Andrea Salvi

Reduced thyroid volume and nodularity in dyslipidaemic patients on statin treatment

Background  Little information is available concerning the possible antiproliferative effects of 3‐hydroxy‐3‐methylglutaryl coenzyme A (HMG‐CoA) reductase inhibitors (statins) on the thyroid gland. We have hypothesized that the antiproliferative effects of statins observed in thyroid cell lines in vitro may have a clinical counterpart that could be detected by investigating the prevalence and size of thyroid nodules in patients on long‐term treatment with statins.

Cortisol secretion in patients on simvastatin

We have investigated the effects of simvastatin on adrenal function in 7 men and 3 women (mean age 53 years) affected by, or at high risk of, ischaemic heart disease and with heterozygous familial hypercholesterolaemia (FH). After eight weeks on the American Heart Association phase-I diet and placebo treatment, our patients received simvastatin as a single daily bedtime dose of 10 mg for six weeks, 20 mg for a further six weeks, followed by 40 mg for twelve weeks. A rapid adrenocorticotropic hormone (ACTH) test (intravenous tetracosactrin, 0.25 mg), blood being obtained for cortisol assay before and 30 and 60 min after injection, was done at the start, at week twelve, and at the end of simvastatin treatment

Effects of fish oil on serum lipids and lipoprotein(a) levels in heterozygous familial hypercholesterolemia

Abstract Ten patients (mean age, 49 ± 14 years) with heterozygous familial hypercholesterolemia who had high levels of lipoprotein (Lp)(a) (>30 mg/dl) and were receiving chronic treatment with simvastatin were treated with six capsules a day of fish oil for 4 weeks. Each 1-gm fish oil capsule contained almost 850 mg of omega-3 fatty acids with a ratio of eicosapentaenoic acid:docosahexaenoic acid of 1:1; the total daily dosage of omega-3 fatty acid was 5.1 gm/day. After 2 and 4 weeks of fish oil supplementation, mean serum Lp(a) levels did not change significantly (baseline, 67 ± 29 mg/dl; week 2, 68.3 ± 35 mg/dl; week 4, 60.6 ± 26 mg/dl). Triglyceride levels decreased by 23% after 2 weeks (from 1.355 ± 0.38 mmol/L to 1.05 ± 0.35 mmol/L) and by 33% after 4 weeks (to 0.91 ± 0.18 mmol/L) ( P P

Effects of the acute subcutaneous administration of synthetic salmon calcitonin in tumoral calcinosis

We examined the effects of the acute administration of salmon calcitonin on phosphate metabolism in tumoral calcinosis. On two different days, 200 MRC U of the synthetic hormone were administered sc to a 38-year-old patient, either as twice daily 100 MRC U injections, or as a continuous sc infusion via a portable pump. Both ways of calcitonin administration elicited a Phosphaturic effect and a lowering of serum phosphate level comparable with that observed after an iv infusion of calcitonin. 1,25 dihydroxyvitamin D level, which was in the normal range during a control study, increased after calcitonin administration. In our patient, long term therapy with diet, a phosphate-binding agent and calcitonin prevented the occurrence of new ectopic calcifications. Owing to its Phosphaturic activity, synthetic salmon calcitonin may be a useful adjunct to diet and aluminium-containing antacids in long-term management of tumoral calcinosis.

Pregnancy in Sheehan's syndrome corrected by adrenal replacement therapy. Case report.

A 23-year-old woman was referred to our Institute in October 1981 for assessment of fatigue, weight loss and postpartum amenorrhoea. The patient, who had had her first pregnancy in 1978 with normal labour and lactation, gave birth a t term after a sccond uncomplicated pregnancy in March 1981. The patient noticed a much heavier blood loss at the second delivery than during her first, but she denied loss of consciousness and no blood transfusion was given. lmmediately after delivery, the patient complained of intense fatigue with drowsiness, depression and anorexia. Afterwards, lactation failed and the patient did not resume her menses, which had always been regular. In the subsequent 7 months, there was an involuntary weight loss from 53 to 45 kg, and she continued to complain of diminished vigour, lethargy and apathy. On admission to our Institute, the clinical features were dominated by a depressive state and remarkable thinness. Her height was 1.60 m and her weight 42 kg. Blood pressure was 90160 mmHg, and the pulse rate 48, otherwise physical examination was not noteworthy; in particular pubic and axillary hair was normal, and she had no signs of hypothyroidism. Routine studies demonstrated a haematocrit of 28.5%, with a haemoglobin of 9.9 &dl, and fasting blood glucose level of 60 mgidl (3.3 mmolil). Several baseline pituitary hormonal levels were reduced (Table 1 shows normal ranges for our laboratory): serum prolactin (PRL) was 2.2ngidl: growth hormone (GH) was 1.4 ng/dl; ACTH was 8 ngidl; but gonadotrophin levels (LH 6 m IUiml and FSH 11 m IUlml) were within the normal range. An early morning plasma cortisol concentration was 1.2 pg/dl, and

