PubMed Health⌕ Search

Biomedical subjects

S Adami

Publications and source records attributed to S Adami.

At least 163 records · Page 9Linked to original sources
PubMed1978

Discriminant analysis in the differential diagnosis of hypercalcaemia.

Linear discriminant analysis, a multivariate statistical procedure, applied to serum calcium, phosphate, alkaline phosphatase, bicarbonate, chloride, creatinine and tubular reabsorption of phosphate, proved to be effective in distinguishing patients with Primary Hyperparathyroidism from other hypercalcaemic patients in eithy-four retrospective cases. The application of the model to thirty-four prospective cases enabled us to separate correctly, hyperparathyroid patients from non-parathyroid hypercalcaemic patients.

Diagnosis, Differential↗
PubMed1976

[Serum calcium evaluation and incidence of primary hyperparathyroidism in hospitalized patients (author's transl)].

Automated laboratory procedures have made possible to "screen" a large population for specific biochemical abnormalities. Primitive hyperparathyroidism is for several respects an excellent disease model for testing "mass screening". Il is often asymptomatic, not uncommon, and is manifested by abnormalities in the levels of serum calcium and inorganic phosphorus, that can be detected cheaply with automated equipment. A computer program has been developed to screen patients with hypercalcaemia. During a period of 18 months 22720 hospitalized patients were investigated by the evaluation of serum calcium, and 80 hypercalcaemic patients were found. The diagnosis of primary hyperparathyroidism was established in 24 patients (in 19 histologically confirmed) so that the incidence of primary hyperparathyroidism (1,05%) compares favorably with that reported from some foreign Authors.

Adult↗
PubMedDate not supplied

Serum thyroid hormone concentrations and weight loss relationships in eight obese women during semistarvation.

Eight obese female patients were studied over a period of 15 days whilst on 300 kcal diet. Serum levels of thyroxine and free throxine index were not altered significantly by semistarvation. A TRH test performed before and after the diet showed no appreciable change. Weight loss was intially rapid but later slowed despite good patients compliance. Serum concentrations of T 3 and reverse T 3 (rT3) early decreased (p less than 0.01) and increased (p less than 0.05) respectively, but returned towards control levels even before discontinuation of semistarvation. There was a positive correlation between the percentage decrease in body weight and the percentage increase in serum rT 3 (p less than 0.001), and a negative correlation between decrease in body weight and decrease in serum T 3 (p less than 0.001). Our results do not suggest that the variations in serum triiodothyronines limit the weight loss; it is probable, on the contrary, that the weight loss promotes the observed variations in thyroid hormones by as yet unknown adaptive metabolic forces.

Adult↗
PubMedDate not supplied

Effects of two oral doses of alendronate in the treatment of Paget's disease of bone.

Twenty patients with mild Paget's disease of bone were given either 20 (10 patients) or 40 mg alendronate daily for 6 months. The 20-mg dose was well tolerated, but in 3 patients on 40 mg/d alendronate, the treatment was withdrawn after 3-5 months because of gastric and oesophageal disturbances. Urinary hydroxyproline excretion fell within the first month to 77 +/- 5% (SD) and to 47 +/- 5% of pretreatment values in the 20- and 40-mg dosing group, respectively (p < 0.001 between group comparison). The serum alkaline phosphatase fell more slowly with the maximum suppression of disease activity reached at 4 months, when it attained a plateau in both groups of patients. However, the decrease in serum alkaline phosphatase was significantly more pronounced in the patients treated with 40 mg/d tablets (50 +/- 10% of pretreatment values) than in those given 20 mg alendronate per day (76 +/- 9% of initial value), in none of whom a disease remission was observed. It appears, therefore, that while 20 mg/d oral doses of alendronate are insufficient, 40 mg/d are associated with a high incidence of side effects. Furthermore, the suppression of disease activity depends on the dose of bisphosphonate given daily or over a short period of time and lower doses cannot be compensated by a longer duration of the treatment course.

Administration, Oral↗
PubMedDate not supplied

[Use of nonsteroidal anti-inflammatory drugs in patients with vertebral osteoporotic fractures].

