Osteoprotegerin and bone turnover markers in heavily pretreated HIV-infected patients.

OBJECTIVES: To characterize osteoprotegerin (OPG) levels, bone remodelling and bone mineral density (BMD) in heavily pretreated HIV-infected patients on antiretroviral therapy, and to evaluate the clinical factors associated with bone density decline. METHODS: Heavily pretreated (> 5 years) HIV-positive patients were enrolled in this cross-sectional, observational study, which was based on a total body bone densitometry examination and a comprehensive evaluation of bone and mineral parameters. RESULTS: Sixty-eight patients (55 male and 13 female) with a median age of 41 years (range 25-60 years) were included in the study. Their antiretroviral treatment lasted for 82 months. On the basis of the World Health Organization criteria, nine patients (13.2%) were osteoporotic [T-score < -2.5 standard deviation (SD)] and 19 patients (27.9%) were osteopenic (T-score between -1 and -2.5). The principal outcomes associated with the presence of a low BMD were high OPG and lysylpyridinoline/creatinine ratio (Dpd) values. Most of the patients (39 of 48; 81.25%) showed vitamin D insufficiency [Vitamin D (25(OH)D) < 18 ng/mL] with secondary hyperparathyroidism (13 of 50 patients: 26%), which proved to be correlated to osteocalcin (BGP) levels [parathyroid hormone (PTH) vs. BGP: r = 0.34; P < 0.01]. There was an inverse correlation between T-scores and serum osteocalcin and alkaline phosphatase (AP) levels, on one hand, and Dpd, on the other. High AP and Dpd values were associated with relative risks of 4.1 [95% confidence interval (CI) = 1.01-17.6] and 7.2 (95% CI = 1.67-31.03), respectively, of a pathological T-score. Multivariate analysis revealed that the factors associated with the presence of osteopenia or osteoporosis were older age and lower body mass index. CONCLUSIONS: About 40% of our heavily pretreated subjects with advanced HIV infection had a low BMD, and 56% (24 of 44 patients) showed a high bone turnover rate with marked osteoclast activation. High OPG levels may protect against bone resorption.

[The intramyocardial coronary artery and the muscular bridge. The physiopathological and surgical considerations in a clinical case]. / La coronaria intramiocardica ed il ponte muscolare. Considerazioni fisiopatologiche e chirurgiche su di un caso clinico.

Muscular bridging of the coronary artery affects both the vessel wall structure and the local blood flow. The vessel wall underneath the muscular bridge is usually thin and free from degenerative atherosclerotic changes. A coronary stenosis caused by a short muscular bridge is considered critical when greater than 75%, but these dynamic obstructions are often asymptomatic because of the diastolic coronary flow. A long intramyocardial course may instead affect blood flow before a critical stenosis has been reached. Spasm and late changes in diastolic compliance of the mural coronary artery play a definite role in the development of ischemia. The case of a young patient with a fully intramuscular left anterior descending artery and repeated episodes of effort spasm is presented, and etiology, features and surgical treatment are discussed.

Tolerability of nimesulide. Epidemiological data.

This review describes the tolerability profile of nimesulide as documented in a global assessment of the clinical data available to Helsinn for this drug. Data from 151 trials were considered and the relevant case report forms and study reports were used as source information. The analysis was conducted using between-treatment and within-treatment comparisons. The between-treatment comparison included data derived from placebo-controlled trials, while the within-treatment comparison included nimesulide data only. Of 4945 subjects treated with nimesulide, 349 (7.1%) experienced adverse events and 52 (1.1%) withdrew from treatment. The most frequently reported adverse events were those related to the digestive system, body as a whole, skin and nervous system. The incidence and nature of adverse events observed for nimesulide-treated patients were similar to those of the placebo group. Nimesulide was particularly well tolerated by the liver, lungs, kidneys and blood.