Continuous basal insulin infusion without premeal boluses in insulin-dependent diabetes mellitus therapy

SummarySix insulin-dependent diabetic patients, poorly controlled on conventional insulin therapy (CIT), underwent continuous basal insulin infusion (CBII) and continuous subcutaneous insulin infusion (CSII) during 2 subsequent periods of 1 month each, employing a Betatron II insulin infusion pump (Lilly, CPI). During CSII, insulin was infused at a continuous basal rate with 3 premeal boluses. During CBII, from 2200 to 0600 a continuous basal nocturnal insulin infusion rate and from 0600 to 2200 a diurnal one, which was approximately twice the former, were maintained and total daily calorie intake was subdivided into 6 isoglycidic and isocaloric meals, taken at regular intervals. We obtained better blood glucose control both by CSII and CBII than by CIT, with significant reduction of HbA1 values. Mean blood glucose levels were lower during CBII than during CSII, while M-index, number of hypo- and hyperglycemic events and insulin requirement were not different. However, daily blood glucose excursions were narrower and percent blood glucose increment after the noon meal was reduced during CBII. CBII insulin profile was characterized by a plateau trend with lower levels at meals in comparison with CSII. Our data show that the subdivision of daily calorie intake into 6 isocaloric and isoglycidic meals allows to achieve good metabolic control by continuous basal insulin infusion without need for premeal boluses and could be especially useful in brittle diabetic patients, whose brittle condition may be caused by erratic absorption of subcutaneous boluses of insulin.

The missing segment of the autopod 1st ray: new insights from a morphometric study of the human hand

Whether the 1st segment of the human autopod 1st ray is a ‘true’ metapodial with loss of the proximal or mid phalanx or the original basal phalanx with loss of the metacarpal has been a long‐lasting discussion. The actual knowledge of the developmental pattern of upper autopod segments at a fetal age of 20–22 weeks, combined with X‐ray morphometry of normal long bones of the hand in the growing ages, was used for analysis of the parameters, percentage length, position of epiphyseal ossification centers and proximal/distal growth rate. The symmetric growth pattern in the fetal anlagen changed to unidirectional in the postnatal development in relation to epiphyseal ossification formation. The percentage length assessment, the distribution of the epiphyseal ossification centers, and differential proximal/distal growth rate among the growing hand segments supported homology of most proximal segment of the thumb with the 2nd–5th proximal phalanges and that of the proximal phalanx of the thumb with the 2nd–5th mid phalanges in the same hand. Published case reports of either metanalysis of ‘triphalangeal thumb’ and ‘proximal/distal epiphyseal ossification centers’ were used to support the applied morphometric methodology; in particular, the latter did not give evidence of growth pattern inversion of the proximal segment of the thumb. The presented data support the hypothesis that during evolution, the lost segment of the autopod 1st ray is the metacarpal.

Study of Endochondral Ossification in Human Fetalcartilage Anlagen of Metacarpals: Comparative Morphology of Mineral Deposition in Cartilage and in the Periosteal Bone Matrix: STUDY OF ENDOCHONDRAL OSSIFICATION

