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R Nuti

Publications and source records attributed to R Nuti.

At least 37 records · Page 2Linked to original sources
PubMed2001

Prevalence of undiagnosed coeliac syndrome in osteoporotic women.

OBJECTIVES: The aims of the study were to quantify the prevalence of asymptomatic coeliac disease (CD) in a cohort of osteoporotic females, and to investigate the features of bone loss. DESIGN AND SUBJECTS: We studied 255 women (mean age 66.6 +/- 8.5 SD) with primary osteoporosis (WHO diagnostic criteria). After the first CD screening with the measure of serum IgG antigliadin antibodies (IgG-AGA), 53 women showed a positive test: antibodies to tissue transglutaminase (TG-ab) were subsequently determined to confirm the diagnosis of CD. Bone metabolism was evaluated by: serum and urinary calcium, serum and urinary phosphate, serum alkaline phosphatase, urinary crosslaps, serum 25(OH)D and serum parathyroid hormone. RESULTS: High levels of IgG-AGA and TG-ab were observed in 24 patients with a prevalence of serological disease of 9.4%. These women were characterized, in comparison with the other patients, by a statistically significant reduction in serum 25(OH)D (17.8 +/- 7.2 vs. 55.1 +/- 20.3 nmol L(-1), P < 0.01) together with a significant increase of iPTH (65.1 +/- 29.7 vs. 35.1 +/- 20.0 pg mL(-1); P < 0.01). Patients with high TG-ab levels showed also slightly raised values of urinary crosslaps (288 +/- 88 vs. 270 +/- 90 microm mol(-1) Cr). In IgG-AG positive patients a statistically significant inverse correlation was found between 25(OH)D serum levels and log-transformed TG-ab values (r: -0.95, P < 0.001). Intestinal biopsies were obtained in 10 TG-ab positive women and verified CD in six patients. CONCLUSIONS: These data support the hypothesis that patients with undiagnosed celiac disease develop high remodelling processes related to calcium malabsorption, secondary hyperparathyroidism and unavailability of vitamin D with a consequent more marked bone loss.

Adult↗
PubMed2001

Leptin and body composition in healthy postmenopausal women.

BACKGROUND: Leptin has been proposed to be involved in central control of adiposity and fat distribution but the role of this peptide is controversial. The aim of our study was to test the relationship between serum leptin and body composition, fat distribution, and some biochemical markers such as fasting insulinemia and lipoproteins in a population of healthy Italian postmenopausal women. METHODS: One hundred and twenty-three postmenopausal women (62.1+/-8.7 years) were evaluated. Body composition (fat and lean mass) was assessed by dual-energy X-ray absorptiometry (DXA). Two regions of interest were determined for regional fat analysis. Serum leptin and insulinemia were measured by radioimmunoassay, lipoproteins with colorimetric methods and apolipoproteins nephelometrically. RESULTS: Plasma leptin levels are strongly related to total fat mass, in grams (r=0.73, p<0.001) or as a percentage of soft tissue (r=0.75, p<0.001), and to adiposity, calculated as ratio between lean and fat mass (r=0.76, p<0.001). A significant correlation was also found between serum leptin and central fat distribution (r=0.29, p<0.01). As concerns biochemical markers, serum leptin was significantly related to fasting insulin (r=0.38, p<0.001), total cholesterol (r=0.29, p<0.01), Apolipoprotein-B (r=0.35, p<0.001), and triglycerides (r=0.22, p<0.05). When corrected for total fat mass, the partial correlation coefficients remain significant for percentage of total body fat (r=0.27, p<0.01), adiposity (r=0.23, p<0.01), and fat proportion in android region (r=0.18, p<0.05). CONCLUSIONS: These data indicate that leptin levels are related to adiposity and fasting insulin levels; indeed fast insulin mantains significant correlation with leptin (r=0.23, p<0.01) after controlling for fat mass. Android distribution of fat mass in elderly women is associated with leptin concentration.

Adipose Tissue↗
PubMed2000

[Reconstructive surgery of the mitral and tricuspid valves with a Cosgrove-Edwards flexible ring].

