Hyperthyroidism in non-seminomatous testicular germ cell tumors: two case reports and literature review

BackgroundHuman chorionic gonadotropin (hCG)–induced hyperthyroidism is a rare paraneoplastic syndrome observed in non-seminomatous testicular germ cell tumors, due to a cross-reaction between the β-subunit of hCG with the thyroid-stimulating hormone receptor. The precise prevalence of this paraneoplastic phenomenon is unclear as, in the majority of cases, hyperthyroidism remains subclinical.Case presentationHere, we present two cases of advanced metastatic non-seminomatous testicular germ cell tumors where patients exhibited signs and symptoms of thyrotoxicosis at primary diagnosis due to excessive serum β-hCG elevation, with complete remission of symptomatology after the start of oncological treatments and no signs of relapse at the time of publication of this report. Additionally, we provide a comprehensive review of the existing literature concerning this uncommon occurrence.ConclusionDespite being a rare event, the presence of hyperthyroidism or thyrotoxicosis without clear etiology in a young man should lead to consider less frequent causes such as testicular tumors. Even if patients typically have mild symptoms that resolve after chemotherapy, in rare cases, it can be a life-threatening condition that requires prompt recognition and specific intervention

Nurses as seen by patients: a phenomenological study

Objective: during the various periods of the history of the nursing profession, many differing representations of nurses have emerged in the collective imagination. The main purpose of this study, based on a qualitative approach, has been to discover the images of the nurse that patients retain in their minds when receiving care. Method: 6 sound-recorded focus groups were created, made up of patients and caregivers. These persons were members of 6 associations. The recordings and observations made were then analysed by adopting a hermeneutic phenomenological approach. Results: 6 themes characterising nurses emerged: Training; Between flexibility and personalisation; Organisation and nursing; Continuity in caregiving; Professional maturity; and Relations. While these themes do not provide a uniform definition for the figure of the nurse they do present the profiles that had the greatest impact on persons receiving care. Conclusions: From the experiences collected among the participants in the focus groups, no pre-defined "image" of nurses emerged, and the stereotypes and prejudices described in the literature were also not to be found. Important indications did, in any case, emerge as to the type of nurse these people want, and concerning areas which must be worked on. These indications provide valuable information that, if acted upon, might contribute to the profession's growth and improvement. In brief, there are various planes of activity upon which nurses should concentrate their efforts: training (greater specialisation), organisation (greater flexibility), and the profession (consideration of professional identity in the light of the task of meeting patients' needs).Keywords: Image, perception, stereotypes, portrayal, role of nurses, patientGli infermieri visti attraverso gli occhi dei pazienti: uno studio fenomenologicoObiettivo: Nel corso della storia professionale, gli infermieri hanno suscitato diverse e spesso distanti rappresentazioni di loro stessi nell'immaginario delle persone. Lo scopo principale di questa indagine, strutturata con approccio qualitativo, è stato quello di comprendere quale immagine d'infermiere si era impressa nella mente delle persone assistite durante un percorso di malattia. Metodo: Sono stati realizzati 6 focus group audio registrati, che hanno interessato sia pazienti che care giver, facenti parte di 6 associazioni diverse. Successivamente, le registrazioni e le osservazioni evidenziate sono state analizzate utilizzando un approccio fenomenologico ermeneutico. Risultati: Sono stati identificati 6 temi caratterizzanti gli infermieri: Formazione; Tra flessibilití  e personalizzazione; L'organizzazione e l'infermieristica; La continuití  assistenziale; La maturití  professionale; La relazione. Questi temi non definiscono una figura di infermiere uniforme, ma ne raffigurano i profili che hanno avuto particolare impatto sulle persone assistite. Conclusioni: Dalle esperienze raccolte dai partecipanti ai focus group non emerge una "immagine" predefinita d'infermiere, né si riscontra la presenza degli stereotipi e dei pregiudizi descritti in letteratura, ma emergono importanti indicazioni su quale tipo d'infermiere queste persone desiderano e su quali ambiti sia necessario lavorare, fornendo preziose informazione che, se accolte, consentirebbero di orientare la crescita e il miglioramento della professione. Essenzialmente, gli infermieri dovrebbero concentrarsi sui piani: formativo (maggiore specializzazione), organizzativo (più flessibilití ), professionale (riflessione sull'identití  professionale in funzione del soddisfacimento dei bisogni dei pazienti). Parole Chiave: Immagine, percezione, stereotipi, ritratto, ruolo dell'infermieri, pazient

