Low-dose spironolactone reduces plasma fibulin-1 levels in patients with type 2 diabetes and resistant hypertension.

Diabetic patients with hypertension are at particularly high risk of vascular damage and consequently cardiovascular and renal disease. Fibulin-1, an extracellular matrix glycoprotein, is increased in arterial tissue and plasma from individuals with type 2 diabetes. This study aimed to evaluate whether antihypertensive treatment with spironolactone changes plasma fibulin-1 levels. In a multicenter, double-blind, randomized, placebo-controlled study, 119 patients with type 2 diabetes and resistant hypertension were included. A dose of spironolactone 25 mg or matching placebo was added to previous treatment at randomization. Blood pressure (BP) and plasma fibulin-1 were measured at baseline and at 16 weeks follow-up. Overall, 112 patients completed the study. All measures of BP were reduced in the spironolactone group at follow-up. Plasma fibulin-1 was significantly reduced after spironolactone treatment (P=0.009), but increased after placebo (P=0.017). Baseline plasma fibulin-1 correlated with BP and estimated glomerular filtration rate. Increased levels of plasma fibulin-1 (P=0.004) were observed in diabetic participants reporting erectile dysfunction as compared with participants who did not. Treatment with low-dose spironolactone reduced plasma fibulin-1 levels in patients with type 2 diabetes and resistant hypertension. This supports the hypothesis that the antihypertensive effect of the mineralocorticoid receptor blocker in part may be due to regression of vascular remodeling.

[Mental health and life style changes in young workers]. / Salute mentale ed alterazione delle abitudini di vita dei lavoratori giovani.

Lifestyle's alterations are hazardous for health. On one hand they produce a high rate of mortality and disease, on the other hand they cause a reduction of work outcomes and an increase of occupational accidents with important consequences for both worker's health and his/her financial status. The aim of this study is to review the scientific literature for possible relationships between mental health and lifestyle alterations of young workers. We considered as lifestyle factors the attitudes towards: smoking, alcohol consumption, eating, use of medications and doping substances, physical activity and sleeping. From our study it clearly emerges the existence of correlation between lifestyle habits and mental health; in fact behavioural alterations can produce problems of mental health and vice versa. Furthermore, some work peculiarities can lead to psychic disturbances and/or to unhealthy habits which can themselves cause negative effects on working activity. It is very important for young workers to understand that unhealthy behaviours, which can be corrected, are hazardous in terms of health and safety for both the single worker and the collectivity and that those behaviours can enhances the other working risks. Because there is a close interaction between mental health and lifestyles, it would be necessary a careful promotion of mental health on workplaces and to take all the preventive measures, with particular regard for those related to the work organization, in order to reduce the onset, exacerbation and unmasking of mental disorders and psychological difficulties. In working environment, the occupational health physician and his relationship with the patient are of fundamental importance. During preventive and periodic medical examinations, the occupational health physician should take detailed information on young worker's habits regarding smoking, alcohol consumption, eating, physical activity, sleeping, pharmacological abuse and possible presence of mental disorders and furthermore he/she should actively take part in the information and education process of the worker.

Urban stressors and plasmatic 17-beta-estradiol (E2) in male exposed workers.

The aim of the study is to evaluate if the occupational exposure to urban stressors could cause alterations in 17-beta-estradiol (E2) plasma levels and related disorders in male traffic police compared with a control group. After excluding from the study, the subjects with the principal confounding factors, traffic police and controls were matched by age, working life, Body Mass Index (BMI), smoking and drinking habit. A total of 171 male traffic police and 171 controls were included in the study. In traffic police, mean E2 values were significantly lower versus controls (P < 0.001). The distribution of E2 values in traffic police and controls was significant (P < 0.001). No significant differences were found in percentage of traffic police versus controls concerning the following questionnaire items: fertility and mental health diseases. Our results suggest that the occupational exposure to chemical urban stressor, interacting with and adding to the psychosocial ones, could alter plasma E2 concentrations in male traffic police compared with a control group. According to our previous researches on other neuro-immune-endocrine parameters, E2 could be used as an early biological marker, valuable for the group, to be used in occupational set even before the onset of the pathologies.

Huntington's disease: review and anesthetic case management.

Huntington's disease is a dominantly inherited progressive autosomal disease that affects the basal ganglia. Symptoms appear later in life and manifest as progressive mental deterioration and involuntary choreiform movements. Patients with Huntington's disease develop a progressive but variable dementia. Dysphagia, the most significant related motor symptom, hinders nutrition intake and places the patient at risk for aspiration. The combination of involuntary choreoathetoid movements, depression, and apathy leads to cachexia. Factors of considerable concern to the anesthesiologist who treats patients with Huntington's disease may include how to treat frail elderly people incapable of cooperation, how to treat patients suffering from malnourishment, and how to treat patients with an increased risk for aspiration or exaggerated responses to sodium thiopental and succinylcholine. The successful anesthetic management of a 65-yr-old woman with Huntington's disease who presented for full-mouth extractions is described.

