Baseline characteristics of the population enrolled in the Italian Observational Study on Severe Osteoporosis (ISSO)

OBJECTIVES

Baseline characteristics of the population enrolled in the ISSO study, designed to evaluate the incidence of vertebral and non-vertebral fractures in Italian patients with severe osteoporosis treated according to clinical practice over 24 months observation.

METHODS

Prospective observational study in 783 post-menopausal women and men entering 18-month treatment with teriparatide in a community setting at 57 centres in Italy. Characterisation included demographics, fracture risk factors, bone mineral density, fracture status, Health-Related Quality of Life (HRQoL) measured by the European Quality of Life Questionnaire, EQ-5D, and back pain assessed by VAS.

RESULTS

Most patients were elderly women (90.5%), mean age±SD was 72.9±8.8 years. Nearly all (91.3%) had experienced ≥ 1 vertebral fracture (mean±SD, 3.6±2.2 per patient), 37.5% had ≥ 1 non-vertebral fracture (mean±SD, 1.4±0.7 per patient). Nearly all patients were suffering from back pain (94.9%), which had significantly restricted their daily activities (51.7%) and had likely or very likely been caused by vertebral fractures (29.2% and 55.8%, respectively). Mean EuroQoL EQ-5D index value was 0.58±0.25 and VAS score 49.2±23.6. Non-vertebral fractures, back pain and multiple vertebral fractures were associated with lower HRQoL (EuroQoL-5D Index both p<0.001, EQ-5D VAS score p=0.025 and p<0.016, respectively). Many patients were physically inactive (81.1%). One third (34.7%) of population had co-morbidities and 60.5% were on chronic concomitant treatments. Few subjects reported a maternal history of osteoporosis (15.5%), regular consumption of alcohol (13.3%) or were current smokers (11.5%). Nearly two-thirds (71.5%) had already been treated for osteoporosis, mainly with bisphosphonates. Calcium and vitamin D supplements were taken by 13% and 15.5% of the total population, respectively.

CONCLUSIONS

At enrollment, the population of ISSO study mostly consisted in aging women, who had osteoporosis with high fracture risk, poor HRQoL and suffered from significant back pain. Most of them had already been treated by bisphosphonates but without calcium and vitamin D supplements. Back pain, as well as non-vertebral and multiple vertebral fractures, were associated with lower HRQoL.

The elderly over 90yr affected by deperession post-stroke respond well to antidepressant therapy with SSRI? study on a population admitted in nursing home (RSA)

Introduction

The frailty of elderly in Tenth Decade with stroke was considered a certainty for many years ruling, and the stroke in 90 year old was a paradigm of fragility in gerontology. However soon enough the existing data on the population in nursing homes.

Method

The aim of this study was to evaluate the response to therapy SSRI antidepressants (fluoxetine 20–40 mg; sertraline 25–100 mg,; citalopram 10–40 mg) in a population of olds with depression after-stroke hospitalized in Nursing Home (RSA) at Catania (Sicily). We evaluated a total sample of 66 patients comparing the 13 patients 90yr-old with the 53 patients younger pertaining to the same RSA for stroke.

Results

Stackable with somatic comorbidity and the post-stroke depression between the two populations, we founded:1.

Conclusion

According to this data the response to antidepressants seems to be good and totally overlapped with the population most 'young studied as a reference.

This data also confirms that it is not age itself but the comorbidity of diseases present that make it’ a frail old man and that probably the frailty of the nineties is a biological myth.

Depression and obstructive sleep apnea (OSAS) in the elderly: Study on a population of elderly patients recovered in acute setting

Introduction

The obstructive sleep-apnea (OSAS) is a syndrome common in elderly, dangerous and frequently misunderstood by the superficiality of the evaluation of nonspecific symptoms of onset.

Objectives and aims

In this study we studied the prevalence of sleep-apnea (OSAS) in a sick elderly population admitted to a Acute Geriatrics, the correlation with cardiovascular disease and the effects on performaces psychometric

Methods

62 subjects were examined in Acute Cure of Geriatrics of University of Catania. All subjects, after a careful medical history, were administered MMSE to cognitive and affective aspect for GDS. Also consider the autonomy and self-reliance by Barthel-Index, IADL and ADL. All subjects also performed 24-hour Holter-ECG examination and examination for Holter blood pressure in 24 hours, made basic spirometric assessments and finally carried out the examination with polysomnography VitalNight-8.

Results

The results in this study have ample evidence on the prevalence of OSAS in the elderly population admitted to the ward for acute cases. Shall also be significant correlations with cognitive status and mood, both largely influenced negatively by the presence of OSAS. They seem much more depressed elderly patients with OSAS compared with the general population. Finally, the highly statistically significant correlation with the presence of OSAS arrhythmias, high pressure is not controlled by drug therapy, obesity and Chronic Bronchitis.

Conclusions

This study reports the evidence of higher correlation between OSAS and Depression in population studied. All these data make us conclude the obvious danger of this disease still so 'little studied in the elderly population.

Use of disphosphonates in the treatment of osteoporosis in thyroidectomized patients on levothyroxin replacement therapy

Bone mineral density at medio distal (MD-BMD) and ultra distal (UD-BMD) sites of non dominant radius were studied, using a DEXA Mineralometer (TURBOSCAN-NIM) on a series of 20 patients, over 60 years old, all thyroidectomized for thyroid carcinoma and treated with levothyroxin replacement therapy. T3 and T4 (RIA method), TSH (IRMA method) and two cardiac parameters as TPER (time peak ejection rate) and TPFR (time peak filling rate) by angiocardioscintigraphy were also determined. Results showed that 19 patients considering MD-BMD values and ten considering UD-BMD values were at risk of fractures. Circulating T3 levels were within normal range in 17 patients, elevated in two cases and reduced in one case. Circulating T4 levels were within normal range in 15 patients, increased in four cases and reduced in one case. Circulating TSH levels were within normal range in 17 patients, reduced in two cases and elevated in one case. TPER were reduced in 18 patients and normal in two cases. TPFR were reduced in six patients and normal in fourteen cases. The authors administered alendronate (10 mg/day) which seems to prevent bone loss, especially at the level of the trabecular bone. Bone loss reverted at 6 and 12 months, confirming that disphosphonates slow down this phenomenon in a situation of increased bone turnover (e.g. patients on long-term L-T4 therapy).