BACKGROUND: Mitral and tricuspid valve asymmetric annular dilation represents the most important mechanism which produces insufficiency. Recent computerized in vitro and in vivo three-dimensional models have been developed in order to better understand the competing factors (annular dilation, displacement of papillary muscles, left and right ventricular geometry). The leading cause of mitral and tricuspid competence is a sphincteric action of both annuli, during systole and diastole, the loss of which produces asymmetric dilation and therefore the absence of cusp coaptation. The Cosgrove-Edwards dynamic ring corrects, alone or in combination with other procedures on the valves, this patho-anatomic feature in a physiological way by restoring the normal annular dimensions and the sphincteric movements during the cardiac cycle. METHODS: Between June 1998 and May 1999, 30 adult patients underwent mitral (n = 20, Group I) or tricuspid valve repair (n = 10, Group II). Regurgitation was due to a degenerative disease in 13 Group I patients and to ischemic (n = 3), congenital (n = 2) or dilated cardiomyopathy (n = 2) in the others. In Group II the leading cause of insufficiency was functional regurgitation in 7 patients and organic in 3. Associated procedures were carried out in 4 Group I patients and in all Group II patients. Regurgitation was evaluated by transesophageal echocardiography before, during and 3 months after operation. The maximal regurgitant area (MRA) and the grade of insufficiency were evaluated using the equation: MRA < 2 cm2 = grade 0, MRA > 2 < 4 cm2 = 1+, MRA > 4 < 7 cm2 = grade 2+, MRA > 7 < 10 cm2 = 3+, MRA > 10 cm2 = 4+. RESULTS: The operative mortality was 0%. One Group I patient died 3 months after operation due to bronchopneumonia. No patient was reoperated on for plasty failure in both groups during the follow-up. Mitral insufficiency was absent (grade 0) in 17 Group I patients and mild (grade 1+) in 3 at the end of operation. At 3-month postoperative transesophageal echocardiographic control mitral insufficiency was absent in 14 patients, mild (1+) in 4 and moderate (2+) in 2. MRA was 3 cm2 in the 2 patients operated on for dilated cardiomyopathy and < 3 cm2 in the others. Preoperative tricuspid insufficiency of grade 4+ in all Group II patients became absent in 9 of them either at the end of operation or at 3-month postoperative control. CONCLUSIONS: The Cosgrove-Edwards dynamic ring as isolated device or in combination with other plasty mitral or tricuspid procedures is a safe, simple, and reproducible method to restore the distorted motion of valvular annuli. It preserves the sphincteric mechanism of the valve and allows for the coaptation of cusps. Although in a small number of patients and for a short period of follow-up our experience corroborates what other more consistent series of patients operated on have shown.

Adult↗
PubMed1998

Secondary osteoporosis.

Generalized osteoporosis currently represents a heterogeneous group of conditions with many different causes and pathogenetic mechanisms, that often are variably associated. The term "secondary" is applied to all patients with osteoporosis in whom the identifiable causal factors are other than menopause and aging. In this heterogeneous group of conditions, produced by many different pathogenetic mechanisms, a negative bone balance may be variably associated with low, normal or increased bone remodeling states. A consistent group of secondary osteoporosis is related to endocrinological or iatrogenic causes. Exogenous hypercortisolism may be considered an important risk factor for secondary osteoporosis in the community, and probably glucocorticoid-induced osteoporosis is the most common type of secondary osteoporosis. Supraphysiological doses of corticosteroids cause two abnormalities in bone metabolism: a relative increase in bone resorption, and a relative reduction in bone formation. Bone loss, mostly of trabecular bone, with its resultant fractures is the most incapacitating consequence of osteoporosis. The estimated incidence of fractures in patients prescribed corticosteroid is 30% to 50%. Osteoporosis is considered one of the potentially serious side effects of heparin therapy. The occurrence of heparin-induced osteoporosis appeared to be strictly related to the length of treatment (over 4-5 months), and the dosage (15,000 U or more daily), but the pathogenesis is poorly understood. It has been suggested that heparin could cause an increase in bone resorption by increasing the number of differentiated osteoclasts, and by enhancing the activity of individual osteoclasts. Hyperthyroidism is frequently associated with loss of trabecular and cortical bone; the enhanced bone turnover that develops in thyrotoxicosis is characterized by an increase in the number of osteoclasts and resorption sites, and an increase in the ratio of resorptive to formative bone surfaces, with the net result of bone loss. Despite these findings, the occurrence of pathological fractures in patients with hyperthyroidism is relatively low, and probably due to the fact that deficiencies in bone mass may be reversed by treatment of the thyroid disease. Most, but not all, studies on insulin-dependent diabetes mellitus (IDDM) report an association with osteopenia. In IDDM, the extent of bone loss is usually slight, which helps explain the discrepancy between the frequency of decreased bone mineral density, and the frequency of osteoporotic fractures in long-standing diabetes. Contradictory results have been obtained in non-insulin-dependent diabetes mellitus (NIDDM) patients. Increased rates of bone loss at the radius and lumbar spine were demonstrated either in patients with two-thirds gastric resection and Billroth II reconstruction, or in those with one-third resection and Billroth I anastomosis, and the metabolic bone disease following gastrectomy may consist also of osteomalacia or mixed pattern of osteoporosis-osteomalacia, with secondary hyperparathyroidism. Miscellaneous causes of secondary osteoporosis are also immobilization, pregnancy and lactation, and alcohol abuse.

