M.L. Di Pietro

Calcium antagonists and hormone release. V: Effects of a calcium-antagonist (Verapamil) on pituitary hormone release in hypersecretory states

Twenty-five patients with various syndromes of pituitary hyperfunction, of tumoral and nontumoral origin, were infused with verapamil (VE), a Ca2+-channel blocker (5 mg/h X 3 h) to assess the calcium dependence of the augmented hormone secretion. In 5 hypogonadal women with elevated gonadotropin secretion, VE produced a marked inhibition of LH (54.6%) and FSH (49.4%) release, comparable to that observed in normal subjects who were infused with VE. In 5 patients with latent or mild hypothyroidism, TSH levels decreased during the VE infusion, and the magnitude of the decrease was directly correlated with the basal levels (r = 0.986, p less than 0.01). In patients harboring a pituitary tumor, differential effects of VE infusion were observed: it induced an inhibition (28.5%) of ACTH secretion in patients with Cushings disease; in acromegalic patients, no alterations in HGH levels were noted; on the contrary, in prolactinoma patients, a clear PRL increment (47.2%) was present. These experiments confirm that the need for extracellular Ca2+ varies from hormone to hormone and that VE infusion can modify the secretion of pituitary hormone in a hypersecretory state, as well as those hormones which are unaffected by VE infusion in basal condition.

O279 CRYOPRESERVATION OF OVARIAN TISSUE IN PEDIATRICS: SEARCHING FOR THE CHILD'S BEST INTEREST

faster procedure could partially relieve the psychological burden created by the period spent waiting for the results, but at the same time the accuracy of the new tests has to be considered. As regards to the fetus, while NIPD sets to zero the risks of indirect abortion, in the meantime it reinforces the idea of the disabled person as an individual to be excluded from society. At the social level, NIPD may emphasize liberal eugenics. Conclusions: The application of NIPD, in order to diagnose the existence of genetic diseases, merely to decide if the fetus has to be aborted, implies and includes in itself the conditions that characterize a negative moral connotation.

Nuovi problemi derivanti dall’impiego delle tecniche di fecondazione artificiale

Le tecniche di fecondazione artificiale (PMA) pongono al medico che opera nel campo delle metodiche della riproduzione e al bioeticista notevoli problemi di ordine morale, per la cui risoluzione e necessaria una base scientifica a monte della valutazione etica. Questo studio analizza, dunque, gli aspetti piu propriamente scientifici in merito alla Intra Cytoplasmic Sperm Injection (ICSI). Tale tecnica e oggi quella piu usata nei centri di PMA ed ha rivoluzionato l’approccio alla sterilita di coppia. Pur tuttavia essa pone notevoli problemi, sia in merito all’impiego di seme di soggetti infertili sia connessi alla stessa tecnica. Per quanto riguarda i primi, si distinguono aspetti correlati: 1. alla presenza di anomalie citogenetiche parentali e delle cellule spermatiche, onde e stato dimostrato che pazienti infertili ammessi a programmi ICSI hanno un alto tasso di aneuploidie negli spermatozoi, inversamente correlate con i parametri seminali e il numero di forme morfologicamente normali dopo selezione; 2. all’esistenza di microdelezioni del cromosoma Y. Su tale aspetto ci si sofferma, evidenziando il ruolo dei segmenti genici coinvolti, nonche il rischio di trasmissione della microdelezione ai figli concepiti via ICSI. Sono quindi descritte le principali problematiche connesse sia alla tecnica sia all’abilita dell’operatore, evidenziando il carattere di sperimentalita della tecnica in esame. Considerando, poi, i risultati delle procedure ICSI, occorre considerare sia il tasso di fecondazione e l’outcome ostetrico sia il seppur lieve aumento di incidenza di malformazioni ed anomalie citogenetiche. Inoltre, il tentativo di ottenere gravidanze da situazioni maschili sempre piu severe, pone il problema di valutare i risultati in rapporto al quadro eziologico di partenza, ma vi sono poche osservazioni in tal senso. In conclusione vengono valutati i nuovi campi di indagine, con particolare riferimento alla round spermatid injection (ROSI), alla round spermatid nuclear injection (ROSNI) ed all’impiego di spermatogoni, fino alle forme di “semi-clonazione”, e gli ulteriori problemi che permangono ancora aperti, quali gli aspetti immunologici o la trasmissibilita dell’infezione da Human Immunodeficency Virus (HIV). ---------- The reproductive technologies (RTs) puts to the physician, involved in the reproductive medicine, and the bioethicist remarkable moral problems; therefore a solid scientific ground is necessary for an ethical evaluation. This study analyses the more properly scientific aspects, particularly related to Intracytoplasmic Sperm Injection (ICSI). Such technique, that is today the more used in the RTs centres, upsets the approach to couple sterility. It places, however, remarkable problems, both about the use of infertile man sperm and about the same technique. As to the first point, we can distinguish aspects connected to the presence of parental citogenetic anomalies and in sperm cells, so it was demonstrated that infertile patients admitted to ICSI programs have a high rate of aneuploidies in the spermatozoa, inversely correlated with the sperm parameters and the number of morphologically normal shapes after selection, and to the existence of micro-deletion of the Y chromosome. About this we meant to stop to us, evidencing the role of the deleted genic segments and the risk of transmission of the microdeletion to sons conceived via ICSI. Then the authors describe the major problems connected to the technique and to the ability of the operator, evidencing the experimentation of this technology. Considering, then, the outcomes of ICSI procedures, it is necessary to consider both the fecondation rate and the obstetrical outcome, and the slight increase of the incidence of malformations and citogenetical anomalies. Moreover, the attempt to obtain pregnancies from more and more severe male situations places the problem to estimate the outcome referred with the etiology, but there are only few observations about it. In conclusion we considered the new perspectives, specially about round spermatid injection (ROSI), round spermatid nuclear injection (ROSNI) and the use of spermatogonia, until “the semi-cloning reproduction” and the other problems still opened, as the immunological aspects or the transmission of the Human Immunodeficiency Virus (HIV).