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Biomedical subjects

L Grasso

Publications and source records attributed to L Grasso.

At least 73 records · Page 4Linked to original sources
PubMed1991

Blood pressure pattern importance in the development of left ventricular hypertrophy in hypertension.

Heterogeneous results regarding correlations between blood pressure, (measured by various methods and in different conditions), and left ventricular mass in arterial hypertension have been reported. Fifty-three essential hypertensives, I-II WHO stage, have been studied in order to verify the relationship between office and average 24-hour blood pressure, and its day- and night-time pattern with left ventricular hypertrophy. All patients had newly diagnosed essential hypertension, and no subject had received any antihypertensive therapy before entry. The subjects underwent 24-hour blood pressure monitoring, evaluating the average of 24 hours, day- and night-time blood pressures, and M-mode echocardiography. Neither subjects with nor without left ventricular hypertrophy showed correlations between office blood pressure and left ventricular mass. On the contrary, average 24-hour systolic and diastolic blood pressure resulted related to left ventricular mass (r = 0.36 and 0.40, p less than 0.01 respectively). Furthermore, in the subgroup with left ventricular hypertrophy, left ventricular mass was correlated directly with nocturnal systolic blood pressure (r = 0.46) and inversely with the rate of nocturnal decrease in systolic pressure (r = -0.60, p less than 0.01). These results appear to confirm the usefulness of 24-hour blood pressure monitoring in evaluating cardiac afterload in essential hypertension, and the important role that the 24-hour systolic pressure has in the development of left ventricular hypertrophy in these subjects.

Adult↗
PubMed1990

Lack of nocturnal serum thyrotropin surge after surgery.

The effects of surgery on TSH secretion, with particular regard to the nocturnal TSH surge, were evaluated in 10 consecutive patients followed for 6 days after surgery. Surgical trauma was associated in all patients with significant decreases in serum total and free T3 and a significant increase in serum rT3 levels, with no variations in serum total and free T4 concentrations. A marked increase in serum cortisol levels was observed, with higher values at night than in the morning. Serum cortisol levels and circadian rhythm normalized on the fifth day. Serum TSH values in the morning significantly decreased on the first day after surgery and returned to normal on the second day. Serum TSH values at night (2400-0200 h) were higher than in the morning preoperatively, but the nocturnal surge was abolished from days 1-5 after surgery and was restored only on the sixth day. Thus, surgery was associated with a prolonged loss of the nocturnal serum TSH surge. This effect on TSH secretion was more marked than predictable on the basis of serum TSH measurements in the morning alone. An inverse relationship was found between serum cortisol and serum TSH values at night, suggesting that the excessive endogenous cortisol secretion might play a role in the derangement of TSH secretion.

Adult↗
PubMed1989

Epinephrine and norepinephrine pattern in elderly patients with borderline and established hypertension.

To evaluate the activity of sympathetic system and of plasm renin in elderly patients with borderline (BH) and established essential hypertension (EH), 31 BH mean age 38 years and 30 EH, mean age 39 years; 15 BH, mean age 66 years, and 15 EH, mean age 68 years, were studied at rest and after dynamic exercise. At the same time blood pressure and heart rate were automatically recorded, while blood samples were collected for PRA and plasma epinephrine (E) and norepinephrine (NE) assays. Plasma E levels showed no significant differences between the groups examined at rest. Nevertheless, young BH had higher plasma E levels than young EH after stress and elderly BH showed plasma E levels higher than age-matched EH in response to dynamic exercise. The PRA behaviour was similar among all the groups, but dynamic exercise induced a greater increase in BH than in EH. Moreover, the stress-induced increase in plasma NE levels was higher in EH than in BH. Our results demonstrate in old BH, as well as in young BH, a response of E to stress greater than in the age-matched EH. In our study BH, both young and old subjects, seem to be characterized by a sympathoadrenal overactivity pointed out by an excessive release of E from the adrenal gland after stress. This exaggerated sympathoadrenal reactivity may constitute an important mechanism in triggering hypertension independent of age.

Adult↗
PubMed1988

Free thyroxine and free triiodothyronine measurement in dried blood spots on filter paper by column adsorption chromatography followed by radioimmunoassay.

