PURPOSE:A study was conducted to evaluate the effectiveness of the medical therapy with synthetic hormone levothyroxine (L-T4) in the elderly subjects with multinodular euthyroid goiter.PATIENTS AND METHODS:187 elderly subjects (34 males and 153 females) ranging between 63 and 85 years of age with multinodular euthyroide goiter were examined. For each subject has been calculated the index of body mass (BMI) which has consented the identify two groups of subjects: the elderly patients with normal weight and the obese subjects.RESULTS:In the mostly of the patients (82%), both normal weight and obese, the L-T4 therapy has not determined significant changes either of the dimensions or the number of the nodules. In the obese subjects the L-T4 therapy has not caused decrease of weight at least to the 20% of the initial body weight.CONCLUSIONS:The results of the research have proved the limited effectiveness of the suppressive therapy with levothyroxine in the reduction of the volume and/or of the number of the nodules, without however denying the usefulness in the preventing the worsening of the nodular disease of thyroid. The study also has revealed that the therapy with levothyroxine is ineffective for the body weight reduction in the obese subjects.

Dehydroepiandrosterone (DHEA) and its sulfated ester DHEAS are the most abundant circulating adrenal steroids but their function remains to be elucidated. DHEAS secretion and serum levels decrease with age and this is parallel to the development of a number of the problems of ageing (immunosenescence, increased incidence of osteoporosis, atherosclerosis and cancer, decrease of cognitive functions and/or well-being). For these reasons a growing interest in replacement of DHEA in elderly people has been developed. The findings from recent studies of replacement of DHEA in elderly are reviewed here. Although we have some positive data about benefit results of this therapy on muscle, bone and well-being, at present it is premature to recommend the routine use of DHEA replacement because most of its aspects remains controversial.

After thyroidectomy, either total or partial, hypocalcaemia can occur in some cases temporary and in other permanent. For explaining transient hypocalcaemia are reported some pathogenetic mechanism can assume particular aspects in hyperthyroid subjects. Permanent hypocalcaemia is substantially due to anatomical lesions to the parathyroid glands. On the other hand, in subjects with hypothyroidism postoperative, a reduced concentration of circulating calcium can coexist with normal values or even elevated of parathormone. The condition of euthyroidism is basic for the resumption of the calcium homoeostasis.

Wilson's disease, also called hepatolenticular degeneration, is a serious inherited disorder of copper metabolism. The disease needs a particular attention because it is estimated that about half of the patients are never diagnosed. Beside, once the diagnosis is made, Wilson's disease can be effectively treated. After the epidemiological, pathogenetical and clinical data, authors present the diagnostical aspects of the disease, and the various approaches to the treatment of the symptomatic or presymptomatic patients and of the pregnant patients. Also reported are two cases of Wilson's disease.

Hyperthyroid syndromes can be approached in three different ways: medical, surgical and radiant. The medical therapy concerning the treatment of Basedow's disease is based on the extended use of thionamide drugs, which inhibits thyroid hormone biosynthesis and allows progressive recovery to normal glandular function. Agranulocytosis has been reported as the most serious side-effect. Inorganic iodide, lithium salts, beta-adrenergic receptor blocking agents and glucocorticoids have been employed as therapeutic alternatives, though of not common clinical use. Thyroidectomy is preferentially indicated in the treatment of toxic adenoma in fertile age groups and hyperfunctional bulky goiters. The postoperative complications connected with thyroidectomy are the main disadvantages. The use of radioactive iodine is currently the therapy chosen for toxic adenoma after forty years of age and particularly for hyperthyroid syndromes of elderly people, in whom scanty compliance with therapeutic suggestions and the increased postoperative risk make it preferable to other therapies, though incidental development of hypothyroidism after radioactive iodine treatment is not an unusual consequence.

H2-receptor antagonists, such as cimetidine (C), ranitidine (R) and famotidine (F) seem to be effective in the prevention and treatment of stress ulcer in transplant recipients receiving cyclosporin A (CyA). The aim of this study was to detect the possible synergistic nephro- and hepato-toxicity of these drugs, assaying the serum creatinine (SC), ALT, AST levels, and the histological features of 45 young male Sprague-Dawley rats, divided into nine groups of five rats each. After 10 days of treatment the results showed: (i) serum CyA levels were increased in the group receiving daily CyA (5 mg/kg) + R(5 mg/kg) (2430 +/- 403 ng/ml; p less than 0.05 vs. controls) and in the group receiving daily CyA (5 mg/kg) +/- C (10 mg/kg) (2440 +/- 265 ng/ml; p less than 0.01 vs. controls); (ii) ALT and AST levels were increased in this latter group (ALT 223 +/- 133 UL, AST 114.67 +/- 39 UL; p less than 0.01 vs. controls); (iii) SC levels were normal; and (iv) steatosis of the liver was observed in these two groups. These findings suggest that C and R, but not F, may inhibit the hepatic cytochromes P-450 which are involved in the oxidative metabolism of the drugs. Furthermore, the high serum CyA levels seem to play a major role in the appearance of biochemical and histological damage to the liver.

The ultrastructure of the thymus was examined in young zincdeficient rats in whom alterations of immune functions were present. There was an increased number of macrophages, which contained large amounts of phagocytized material per cell. Signs of hyperactivity of epithelio-reticular cells, associated with a sharp reduction of thymocytes was observed. Thymic hormone activity was reduced. The possible correlation between zinc deficiency and changes of thymus function and structure in rats is discussed.

It was our aim to evaluate the degree of impairment of the blood rheological properties according to the clinical stage of peripheral occlusive arterial disease. From the 2nd to the 4th clinical stage the following hemorheological changes were observed: a progressive increase of whole blood viscosity, plasma viscosity, erythrocyte aggregation and plasma fibrinogen levels, as well as a progressive decrease of erythrocyte filterability.

Three cases of primary hyperviscosity syndrome with different etiology are described. For each of them the specific hemorheological characteristics which produce the common expression of blood hyperviscosity are emphasized.