[Circadian rhythm of melatonin in liver cirrhosis]. / Ritmo circadiano della melatonina (aMT) nella cirrosi epatica.

The liver plays an important role in the intermediate metabolism of numerous substances involved in hormonal action. Starting from the presupposition that the pineal has an inhibitory effect on the reproduction system through melatonin (aMT) and that hepatic cirrhosis can be included among the pathologies characterised by sexual disorders, the authors felt that it was interesting to evaluate the light/darkness rhythm of aMT in some patients suffering from hepatic cirrhosis in order to highlight the possible pathogenetic role of aMT in causing the altered sexual activity observed in this pathology. A total of 4 subjects (3 males and 1 female), with a mean age of 60.5 years, suffering from hepatic cirrhosis and a matched group of healthy controls were included in the study. Circadian changes in aMT plasma levels and plasma levels before and after TRH stimulus (200 micrograms) of aMT and PRL were studied in all subjects. The results revealed the presence of a circadian rhythm of aMT with a nocturnal peak secretion in both groups; in patients with cirrhosis, however, the rhythm appeared to be "out of phase" and presented a late and prolonged increase in aMT compared to controls. Responses to TRH did not show any differences in aMT between the two groups, but the response to PRL was higher and longer than in hepatopathic patients. These findings showed an alteration in the secretory pattern of aMT in cirrhotic patients which can be attributed to reduced hormone metabolism at an hepatic level. The altered response to PRL is attributable to an altered neurotransmitter function at the central level.

[Primary extranodal non-Hodgkin's lymphoma of muscle tissue]. / Linfoma non-Hodgkin extranodale primitivo del tessuto muscolare.

Primary muscular involvement is extremely rare in non-Hodgkin's lymphomas. To our knowledge few cases are reported in literature and all of them concern patients with unifocal muscular lymphoid masses usually growing in one of the extremities. Our case-report, instead, regards a 78 years-old woman presenting primary multifocal muscular involvement by extranodal non-Hodgkin's lymphoma (right upper and lower limbs affected at the same time). Therefore, in contrast with the therapeutic approach suggested by other Authors in such neoplasms (radiotherapy or combined radio-chemotherapy), we preferred to administer only chemotherapy. The treatment led to a complete regression of all lymphoid masses. By now the woman is healthy and disease-free as confirmed at the one-year haematological follow-up.

[Occurrence of primary hypothyroidism in alpha-interferon treatment]. / Insorgenza di ipotiroidismo primitivo in corso di terapia con alfa-interferone.

In recent years recombinant alpha interferon (IFN) has been widely used in the treatment of neoplastic and infectious diseases. Induced autoimmune disorders and thyroid impairment are getting increasing relevance in the field of side-effects complicating long-term alpha-interferon courses. We monitored thyroid function in 35 patients receiving alpha-IFN therapy for different diseases (chronic hepatitis, essential thrombocytemia, multiple myeloma, chronic myeloid leukemia, essential polycytemia, essential crioglobulinemia and hairy-cell leukemia). All of them were euthyroid and negative for anti-thyroid serum antibodies before treatment. Six months later, 6 patients (17%) developed primary hypothyroidism with elevated antithyroid antibodies in 5 cases; 1 continuing to be negative. None of our patients developed hyperthyroidism. Overall, "indirect-autoimmune" and "direct non autoimmune" mechanisms are considered possible and/or combined pathogenetic moments of thyroid disfunction during alpha-IFN therapy. Thyroid complications mainly occur when latent impairment of immune system exists. Thyroid circulating hormones levels and autoimmunity screening should be performed in all patients before starting and during long-term alpha-IFN treatment.

[The neuroglycopenic syndrome due to insulinoma. A clinical case report]. / Sindrome neuroglicopenica da insulinoma. Descrizione di un caso clinico.

The authors report a case of a woman affected by pancreatic insulinoma who had been suffering from recurrent and misdiagnosed hypoglycemic attacks since 3 years. The total loss of warning neurogenic symptoms replaced by sudden onset of neuroglycopenic symptoms had delayed the proper and early diagnosis because of repeated and useless cardiovascular and neurological investigations. Moreover, it is stressed how difficult is to reveal such neoplasia that, despite the severe symptoms, are usually small in size and often undetectable even with TC scan. Therefore, when clinical pattern is strongly suggestive for insulinoma the use of invasive angiography or other techniques is mandatory and often conclusive. Actually clinical data have the priority in whole diagnostic pathway.

[Blood prolactin patterns in hepatic cirrhosis]. / Osservazioni sul comportamento della prolattinemia in corso di cirrosi epatica.

Variations in PRL secretion were observed during chronic hepatic disorders. The aim of our study was to evaluate the behaviour of PRL in patients affected by hepatic cirrhosis. 6 patients (4 males and 2 females) were studied and matched with a group of healthy controls. In all subjects PRL values were evaluated in basal conditions and after TRH stimulation. The results obtained showed higher basal levels of PRL, together with higher and more prolonged TRH responses in patients with hepatopathies than in controls (p < 0.01). These abnormalities in PRL secretion during hepatic cirrhosis could be due to alterations of neurotransmitters at central level.

[Immunological indices in myelodysplastic syndromes]. / Indici immunologici nelle sindromi mielodisplastiche.

Several studies aiming to describe the immunological abnormalities occurring in patients affected by myelodysplastic syndromes (MDS) have been carried out in recent years. We report on the immunological abnormalities found in 22 myelodysplastic patients at the time of diagnosis (RA: 2 cases; ASIA: 4 cases; AREB: 6 cases; AREB-T: 6 cases. LMMC: 4 cases). Matched with similarly aged healthy people (controls) all our patients revealed a significant lymphocytopenia mainly due to a reduction both in number and percentage of T-helper series with decreased OK T4/OK T8 ratio as a result; even B-cells were reduced in number but their percentage still overlapped with the controls. Out of 22 patients, 13 showed hypergammaglobulinemia (polyclonal in 12 cases, monoclonal in the one left) and 2 read positive for Coomb's and Ana-test respectively. The involvement of T-cell immunity in the course of MDS can be explained if we consider the clonal origin of such diseases. Among myelodysplastic patients the ones affected by LMMC, AREB and AREB-T show the heaviest immunological abnormalities: in these cases the whole of T-cells subsets and NK cells as well are affected. Eventually, the mentioned abnormalities are of paramount importance to explain how easily these patients can develop both severe infectious diseases and abrupt acute leukemia.

[Partial remission of non-Hodgkin's lymphoma (stage IV-B) following immunostimulating therapy with thymopentin]. / Remissione parziale di LMNH stadio IV-B in seguito a terapia immunostimolante con timopentina.

Therapy of low-grade of malignancy non-Hodgkin's lymphoma in an advanced stage is still under discussion: aggressive poly-chemotherapies, such as radiotherapy and conventional chemotherapies did not prove to be more effective than conservative treatments. We report the case of a woman suffering from a low-grade of malignancy non-Hodgkin's lymphoma (stage IV-B). She was in such bad general conditions that she could not be treated with chemotherapy. She received an immunostimulating drug, thymopentin for 10 months. After this treatment, the general condition of the patient was improved and a partial remission of the lymphoproliferative disease was observed. The patient is still in constant fairly good health.