Bone turnover markers, BMD and TBS after short-term, high-dose glucocorticoid therapy in patients with Graves' orbitopathy: a small prospective pilot study.

PURPOSE: Chronic GC administration has numerous side effects, but little is known about the side effects of their short-term use (< 3 months)-particularly, when high doses are involved, as in the treatment of Graves' orbitopathy (GO). We investigated the effects of short-term, high-dose GC on bone turnover markers, bone mineral density (BMD), and trabecular bone scores (TBS). METHODS: Eleven patients (10 females and 1 male; median age 56 years) with active GO who were candidates for treatment with intravenous (iv) methylprednisone were consecutively enrolled. All patients were pretreated with a loading dose of 300,000 units of cholecalciferol, then given a median cumulative dose of 4.5 g (range 1.5-5.25 g) iv methylprednisone. Biochemical parameters of bone metabolism (25OHD3, PTH, P1NP, CTX and bALP) were measured at the baseline, and then 1 week and 1, 3, 6 and 12 months. BMD and TBS were obtained by X-ray absorptiometry (DXA) at the baseline and at 6 and 12 months. On DXA image, morphometric vertebral fracture assessment (VFA) was done. RESULTS: There were no significant changes in PTH, bALP or P1NP. A significant drop in CTX was seen at 1 month (down Δ49.31% from the baseline, p = 0.02), with a return to the baseline at the 3-month measurement. There was a moderate (not significant), but persistent reduction in P1NP. No changes in BMD or TBS came to light. No vertebral fractures were documented. CONCLUSIONS: Short-term, high-dose GC treatment caused a rapid, transient suppression of bone resorption, with no effects on BMD or bone micro-architecture (TBS).

Association of the COMT synonymous polymorphism Leu136Leu and missense variant Val158Met with mood disorders.

BACKGROUND: Major depressive disorder (MDD) and bipolar disorder (BD) are the two most common mood disorders. Given the recognized involvement of catecholamines in depression, genetic research focused on the evaluation of polymorphisms in genes coding for proteins that regulate neurotransmitter release, transport and degradation. Here we aimed at evaluating the distribution of two genetic variants of catechol-O-methyltransferase (COMT), namely the well characterized missense polymorphism G1947A (Val158Met) and the recently reported synonymous polymorphism C1886G (Leu136Leu), in MDD and BD patients compared with healthy subjects. METHODS: Genotyping for COMT polymorphisms was carried out by DNA direct sequencing in 112 patients (54 MDD and 58 BD) and 58 healthy subjects. RESULTS: We did not find significant differences in the Val158Met variant distribution between patients and controls. Instead, we found that the C1886 major allele and the CC1886 wild-type genotype frequencies were significantly higher in controls than in both groups of patients. On the contrary, the G1886 minor allele and the heterozygous CG1886 genotype were significantly more present in both MDD and BD patients than in healthy subjects. When looking at combined polymorphisms, we found a significantly higher frequency of the double heterozygous diplotype CG/GAVal/Met158 in both MDD and BD patients than in controls. Instead, the diplotype CC/GAVal/Met158 showed a significantly higher frequency in controls than in BD patients. LIMITATIONS: The small size of our study cohort may limit the generalizability of the present findings. CONCLUSIONS: This work first showed the association of combined Leu136Leu and Val158Met variants of COMT gene with MDD and BD.

Proton magnetic resonance spectroscopy (H-MRS) in chronic schizophrenia. A single-voxel study in three regions involved in a pathogenetic theory.

The cognitive dysmetria theory suggests a disconnectivity between the dorsolateral prefrontal cortex, thalami and vermis to explain the pathophysiology of schizophrenia. This study investigated the metabolic integrity of this neurologic circuit in patients with schizophrenia using proton magnetic resonance spectroscopy (H-MRS). Twenty-two patients with schizophrenia and twelve control subjects were studied. Metabolites concentrations were evaluated by a single-voxel technique in the prefrontal cortex, thalami and vermis. To our knowledge, this is the first H-MRS experience with concomitant evaluation of these regions in schizophrenic patients. We found no significant statistical difference in N-AA, Cho and Cr absolute concentrations and N-AA/Cho, N-AA/Cr and Cho/Cr ratios between the schizophrenic patients and control group. At the vermis, we found a constant spectrum with low levels of N-AA and higher levels of Cho and Cr. Our experience does not clearly support or refute the cognitive dysmetria theory. The consistency of metabolic findings in the cerebellar vermis could represent an important datum, highlighting the specificity of metabolic and functional activity in this region.

Topiramate augmentation of clozapine in schizophrenia: a double-blind, placebo-controlled study.

