Lenvatinib-induced renal failure : two first-time case reports and review of literature

Introduction: Lenvatinib (LEN) is a multi-kinase anti-angiogenic drug recently approved in several cancers. LEN is not easily manageable due to its complex safety profile. Proteinuria and renal failure (RF) were reported among the most frequent LEN-induced adverse events (AEs), often leading to discontinuations or dose modifications. Understanding the pathogenesis of these AEs could ameliorate the management of LEN-induced renal toxicity. Areas covered: We present two cases of LEN-induced renal failure (LIRF) with different pathogenesis. 1) LIRF with severe proteinuria in a man treated for a metastatic papillary thyroid carcinoma. Kidney biopsy showed a glomerular damage secondary to LEN, having excluded other causes of RF. 2) LIRF without proteinuria in a woman with metastatic adenoid cystic carcinoma of minor salivary gland. A tubulointerstitial nephropathy was supposed by clinical evaluation and laboratory tests. Effective management was obtained by oral steroids without interrupting LEN. Expert opinion: The case 1 presented for the first time the histological picture of LIRF with a classical glomerular damage leading to secondary proteinuria and tubular failure. Case 2 showed an alternative LIRF pattern of likely tubulointerstitial injury without proteinuria. These reports reflect two sides of the same coin, both to be considered in case of LIRF

The size criteria in minimally invasive video-assisted thyroidectomy

BACKGROUND: Thyroid size is a very important criteria of MIVAT exclusion because the working space provided by the technique is limited. The aim of this work has been to verify the suitability of MIVAT and its applicability in clinical practice, not only in patients with a thyroid volume up to 25 ml but also in patients with a thyroid volume included from 25 to 50 ml. METHODS: From January 2003 to February 2006, 33 patients have been selected for MIVAT. A completely gasless procedure was carried out through a central 20 to 35 mm skin incision performed "high" between the cricoid and jugular notch. RESULTS: The patients were separated in 2 groups. The first group (less than 25 ml) included 23 patients, the second group (from 25 to 50 ml) included 10 patients. The skin incision performed was from 20 to 25 mm (mean 23.61 mm ± 1.83) long in the first group and from 25 to 35 mm (mean 27.8 mm ± 2.20) long in the second one; this difference is significant (t test p < 0.001). CONCLUSION: Our study suggest that the MIVAT using for thyroids bigger than 25 ml and up to 50 ml in volume is feasible and safe. This way allows more patients, excluded before, to take the advantages of minimally invasive approach

The minimally invasive open video-assisted approach in surgical thyroid diseases

BACKGROUND: The targets of minimally invasive surgery (MIVA) could be summarised by: achievement of the same results as those obtained with traditional surgery, less trauma, better post-operative course, early discharge from hospital and improved cosmetic results. The minimally invasive techniques in thyroid surgery can be described as either endoscopic "pure" approach (completely closed approach with or without CO(2 )insufflation), or "open approach" with central neck mini-incision or "open video-assisted approach". Traditionally, open thyroidectomy requires a 6 to 8 cm, or bigger, transverse wound on the lower neck. The minimally invasive approach wound is much shorter (1.5 cm for small nodules, up to 2–3 cm for the largest ones, in respect of the exclusion criteria) upon the suprasternal notch. Patients also experience much less pain after MIVA surgery than after conventional thyroidectomy. This is due to less dissection and destruction of tissues. Pathologies treated are mainly nodular goiter; the only kind of thyroid cancer which may be approached with endoscopic surgery is a small differentiated carcinoma without lymph node involvement. The patients were considered eligible for MIVA hemithyroidectomy and thyroidectomy on the basis of some criteria, such as gland volume and the kind of disease. In our experience we have chosen the minimally invasive open video-assisted approach of Miccoli et al. (2002). The aim of this work was to verify the suitability of the technique and the applicability in clinical practice. METHODS: A completely gasless procedure was carried out through a 15–30 mm central incision about 20 mm above the sternal notch. Dissection was mainly performed under endoscopic vision using conventional endoscopic instruments. The video aided group included 11 patients. All patients were women with a average age of 54. RESULTS: We performed thyroidectomy in 8 cases and hemithyroidectomy in 3 cases. The operative average time has been 170 minutes. CONCLUSION: Nowadays this minimally invasive surgery, in selected patients, clearly demonstrates excellent results regarding patient cure rate and comfort, with shorter hospital stay, reduced postoperative pain and most attractive cosmetic results

Interim 2024/25 influenza vaccine effectiveness:eight European studies, September 2024 to January 2025

The 2024/25 influenza season in Europe is currently characterised by co-circulation of influenza A(H1N1) pdm09, A(H3N2) and B/Victoria viruses, with influenza A(H1N1)pdm09 predominating. Interim vaccine effectiveness (VE) estimates from eight European studies (17 countries) indicate an all-age influenza A VE of 32–53% in primary care and 33–56% in hospital settings, with some signals of lower VE by subtype and higher VE against influenza B (≥ 58% across settings). Where feasible, influenza vaccination should be encouraged and other prevention measures strengthened.</p

Alterazioni elettrolitiche fatali dopo somministrazione di clisma opaco a base di sodio fosfato in un paziente anziano con insufficienza renale

