Low dose of Rotigotine in post-stroke patients with vascular parkinsonism and obstructive sleep apnoea syndrome, effects on quality of life and rehabilitation therapy

Stroke is a frequent cause of disability in U.S.A. (200.000/ year). Aim: The aim of this study is to underline the effect of low dose of Rotigotine patches 2 mg/24 h, a complete dopamine agonist with continuous dopaminergic stimulation through the transdermal administration, in elderly with recent stroke and vascular Parkinsonism about quality of life and adherence to rehabilitation therapy. Methods: We have enrolled 6 elderly patients (3 males and 3 females, range age 60 – 95 years) with recent ischemic and vascular Parkinsonism. We have evaluated quality of life and cognitive function with UPDRS part III, MMSE, ADL, IADL and Morinsky Scale. At the same time we have evaluated the adherence to therapy and timing of rehabilitation therapy before and post-administration of Rotigotine 2 mg/24 hours. Conclusion: In conclusion, Rotigotine could be a new useful approach in the treatment of elderly patients with recent ischemic and hemorrhagic stroke correlated with vascular Parkinsonism which can lead to an akinesia with the need to start rehabilitation therapy. Our preliminary data gives comfortable results but, at this time, we have enrolled only few patients to give conclusive results

Malignant insulinoma with multiple liver metastases and hypercalcitoninemia in a patient with type 2 diabetes mellitus presenting as recurrent episodes of diaphoresis due to severe hypoglycemia

Insulinoma is an insulin-producing pancreatic neuroendocrine tumor that can be malignant in about 10% of cases. Locoregional invasion, lymph node metastases, or remote metastases are the main criteria of malignant insulinoma. Its incidence in patients with pre-existing diabetes mellitus (DM) is exceptionally rare. In this report, we describe a 66-year-old man with long-standing type 2 DM who presented with recurrent episodes of diaphoresis due to severe hypoglycemia despite the withdrawal of insulin therapy, hypercalcitoninemia, and biochemical and radiological findings suggestive of metastatic malignant insulinoma. Unfortunately, after few days of diazoxide treatment, edema, hypotension, oliguria, and water retention were observed, patient's clinical status deteriorated rapidly, and he died in our department from acute renal failure

A large, international study on post-transplant glomerular diseases: the TANGO project

BACKGROUND: Long-term outcomes in kidney transplantation (KT) have not significantly improved during the past twenty years. Despite being a leading cause of graft failure, glomerular disease (GD) recurrence remains poorly understood, due to heterogeneity in disease pathogenesis and clinical presentation, reliance on histopathology to confirm disease recurrence, and the low incidence of individual GD subtypes. Large, international cohorts of patients with GD are urgently needed to better understand the disease pathophysiology, predictors of recurrence, and response to therapy. METHODS: The Post-TrANsplant GlOmerular Disease (TANGO) study is an observational, multicenter cohort study initiated in January 2017 that aims to: 1) characterize the natural history of GD after KT, 2) create a biorepository of saliva, blood, urine, stools and kidney tissue samples, and 3) establish a network of patients and centers to support novel therapeutic trials. The study includes 15 centers in America and Europe. Enrollment is open to patients with biopsy-proven GD prior to transplantation, including IgA nephropathy, membranous nephropathy, focal and segmental glomerulosclerosis, atypical hemolytic uremic syndrome, dense-deposit disease, C3 glomerulopathy, complement- and IgG-positive membranoproliferative glomerulonephritis or membranoproliferative glomerulonephritis type I-III (old classification). During phase 1, patient data will be collected in an online database. The biorepository (phase 2) will involve collection of samples from patients for identification of predictors of recurrence, biomarkers of disease activity or response to therapy, and novel pathogenic mechanisms. Finally, through phase 3, we will use our multicenter network of patients and centers to launch interventional studies. DISCUSSION: Most prior studies of post-transplant GD recurrence are single-center and retrospective, or rely upon registry data that frequently misclassify the cause of kidney disease. Systematically determining GD recurrence rates and predictors of clinical outcomes is essential to improving post-transplant outcomes. Furthermore, accurate molecular phenotyping and biomarker development will allow better understanding of individual GD pathogenesis, and potentially identify novel drug targets for GD in both native and transplanted kidneys. The TANGO study has the potential to tackle GD recurrence through a multicenter design and a comprehensive biorepository