Biomedical subjects

A Mancini

Publications and source records attributed to A Mancini.

At least 109 records · Page 6Linked to original sources

PubMed1993

Localized but unresectable neuroblastoma: treatment and outcome of 145 cases. Italian Cooperative Group for Neuroblastoma.

PURPOSE: To define factors that influence outcome in children with localized but unresectable neuroblastoma by retrospective investigation of response to therapy and outcome in 21 Italian institutions. PATIENTS AND METHODS: Of 145 assessable children diagnosed between 1979 and 1990, 77 were treated between 1979 and 1984 with three consecutive standard-dose (SD) protocols, and 68 between 1985 and 1990 with a high-dose (HD) protocol. All protocols included chemotherapy, followed by resection of primary tumor if feasible. If at least partial resection was achieved, consolidation therapy followed, except that from 1985 onward, patients considered disease-free following surgery received no further treatment. RESULTS: Ninety-four of 145 patients (65%) achieved a complete response (CR) or partial response (PR) with chemotherapy and 75 (52%) subsequently underwent complete resection of the primary tumor. Eighty-one patients are alive (73 without disease, eight with disease), 63 have died, and one is lost to follow-up. The 5-year overall survival (OS) rate is 55% and progression-free survival (PFS) rate 50%. Both OS and PFS correlated with response to chemotherapy, removal of primary tumor, HD therapy, and serum lactate dehydrogenase (LDH) levels. Infants (< 1 year), independent of primary tumor site, and children aged 1 to 15 years with a nonabdominal primary tumor, did better compared with children aged 1 to 15 years with an abdominal primary tumor (PFS, 72% and 64% v 30%; P < .001 and < .01, respectively). Outcome of this last group improved with the HD protocol (PFS, 40% v 23%; P = .01). CONCLUSION: In children with unresectable neuroblastoma, risk categories can be defined by age and primary tumor site. HD chemotherapy should be investigated for the poor-risk category age 1 to 15 years with an abdominal primary tumor.

Adolescent↗

PubMed1993

Rectal metal stents for palliation of colorectal malignant stenosis.

Thirteen patients with colorectal obstructing tumors were submitted to endoscopic insertion of self-expanding metal stents to restore luminal patency. The procedure was performed entirely under endoscopic control, without using fluoroscopy, during a 1-day hospitalization. The prostheses were correctly placed in 12/13 patients (92%), with no immediate complications. The mean follow-up is 7 months. Ten out of 12 patients (83%) had a permanent restoration of the luminal patency; they experienced no pain, tenesmus or any other discomfort during the follow-up period. In the remaining 2 patients long-term complications occurred and were treated by endoscopy in 1 case, and by surgical resection in the 2nd case. Self-expanding metal stents proved to be safe and effective; the main drawbacks, at present, are the lack of effectiveness of these devices in case of a fistula and their high costs.

Adult↗

PubMed1993

Naloxone effects on post-prandial glucose, insulin and C-peptide levels in obese subjects.

In order to investigate the relationships between glucose metabolism, insulin secretion and endogenous opioids in obese patients, we have studied the effects of a naloxone infusion on insulin and C-peptide release after a normal meal (800 kcal) eaten at 12.00 hr in 16 obese women, aged 20-61 yr, with a BMI ranging from 25 to 37.2 kg/m2, with normal glucose tolerance (Group 1) and with NIDDM (Group 2). Naloxone was administered in a bolus of 1.6 mg i.v., followed by a continuous infusion of 4 mg in 2 hr starting immediately after feeding. In Group 1 naloxone infusion significantly increased the glucose levels, but insulin secretion was unaffected. In Group 2, naloxone infusion failed to modify significantly the postprandial levels of glucose, insulin and C-peptide. Therefore, in our study naloxone infusion seems to have beta-endorphin-like effects in non-diabetic obese subjects by increasing their glycemic levels, with no evidence of expected insulin decrease. In diabetic obese patients we observed a trend towards decrease in glycemic values during naloxone infusion, as expected, due to insulin plasma levels increase. By these data we can hypothesise a complex regulatory role of opioids in metabolic balance in obesity. In diabetic patients, naloxone can improve the surviving insulin secretion with better glucose tolerance. In non-diabetic subjects naloxone exerts its effects, probably, on peripheral organs.