Prevalence of diabetes mellitus in a sample of the elderly population of the city of Catania

The prevalence of diabetes mellitus is increasing world-wide, even if it varies markedly in the geographical areas and populations investigated. This study is part of the Progetto Finalizzato Invecchiamento (Aging Project) of the Italian NCR (National Research Council) and is aimed at investigating the prevalence of diabetes and selected clinical characteristics in a study sample aged between 65 and 84 years of age resident in Catania (Italy). The prevalence rate for type II diabetes was 22.8% and it is certainly among the highest values recorded to date in other areas of Italy and abroad. We distinguished between two forms of diabetes in subjects >70 years of age: aged diabetes with onset in middle age (AD); and diabetes of senescence with onset after 70 years of age (DS). Prevalence rate was 18% for AD and 4.8% for DS, respectively. The age-specific rates of AD and DS show the progressive lower prevalence rates of the former and the higher rates of the latter. We assume that DS is mainly caused by atherosclerotic processes and represents the typical form of diabetes in the elderly.

Laboratory parameters in centenarians of Italian ancestry

Studies aimed at collecting reference parameters for haematochemical analysis in the elderly are scarce and for the oldest old subjects even more rare. In order to establish the reference values for the most common laboratory text in long living individuals, we measured haematochemical parameters in >100 years old subjects and in aged subjects as control. Six hundred and two centenarians accepted to be enrolled in the study. A case history containing the complete anamnesis, clinical examinations, evaluation of the clinical cognitive and functional tests, was prepared for each centenarian. Blood samples from 120>100 years old subjects free of chronic or acute Illness (i.e. Alzheimer's disease, metabolic diseases, cardiovascular disease, stroke, neoplastic and infectious diseases) were analysed. A population of 381 healthy old subjects (age range 65-85 years old), recruited in the same geographic areas and with the same clinical characteristic of the health centenarians, was utilized as control. Significant differences were observed for blood glucose, ALT, cholesterol and platelet levels, reduced in centenarians respect to the old subjects, whereas blood urea nitrogen levels were found significantly increased in centenarians. In conclusion, reference values of the healthy adults can generally been utilized also for the healthy oldest old group, with the notable exception of the above mentioned laboratory parameters that appear to be modified in long living subjects.

The teriparatide in the treatment of severe senile osteoporosis

The osteoporosis is a systemic disease of multicausal etiopathogenesis. A progressive bone loss and qualitative alterations in the macro- and micro-architecture of the remaining bones, resulting in a loss of strength of bones to such an extent that even very modest traumas will cause fractures characterize it. Three forms are defined (i) postmenopausal appearing after the menopause, (ii) senile appearing with advancing age, and (iii) the idiopathic forms. Severe osteoporosis is declared when the patients suffer vertebral or femoral fractures without any trauma during a treatment with anti-reabsorptive medicines of at least 1-year. The treatment of osteoporosis is based on various categories of pharmaca, such as bisphosphonates, selective estrogen receptor modulators (SERMs), diaminobutyric acid (DABA), parathyroid hormone (PTH), estrogens and non-hormonal drugs. The teriparatide, the recombinant human (rh)PTH(1-34), is identical in amino acid sequence until the 34th (N-terminal) amino acid of the endogenous, human PTH. It is produced in E. coli using the recombinant DNA technology. It is a pharmacon having a strong trophic-anabolic action on the bone tissue, assuring both the inhibition of the bone loss, and the formation of new bones of good quality. It acts as a stimulant of the osteoblast functions, and at the same time, increases the absorption of calcium from the intestine, and also the renal reabsorption of calcium, and decreases the excretion of phosphates in the kidney. This study summarizes our own experience with the use of rhPTH(1-34) in the treatment of senile patients with severe osteoporosis. Our sample consisted of 40 elderly women of the mean age of 78+/-5 years, having severe osteoporosis. They displayed a columnar T-score>-3.5 and femoral T-score>-2.5, had been under antireabsorptive treatment since at least 12 months. In particular, 15 patients were treated with Alendronate (70 mg/week), 10 of them with Risedronate (35 mg/week), and 15 of them with Raloxifene (60 mg/day). These patients in our study were treated for 1 year with 20 microg/day of rhPTH (1-34), injected subcutaneously, and supplemented also with a daily dose of 1g of calcium and 800 IU of Vitamin D, per os. At start of this treatment (time t(0)), after 6 months (time t(6)) and after 12 months (time t(12)) patients underwent a bone mineral density (BMD) analysis (Dexa-Lunar-DPX-P) on the lumbar vertebral column, (L1-L4 zone), as well as a femoral BMD. We applied also quality of life (QoL) questionnaire of the European Foundation for Osteoporosis (QUALEFFO), and evaluated also the use of non-steroidal anti-inflammatory drugs (NSAIDs). Our final considerations are that the teriparatide therapy increases significantly the bone mass density, expressed in terms of T-Score, reduces the occurrence of new fractures, improves the QoL, and decreases also the consumption of NSAIDs.

Auditory event-related potentials in subcortical vascular cognitive impairment and in Alzheimer's disease

BACKGROUND

Few studies exist on ERPs and patients with subcortical vascular cognitive impairment (SVCI). This latter is a quite homogeneous subtype of vascular dementia whose cognitive profile is quite different from that of Alzheimer disease (AD).

AIMS

The present study aims at comparing the ERPs profile both in patients with SVCI and in patients with AD.

SUBJECTS AND METHODS

ERPs and psychometric tests were collected from 39 healthy elderly controls, 51 patients with SVCI and 43 patients with AD. Subjects mentally count high pitched target tones that were randomly intermixed with low pitched frequent tones. We measured ERPs latencies (N1, P2, N2 and P3), and interpeak latencies (N1-P3, N1-P2, N1-N2).

RESULTS

Grand averaged potentials in SVCI showed a significant increase of P3 latency. AD patients showed a prolongation of N1, P2, N2, P3 latencies. As far as interpeak latencies are concerned, SVCI patients showed a significant prolongation of N1-P3, AD patients had a significant increase of N1-N2, and N1-P3 intervals. When all patients were considered as a single group, correlation of neuropsychological tests scores showed a significant negative relationship between P300 latency and, respectively, Mini Mental Status Examination, auditive and visual span forward. In both groups, ERPs latency sensitivity, was low, whilst specificity values were quite high.

CONCLUSIONS

Our finding suggest that these two dementing diseases have different electrophysiologic features that may be related to their specific underlying pathogenetic mechanism; in particular, we hypothesise that, differently from AD, P300 latency prolongation characterizes the early stage of SVCI. So, this ERPs approach could be helpful to detect early alterations of the attentional/working-memory functions in patients with subcortical ischaemic vascular disease.

