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To investigate the effect of gluten-free diet on mineral and bone metabolism in women with celiac disease and, using the strontium test, to assess intestinal calcium absorption.We studied body mass index, biochemical and bone mineral indices, strontium absorption test, and bone mineral density in 18 women (mean age 36.8 yr, range 18-68 yr) with celiac disease at diagnosis and after 12 months of gluten-free diet.Mean strontium absorption at diagnosis was markedly decreased with respect to control values (13.84 +/- 9.03% vs 22.47 +/- 4.21%, p0.0001), and 11 of the 18 patients (61%, subgroup A) had low values. In all patients, mean hemoglobin, serum potassium, magnesium, plasma calcium, urinary calcium, and phosphorus were significantly abnormal at diagnosis, whereas only the subgroup A had significantly reduced body mass index, 25 OH vitamin D, and elevated alkaline phosphatase. This subgroup differed in body mass index (p0.003) and calciuria (p0.035) with respect to the other patients. Strontium absorption correlated with body mass index, calcemia, and 25 OH vitamin D. After the gluten-free diet, all biochemical variables and strontium absorption normalized (23.23 +/- 5.54%), whereas bone mineral density did not change.At diagnosis, the patients frequently had intestinal calcium malabsorption, as demonstrated by strontium test, with an early renal compensatory mechanism. After the gluten-free diet, the normalization of calcium absorption and the decrease of mid-molecule parathyroid hormone suggested a normalization of mineral metabolism, although a positive effect on bone mineral density was not evident at that time.

La storia naturale della calcolosi urinaria è quella di una patologia che tende a recidivare e che può associarsi ad aumentato rischio di malattia renale cronica, ossea e cardiovascolare. Per questo una ampia valutazione clinico-metabolica del paziente è di grande importanza sin dalla prima presentazione della calcolosi, allo scopo di impostare un appropriato trattamento preventivo. Il percorso diagnostico-terapeutico che viene proposto si compone di una accurata valutazione al fine di evidenziare malattie sistemiche e/o i principali fattori di rischio per la calcolosi, la malattia cronica renale, cardiovascolare e ossea; l'esecuzione di uno studio metabolico articolato su più livelli secondo la gravità della malattia e la presenza o meno di fattori di rischio; l'esecuzione di indagini strumentali appropriate; la terapia medica della calcolosi renale. Le informazioni così raccolte consentono di impostare un trattamento preventivo consistente in norme di carattere generale e, se necessario, di interventi farmacologici o nutrizionali specifici. Il documento è stato realizzato dal Gruppo Italiano Multidisciplinare di Studio per la Calcolosi Renale, ed è indirizzato a tutte le figure professionali impegnate nella gestione del paziente affetto da nefrolitiasi a partire dal medico di pronto soccorso fino al medico di medicina generale, passando dall'urologo, nefrologo, radiologo e dal dietista. Il "Percorso diagnostico-terapeutico per il paziente con calcolosi urinaria", è stato pubblicato sul Giornale Italiano di Nefrologia nel 2010: a distanza di 10 anni esatti, viene riproposto, emendato e aggiornato in questo articolo, che vuole essere un aiuto di semplice, rapida e agile lettura ed applicazione, indirizzato alla buona pratica clinica nel paziente con calcolosi renale.

This work reconstructs a now completely eroded late Eocene to earliest Oligocene carbonate factory of Northern Italy, through the analysis of a carbonate deep-water-fan sequence (Ternate-Travedona Formation) and the limestone detritus dispersed into the late Oligocene clastic-wedge of the Gonfolite Lombarda Group. Textural characteristics and skeletal assemblages of the Gonfolite pebbles were studied and compared to those of the Ternate-Travedona Formation. The same skeletal assemblage and the same taxa were found in samples from both areas, suggesting their common origin. Whereas the Ternate-Travedona Formation skeletal grains were reworked during transport, the Gonfolite Lombarda Group pure-limestone pebbles are pristine fragments of the carbonate platform, that was uplifted and eroded from the late Eocene to the early Oligocene. Using both these sources of information it was possible to reconstruct the late Eocene environment and its facies distribution. The areas undergoing high hydrodynamic energy were dominated by free-living coralline-algal branches, rhodoliths and larger thick-tested benthic foraminifera. A coralline framework, associated with thin-tested benthic foraminifera and boxwork rhodoliths, was present in slightly deeper and sheltered environments. Episodic debris flows, mainly triggered by river floods, supplied the sub-marine fan of the Ternate-Travedona Formation. These events were able to down-cut through the narrow platform and rip off large fragments of the substrate. River runoff probably also supplied large quantities of organic matter, leading to local oxygen-depletion and preservation of organic matter. The combined stressful effects of bottom instability and riverine discharge probably excluded corals from the association. The integrated study of the Ternate-Travedona Formation, and of the limestone pebbles in the Gonfolite Group, have enabled the reconstruction of this otherwise lost Eocene carbonate factory., Rivista Italiana di Paleontologia e Stratigrafia (Research In Paleontology and Stratigraphy), V. 122, N. 3 (2016)