Adult↗

PubMed1993

[Lymphocytic infiltration in thyroid neoplasms. Preliminary prognostic assessments].

INTRODUCTION: It is known that the immune system is involved in several thyroid diseases and in the reaction against cancer progression. We have therefore evaluated lymphocytic infiltration in the slices of surgically removed thyroids in patients affected by thyroid carcinomas, to further clarify the anatomic and clinical characteristics of this pathology and the possible prognostic correlations. MATERIALS AND METHODS: Thirty-eight patients, 7 men and 31 women, aged 23-73 years, were studied. They underwent total or subtotal thyroidectomy for thyroid carcinoma. The histopathological findings were: papillary carcinomas (P): 22 cases; follicular carcinomas (F): 10 cases; undifferentiated carcinomas (U): 3 cases; other types (e.g., medullary carcinoma, M): 3 cases. RESULTS: The lymphocytic infiltration was evaluated in 4 different grades. The following results, regarding the different histological types, were found: grade 0 (no lymphocytic infiltration) in 10 cases (6 P, 2 F, 1 U, 1 mixed); grade 1 (poor lymphocytic infiltration, equivalent to a non specific inflammatory reaction) in 21 cases (11 P, 6 F, 2 U, 1 M); grade 2 (moderate lymphocytic infiltration) in 4 cases (2 P, 2 F); grade 3 (plentiful lymphocytic infiltration) in 3 cases (2 P, 1 trabecular carcinoma). In 3 patients a lymphocytic (Hashimoto's) thyroiditis was also present. The follow-up, 2 years after surgery, showed, among 17 patients examined, local recurrence and/or lymph node localization in 8 cases (the lymphocytic infiltrations was: grade 1: n = 6; grade 0: n = 2; no one exhibited a higher grade) and apparent remission in 9 (grade 3: n = 2; grade 2: n = 1; grade 1: n = 6; no one exhibited a grade 0 lymphocytic infiltration). DISCUSSION: In most patients a poor or absent infiltration was found. In 7 cases, however, the infiltration was moderate or high. In our experience, no correlation between the histologic type and the infiltration grade was observed. However, in no patient with recurrence of neoplasia a relevant (grade 2-3) infiltration could be observed; patients without recurrence often showed a grade 2-3 infiltration, and no one of them showed a grade 0. The significance of lymphocytic infiltration in thyroid carcinoma is not well clarified. In fact, a few studies underline a possible unfavourable role, since a relevant infiltration seems to be associated with a weak cell-mediated immunity, mostly in follicular and anaplastic carcinomas. However, most data support the hypothesis that the lymphocytic infiltration is a good prognostic feature: in fact, it can be often found in papillary carcinomas and in juvenile thyroid carcinomas, both characterized by a good long-term prognosis. CONCLUSIONS: Our preliminary data underline the opportunity of comparing the clinical course of the disease, the histologic grading and the tumour staging with the lymphocytic infiltration grade, an easily available pathologic datum, for a better prognostic evaluation of patients.

Adult↗

PubMed1993

[Gastroenterologic pathology and replacement organotherapy in thyroidectomized patients].

Thyroid replacement therapy in patients treated by near-total or total thyroidectomy, as well as spontaneous hypothyroidism , can be difficult in patients with alterations in absorption functions or specific gastroenteric diseases. We have studied 25 patients, 22 women and 3 men, 18-72 years old (mean 47 years), affected by spontaneous or post-surgical hypothyroidism, who presented, during the usual replacement therapy, persistently elevated or high-normal TSH levels, and therefore required repeated variations in the prescribed dose of thyroxine. In these patients we evaluated hormone pattern, the presence of autoantibodies (anti-tyroglobulin, anti-Sm, anti-DNA, anti-microsomal antigens, anti-gliadin and anti-parietal cell), and performed an esophagogastroduodenoscopy (EGD) with histological examination. In all patients, plasma TSH ranged from 2.5 to 20 microU/ml. Only 17% of patients exhibited the presence of antibodies against thyroglobulin, 17% of patients had antibodies against microsomal antigens, 6% of patients presented antibodies against nuclear antigens; 4% had against gliadin. Histological examination revealed chronic gastritis (98%) with atrophic aspects (20%) and intestinal metaplasia (28%); and chronic duodenitis (86%) with villus abnormalities (23%) and total villus atrophy (4%). We underline the case of a patient, treated by total thyroidectomy for papillary carcinoma, who presented, two months after starting L-thyroxine therapy, a recurrence of celiac disease, that had been silent after childhood. The EGD showed, at the level of the second duodenal segment, a reduction of number and thickness of mucosal folds; the histological examination showed total villus atrophy, elongated crypts and a dense infiltration of chronic inflammatory cells in the lamina propria. Our experience underlines the frequent association of gastroenteric disease and hypothyroidism.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

[Adrenal gland cysts. Our experience].