Association of quantitative heel ultrasound with history of osteoporotic fractures in elderly men: the ESOPO study

In order to evaluate the usefulness of calcaneal quantitative ultrasound (QUS) in the assessment of male osteoporosis, a cross-sectional, population-based study was performed. A cohort of 4,832 men, randomly selected, community-dwelling, aged 60-80 years and representative of the general older male Italian population was recruited. QUS measurements were assessed in 83 centers distributed all over Italy and equipped with an Achilles device (GE-Lunar, Madison, Wisconsin, USA). All participants were administered a questionnaire covering lifestyle variables and medical history. Low-energy fractures that had occurred since age 50 were recorded. Overall, 43 subjects reported a previous hip fracture and 455 subjects reported other non-spinal fractures. Univariate analysis showed that fractured subjects were older, with a lower level of outdoor physical activity and a more frequent history of prolonged bedridden periods in comparison with unfractured subjects. Men reporting non-spinal fractures showed a higher prevalence of smoking, while no difference was found among groups in anthropometric measures and calcium intake. QUS measurements showed that all QUS parameters were significantly lower in both fracture groups (p<0.001). Multiple logistic regression analysis demonstrated that each SD reduction in QUS measures was associated with an approximate doubling of the risk for hip fracture, independent of age and other clinical variables (broadband ultrasound attenuation [BUA]: odds ratio [OR]=2.24; 95% confidence interval [CI] 1.61-3.08; stiffness index: OR=2.19; CI 1.56-3.11; speed of sound [SOS]: OR=1.71; CI 1.18-3.24) and with an increase of the risk of other non-spinal fractures (BUA: 1.38; CI 1.22-1.59; stiffness index: OR=1.27; CI 1.17-1.38; SOS: OR=1.14; CI 0.96-1.40). It can be concluded that calcaneal QUS measurement is associated with the risk for hip fracture and any non-spinal fractures among a community-dwelling cohort of elderly men. The strength of the association between QUS measurement and fracture is similar to that observed in elderly women.

Altered laboratory thyroid parameters indicating hyperthyroidism in elderly subjects

The most common laboratory alterations of thyroid function indicating hyperthyroidism were evaluated in a series of 3015 subjects over 65 years of age by determining total T3, total T4 and TSH. Ultrasound and scintigraphy of the thyroid were performed where necessary. Our results showed a high prevalence of laboratory alterations hyperthyroidism type of around 8.09%, whereas the real prevalence (both clinical and laboratory) is 2.00% with a female/male ratio of 2.00. The most frequent hyperfunctioning thyreopaty is thyroidal adenoma (50%), followed by toxic multinodular goiter (33%) and Basedow's disease (17%). The most common clinical signs of hyperthyroidism involve the neuromuscular system and are often present in the so called 'euthyroid' elderly subject. We conclude that it is very difficult to diagnose hyperthyroidism in the elderly on clinical and laboratory grounds. The most significative laboratory thyroid parameter indicating hyperthyroidism seems to be TSH values below 0.2 IU/ml determined using the ultrasensitive IRMA method.

Cardiovascular aging and psychometric performances: correlations in a group of ultraseptagenarian elderly

Aging of the Italian population resulted in a net increase of the cardiovascular pathologies, and the correlated disabilities. In addition, the cardiovascular diseases represent actually in Italy the most frequent cause of death. With advancing age, both the heart and the blood vessels undergo numerous morphological and functional modifications, which are reducing the functional reserves of these organs. The present study looked for correlation between the cardiac functionality and the cognitive, as well as affective functions. Furthermore, we evaluated the functional variations of the autonomy and autosufficiency of the same patients. We had 171 enrolled subjects (108 women and 63 men), all above the age of 70 years. Based on the classification of the New York Heart Association (NYHA), 85 of these patients (35 men and 50 women) had a II class (Group A), and 86 of them (28 men and 58 women) a III NYHA class of heart function (Group B). We included only patients who did not have any cerebrovascular event yet, and were not bed-ridden. The psychometric performance has been evaluated by using the mini-mental state examination (MMSE), the geriatric depression scale (GDS), the activities of daily living (ADL) and the instrumental activities of daily living (IADL) scales. Cardiac functions have been measured by Doppler echocardiography, in M-mode. The Group A (of mean age 71 +/- 3 years) displayed ventricular ejection fraction (VEF) values in average of 43 +/- 4%, MMSE scores 27 +/- 2; GDS scores 14 +/- 3; IADL 6 +/- 1, and ADL = 6, i.e., maintained a complete autosufficiency. The Group B (mean age 74 +/- 4 years) displayed VEF values in average of 26 +/- 3%, MMSE scores 23 +/- 4; GDS scores 22 +/- 3; IADL 4 +/- 2, and ADL = 4 +/- 1, i.e., had a reduced autosufficiency. These results confirm that also the heart pays a toll for aging: the myocardial contractility becomes significantly altered, meaning the loss of cardiac functions itself. These morpho-functional heart alterations are accompanied by decreased psychometric performances during aging, with consequent reductions of cognitivity, affectivity, autosufficiency and autonomy, involving a complex decrease of the quality of life.

Interleukin-18 (IL-18) and matrix metalloproteinase-9 (MMP-9) in post-menopausal osteoporosis

This survey covered 60 post-menopausal women with osteoporosis. The patients were divided into three equal groups, and each group was treated with one of the three so-called anti-resorptive drugs, namely alendronate (10 mg/day) risedronate (5 mg/day) and raloxifene (60 mg/day) for 12 months. The Elisa technique was used to measure circulating IL-18 and MMP-9. Lumbar bone mineral density (BMD) levels were determined by using dexa mineralometry (Lunar DPX) at baseline and after 12 months of treatment. The results showed comparable responses of the patients treated with alendronate or risedronate, being a significant increase in BMD, an increase in circulating IL-18, and only slight modifications in circulating MMP-9 levels. After 12 months of treatment with raloxifene, there were minimal, non-significant increases in BMD, slight modifications in IL-18 levels, and a significant reduction in circulating MMP-9 levels. The conclusions can be drawn that all three drugs, albeit through different mechanisms, can be considered valid treatments for post-menopausal osteoporosis. Although measurements of circulating IL-8 and MMP-9 levels allowed us to differentiate the effects of the three drugs used, as of today, they have no real role in the diagnosis and/or follow-up of osteoporosis.

