Use of a lipid-lowering food supplement in patients on hormone therapy following breast cancer.

AIM: The aim of this paper was to determine the activity of a natural nutraceuticals combination (AP=Berberine+Red Yeast Rice) on dyslipidemia which frequently persists after life style changes in patients on hormone-therapy following breast cancer (HT-BC). METHODS: Twenty-one HT-BC patients, free of tumor, mean age 59.9 years, BMI 28,9 kg/m2, waist circumference 95.9 cm, with altered lipid profile (total cholesterol 269.0 mg/dL, high-density lipoprotein (HDL) cholesterol 54.9 mg/dL, low-density lipoprotein (LDL) cholesterol 184.0 mg/dL, and triglycerides 263.3 mg/dL) were recruited. They were recommended a 3-month period of diet followed by a 3-month period of treatment with AP 1 tablet/day. AP tablets contain berberine 500 mg, red yeast rice extract 200 mg (equivalent to 3 mg monacolins), policosanol 10 mg, folic acid 0.2 mg, coenzyme Q10 2 mg, and asthaxantin 0.5 mg. RESULTS: The lipid profile was significantly improved by AP vs. diet: 1.8% decrease in total cholesterol on diet and a further 15.3% decrease with AP vs. diet (P<0.001); a 3.1% decrease in LDL cholesterol after diet and an 18.9% decrease after AP treatment vs diet alone (P<0.01); a 2.3% decrease in triglycerides after diet alone and a 36.5% decrease after AP vs. diet (P<0.05). CONCLUSION: Adequate life style therapy is effective in reducing, but not in normalizing, the lipid profile in patients on hormone-therapy following breast cancer. The use of natural nutraceuticals as AP, combined with diet, leads to a good therapeutic response and optimal acceptance by the patients.

[The role of food in the workplace for health promotion and education to the future]. / Il ruolo dell'alimentazione sui luoghi di lavoro per la promozione del benessere organizzativo e l'educazione al futuro.

Health promotion and education to the future and sustainability are a new potential approach in order to try to reduce diet- and lifestyle-related diseases (cancer, metabolic disorders, obesity, neurodegenerative diseases). Inclusion of educational pathways associated to food consumption out of the home, especially in the workplace, may represent a brand new strategy of intervention, an alternative to the disappointing results of more traditional information-educational strategies implemented so far.

Measurement of skeletal muscle mass in Duchenne muscular dystrophy: use of 24-h creatinine excretion.

Creatinine concentration in 24-h urine has been proposed as an indirect measure of body skeletal muscle mass (SMM). We attempted to correlate urinary creatinine levels with SMM in eight patients with Duchenne muscular dystrophy, a progressive disease in which the degree of muscle wasting parallels the rate of progression. Magnetic resonance imaging and a newly developed protocol for image analysis were used for the measurement of SMM. The patients ate a creatine-free diet for the week before urine collection. Creatinine was measured with an enzymatic-colorimetric method. Mean (+/-SD) SMM value was 5.4+/-2.5 kg and urine creatinine levels 205.8+/-96.4 mg/day. Daily urinary creatinine excretion did not correlate with SMM. The simple creatinine determination in urine cannot predict SMM in Duchenne muscular dystrophy.

Body composition and energy expenditure in Duchenne muscular dystrophy.

OBJECTIVE: To investigate the relationship between resting energy expenditure (REE) and body composition in Duchenne Muscular Dystrophy (DMD). DESIGN: An observational study. SETTING: University Research Centre. SUBJECTS: Nine Duchenne children (age range 6-12 y), mean relative weight 128%, agreed to undergo the investigation and all of them completed the study; INTERVENTIONS: Assessment of body composition (total body fat and skeletal muscle mass) by magnetic resonance imaging and resting energy expenditure by indirect calorimetry. MAIN OUTCOME MEASURES: Fat mass (FM; kg and percentage weight), fat-free mass (FFM; kg and percentage weight), muscle mass (kg and percentage weight), resting energy expenditure (kJ/kg body weight and kJ/kg fat-free mass). RESULTS: : In Duchenne children fat mass averages 32% and total skeletal muscle mass 20% of body weight. Resting energy expenditure per kg of body weight falls within the normal range for children of the same age range, while when expressed per kg of FFM is significantly higher than reference values. No relationship was found between REE and total skeletal muscle mass. CONCLUSIONS: Our results do not demonstrate a low REE in DMD boys; on the contrary REE per kg of FFM is higher than normal, probably due to the altered FFM composition. We suggest that the development of obesity in DMD children is not primarily due to a low REE but to other causes such as a reduction in physical activity and or overfeeding.