Adrenal cysts are an uncommon finding, in most cases unexpectedly discovered in the evaluation of nonspecific abdominal pain or at autopsy. Cystic adrenal masses can be classified into neoplastic and non-neoplastic aetiologies. The distinction between malignant and benign adrenal cysts can still be difficult. Cysts of neoplastic aetiology occur as a result of necrosis and cystic degeneration within both benign and malignant tumours. Non-neoplastic cysts have been conventionally divided into four categories: endothelial (45%), haemorrhagic or pseudocystic (39%), epithelial (9%) and parasitic (7%). Small adrenal cysts are clinically silent, while cysts of large size can cause displacement and compression of adjacent organs. The radiological aim is to detect the adrenal mass and CT is regarded as the best method available for this detection, although a differentiation between benign and malignant tumours can be difficult. Here we report our experience in nine patients with adrenal cysts. Abdominal pain was the dominant sign, two patients were hypertensive, one presented a palpable mass at abdominal examination and another presented oligomenorrhea with hypertrichosis, in five patients the adrenal mass was discovered unexpectedly during radiologic examination. All cysts in our patients were unilateral. All patients were examined by ultrasound and CT, one by RM, three by 75Se-Seleniumcholesterol cortical scintigraphy and two by 131I-MIBG medullary scintigraphy. In three patients a percutaneous aspiration of the cyst was performed via a posterior approach with CT or US guidance. This approach has been used for diagnostic and therapeutic purposes. Examination of aspirated cyst fluid for steroid hormones showed markedly elevated cortisol levels compared with normal plasma cortisol levels in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Gland Diseases↗

PubMed1993

[A case of adrenal adenoma with radiologic "cystic" appearance associated with hypophyseal adenoma].

Expansive lesions of the adrenal glands without signs of hormonal hypersecretion are usually discovered "incidentally", and are therefore called "incidentalomas". Since the silent adrenal masses constitute a heterogeneous group of lesions, the most important issue raised by the identification of these masses is their possible malignant potential. Therefore, the age and sex of the patients, the size of the mass, its imaging characteristic and its histologic features are the most important factors in the assessment of nonfunctioning adrenal masses. We report here the case of a women, aged 43 years mild hypertension, harbouring a great adrenal mass of 8 cm diameter, with cystic appearance at CT scan and ultrasonography, it did not show any uptake after 75Se-Seleniumcholesterol or 131I-Metaiodobenzyl-guanidine. The patient was also affected by mild hyperprolactinemia caused a small pituitary adenoma. After selective venography, she underwent the surgical removal of the left adrenal gland with its mass, which showed a hystological picture of adrenal adenoma. The postoperative course was clinically normal. The interest of this case resides: in the dimensions of the adrenal tumor (the presence of adenomas greater than 6 cm diameter is extremely rare); in the radiographic findings, showing a cystic appearance, probably related to a fluid component, in the association of adrenal and pituitary adenoma, as a possible variant of multiple endocrine neoplasia (MEN) of type I.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗

PubMed1993

[Reevaluation of the I-dopa test in acromegaly: anatomo-clinical and prognostic correlations].

