5 research outputs found
Hyperparathyroidism in multiple endocrine neoplasia type II A
Primary hyperparathyroidism (PHPT) in multiple endocrine
neoplasia (MEN) 2A occurs in only 15-30% of patients. It is
rarely the first feature recognized in the syndrome, is generally
mild and is sometimes expressed only as parathyroid tumors
discovered during surgery for medullary thyroid carcinoma.
A predisposition to MEN 2 is caused by germline mutations
of the RET proto-oncogene on chromosome 10q11.2.
Genetic studies have demonstrated the association of PHPT
with a specific mutation at codon 634 (C634R). Therefore, all
codon 634 mutation carriers are at some risk for hyperparathyroidism
and should be submitted to an early screening
of the disease. The rarity of MEN 2A-related PHPT has prevented
the establishment of a well-defined therapeutic strategy
for treating this condition, so that recommendations about
the surgical approach have been controversial. Patients with
MEN 2A should have annual screenings for hyperparathyroidism
by serum calcium and intact parathyroid hormone level
measurements. Parathyroidectomy should be considered in
all patients who have some evidence of symptomatic disease.
The objectives of parathyroid surgery are to a) obtain and
maintain normocalcemia for the longest time possible, b)
avoid iatrogenic hypoparathyroidism, and c) facilitate future
surgery for recurrent disease. Finally, most of the patients
with MEN 2A-related PHPT have mild disease and they could
be classified as asymptomatic based on the NIH consensus
conference regarding the diagnosis and management of
asymptomatic PHPT. Therefore, these patients can be followed
up safely without parathyroid surger
Use of low-molecular weight heparin, transfusion and mortality in COVID-19 patients not requiring ventilation
: It is still debated whether prophylactic doses of low-molecular- weight heparin (LMWH) are always effective in preventing Venous Thromboembolism (VTE) and mortality in COVID-19. Furthermore, there is paucity of data for those patients not requiring ventilation. We explored mortality and the safety/efficacy profile of LMWH in a cohort of Italian patients with COVID-19 who did not undergo ventilation. From the initial cohort of 422 patients, 264 were enrolled. Most (n = 156, 87.7%) received standard LMWH prophylaxis during hospitalization, with no significant difference between medical wards and Intensive Care Unit (ICU). Major or not major but clinically relevant hemorrhages were recorded in 13 (4.9%) patients: twelve in those taking prophylactic LMWH and one in a patient taking oral anticoagulants (p: n.s.). Thirty-nine patients (14.8%) with median age 75 years. were transfused. Hemoglobin (Hb) at admission was significantly lower in transfused patients and Hb at admission inversely correlated with the number of red blood cells units transfused (p < 0.001). In-hospital mortality occurred in 76 (28.8%) patients, 46 (24.3%) of whom admitted to medical wards. Furthermore, Hb levels at admittance were significantly lower in fatalities (g/dl 12.3; IQR 2.4 vs. 13.3; IQR 2.8; Mann-Whitney U-test; p = 0.001). After the exclusion of patients treated by LMWH intermediate or therapeutic doses (n = 32), the logistic regression showed that prophylaxis significantly and independently reduced mortality (OR 0.31, 95% CI 0.13-0.85). Present data show that COVID-19 patients who do not require ventilation benefit from prophylactic doses of LMWH