Termoablazione percutanea a radiofrequenza dell'osteoma osteoide con elettrodi ad uncini multipli espandibili

L'osteoma osteoide rappresenta un tumore osseo benigno costituito da un "nidus" centrale di dimensioni solitamente inferiori a 2 cm, circondato da una zona di reazione ossea. Tale lesione rappresenta approssimativamente il 12% dei tumori ossei benigni e colpisce per il 90% pazienti che hanno un'età compresa tra 5 e 25 anni. L'osteoma osteoide presenta come sintomo clinico caratteristico un dolore persistente, sordo, con acme notturno e sensibile alla terapia con farmaci antinfiammatori non steroidei, tipicamente i salicilati. L'unico modo per ottenere una rimozione definitiva del dolore è l'eradicazione del nidus, al cui scopo l'escissione chirurgica può essere utilizzata come prima scelta di trattamento, ma la difficile localizzazione intraoperatoria, il rischio di alterazioni dell'accrescimento e il rischio di fratture rendono spesso controindicato l'accesso chirurgico. I trattamenti percutanei, tra i quali in particolare la termoablazione a radiofrequenza, sembrano rappresentare una sicura ed efficace alternativa alla chirurgia. Scopo del nostro studio è stato quindi valutare i risultati dell'ablazione a radiofrequenza percutanea TC-guidata dell'osteoma osteoide utilizzando elettrodi ad uncini multipli espandibili. I risultati confermano che l'ablazione a radiofrequenza percutanea TC-guidata dell'osteoma osteoide effettuata con elettrodi ad uncini multipli espandibili è fattibile, sicura ed efficace. La risoluzione del dolore e il ritorno alle normali attività si sono infatti verificate in un'alta percentuale dei pazienti trattati

Acquired Carotid-Jugular Fistula: Its Changing History and Management

Abstract Purpose. To highlight the changes that have come about in recent years in the etiology, diagnosis, and treatment of acquired carotid-jugular fistulas. Methods. We present a review of the literature on acquired carotid-jugular fistulas (CJFs), which includes studies from World Wars I and II up to today and a retrospective analysis of the lesion reports published in the period 2000–2012, with an update of Talwar's table. The case study of one patient suffering from an untreated, long-standing CJF recently treated by us is also presented and included in the updated table. Results. Thanks to early treatment of acute lesions by reconstructive and endovascular surgery, incidence of posttraumatic carotid-jugular fistulas is decreasing, while the number of iatrogenic ones due to medical advances is concomitantly increasing, specifically because of the ever more widespread use of central venous catheters for venous pressure monitoring, parenteral nutrition, and hemodialysis. Conclusion. Although such lesions seem destined to diminish in the future thanks to the above-mentioned diagnostic and therapeutic advances, the increasing number of internal jugular vein catheterizations performed worldwide implies that physicians will still be dealing with carotid-jugular fistulas for many years to come

Advancements in the treatment of hypothyroidism with L-T4 liquid formulation or soft gel capsule: an update

INTRODUCTION: The most recent advance concerning levothyroxine (L-T4) therapy is the development of novel oral formulations: the liquid preparation, and the soft gel capsule. AREAS COVERED: This review evaluates the most recent clinical studies about these new formulations. The liquid formulation has been shown to overcome: the food and beverages intereference with L-T4 tablets absorption, caused by food or coffee at breakfast; malabsorption induced by the increased gastric pH, resulting from atrophic gastritis, or due to proton-pump inhibitors; and malabsorption after bariatric surgery. The use of liquid L-T4 has been studied also in pregnancy, newborns and infants, suggesting a better bioequivalence than tablets. Finally, liquid L-T4 is more active than tablets in the control of thyroid-stimulating hormone (TSH) in hypothyroid patients without malabsorption, drug interference, or gastric disorders, leading to a hypothesized higher absorption of liquid L-T4 also in these patients. Few studies have evaluated soft gel L-T4 with promising results in patients with malabsorption related to coffee or gastritis. EXPERT OPINION: Liquid L-T4 (and soft gel capsules) are more active than the tablet L-T4 in the control of TSH in hypothyroid patients with gastric disorders, malabsorption, or drug interference, but also in patients without absorption disorders

The safety and efficacy of vandetanib in the treatment of progressive medullary thyroid cancer

Introduction: Traditional therapies for advanced or metastatic progressive medullary thyroid cancer (pMTC) are poor effective. Several TKIs have been tested in clinical trials in pMTC patients. Areas covered: This paper reviews efficacy and safety of vandetanib in the treatment of pMTC. Expertcommentary: Vandetanib (trade name CAPRELSA® [Vandetanib]) has been shown to improve progression-free survival (30.5 vs 19.3 months in controls) in pMTC patients. Vandetanib is approved by FDA and EMA for metastatic MTC in adults; in adolescents and children with metastatic or locally advanced MTC, vandetanib seems to be effective. The most common adverse events in vandetanib-treated patients are: diarrhea, rash, folliculitis, nausea, QTc prolongation, hypertension and fatigue. In patients with aggressive differentiated thyroid cancer, vandetanib has shown promising results. Further research is needed to determine the ideal targeted therapy, based on tumor molecular characterization and host factors, to obtain the best response in terms of survival and quality of life