It is known that in acromegalic patients the GH secretion exhibits a pattern of response to various stimuli that differs from that observed in normal subjects. We have evaluated the paradoxical GH response to 1-Dopa in acromegaly, in order to clarify the relationships between this datum and the tumour size, the basal GH secretion, the GH response to TRH and the long-term prognosis. MATERIALS AND METHODS. 34 acromegalic patients, 12 men and 22 women, aged 35-70 yr, participated in this study. They were divided in 4 classes, according to Hardy's classification of pituitary neoplasias: (1) intrasellar microadenomas, < 10 mm (n = 8); (2) intrasellar macroadenomas, > 10 mm (n = 14); 3) adenomas with local expansion (n = 9); (4) adenomas with extrasellar expansion (n = 3). All patients underwent a 1-Dopa-test; 18 of them underwent a TRH-test. Basal postoperative GH and basal pre- and postoperative PRL levels were also determined. RESULTS. The basal preoperative GH values in all patients ranged between 16 and 278 ng/ml. 22 patients showed a paradoxical response to 1-Dopa, 12 were non-responders. The following results were observed in the different classes: [table: see text] Moreover, 10 subjects (56%) were TRH-responders (9 of them were also 1-Dopa-responders, 1 was non-responder) and 8 were TRH non responders (6 were 1-Dopa non-responders, 2 were 1-Dopa responders). Basal postoperative GH values were > 5 in 17 1-Dopa responders and in 9 non responders. Basal preoperative PRL levels were > 25 ng/ml in 7 1-Dopa responders and in 2 non responders. After surgery, basal PRL became normal in 5 responder patients. DISCUSSION. In a previous work we have correlated the paradoxical GH response to TRH with tumour size and GH levels, observing a higher percentage of paradoxical response in patients in class I and II and, postoperatively, lower GH levels in preoperative TRH responders. So, we have underlined the good prognostic feature of a preoperative paradoxical response. In this paper we have evaluated the paradoxical GH response to 1-Dopa in the different Hardy's classes and compared it with the GH levels and the GH response to TRH. The results show that a paradoxical response can be observed more frequently in small (class I) adenomas than in greater size ones, and in presence of lower GH basal levels. Moreover, a concordance between 1-Dopa and TRH tests can be observed. CONCLUSIONS. The results clearly indicate that the responses to dynamic GH tests should be evaluated considering the anatomic characteristics of the neoplasias. It could be suggested that the paradoxical response can be expressed only when hypothalamus-pituitary interactions are intact.

Acromegaly↗

PubMed1993

[Ultrasonography-guided alcohol injection in simple renal cysts. Long-term results].

The percutaneous treatment of simple renal cysts must be restricted to symptomatic lesions. It consists in a guided puncture, fluid aspiration and the injection of a sclerosing agent. The authors describe the procedure they followed, which has been made possible by technical progress. It consists in US guidance, a Trocar catheter drainage set and the injection of absolute alcohol. Moreover, the long-term results are reported of a retrospective study of 69/148 treated patients who underwent one or more US exams 15 days to 5 years after the procedure. Eleven of 69 patients (15.9%) exhibited complete regression, 42 of 69 (60.9%) had lesion relapse < 5 cm phi and 16 of 69 (23.2%) had > 5 cm relapse. On the whole, 53 (76.8%) positive results were obtained after the first treatment; positive results were obtained after the second treatment in 4 of 16 patients with > 5 cm relapse. US follow-up showed changes in the sizes of the relapsed cysts, which sometimes shrunk in the long run. All treated cysts reduced in volume; nevertheless, it would be useful to look for new sclerosing agents allowing a higher rate of complete regressions.

Adult↗

PubMed1992

Reversibility of the reactions catalyzed by cholinephosphotransferase and ethanolaminephosphotransferase solubilized from rat-brain microsomes.

The incorporation of CMP into CDP-ethanolamine and CDP-choline, catalyzed by ethanolaminephosphotransferase (EC 2.7.8.1) and cholinephosphotransferase (EC 2.7.8.2), respectively, has been studied in solubilized preparations of rat-brain microsomes. Mn2+ ions were required for the maximal activity of both enzymes. The CMP concentration needed to reach the half-maximal reaction rate was 1.6 microM for both activities. The rate of incorporation of CMP into CDP-choline and CDP-ethanolamine was increased by increasing the concentration of phosphatidylcholine and phosphatidylethanolamine, respectively, in detergent-phospholipid micellar systems. The rate of the reaction at pH 6.5 was comparable with that measured at pH 8.5, whereas the rate of synthesis of phosphatidylcholine and phosphatidylethanolamine, catalyzed by the same enzymes, increased with pH. Ethanolaminephosphotransferase, which catalyzes the synthesis of phosphatidylethanolamine from CDP-ethanolamine and diacylglycerol, was co-eluted with the enzyme activity catalyzing the reverse reaction, when solubilized microsomes were submitted to anion exchange chromatography on DEAE Bio-Gel A. Cholinephosphotransferase was inactivated during the chromatographic procedure.