The progression of mineral phase deposition in hypertrophic cartilage and periosteal bone matrix was studied in human metacarpals primary ossification centers before vascular invasion began. This study aimed to provide a morphologic/morphometric comparative analysis of the calcification process in cartilage and periosteal osteoid used as models of endochondral ossification. Thin, sequential sections from the same paraffin inclusions of metacarpal anlagen (gestational age between the 20th and 22nd weeks) were examined with light microscopy and scanning electron microscopy, either stained or heat‐deproteinated. This process enabled the analysis of corresponding fields using the different methods. From the initial CaPO4 nucleation in cartilage matrix, calcification progressed increasing the size of focal, globular, randomly distributed deposits (size range 0.5–5 µm), followed by aggregation into polycyclic clusters and finally forming a dense, compact mass of calcified cartilage. At the same time, the early osteoid calcification was characterized by a fine granular pattern (size range 0.1–0.5 µm), which was soon compacted in the layer of the first periosteal lamella. Scanning electron microscopy of heat‐deproteinated sections revealed a rod‐like hydroxyapatite crystallite pattern, with only size differences between the early globular deposits of the two calcifying matrices. The morphology of the early calcium deposits was similar in both cartilage and osteoid, with variations in size and density only. However, integration of the reported data with the actual hypotheses of the mechanisms of Ca concentration suggested that ion transport was linked to the progression of the chondrocyte maturation cycle (with recall of H2O from the matrix) in cartilage, while ions transport was an active process through the cell membrane in osteoid. Other considered factors were the collagen type specificity and the matrix fibrillar texture. Anat Rec, 301:571–580, 2018.

Trigger-oriented HIV testing at Internal Medicine hospital Departments in Northern Italy: an observational study (Fo.C.S. Study)

Abstract Background: Early detection of undiagnosed HIV infected patients is of paramount importance. The attitude of Italian hospital-based Internal Medicine physicians to prescribe HIV testing following the detection of HIV-associated signs, symptoms and behaviours (triggers) has been reported to be poor. The aim of the study is to quantify the extent of the missed opportunities for early HIV diagnosis in Internal Medicine Departments (IMD). Methods: Patients admitted to IMD of a General University Hospital in Italy in March–June 2013 were interviewed using a structured questionnaire investigating the presence of triggers for HIV testing, including patient’s characteristics, symptoms and conditions associated with HIV infection. HIV tests performed during hospitalisation were recorded. Results: HIV testing was performed in 73 (6.6%) out of 1113 hospitalisations (1072 patients), providing positive results in three cases (4.1%). All of them presented ≥1 triggers. Conversely, 853 triggers were identified in 528 hospitalisations with at least one trigger (47.4%). The proportion of hospitalisations where an HIV testing was prescribed was 3.1%, 9.5% and 16.0% in the presence of zero, one-to-two or more triggers, respectively. Age <70 years, female gender, length of hospital stay, haematological disease, HBV infection, multiple sexual partners and lymphadenopathy were predictors of HIV testing by logistic regression analysis. Conclusions: Although chances of an HIV test being performed in patients hospitalised in IMD increases along with the number of triggers, the number of tests being performed in people presenting with triggers is unacceptably low and requires educational interventions in order to obtain individual and public health advantages.

A strange chest pain after dental surgery

In May 2007, a 29-year-old man was admitted to our ward complaining of chest pain exacerbated by deep breathing but not by change of position. The chest pain episodes were short-lasting (some minutes), but the patient complained of several relapses. Simultaneously, soft-consistency bilateral swelling of the neck appeared in the submandibular and lateral cervical regions. Ten hours before admission, the patient had undergone dental surgery for removal of the III right inferior wisdom tooth. The procedure was particularly difficult and lasted for more than 90 min. The family history was negative for cardiovascular disease; no relevant previous disease was present. He was not on any medical treatment; however, he smoked 15 cigarettes a day, and his alcohol intake was moderate. Physical examination of the patient showed normal blood pressure (120/80 mmHg) and heart rate (65 beats/ min). He was eupnoeic, and oxygen saturation of the blood was 97% (no oxygen supply). Body temperature was normal. A physical examinations showed bilateral swelling of subcutaneous tissues that were more pronounced on the right side of the neck, chest, and in the submandibular, lateral cervical, supraclavicular, and mammary regions, with modest pain and ‘‘crepitation’’ on digital pressure. The cardiac auscultation produced crackling, bubbling, and rubbing related to systole. The patient’s white cell count was modestly elevated (11,100/mm), while the renal and liver functions and urinalysis were normal. No elevation of troponin I or T and of creatinine–phosphokinase was detected. The ECG showed the presence of sinus rhythm and high-voltage Twaves in peripheral leads. The chest X-ray examination showed no abnormal findings (Fig. 1). Based on these findings, a preliminary diagnosis of acute pericarditis was made.