The Beneficial Effects of Bariatric-Surgery-Induced Weight Loss on Renal Function.

Obesity represents an independent risk factor for the development of chronic kidney disease (CKD), leading to specific histopathological alterations, known as obesity-related glomerulopathy. Bariatric surgery is the most effective means of inducing and maintaining sustained weight loss. Furthermore, in the context of bariatric-surgery-induced weight loss, a reduction in the proinflammatory state and an improvement in the adipokine profile occur, which may also contribute to the improvement of renal function following bariatric surgery.

Arterial Hypertension and Cardiopulmonary Function: The Value of a Combined Cardiopulmonary and Echocardiography Stress Test.

Arterial hypertension (AH) is a global burden and the leading risk factor for mortality worldwide. Haemodynamic abnormalities, longstanding neurohormonal and inflammatory activation, which are commonly observed in patients with AH, promote cardiac structural remodeling ultimately leading to heart failure (HF) if blood pressure values remain uncontrolled. While several epidemiological studies have confirmed the strong link between AH and HF, the pathophysiological processes underlying this transition remain largely unclear.

Predicting the transition to and progression of heart failure with preserved ejection fraction: a weighted risk score using bio-humoural, cardiopulmonary, and echocardiographic stress testing.

Aims: Risk stratification of heart failure (HF) patients with preserved ejection fraction (HFpEF) can promote a more personalized treatment. We tested the prognostic value of a multi-parametric evaluation, including biomarkers, cardiopulmonary exercise testing-exercise stress echocardiography (CPET-ESE), and lung ultrasound, in HFpEF patients and subjects at risk of developing HF (HF Stages A and B).

Background: Risk stratification of heart failure (HF) patients with preserved ejection fraction (HFpEF) can promote a more personalized treatment.

Cardiac Reserve and Exercise Capacity: Insights from Combined Cardiopulmonary and Exercise Echocardiography Stress Testing.

Background: Cardiopulmonary exercise testing (CPET) represents the gold standard to estimate peak oxygen consumption (VO) noninvasively. To improve the analysis of the mechanisms behind effort intolerance, we examined whether exercise stress echocardiography measurements relate to directly measured peak VO during exercise in a large cohort of patients within the heart failure (HF) spectrum.

Methods: We performed a symptom-limited graded ramp bicycle CPET exercise stress echocardiography in 30 healthy controls and 357 patients: 113 at risk of developing HF (American College of Cardiology/American Heart Association stage A-B) and 244 in HF stage C with preserved (HFpEF, n = 101) or reduced ejection fraction (HFrEF, n = 143).

The Complex Relationship Between Serum Uric Acid, Endothelial Function and Small Vessel Remodeling in Humans.

Aims: The relationship between serum uric acid (SUA) and microvascular remodeling in humans remains largely unexplored. We assessed whether SUA provides additional information on the severity of microvascular remodeling than that obtained from the European Heart Score (HS), the patterns of microvascular remodeling associated with changes in SUA levels and the mediation by endothelial function and nitric oxide (NO) availability on this relationship.

Methods: A total of 162 patients included in the microvascular dataset of the Italian Society of Hypertension with available information on SUA, media-to-lumen (M/L) ratio, media cross-sectional area (MCSA), endothelial function, NO availability and HS were included in the analysis.

Painless lymphadenopathy, eosinophilia and nephrotic syndrome: a diagnostic challenge in an era of increased migration.

Kimura's disease is a rare chronic inflammatory condition of unknown cause that most frequently affects Asian adults. It is characterized by painless lymphadenopathy in the head and neck region and eosinophilia, often associated with nephrotic syndrome. Α young Asian male presented to our Department with œdema at the lower limbs and scrotum, retroauricular masses, eosinophilia and proteinuria.

Inflammation and Vascular Ageing: From Telomeres to Novel Emerging Mechanisms.

Cardiovascular disease (CVD) remains the leading cause of morbility and mortality worldwide. The identification of common cardiovascular risk factors has led to the development of effective treatments that enabled a significant reduction of the global cardiovascular disease burden. However, a significant proportion of cardiovascular risk remains unexplained by these risk factors leaving many individuals at risk of cardiovascular events despite good control of the risk factors.

Protocols cure diseases, not patients: flaccid paresis in post-NSTEMI statin treatment.

An 82-year-old white woman presented at our Internal Medicine ward with flaccid tetraparesis. Two months earlier, she had suffered a non-ST elevation myocardial infarction treated with percutaneous coronary intervention (PCI) and stenting, and she had been prescribed the classical post-PCI therapy (β-blockers, statins and antiplatelet agents). At admission, she was haemodynamically stable and the physical examination revealed reduced reflexes in the four limbs.