Animals↗

PubMed1992

[Importance of cleansing in the topical treatment of skin lesions. A parallel study carried out in 20 patients and 30 rats].

There are frequent reports of the chronic nature of skin ulcers of varying etiology (burns, bedsores, wound diastasis, etc.); these heal with considerable difficulty probably due to problems related to the excessive use of disinfectants which, in spite of having a good bacterial action, interfere with re-epithelialisation processes. The aim of this study was to assess the value of simple wound cleansing instead of disinfection in those cases where there are no manifest signs of bacterial contamination. A widely sold solution, Katoderm (Devergè, Turin), was used in this study. The study was performed in two stages; the first in laboratory animals and the second in patients with small persistent lesions. The results of the study carried out in rats showed a significant prolongation of healing time in the group treated with polyvinylpyrrolidone-iodine compared to those in which lesions were only cleansed with Katoderm. The results of the clinical study also highlighted the faster speed of healing in patients treated with cleansing alone.

Administration, Topical↗

PubMed1992

Disseminated neuroblastoma (stage IV and IV-S) in the first year of life. Outcome related to age and stage. Italian Cooperative Group on Neuroblastoma.

BACKGROUND: Infants (age 0-11 months) with disseminated neuroblastoma are known to have a better prognosis than older children with the disease, but there is little information regarding factors that influence the outcome of the disease in these patients. METHODS: The authors report a series of 110 infants with disseminated neuroblastoma with disease diagnosed between March 1976 and February 1991 in 21 institutions participating in the Italian Cooperative Group on Neuroblastoma (ICGNB). Of the 110 infants, 34 had Stage IV disease, and 76 had Stage IV-S disease. RESULTS: The 5-year survival probability was 77% for all patients, 71% for those with Stage IV disease, and 81% for those with Stage IV-S disease. Of the 34 infants with Stage IV disease, the 9 who were 5 months or younger at the time of disease diagnosis are all alive (1 with active disease) at 7-143 months after diagnosis, whereas of the 25 infants who were 6-11 months of age at the time of disease diagnosis, 10 have died. Of the 76 infants with Stage IV-S disease, 12/64 who were 5 months of age or younger at the time of disease diagnosis died (mostly of massive hepatomegaly); 9 of these deaths occurred in infants with disease diagnosed before they were 2 months old, whereas 1 death occurred in the 12 infants with disease diagnosed when they were 6-11 months old. Four infants with Stage IV-S disease achieved complete disease remission and subsequently had relapse of disease. High levels of serum LDH and low urinary excretion of vanillylmandelic acid were associated with worse prognosis. CONCLUSIONS: The authors suggest that infants older than 6 months of age who have Stage IV disease require aggressive therapy. For infants with disease diagnosed before they are 2 months old, Stage IV-S disease may have a worse prognosis than Stage IV disease.

Age Factors↗

PubMed1992

Serum markers of immune activation and liver allograft rejection.

We monitored the immune response after liver transplantation in 20 patients by measuring the serum levels of soluble interleukin-2 receptor (sIL-2R), soluble CD8 (sCD8), serum amyloid-A protein (SAA), and tumor necrosis factor-alpha (TNF-alpha). In six patients data were available to extend the follow-up period to one year. In all patients mean sIL-2R levels increased in the first month after liver transplantation, and subsequently decreased to values similar to pre-OLT ones, while SAA mean levels rose in the first week after OLT only in patients with rejection. sCD8 levels did not significantly rise after OLT, and TNF-alpha was undetectable in most cases. During episodes of rejection, rejector patients had significantly higher levels of sIL-2R, sCD8, and SAA than stable (without complications) patients. Conversely, no significant difference between rejectors and patients with other complications existed for any of the markers studied. These results diminish the importance of these serum markers of immune activation as laboratory tools in the differential diagnosis of acute rejection from other complications. However, sIL-2R, SAA, and sCD8 levels correlated with the histological grade of rejection and therefore can be utilized to monitor patients with an established diagnosis of acute rejection.

Biomarkers↗

PubMed1992

Effect of intra-arterial versus intravenous cisplatin in addition to systemic adriamycin and high-dose methotrexate on histologic tumor response of osteosarcoma of the extremities.