Il clisma ipertonico di sodio fosfato (NaP) è frequentemente utilizzato per il trattamento della stipsi in base alla caratteristica di iperosmolarità. Tuttavia, sono stati descritti casi di exitus correlati ad elevate concentrazioni ematiche di Na e P. Un uomo di 90 anni è stato ricoverato dapprima in Pronto Soccorso poi in Nefrologia per grave scompenso cardiaco congestizio e insufficienza renale (creatininemia, 3,7-5,6 mg/dL). In anamnesi, un pregresso intervento di prostatectomia radicale e radioterapia pelvica,by-pass aorto-coronarico e impianto di pace-maker. Terapia abituale: ACE inibitori, furosemide, aspirina, nitrato transdermico. In sesta giornata dal ricovero, a causa di stipsi ostinata veniva somministrato clisma evacuativo con NaP, 120 mL (2 dosi a distanza di 30 min), contenenti 19,2 gr di NaP monobasico e 7,2 g di bibasico. Nella notte vomito ripetuto e inserimento di un drenaggio naso-gastrico. Il mattino il paziente era ipoteso, disidratato, confuso e presentava ileo paralitico. Gli esami di laboratorio mostravano ipocalcemia [3,7 mg/dL (rif. 8,5-10.5)] calcio ionizzato 1,28 mg/dL, ipernatremia [l53 mmol/L (rif. 135-145)], ipokaliemia [2,7 mmol/L (rif. 3,5-5,O)J e iperfosfatemia (30 mg/dL, rif. 2,5-4,5)]. Nei limiti fisiologici cloro, bicarbonati e magnesio plasmatici. Infine, urea e creatinina plasmatiche di 233 mg/dL e 3,7/dL, rispettivamente. Venne praticata d'urgenza infusione endovena di calcio gluconato e programmata seduta di emodialisi. Un arresto cardiaco irreversibile portava a exitus, prima di poter iniziare la dialisi. Il paziente presentava alcuni fattori di rischio per intossicazione da NaP: insufficienza renale avanzata, età, ridotta motilità intestinale, sclerosi colon-pelvica post-radioterapia, scompenso cardiaco. Il massivo assorbimento intestinale di P era favorito dalla anomalia intestinale. Le alterazioni elettrolitiche a esito fatale, riportate anche in letteratura, consistevano in ipocalcemia, iperfosforemia severa, ipernatremia, ipokaliemia, associate a insufficienza renale e aggravate, per la prognosi infausta, dall'età avanzata. Il caso presentato conferma la necessità di osservare estrema cautela nel praticare clisma ipertonico NaP in pazienti con importanti fattori di rischio, quali quelli sopra descritt

Uno sforzo isometrico per la diagnosi delle arteriopatie obliteranti croniche degli arti inferiori [An isometric exercise for the diagnosis of chronic obliterating arteriopathies of the lower extremities]

A non-invasive method for the diagnosis of occlusive diseases of the peripheral arteries and the followup of therapy is proposed. The method consists in the performance of an isometric effort of the inferior limbs and Doppler detection of the dorsalis pedis systolic pressure. 41 patients with different degrees of peripheral artery involvement were studied and the results compared with those obtained in a control group of 12 normal subjects, equally matched for age and sex. In the normal subjects, the maximal dorsiflection of the feet for 30 seconds caused a mean increase of the heart rate of 20% and no changes of the systolic blood pressure. In the patients with peripheral artery disease, the isometric effort caused, contemporary to the increase of the heart rate, a decrease of the dorsalis pedis systolic pressure, that varied from 15 to 100% according to the degree of the arterial involvement. A close correlation was found between the degree of the percent reduction of peripheral systolic pressure and the entity of the arterial involvement, as evidenced by other invasive and non-invasive methods. The method proposed appears useful for a proper diagnosis of peripheral vascular diseases in those patients who cannot undergo invasive investigations or the treadmill effort test

A rare case of atypical chronic lymphocytic leukaemia presenting as nephrotic syndrome

Chronic lymphocytic leukaemia (CLL) is characterised by a lymphocytosis of mature-appearing clonal CD5+, CD23+ B lymphocytes. CLL cells arise from the bone marrow and infiltrate lymphoid tissues such as lymph nodes and spleen. Presentation is usually through discovery of lymphocytosis or lymphadenopathy. Unusual presentations, especially paraneoplastic syndromes are rare. Here, we describe a rare case presenting with severe nephrotic syndrome associated with the presence of a monoclonal protein in serum. Workup for suspected plasma cell dyscrasia led instead to the diagnosis of bone marrow infiltration by atypical CLL without lymphocytosis. Renal biopsy showed a glomerulonephritis that turned out to be paraneoplastic as it went into remission after treatment for CLL. Our case shows an unusual presentation of CLL and prompts for increased awareness of lymphoproliferative disorders in the context of seemingly unrelated conditions that may be paraneoplastic in origin

Case Report: Hyperreactive Malarial Splenomegaly Syndrome Diagnosed with Loop-Mediated Isothermal Amplification and Treated with Artemisinin-Based Combination Therapy.

Hyperreactive malarial splenomegaly syndrome (HMSS) is a rare cause of splenomegaly in the Western world. Hyperreactive malarial splenomegaly syndrome is caused by an aberrant immunological response to chronic malaria exposure in endemic areas. Revised Fakunle's criteria may be helpful for diagnosis: persistent splenomegaly (> 10 cm below the costal margin), increased anti-Plasmodium antibodies, increased IgM levels, exclusion of other causes of splenomegaly or malignancy, and a favorable response to antimalarial treatment. We describe the case of a 16-year-old patient, who recently arrived in Belgium from Guinea with a history of splenomegaly and B symptoms in whom HMSS diagnosis was achieved, thanks to the loop-mediated isothermal amplification method. To our knowledge, this is also the first described case treated by dihydroartemisinin/piperaquine.info:eu-repo/semantics/publishe