Pulmonary alveolar microlithiasis (PAM) is a rare disease characterized by widespread localization of calcispherites in the alveolar spaces. The patients are symptomless for a long time. Nevertheless, this disease slowly develops into pulmonary fibrosis and cardiac failure. The chest X-rays and high-resolution computed tomography strongly point towards a diagnosis of PAM. As for therapeutic approaches, repeated broncho-alveolar lavages (BAL) have been performed with improvement of symptoms but without recovery, and a new oral drug treatment is still under way. We report 2 familial cases of PAM. Both patients underwent chest X-ray examination showing diffuse bilateral micronodular opacities of calcific density. After 5 years, in May 1993, one of them developed exertional dyspnoea, cyanosis, dry cough and was admitted to our Division. Cardiokinetic and diuretic drugs as well as oxygen were administered with satisfactory results. Then repeated BAL were performed. The chest X-ray after 6 months of sodium etidronate (300 mg t.i.d.) administration was unchanged.

Objective of the present retrospective analysis was to evaluate resources consumption for psychotic patients treatment with olanzapine (OLZ), risperidone (RIS) or typical neuroleptics (NL) during year 2000 in the Dipartimento di Salute Mentale (DSM) of Ravenna. The screening of total number of psychotic patients followed in the Ravenna DSM during year 2000 generated 26 cases treated with OLZ, 22 treated with RIS and 17 treated with NL that were respecting criteria of equivalence for age and illness severity. For these patients we analyzed pharmacological, non pharmacological (medical visits, nurse visits, social assistance, rehabilitative sessions) and hospital interventions during the year of observation, choosing the point of view of the DSM for costs attribution. The analysis of pharmacological interventions evidentiated a major usage of associated neuroleptics in the RIS and NL groups in respect to OLZ (p<0,05 OLZ vs RIS and OLZ vs NL), other significant differences were about associated anticholinergics (OLZNL>RIS, p<0,05 for all comparisons). Hospital days during the year of observation in the three groups were 4,42 for OLZ patients, 7,71 for NL patients and 10,95 for RIS patients (p<0,05 for all comparisons: OLZ vs RIS, OLZ vs NL and RIS vs NL). The sum of pharmacological, non pharmacological and hospital costs (from 8.856.000 to 10.818.000 LIT) didn't generated statistically significant differences even if the OLZ group followed more intense rehabilitative activities (+71,65% vs RIS and +24,41% vs NL). Farmeconomia e percorsi terapeutici 2001; 2 (4): 217-222

Pulmonary alveolar microlithiasis (PAM) is a rare disease of unknown etiology, characterized by the presence of calcific concretions in the alveolar spaces. A familial occurrence is frequently found so that an inherited trait is thought to be involved. The chest X-ray is characterized by a 'sandstrom' picture while the clinical state undergoes to a slow and progressive impairment resulting in respiratory failure at the end stage. We have reviewed the Italian literature of the past 50 years detecting 48 case-reports of PAM (19 males and 29 females). Only 20 out of them were documented in international journals. A familial occurrence of 43.7% was found and 18 patients were under age fifteen. There was a prevalence in the female sex (60.4%) and in the second decade of life. Chest X-ray was the most important tool to diagnose PAM revealing the characteristic picture in all patient. Bronchoalveolar lavage (BAL) and open lung biopsy respectively show the characteristic calcospherites in the recovered fluid (BALF) and in the alveolar spaces. About 300 cases of PAM are reported in the international literature. We believe these data are probably underestimated because many case-reports are not published in international literature.

