Update on acquired hypogonadism in men living with HIV: pathogenesis, clinic, and treatment

Hypogonadism is a frequent finding among men living with HIV (MLWH) and it seems to occur earlier in comparison with the general male population. Although the prevalence of hypogonadism in MLWH has significantly lowered thanks to advancements in medical management, it remains high if compared with age-matched HIV-uninfected men, ranging from 13% to 40% in the age group of 20-60 years. Signs and symptoms of low serum testosterone (T) in MLWH are cause of concern since they are non-specific, of mild-to-moderate degree, and often overlapping with those of infection per se. For these reasons, hypogonadism can be underestimated in the absence of targeted laboratory blood examinations. With regard to the etiological factors involved in the T decrease, emerging evidence has suggested the functional nature of hypogonadism in MLWH, pointing out the mutual relationship between sex steroids, health status, comorbidities, and HIV-related factors. In agreement with this hypothesis, a therapeutic approach aiming at improving or reversing concomitant diseases through lifestyle changes (e.g. physical activity) rather than pharmacological T treatment should be theoretically considered. However, considering both patient’s barriers to lifestyle changes to be maintained overtime and the lack of evidence-based data on the efficacy of lifestyle changes in normalizing serum T in MLWH, T therapy remains an option when other non-pharmacological interventions are ineffective as well as for all other functional forms of hypogonadism. From this perspective, the traditional therapeutic management of male hypogonadism in MLWH, especially the role of T supplementation, should be revised in the light of the probable functional nature of hypogonadism by considering a good balance between benefits and harmful. This narrative review presents an overview of current knowledge on hypogonadism in MLWH, deepening the factors driving and taking part in T decrease, providing advice for the clinical approach, and underlining the importance of individualized treatment aiming at optimizing non-gonadal comorbidities and thus avoiding over-, or even unnecessary, treatment with T

The rare case of positive FDG-positron emission tomography for giant cavernous hemangioma of the liver

Hemangioma is the most common benign liver tumor and the second most common liver tumor after metastases. Large hemangiomas are often heterogeneous. When they exceed 4 cm in diameter, they are termed giant hemangiomas. These giant hemangiomas often present heterogeneous patterns. These heterogeneous appearances are shown because of intratumoral changes due to several degenerative phenomena. PET/CT is reported to be useful for the differentiation of benign from malignant liver lesions. We report the case of a large hepatic hemangioma characterized by high FDG uptake

Una reale nostalgia. «Courbet e al natura», Ferrara Palazzo dei Diamanti, fino al 6 gennaio 2019

"Courbet and Nature", the analysis of the historical and artistic path of the genius of realism displayed at Palazzo dei Diamanti is the chance for insights into the spectacle of nature reproduced by Courbet's artworks and as well as the spectatorial effect

Resistant arterial hypertension in a patient with adrenal incidentaloma multiple steno-obstructive vascular lesions and antiphospholipid syndrome

Resistant hypertension is defined as above of blood pressure (≤ 140/90 mmHg) despite therapy with three or more antihypertensive drugs of different classes at maximum tolerable doses with one bling a diuretic. An important consideration in defining a patient with resistant hypertension is the mislabeling of secondary hypertension as resistant hypertension. Here, we report a patients with resistant hypertension caused by multiple stenoocclusive arteries due to antiphospholipid syndrome and coexisting with subclinical Cushing’s syndrome

Arte, natura, evento. In ricordo di Christo & Jeanne-Claude

The artworks of Christo (Christo Javacheff, 1935) and his wife Jeanne-Claude had nothing to do with an aesthetic of disappearance, typical of modernity dominated by the myth of speed expressed by Paul Virilio. However, their projects may have led to misunderstanding just a will to hide, to disappear, to deny

Adrenal pheochromocytoma incidentally discovered in a patient with parkinsonism

To evaluate the diagnostic route of pheochromocytoma (PHEO) in a patient under dopaminergic treatment. A 70-year-old man with Parkinsonism and under treatment with levodopa and carbidopa came to our observation for evaluation of arterial hypertension and right adrenal mass discovered incidentally. To evaluate adrenal hormone levels we performed a dexamethasone suppression test, plasma aldosterone levels and 24-hr urinary metanephrine, which revealed elevated levels of catecholamines metabolities. 123-I-metaiodobenzylguanidine SPECT scintiscan revealed raised activity within the right adrenal gland concordant with the mass. The diagnosis of PHEO was posed and an elective laparoscopic adrenalectomy was performed; histopathological examination confirmed the PHEO diagnosis. Recently the coexistence of PHEO and Parkinsonism is a very rare association of diseases, with only 3 cases reported in literature. In this article, another case is reported and diagnostic procedures are discusse

Rito e Arte alla 57^ Esposizione Internazionale d’Arte di Venezia

The Italian Pavillion at the 57. Venice Art Exhibition is the starting point for an analysis on art, rite, and magic that considers Aby Warburg investigations, Ernesto de Martino's essay on rituality in southern Italy, and André Breton's studies on art and magic

The relation between cardiac 123I-mIBG scintigraphy and functional response 1 year after CRT implantation

Cardiac resynchronization therapy (CRT) is a disease-modifying therapy in patients with chronic heart failure (CHF). Current guidelines ascribe CRT eligibility on three parameters only: left ventricular ejection fraction (LVEF), QRS duration, and New York Heart Association (NYHA) functional class. However, one-third of CHF patients does not benefit from CRT. This study evaluated whether 123I-meta-iodobenzylguanidine (123I-mIBG) assessed cardiac sympathetic activity could optimize CRT patient selection

Destinazione Museo. Le nuove professioni per il turismo culturale

A partire dal recente piano strategico di Sviluppo per il turismo del MiBACT l'articolo offre una breve panoramica delle figure professionali e alla promozione del turismo culturaleMuseums, as an integral part of cultural heritage, require a complex treatment marked by a strongly interdisciplinary approach. The integration of skills and competencies is the only way to address the complex issues related to cultural heritage considering also aspects of the dynamics of tourist flows that actively participate in enriching this whole

Early 18F-FDG PET/CT in COVID-19

We report the case of who has been hospitalized complaining about fever in the last 4 days. Laboratory data revealed lymphocytopenia and leucopenia with an elevation of C-reactive protein and positive real-time reverse transcription-polymerase chain reaction (RT-PCR). Six days before this hospitalization, when the patient was asymptomatic, 18F-FDG PET/CT images were performed for the therapeutic control of liver metastases of colorectal cancer. Lung abnormality findings at 18F-FDG PET/CT images, unrelated to cancer metastases, but suspicious for viral infection, may suggest the presence of COVID-19 disease in its early phase before symptoms onset. Since PET/CT is more sensitive than CT scan in detecting host’s reaction, the added value of this technique could be monitoring disease progression and could be used as a biomarker of lung disease activity and therefore as an important tool for a better understanding of the factors that contribute to the progression of lung disease