Hyperthyroidism in non-seminomatous testicular germ cell tumors: two case reports and literature review

Background Human chorionic gonadotropin (hCG)-induced hyperthyroidism is a rare paraneoplastic syndrome observed in non-seminomatous testicular germ cell tumors, due to a cross-reaction between the beta-subunit of hCG with the thyroid-stimulating hormone receptor. The precise prevalence of this paraneoplastic phenomenon is unclear as, in the majority of cases, hyperthyroidism remains subclinical.Case presentation Here, we present two cases of advanced metastatic non-seminomatous testicular germ cell tumors where patients exhibited signs and symptoms of thyrotoxicosis at primary diagnosis due to excessive serum beta-hCG elevation, with complete remission of symptomatology after the start of oncological treatments and no signs of relapse at the time of publication of this report. Additionally, we provide a comprehensive review of the existing literature concerning this uncommon occurrence.Conclusion Despite being a rare event, the presence of hyperthyroidism or thyrotoxicosis without clear etiology in a young man should lead to consider less frequent causes such as testicular tumors. Even if patients typically have mild symptoms that resolve after chemotherapy, in rare cases, it can be a life-threatening condition that requires prompt recognition and specific intervention

Beyond the Prognostic Value of 2-[18F]FDG PET/CT in Prostate Cancer: A Case Series and Literature Review Focusing on the Diagnostic Value and Impact on Patient Management

The role of 2-deoxy-2-[18F]fluoro-D-glucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) in the management of prostate cancer (PCa) patients is increasingly recognised. However, its clinical role is still controversial. Many published studies showed that FDG PET/CT might have a prognostic value in the metastatic castration-resistant phase of the disease, but its role in other settings of PCa and, more importantly, its impact on final clinical management remains to be further investigated. We describe a series of six representative clinical cases of PCa in different clinical settings, but all characterised by a measurable clinical impact of FDG PET/CT on the patients’ management. Starting from their clinical history, we report a concise narrative literature review on the advantages and limitations of FDG PET/CT beyond its prognostic value in PCa. What emerges is that in selected cases, this imaging technique may represent a useful tool in managing PCa patients. However, in the absence of dedicated studies to define the optimal clinical setting of its application, no standard recommendations on its use in PCa patients can be made

Choosing the appropriate pharmacotherapy for breast cancer during pregnancy: what needs to be considered?

Introduction: Breast cancer is the most commonly diagnosed malignancy during pregnancy. Breast cancer during pregnancy is a challenging clinical condition requiring proper and timely multidisciplinary management. Areas covered: This review focuses on the management of breast cancer during pregnancy with a focus about the current state-of-the-art on the feasibility and safety of pharmacotherapy approaches in this setting. Expert opinion: Multidisciplinary care is key for a proper diagnostic-therapeutic management of breast cancer during pregnancy. Engaging patients and their caregivers in the decision-making process is essential and psychological support should be provided. The treatment of patients with breast cancer during pregnancy should follow the same recommendations as those for breast cancer in young women outside pregnancy but taking into account the gestational age at the time of treatment.Anthracycline-, cyclophosphamide-, and taxane-based regimens can be safely administered during the second and third trimesters with standard protocols, preferring weekly regimens whenever possible. Endocrine therapy, immune checkpoint inhibitors, and targeted agents are contraindicated throughout pregnancy, also due to the very limited data available to guide their administration in this setting. During treatment, careful fetal growth monitoring is mandatory, and even after delivery proper health monitoring for the children exposed in utero to chemotherapy should be continued

