Amyotrophic lateral sclerosis (ALS) is a progressive, fatal, neurodegenerative disease caused by the degeneration of motor neurons. We report a case of a 45-years-old patient with ALS to underline difficulties and challenges in ALS management. Even though ALS remains fatal, several advances have been made in improving the consequences of this disease: symptomatic treatments have an important role in controlling sialorrhea, bronchial secretions, pseudobulbar emotional lability, cramps, spasticity, depression and anxiety, insomnia and pain. An adequate management of ALS should be multidisciplinar, involving not only the neurologist, but also family physicians and many other specialists, such as pulmonologist, rehabilitation medicine physician, speech therapist, dietitian and psychologist. The multidisciplinary approach should be aimed at relieving specific problems associated with the disability of single patients and improving their quality of life.

To obtain regional and national data on the quality of diabetes care within the Italian National Health Service, a national survey among persons with diabetes was conducted in 2004. A sample of 3,426 diabetic patients (age 18-64 years) were interviewed using a standardized questionnaire. The population was middle-aged (median age 57 years), had a low educational level, and was followed primarily in public diabetes centres. A total of 54% reported having hypertension but 14% were not on treatment; for hypercholesterolemia, the corresponding figures were 44% and 26%. Of the 72% who were overweight or obese, 51% were trying to lose weight; 26% currently smoked. Only 66% of patients had undergone haemoglobin A1c testing in the past four months (among the 67% who had ever heard of test); 30% suffered from microvascular or macrovascular complications. Only 5% received all eight main tests recommended by the guidelines within the specified intervals. Our study demonstrates that diabetic patients receive less than optimal care, they are engaged in unhealthy behaviours and received inadequate treatment for comorbidities, and that the translation of guidelines into clinical practice was unsatisfactory. These data have been used to formulate national and regional policy regarding integrated case management to improve the quality of diabetes care.

We report a case of a 50-year-old woman with familial hypercholesterolemia (FH). Patients with FH have an increased incidence of atherosclerotic cardiovascular disease (CVD). Lifestyle measures, including fat-modified diets, and pharmacotherapy, particularly with statins, can substantially decrease the risk of CVD. FH fulfils all the WHO criteria for disease screening: to avoid cardiovascular events, screening is one of the most important features, but regrettably this is not practiced regularly at present. Healthcare systems must implement well-organized screening strategies, supported by an efficient disease management program. These initiatives will require optimization of primary care, because general practitioners are in first line in the overall prevention of CVD.

A 32-year-old woman was admitted in congestive heart failure (CHF) 3 days after delivery. She had no history of cardiovascular disease and impaired left ventricular Ejection Fraction (EF 35%). She underwent complete heart catheterisation, selective coronary angiography and right ventricular endomyocardial biopsy (EMB).Coronary arteries were normal and EMB revealed active virus negative myocarditis. Serum was positive for anti-heart autoantibodies (AHA). Thus myocarditis was classified as autoimmune and the patient was treated with immunosuppressive therapy, with clinical and hemodynamic improvement. At 27 months follow-up EMB showed healed myocarditis. Peripartum cardiomyopathy (PPCM) is a rare disorder in which left ventricular dysfunction and heart failure occur in the peripartum period in previously healthy women. The etiology is still unknown but a sizable proportion of patients may have an underlying organ-specific autoimmune myocarditis.

quei contenziosi che derivano dall'aumentata pratica di una medicina pensata in termini eminentemente contrattualistici.

Fever of unknown origin is a common problem in medical practice and assemble a broad spectrum of diagnostic possibilities. We report a case of a 24-year-old woman with high-spiking fever. A diagnosis of adult-onset Still’s disease (AOSD) was made. This is a rare inflammatory disease with an unknown aetiology. The diagnosis of adult-onset Still’s disease can be very difficult. There are no specific tests and reliance is usually placed on a symptom complex and the well described typical rash seen in most patients. Thus, the diagnosis is made by exclusion and with the help of diagnostic criteria. The treatment of this disease has to limit the intensity of the symptoms, and this is usually obtained with NSAIDs (NonSteroidal Anti-Inflammatory Drugs), and to control the disease evolution, through the use of corticosteroid, methotrexate or ciclosphorine A. In the case here described treatment with corticosteroid met with a good response.