Thyroid hormone serum concentrations, the thyrotropin (TSH) and prolactin (PRL) response to thyrotropin-releasing hormone (TRH) were evaluated in patients undergoing cardiopulmonary bypass (CPB) conducted in hypothermia. During CPB a marked decrease of thyroxine (T₄) and triiodothyronine (T₃) concentration with a concomitant increase of reverse T₃ (rT₃) were observed similarly to other clinical states associated with the ‘low T₃ syndrome’. Furthermore, in the present study elevated FT₄ and FT₃ concentrations were observed. In a group of patients, TRH administered during CPB at 26°C elicited a markedly blunted TSH response. In these patients, PRL concentration was elevated but did not significantly increase after TRH. The increased concentrations of FT₄ and FT₃ were probably due to the large doses of heparin administered to these patients. Thus, the blunted response of TSH to TRH might be the consequence of the elevation of FT₄ and FT₃ in serum, however, other factors might play a role since also the PRL response to TRH was blocked.

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The main parameters of muscle acid-base, water and energy metabolism were studied in ten patients undergoing low-flux (1.5 l/min/m2), low-pressure (40 to 60 mmHg) hypothermic (26 degrees C) cardiopulmonary bypass (CPB) for aortocoronary grafting; absolute gas exchange and haemodynamic data were also measured throughout the entire CPB period. At the end of CPB a substantial preservation of water and energy metabolic indexes was found; a condition of extracellular metabolic acidosis was apparently sustained by muscle cell anaerobic glycolysis enhancement with a consequent increase of both muscle and plasma lactate content. Subnormal cell phosphocreatine levels as well as reduced bicarbonate buffer stores and decreased intracellular pH, were detected. Direct limiting effects of hypothermia on tissue O2 delivery and muscle oxidative metabolism as well as vasoconstriction and arteriovenous shunting associated with CPB procedures are likely to be involved in the above mentioned alterations of cell metabolism.

15 patients affected with advanced mammary carcinoma have been treated with triethylene-thio-phosphoramide (Thio-Tepa). The drug, which has practically no damaging side-effects at the doses employed, allows, in the majority of the cases, considerable improvements; in some patients a regression of the neoplastic lesions (especially lymphoglandular and pleuro-pulmonary) has been obtained. Favourable results, especially with regard to the duration, have been obtained by the association of chemotherapy and endocrino-surgical operations. The reasons for the use of Thio-Tepa in 14 patients during the intervention of breast removal and in the days immediately following it, are presented and discussed.