The impact of coexistent diabetes on the prevalence of coronary heart disease.

The increased risk of developing cardiovascular disease in diabetic population has been well documented, but the prevalent mechanism of this susceptibility is still only partly explained. We compared the impact of diabetes on ischemic heart disease in patients hospitalized in a public general hospital over a 10-year period. The prevalence of coronary heart disease (CHD) was consistently higher among diabetic population [namely, among non-insulin-dependent diabetes mellitus (NIDDM) patients] when compared with the nondiabetic population. The prevalence was similar in both genders, increasing with age, and was independent from body-mass index, history of smoking, metabolic control, or lipid pattern. Heart rate and blood pressure levels were significantly higher in NIDDM patients with CHD; similarly, there was a significant association between ischemic heart disease and atherosclerotic peripheral artery disease prevalence, and this trend was observed even in subjects with impaired glucose tolerance. These observations support the evidence that diabetes exerts a deleterious effect on general risk factors of atherosclerosis and increases susceptibility to cardiovascular disease by itself as an "independent" risk factor; on the other hand, the epidemiological evidence of an excessive occurrence of type II diabetes in individuals with pre-existing vascular disease suggests a genetically determined link between metabolic disturbances and cardiovascular disease.

The value of routine screening of female serum for antisperm antibodies in assisted reproductive technology cycles.

OBJECTIVE: To determine the effect of antisperm antibodies in the female serum on fertilization and pregnancy rates (PRs) in assisted reproductive technology (ART) cycles. DESIGN: Retrospective case control study. SETTING: Assisted reproductive technology program at North Shore University Hospital. PATIENTS, PARTICIPANTS: All patients undergoing an ART cycle in 1990 whose husbands did not have significant antisperm antibodies in the semen. Thirty-four female patients had significant antisperm antibodies level in the serum (antisperm antibodies-significant); 62 patients with no antibodies or nonsignificant levels constituted the control group (antisperm antibodies-negative). Incubation media were prepared with maternal serum in 37 of the antisperm antibodies-negative and in 10 of the antisperm antibodies-positive patients, whereas donor's serum (DS) was used for 25 and 24 patients, respectively. MAIN OUTCOME MEASURES: Fertilization rate and clinical PR, defined as an intrauterine sac by transvaginal ultrasonography, were recorded for each group. RESULTS: Analysis of variance showed a significant interaction between antisperm antibodies grouping and the type of media used, with fertilization rate in antisperm antibodies-significant patients significantly higher with maternal serum than with DS, whereas fertilization rate in antisperm antibodies-negative was quantitatively, though not statistically lower with maternal serum than with DS. When maternal serum was used, fertilization was higher in antisperm antibodies-significant than antisperm antibodies-negative. Of 29 clinical pregnancies, 11 were in antisperm antibodies-significant and 18 in antisperm antibodies-negative. In 10 of the pregnancies, maternal serum was used, whereas in 19 pregnancies DS was used. No variable was significantly predictive of pregnancy in the logistic regression analysis. CONCLUSIONS: [1] Female patients with significant levels of antisperm antibodies in the serum had similar fertilization rates as patients with nonsignificant levels if DS was used. [2] The use of maternal serum in antisperm antibodies-significant patients did not result in inferior fertilization rates or the occurrence of pregnancy. [3] These findings suggest that a female antisperm antibodies may not hinder fertilization in vitro. [4] This study questions the value of routine screening of female serum for antisperm antibodies in ART.

[Insulin resistance: related clinical syndromes]. / Insulino-resistenza: sindromi cliniche correlate.

The authors, after having defined and listed the pathogenetic mechanisms of insulin resistance, describe the main, more or less frequent, syndromes with accompany this condition, classified on the basis of the prevalent etiology (dismetabolic, disendocrine, genetic, mixed), identifying of each one, when possible, the modes of determining the same insulin resistance. The more frequent diseases, whose common feature is the insulin resistance (obesity, non insulin dependent diabetes mellitus, acanthosis nigricans, polycystic ovarian syndrome) are particularly considered on the basis of recent literature and of personal data.

Evaluation of new computerized method for recording 7-day food intake in IDDM patients.