OBJECTIVE: The aim of the study was to assess the use of Non Steroidal Anti-Inflammatory Drugs (NSAIDs) in patients with a history of osteoporotic vertebral fractures. METHODS: We investigated 119 patients with postmenopausal osteoporosis complicated by one or more non recent vertebral fractures. RESULTS: More than 60% of the patients took at least one dose of NSAID weekly. The most prescribed NSAID was nimesulide, at a dose with an exclusively antalgic effect. Patients with wedge fracture and those with a documented vertebral fracture in the last 12 months were those taking NSAIDs more frequently. 77% of the patients that used NSAIDs had concomitant features of osteoarthritis, mainly at the spine or at the knee. The use of NSAIDs was negatively related to the use of specific therapy for osteoporosis, particularly for oral daily tablets. CONCLUSIONS: This study highlights the significant use of NSAIDs in patients with osteoporotic vertebral fractures and the overlap between osteoporosis, osteoarthritis and related treatments.

Aged↗
PubMedDate not supplied

[Pain patterns in Italian patients with osteoarthritis: preliminary results of the MI.D.A. Study (Misurazione del Dolore nell'Artrosi)].

OBJECTIVES: To evaluate the characteristics of pain in a cohort of Italian patients with osteoarthritis (OA) of the hip and knee. METHODS: The 657 general practitioners participating in the study were asked to enroll 10 consecutive patients with OA diagnosed according to the American College of Rheumatology (ACR) clinical criteria. A questionnaire evaluating demographic data, clinical characteristics of OA, including the "Questionario Semantico Reumatologico" (QSR) pain questionnaire, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Lequesne indices, and information on previous diagnostic and therapeutic interventions was administered. RESULTS: A total of 4,109 patients were enrolled. Of them, 2356 were affected by knee OA and 1817 by hip OA. There were 2863 (69.7%) women and 1246 (30.3%) men. Median age was 68.2 years (range 50-103 years). Of the 4109 enrolled subjects, 3128 (76.1%) reported one or more medical comorbidities, mostly cardiovascular (52.7%), endocrinological (14.7%), gastrointestinal (13.4%), and respiratory (11.2%) disorders. The median pain visual analogue scale (VAS) score was 58.1+/-22.6 mm, higher in women (60.2+/-22.3 mm) than in men (53.3+/-22.6mm) (p<0.00001). OA pain was also higher in patients from Southern Italy (p<0.00001). NSAIDs were administered to nearly 70% of patients, COX-2 inhibitors to 55%, disease-modifying anti OA drugs to 19% and analgesics to 28.2%. Differences in drugs utilization were associated with OA localization and patient's geographical origin. Results of the WOMAC index were similar throughout groups. Responses to the QSR pain questionnaire showed differences, which are related to OA localization and geographical origin of the patients. CONCLUSIONS: The MI.D.A. study can help to better understand the patterns of pain in osteoarthritis and the associated treatment.

Age Factors↗
PubMedDate not supplied

[Incidence and socioeconomic burden of hip fractures in Italy].

OBJECTIVES: The aim of this study was to evaluate the trend of the incidence and costs of hip fractures in Italy. METHODS: The incidence of hip fractures after 45 years of age in both females and males during the years 1999-2002 was obtained by analyzing the Italian Ministry of Health national hospitalization database, according to the diagnosis codes of International Classification of Diseases, Clinical Modification, 9th edition (IDC-9-CM) that indicate femoral fracture. We have computed all direct costs sustained by the National Health Service for hospitalization and treatment of hip fractures on the basis of the value of the Diagnosis Related Groups (DRG) referring to hip fractures. The expenses of rehabilitation and indirect expenses were based on estimates. RESULTS: In 2002, more than 86,000 hip fractures were registered in Italy in male and female patients over 45 years old, with 9% progression compared to 1999; 77% were female and 80% were over 75 years of age. In 2002 the direct costs of hospitalization, in the patients over 65 years alone, were almost 400 million euros, with an increase of 15% as compared to 1999. Considering also estimated rehabilitation costs, social aid and indirect costs, we estimate that hip fractures due to age-related osteoporosis created over a billion euros in expenses in 2002. CONCLUSIONS: Preventive intervention regarding the risk of hip fracture in elderly patients is urgent.

