Exercise training and music therapy in elderly with depressive syndrome: a pilot study.

OBJECTIVE: Recent studies have thrown doubt on the true effectiveness of anti-depressants in light and moderate depression. The aim of this study is to evaluate the impact of physical training and music therapy on a sample group of subjects affected by light to moderate depression versus subjects treated with pharmacological therapy only. DESIGN AND SETTING: Randomized controlled study. Patients were randomized into two groups. Subjects in the pharmacotherapy group received a therapy with antidepressant drugs; the exercise/music therapy group was assigned to receive physical exercise training combined with listening to music. The effects of interventions were assessed by differences in changes in mood state between the two groups. MAIN OUTCOME MEASURES: Medically eligible patients were screened with the Hamilton Anxiety Scale and with the Geriatric Depression Scale. We used plasmatic cytokine dosage as a stress marker. RESULTS: We recruited 24 subjects (mean age: 75.5 ± 7.4, 11 M/13 F). In the pharmacotherapy group there was a significant improvement in anxiety only (p<0.05) at 6-months. In the exercise/music therapy was a reduction in anxiety and in depression at 3-months and at 6-months (p<0.05). We noted an average reduction of the level of TNF-a from 57.67 (± 39.37) pg/ml to 35.80 (± 26.18) pg/ml. CONCLUSIONS: Our training may potentially play a role in the treatment of subjects with mild to moderate depression. Further research should be carried out to obtain more evidence on effects of physical training and music therapy in depressed subjects.

Hypovitaminosis D: which oral supplement therapy?

OBJECTIVES: the possible therapeutic role of vitamin D in different kind of diseases explains the growing interest in this vitamin due to its pleiotropic effects. This short report shows preliminary results of prevalence of hypovitaminosis D in a group of patients and proposes a oral supplement therapy effective in correcting hypovitaminosis in a short time, without side effects. METHODS: 243 patients (aged 26-93; 67 males) were enrolled at this study. We evaluated plasma levels of 25-hydroxyvitamin D [25(OH)D] with the following cut-off values: <10 ng/ml or <0-25 nmol/L (deficient), 10-30 ng/ml or 25-75 nmol/L 30-50 (insufficient) and > 30 ng/ml or > 50 nmol/L (normal). The first 73 patients with hypovitaminosis D received at baseline 25,000 IU (Cholecalciferol) per os twice a month (Tp.A). The next patients (Tp.B) at baseline received a loading dose of 50,000 IU once a week for 8 weeks, followed by a maintenance dose of 25,000 IU twice a month. RESULTS: hypovitaminosis D is a widespread condition (i.e., 82.3%) not only in elderly (75.6% of 75 patients aged <65 yrs and 86.5% of 168 subjects aged >65 yrs). Preliminary results at 6 months show that Tp.B is more effective in correcting hypovitaminosis D (baseline 14.4 ± 5.3 ng/ml; 24 wk 43.3 ± 14.7 ng/ml; p<0.0001). CONCLUSION: hypovitaminosis D is an important public health problem. We believe it is important to quickly achieve normal Vit. D plasma values in order to produce pleiotropic effects.

Vitamin D: drug of the future. A new therapeutic approach.

Besides increasing calcium absorption in the bowel and promoting the normal formation and mineralization of bone, vitamin D exerts relevant pleiotropic effects in different tissues. Serum levels of vitamin D show correlation with the risk of infections, cardiovascular diseases, cancer and autoimmune disorders. The possible therapeutic role of vitamin D in different kind of diseases: inflammatory, immunologic, infectious and neoplastic ones, explains the growing interest in this vitamin due to its pleiotropic effects, and makes it a candidate to become a potential drug in the next future.

Third degree of atrioventricular block: a rare geriatric complication that may cause sudden death. Remarks on two clinical cases.

Two clinical cases are reported that have in common the electrocardiographic detection of a third degree atrioventricular block (AVB), which occurred in the first case in a man of 78 years, hospitalized in our unit after an accidental fall with an ensuing head trauma, and in the second case, in a woman of 67 years, after cataract surgery on her left eye. The complete or third degree AVB is a bradyarrhythmia characterized by the absence of paroxystic or permanent atrioventricular conduction. Several studies conducted on subjects between the ages of 60 and 85 pointed out that the incidence of AVB-type bradyarrhythmias of a degree greater than the first is extremely rare, i.e., it is close to zero. It is, however, necessary to make an early diagnosis of the AVB, as in many cases it may complicate the patient's clinical progress and may often lead to sudden death. Clinical and experimental observations have shown that electrocardiographic alterations and arrhythmias are frequent complications of cerebral accidents such as head traumas, or of ophthalmic surgery. It is therefore necessary, especially in elderly patients in whom bradyarrhythmias are characterized by the presence of widespread histological alterations of the conduction system, to perform a 24-h monitoring of all adverse events that may lead to an AVB.

An assessment of the main metabolic variables of cardiovascular risk in a sample population of workers in Rome.

