Diabetes insipidus secondary to nivolumab-induced neurohypophysitis and pituitary metastasis

A 62-year-old patient with metastatic hypopharyngeal carcinoma underwent treatment with nivolumab, following which he developed symptoms suggestive of diabetes insipidus. Nivolumab was stopped and therapy with methylprednisolone was started. During corticosteroid therapy, the patient presented himself in poor health condition with fungal infection and glycemic decompensation. Methylprednisolone dose was tapered off, leading to the resolution of mycosis and the restoration of glycemic compensation, nevertheless polyuria and polydipsia persisted. Increase in urine osmolarity after desmopressin administration was made diagnosing central diabetes insipidus as a possibility. The neuroradiological data by pituitary MRI scan with gadolinium was compatible with coexistence of metastatic localization and infundibuloneurohypophysitis secondary to therapy with nivolumab. To define the exact etiology of the pituitary pathology, histological confirmation would have been necessary; however, unfortunately, it was not possible. In the absence of histological confirmation, we believe it is likely that both pathologies coexisted

Acromegaly is associated with increased cancer risk: A survey in Italy

It is debated if acromegalic patients have an increased risk to develop malignancies. The aim of the present study was to assess the standardized incidence ratios (SIRs) of different types of cancer in acromegaly on a large series of acromegalic patients managed in the somatostatin analogs era. It was evaluated the incidence of cancer in an Italian nationwide multicenter cohort study of 1512 acromegalic patients, 624 men and 888 women, mean age at diagnosis 45 \uc2\ub1 13 years, followed up for a mean of 10 years (12573 person-years) in respect to the general Italian population. Cancer was diagnosed in 124 patients, 72 women and 52 men. The SIRs for all cancers was significantly increased compared to the general Italian population (expected: 88, SIR 1.41; 95% CI, 1.18-1.68, P < 0.001). In the whole series, we found a significantly increased incidence of colorectal cancer (SIR 1.67; 95% CI, 1.07-2.58, P = 0.022), kidney cancer (SIR 2.87; 95% CI, 1.55-5.34, P < 0.001) and thyroid cancer (SIR 3.99; 95% CI, 2.32-6.87, P < 0.001). The exclusion of 11 cancers occurring before diagnosis of acromegaly (all in women) did not change remarkably the study outcome. In multivariate analysis, the factors significantly associated with an increased risk of malignancy were age and family history of cancer, with a non-significant trend for the estimated duration of acromegaly before diagnosis. In conclusion, we found evidence that acromegaly in Italy is associated with a moderate increase in cancer risk

Economia del turismo: note su crescita, qualità ambientale e sostenibilità

We analyse some key problems facing a small country for whom specialisation in nature-based tourism is an available option, and who aims at maximising non-resident tourists’ total expenditure. We discuss and develop some of the main results of the thin economic literature on the topic. As for growth prospects associated with specialisation in tourism, we find that few plausible changes in assumptions generate more favourable results than those previously known in the literature. Then we turn to the impact of tourism development on the quality of the resource. We show that, since in the tourism case the exhaustible components of the latter are characterised by a quality-quantity trade-off, a specific economic incentive exists such that the optimal rate of exploitation is more conservative than in the case of traditional natural resources. Finally, we briefly discuss problems of sustainability as well as some specific market failures in the presence of non homotheticity and of strong exogenous seasonality in demand patterns. We conclude that even though potentially the economic consequences of specialisation in tourism are promising ones, market solutions implying unsustainable economic exploitation of the natural resource are likely.

Detecting Technological Catch-Up in Economic Convergence

Our aim is to address the problem of measuring how much of the convergence that we observe is due to convergence in technology versus convergence in capital-labour ratios, in the absence of data on the level of technology. To this aim, we first develop a growth model where technology accumulation in lagging economies depends on their propensity to innovate and on technological spillovers, and convergence is due both to capital deepening and to catch-up. We study the transitional dynamics of the model to show how to discriminate empirically among the following three hypotheses - (i) convergence due to capital deepening with technology levels uniform across economies, as in Mankiw, Romer and Weil (1992); (ii) convergence due to capital deepening with stationary differences in individual technologies, as in Islam (1995); (iii) convergence due to both catch-up and capital deepening (non-stationary differences in individual technologies. We show that, in the absence of TFP data, hypotheses (ii) and (iii) may be difficult to distinguish in cross-section or panel data. We suggest that discrimination can be nevertheless obtained by exploiting the fact that if heterogeneity is the source of catch-up, technology growth is not uniform across countries and the initial differences in technology levels may tend to decrease over time. Given this implication, one way to discriminate between (ii) and (iii) would be to test whether estimates of fixed-effects in sub-periods show the pattern implied by either hypothesis.

Agglomeration and growth in the NEG: a critical assessment

This chapter is divided into two parts. In the fi\u85rst part we review the main results of a typical "New Economic Geography and Growth" (NEGG) model (Baldwin and Martin, 2003) and assess the contribution of this literature to the issue of long-run income gaps between countries. In the second part we discuss the robustness in some results of these models which are directly linked to important policy implications and we show that these results crucially depend on very restrictive values of some parameters of the model. In particular, depending on the different values of the degree of love for variety and the elasticity of substitution between traditional and manufacturing goods, our analytical examples reveal that: a) when trade is costly enough the symmetric equilibrium might not be stable also when capital is perfectly mobile; b) the rate of growth might depend on the geographical allocation of industries also when spillovers are global and, c) when industrial \u85firms are concentrated in only one region, countries might not grow at the same rate in real terms