Antiresorption therapy and reduction in fracture susceptibility in the osteoporotic elderly patient: open study

The identification of risk factors for osteoporosis has been an essential step towards the understanding of the onset of the disease as well as of the osteoporosis-related fractures due to bone fragility. The present study has been aimed at assessing whether a correlation may exist between the increment in bone mass, consequent to an antiresorption therapy, and the reduction in the incidence of fractures. Moreover, the possibility that such a reduction might result from the action of other factors, such as the changes in bone microstructure, has been investigated. A total of 2,000 osteoporotic women (mean age: 68 +/- 9 years) were enrolled in the study and divided at random into 4 treatment groups. Each group received one of the following treatments: Alendronate 10 mg/daily (1,000 patients), Clodronate 100 mg/weekly i.m. (800 patients), Risedronate 5 mg/dailt (100 patients), and Raloxifene 60 mg/daily (100 patients). Clinical evaluation was based on bone mineral density (BMD) assay on lumbar vertebrae (L1-L4) by means of a DEXA (Lunar DPX) mineralometer, as well as on the incidence of fractures following both 12- and 24-month treatment periods. The results showed an overlapping pattern in patients treated with Alendronate or Risedronate, namely a significant increment in BMD after a 24-month treatment period, whereas such an increment in BMD was less evident in patients receiving either Clodronate or Risedronate after a 24-month treatment period. In addition, a total of 18 osteoporosis-related fractures were observed during the entire study period; 10 out of 18 fractures occurred in the Alendronate treated group, whereas the remaining 8 fractures were observed in the Clodronate treated group. Fourteen fractures were detected in patients over 80-year old, whereas the remaining 4 occurred in patients aged from 70 to 79 years and appeared to be independent of both the T-score assigned and the BMD increment obtained as a result of the therapy. Such findings suggest that the plain monitoring of BMD appears not to be adequate to anticipate clearly the danger of the probable onset of additional fractures, while the higher incidence of fractures in patients over 80-year old evidences that "old age" has to be considered the most serious risk factor for osteoporosis, since it is also the real responsible factor for changes taking place in bone microstructure.

Alendronate reduces the daily consumption of insulin (DCI) in patients with senile type I diabetes and osteoporosis

The use of Alendronate for the treatment of senile diabetes with osteopenia or osteoporosis is a common practice today, although the reasons for the success of this treatment are not completely understood. We investigated 40 elderly female patients, over 70 years of age, divided in two Groups (A and B) 20 cases of each, with insulin-dependent senile diabetes and fair metabolic balance, with an average disease duration of 30 +/- 4 years. They all had osteoporosis shown by the mean T-score of bone mineral densitometry. The Groups were treated as follows, Group A with 10 mg/day of Alendronate per os, with morning fasting plus a supplementation of calcium and vitamin D3, while the Group B received only calcium and vitamin D3 per os. Bone mineral density (BMD) expressed in mg/cm2, and in terms of T-score and Z-score at the spine (L1-L4) was monitored over time after 12 and 24 months, using dexa technique with a Lunar DPX densitometer. Moreover, the variation of daily consumption of insulin (DCI) of all the study population was calculated 12 and 24 months after the start of treatments. The data of Group A showed an improvement of osteoporosis, as evidenced by the increase of BMD at both times of measurement, accompanied by a significant reduction in the DCI (-21.6% by the 12th month, and -36.2% by the end of the observation period). In the Group B only small, statistically insignificant changes were observed in both the BMD and DCI. The most plausible explanation of reduction of DCI in Group A seems to be that Alendronate has improved the clinical symptoms of osteoporosis (pain, rigidity, and reduction of movements) through its action on the bone mass recovery and slowing down the bone turnover and under these conditions the diabetic patients improved their own physical performance. The better and more extensive movements certainly produced a reduction in the DCI, since a correct and adequate physical activity does contribute to an improved glucose metabolism.

The leptin, a new hormone of adipose tissue: clinical findings and perspectives in geriatrics

Obesity has gained a great importance during the last decades, and this fact stimulated numerous studies regarding the genetic causes of this disease. A recently discovered new molecule, called leptin, raised a wide interest. It is a product of the adipocytes, it exerts inhibitory effects on the center of appetite and increases the energy expenditure of the organism. The present study evaluated blood leptin levels in 57 elderly subjects and searched for eventual correlations between this parameter and the age, the body mass index (BMI), the fat body mass (fat%), the waist (W) and hip (H) circumference, as well as the ratio (R) of these latter two values (WHR). Blood leptin levels do not correlate with age, body height and the WHR, but display significant positive correlations with the body weight, the BMI, the fat%, the W, H and WHR. A deeper knowledge on leptin and the correlations of this hormone with other body parameters might be helpful in a better understanding of several pathogenetic mechanisms related to aging and involved in a deterioration of the quality of life in elderly, like multiple atherosclerotic and metabolic diseases (diabetes, dyslipidemias).

OXIDATIVE STRESS AND AGING: STUDIES ON AN EAST-SICILIAN, ULTRAOCTAGENARIAN POPULATION LIVING IN INSTITUTES OR AT HOME

The role of the free radicals in aging has been in center of research for long years. It is assumed that with advancing age, damaging effects of oxygen free radicals might be accumulated in the organisms on all components, especially on the DNA and the mitochondria. In addition, because of the decreased efficiency of the antioxidant systems, the oxidative mechanisms prevail in numerous age-dependent diseases, such as the arterio -sclerosis, Parkinson and Alzheimer diseases. The present study was aimed at revealing an eventual correlation between the free radical levels and the psychophysical health state of an ultraoctagenarian East-Sicilian population living in institutes or at home. Our study population consisted of 125 ultraoctagenarian subjects, 62 of them were institutionalized and 63 living outside the institutes. The free radical effects were measured by using the free radical analytical system (FRAS) assessing the derivatives of reactive oxygen metabolites(D-ROMs). The results are expressed in units of Caratelli (U-CARR). The psycho-physical state of the subjects was estimated by means of the mini mental state examination(MMSE), geriatric depression scale (GDS), activities of daily living (ADL) and instrumental activities of daily living (IADL). The nutritional state and the physical activity of the subjects were evaluated through the mini nutritional assessment (MNA) and the physical performance test (PPT). All studied parameters underwent a correlation analysis of Pearson. Statistically significant negative correlation was found between the free radical levels and the cognitive performance (p < 0.0001), as well as the levels of autonomy and autosufficiency,the physical activity in the total population (p < 0.01). These correlations were even more expressed in the institutionalized subjects. Statistically significant positive correlation seems to exist between the free radical levels and the nutritional status (p < 0.001). These studies revealed some important differences between the institutionalized and noninstitutionalized population. The levels of oxygen free radicals were higher in the former group, indicating a stronger oxidative stress, influencing the psychophysical state of the elderly subjects. This may have negative consequences on the quality and duration of the life. It is difficult to define the exact role of free radicals in the determination of aging pattern,but they may be considered without any doubt as true "markers" of an enhanced oxidative stress, accompanying a non-successful aging process.

Cardiovascular risk in type 2 diabetics and pharmacological regulation of mealtime glucose excursions

In type 2 diabetic patients mealtime glucose fluctuations are important determinants of overall glucose control and overall risk of diabetes cardiovascular complications. In fact, acute elevation of plasma glucose concentrations trigger an array of tissue response that may contribute to development of such vascular complications since it may result in a thrombophilic condition, causes endothelial dysfunction (possibly through a reduction of nitric oxide availability) and is responsible for non-enzymatic glycation and production of free- radicals with ensuing oxidative stress. To keep post-prandial glucose with narrow range, metiglinide analogues drugs have been developed. In particular, repaglinide and nateglinide seem the most useful ones. In fact, both drugs improve 1(st) phase insulin release but they do not affect the total daily amount of insulin released by the pancreas. Due to the mechanism of action and to pharmacokinetic properties, repaglinide and nateglinide allow diabetic patients to get a more tight metabolic glucose control with a contemporary reduction in the cases of severe hypoglycaemia. In conclusions, repaglinide and nateglinide are new and powerful pharmacological tools not only for achieving a better metabolic glucose control but also for preventing the development of diabetes-related cardiovascular complications.