Free thyroxine (FT4) and free triiodothyronine (FT3) were measured by column adsorption chromatography followed by radioimmunoassay in dried blood spots on filter paper in euthyroid subjects, hyperthyroid and hypothyroid patients, and in subjects with TBG excess. The sensitivity (B/T% = 95%) was 1.5 pg/ml (working range 1.5-46.4 pg/ml) for FT4 and 1.5 pg/ml (working range 1.5-32.0 pg/ml) for FT3. Intraassay coefficient of variations (CVs) ranged 4.4-8.8% for FT4, 8.7-10.1% for FT3; interassay CVs varied from 8.9-9.0% for FT4, 9.3-10.4% for FT3. FT4 and FT3 values found in dried blood spots were highly correlated with the corresponding values in serum (r = 0.97, P less than 0.001 for FT4; r = 0.96, P less than 0.001 for FT3). FT4 concentrations in dried blood spots ranged 8.1-20 pg/ml in euthyroid subjects, 19.4-60.0 pg/ml in hyperthyroid patients, less than 1.5-7.1 pg/ml in hypothyroid patients, 7.8-18.8 pg/ml in euthyroid subjects with TBG excess. FT3 values in dried blood spots ranged 2.5-5.8 pg/ml in euthyroid subjects, 7.1-30.0 pg/ml in hyperthyroid patients, less than 1.5-2.8 pg/ml in hypothyroid patients, 2.5-5.2 in euthyroid subjects with TBG excess. The results of the present study, while confirming previous data on FT4 determination in dried blood spots, represent the first report on FT3 measurement in the same system, thus allowing a more complete assessment of thyroid status made by mail at the expense of few drops of blood.

Adolescent↗
PubMed1988

Oral thyrotropin-releasing hormone treatment in inherited ataxias.

We studied the effectiveness of orally administered thyrotropin-releasing hormone (TRH) (40 mg/day) for 10 days against placebo in 11 patients with hereditary ataxias (HA). All patients completed the trial and none reported any noticeable side effects. A clinical rating scale for inherited ataxias and the Northwestern University Disability Scale for clinical disability showed no significant variation over the duration of the study. Manual dexterity, studied with the peg board test, showed a significant improvement after TRH compared with basal values, which persisted after washout. Eye movement alterations, as revealed by electroculography were reduced after TRH and washout when compared with placebo and basal scores. Hormonal monitoring showed only a transitory effect on the hypothalamus-hypophysis-thyroid axis. These results demonstrate that orally administered TRH has a mild but significant effect only on some cerebellar symptoms in HA.

Administration, Oral↗
PubMed1988

Usnic acid revisited, its activity on oral flora.

The antibacterial activity of usnic acid, the most widely distributed antibiotic among the numerous ones produced by many lichen species has been re-examined and particular attention has been devoted to the activity of optically active forms of usnic acid against Streptococcus mutans. The D(+) enantiomer was found to be more active than the L(+) form and was observed to exert a rather selective activity against S. mutans. Trials carried out in volunteers showed that mouth-rinse with D(+) usnic acid preparations exerted a selective and long lasting action against S. mutans, without substantially altering the equilibrium of normal oral bacterial flora. The adherence of S. mutans to smooth surfaces is not increased by the presence of subinhibiting concentrations of D(+) usnic acid. This is at variance with what has been observed with other antibiotics. These characteristics make D(+) usnic acid a suitable candidate for topical use in oral medicine.

Benzofurans↗
PubMed1988

Sympathetic activity in borderline and established hypertension in the elderly.

Although increased sympathetic outflow has been implicated in the induction of early essential hypertension, the increase in norepinephrine with advancing age could reflect a compensatory mechanism for a declining peripheral response to adrenergic stimuli or an age-related decrease in norepinephrine clearance. To evaluate the activity of the sympathetic system and of plasma renin in elderly patients with borderline and established essential hypertension, 31 borderline hypertensives aged less than 60 years (mean age 38 years), 30 established essential hypertensives aged less than 60 years (mean age 39 years), 15 borderline hypertensives aged greater than 60 years (mean age 66 years) and 15 essential hypertensives aged greater than 60 years (mean age 68 years) were studied at rest and after dynamic exercise. Blood pressure and the heart rate were automatically recorded and blood samples were collected for plasma renin activity and plasma epinephrine and norepinephrine assays. Plasma epinephrine levels showed no significant differences between the groups examined at rest. Nevertheless, young borderline hypertensives had higher plasma epinephrine levels than young essential hypertensives after stress, and elderly borderline hypertensives showed higher plasma epinephrine levels than the age-matched essential hypertensives in response to dynamic exercise. The plasma renin activity profile was similar among all the groups, but dynamic exercise induced a greater increase in borderline than in essential hypertensives. Moreover, the stress-induced increase in plasma norepinephrine levels was higher in essential than in borderline hypertensives. Our results show a greater epinephrine response to stress in elderly and young borderline hypertensives than in age-matched essential hypertensives.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Serum TSH measurements by a sensitive enzyme immunoassay discriminate euthyroid from hyperthyroid subjects and avoid the need for TRH test during suppressive therapy with L-thyroxine.