The persistence of psychotic, affective, cognitive, and psychosocial symptoms despite medications is commonly observed in schizophrenic patients. The present study was a 24-week double-blind, randomized, placebo-controlled trial aimed to explore the efficacy of topiramate add-on pharmacotherapy on clinical symptomatology and cognitive functioning in a sample of treatment-resistant schizophrenic patients receiving clozapine. After clinical and cognitive assessments were randomly allocated to receive either up to 200 mg/day of topiramate or a placebo. A final sample of 43 patients completed the study. The results obtained indicate that topiramate appeared to be scarcely effective for reducing clinical symptomatology in schizophrenic patients who have had an incomplete clinical response to clozapine. Regarding cognitive functioning, in our sample a trend to experience cognitive impairment in the examined domains was observed, as the patients included in the topiramate groups expressed cognitive complaints partially confirmed by a mild worsening of performances on certain cognitive tasks. Schizophrenia is a heterogeneous disorder with regard to pathophysiology; therefore, data reflecting the mean response of a sample of patients may fail to reveal therapeutic effects. More research is needed to better identify subgroups of patients with peculiar features which may account for responsivity to experimental medications and augmentation strategies.

[Results of elective open surgery for juxtarenal aortic aneurysms]. / I risultati del trattamento elettivo in open surgery degli aneurismi juxtarenali dell'aorta.

Review of the most significant surveys (data base: Pub Med on September 2003) of elective open surgery for Juxtarenal aneurysms and personal results of 106 cases (9.3% of AAA consecutively operated in the last 11 yrs.) are reported. Mortality and morbidity are discussed related to: technique of aortic cross-clamping; protective measures on splanchnic and renal perfusion; risks from previous CAD and chronic renal failure. Over all, the main predictive factor is the accuracy of the selected technique, without any difference among different approaches, and the same results of infrarenal aneurysms can be obtained.

Comparative study of the prevalence of dementia in two Sicilian communities with different psychosocial backgrounds.

The role of education and psychosocial environment as factors for the development of dementia is controversial. We carried out a comparative study on the prevalence of dementia among persons over 74 years of age in two Sicilian municipalities, Troina and S. Agata Militello, with different psychosocial backgrounds. A two-stage survey was performed for both samples. In stage 1 the Mine Mental Status Examination (previously validated for the cutoff score with 100% sensitivity and the highest specificity) was used to screen a 50% random sample of persons over 74 years of age. In those referred to stage 2, the diagnosis of dementia was made be a neurologist according to DSM-III R. Three hundred and sixty-five subjects were recruited in Troina and 408 in S. Agata Militello. The minimal estimates of dementia prevalence were 21.9% (21% men, 21.9% women) in Troina and 28.4% (26.6% men, 29.6% women) in S. Agata Militello. Although intrasample multiple logistic exact analysis (demented vs. unproven demented) indicated poor formal education and manual occupation at risk factors for dementia, and intersample comparison (Troina vs S. Agata Militello) showed that these variable were more frequent in Troina, we did not find a higher prevalence of dementia in this community. We discuss this apparently ambiguous result and suggest that psychosocial and cultural variables might be considered multiple interacting factors with different protective or predisposing roles for dementia. Higher or lower risk could than be the result of this complex interaction in different populations.

Prevalence of dementia among elderly people in Troina, Sicily.

We performed a two-stage survey on the prevalence of dementia among people aged over 74 in Troina, northern Sicily, Italy. During the first stage people were screened by the Mini Mental Status Examination (MMSE), previously validated in our population for the cut-off score with 100% sensitivity and the best specificity to diagnose dementia. During the second stage people scoring 19 or less at the MMSE test were invited to be examined by a neurologist who diagnosed dementia according to DSM-III R. Out of 365 subjects of the initial sample 347 were screened by MMSE test and 163 scored 19 or less. Of these, 135 were neurologically and neuropsychologically examined in the second stage, and 80 proved to be demented. The minimal estimate of prevalence of dementia in our sample was 21.9% (21.9% men, 21.8% women). The poor education and psychosocial life may be the underlying condition favoring dementia in this sample of elderly people.

[Alcoholic myopathy. Histochemical and ultrastructural study]. / La miopatia alcoolica. Studio istochimico ed ultrastrutturale.

Muscles of alcoholic rats undergo histochemical and ultrastructural study. Significative alterations have not been found. The authors compare their experimental data with analogous human pathology, pointing out the possible biochemical and immunological differences.

[Bilaterally strangulated bilateral obturator hernia. Plastic surgery, using the round ligaments]. / Ernia otturatoria bilaterale bilateralmente strozzata. Plastica mediante i legamenti rotondi.

An unusual case of bilateral obturaptor hernia with double ileal strangulation is reported. An account is given of obturator hernia, its pathogenesis, and surgical management. Of the various possibilities that exist in this respect, the simplest and most resolutive, it is submitted, is that in which the ligamentum teres uteri is employed to close the hernial porta.

[Esophagocolonoplasty in the palliative treatment of cancer of the esophagus]. / L'esfagocolonplastica nel trattamento palliativo delle neoplasie dell'esofago

Treatment of cancer of the upper and middle thirds of the oesophagus is discussed. Should the condition be handled in radical or palliative fashion? In the light of the discouraging results obtained by most workers with radical therapy, palliative measures are favoured. Possible operations are listed and a personal case of palliative ileocolonesophagoplasty of about a year's standing and another operated on only two months previously are reported and preoperative and postoperative documentation given.