Brucella spondylitis with paravertebral abscess due to Brucella melitensis infection: a case report.

This report describes the case of a 45-year-old woman with a 5-month history of fever, generalized malaise, myalgia, lower back pain and difficulty in walking. Serodiagnosis for brucella, carried out at the onset of symptoms 5 months previously, was negative. When the patient was admitted to our hospital there was contracture of the paraspinal muscles but no peripheral nerve damage. Laboratory tests showed positive agglutination for Brucella and an increase in the rate of dilution from 1/160 to 1/640 over 2 weeks. Radiographs and a computed tomography scan of the spine revealed bone erosion in the posterior borders of the L4-L5 vertebral end plates and a soft tissue mass surrounding the interposed disc and protruding into the spinal canal. Magnetic resonance imaging confirmed the presence of a paraspinal abscess around the affected disc and tissue edema. Culture tests of the blood and abscess tissue, taken by biopsy, were negative. Rifampicin treatment (600 mg daily), combined with a bust cast to immobilize the spine, led to clinical healing without the need for surgery. Because onset symptoms are nonspecific and insidious, in nonrisk subjects a diagnosis of brucellosis may sometimes be suspected only if there are local symptoms. The phenomenon of the absence of positivity in patients with a high antibody titer should also be considered Cases such as that described herein demonstrate the need for culture tests and serodiagnosis, even in nonrisk patients with persistent fever and arthralgia, to prevent the later complications of brucellosis.

[Ritualistic female genital mutilation. The sentiment of the women]. / Mutilations génitales rituelles féminines. La parole aux femmes.

Female genital mutilation (FGM) is considered as the most dangerous custom still ritually practiced and 2 million girls undergo the ordeal each year. This practice is anchored and fixed firmly in numerous African people's culture and Western countries are confronted to it through African immigrants. In order to understand the justifications and the consequences of FGM we interviewed 14 genitally mutilated African women living in France. Unfortunately and despite the conscious knowledge of consequences and absurd side of such practice, yet it seems to be perpetuated over the descendants. Educational approach is the best solution to fight female genital mutilation fixed firmly in numerous African people's culture.

Calcitriol and alendronate combination treatment in menopausal women with low bone mass.

Serum calcitriol levels decrease with advancing age in relation to reduced dietary intake or poor intestinal absorption of vitamin D. These decreased levels affect the development of senile osteopenia, which can be effectively prevented by the administration of alendronate and calcium. To evaluate the effect of a combined treatment with alendronate and calcitriol on bone mineral density (BMD), we followed 152 osteopenic postmenopausal women, aged 55-75 years, for 9 months. They were divided into three groups. The first group was treated every other day with 0.25 microgram of synthetic 1,25-dihydroxyvitamin D3 plus 10 mg alendronate. The second group received the same dose of alendronate plus calcium (500 mg/day). The third group received only calcium (500 mg/day). BMD measurements were made at the level of the lumbar spine and the femoral neck. At the beginning and at the end of the period of treatment the same biochemical analyses of bone metabolism were made. There were no significant differences in the baseline values of the three groups in the biological parameters. Alendronate plus calcium treatment led to a significant reduction in total alkaline phosphatase and hydroxy prolinuria as well as to a significant increase in lumbar and femoral bone density. The same changes were observed in the group treated with alendronate plus calcitriol except that femoral BMD did not significantly improve. These results show that continuous treatment for 9 months with calcitriol or calcium in combination with alendronate significantly increases both vertebral and femoral neck density (from 3.8% to 4.5% and from 0.61% to 2.36% respectively) in osteopenic postmenopausal women. The effects of both combinations on bone mass are clearly greater than those achieved by calcium monotherapy.

Thyroid hormone regulation of MHC isoform composition and myofibrillar ATPase activity in rat skeletal muscles.