Prevalence of hypovitaminosis D in elderly women in Italy: clinical consequences and risk factors

In order to evaluate the prevalence, risk factors, and clinical consequences of hypovitaminosis D in elderly Italian women a multicenter study of 43 osteoporosis centers from all regions of Italy was carried out. Study population included 700 women aged 60-80 years in whom blood was taken for 25-hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) measurements. All subjects were also questioned to assess the prevalence of several risk factors for hypovitaminosis D, osteoporotic fractures and activities of daily living (ADL). Values of 25OHD lower than 5 ng/ml were found in 27% of the women and lower than 12 ng/ml in 76%. 25OHD and PTH levels were negatively correlated ( r=-0.38, after logarithmic transformation of both variables). 25OHD levels significantly declined with advancing age and number of pregnancies and were positively correlated with educational level (years spent at school), dairy calcium intake, and days spent on holiday by the sea. In a multivariate model including all these variables, the only one that remained significant was the level of education. The lowest age-adjusted 25OH D levels were found in smokers or in women living in central Italy as compared with those living in northern or southern Italy. The mean (+/-SD) age-adjusted 25OH D values were significantly lower in women who sustained a hip fracture (7.1+/-2.2 versus 11.0+/-9.9). Women with low 25OHD levels (<12 ng/ml) had worse scores for ADL and mobility ADL (move outdoors, use stairs, walk at least 400 m, carry a heavy object). Vitamin D deficiency is extremely common among elderly Italian women. Women with lower educational level, living in central Italy, smokers or with lower intake of dairy products are at greater risk. Hypovitaminosis D is associated with worsening of the ability to perform activities of daily living and higher hip fracture prevalence. This finding should lead to an urgent population-based strategy to remedy this condition.

Alterations of the lymphocytic set-up in elderly patients with cancer

It is assumed that the increased incidence of neoplastic pathologies with advancing age is correlated with the immunosenescence and with the altered immune-surveillance. The present study was aimed at evaluating the role of the immunocompetent system and immunosenescence in carcinogenesis. A pool of 99 subjects (38 females, 61 males) has been analyzed in three groups as follows. Group A: 51 elderly subjects with cancer (16 females and 35 males, average age 73.7 +/- 7.5 years). Group B: 24 young subjects with cancer (12 females, 12 males, average age 49.5 +/- 10.3 years). Group C: 24 elderly subjects without any clinical evidence of cancer (10 females, 14 males, average age 74.6 +/- 6.3 years). Hemo-chromocytometric analysis and cytofluorimetric typifying have been performed in all subjects. A decrease of T (CD3+)-lymphocytes has been observed in group A, if compared to group B (P < 0.007), and to group C (P < 0.01), The T (CD4+)-lymphocytes were fewer in group A, than in group C (P < 0.004), and also the NK cells showed the same trend (P < 0.002). The numbers of leukocytes and monocytes increased in group A compared to group C (P < 0.01 and P < 0.004, respectively). Red cell numbers, hemoglobin and hematocrit values were lower in group A than in group B (P < 0.03, P < 0.03, P < 0.01, respectively), and also than in group C (P < 0.007, P < 0.001, P < 0.01, respectively), The results demonstrate that the alterations of the immunocompetent cells, particularly of the T-cell pool, may play an important role in the carcinogenesis of the elderly.

Correlation between the bone mass, psychometric performances, and the levels of autonomy and autosufficiency in an elderly Italian population above 80 years of age

This study was aimed at evaluating the correlation between bone mineral density (BMD) and the psychophysical health status in an elderly study population (62 subjects, mean age 84+/-5 years, 21 males and 41 females), institutionalized (Group A) in various structures of Pozzallo, a marine locality of the Ragusa Province in Sicily. BMD was measured by using ultrasonography of the calcanear area (T-score, Z-score, stiffness). The alterations of the cognitive and affective spheres as well as the levels of autonomy and autosufficiency were estimated by means of psychometric scales like mini-mental state examination (MMSE), geriatric depression scale (GDS), activities of daily living (ADL) and instrumental activities of daily living (IADL). Other biological, social and health-related factors, such as age, sex, body weight and height, nutritional and drug-taking habits, physical activity and previous pathologies, were also considered. These variables were compared to those obtained in a similar, but non-institutionalized controls (Group B) of 63 subjects (mean age 85+/-2 years, 27 males and 36 females), being similar in number and age distribution, frequenting the Geriatric Day Center of the same locality. Statistical analysis revealed significant differences between Groups A and B: the BMD was considerably lower, but also the cognitive and affective performances were strongly reduced in Group A. These findings can be attributed to decreased psychosensorial stimuli and lost interest of the patients in Group A, resulting in a lower physical activity, accompanying the depressive state, and may represent the first signs of a decreased intellectual performance, which can later be transformed into dementia. The functional abilities and the levels of autonomy are also reduced, risking the loss of autosufficiency. Also, the drug usage was different in Group A: more sedative-hypnotics and anticoagulants were consumed. As regards the polymorbidities, arterial hypertension and consequent chronic renal failure, hepatopathies and thyreopathies were most frequent, these latter two being more frequent in the Group A.

A new method for diagnosing fever of unknown origin (FUO) due to infection of muscular-skeletal system in elderly people: leukoscan Tc-99m labelled scintigraphy

Twenty patients affected by fever of unknown origin (FUO), due to a likely infection of the muscular or skeletal tissues, were studied by a Total Body scan with a monoclonal antibody fragment (Leukoscan) labelled with Tc-99m. The diagnostic procedure helped reach a final diagnosis in 8 out of the 20 patients because it identified the focus of the infection of the muscles or bones in joint proximity. Our data show that Leukoscan deserves to become a first line diagnostic procedure in the diagnostic algorithm for the evaluation of patients with FUO.

Serum lipoprotein(a) changes in acute myocardial infarction

BACKGROUND

A strong correlation between high serum Lp(a) levels, a genetic modification of cholesterol-low density lipoproteins (c-LDL), and increased coronary heart disease rate has been found. Transient increased serum levels of this lipoprotein during acute myocardial infarction (AMI) and surgical interventions have been found.