The association of other autoimmune diseases in patients with autoimmune thyroiditis: Review of the literature and report of a large series of patients

We have evaluated prospectively the prevalence of other autoimmune disorders in outpatient clinic in 3069 consecutive patients with diagnosed chronic autoimmune thyroiditis (AT), with respect to two age- and sex-matched control groups: a) a control group of 1023 subjects, extracted from a random sample of the general population without thyroid disorders; b) 1023 patients with non-toxic multinodular goiter extracted from the same random sample of the general population, with similar iodine intake. The results of our study demonstrate a significant increase of the prevalence of autoimmune disorders in AT patients (with respect to both controls), for the following diseases: chronic autoimmune gastritis (CAG), vitiligo (Vit), rheumatoid arthritis, polymialgia rheumatica (Polym), celiac disease, diabetes, sjogren disease, multiple sclerosis, systemic lupus erythematosus, sarcoidosis, alopecia, psoriathic arthritis, systemic sclerosis, and HCV-related cryoglobulinemia. While the statistical analysis reached near the significance for Addison's disease and ulcerative colitis. Interestingly, the association of three autoimmune disorders was observed almost exclusively in AT patients, and the most frequent associations were AT+CAG+Vit and AT+CAG+Polym. We suggest that patients with AT who remain unwell, or who develop new not specific symptoms (despite adequate treatment) should be screened for other autoimmune disorders, avoiding the delay in the diagnosis of these disorders

Trattamento dei carcinomi differenziati della tiroide con chirurgia mini-invasiva

I tumori maligni della ghiandola tiroide possono originare dalle cellule follicolari (90-95%) o dalle cellule parafollicolari o cellule C (5-10%). Il carcinoma papillare della tiroide (PTC) ed il carcinoma follicolare della tiroide (FTC), che derivano dalle cellule follicolari, rappresentano l’80% e il 10% rispettivamente, di tutti i carcinomi della tiroide. La caratteristica di questi tumori è quella di essere ben differenziati (DTCs) ossia di mantenere l’architettura e le caratteristiche (TSH dipendenza, sintesi di tireoglobulina, capacità iodocaptante) della cellula tiroidea originaria, ed hanno un tasso di sopravvivenza molto elevato, di circa il 95% per il PTC e dell’80% per il FTC. Fino a pochi anni fa il trattamento chirurgico delle neoplasie della tiroide prevedeva esclusivamente un approccio di tipo convenzionale con cervicotomie più o meno ampie a seconda dell’entità delle lesione. Nell’arco degli ultimi dieci anni invece sono stati proposti numerosi approcci mini-invasivi sia totalmente endoscopici che video-assistiti ideati inizialmente solo per il trattamento delle patologie benigne della tiroide e successivamente anche per quelle maligne ma solo dopo un attenta e scrupolosa selezione dei casi. I pazienti eleggibili per questo tipo di chirurgia mini-invasiva rientrano nel gruppo di quelli a basso rischio e in più devono avere tumori con diametro massimo di 2cm e senza linfoadenopatie evidenti. La tiroidectomia mini-invasiva video-assistita (MIVAT) ha dimostrato una serie di vantaggi importanti rispetto alla chirurgia tradizionale, vantaggi che sono stati evidenziati anche in studi prospettici e che sono rappresentati essenzialmente da un miglior risultato estetico e da un decorso post-operatorio più rapido e confortevole per il paziente. Questa tecnica ha dimostrato di essere sicura ed applicabile in ogni contesto chirurgico con una percentuale di complicanze perfettamente sovrapponibile e quella della chirurgia tradizionale

Performance of chloride/phosphate test in patients with primary hyperparathyroidism: Is it related to calcium level?

Objectives: To examine the sensitivity of the chloride/ phosphate (Cl/PO4) ratio with a cut-off point of >33 as a diagnostic test for primary hyperparathyroidism (pHPT) in surgically proven patients, and its performance at different calcium levels. Methods: This is a retrospective medical records based study. Data of 120 patients diagnosed with pHPT, already operated in the Department of Surgery, Cisanello Hospital, Pisa, Italy between March 2010 and June 2011 were reviewed. They were divided into 4 subgroups according to their calcium levels. The Cl/PO4 ratio was measured for each patient, with a cut-off point of 33, sensitivity of Cl/PO4 test was measured. Test sensitivity was calculated for each subgroup, and a correlation with the parathyroid hormone (PTH) level was investigated. Performance of the equation was tested for the normocalcemic patients with a suitable control group. Results: The sensitivity of Cl/PO4 ratio for the whole group was 0.883 (0.809-0.932). The sensitivity was 0.9340 (0.857-0.973) for patients with serum calcium above normal levels. A similar result of 0.933 (0.830-0.978) was demonstrated for the subgroup with hypercalcemia <1 (mg/dL) above normal level. Normocalcemic patients constituted 24%; for this subgroup, the sensitivity test was 0.724 (0.562-0.887), specificity was 0.763 (0.628-0.898), positive predictive value was 0.700 (0.536-0.864), and negative predictive value was 0.784 (0.651-0.916). No correlation was identified between the performance of formula and serum PTH level. Conclusion: The Cl/PO4 test seems to be a good tool to anticipate pHPT and showed a fair performance in normocalcemic patients. Indexed keyword