Platinum-based chemotherapy and PARP inhibitors for patients with a germline BRCA pathogenic variant and advanced breast cancer (LATER-BC): retrospective multicentric analysis of post-progression treatments

Introduction: Patients with breast cancer (BC) harbouring a germinal BRCA pathogenic variant (gBRCA-PV) may have an enhanced sensitivity to platinum-based chemotherapy (PBC) and PARP inhibitors (PARPi). As reported in ovarian cancer, however, sensitivity and resistance to these treatments could partially overlap. In patients with a gBRCAPV and advanced BC (aBC), it remains unclear whether prior exposure to PARPi/PBC affects tumour response to subsequent PBC/PARPi, respectively.Methods: We conducted a retrospective, multicentric study to investigate the clinical benefit of post-PBC PARPi and vice versa in patients with a gBRCA-PV and aBC. Patients included had received (neo)adjuvant PBC and then PARPi in advanced setting (group 1), PBC followed by PARPi (group 2) or PARPi followed by PBC (group 3), both in advanced setting. We reported median progression-free survival (mPFS) and disease control rate (DCR) in each group.Results: A total of 67 patients from six centres were included. PARPi-mPFS in advanced setting was 6.1 months in patients in group 1 (N = 12), while PARPi-DCR was 67%. In group 2 (N = 36), PARPi-mPFS was 3.4 months and PARPi-DCR was 64%. Age 6 months were associated with longer PARPi-PFS; previous PBCPFS > 6 months and PBC in first to second line were associated with longer PARPi-DCR. Patients in group 3 (N = 21) reported a PBC-mPFS of 1.8 months and a PBC-DCR of 14%. PARPi-PFS & GE; 9 months and PARPi-FI & GE; 6 months were associated with better PBC-DCR.Conclusions: Sensitivity and resistance to PARPi and PBC partially overlap in patients with a gBRCA-PV and aBC. Evidence of PARPi activity emerged in patients who progressed on previous PBC.& COPY; 2023 Elsevier Ltd. All rights reserved

Patterns of care at the end of life: a retrospective study of Italian patients with advanced breast cancer

Abstract Objectives To better understand the type of care offered to Italian patients with advanced breast cancer at the End-of-Life (EoL), we conducted a retrospective observational study. EoL was defined as the period of six months before death. Methods One hundred and twenty-one patients with advanced breast cancer (ABC) treated at IRCCS San Martino Policlinic Hospital who died between 2017 and 2021 were included. Data about patient, disease, and treatment characteristics from breast cancer diagnosis to death, along with information about comorbidities, medications, imaging, specialist evaluations, hospitalization, palliative care and home care, hospice admissions, and site of death were collected. Results 98.3% of the patients received at least one line of active treatment at EoL; 52.8% were hospitalized during the selected period. Palliative (13.9%), psychological (7.4%), and nutritional evaluations (8.2%) were underutilized. Palliative home care was provided to 52% of the patients. Most of the patients died at home (66.1%) and fewer than one out of five (18.2%) died at the hospital. Among the patients who died at home, 27.3% had no palliative support. Conclusions Our findings indicate that palliative care in EoL breast cancer patients is still inadequate. Only a minority of patients had psychological and nutritional support While low nutritional support may be explained by the fact that typical symptoms of ABC do not involve the gastrointestinal tract, the lack of psychological support suggests that significant barriers still exist. Data on the site of death are encouraging, indicating that EoL management is increasingly home centered in Italy

Rapid spread of a new West Nile virus lineage 1 associated with increased risk of neuroinvasive disease during a large outbreak in northern Italy, 2022: One Health analysis

A new strain of WNV lineage 1 (WNV - 1) emerged in the Veneto Region, northern Italy, in 2021, eight years after the last outbreak of WNV - 1 in Italy. The virus, which co-circulates with WNV-2, has become endemic in the Region, where, in 2022, most human cases of neuroinvasive disease (WNND) reported in Europe have occurred