Serum TSH was determined photometrically by a recently developed enzyme immunoassay (EIA) based on the use of a monoclonal antihuman TSH-beta antibody and a polyclonal antiTSH antibody coupled to horseradish peroxidase. The results obtained in patients with various thyroid disorders and in normal controls were compared with those achieved by conventional double antibody radioimmunoassay (RIA). In normal subjects, serum TSH was detectable in all cases by EIA (values ranging from 0.27 to 5.1 mU/L), but only in 76% by RIA. Ninety-two percent of hyperthyroids had undetectable serum TSH by EIA and the remaining 8% had values between 0.2 and 0.4 mU/L. In clinically euthyroid patients with nontoxic goiter, 9% had undetectable serum TSH by EIA, suggesting the presence of autonomously functioning areas within the thyroid. Serum TSH under basal conditions and after TRH stimulation was measured in 45 patients on L-thyroxine suppressive therapy. Undetectable basal serum TSH by EIA was associated with a lack of TSH response to TRH in 95% of cases. Conversely, 37.5% of patients with undetectable basal serum TSH by RIA had a normal or blunted response to TRH. Detectable basal values were predictive of a normal response to TRH by both methods. These data indicate that basal serum TSH measurement by EIA allows an almost complete differentiation of normal from thyrotoxic patients and can avoid the need of the TRH stimulation test.

Adolescent↗
PubMed1987

Clinical usefulness and limitations of serum thyrotropin measurement by 'ultrasensitive' methods. Comparisons of five kits.

Five different ultrasensitive thyrotropin (TSH) assay kits (Boots-Celltech, Immunotech, ORIS-CIS, Travenol and Boehringer) have been used for TSH measurements in various conditions. All the kits were based on an immunometric method but differed with regard to components and procedure. The sensitivity appeared essentially the same for the five kits (0.10 microU/ml) as well as the intraassay precision (coefficient of variation less than 12%). In contrast, the interassay coefficients of variation in the low TSH range varied from 12.8 to 21.3%. Discrepancies from kit to kit were observed and accounted for by differences in the components and procedure of the kits. Basal serum TSH was determined in normal subjects (n = 261) and in patients with thyroid dysfunction (n = 392). No overlap was shown between normals and patients with overt hypothyroidism. In contrast, an overlap existed between normals and hyperthyroids for all the kits but one. Measurements in patients with nontoxic goiter showed that TSH may be undetectable in clinically euthyroid patients, whatever the kit used. After TRH stimulation, 95% of the 375 patients tested associated either an absence of response to TRH with undetectable basal TSH values, or a blunted response with low basal TSH levels or normal response with normal basal TSH concentrations. However, 9 patients with suppressed TSH showed a response to TRH and 7 patients with normal basal TSH levels presented an exaggerated response to TRH. Taken together, these results demonstrate that even though ultrasensitive measurements of TSH do not meet the expectation of completely discriminating euthyroid from hyperthyroid patients, ultrasensitive TSH assay kits represent a powerful tool in the diagnosis of thyroid dysfunction, which would eliminate, in most instances, the need for TRH test and diminish thyroid hormone assay requests.

Adolescent↗
PubMed1987

Factors affecting suppression of endogenous thyrotropin secretion by thyroxine treatment: retrospective analysis in athyreotic and goitrous patients.

