The management of the patient with osteoporosis: from evidence to clinical practice

Osteoporosis is the most common bone disease and is an important problem of public health. In fact, it represents the main cause of age-related fractures and disabilities with a consequent increasing sanitary, social and economic impact. Unfortunately, often osteoporosis is not as thoroughly investigated as it would be desirable and it is underestimated in diagnosis and therapy. The aim of this monograph is to sensitize medical internists to a careful evaluation and an efficacious treatment of osteoporosis in order to reduce the risks of this disease, in particular the fractures, with a view to improving the quality of patients' life

Revisione critica della letteratura internazionale di pertinenza internistica prodotta nel biennio 2007-2008 sul tema della nefrolitiasi

Abstract non disponibil

Caratteristiche cliniche dei pazienti con sindrome metabolica e nefrolitiasi recidivante da ossalato di calcio

La sindrome metabolica è un fattore di rischio per nefrolitiasi. Questo studio è stato effettuato per valutare il profilo clinico e biochimico di pazienti con nefrolitiasi recidivante da ossalato di calcio e sindrome metabolica. Sono stati arruolati un totale di 526 calcolotici, 184 dei quali con sindrome metabolica, e 214 controlli. I calcolotici con sindrome metabolica hanno mostrato un'escrezione di sodio superiore [media (95% intervallo di confidenza), 196 (176-218) vs 160 (150-168) mmol/24h;

Clinical Characteristics and Evolution of Giant Cell Tumor Occurring in Paget's Disease of Bone

Patients with Paget's bone disease (PDB) have an increased risk of developing giant cell tumor (GCT). This study was performed to evaluate the clinical characteristics and evolution of GCT complicating PDB and to compare these clinical characteristics to those observed in two large PDB cohorts, the PDB Italian Registry and the United Kingdom's Multi-Centre Randomised Controlled Trial of Symptomatic Versus Intensive Bisphosphonate Therapy for Paget's Disease (PRISM) study. A systematic literature review identified 117 cases of PDB complicated by GCT (PDB-GCT), which involved the skeletal sites affected by PDB (110 patients) or the extraskeletal tissues adjacent to affected bones (7 patients). In contrast to what previously reported for GCT patients without GCT patients (83.2%) were white and one-fourth of them (24.8%) had multifocal GCTs. Compared to PDB patients without GCT, PDB-GCT patients showed a higher male/female ratio (2.1 versus 1.2) and more severe disease (age at PDB onset 52.1 ± 12.1 versus 63.3 ± 10.6 years; number of affected sites 6.1 ± 2.9 versus 2.34 ± 1.6; prevalence of polyostotic PDB 93.3% versus 60.6%). The mortality rate of PDB-GCT patients was higher than those occurring in GCT patients without PDB (about 50% versus 0% to 5% at 5 years) or in PDB patients without GCT (log rank = 29.002). Moreover, up to 98% of PDB-GCT cases had elevated total alkaline phosphatase levels at neoplasm diagnosis, suggestive of active PDB. Importantly, PDB-GCT patients from Southern Italy (45.6% of all GCT patients) showed a higher prevalence of multifocal GCT (51.7%) and of positive familial history for PDB (70.8%) and GCT (65.0%). Finally, indirect evidence suggests a decline in the incidence of GCT in PDB patients. The occurrence of GCT in PDB patients is associated with severe disease and reduced life expectancy of affected patients. The increased prevalence of familial diseases in PDB-GCT patients from Southern Italy suggests a founder effect. The observed changes over time in the incidence of GCT in PDB patients could be related to improved clinical management and/or living conditions of patient

Resolution of angina pectoris and improvement of the coronary flow reserve after ranolazine treatment in a woman with isolated impaired coronary microcirculation

In a 61-year-old woman with well controlled arterial hypertension, hypercholesterolemia, and smoke and suffering from recurrent angina pectoris despite angiographically normal epicardial coronary vessels and maximal therapy, the replacement of nitrates with novel antiangina drug ranolazine, after 6-month therapy, induced a complete relief of angina and a relevant rising of the transthoracic Doppler-derived coronary flow reserve (CFR). The present clinical case underlines therefore how in patients with chronic ischemic heart disease without epicardial coronary stenosis ranolazine can induce an improvement till the complete solution of the angina symptoms and a substantial increase of CFR as expression of the enhancement of the microvascular coronary function. The improvement of both symptoms and coronary microvascular function is strictly linked to the mechanism of action of the drug. Ranolazine induces in fact a reduction of the intracellular late sodium current that leads to a reduction of the intracellular calcium concentration thus producing a better myocardial diastolic relaxation process which in its turns enhances the myocardial perfusion. The ranolazine acts therefore as a lusitropic drug that improves the diastolic dysfunction and the segmental ischemia thus affecting one of the first steps of the ischemic cascade

