A primary pancreatic carcinoid tumour with unusual clinical complaints: A case report

BACKGROUND: Unless metastatic or compressing the pancreatic duct, carcinoid of the pancreas are asymptomatic showing normal levels of serotonine and its metabolites in plasma and urine, thus resulting in delayed diagnosis and a consequent poor prognosis. However, if resection is timely accomplished, no local recurrence might be encountered and a normal survival might be expected in the absence of metastatic disease. CASE PRESENTATION: The reported case of pancreatic carcinoid tumour in a 62-year-old woman reporting only atypical symptoms consisting of intermittent epigastric pain and nausea. Urinary 5-hydroxyindolacetic acid levels were within normal limits and only a slight elevation of serum serotonine level was detected on admission. After tumour localisation with endoscopic ultrasonography, left splenopancreasectomy with splenic, celiac and hepatic lymphadenectomy was carried out. CONCLUSION: The role of endoscopic ultrasonography in early detection and precise localisation of pancreatic carcinoids, as well as the role of somatostatin-receptor scintigraphy with (111)Indium labelled pentreotide in excluding distant metastases, are confirmed. The radical resection with lymphadenectomy is recommended in order to have a precise histological examination and detect occult lymph node metastases

TUSC (TUrbinate Surgery Classification): A Novel Classification Proposal for Turbinate Surgery

Aim of this manuscript is to propose a clear and easily applicable classification for turbinate surgery, based on the use of a numerical model, which could be introduced in the practice of Otolaryngologists and Maxillo-Facial surgeons.Applying this classification, it will be possible to offer an easy format when describing which turbinates are involved in a procedure, and to offer a quick method to record and analyse clinical data, also for scientific purpose

Gastric emptying of solids in gastroesophageal reflux.

Delayed gastric emptying has been assumed to play an important role in the pathogenesis of gastroesophageal reflux (GER), even though this relationship has not been definitely established. Eleven patients with symptomatic GER were studied by esophageal manometry, endoscopy, gastroesophageal scintiscanning and gastric emptying of a mixed meal. Nine healthy subjects served as controls. Gastric emptying of solids (evaluated both as emptying half-time and emptying index) in GER patients was significantly slower than in controls. In comparison with a "normal" range previously established in 50 healthy subjects, only 2 of 11 (18.2 p. 100) of GER patients had a normal emptying rate. In addition, a significant correlation was found between the emptying half-time and the degree of esophageal lesions. These results suggest that impaired motor function of the gastric antrum could influence the natural history of GER disease and especially the appearance of esophagitis. The lack of esophageal lesions in the only two patients with "normal" emptying strongly supports this hypothesis

Case Report - Wedge resection for duodenal stromal tumor

A discrete bleeding tumor of the external aspect of the descending duodenum revealed to be a gastrointestinal stromal tumor (GIST) in a 60-year-old man. Authors discuss the adequacy of the free-margin local resection they opted for thanks to the favorable tumor localization. They conclude that, in spite of the increasing knowledge about GISTs, it still remains an open issue whether performing possible limited resections, looking at the patient\u2032s quality of life or extensive resections, looking at a potentially curative approach

Case Report - Wedge resection for duodenal stromal tumor

A discrete bleeding tumor of the external aspect of the descending duodenum revealed to be a gastrointestinal stromal tumor (GIST) in a 60-year-old man. Authors discuss the adequacy of the free-margin local resection they opted for thanks to the favorable tumor localization. They conclude that, in spite of the increasing knowledge about GISTs, it still remains an open issue whether performing possible limited resections, looking at the patient′s quality of life or extensive resections, looking at a potentially curative approach

Clinical features of benign paroxysmal positional vertigo of the posterior semicircular canal

Objective: The aim of this study was to evaluate the relationship between age, gender and affected ear, in patients presenting benign paroxysmal positional vertigo. Methods: This was a retrospective study. Data from benign paroxysmal positional vertigo clinical reports (January 2009–December 2014) were analysed. A total of 174 patients affected by benign paroxysmal positional vertigo of the posterior semicircular canal have been identified. Pearson chi-square test has been used to evaluate the probability of benign paroxysmal positional vertigo occurrence in relation to gender and side, within the studied groups. The level of significance was set at a p 65 years. In each group, the right posterior semicircular canal was involved in the majority of cases (group 1 incidence: 12/16; group 2 incidence: 49/79 and group 3 incidence: 52/79). In all three groups, female patients were significantly more affected (9/16 in group 1, 61/79 in group 2 and 55/79 in group 3). Conclusion: Benign paroxysmal positional vertigo is most prevalent in female subjects having an age>40 years and mainly involves the right posterior semicircular canal

Newborn hearing screening at the Neonatal Intensive Care Unit and Auditory Brainstem Maturation in preterm infants

OBJECTIVES: Aim of this study is to report and discuss the results of 4 years of Newborn hearing screening (NHS) program at the Neonatal Intensive Care Unit (NICU), particularly evaluating the clinical ABR results. METHODS: Retrospective study. NHS data from NICU newborns, admitted for ≥5 days, in the period from January 1st, 2013 and December 31st, 2016, were retrieved and analyzed. NHS results were classified as following: (i) "pass" when both ears for both the a-TEOAE (automated Transient-Evoked Otoacoustic Emissions) and the a-ABR (automated Auditory Brainstem Response) protocol resulted as "pass"; (ii) "fail" when one ear, at either one of the two performed tests resulted as "fail"; (iii) "missing" when the newborns were not tested with both protocols. All "fail" and "missing" newborns were retested (with both tests): in the case of a second "fail" result, a clinical ABR was performed within a period of 3 months. RESULTS: A total of 1191 newborns were screened. From those, 1044/1191 resulted as "pass", 108/1191 as "fail", and 39/1191 as "missing". During the re-testing of these 147 newborns, 43 were assigned as "missing", 63 were assigned as "pass" (showing bilaterally a wave V identifiable within 30 dB nHL) and 25 failed the retest and/or did not present an identifiable wave V within 30 dB nHL. Among the 147 retested infants, we identified a group of 16 subjects who resulted as NHS "refer" and who, during the audiological follow-up, showed either: (i) a unilateral or bilateral wave V identifiable over 30 dB nHL, at the first clinical ABR assessment; or (ii) a bilateral wave V identifiable within 30 dB nHL, in a following clinical ABR test during the first year of life. These 16 subjects were defined to have an 'Auditory Brainstem Maturation' issue. CONCLUSIONS: A possible "maturation" of the ABR response (and therefore of the auditory pathway) has been hypothesised in 16 out of 1191 infants (1.3%). A delay of the auditory pathway maturation in preterm babies compared to term newborns has already been suggested in the literature. A possible delay of the NHS retest could be considered, in selected cases, with significant savings in economic resources and parental anxiety