UNLABELLED: Factors affecting TSH suppression by L-T4 administration were retrospectively evaluated in 452 patients: 180 who were athyreotic after total thyroidectomy and remnant radioiodine ablation for differentiated thyroid carcinoma and 272 with nontoxic diffuse or nodular goiter. All patients were considered clinically euthyroid. TSH secretion was assessed by iv TRH stimulation testing. The T4 dose associated with an undetectable basal serum TSH level and no increase in serum TSH after TRH administration (suppressive dose) averaged 2.7 +/- 0.4 (SD) micrograms/kg body weight (BW)/day in athyreotic patients and 2.1 +/- 0.3 micrograms/kg BW/day in goitrous patients (P less than 0.001). The 25th-75th percentile intervals were 2.5-2.9 micrograms/kg BW/day for athyreotic patients and 1.9-2.3 micrograms/kg BW/day for goitrous patients. The suppressive dose of T4 was dependent in both groups on patient age, younger patients needing higher doses than older patients. The duration of treatment also proved to be an important parameter, since in both groups the percentage of patients with suppressed TSH secretion increased if TRH testing was carried out after at least 6 months after the initiation of therapy. Serum total T4, total T3, free T3 (FT3), free T4 (FT4) index, and FT3 index values did not differ in the two groups and were significantly higher (P less than 0.001) than in normal subjects. Mean serum FT4 was significantly higher in athyreotic patients than in goitrous patients with suppressed TSH secretion. Among athyreotic patients with suppressed TSH secretion, 24% had elevated serum FT4 and FT3, and 47% had elevated serum FT4 alone. Of goitrous patients with suppressed TSH secretion, 20% had elevated serum FT4 and FT3, and 27% had elevated serum FT4 alone. On the other hand, 35% of athyreotic patients and 14% of goitrous patients whose TSH secretion was not suppressed had elevated serum FT4. Serum sex hormone-binding globulin concentrations were measured in 3 groups of goitrous women. Values above normal limits were found in 13/26 patients (50%) with high serum FT4 and FT3, in 4/30 patients (13%) with elevated serum FT4 alone, and in 1/25 patients (4%) with normal FT4 and FT3. IN CONCLUSION: TSH suppression requires daily doses of T4 between 2.5 and 2.9 micrograms/kg BW in athyreotic patients and between 1.9 and 2.3 micrograms/kg BW in goitrous patients, with appropriate adjustments in relation to the age of the patient; Assessment of the adequacy of treatment should not be carried out before 6 months after the institution of therapy.

Adolescent↗
PubMed1987

Evaluation of the nocturnal serum thyrotropin (TSH) surge, as assessed by TSH ultrasensitive assay, in patients receiving long term L-thyroxine suppression therapy and in patients with various thyroid disorders.

Circadian variations of serum TSH concentrations have been reported, with higher values occurring in the late evening or early morning. In patients receiving long term L-T4 suppression therapy, it may be important to achieve suppression of TSH secretion throughout the day. To investigate whether undetectable serum TSH values in the morning are associated with undetectable serum TSH levels at night, serum TSH concentrations were measured by an ultrasensitive immunoradiometric assay in 16 normal subjects, 20 hyperthyroid patients, 10 patients with primary hypothyroidism (either untreated or inadequately treated with L-T4), 1 patient with central hypothyroidism, 10 patients with nontoxic nodular goiter, 5 patients with functioning thyroid adenoma, 20 patients receiving L-T4 replacement therapy, and 30 patients receiving L-T4 suppression. In 6 subjects blood was drawn at hourly intervals for 24 h; in 2 normal subjects a major TSH surge occurred between 2300-0100 h, with other minor peaks, and the same pattern was found in two patients receiving L-T4 replacement, whereas in 2 patients receiving L-T4 suppression, serum TSH was constantly below the limit of detection of the assay (i.e. less than 0.07 mU/L). In the remaining patients blood was drawn at hourly intervals between 2300-0200 h and on the next morning before (0830-0900 h) and 30 min after iv TRH administration. In normal subjects, in patients receiving L-T4 replacement therapy, and in hypothyroid patients, serum TSH values at night were higher than in the morning, with normal responses to TRH in the first 2 groups and exaggerated responses in the latter. The patient with central hypothyroidism had no nocturnal TSH surge and no TSH response to TRH. In all hyperthyroid patients, serum TSH was undetectable both at night and during the day, and none had a serum TSH response to TRH. Among patients with nontoxic goiter, 7 had detectable serum TSH in the morning, with higher values at night, and a normal response to TRH; the remainder had undetectable serum TSH both at night and in the morning, and subnormal or absent TSH responses to TRH. All 5 patients with a functioning thyroid adenoma had undetectable serum TSH levels in the morning and during the night, and subnormal or absent TSH responses to TRH. Of the 30 patients receiving long term (greater than 6 months) L-T4 suppression therapy, 28 had undetectable serum TSH both during the night and in the morning and unresponsiveness to TRH.(ABSTRACT TRUNCATED AT 400 WORDS)

Adenoma↗
PubMed1987

Effects of enalapril maleate on blood pressure, renin-angiotensin-aldosterone system, and peripheral sympathetic activity in essential hypertension.

