwards, the innominate artery was absent and the right subclavian and common carotid issued directly from the arch. On the left, too, it was noted that the subclavian issued from the left branch of the pulmonary artery. If is suggested that these alterations were the result of primary obliteration of the left 4th aortic arch. This would explain both the dextroversion of the final arch and the absence of the anonymous artery. A further outcome would be prevention of the normal formation of the left subclavian, and its derivation from the left component of the 6th pair of aortic arches. Histological sections of the large vessels examined were prepared for investigation under the light microscope.