Approach in glucocorticoid-induced osteoporosis prevention: results from the Italian multicenter observational EGEO study.

Glucocorticoid-induced osteoporosis (GIO) is the most frequent cause of secondary osteoporosis. GIO is linked to glucocorticoids (GC) daily assumption with maximum effect within first months of treatment and decreasing to basal levels as the therapy is discontinued. In Italy, primary prevention of GIO is suggested when GC therapy (prednisone >5 mg/day or equivalent) is taken for longer than 3 months. Lazio GISMO (Italian Group for Study and Diagnosis of Bone Metabolism Diseases) group organized the GC and Osteoporosis Epidemiology study (EGEO) to evaluate physician's approach in preventing GIO. The study involved 19 osteoporosis centers. Patients taking long-term GC therapy were recruited and information collected: medical history and anthropometric data, GC therapy, primary disease, physician's specialty, osteopororosis screening, and pharmacological intervention. The study included 1334 patients. Mean age was 63 ± 13 yr; 243 (18%) patients had a history of falls from standing position in the previous 12 months, 78 (35%) vertebral fractures, 91 (41%) fractures other than vertebral, 27 (12%) femoral fractures, and 27 (12%) multiple sites fractures. The molecules of GC more often prescribed were prednisone and 6-metil prednisolone. One thousand and forty patients (78%) were taking GC for more than 6 months. GC therapy was prescribed more frequently by rheumatologists (62%). Antiosteoporotic drugs for GIO prevention were prescribed in 431 patients (32%). Among the patients, only 27% (360) received calcium and vitamin D supplements, and 39% (319) treated by rheumatologists received anti-resorptive drugs. In conclusion, our data show that in Italy, as already described elsewhere, only a small subpopulation of GC-treated patients was supported by an anti-osteoporotic therapy, indicating the need to further stimulate awareness of both patients and specialists, prescribing GC therapy, to an appropriate and prompt GIO prevention.

Atypical renal onset and involvement in primary antiphospholipid syndrome in a child.

A case of primary antiphospholipid syndrome (APS) with renal involvement in a 10-year-old child is reported. The peculiarity of the case resided not only in the apparent "primary" occurrence of APS in the pediatric age, but also in the involvement of the kidney. The renal picture in the case described consisted of a focal proliferative glomerulonephritis, without any sign of glomerular thrombosis. We conclude that this should lead to a consideration of primary APS in the differential diagnosis of nephropathies, also in childhood.

[Clinical experience with the use of piroxicam in fast-dissolving sublingual capsules in acute recurrent osteoarthritis]. / Esperienza clinica sull'impiego del piroxicam compresse sublinguali a rapida dissoluzione nell'osteoartrosi riacutizzata.

Open, non comparative study to evaluate the efficacy and safety of piroxicam Fast Dissolving Dosage Form (FDDF) for sublingual administration in treatment of reacutized osteoarthritis. Fifty-four patients with flare-ups of osteoarthritis involving various joints were enrolled in the study. They were treated with 20 mg/die piroxicam sublingual tablets for a total of 4 weeks. Drug efficacy was evaluated on the basis of the variation of spontaneous pain, pain on passive motion, functional limitation and capacity of performing a specific activity. Intensity of spontaneous pain on the first day showed a statistically significant improvement (p < 0.0001) only 15 minutes after the drug administration. This improvement in pain intensity increased until day 3. All other efficacy parameters showed a statistically significant improvement (p < 0.0001) 7 days after the beginning of treatment. Local and systemic tolerability was good. No patient showed local side effects; only 6 patients experienced systemic side effects. In conclusion, piroxicam sublingual tablets for treatment of osteoarthritis flare-ups showed analgesic efficacy already 15 minutes after drug administration, and good anti-inflammatory efficacy with good local and systemic tolerability.

High-dose synthetic progestogens inhibit foam and smooth muscle cell proliferation and atherosclerotic plaque formation in aortas of rabbits fed a hypercholesterolemic diet.

Female rabbits on a hypercholesterolemic atherogenic diet were treated with high doses of the synthetic progestogens norethisterone and medroxyprogesterone acetate in order to clarify the effect and possibly some of the mechanism of action of these hormones on diet-induced atherogenesis. We employed morphometric studies to determine the surface area of the rabbit aorta occupied by and the maximum thickness of lipid plaques. Autoradiography with tritiated thymidine was performed to demonstrate the effect of the progestogens on cell proliferation, which plays a key role in atherogenesis. Medroxyprogesterone acetate-treated and, above all, norethisterone-treated animals exhibit a more marked reduction of atherosclerosis than control rabbits fed the same diet. Our results suggest that both progestogens we used inhibit the development of atherosclerosis mainly by blocking the proliferation of smooth muscle cells in the tunica media and the cell population of the plaque.

[Chemotherapy of carcinoma of the vulva and vagina. Current approaches]. / Chemioterapia del carcinoma della vulva e della vagina. Orientamenti attuali.

In the present work, on the basis of the most recent knowledges, the Authors analyse and discuss the current status of the chemotherapeutical treatment of epidermoid carcinomas of the vulva and vagina, both in case of in situ forms (topical chemotherapeutic administration) and in case of invasive tumors (systemic chemotherapeutic administration).

Skin eosinophilia from influenza viruses. An experimental histological study.

The authors would first like to stress the increasing frequency of bronchial asthma during or after influenza. To find an explanation for this occurrence they observed tissue reactions following an injection of viral material. In their experiments, they injected into the skin of guinea pigs, strains of the Hong Kong, Texas and USSR influenza viruses using current vaccines, sacrificing groups of animals 2, 6, 24, 48 hours and 7 days after the injection. The histological study revealed the following picture of reaction to influenza viruses. Two hours after the injection: marked and diffuse infiltration of eosinophils in the connective tissue of the skin. After 6 hours: the infiltration shows a predominance of neutrophils. After 24 hours: the neutrophil infiltration is predominant and diffuse. There is evidence of considerable degranulation of eosinophils. The cutaneous histiocytes undergo fibrocytic and marcophagic proliferation. After 28 hours, the same picture. After 7 days there is sever degeneration with a peripheral fibroblastic reaction. The most important finding of this experiment is the early marked infiltration of eosinophils which follows the injection of the influenza viruses. The eosinophil infiltration appears to be related to the release of histamine caused by influenza viruses. The histological examination did not reveal the presence of immune allergic-type cells at any time. Therefore, the onset of asthmatic attacks would appear to be more related to the histamine-releasing action of the influenza viruses rather than to their sensitizing activity. Naturally, the latter may occur in human pathologies.

[Toxological problems inherent in varnish and paint products used in aeronautics]. / Problemi tossicologici inerenti ai prodotti vernicianti di impiego aeronautico.

Paint products and the need for their employment on aircraft and spacecraft are described and reference is made to the types of poisoning that may arise from their application. The main solvents and diluents are listed, together with their toxicological features. Lastly, mention is made of technical products required by the aeronautical regulations, the dangers associated with them, and the preventive measures required.