Evidence for epistatic interaction between VDR and SLC13A2 genes in the pathogenesis of hypocitraturia in recurrent calcium oxalate stone formers

Genetic factors play a key role in the pathogenesis of hypocitraturia, a common risk factor for nephrolithiasis. The Na(+)-dicarboxylate cotransporter NaDC1, encoded by the sodium-dicarboxylate cotransporter (SLC13A2) gene, is a major determinant of urinary citrate excretion and its biological functions are regulated also by the vitamin D/Vitamin D receptor (VDR) biological system. The aim of this case-control study was to evaluate the possible epistatic interaction between VDR (rs731236)and SLC13A2 (rs11567842) allelic variants in the pathogenesis of hypocitraturia

Prevalence of Simple Nodular Goiter and Hashimoto's Thyroiditis in Current, Previous, and Never Smokers in a Geographical Area with Mild Iodine Deficiency

Simple nodular goiter and Hashimoto's thyroiditis are 2 frequent nonmalignant thyroid diseases. Tobacco smoking has detrimental effects on the endocrine system and in particular on thyroid function and morphology. The objective of this cross-sectional study, involving 1800 Caucasian adults from a geographical area with mild iodine deficiency, was to evaluate the relationship between tobacco smoking, smoking cessation, and the prevalence of simple nodular goiter and Hashimoto's thyroiditis. Thyroid status was evaluated by ultrasonic exploration of the neck, measurement of FT3, FT4, TSH, antibodies against thyroid peroxidase and thyroglobulin, and urinary iodine excretion. The fine-needle aspiration biopsy of significant nodules was also performed. Smoking habits were evaluated by a specific questionnaire and the calculation of number of pack years. Both current and previous smokers showed an increased risk of simple nodular goiter compared to never smokers after adjustment for potential confounders and known goitrogen factors. Interestingly, the simple nodular goiter risk was similar for never smokers and for previous smokers declaring a time since cessation of smoking for more than 69 months. Smoking habit was not associated to an increased risk of Hashimoto's thyroiditis. Smoking appears to be an independent risk factor for simple nodular goiter but not for Hashimoto's thyroiditis in an area with mild iodine deficiency. A prolonged withdrawal of smoking dramatically reduces the risk of simple nodular goiter occurrence

Nonsymmetric myocardial contribution to supranormal right ventricular function in the athlete's heart: combined assessment by speckle tracking and real time three-dimensional echocardiography

PURPOSE: To investigate determinants of right ventricular (RV) function in competitive athletes by a combined assessment of speckle tracking (STE) and real time 3D echocardiography (RT3DE). METHODS: Right ventricular function of 40 top-level rowers was compared to 43 sedentary normal controls by standard Doppler echocardiography, RT3DE, and STE. RV diameters and wall thickness, tricuspid annular plane systolic excursion (TAPSE), tricuspid E/A ratio, and pulsed tissue Doppler of lateral tricuspid annulus were analyzed. RV volumes, ejection fraction (EF), and stroke volume (SV) were determined. RV global longitudinal strain (GLS) (average of 6 regions), septal strain (average of 3 septal regions, septal longitudinal strain [SLS]), and lateral strain (average of 3 lateral regions, lateral longitudinal strain [LLS]) were estimated by STE. RESULTS: The 2 groups were comparable for age, body mass index, and blood pressure, but heart rate was lower in rowers. RV diameters were larger and TAPSE, tricuspid E/A ratio, and tissue Doppler-derived s' and e' velocities were higher in rowers. By RT3DE, RV end-diastolic volume (EDV) and end-systolic volume were greater in rowers (both P < 0.0001), without difference in EF. GLS (P < 0.005) and LLS (P < 0.001), but not SLS, were greater in rowers. In pooled groups, LLS was related to EDV and SV, even after adjusting for heart rate, body mass index, and RV wall thickness by separate multiple linear regression analyses (β coefficient = 0.247, P < 0.01 and β = 0.225, P < 0.02, respectively). CONCLUSIONS: Right ventricular preload exerts its maximal influence on the longitudinal lateral fibers, which is independent on potential confounders and largely induces RV supranormal function in the athlete's heart