Aged↗
PubMedDate not supplied

[Improvements in the management of rheumatic patients from vertebral image obtained through dual-energy X-ray absorptiometry].

The diagnosis of asymptomatic vertebral fracture is clinically useful and the identification of new fractures may influences the choice of appropriate therapeutic measures. In order to identify moderate and asymptomatic vertebral deformities in an objective and reproducible manner, vertebral morphometry is performed. This method measures the vertebral body's anterior, middle and posterior heights at the dorsal and lumbar level. Currently this technique is performed on lateral images of the spine obtained through the traditional X-ray method (radiological morphometry or morphometric X-ray radiography, MRX) and, more recently from images obtained through dual-energy X-ray absorptiometry (DXA) machines (visual assessment of X-ray absorptiometry scans or morphometric X-ray absorptiometry, MXA), commonly used to measure bone mineral density. The main advantage of MXA relative to MRX is the lower radiation dose to which the patient is exposed during the exam. In addition, MXA scans offers the advantage of acquiring a single image of thoracic and lumbar spine, without any distortion (e.g.: coning). The most obvious advantage of MXA is the opportunity of obtaining during the same session a bone mineral density evaluation, and digital images that are easily processable, manageable, recordable and comparable for the patient's follow up. A limitation of the MXA technique is the inferior quality of the images, that make often impossible the detection of the vertebral edges, and the impossibility to visualize the upper thoracic vertebral bodies. MXA, despite its intrinsic limitations, when carried out by trained personnel may provide substantial improvements in the management (diagnosis and follow-up) of rheumatic patients.

Absorptiometry, Photon↗
PubMedDate not supplied

[Study of vitamin D status of rheumatoid arthritis patients. Rationale and design of a cross-sectional study by the osteoporosis and metabolic bone diseases study group of the Italian Society of Rheumatology (SIR)].

The fundamental role of Vitamin D has been long known in regulating calcium homeostasis and bone metabolism. An increased contribution of Vitamin D was recently described in association with a lower incidence of Rheumatoid Arthritis (RA). This must not be surprising, as the immunomodulating effects of Vitamin D are clear, which have been attributed protective effects in autoimmune disorders such as some chronic inflammatory bowel diseases, multiple sclerosis and type I diabetes. An interaction was suggested between Vitamin D metabolism and inflammation indexes through mediation of TNF-alpha which is also especially involved in osteoclastic resorption and therefore in bone loss processes. Some preliminary data would indicate an association between seasonal changes of Vitamin D serum levels, latitude and disease activity (DAS28) in RA patients. Consequently, the Osteoporosis and Metabolic Bone Diseases Study Group of SIR believes that there are grounded reasons for assessing the Vitamin D status of RA patients in order to investigate whether this is to be related to physiopathological and clinical aspects of disease other than those of bone involvement. Primary end point of the study will be to assess the levels of 25 OH Vitamin D in RA patients. Secondary endpoints will include correlation with dis-ease activity, densitometry values and bone turnover. The cross-sectional study will enroll patients of both sex genders, age ranging between 30 and 75 years according to the 1988 ACR criteria, onset of symptoms at least 2 years prior to study enrollment. Patients will be excluded suffering from osteo-metabolic diseases, liver and kidney insufficiency and those administered Vitamin D boli in the previous 12 months. Disease activity will be evaluated with the HAQ. Hemato-chemical tests and femoral and lumbar bone densitometry will be performed, unless recently undergone by patients. Blood levels of 25 OH C Vitamin D and PHT and of the two bone remodelling markers (bone alkaline phosphatase and serum CTX) will be measured, as well. Patient enrollment will start on February 2007 and will last 4 months. By the end of 2007 the study will be concluded and results will be published.

Absorptiometry, Photon↗
PubMedDate not supplied

Primary hyperparathyroidism: diagnostic value of a model of multivariate statistical analysis.

In examining a group of 90 hypercalcaemic patients (37 with primary hyperparathyroidism), a comparison was made of the diagnostic reliability of: 1) tests commonly used for diagnosis of primary hyperparathyroidism; 2) radioimmunoassay of plasma parathormone; 3) a recently introduced model of multivariate statistical analysis. The results indicate that, at present, the model of multivariate statistical analysis used is of higher diagnostic reliability in the diagnosis of primary hyperparathyroidism than renal phosphate excretion tests and the radioimmunoassay of PTH itself.