METHODS

EXPERIMENTAL DESIGN

we assessed complete lipidic pattern in a study series composed of 19 patients with AMI. We also evaluated the changes of Lp(a) serum levels within the first week of the disease in order to assess whether a correlation between this parameter and extent of necrotic myocardial area is present.

PATIENTS

study series was made up of 19 patients (13 males, 6 females; mean age 57.94+/-10.7 years) with AMI compared to 25 control subjects (12 males and 13 females; mean age 51.12+/-15.34 years).

MEASURES

we also withdrew a blood sample on days 1, 3 and 7 from the onset of the AMI. On the first day we evaluated the serum levels of the following parameters: glycaemia, azotemia, creatininemia, urycaemia, total cholesterol, high density lipoprotein cholesterol (c-HDL), low density lipoprotein cholesterol (c-LDL), triglycerides, fibrinogen, creatinphosphokinase, aspartate aminotranspherase, thromboplastine time and prothrombinic activity. Lp(a) has been evaluated on day 1, 3 and 7 and after 6 months from AMI. We performed an ultrasound scanning (US) of the heart in day 7 for evaluation of the extent of necrotic myocardial area by observation of "segmental kinetic area".

RESULTS

Mean basal Lp(a) serum level was 28.94+/-29.78 mg/dl (as median 17), (normal values 0 to 25 mg/dl). This value was not changed on day 3 (mean 29.47+/-30.46 mg/dl, median 18), while significantly increased on day 7 (39.84+/-42.77, median 26, p=0.05). Spearman's rank correlation test showed a strong correlation between the increase of Lp(a) serum levels on day 7 and extent of necrotic myocardial area (r=0.696, p=0.001).

CONCLUSIONS

The positive correlation between mean Lp(a) values on day 1 and 7, and the size of the necrotic area, suggest that Lp(a) has an atherogenic and prothrombotic role. Moreover, elevated Lp(a) values were related to greater tissue damage. We believe that periodical determination of Lp(a) values in subjects with coronary disease is useful in order to predict further acute vascular events.

Atherosclerosis and pancreatic damage

The appearance of diabetes in advanced age may be considered as a part of the involutive processes of aging, and as such, it might have a pathogenesis completely different from that of type 2 diabetes of medium age. As a matter of fact, it has been observed that the pancreas undergoes numerous structural and functional alterations with advancing age, both in exocrine and endocrine parts. The present studies have been performed to reveal the quantity and quality of the pancreatic lesions, which may be attributed to atherosclerosis. We have already studied elderly subjects, therefore, we were now looking for further supports in a population of middle age people, died in complications of malignant hypertension. We investigated the pancreas, kidney and heart of 36 subjects (20 males and 16 females) with mean age of 48.6+/-8.9 years. Of this group, eight subjects (22.2%) became diabetic after the appearance of malignant hypertension. Arteriolar atherosclerosis damage (hyalinosis, thickening and stenosis) of the pancreatic arterioles were found in 92.8% of the non-diabetic, and in 87.5% of the diabetic subjects. Lesions of the pancreatic islets were observed in 32% of the non-diabetics, and in 50% of the diabetic subjects. The pancreas is an organ, which tends particularly to develop atherosclerotic damage. The vascular lesion of atherosclerotic origin, independently from the mechanism of its appearance, causes first only a decrease of the blood flux and hypoxia in the pancreatic islets with a consecutive functional decline of the beta-cells. This is then followed by structural modifications of the islets accompanied by the appearance of hyalinosis, loss of beta-cells, and a further decrease of insulin production.

Immunosenescence: a review

Aging involves the morphological and functional integrity of all organs, including the cellular and humoral immunological functions. The main alterations can be listed as follows: (i) Thymic involution resulting in the decreased number of lymphoid precursor T- and B-cells. (ii) Reduced proliferative capacity of T-cells; loss of lymphocyte subgroups as a consequence of the shortening of telomeres. (iii) Qualitative deficiency of B-lymphocytes with a reduced response to exogenous antigens. (iv) Compromised activity of the accessory cells, both directly by depressing the chemotactic and phagocytic responses, and indirectly by increasing the prostaglandin production which inhibit the proliferation of T-cells. (v) Alterations in the production and secretion of various cytokines. (vi) Other factors like the general physiological conditions, the nutritional state, psychological habit and various hormone levels.

Use of alendronate in treatment of secondary osteoporosis from hypopituitarism: a case report

The authors report a case of hypogonadotropic and hypothyrotropic partial hypopituitarism, being treated for over sixteen years with a substitution therapy consisting of estroprogestogenal hormones and L-thyroxine, presenting severe secondary osteoporosis, detected by densitometric examination (DEXA) of the medial and ultradistal sites of the non dominant radius. The patient was treated with alendronate (10 mg/die) for two years, in addition to the estroprogestogen therapy, resulting in a significant recovery of bone mass, equal to 16% compared to initial values, reaching near normal bone density values. On analysing the mechanisms of action of the bisphosphonates, the estrogens and the L-thyroxines, the authors suggest a synergic mechanism between the estrogen and the alendronate, which act on the bone turn-over at different times. Also, the alendronate would seem to antagonise the osteopenia of L-thyroxine, though this mechanism is still unknown.

The comorbidities of elderly oncologic patients

The scope of this study was to evaluate the prevalence of comorbidity in elderly subjects with neoplastic diseases, and to compare it to those without tumor pathologies. Three groups of patients have been considered: (A)35 elderly oncological patients; (B)38 young/adult oncological patients; (C)25 elderly patients without oncological pathology. After clinical evaluation and pathohistological diagnostic analysis, the concomitant pathologies have been estimated by means of two methods: (i)the Satariano's score; and (ii)the Charlson Comorbidity Index (CCI). Statistical analyses performed by using the Chi-square and the Student's t-test gave coherent results, and revealed that the prevalence of comorbidities was the highest in Group C, and displayed significantly reduced prevalences in the sequence Group B, Group A.

Leukoaraiosis, cognitivity and affectivity in elderly patients: on the lack of correlations between neurodiagnostic and psychometric findings

Among the age-related pathophysiological alterations of the brain, the anomalies of the white matter are becoming of increasing interest at both pathological and clinical levels. Wherever specific pathologies of the white matter can be excluded, the still encountered anomalies are generally defined as leukoaraiosis (from the Greek words white and rarefaction), in order to indicate certain ill-defined, slurred subcortical areas which may be single, multiple, or confluent, representing transparent white matter regions, most probably of ischemic origin. The causes, risk factors and clinical significance of leukoaraiosis have remained so far unknown. At clinical level, it is believed to be connected with cognitive and affective disorders. This study intended to collect evidence of the presence and to estimate the extent of eventual cognitive and affective disorders in a sample of elderly patients displaying cerebral lesions like simple or associated leukoaraiosis, as well as other stabilized focal, single or multiple ischemic lesions, cerebral atrophy, lacunar state and vascular cerebropathies without leukoaraiosis. So far no significant correlations have been encountered between the neurodiagnostic and psychometric findings.