Adult↗
PubMed1998

Central diabetes insipidus with spontaneous remission. A case report.

We report a case of central diabetes insipidus with spontaneous remission 8 months after clinical beginning of the disease. A 20 years-old man developed polydipsia and polyuria in October 1994. A water deprivation study showed a defect in the urine concentrating function, which was corrected by vasopressine. A Magnetic Resonance imaging of the skull revealed a thickening of the pituitary stalk. His condition was well controlled by nasal DDAVP administration and 6 months later patient reduced spontaneously medication dose without clinical worsening. 8 months after clinical beginning, patient has become completely free from the need for medication to control clinical symptoms and urine concentrating function, as demonstrated by a re-evaluation study with water deprivation. A control Magnetic Resonance showed the regression of stalk enlargement. The clinical and radiological features of this case are discussed.

Adult↗
PubMed1997

Age-related changes in body composition of healthy and osteoporotic women.

OBJECTIVES: The study was carried out to assess age-related changes of body composition and to evaluate the influence of lean and fat mass in bone mineral density of healthy and osteoporotic women. METHODS: 166 healthy women in premenopause (43.2 +/- 6.7 years), 591 healthy postmenopausal women (59.9 +/- 8.1 years) and 373 women with established involutive osteoporosis (66.2 +/- 7.8 years) were evaluated: bone mineral density (BMD) and soft tissue composition (fat mass, lean mass) were measured by a total body Lunar DPX device. RESULTS: no difference in lean mass was appreciated between the groups. Fat mass was significantly lower in premenopausal women (19.5 +/- 6.5 kg) and osteoporotic patients (18.8 +/- 5.2 kg) than in postmenopausal healthy women (21.8 +/- 5.7 kg). In premenopause weight, soft tissue mass and fat mass increased with age (P < 0.05). In postmenopause, lean mass decreased significantly in healthy women (P < 0.05). Fat mass was lower in the osteoporotics than in normals. Total BMD correlated significantly with fat and lean mass in all groups (P < 0.01). BMD/height ratio correlated significantly with fat mass (P < 0.01), not with lean mass. CONCLUSIONS: BMD is closely related to fat mass in healthy premenopausal and postmenopausal women, and in osteoporotic patients; osteoporotic patients and healthy premenopausal women are characterized by a lower fat mass than healthy postmenopausal women; fat mass may be considered one of the determinants of bone mass also in involutive osteoporosis.

Adipose Tissue↗
PubMed1996

Bone loss in men.

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Age Factors↗
PubMed1995

Age-related changes of whole skeleton and body composition in healthy men.

We examined age-related changes of the entire skeleton and its major anatomical areas (spine, trunk, pelvis, arms, legs) in 139 healthy males (19-99 years of age) and evaluated the influence of lean mass and fat mass on these changes. The population studied was stratified according to their ages referred in decades. Bone mineral density (BMD) and body composition (fat mass, lean mass) were measured by Lunar DPX. A negative linear correlation between BMD values and age was observed. The overall bone loss from the young to the aged was statistically significant for all skeletal sites, with a lower level of significance for the spinal area: BMD percentage decrease ranged from 19.4% for the pelvis to 9% for the spine. Peak bone mass was observed in the first decade (19-29 years of age). Soft tissue increased until the fifth and sixth decades, followed by a gradual decrease. Lean mass declined in a uniform way from the first to the last decades. BMD values were significantly related to lean mass, but there were no correlations with the fat mass. Lean body mass was significantly related to BMD/height, index of "true" volumetric density. Multiple regression analysis confirmed that in males the principal determinant of total body bone density is fat-free mass.

