Sara Spandrio

Cortisol secretion in patients on simvastatin

We have investigated the effects of simvastatin on adrenal function in 7 men and 3 women (mean age 53 years) affected by, or at high risk of, ischaemic heart disease and with heterozygous familial hypercholesterolaemia (FH). After eight weeks on the American Heart Association phase-I diet and placebo treatment, our patients received simvastatin as a single daily bedtime dose of 10 mg for six weeks, 20 mg for a further six weeks, followed by 40 mg for twelve weeks. A rapid adrenocorticotropic hormone (ACTH) test (intravenous tetracosactrin, 0.25 mg), blood being obtained for cortisol assay before and 30 and 60 min after injection, was done at the start, at week twelve, and at the end of simvastatin treatment

Residual B-cell function in insulin-dependent (type I) diabetics with and without retinopathy

SummaryIn order to evaluate if residual B-cell function is a protecting factor against the development of diabetic retinopathy in type I diabetics we measured C-peptide levels before and after glucagon stimulation (1 mg i.v.) in 74 type I diabetics. In all patients retinopathy was assessed by fluorescein angiography and retinal lesions were classified as: grade 0, normal; grade 1, background retinopathy; grade 2, proliferative retinopathy. We then correlated the degree of retinopathy to sex, age, duration of diabetes, smoking, percentage of ideal body weight, systolic and diastolic blood pressure, serum cholesterol, triglycerides, creatinine and C-peptide by means of multiple linear regression analysis. Twenty-three out of 74 type I diabetics had retinopathy. In all 7 subjects with proliferative retinopathy duration of diabetes exceeded 10 years. There was significant correlation between retinopathy and duration of diabetes (r=0.373, p<0.001). No correlation was found between retinopathy and all the other variables, in particular between retinopathy and basal C-peptide or C-peptide increment (Δ). An inverse correlation was found between the increment of C-peptide and duration of diabetes (r=−0.404, p<0.01). Our data show that residual B-cell function cannot be considered a protecting factor against the development of diabetic retinopathy.

Effects of fish oil on serum lipids and lipoprotein(a) levels in heterozygous familial hypercholesterolemia

Abstract Ten patients (mean age, 49 ± 14 years) with heterozygous familial hypercholesterolemia who had high levels of lipoprotein (Lp)(a) (>30 mg/dl) and were receiving chronic treatment with simvastatin were treated with six capsules a day of fish oil for 4 weeks. Each 1-gm fish oil capsule contained almost 850 mg of omega-3 fatty acids with a ratio of eicosapentaenoic acid:docosahexaenoic acid of 1:1; the total daily dosage of omega-3 fatty acid was 5.1 gm/day. After 2 and 4 weeks of fish oil supplementation, mean serum Lp(a) levels did not change significantly (baseline, 67 ± 29 mg/dl; week 2, 68.3 ± 35 mg/dl; week 4, 60.6 ± 26 mg/dl). Triglyceride levels decreased by 23% after 2 weeks (from 1.355 ± 0.38 mmol/L to 1.05 ± 0.35 mmol/L) and by 33% after 4 weeks (to 0.91 ± 0.18 mmol/L) ( P P

Effects of a gluten-free diet on serum lipids and lipoprotein (a) levels in a group of patients with celiac disease.

SummaryThe influence of nutrient absorption, caloric content, and diet on lipoprotein (a) [Lp(a)J concentration is uncertain. To our knowledge, there are no reports on Lp(a) behavior in malabsorption. Serum lipids and Lp(a) concentrations were evaluated in 17 celiac patients (5 male and 12 female patients; age range, 1–24 years) when the diagnosis was established and after a 3-month gluten-free diet. Mean total and low-density lipoprotein cholesterol did not show significant change, while mean high-density lipoprotein cholesterol rose and triglycerides decreased significantly after the diet. The Lp(a) concentration remained unchanged in all patients (median values, 35 mg/L before and 40 mg/L after the diet). Our results suggest that, in our patients, the lipoprotein profile was influenced by the gluten-free diet, while the Lp(a) concentration was not modified.