In neoadjuvant treatment of osteosarcoma of the extremities intra-arterial (IA) instead of intravenous (IV) administration of cisplatinum (CDDP) has been advocated to improve local response and consequently increase the percentage of limb salvages and the cure rate. Since the major local advantages from the IA use of CDDP have been recently questioned, a comparative prospective study was performed at the Rizzoli Institute between July 1990 and September 1991. Preoperative chemotherapy consisted of two cycles of high-dose methotrexate (HDMTX), followed 6 days later by CDDP and adriamycin (ADM), HDMTX and ADM were delivered intravenously while CDDP was delivered according to previous randomization, either intra-arterially or intravenously. Of the 79 patients who entered the study 40 received CDDP IA and 39 CDDP IV. The percentage of clinical and radiological response of the tumor as well as the percentage of limb salvage procedures performed was the same in the two groups. However the rate of good histological response (tumor necrosis greater than 90%) was significantly higher in the group of patients who received IA CDDP than in the patients who received the drug intravenously (77.5% vs 46%: p less than 0.01). No differences in terms of local or systemic side effects were found in the two groups. A longer follow-up is necessary to establish if this improved good response rate achieved with IA CDDP will lead to an improved cure rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1992

Influence of pyridostigmine on growth hormone (GH) response to GH-releasing hormone pre- and postprandially in normal and obese subjects.

The effect of pyridostigmine (PYR), an inhibitor of acetylcholinesterase, on the GH response to GH-releasing hormone (GHRH) before and after a meal was studied in 14 normal subjects (8 females and 6 males) and 21 obese subjects (13 females and 8 males). In normal subjects tested in a fasting state, PYR was capable of stimulating GH secretion and increasing the GH response to GHRH. These effects were not apparent after food, suggesting a reduction in cholinergic hypothalamic activity. In obese subjects tested in a fasting state, PYR was ineffective when administered alone. On the contrary, it was able to increase the GH response to GHRH. After food, the augmenting effect of PYR on the GH response to GHRH was not observed, whereas a delayed inhibition of the GH response was found after PYR plus GHRH treatment. Our findings support the hypothesis that cholinergic hypothalamic activity plays a pivotal role in impaired GH regulation and the altered sensitivity of GH secretion to metabolic fuels in obese subjects.

Adult↗

PubMed1992

Conversion of the arthrodesed hip to a total hip arthroplasty. Indications and limitations.

Arthrodesis of the hip is thought to achieve satisfactory clinical and functional results in the adult despite the loss of articular mobility involved (Santori et al., 1986; Russel, 1987; Weber, 1987). Over the long term, however, most patients develop secondary degenerative arthritis in the spine, contralateral hip, and knees due to overloading. The deteriorating condition of these joints eventually causes the onset of pain, which often requires further intervention. Surgery on these joints may yield satisfactory short-term results, but these will not last if the arthrodesed hip is not converted to total hip arthroplasty either prior to or at the same time as such operations.

Adult↗

PubMed1992

The cementless PCA primary total hip system. Medium-term follow-up of 235 cases.

The Porous Coated total hip Arthroplasty (PCA), used by the authors since August 1984, represents a considerable advancement in the field of prosthetic replacement. Its original design and biological fixation give it long-lasting stability not only in young patients, but also patients with initial osteoporosis. Its use in cases of advanced osteoporosis, however, is more controversial. The 8-year results are quite satisfactory from both a clinical and radiographic standpoint, confirming, as other authors have reported, that the medium and long-term results of cementless total hip replacement tend to stabilize because there is a lack of late reactions, which are more common in cemented implants.

Adult↗

PubMed1992

Calcium antagonists and hormone release. VIII. Effects of verapamil infusion on C-peptide to insulin molar ratio in normal subjects and obese subjects with normal glucose tolerance.

It is known that calcium-antagonist drugs can modify the insulin response to various secretagogues. In order to clarify whether calcium-antagonist effect was directed at the level of pancreatic insulin secretion or hepatic insulin extraction and further investigate the pathogenesis of hyperinsulinemia in obesity, an oral glucose tolerance test (OGTT) was performed in basal conditions and during a Verapamil infusion (VE, 5 mg/h x 3.5 h) in 12 normal subjects and 14 obese patients with normal glucose tolerance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