[Applications and results of photon absorptiometry]. / Applicazioni e risultati della mineralometria a raggi fotonici.

Bone mineral content (CMO, mg/cm2) was measured at the distal radius by dual photon absorptiometry (DPA, I125, Am241) in 1.161 women (w), aged 20-87 years. Women were subdivided into different groups according to the presence and duration of menopause. For gross evaluation of spinal osteoporosis (OP), the results of spinal X-rays were graded as follows: score 0: no signs of OP; score 1: aspecific signs of OP; score 2: typical signs of OP; score 3: wedging or collapse of one or more vertebrae. Women in postmenopausal state showed significantly reduced CMO (p less than .0005) when compared to women in premenopausal state; a significant correlation was found between CMO and years since menopause (p less than .0001). Concerning the relationship between CMO and spinal score, a progressive decreases in CMO from score 0 to score 3 was present and the correlation was significant (p less than .0001). In addition, women with score 3 showed a mean CMO below the "fracture threshold", in spite of the large overlap in individual CMO values. Our data suggest that radial DPA should be maintained as a "screening" procedure for OP.

Prevention of glucocorticoid-induced osteopenia: effect of oral 25-hydroxyvitamin D and calcium.

Twenty-four patients (9 M and 15 F, age range 51-82) with polymyalgia rheumatica receiving 6-methylprednisolone for a period of 9 months (16 mg/daily/two weeks, 14 mg/daily/two weeks, 12 mg/daily/1 month, 10 mg/daily/1 month, 8 mg/daily/1 month, 6 mg/daily/1 month and 4 mg/daily for the last four months) were randomly assigned to receive either 250HD3 (35 mcg/day for 25 days/month) (Group A) or placebo (Group B) in a double-blind study. All patients also received 500 mg elemental calcium daily. Before and at 3, 6 and 9 months ESR, tenderness on palpation and subjective pain were evaluated. At the same times, mineral metabolism parameters (serum calcium, phosphorus, alkaline phosphatase, 24-h urinary calcium, phosphate and 24-h hydroxyproline excretion) and radial bone mineral content (BMC) were evaluated. Activity indexes (ESR and clinical parameters) improved in both groups. Furthermore, serum alkaline phosphatase and 24-h hydroxyproline excretion decreased significantly only in Group A, and BMC decreased significantly in Group B but rose slightly in Group A. No side effects were observed in any of the patients.

Cryoglobulins and immune complexes in essential mixed cryoglobulinemia.

The authors review the role, clinico-serological correlations and the putative pathogenetic relevance of a number of immunological parameters in essential mixed cryoglobulinemia. On the whole, in spite of the fact that levels of cryoglobulins, immune complexes, complement as well as reticuloendothelial splenic function are frequently abnormal in this condition, they are generally poorly correlated with clinical features. Therefore, it is postulated that this apparent discrepancy may either be due to the contemporary presence in the same serum of many types of immune complexes with different toxicity, or to the influence of rheumatoid factor on the nature of circulating immune complexes.

Plasma-exchange in mixed cryoglobulinemia. Effects on renal, liver and neurologic involvement.

Prolonged plasma-exchange without addition of cytotoxic agents was employed in 16 patients with mixed cryoglobulinemia and kidney, liver or neurologic involvement. Patients with rapidly progressive renal failure or active and reversible lesions generally improved after plasma-exchange, as well as those with a recently occurring sensory-motor peripheral neuropathy. In 4 out of 6 patients with mixed cryoglobulinemia and chronic active hepatitis, plasma-exchange was followed by either normalization or significant reduction of liver enzymes and bromosulfophthalein retention. In all cases responding to plasma-exchange the beneficial effects were evident after the first 2-3 weeks of treatment, while symptoms did not generally recur when the procedures were either slowly tapered or discontinued. Although the pathogenetic mechanism(s) of action of plasma-exchange remains largely unknown, preliminary data indicate that these procedures induce quantitative as well as qualitative changes in the immune system.