[Therapeutic protocols compared in the treatment of postmenopausal osteoporotic disease]. / Protocolli terapeutici a confronto nel trattamento della malattia osteoporotica post-menopausale.

The authors have compared the results obtained using four main drugs (calcitonin, ipriflavone, transdermal estrogens, fluorine-calcium) actually employed for the treatment of post-menopausal osteoporosis, administered to four groups of fast loser patients (442) in natural (months mean 19.97 +/- 5.99) and surgical (months mean 16.94 +/- 4.29) menopause. After six months of treatment, the efficacy of therapy has been evaluated on the basis of BD (bone density) and osteoarticular pain changes. The BD results have been compared with those of 100 non-treated patients, in the same clinical conditions. The authors have noticed an increase in bone mass (from +0.47% to +1.59%) and a great improvement in osteoarticular pain with all therapeutical protocols used while in the control group there was a progressive decrease of BMC (-1.23%) and a worsening pain. Comparing the results obtained with different therapies, the difference of mean mineralometric gain is not particularly significant among several treatments; but this difference is very significant between treated and non-treated patients who have continued to lose bone mass. The collateral effects, observed during administration of different drugs, have been minimal and the suspension of therapy has been always associated to their disappearance. In the opinion of the authors the good results, achieved with different therapies, depend on the precocity of the treatment, but also on the fact that, in peri-menopausal period, their effect has been increased by the estrogens. Being osteoporosis a multifactorial pathology, a careful control of the risk factors is appropriate and needs to be enforced in order to carry out a precocious treatment with specific drugs on bone metabolism and try to balance the natural turnover with the loss of bone mass.

Anatomical features and clinical correlations in Caucasian patients with definite arrhythmogenic right ventricular dysplasia/cardiomyopathy.

AIM: Arrhythmogenic right ventrticular dysplasia/cardiomyopathy (ARVD/C) is an inherited cardiomyopathy characterized by fibrofatty replacement and a high risk of ventricular arrhythmias (VA) and sudden cardiac death (SCD). The aim of the present investigation is to examine the pathological profile and the clinical correlations in a group of ARVD/C patients. METHODS: We conducted a multicenter study evaluating 47 patients (31 men; mean age 37±14 years) with definite ARVD/C. Diagnosis was established according to the actual clinicomorphologic criteria at autopsy or clinically. We divided the study population in 2 different groups. First group included 28 alive patients and the second 19 patients dead suddenly. RESULTS: Age at presentation was different in the two groups (P=0.0015). We observed an important association regarding the risk of sudden death and the history of physical exercise (P=0.0017). Moreover patients with negative outcome (i.e., SCD, cardiac transplantation, congestive heart failure) had a significantly association with biventricular form of ARVD/C (P=0.0034) and age presentation (P=0.003). Left ventricular (LV) involvement was frequently observed in the two groups (17% and 32% respectively). Post-mortem examination revealed frequent inflammatory infiltrates (26%) indicating active myocarditis, which probably justify the fatal arrhythmic events occurred in these patients. CONCLUSION: Frequent LV involvement justifies the recent adoption of the broad term Arrhythmogenic Cardiomyopathy. Early age presentation, sport activity and the biventricular form of ARVD/C represent important predictors of adverse outcome that can be useful to early identify patients at high risk.