Serum Lipoprotein(a) Is Not Increased in NIDDM Patients With Microalbuminuria

DW: Is the corrected QT interval a reliable indicator of the severity of diabetic autonomic neuropathy? Diabetes Care 16: 1249-1253, 1993 2. Kempler P, Varadi A, Szalay F: Autonomic neuropathy in liver disease. Lancet II: 1332, 1989 3. Kempler P, Varadi A, Tamas Gy: Autonomic neuropathy in newly diagnosed diabetes mellitus. Diabetes Care 16:848-849,1993 4. Ewing DJ, Clarke BF: Diagnosis and management of diabetic autonomic neuropathy. BrMedJ 285:916-918, 1982 5. Bazett HC: An analysis of time: relations of electrocardiograms. Heart 7:353-370, 1920 6. GoninJM, Kadrofske M, Schmaltz S, Bastyr EJ, Vinik AI: Corrected QT interval prolongation as diagnostic tool for assessment of cardiac autonomic neuropathy in diabetes mellitus. Diabetes Care 13:68-71, 1990 7. Ahnve S, Gilpin E, Madsen EB, Froelicher V, Henning H, Ross J: Prognostic importance of QTC interval at discharge after acute myocardial infarction: a multicenter study of 865 patients. Am Heart] 108:395400, 1984

Diabetes mellitus as presenting feature in extra-adrenal pheochromocytoma: Report of a case

SummarySecondary diabetes mellitus was the main abnormal finding in a young lean woman with benign extra-adrenal para-aortic norepinephrine and dopamine secreting pheochromocytoma. Glucose and insulin response to oral glucose and C-peptide secretion after glucagon i.v. were evaluated before and after alpha-blockade with phenoxybenzamine. Alpha-blocking treatment restored the inhibited basal and stimulated C-secretion but did not normalize glucose tolerance. After tumor removal metabolic abnormalities were normalized, confirming the role of endogenous catecholamine excess in the pathogenesis of our patient’s glucose intolerance.

Sinus Histiocytosis With Massive Lymphadenopathy (Rosai-Dorfman Disease) Involving the Ovary

A 66-year-old woman affected by sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) is described. She presented with renal and ovarian masses. Percutaneous fine-needle aspiration was performed. Histologic specimens showed numer ous histiocytes that contained lymphocytes or plasma cells in their cytoplasm. Strong reac tivity for histiocyte-associated antigens was diffusely present in these cells. She was treated with prednisone and cyclophosphamide; a partial remission was obtained. Int J Surg Pathol 2(4) :329-332, 1995

Severe microvascular disease in type II diabetes of early onset. A family study

SummaryBoth early onset and late onset type II diabetes were present in one family of nine siblings. The three early onset type II diabetic siblings showed severe microvascular complications: proliferative retinopathy, diabetic nephropathy, and peripheral neuropathy. Early onset type II diabetes was not associated with any particular HLA haplotype. Early onset type II diabetes could be considered a clinical and genetic disease entity different from MODY type diabetes.

Continuous basal insulin infusion without premeal boluses in insulin-dependent diabetes mellitus therapy

SummarySix insulin-dependent diabetic patients, poorly controlled on conventional insulin therapy (CIT), underwent continuous basal insulin infusion (CBII) and continuous subcutaneous insulin infusion (CSII) during 2 subsequent periods of 1 month each, employing a Betatron II insulin infusion pump (Lilly, CPI). During CSII, insulin was infused at a continuous basal rate with 3 premeal boluses. During CBII, from 2200 to 0600 a continuous basal nocturnal insulin infusion rate and from 0600 to 2200 a diurnal one, which was approximately twice the former, were maintained and total daily calorie intake was subdivided into 6 isoglycidic and isocaloric meals, taken at regular intervals. We obtained better blood glucose control both by CSII and CBII than by CIT, with significant reduction of HbA1 values. Mean blood glucose levels were lower during CBII than during CSII, while M-index, number of hypo- and hyperglycemic events and insulin requirement were not different. However, daily blood glucose excursions were narrower and percent blood glucose increment after the noon meal was reduced during CBII. CBII insulin profile was characterized by a plateau trend with lower levels at meals in comparison with CSII. Our data show that the subdivision of daily calorie intake into 6 isocaloric and isoglycidic meals allows to achieve good metabolic control by continuous basal insulin infusion without need for premeal boluses and could be especially useful in brittle diabetic patients, whose brittle condition may be caused by erratic absorption of subcutaneous boluses of insulin.