The NTX assay in the follow-up of the osteoporotic patients: 3 years of alendronate treatment

These studies were conducted on 38 female patients treated with alendronate (10 mg/day, per os) for 3 years, because of osteoporosis. Of these patients, 29 were in the menopausal age longer than 10 years, and the remaining nine patients were in menopausa shorter than 10 years. Urine sample were taken at the start of the treatment and every 6 months afterward for 3 years, and crosslinked N-telopeptides of type I collagen (NTx) have been measured in them by means of an ELISA technique. Bone mineral density (BMD) has been recorded at the ultradistal (UDBMD) and mediodistal (MDBMD) region of radius of the non-dominant side. Body mass index (BMI) of the subjects has also been determined each time. The baseline values of NTx varied very much, scattered in a range of 11-215 nanomoles bone collagen equivalent/millimoles creatinine (nM BCE/mM Cr), in average 59+/-46; those of UDBMD and MDBMD amounted to 258+/-63 and 587+/-112 mg/cm(2), respectively. NTx, the BMD values and the menopausal age does not correlate with cach other. Both BMD values increased almost linearly in the total study pool during the 3-years-long treatment, being 3.0-9.2 and 0.8-2.5% higher in terms of UDBMD and MDBMD, respectively. Urine NTx concentrations decreased during the same time 30-35%. It is concluded that monitoring of urine NTx levels may be very useful during antiosteoporotic treatments, because a reduction of NTx is an indicator of the slowing down of bone turnover and the bone losses, as was observed during the alendronate therapy.

Assessment of cognitive and affective disorders in an elderly population undergoing hemodialysis

The purpose of this study was to assess the prevalence of cognitive and affective disorders in a group of elderly people suffering from chronic renal failure (CRF) and undergoing outpatient hemodialysis. Psychogeriatric assessment was performed on 39 individuals over 65 years of age suffering from CRF, and on a control group composed of 35 healthy elderly individuals. Assessment was made through Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Activity Daily Living (ADL) and Instrumental Activity Daily Living (IADL) shortly before hemodialysis. A number of blood parameters were determined for both groups to evaluate the state of metabolic compensation. The elderly people undergoing hemodialysis did not seem to present a greater decline in cognitive capacity than their healthy peers, even if this is closely related to the level of anemia present in hemodialysis patients. On the other hand, affective disorders were widely observed, although in mild form, and seem to depend on factors other than age. There is certainly a reactive element deriving from the hemodialysis condition itself and the problems related to it, whereas an organic element linked to CRF cannot be excluded, and which seems to be related to anemia. Finally, the level of independence does not seem to be compromised in hemodialysis patients.

Treatment of familial hypertriglyceridaemia with acarbose

AIM

The evaluation of serum triglyceride levels has played an important role as an independent method for assessing the risk factor for coronary atherosclerosis. Fibrates, nicotinic acid, and omega-3 polyunsaturated fish oils are the pharmacological tools most used today against hypertriglyceridaemia. Acarbose is a pseudotetrasaccharide of microbial origin which exerts a competitive, selective and reversible inhibition of the intestinal alpha glucoside-hydrolase. We evaluated the efficacy and side-effects of acarbose as a new and alternative drug in the treatment of hypertriglyceridaemia in non-diabetic patients.

METHODS

We enrolled 30 non-diabetic patients (18 men, 12 women; mean age 59.23 +/- 6.27 years) without a family history of diabetes mellitus affected by familial hypertriglyceridaemia. The study covered a total period of 6.5 months: half of the patients were on 1.5 months of 'run in' diet only followed by 5 months of therapeutic diet plus acarbose; and half were on the therapeutic diet plus placebo. We gave 30 dividable pills to all patients. The administration was as follows: half a pill before lunch and half a pill before dinner while on the 'run in' diet. Fifteen patients (group A) took acarbose while the reminder (group B) took a placebo (50 mg of starch); these were distributed randomly and the test was double blind. The 20 weeks of study were divided in five 4-week periods. Fasting serum concentrations of total cholesterol, triglycerides, HDL-cholesterol (HDL-c), LDL-cholesterol (LDL-c) and glucose were determined at the starting of the study and after each treatment cycle. Glucose values were determined 2 h after lunch at the beginning of the study and at the end of the first, third and fifth month of treatment. All parameters assessed have been analysed by anova.

RESULTS

The serum total cholesterol, LDL-c levels observed in the two groups did not change during the course of treatment. We observed a noteworthy progressive reduction of mean baseline triglyceride levels until the fourth month (p < 0.05) in acarbose-treated patients, with an increase in HDL-c (p < 0.008).

CONCLUSIONS

We maintain that acarbose may be a useful therapeutic tool in addition to the diet in order to reduce triglyceride serum levels in non-diabetic patients.

Thyroid hormones and lipid metabolism in a group of patients over seventy

Numerous studies have suggested a marked correlation between thyroid functionality indices and lipid metabolism. In this trial we assessed the functional parameters of 165 individuals over 70, 87 women and 78 men, correlating the serum values of T3, T4, FT4, TSH with cholesterol, triglycerides, HDL, Apo-A and Apo-B levels. The correlation was performed over the whole population studied and subsequently, after dividing the population by sex and age (3 age groups: A, 70-75; B, 76-80; C, over 80) in the individual groups. In the population as a whole, we have observed a statistically significant correlation between T4/cholesterol (P=0.0001); T3/cholesterol (P=0.06); T4/triglycerides (P=0.0001); T3/triglycerides (P=0.09); T4/HDL (P=0.0001); T4/Apo-A (P= 0.02); T3/Apo-A (P=0.008); T4/Apo-B (P=0.0001). Analysis by gender shows a statistically significance between the female and male sexes in the correlation between T3/cholesterol (P=0.001); T3/triglycerides (P=0.06); T4/cholesterol (P=0.0001) and T4/triglycerides (P=0.0001). When the data were analyzed by age, in Group A (75-80) there was no statistically significant correlation, whereas in Group B (76-80) there has been an increase in significance in the correlation between T3/cholesterol (P=0.006); T3/triglycerides (P=0.001); T3/Hdl (P=0.08); T3/Apo-A (P=0.0001); T3/Apo-B (P=0.08); T4/cholesterol (P=0.00001) and ); T4/Apo-A (P=0.0001). On the other hand in the Group C age group (over 80) this significance is considerably lower. Maybe this decrease of correlations should be attributed to a global savings of the older organisms, or to a process of natural selection.