Calcium↗
PubMedDate not supplied

Short-term intravenous therapy with Neridronate in Paget's disease.

AIMS: To describe the effects of two consecutive intravenous infusions of aminohexane bisphosphonate (Neridronate) in patients with active Paget's disease of bone. METHODS: The study population included 83 patients, aged 41 to 85 years, randomized to 4 cumulative doses of Neridronate (25, 50, 100, 200 mg) given over 2 days, with a follow up of 180 days. The baseline serum alkaline phosphatase activity was at least 10% above the upper limit of the laboratory range. The response to treatment was assessed by changes in the serum total alkaline phosphatase (primary end point of the study), bone alkaline phosphatase and N-telopeptide urinary excretion. RESULTS: All Neridronate doses significantly suppressed the biochemical indices of disease activity. The nadir of total alkaline phosphatase levels ranged from -16 % to -57.5% of pretreatment values in the four groups, with a dose-response relationship that was apparent even between the two highest doses. The proportion of patients still maintaining a partial response (decreases in serum total alkaline phosphatase >25%) at the 6 month follow-up was also related to the dose: 98%, 67%, 57%, 21% in the patients given 200, 100, 50, 25 mg respectively. The proportion of responders in terms of bone alkaline phosphatase and N-telopeptide excretion changes was similar. Bone pain attributed to Paget's disease was significantly reduced. A typical acute phase reaction (fever and/or arthromyalgia) occurred in 16 out of 83 patients. CONCLUSIONS: We conclude that all of the Neridronate doses tested here were well tolerated and effective in decreasing, in a dose-related manner the bone turnover parameters of Paget's disease. The highest dose (200 mg) resulted in the normalization of the markers of disease activity in more than 60% of the patients.

Adult↗
PubMedDate not supplied

[Therapeutic strategies in osteoporosis: whom and when to treat].

Postmenopausal bone loss can be efficiently prevented by compounds which inhibit bone resorption, but they can not induce a sustained and relevant bone gain. The initial increase in bone volume observed within the first year of treatment is due to a transient uncoupling between bone resorption and formation: the first is suddenly blocked whereas bone formation decreases slowly within several months; bone is gained until the previously resorbed cavities are refilled. This net increase in bone mass is completely lost as soon as treatment is withdrawn. Since these antiresorptive agents can only be used in order to prevent bone loss, they should be given for several years. Thus, the choice of the drug is also conditioned by its cost and long-term compliance. Estrogen replacement is very convenient, from these points of view in most patients immediately after the menopause. Afterwards, parenteral calcitonin has been, up to now, the sole available alternative with convincing evidence of effectiveness, at least in the medium term. Its cost and the scarce compliance to injections have strongly limited its extensive use. There is increasing evidence that oral bisphosphonates are very effective and therefore they might represent, in the near future, an effective and convenient alternative to estrogen replacement therapy.

Aged↗
PubMedDate not supplied

Disease-modifying antirheumatic drugs and bone mass in rheumatoid arthritis.

This article reviews the effects of DMARDs (including biologic agents) on bone metabolism in rheumatoid arthritis (RA). At present there is no evidence that methotrexate, at least at dosages ranging from 5 to 20 mg/week, negatively affects bone mass as measured by DXA (BMD) as documented in both cross-sectional and longitudinal studies. Most studies of cyclosporine (CyA) use reporting a reduction in erosions and joint damage with no adverse effects on bone, did not measure BMD; CyA treatment is associated with a dose-dependent increase of bone turnover as well as a decrease in both animal and human studies; however, its use in RA setting at a dose < or =5 mg/Kg/ day has so far not been associated with clinical relevant adverse effects on bone metabolism. Anti-TNF-alpha agents, infliximab reduced markers of bone turnover in two longitudinal studies. Data on BMD are not available in RA; nevertheless, an increase in BMD has been documented in spondyloarthropathies with infliximab and etanercept. No clinical data concerning BMD are available on leflunomide as well as on the newer biologic agents (adalimumab, rituximab, anakinra).

Antibodies, Monoclonal↗