Biomedical subjects
Publications and source records attributed to E Moneta.
The observation of pregnancy in women with a mitral and aortic valvular prosthesis, allows the authors to point out the high maternal and fetal risk and to show the therapeutical treatment chosen. The obtained results, confirm the effectiveness of the anticoagulant treatment by heparin and of delivery by cesarean section.
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Recent reported data on hyperandrogenisms of suprarenal origin are presented and the case of a 26-year-old woman suffering from hirsutism and secondary amenorrhoea reported. Preoperative hormonal measurement showed very high Dehydroepiandrosterone (DHEA) levels (8,000 ng/ml) and a less dramatic increase in Androstenedione (A) and Testosterone (T), of 3.5 and 1.17 ng/ml respectively. Androgens were uniformly increased following administration of ACTH (250 micrograms for 3h for 2 days) and inhibited by intake of Desamethazone (8 mg/die for 3 days per os). ACTH values were low and failed to increase after insulin-induced hypoglycaemic stimulus. Pelvic echography and laparoscopy showed normal ovaries. A suprarenal scan revealed slight bilateral hyperplasia with irregular trace distribution on the left. CT showed a slight anomaly of the left gland which appeared spherical with convex margins. Unilateral suprarenectomy was carried out and the controlateral gland explored. The removed gland presented a histological picture of "micronodular focal hyperplasia". Treatment was begun with Prednisone and temporary remission of the clinical and biochemical pictures was achieved but one year after the operation androgen concentration was found again to be abnormally increased. The final diagnosis was "Bilateral suprarenal hyperplasia" with initial unilateral involvement. To conclude, this particular hyperandrogenism with ACTH levels at the lower limits of normal and with underlying primary suprarenal hyperplasia may be included among the better known suprarenal hyperplasia syndromes responsible for the Cushing and Conn syndromes.
The possibility of recurring gestosis is analysed in the light of personal experience and reports in the literature. The importance of the time of onset and the severity of the initial event is emphasised with details of measures that can be taken to identify and treat recurrences as soon as they arise. In particular, the importance of a low fat diet, which probably has the same effect as anti-aggregant treatment, is underlined.
Adrenal hyperplasia due to 17-alpha-hydroxylase deficiency is coupled with precocious hypogonadism, which causes pseudohermaphroditism in XY subjects and primary amenorrhea in XX subjects. The physiology of gluco- and mineral-corticoid adrenal activity, as well as the biosynthesis of gonadal steroids, is totally altered. We report two cases of XY subjects, identified as females, who came to our observation for primary amenorrhea and exhibited a hypertension with hypokaliemia. We also report a critical review of the literature, with a main attention to differential diagnosis and mineralcorticoid physiopathology, in order to contribute to the knowledge of normal adrenal function and of this enzymatic defect.
The effect of intrahippocampal infusion of 70 nmol (1 microliter/2 min) D,L-2-amino-7-phosphonoheptanoic acid (APH), a selective antagonist of N-methyl-D-aspartate (NMDA)-type receptors, was studied on behavioral seizures and afterdischarge (AD) at different stages of hippocampal kindling in rats. After completion of kindling (3 consecutive stage 5 seizures) APH infusion at the site of stimulation (granule cells of dentate gyrus) 60 min before stimulus delivery (50 Hz, 2 ms monophasic rectangular wave pulses for 1 s, current intensity 60-200 microA) suppressed the behavioral convulsions and focal AD. Four stimulations were needed after drug injection to recover stage 5 seizures and AD. When similarly injected early in kindling (stage 1-2) APH had no effect on the AD duration but significantly increased (by 37% with respect to controls) the number of stimulations needed to reach the first stage 5 seizures. Thus, it appears that NMDA-type receptors at the site of stimulation become progressively involved during the development of kindling and mediate the behavioral convulsions and focal AD observed at stage 5.
Four pregnant women with antithrombin III congenital deficiency underwent thrombosis prophylaxis including oral anticoagulants administered from the 16-18th week to the 36-37th week of pregnancy, subcutaneous heparin before the 16-18th week and after the 36-37th week, and a single infusion of AT III concentrate in the peripartum period in order to obtain a minimal level of 0.8 U/ml of AT III functional activity. The level of circulating AT III after the concentrate infusion needs to be evaluated by functional methods, because of a consistent amount in the concentrates of inactive AT III immunoreactive material. No thrombotic or haemorrhagic complication occurred after starting prophylaxis in any woman either in any newborn.