Electroionotherapy in acute arthrorheumatic pain

The authors evaluated the efficacy of an electronic treatment for pain, using an ion flow generator, BE-101 model by Bio-Ejt, on 19 patients suffering from acute pain of an arthrorheumatic nature. Each patient was treated for two weeks every other day (6 sittings), each sitting lasting 20 minutes at an intensity of about 30 microAmper for both transducers. The results demonstrated that this technique is very effective in curing the pain.

Estrogens and euosteogenesis in men

The bone mineral density (BMD) has been analyzed in 200 male patients divided in 4 groups of age as follows: (A) 40-49, (B) 50-59, (C) 60-69, and (D) 70 years and above. BMD was measured by using the DEXA technique both in the ultradistal and mediodistal region of radius of the non-dominant side. In addition, the serum levels of testosterone (Ts), dihydrotestosterone (DHT) and 17-beta estradiol (E-2) have also been measured. The data obtained have shown that bone mineral density values are decreasing also in the males with advancing age, and the positive correlation (p < 0.05) of BMD with the E-2 levels also tend to decrease. These results suggest the hypothesis that the true sexual hormones regulating the rhythm of osteogenesis may be the estrogens in the males, too.

Altered laboratory thyroid parameters indicating hypothyroidism in elderly subjects

The altered laboratory thyroid parameters indicating hypothyroidism were evaluated in a series of 3015 subjects over 65 years of age by determining total T3, total T4 and TSH. In addition, clinical signs of hypothyroidism were recorded in a subsample of 300 randomly selected elderly. Our results showed a high prevalence of altered laboratory thyroid parameters indicating hypothyroidism of 17.88%, whereas the real prevalence (both clinical and laboratory) is 1.00% with a female/male ratio of 2.00. The most frequent laboratory alterations was the so-called 'alerted pituitary' status'. The most common clinical signs of hypothyroidism involved the nervous system. We conclude that it is very difficult to diagnose hypothyroidism in the elderly and that the most indicative laboratory alterations seem to be TSH values above 3 IU/ml determined using the IRMA method.

Senile diabetes and bone mineral density

Bone mineral density was determined in a series of 67 elderly diabetics (38 males and 29 females) and 40 non-diabetic elderly subjects (20 males and 20 females) at the third medial and tenth ultradistal of the non-dominating radius using an X-ray densitometer (DEXA). Bone metabolism markers (Ct, PTH, HOP, UCA, AP, Vit-25-OH-D, BGP) were also measured. Our results indicate that there is no significant difference in values of BMD and the bone metabolism markers studied between diabetic and non-diabetic elderly subjects. We believe that senile diabetes is not a risk factor of onset and maintenance of senile osteoporosis.

Ipriflavone-treatment of senile osteoporosis: results of a multicenter, double-blind clinical trial of 2 years

Eighty-four out of 100 enrolled female patients affected by osteoporosis completed a double-blind, randomized trial, using ipriflavone (IP) in a dose of 3 x 200 mg/day (41 patients) or placebo (P)(43 patients). All patients received 1 g/day oral calcium supplementation. Inclusion criteria were: age over 65 years; at least one vertebral fracture in the past; bone mineral density measured at the distal tenth of the radius lower than the normal average -2 x S.D. The trial period was between June 1990 and November 1993. Patients of the IP group showed a significant increase in bone mineral density (P < 0.05) compared with the starting values during the whole study period. Pain decreased rapidly, intake of analgesics dropped, and often significant decreases in calciuria, hydroxyprolinuria, alkaline phospatase, osteocalcin and parathormone values were observed. Only two new fractures occurred during the trial in the IP group. Patients of the P group at the end of the study displayed decreased bone mineral densities (P < 0.05), increased pain, greater consumption of analgesics, and often significant increases in the bone metabolism parameters listed for the IP group. In the

Alterations of blood and plasma viscosity and erythrocyte filtration in senile osteoporosis

Blood and plasma viscosity, as well as erythrocyte filtration rates were studied in 44 osteopenic (20 men and 24 women) and in 40 non-osteopenic (20 men and 20 women) patients, all over 65 years of age. Pathological hemorheological parameters were observed only in 12 subject of the osteopenic group, and 10 controls. The results indicate that although the hemorheological parameters do not show a direct correlation with the osteopenia, it is worthwhile following these parameters, among others, in order to optimize the treatment with anti-osteoporotic drugs which are able to regulate them.

Serum levels of myoglobin in aged thyreopathic patients

Serum concentrations of triiodothyronine (T-3), thyroxine (T-4) and myoglobin were determined by radioimmunoassay in 10 hypothyroid, 15 hyperthyroid and 14 euthyroid aged patients. The average ages were between 69 and 71 yr for these groups. The serum levels of T-3 and T-4 were typical for the clinical diagnosis and were accompanied by characteristic changes in the serum myoglobin concentrations. The hypothyroid, the euthyroid and the hyperthyroid groups displayed 107.0, 33.1 and 17.0 ng myoglobin per ml of serum, respectively. These differences are statistically highly significant. The authors are of the opinion that the serum myoglobin level depends on the myoglobin content of the muscle tissue, being higher in hypothyroid and lower in hyperthyroid patients as compared to the euthyroid persons.

Effects of cyclic somatostatin on insulin, C-peptide and immunoreactive glucagon response to oral glucose loading in obese patients

The effects of somatostatin (SRIF) infusion on blood sugar, immunoreactive insulin (IRI), immunoreactive glucagon (IRG) and C-peptide after administration of oral glucose load (100 g) to 23 obese subjects were examined. The latter were divided in two groups according to oral glucose tolerance (OGTT): (1) normal OGT; (2) impaired OGT. During SRIF infusion IRI and C-peptide response to oral glucose was significantly reduced in both groups as compared with the response under saline infusion. Blood sugar values fell markedly in the second group. After SRIF infusion ended a marked increase in C-peptide, IRG and blood sugar was observed. The results suggest that SRIF infusion is only able to inhibit the release of IRI and IRG temporarily. They do not demonstrate if the behaviour of blood sugar is influenced by variations of these hormones or by the direct effect of SRIF infusion on absorption of the glucose load.

[Effects of oral glucose, fructose and saccharose loads on blood sugar, insulin and lipids in normal subjects]

Blood sugar, insulin, NEFA, triglycerides and cholesterol were evaluated in metabolically healthy subjects following oral glucose (100 g in 12 subjects), fructose (50 g in 9 subjects), and saccharose (100 g in 9 subjects). As shown in the literature, glucose led to a slight sugar increase at 60', a marked increase in insulin at 60', and a pronounced fall in NEFA at 120'. Fructose had no effect on sugar and NEFA, whereas there was significant and gradual rise in the insulin curve until 180' (P less than 0.01). In the case of saccharose, the changes in blood sugar, insulin and NEFA were slightly less evident than with glucose. No significant alterations in cholesterol and triglyceride levels were noted throughout the experiment.