Absorptiometry, Photon↗
PubMed1995

Idiopathic avascular necrosis of the scaphoid. A case report.

Avascular necrosis of the carpal scaphoid is a common disorder after a trauma, i.e. a fracture or mild and repetitive injury. Sometime it can be associated with a systemic disease or chronic steroid intake. Rarely avascular necrosis is found in the absence of a known etiology and so termed "idiopathic". We report a case of idiopathic avascular necrosis of the scaphoid. A painful wrist of six months' duration was observed in a 62-year-old housewife. No history of trauma or steroid administration could be elicited. X-ray showed an osteolytic area with irregular edges surrounded by a ring of osteosclerosis at the proximal pole of the left scaphoid. This datum was confirmed by the magnetic resonance imaging.

Carpal Bones↗
PubMed1994

Management of osteoporosis and Paget's disease. An appraisal of the risks and benefits of drug treatment.

Osteoporosis is a major public health problem occurring primarily among the postmenopausal population. Osteoporosis is a preventable disease, but despite several advances in its prevention, treatment of the established disease to date remains a major challenge to be managed by primary care physicians. Stabilisation of bone mass and prevention of falls are of paramount importance in any therapeutic programme for osteoporotic patients with established vertebral fractures. Drug therapy for osteoporosis can be divided operationally into 2 main categories: those that inhibit bone resorption, and thus reduce bone turnover, and those that stimulate bone formation, exerting an anabolic effect. Therapeutic agents that inhibit bone remodeling would appear to be best suited to those patients with high turnover osteoporosis (about 30%). Included in this category are calcium, vitamin D and its metabolites, gonadal steroids, calcitonin, ipriflavone and bisphosphonates. Although estrogen replacement therapy has been proven to be effective in older females, calcitonin appears to be the treatment of choice for this population since it stabilises or increases bone mass and also has reported analgesic properties. Drugs that stimulate bone remodeling or bone formation would be best suited to patients with low turnover osteoporosis (about 70%). The agent in this class that is widely used is sodium fluoride. New therapies include intermittent injections of synthetic parathyroid hormone, and cyclic bisphosphonates to activate then depress resorption and formation. Any attempts to stabilise the skeleton with any drug regimen must be accompanied by an adequate calcium supply, i.e. 1200 to 1500 mg/day). The theoretical basis of tailoring treatment for osteoporosis to the underlying histology has not yet been fully proven, but there is increasing experimental support to this approach. Drugs that inhibit bone turnover, such as calcitonin, appear to be effective in increasing bone mass for 1.5 to 2 years, about the time it would take to replenish the remodeling space in a patient with high turnover osteoporosis. In contrast, although bone mass appears to increase for as long as 5 years in patients treated with sodium fluoride, there has been no consistent reduction in occurrence of vertebral or hip fractures. Paget' disease of bone is a focal disorder of the skeleton characterised by excessive resorption and subsequently disorganised formation of bone. The aetiology of the disease is unknown. Paget's disease may be mono-ostotic or polyostotic; pain and bone deformities due to enlargement of skeletal segments represent the main clinical aspects. However, in many patients the disease may be asymptomatic.(ABSTRACT TRUNCATED AT 400 WORDS)

Bone Development↗
PubMed1993

Effects of age and menopause on bone density of entire skeleton in healthy and osteoporotic women.