OBJECTIVE: To evaluate a new computerized method for recording 7-day food intake. RESEARCH DESIGN AND METHODS: Randomized crossover trial was conducted with patients recording the amount and type of every food and drink consumed during a week by either a computerized device (Food-meter) or recording the data in a diary. Each method was applied twice. Twenty-one insulin-dependent diabetic patients (mean +/- SD age 25 +/- 9 yr) were studied. RESULTS: The two methods showed very good agreement in the evaluation of the patients' diets (1792 +/- 408 vs. 1764 +/- 436 kcal/day, 84 +/- 19 vs. 82 +/- 21 g/day protein, 68 +/- 22 vs. 67 +/- 23 g/day fat, 210 +/- 60 vs. 207 +/- 58 g/day carbohydrate with the conventional and computerized methods, respectively). The variability between the methods and the variability within each method were of similar magnitude. CONCLUSIONS: The Food-meter represents a useful tool for computerizing the 7-day food record. The method is easy, reliable, and time saving. Moreover, it minimizes the risk of transcriptional errors.

Evaluation of B-cell secretion and peripheral insulin resistance during pregnancy and after delivery in gestational diabetes mellitus with obesity.

Nine pregnant women with gestational diabetes mellitus (GDM) were studied. Six normal pregnant women and six normal nonpregnant women were evaluated as control groups. All the women underwent oral glucose tolerance test and glucose clamp during the third trimester of pregnancy and two months after delivery. During OGTT, glucose, C-peptide and insulin plasma levels were determined. C-peptide and insulin values in the late phase of OGTT were higher during pregnancy than after delivery in both groups. In gestational diabetic women, the M-value in the second steady-state during glucose clamp was lower than in controls, both during pregnancy and after delivery. Nevertheless, in both groups the M-value during pregnancy was lower than after delivery. Moreover, in gestational diabetic women there was an inverse correlation between M-value in the second steady-state and ponderal excess index after delivery. In conclusion, the impaired peripheral glucose utilization and the pancreatic pattern of gestational diabetic women compared to normal suggested altered B-cell secretion response, increased peripheral resistance and overweight to be the main changes in GDM.

Histologic study of the inhibition of bone resorption in organ cultures by myo-inositol-2-monophosphate.

This study examines chemically and histologically the relative abilities of inositol monophosphate (IP1), inorganic phosphate (Pi), ethane-1-hydroxy-1, 1-diphosphonate (EHDP) and dichloromethylene disphosphonate (Cl2MDP) to inhibit parathyroid hormone (PTH)--induced resorption of fetal rat long bones in organ culture. Pregnant rats injected with 45Ca on the 18th day of gestation were killed the next day and their fetuses removed. Half of each pair of dissected long bones was incubated in a chemically defined control medium while the contralateral half was incubated in medium containing PTH or PTH plus the compound to be tested. 45Ca released into the medium was indicative of the amount of bone resorption. Bones were then processed histologically and examined microscopically. All compounds inhibited resorption to some extent with IP1 and Pi being less effective than EHDP or C12MDP at comparable phosphate concentrations. However, the disphosphonates damaged osteoclasts whereas IP1 and Pi did not. This suggests that IP1 may inhibit resorption by a different mechanism perhaps related only to prevention of crystal dissolution.

[Various biohumoral parameters (blood triglycerides, blood cholesterol, blood uric acid, blood electrolytes) after automatic control by an artificial pancreas in subjects with type I diabetes mellitus]. / Valutazione di alcuni parametri bioumorali (trigliceridemia, colesterolemia, uricemia, elettroliti ematici) dopo controllo automatico mediante pancreas artificiale in soggetti con diabete mellito di tipo I.

Aim of the present paper is to study the modifications of some laboratory parameters most related to glycaemic metabolism during 24 hours of feed-back glycaemic control by artificial beta-cell. Twelve subjects affected by insulin dependent diabetes mellitus were submitted to GCIIS BIOSTATOR Miles evaluating, before and after 24 hours, blood tryglicerides, cholesterol, uric acid, sodium, potassium. A significant variation was found between the trygliceridemic values before and after automatic control. There was no variation in natriemic values before and after control. Variations, but not significant, were found in cholesterolemic, kaliemic and uricacidaemic values.

[Early post-prandial hyperglycemic response: from case reports of insulin-dependent diabetics evaluated with an artificial pancreas]. / Risposta iperglicemica post-prandiale precoce: da una casistica di soggetti diabetici insulino-dipendenti valutati mediante pancreas artificiale.

In order to define the after-meal glycaemic response in diabetic subjects, we studied it in 20 insulin-dependent diabetic patients by automatic control using artificial beta-cell. We observed a different behaviour of blood glucose and of the consequent insulin requirement at the meals: in two subjects an early and excessive rise of blood glucose values at the meal was shown, not rapidly normalizable by artificial beta-cell. It should support, in our opinion, in these subjects, an increased neuro-entero-hormonal activity on endocrine pancreas production and a subsequent enhancement of hepatic glucose output.