[Atrial fibrillation and thyroid nodules].

Our previous papers reported an association between atrial fibrillation and supracentimeter thyroid nodules. Recently we noticed that the number of patients admitted to our ward presenting this relationship, was higher than average data relating to whole world's population. In this study we tried to prove the existence of this association in a selected group of inpatients aged between 71 and 80.

[Celiac disease and myelodysplastic syndrome. A case report].

Celiac disease is an immune-mediated disorder induced by the intake of gluten proteins involving primarily the gastrointestinal tract. Myelodysplastic syndromes are clonal hematologic disorders, expanded from myeloid stem cells of uncertain pathogenesis. Anaemia is a common finding in patients with celiac disease.

[Pure red cell anaemia secondary to medullary B cell chronic lymphoproliferative disorders. A rare case].

Acquired erythroblastopenia is rather rare, more frequent in adult or old male. In absence of anti EPO antibody, it's associate to inhibition of the erythroid growth mediated by suppressive T lymphocytes, generally T8 or NK or mediated by IgG antibody in association with timoma, lymphoproliferative or immunological disorders, and other diseases. The course usually is chronic and follows that of the associate pathology.

[Hypokalemia from ectopic ACTH secretion and hypothiroidism in patient affected by small cell lung cancer].

Endocrin paraneoplastic syndromes are characterized by an ectopic hormonal production. The ectopic adrenocorticotropic hormone (ACTH) secretion is often associated with small cell lung cancer. We report the case of 64-years-old man with persistent hypokalemia in Cushing's syndrome due to ectopic ACTH secretion.

[New therapeutic strategies to the advanced non small cell lung cancer].

Lung cancer is an elevated mortality disease in spite of conventional therapy. Today it is possible to identify some molecules, as the epidermal growth factor receptor, involved in the earliest molecular alterations ofcancerogenesis. Here we show the inhibitors of the epidermal growth factor receptor as a therapeutic mean.

[Incidence of thyroid nodules in patients with and without atrial fibrillation].

In one of our previous articles we noted that many patients affected by atrial fibrillation had more thyroid nodules > or = 10mm (38%) than general population (10%). These data are confirmed by a same number of patients without atrial fibrillation admitted to our Department of Internal Medicine. The high incidence of low-T3 syndrome is confirmed too.

[Clinical differences between heart failure versus ischemic patients].

Heart failure represents a very common disease with high mortality, despite therapeutic and preventive measures. In order to evaluate the characteristics of heart failure patients, a case-control study was carried out, comparing sixty heart failure patients versus sixty patients who presented an evident atherosclerotic disease, but not heart failure. Among the differences we found, a higher heart rate, reduced levels of free-triiodothyronine and increased levels of serum uric acid in heart failure patients might directly contribute to its pathophysiology and represent potential therapeutic targets.

Relationship between low T3 syndrome and NT-proBNP levels in non-cardiac patients.

Objectives: A low T3 syndrome was described in patients with heart failure (HF), and it appears to be associated with adverse outcome, representing an independent predictor of mortality. However, it is not known if low T3 levels contribute to the pathophysiology of HF. On the other hand, it has been seen that an elevation of brain natriuretic peptides (BNP and NT-proBNP) may represent a warning signal for future cardiovascular disease and may be an early marker of diastolic dysfunction.

Systolic blood pressure response to exercise in type 1 diabetes families compared with healthy control individuals.

Objective: Oxidative stress is increased in type 1 diabetes families. Since oxidative damage is a mediator of vascular injury and familial predisposition to hypertension increases the risk of hypertension and diabetic nephropathy, we studied blood pressure responses to exercise and cardiovascular risk factors in type 1 diabetes families.

Methods: Thirty-five type 1 patients, 74 first-degree relatives, and 95 healthy individuals without established coronary heart disease underwent a cycle ergometer test.

[Atrial fibrillation and thyroid gland].

Many diseases can lead to atrial fibrillation and one of these is thyroid disfunction. The prevalence of atrial fibrillation does not differ between subclinical and overt hyperthyroidism. Hypothyroidism also can be associated to atrial fibrillation.

Amylase: a disease activity index in multiple myeloma?

This study reports a case of a patient with lambda-light chain multiple myeloma who developed a high hyperamylasaemia of the salivary type during the disease and soon afterwards died. Ectopic production of amylase by myeloma cells has been described in a few cases and demonstrated by tissue culture and immunohistochemical techniques. The common characteristics of these cases were: salivary amylase isoenzyme increase, high tumor mass, extensive extra-medullary spread, extensive bone destruction and poor prognosis.