La presenza di un'importante fase deformativa avvenuta tra la fine del Triassico e l'inizio del Giurassico è testimoniata in più località del SE-Pamir da spettacolari discordanze angolari a 90° tra le successioni Permo-Triassiche e i depositi del Giurassico basale. Pieghe da chiuse a isoclinali e sovrascorrimenti con direzione compresa tra N-S e NNW-SSE sono osservabili sia a scala mesoscopica, sia a quella regionale nella porzione orientale della catena dei Monti di Alichur, situati a E di Murgab. Queste strutture indicano un importante evento deformativo di tipo compressivo, connesso alla collisione di questo blocco con il margine meridionale di Eurasia. L’evoluzione paleogeografica, ricostruita attraverso l’analisi delle successione Permiane e Triassiche, indica infatti che il SE Pamir si è separato dal margine Gondwaniano nel Permiano Inferiore, per migrare verso N in seguito all’apertura della Neotetide e raggiungere il margine Eurasiatico alla fine del Triassico. La messa in posto di alcuni di corpi ofiolitici (Bashgumbaz Complex) presenti in quest’area del SE Pamir sembra essere legata allo stesso evento deformativo Cimmerico

A series of 234 malignant lymphomas (121 Hodgkin lymphomas and 113 non-Hodgkin lymphomas) observed at the Brescia City Hospital between 1981 and 1987 has been reviewed. This paper is aimed at assessing: 1) in which sectors of the staging radiology is indicated; 2) which radiological techniques are needed for the staging of chest lymphomas; 3) which impact they have on the therapeutic program. All patients underwent chest X-ray, which was integrated by conventional tomography in 80% of cases. Only 76 patients underwent CT: 35 times for staging, and 69 times for restaging (overall figure: 104). The two techniques were compared: in untreated patients CT gave supplementary information in 19 out of 35 cases (54.3%). In 7 patients (20%) the findings were such as to determine a change in the previous staging; only in a case (2.8%) was the management affected; in treated patients CT proved to be superior to conventional radiology in 28 out of 69 cases (40.56%) and allowed the possibility of a recurrence (which was suggested by clinical and radiological findings) to be ruled out in 23 patients (33.3%). In our opinion, CT should not be used as a routine investigation in the staging of malignant thoracic lymphomas; on the contrary, it should be limited to selected cases, when a radical radiotherapy is to be performed, or when clinics and plain radiographs proved unable to assess the nature of a pathologic thoracic condition.

Bone mineral abnormalities (defined as Chronic Kidney Disease Mineral Bone Disorder; CKD-MBD) are prevalent and associated with a substantial risk burden and poor prognosis in CKD population. Several lines of evidence support the notion that a large proportion of patients receiving maintenance dialysis experience a suboptimal biochemical control of CKD-MBD. Although no study has ever demonstrated conclusively that CKD-MBD control is associated with improved survival, an expanding therapeutic armamentarium is available to correct bone mineral abnormalities. In this position paper of Lombardy Nephrologists, a summary of the state of art of CKD-MBD as well as a summary of the unmet clinical needs will be provided. Furthermore, this position paper will focus on the potential and drawbacks of a new injectable calcimimetic, etelcalcetide, a drug available in Italy since few months ago. Bone mineral abnormalities (defined as Chronic Kidney Disease Mineral Bone Disorder; CKD-MBD) are prevalent and associated with a substantial risk burden and poor prognosis in CKD population. Several lines of evidence support the notion that a large proportion of patients receiving maintenance dialysis experience a suboptimal biochemical control of CKD-MBD. Although no study has ever demonstrated conclusively that CKD-MBD control is associated with improved survival, an expanding therapeutic armamentarium is available to correct bone mineral abnormalities. In this position paper of Lombardy Nephrologists, a summary of the state of art of CKD-MBD as well as a summary of the unmet clinical needs will be provided. Furthermore, this position paper will focus on the potential and drawbacks of a new injectable calcimimetic, etelcalcetide, a drug available in Italy since few months ago.