Myosin heavy chain (MHC) isoform composition and Ca2+ Mg2+ dependent ATPase activity were determined in myofibrils prepared from skeletal muscles (diaphragm, soleus, plantaris and tibialis anterior) of euthyroid (C), hypothyroid (Tx) and hyperthyroid (T3) rats. Direct comparison between T3 and Tx gave an indication of the maximal effect of thyroid hormones. Significant differences in MHC-1 and MHC-2B proportions and in ATPase activity were found in all muscles. The difference in MHC-2A/X proportion was significant only in soleus, diaphragm and plantaris. When T3 and C were compared, significant variations in MHC isoform composition were found only in plantaris and diaphragm. The comparison between Tx and C showed significant differences in MHC isoform distribution and in ATPase activity in most muscles. The differences in ATPase activity among muscles and among thyroid states were consistent with those in MHC isoform distribution. From the correlations between ATPase activity and MHC isoform distribution the enzymatic activities of individual MHC isoforms were calculated. The results indicate that MHC isoform distribution is controlled by thyroid state in all skeletal muscles and that changes in MHC isoforms distribution are accompanied by proportional changes in ATPase activity.

Thromboxane antagonism and cough induced by angiotensin-converting-enzyme inhibitor.

BACKGROUND: The increased prostaglandin synthesis that might follow stimulation of the arachidonic acid cascade by angiotensin-converting-enzyme inhibition (ACE-I) has been suggested to underlie the appearance of cough on ACE-I treatment. We investigated whether the prostanoid thromboxane was involved. METHODS: Nine patients with essential hypertension who had cough after enalapril 20 mg once a day (coughers) were treated, while continuing the enalapril, in a double-blind crossover study with placebo or picotamide, 600 mg twice daily. Picotamide is a platelet antiaggregant that acts through both inhibition of thromboxane synthase and thromboxane-receptor antagonism. Thirteen hypertensive patients with no history of ACE-I-induced cough were also treated with enalapril and served as controls. Cough frequency was measured by a visual analogue scale and by a daily cough diary. 24 h urinary recovery of 11-dehydro-thromboxane-B2 and 6-keto-PGF1 alpha were measured to assess any changes in endoperoxide metabolism during the study periods. FINDINGS: 11-dehydro-thromboxane-B2 (TXB2) recovery was significantly reduced by picotamide, which led to the disappearance of cough in eight patients within 72 h. Picotamide urinary recovery data suggested incomplete absorption in the non-responder. At baseline and after rechallenge with enalapril, 11-dehydro-TXB2 excretion was in the same range in the controls and in the coughers, but the latter showed significantly lower excretion of 6-keto-PGF1 alpha, and their ratio of 11-dehydroTXB2 to 6-keto-PGF1 alpha was twice that of the controls (1.40 [95% CI 0.86-1.95] vs 0.61 [0.37-0.84]). INTERPRETATION: A thromboxane antagonist is effective in ACE-I-induced cough. An imbalance between thromboxane and prostacyclin may represent a marker of patients susceptible to ACE-I-induced cough.

Direct depressant effect of phosphodiesterase inhibitors on ATPase activity of rat cardiac myofibrils.

The aim of this study was to determine (i) whether phosphodiesterase inhibitors influenced ATPase activity of maximally calcium activated cardiac myofibrils and (ii) whether this effect varied in relation to isomyosin composition. Myofibrils were prepared from ventricular myocardium of 2- to 3-month-old rats. ATPase activity was determined at low ionic strength at high (> 7.5) and low (4.4) pCa. Five compounds (amrinone, milrinone, enoximone, piroximone, and rolipram) were examined at concentrations between 10 microM and 1 mM. The results obtained showed that only milrinone and amrinone inhibited ATPase activity; inhibition was dose dependent, and milrinone was more potent than amrinone. To assess whether isomyosin composition might influence the responsiveness of myofibrils to phosphodiesterase inhibitors, the effect of 1 mM milrinone was also determined in myofibrils from hypothyroid rats. According to previous observations hypothyroidism caused an isomyosin shift from V1 to V3 in rat ventricular myocardium. The inhibitory effect of milrinone was lower in myofibrils prepared from hypothyroid rats than in myofibrils from euthyroid rats.

[Carcinomatous meningitis. Presentation of 3 cases]. / Meningite carcinomatosa. Presentazione di tre casi.