We studied 885 women to evaluate the effects of age and menopause on bone mineral density (BMD) in both healthy and postmenopausal osteoporotic subjects. The study cohort consisted of 161 healthy premenopausal women (age range 25-54 years), 357 healthy postmenopausal women (35-85 years) and 367 osteoporotic women (41-87 years). Total body and regional (spine, trunk, pelvis, arms, legs) BMD were measured with a dual-energy X-ray (DXA) device (Lunar DPX). Premenopausal BMD values remained essentially unchanged until the first half of the fourth decade, when they decreased. BMD values in both healthy postmenopausal and osteoporotic women were significantly lower than premenopausal values, and continued to decrease statistically after the onset of menopause. The highest Z-score (0.96 +/- 0.92) was found for total body BMD. Higher T-score values were found in osteoporotic than in normal postmenopausal women. In both healthy and osteoporotic postmenopausal women the best fits for BMD changes in total body, spine, trunk, arms and legs were obtained with the natural logarithm of years since menopause; only the pelvis BMD decreased linearly. Multiple regression analysis indicated that postmenopausal BMD changes in both normal and osteoporotic women were linked chiefly to body weight and years since the onset of menopause.

Adult↗
PubMed1993

Cerebrotendinous xanthomatosis: pathophysiological study on bone metabolism.

A condition of osteopenia in some cerebrotendinous xanthomatosis (CTX) patients led us to investigate bone metabolism in 8 patients belonging to 5 families. Serum calcium, phosphate and vitamin D metabolites were in the normal range; a reduction in total body density and impairment of intestinal radiocalcium absorption were found in the majority of our patients.

Absorptiometry, Photon↗
PubMed1993

Total body, spine, and femur dual X-ray absorptiometry in spinal osteoporosis.

The aim of this study was to evaluate the ability of dual x-ray absorptiometry (DXA) to discriminate between normal and osteoporotic patients. A total of 152 postmenopausal women entered the study: 73 (aged 61.2 +/- 8 years) had established postmenopausal osteoporosis with one or more vertebral crushes on lateral X-ray of spine, and 79 (aged 59.3 +/- 7.8 years) had no vertebral fractures. Measurements of bone mineral content (BMC) in grams, bone mineral density (BMD) in g/cm2 and body composition (lean and fat mass in grams) of total body, lumbar spine (L2-L4), and femur (neck, trochanter, Ward's triangle) were carried out with a LUNAR DPX densitometer. In all sites, BMD values of osteoporotic patients were significantly lower than those of the control subjects. The higher Z-score was found for total body density (-2.14) followed by L2-L4 (-2.0), femoral neck (-1.93), Ward's triangle (-1.69), and trochanter (-1.4). Only the trochanter Z-score was significantly different compared with the other sites. A fracture threshold was determined for each site from osteoporotic patients and normal controls: with a sensitivity set at 90%, the best specificity was obtained at the lumbar spine and total body sites (89% and 84%, respectively). BMD values were highly related to lean and fat body mass, but bone loss with age was unrelated to soft tissue change. In conclusion, BMD measurements at different skeletal sites enable detection of spinal osteoporosis although sensitivity for femoral areas was less with respect to total body and L2-L4 BMD values.

Absorptiometry, Photon↗
PubMed1992

Measurements of bone mineral density by DXA total body absorptiometry in different skeletal sites in postmenopausal osteoporosis.

In order to evaluate the bone mineral density (BMD) of the entire skeleton and its major anatomical areas, total body DXA absorptiometry was performed in 330 postmenopausal women whose ages ranged from 42-85 years. Sixty-three of them were normal women and constituted the control group (Group 1). Two hundred sixty-seven were patients affected with postmenopausal osteoporosis: 107 osteoporotic patients had vertebral biconcavity deformities of grade 1 (Group 2), and the other 160 had vertebral wedge, biconcavity, and compression deformities of grade 2 (Group 3). Total body absorptiometry was assessed by a DXA system (Lunar DPX). Significant reduction in total body BMD values was observed in patients in Groups 2 and 3 (p less than 0.01): the bone loss was more intense in osteoporotic women of Group 3. The low values of the BMD in osteoporotic patients are, moreover, localized in the areas of spine, arms, and legs; the osteopenia was particularly enhanced in patients with grade 2 vertebral deformities. Multiple linear regression indicated that values of total BMD were significantly related to age and BMI. Receiver operating characteristic (ROC) analysis showed that total BMD provided high sensitivity: At 90% of specificity it was 78% for Group 2 and 89% for Group 3. DXA total body absorptiometry has demonstrated that, in postmenopausal osteoporotic women, the reduction in bone mass is not localized only in the spine, but also involves the appendicular skeleton.

Absorptiometry, Photon↗