Parathyroid apoplexy, the explanation of spontaneous remission of primary hyperparathyroidism: a case report

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Endoscopic Treatment of a Gastrocutaneous Fistula Using the Over-The-Scope-Clip System: A Case Report

The over-the-scope-clip (OTSC; Ovesco Endoscopy GmbH, Tuebingen, Germany) system is a newly designed method for the mechanical compression of large areas in the gastrointestinal tract. So far, indications for OTSC application are hemostasis of primary or postinterventional bleeding, closure of iatrogenic full-thickness or covered perforations. Recently closure of gastrointestinal tract fistulas using this device has been described. A 44-year-old man developed a gastrocutaneous fistula after surgical treatment for a perforated gastric ulcer. We describe the successful endoscopic closure of the fistula using the OTSC system. The patient's clinical followup was uneventful. Fistula closure was successfully implemented as it was documented by imaging and endoscopic examinations performed on the 2nd day and 6th week after the application of the clip. Endoscopic application of the OTSC device was safe and effective for the treatment of a gastrocutaneous fistula

Peptic Ulcer Perforation as the First Manifestation of Previously Unknown Primary Hyperparathyroidism

A patient admitted for acute abdomen was incidentally found with elevated serum calcium level. In surgery, under conservative treatment of the hypercalcemia, a perforated duodenal ulcer was found and simple closure was performed. Postoperatively, calcium level continued to rise, parathyroid hormone was elevated and ultrasonographic examination showed a lesion in the right anterior neck, while serum gastrin level was normal, thus documenting the diagnosis of primary hyperparathyroidism. Conservative treatment had no effect on calcium level and the patient was subjected to emergency neck exploration, where a large parathyroid adenoma was removed. After surgery, calcium and PTH levels were normalized and the patient was discharged on the 5th postoperative day. Peptic ulcer and its complications are usual manifestations of primary hyperparathyroidism, with or without increased gastrin level. On the other hand, cases of a perforation of peptic ulcer as the first clinical manifestation of primary hyperparathyroidism are extremely rare

Multifocality of thyroid carcinomas: a “privilege” of papillary tumors or not?

Obiettivo. Studio della frequenza della multifocalità nei carcinomi tiroidei ben differenziati non midollari e della sua correlazione con diversi fattori epidemiologici, oltre che con la sopravivenza dei pazienti. Pazienti e metodi. Lo studio è stato condotto in 80 pazienti sottoposti a tiroidectomia totale dal gennaio 1985 al dicembre 2004 nel Primo Dipartimento di Chirurgia della Università della Tracia Democritus, Grecia, per carcinoma ben differenzato (papillare e follicolare). Sono stati analizzati età, sesso, tipo istologico, multifocalità dei tumori, sopravvivenza. Risultati. La multifocalità è stata identificata in 17/80 pazienti (21,25%). Tumore multifocalizzato è stato trovato in 4/20 (20%) e in 13/60 donne (21,67%), in percentuali quindi sovrapponibili. Alta frequenza di multifocalità si è trovata nei seguenti gruppi di età 20-29, 30-39 e 70-79, bassa frequenza è stata trovata nei gruppi 0-9, 10-19 e 60-69 anni. La frequenza nei follicolari è stata del 20%, analoga a quella dei papillari (22,2%). Invece, frequenza molto alta è stata trovata nei tumori misti papillari-follicolari (75%). La sopravvivenza non è influenzata dalla multifocalita del tumore. Conclusioni. La multifocalita non deve essere considerata un “privilegio” dei tumori tiroidei papillari, ma caratteristica comune dei carcinomi tiroidei. In caso di tiroidectomia totale la presenza di multifocalita non influenza ovviamente la prognosi e la sopravvivenza del paziente

Crohn’s Disease Associated Pyoderma Gangrenosum Treated with Adalimumab

Pyoderma gangrenosum is a known, though infrequent, ulcerative skin lesion that is often associated with systemic inflammatory and immunologic diseases. Objective: To present the efficacy of Adalimumab, a fully human Tumour Necrosis Factor-α antagonist, in the treatment of pyoderma gangrenosum associated with Crohn’s disease. Methods: A young male patient with pyoderma gangrenosum of the shin as the first sign of clinically active Crohn’s disease, who was treated with Adalimumab, is herein presented. Results: Almost complete healing of the lesion was achieved after 12 weeks of treatment. Conclusions: Successful treatment outcome suggests that Adalimumab is not only a therapeutic option for Crohn’s disease but may also be a safe and effective therapy for Pyoderma gangrenosum associated with the disease. Pyoderma gangrenosum should be suspected in any cutaneous ulcerative lesion occurring in patients with Crohn’s disease