Osteodystrophy in chronic liver diseases.

Osteoporosis and osteomalacy are, to date, among the most common metabolic disease in the world. Recently, association between metabolic bone diseases and chronic liver diseases has been increasingly reported, inducing many authors to create a new nosographic entity known as "hepatic osteodystrophy". The importance of such a condition is, moreover, further increased by morbidity of these two diseases, which greatly reduce patients quality of life because of frequent fractures, especially vertebral and femoral neck ones. For this, early identification of high-risk patients should be routinely performed by measuring Bone Mass Density. The explanation for the association between bone diseases and chronic liver disease is still uncertain, and involves many factors: from hypogonadism to use of corticosteroid drugs, from genetic factors to interferon therapy. To date, few studies have been conducted, and all with a small number of patients, in order to establish definitive conclusions about the possible treatment, but some evidences are beginning to emerge about the safety and efficacy of bisphosphonates

Atypical Bartonella henselae neuroretinitis in an immunocompetent patient.

We report a case of a 57-year-old immunocompetent male, admitted to our Department due to the loss of visual acuity to the right eye, occurred during the two weeks before the hospitalization, and hyperglycaemia. Our patient suffered from metabolic syndrome, characterized by visceral obesity, impaired glucose tolerance, arterial hypertension, complicated by proteinuria, and moderate grade hypertensive retinopathy. Surprisingly, and despite its many comorbidities, the final diagnosis was neuroretinitis by Bartonella henselae, without any other symptoms/signs of cat-scratch disease. The patient denied any kind of contact with cats. He was cured by specific antibiotic therapy, restoring status ‘quo ante’

Risk of low bone mineral density and low body mass index in patients with non-celiac wheat-sensitivity: a prospective observation study.

Background: Non-celiac gluten sensitivity (NCGS) or ‘wheat sensitivity’ (NCWS) is included in the spectrum of gluten-related disorders. No data are available on the prevalence of low bone mass density (BMD) in NCWS. Our study aims to evaluate the prevalence of low BMD in NCWS patients and search for correlations with other clinical characteristics. Methods: This prospective observation study included 75 NCWS patients (63 women; median age 36 years) with irritable bowel syndrome (IBS)-like symptoms, 65 IBS and 50 celiac controls. Patients were recruited at two Internal Medicine Departments. Elimination diet and double-blind placebo controlled (DBPC) wheat challenge proved the NCWS diagnosis. All subjects underwent BMD assessment by Dual Energy X-Ray Absorptiometry (DXA), duodenal histology, HLA DQ typing, body mass index (BMI) evaluation and assessment for daily calcium intake. Results: DBPC cow's milk proteins challenge showed that 30 of the 75 NCWS patients suffered from multiple food sensitivity. Osteopenia and osteoporosis frequency increased from IBS to NCWS and to celiac disease (CD) (P <0.0001). Thirty-five NCWS patients (46.6%) showed osteopenia or osteoporosis. Low BMD was related to low BMI and multiple food sensitivity. Values of daily dietary calcium intake in NCWS patients were significantly lower than in IBS controls. Conclusions: An elevated frequency of bone mass loss in NCWS patients was found; this was related to low BMI and was more frequent in patients with NCWS associated with other food sensitivity. A low daily intake of dietary calcium was observed in patients with NCWS

Autoimmune liver disease in a sicilian woman.

Autoimmune hepatitis (AIH) is a chronic liver disease characterized by clinical features analogue to viral and non-autoimmune liver disorders, but with distinct sero-autoimmunologic properties. The disease results from a network of complex interactions involving genetic predisposition, triggering factors, autoantigens and immunoregulatory system. Diagnosis of AIH relies on positive autoantibodies determination and on liver core biopsy histological appearance. Corticosteroid and immunosuppressive drugs are generally useful in the treatment of disease. However, when inflammation cannot be controlled, progression from chronic hepatitis to cirrhosis is often observed and hepatocellular carcinoma may appear at the end stage. Here we reported a case of a woman, affected with AIH. The patient presented features of chronic liver disease of neither viral nor alcoholic aetiology. Serum evidence of hypertraminasemia, hypergammaglobulinemia and specific autoantibodies were the leading points to final diagnosis, which was validated by liver biopsy. The patient was, finally, successfully treated with steroids

Heterogenous forms of dyslipidemiain women with polycystic ovary syndrome

Forms of dyslipidemia are very common in individuals affected by polycystic ovary syndrome (PCOS), but in addition to plasmatic lipids, it is necessary to evaluate the alterations in the atherogenic lipoproteins (Lp) and apolipoproteins (apo). In our study we measured the concentrations of apoB, Lp(a) and low density lipoproteins (LDL) in 42 patients with PCOS (age: 28 +/- 7 years, body mass index: 27 +/- 5 kg/m-) and 37 healthy women (of the same age and body mass index). Methods: values of Lp(a) >30 mg/dl were considered high, whereas for apoB, values >100 g/l were considered high. Results: the patients with PCOS showed an increase in triglycerides (p=0.0011) and low levels of high density lipoproteins (HDL) (p=0.0131), but the total cholesterol and the LDLs were not significantly different to those of the control group. High levels of Lp(a) were found in 24% of the individuals with PCOS, and a smaller number showed high levels of apoB (14%). This analysis shows that the concentrations of Lp(a) are only correlated to the HDL levels (r =0.378, p= 0.0431). 36% of the patients with PCOS with normal levels of plasmatic lipids show high levels of Lp(a) and apoB, and small and dense LDLs. Conclusions: alterations in the plasmatic lipids are present in 1/3 of the women affected by PCOS. More research is necessary to better understand the mechanisms responsible to reduce the risk of cardiovascular problems in young women with polycystic ovary syndrome

Bisphosphonate-associated femoral fracture: implication for management

Studies carried out on individuals being treated long term with bisphosphonates have provoked considerable interest and perplexity about the effect that these drugs have on bone turnover in the long run. In fact the experiences reported by numerous researchers tend to highlight how treatment with high doses of bisphosphonates over many years, of individuals with osteoporosis complicated by or secondary to neoplastic pathologies, causes a suppression of bone turnover that over time predisposes the bone to the accumulation of micro damage that can then result in complicated fractures, as in the case described here