Meningeal carcinomatosis is characterized by diffuse infiltration of the leptomeninges by metastatic cancer in patients usually with a previous history of malignancy. Primary tumors are adenocarcinomas of the breast or lung, or malignant melanoma. The clinical presentation is pleomorphic and commonly affects the cerebral hemispheres, the cranial nerves, or spinal cord and its roots. Diagnosis is confirmed by the presence of the malignant cells in the cerebrospinal fluid (CSF). Computed tomography (CT) and magnetic resonance (MRI) show abnormal findings including ventricular dilatation and small enhancing lesions along the CSF space. Despite radiotherapy and chemotherapy, vital prognosis remains bad and the treatment is useful in improving the quality of life. Three cases presented here emphasize once again the important fact that meningeal carcinomatosis remains a very difficult diagnosis; several lumbar punctures were sometimes necessary, and cerebral fluid studies cannot yet be replaced by other diagnostic techniques like contrast enhanced CT or MRI with gadolinium.

Pathology from hydroxyapatite deposits in periarticular tissues. First conclusions on etiopathogenesis.

Biopsies of periarticular tissues from patients with episodes of chronic periarthritis were examinated by histological, ultrastructural and chemico-crystallographic methods. In all samples the mineralogical observations at the optical microscope, showed aggregates of microcrystalline incrustations, whose ultrastructural morphology has been characterized by SEM. The histological observations showed necrosis of collagen fibres and microcrystallization process in cavities and in metaplastic fibrocartilage. The HA deposits in the periarticular tissues, in the next stage of the process, are surrounded and demolished by macrophages and multinucleated giant cells. At the same time granulation tissue carries out the repair process, that begins with the formation of thin parallel collagen fibers interposed with many fibroblasts and numerous small vessels.

[Neuropathy or the brachial plexus associated with pregnancy. Report of a case]. / Neuropatia del plesso brachiale associata a gravidanza. Presentazione di un caso.

Idiopathic neuropathy of the brachial plexus can appear in two different forms, a sporadic one and a family one, autosomic dominant, much rarer which can be associated with pregnancy. Authors report a clinical case of brachial plexus neuropathy in a patient to the seventh month of pregnancy and with no observation of hereditary disease of nervous peripheric system. Clinical, electrophysiological aspects and possible pathogenetic mechanisms are here debated. Also therapeutic strategies and psychological implications are considered.

Tricuspid endocarditis: a rare infectious complication of cardiac pacemaker in a patient with Chagas' disease--a case report.

Tricuspid endocarditis was diagnosed in a sixty-four-year-old patient with Chagas' disease who had a permanent cardiac pacemaker and whose generator had been replaced five months before an infection in the pocket. The pacing system was replaced by an epicardial one and the patient received antibiotics with good results.

[Calcification of the basal ganglia and Fahr disease. Report of two clinical cases and review of the literature]. / Calcificazione dei gangli della base e malattia di Fahr. Presentazione di due casi clinici e revisione della letteratura.

Computed Tomography (CT) is superior to conventional skull radiographs in detecting calcifications of the basal ganglia. Basal ganglia calcification has been associated with different conditions, abnormality in the calcium-phosphorus metabolism being the most common of these associations. Some patients, without any evident disease, are well documented and called idiopathics of Fahr's syndrome; less numerous patients present familiar trait, with autosomal dominant inheritance. The correlation of neurological impairment with symmetrical calcification of basal ganglia is not so frequent. Here we present two cases of Fahr's disease, in whom CT aspects were very similar, but the neurological manifestations were different. The review of the literature shows, now, that there is no definite pathogenesis of basal ganglia calcifications.

[An open study on the clinical efficacy of citicoline in patients with chronic cerebral vasculopathy]. / Studio in aperto sull'efficacia clinica della citicolina in pazienti affetti da cerebrovasculopatia cronica.

In this study we evaluated the safety/efficacy of citicoline in 30 patients affected by atherosclerotic processes with cerebral localization. Aim of this study was to confirm, from a clinical point of view, the efficacy of citicoline in increasing blood flow in the vascular zone and in exerting a trophic action on cerebral cells improving the symptoms related to the chronic cerebrovasculopathy. Therapeutic effect was evaluated, by means of subjective parameters, at the beginning, during and at the end of the study. The results obtained was statistically analyzed confirming the efficacy of citicoline on the subjective symptomatology. Safety was excellent in all cases.