Basal serum levels of prolactin (PRL) in 21 nursing mothers were measured by radioimmunoassay on the 2nd, 3rd and 4th days of the puerperium. The quantity of breast milk suckled during the 4th day of life was also evaluated by calculating the difference in the baby's weight before and after each feeding. During the first postpartum days, mean basal levels of PRL did not change. However these levels were noted to be significantly lower in the multiparas (p less than 0.05) than in the primiparas. In addition, the milk intake in neonates of multiparous mothers was significantly greater (p less than 0.05) than that in neonates of primiparous mothers. The author's hypothesis, based on the results of animal experimentation described in the literature, is that initiation of breast-feeding is facilitated in multiparas by the increased number of occupied PRL receptors in the mammary glands reflected by the lowered serum levels of the hormone.
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Forty-eight patients affected with missed abortion, intrauterine fetal death and hydatiform mole were treated with vaginal suppositories containing 1 mg of 16,16-dimethyl-trans-delta 2-PGE1 methyl ester (ONO-802). The patients were divided into two treatment groups. The first, Group A, was given one vaginal suppository every 3 h to a maximum of five suppositories. The product of conception was expelled in 95.8% of patients. In Group B the maximum number of suppositories was reduced to three. The product of conception was expelled in 100% of cases and the average duration of treatment was similar to that for the first group. Although side-effects were mild in both groups, they were reduced in the patients of Group B.
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Kallikrein and kininase activities were determined in urine of 58 hospitalized pregnant patients: 15 with E.P.H. gestosis, 10 with chronic hypertension, 18 with non proteinuric pregnancy induced hypertension, 15 with no hemodynamic disease as controls. All our cases with hypertension were treated with alpha-methyl-dopa. A significant increase in urinary kininase activity was shown by only E.P.H. gestosis group vs. controls. In the same group we found a significant decrease in urinary kallikrein activity vs. controls, in contrast with the results obtained previously, perhaps because of the different measuring method. The kininase/kallikrein ratio, theoretically indicative of kinins activity, increased significantly only in the E.P.H. gestosis group.
The authors report the preliminary results of a prospective study on intra-arterial chemotherapy and radiotherapy of advanced cervix carcinoma. The drugs were delivered by a totally implanted Infusaid Model 400 pump and patients received cyclic therapy consisting of Cis-Platinum, Methotrexate and Bleomycin. The catheter tips were positioned during a laparotomy in the hypogastric arteries with sutures and the pump was implanted in a subcutaneous pouch in the abdomen. After chemotherapy all patients had radiotherapy. Five patients entered in the study. Preliminary results suggest that long-term intra-arterial infusion chemotherapy for the treatment of advanced cervix carcinoma is practical for many patients. Two of five patients, after intra-arterial chemotherapy and radiotherapy, had radical hysterectomy.
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13 cases of MVP in pregnancy were examined and compared with a control group. No significant differences were found in the various parameters assessed in the two groups nor did there appear to be any significant increase in obstetric or neonatal risk.
Direct administration of isoxsuprine to the rat fetus increases placental transfer of 35S-methionine and this increase is statistically significant on day 17 as compared with intraperitoneal administration and controls (p less than 0.01; p less than 0.05). In contrast, no statistically significant differences were found between the groups on day 16.
The authors have evaluated placental blood flow using a non-invasive radioisotopic approach. The procedure involves the intravenous administration of 113mIn and the technique is a modified version of a previously reported method for a non-diffusive tracer kinetics analysis. The method is presented in detail and its performance is evaluated in 17 normal and 32 pathologic pregnancies (19 intrauterine growth retarded patients; 7 patients with iso-Rh immunization; 5 patients with gestational diabetes, and 1 pregnancy with extensive fetal malformation which was not included in any group). The normal pregnancies showed a flow index of 5.34 +/- 1.64 (1 SD) units compared to the pathological pregnancies value of 2.73 +/- 0.73 (1 SD) units (p less than 0.001). The conclusions drawn are: (1) the method is very well suited to clinical evaluation of placental blood flow; (2) the evaluation of placental blood flow cannot be directly equated with fetal development as it is not its only determinant, and (3) no other independent test to evaluate the radioisotopic study in terms of accuracy exists.