Recent experimental studies showed that inhibition of angiotensin II synthesis may reduce sympathetic activity as evaluated by plasma catecholamine assay, sharing in the antihypertensive effect of angiotensin converting enzyme (ACE) inhibitors. Fifteen patients with essential hypertension were studied. Blood pressure and heart rate were evaluated both at rest and after stressor laboratory tests, before and four hours after administration of 20 mg of enalapril maleate and on the 14th and 120th days of continued administration. At the same time, blood samples were drawn for determinations of plasma renin activity, ACE, angiotensin II, plasma aldosterone concentration, and plasma norepinephrine levels. Enalapril in a dosage of 20 mg/day significantly and progressively lowered systolic and diastolic blood pressure at rest, with maximal decreases observed on the 120th day of the study period (P less than 0.001). Heart rate at rest and after exercise showed no significant differences throughout the study period. Good blood pressure control was observed during stressor laboratory tests. The greatest impact of blood pressure was observed on the 120th day during dynamic exercise (mean blood pressure from 139 +/- 3.9 to 111.5 +/- 6.3 mmHg; P less than 0.01) and on the 14th day during the cold pressure test (mean blood pressure from 133.3 +/- 3.9 to 111.2 +/- 4.7 mmHg; P less than 0.005). A marked and persistent ACE inhibition and a gradual and progressive decrease of angiotensin II (from 12.42 +/- 2.15 to 5.45 +/- 1.68 pg/ml; P less than 0.005) characterized the humoral activity of enalapril maleate. Moreover, a significant decrease of plasma norepinephrine levels was observed during the follow-up period with maximal reduction on the 120th day (from 311 +/- 34 to 197 +/- 33 pg/ml; P less than 0.01). It has been demonstrated that the pressor effect of angiotensin II was blunted during exercise. Our hemodynamic and humoral results appear to confirm the hypothesis that enalapril maleate may reduce blood pressure by direct inhibition of ACE and of kininase II as well as by a decreased sympathetic output, which may be secondary to angiotensin II inhibition. These results agree with the recent experimental demonstration of a reduced sympathetic nervous response to nerve stimulation during ACE inhibition.

Adult↗
PubMed1987

Role of epinephrine in the development of essential hypertension.

Recently, it has been showed that Epinephrine (E) plays an important role in the pathogenesis of essential hypertension in rats. Furthermore, some literature data demonstrated the existence of high E plasma levels at rest and after stress in essential hypertension. To evaluate the sympatho-adrenal activity, both in basal condition and after stress, and its relationship with the renin-angiotensin-aldosterone (RAA) system, 31 borderline hypertensives (BH), 30 essential hypertensives (EH), and 15 healthy subjects were studied. After a wash-out period and electrolyte evaluation, all subjects were studied at rest, during dynamic exercise, and after 30 minutes of recovery; at the same time blood pressure and heart rate were automatically recorded and blood samples were collected for plasma renin activity (PRA), E, Norepinephrine (NE) and aldosterone plasma concentrations assay. BH showed a percentage increase of mean blood pressure greater than EH (p less than 0.01) during dynamic exercise. PRA showed no significant differences between the 3 groups examined at rest; on the contrary, PRA levels and the percentage increases were significantly higher in BH than in EH (p less than 0.05 respectively). E plasma levels and its percentage increases were significantly greater in BH than both in EH (p less than 0.05) and in controls after exercise. Furthermore, raised E plasma levels lasted significantly throughout the recovery period (p less than 0.05) only in BH. A significant correlation between both E plasma levels and percentage increases with NE percentage increases was observed after exercise in BH. Our results demonstrate a sympatho-adrenal overactivity in borderline hypertension, which is characterized by a prolonged E hyper-responsiveness, a renin hyper-secretion and a high hemodynamic response to stress. In borderline hypertension, E, excessively released from the adrenal gland, may act as a sympathetic cotransmitter inducing functional adrenoceptors hyperactivity.

Adolescent↗
PubMed1986

Serum free thyroid hormones in subclinical hypothyroidism.

Serum free thyroxine (FT4) and free triiodothyronine (FT3) concentrations were measured in a group of 52 patients with subclinical hypothyroidism (SH) and in an equal group of age and sex-matched normal controls. SH was defined by normal total T4 (TT4) and total T3 (TT3) concentrations, normal FT4 and FT3 indices, raised TSH levels, in the absence of signs and symptoms of hypothyroidism. Serum FT4 levels averaged 6.1 +/- 1.6 pg/ml (mean +/- SD, p less than 0.001 vs controls), with values below lower normal limits in 33/52 patients; mean FT3 concentrations averaged 3.1 +/- 0.7 pg/ml (p less than 0.001 vs controls), with values below lower normal limits in 8/52 patients. The analysis of results by the Galen and Gambino predictive value model demonstrated a higher sensitivity, but a lower specificity of FT4 as compared to FT3 in the diagnosis of SH. These results indicate that FT4 should be measured in addition to TSH for the diagnosis of impending thyroid failure, thus showing that in many cases patients with so-called subclinical hypothyroidism are actually already mild hypothyroid.

Adult↗