A growing body of literature is available about the valorization of food by-products to produce functional foods that combine the basic nutritional impact with the improvement of the health status of consumers. In this context, this study had two main objectives: (i) An innovative multistep extraction process for the production of a refined olive oil enriched with phenolic compounds (PE-ROO) extracted from olive pomace, olive leaves, or grape marc was presented and discussed. (ii) The most promising PE-ROOs were selected and utilized in in vitro and in vivo trials in order to determine their effectiveness in the management of high fat diet-induced-metabolic syndrome and oxidative stress in rats. The best results were obtained when olive leaves were used as source of phenols, regardless of the chemical composition of the solvent utilized for the extraction. Furthermore, while ethanol/hexane mixture was confirmed as a good solvent for the extraction of phenols compounds soluble in oil, the mix ROO/ethanol also showed a good extracting power from olive leaves. Besides, the ROO enriched with phenols extracted from olive leaves revealed an interesting beneficial effect to counteract high fat diet-induced-metabolic disorder and oxidative stress in rats, closely followed by ROO enriched by utilizing grape marc.

Ipertensione arteriosa polmonare: stima della casistica italiana e considerazioni sull'impatto sul budget dell'introduzione di tadalafil causa della veloce degradazione a opera della fosfodiesterasi (PDE), in particolare quella di tipo 5, che idrolizza la cGMP, inibendone l'azione vasodilatatoria. Inibitori della PDE-5 come tadalafil, potrebbero quindi prolungare gli effetti vasodilatatori ed antiproliferativi del cGMP.Obiettivo delle analisi qui presentate è effettuare una stima epidemiologica della IAP in Italia e valutare l'impatto dell'introduzione di tadalafil sul budget farmaceutico. MaterIalI e MetodI Stima epidemiologicaLa stima che effettuiamo della prevalenza della IAP in Italia si basa sui dati di letteratura internazionale relativi alla popolazione affetta da questa malattia. Negli ultimi 30 anni sono stati pubblicati solo 3 studi sull'argomento e rappresentano la fonte più impiegata per le stime di incidenza e prevalenza della IAP [1,2,5]. Una stima alternativa dell'epidemiologia viene inoltre condotta attraverso l'analisi dei dati di vendita dei farmaci a indicazione specifica per la IAP. Stima dei costi farmaceuticiIn letteratura non esistono valutazioni dei costi di trattamento della IAP. Gli schemi di trattamento infatti sono molto vari e molto spesso, oltre ai farmaci a indicazione specifica, viene fatto ricorso a interventi non farmacologici e a presidi fuori indicazione (per esempio antiperIntroduzIone L'ipertensione arteriosa polmonare (IAP) è considerata una malattia rara [1][2][3][4][5]. Secondo studi epidemiologici condotti in Francia, Svizzera e Scozia l'incidenza varia da 2,4 a 7,6 casi nuovi/anno/1.000.000 abitanti adulti [1][2][3]. Nell'ultima classificazione fatta dagli esperti [4] l'ipertensione polmonare (IP) è stata suddivisa in 6 sottogruppi, solo le IP appartenenti al gruppo I sono ascrivibili alla definizione di IAP e comprendono, fra le altre, quella idiopatica (IAPI) e quella associata a malattie del tessuto connettivo. La gravità della IAP tipo I è tale che, senza trattamento specifico, la morte dei pazienti soggiunge in media dopo 2,8 anni dalla diagnosi mentre, con trattamento adeguato, l'aspettativa di vita si prolunga fino a una media di 5 anni [6,7]. L'ossido nitroso (NO), prodotto dagli enzimi NO sintetasi, si trova ovunque nell'organismo ma è presente in maggior concentrazione in vicinanza dei vasi sanguigni e i suoi effetti sono variabili a seconda del recettore sul quale agisce. In particolare, gli effetti a livello dell'albero arterioso polmonare provocano una forte vasodilatazione in quanto aumentano e mantengono la concentrazione di guanosina monofosfato ciclico (cGMP) all'interno della componente muscolare non striata vascolare. L'ossido nitroso, infatti, attiva la guanilato ciclasi, che induce un aumento della produzione di cGMP, il quale a sua volta provoca vasodilatazione. I suoi effetti sono di breve durata a aBStraCt This contribution is an attempt to estimate a range of Pulmonary Arterial Hypertension (PAH) prevalence in Italy using international literatur...