BACKGROUND: The last few years have seen an increased necessity to assess the cardiovascular risk factors on large samples of the population in Italy. A look at the citizens of a small rural town Brisighella is well known. METHODS: Three hundred and five individuals of average age 40.8 years (+/-8.22), recruited between September 1988 and December 1989 (198 men, 107 women) were taken into consideration. Clinical and instrumental investigations were then performed (intern visits with data obtained from primary anthropometric, otorhinolaryngological and ocular variables, heart X-ray, electrocardiogram). The following analyses were also performed: haemochrome, ESR, uricemia, azotemia, glycemia, AST, ALT, bilirubinemia, protein electrophoresis, triglyceridemia, total cholesterol, HDL cholesterol, creatinine level and urine analysis. Women also received PAP-test. Another variable was lifestyle habits which may be considered a risk for cardiovascular disease. Hygienic and diet suggestions were made. After seven years, in 1997, 100 of these individuals (51 men, 49 women - mean age 42.7+/-6.5 years) were chosen at random and administered the same clinical and laboratory examinations as before. RESULTS: The analysis of the data show average BMI values 24.07+/-2.7 in men and 22.8+/-2.6 in women, inferior to those found in other Italian investigations. We observed an increase of BMI along with age, despite measures of preventive medicine, in married subjects and along with education and occupation level. Mean values of cholesterol level in men increased between the ages 30 and 39 and stabilised after 40 years; in women they increased only after the 5th decade of life. CONCLUSIONS: We observed a direct correlation between the increase of uricemia and triglyceride levels, triglyceride and cholesterol levels, BMI and triglyceride levels conferming the tight bond among these metabolisms and the importance of obesity as a risk factor. Uricemia levels correlate with systolic and diastolic blood pressure.

Life habits and cardiovascular risk in a group of bank employees in Rome.

BACKGROUND: For the past thirty years, many countries, especially the USA, have been performing clinical and laboratory studies to establish the most prominent disease risk factors, in particular those involved in cardiovascular diseases. The main aim of these studies is to reduce disease related risks by intervening at an early age. METHODS: We studied 305 patients, 198 males and 107 females, all employees in Rome, mean age 40.8 years (+/- 8.22), enrolled from September 1988 to December 1989. We measured the main anthropometric parameters and performed otolaryngologic and ocular examination, a telecardiogram and an EKG; the following analyses were performed: hemochrome, ESR uric acid, azotemia, glycemia, AST, ALT, gamma GT, bilirubinemia, proteic electrophoresis, triglyceridemia, total cholesterolemia, HDL cholesterolemia, creatinine, urine examination, Pap-Test for women. Lifestyle habits that might be considered cardiovascular disease risk factors were considered and hygienic eating habits were suggested. Seven years later, in 1997, 100 of these patients were randomly selected (51 man and 49 women) and underwent the same clinical and laboratory tests as before. RESULTS: The results suggest a deep correlation between lifestyles and the increase of some cardiovascular risk factors. CONCLUSIONS: The authors believe that this study can be of some help in guiding future preventive medicine interventions that may be carried out on this population sample.

Mammary Paget's disease with acantholytic features and without any detectable breast tumor.

Paget's disease is usually associated with an underlying adenocarcinoma of the breast. The initial manifestation is an eczematous or psoriasiform lesion of the nipple, soon extending to the mammary areola and then to the surrounding skin. The histology of the lesions is characterized by the presence, within the epidermal layer, of the so-called Paget's cells, i.e. large cells with vesicular nucleus and clear cytoplasm. The authors report a recent case of Paget's disease of the breast in a 75-year-old woman, unusual both for clinical course and observed histology. As for the clinico-evolutive aspects, although in the case observed the initial skin lesions appeared 20 years before, the different diagnostic procedures repeatedly performed showed no evidence in this patient of an underlying adenocarcinoma. The histologic aspect, on the other hand, was peculiar since the typical characteristics of an acantholytic disease were evident. The presence of intraepidermal cleavages with lost, at times, of the normal contacts among the cells of the Malpighian layer has been described only once in Paget's disease. This fact caused some diagnostic difficulties: however, the typical finding of the Paget cells, their positivity to histochemical methods such as cytokeratin and acid phosphatase allowed the diagnosis. The authors, at last, evaluate the need of a surgical therapy in Paget's disease of the breast without an underlying adenocarcinoma.

Ovarian cancer and unilateral naevoid telangiectasia: a rare association.

The Authors describe the case of a 58-year-old woman affected by erythematous telangiectasis lesions on the antero-lateral surface of the right hip during papillary serous cystoadenocarcinoma of the right ovary. The diagnosis, based on clinical and histological findings, was unilateral naevoid telangiectasia. After a review of literature the Authors assume a possible role of the oestrogens in the pathogenesis of such infrequent disease.

[Juvenile dyslipidemia as early risk factor for atherosclerosis. Analysis of a sample of school age boys]. / Le dislipidemie giovanili come fattore di rischio precoce di aterosclerosi. Analisi di un campione di giovani di sesso maschile in età scolare.

Atherosclerosis appears already in the first years of life. Several factors may accelerate the age of onset and the gravity of its symptoms. Particular importance is attributed to lipid metabolism in youth. Ther Authors studied the rates of cholesterol, HDL, LDL, triglycerides, apolipoproteins AI and B100, lipoprotein a and several anamnestic and anthropometric parameters in a group of 103 young people of Rome, between 16 and 19 years of age. They processed these data statistically and compared them with those of a similar American group. The results showed a tendency to fatness in the Italian sample, and to dyslipidosis in the American group. Besides, the subjects who had been breast-fed presented higher blood levels of cholesterol and apolipoprotein B100.

Situs viscerum specularis in monozygotic twins.

A case is reported of a 14-year old male MZ twin pair, with only one partner affected by situs viscerum inversus, whereby the condition is termed situs viscerum specularis. The high degree of mirror imaging is seen as an abnormal variation of the biological time of the cleavage giving rise to MZ twinning. Electrocardiographic findings are presented and the biological implications of the condition are discussed.