Tako-tsubo Syndrome as First Manifestation in a Case of Pheochromocytoma Developed From a Non-functional Adrenal Incidentaloma

Abstract Background: Pheochromocytoma is a catecholamine secreting tumor that, in extremely rare cases, may develop over time from a non-functional adrenal adenoma. Catecholamine excess can lead to a kind of cardiomyopathy similar to that seen in tako-tsubo syndrome (TTS). Case report: A 69 years old female with a history of type 2 diabetes, hypertension, and a non-functional right adrenal adenoma diagnosed 3 years earlier was referred to our center for further investigations. During the evaluation, she had a hypertensive crisis with chest pain, tachycardia, and diaphoresis. Suspecting an acute coronary syndrome, she underwent coronary angiography, which showed the typical features of TTS. The high 24 h-urinary metanephrines excretion and abdominal MRI findings were suggestive of pheochromocytoma. Right laparoscopic adrenalectomy was performed, with the resolution of all symptoms. Pathology findings confirmed the diagnosis of pheochromocytoma. After 12 months, the patient was still asymptomatic, with the echocardiography displaying a complete recovery of the left-ventricular function. Conclusions: The development of a pheochromocytoma from an adrenal non functional adenoma is an extremely rare event, but potentially life-threating because of the catecholamine-associated cardiovascular toxicity. In particular, TTS is a form of cardiomyopathy that has been increasingly described as associated with catecholamine-secreting tumors. The exclusion of pheochromocytoma in a patient with TTS has important therapeutic implications, since the administration of β-blockers may be extremely harmful in patients with catecholamine surge in the absence of adequate α-blockage. Keywords: adrenal incidentaloma; catecholamine; infarction; pheochromocytoma; tako-tsubo syndrome; ventricular dysfunction

Thyroid ultrasonography reporting: consensus of Italian Thyroid Association (AIT), Italian Society of Endocrinology (SIE), Italian Society of Ultrasonography in Medicine and Biology (SIUMB) and Ultrasound Chapter of Italian Society of Medical Radiology (SIRM)

Thyroid ultrasonography (US) is the gold standard for thyroid imaging and its widespread use is due to an optimal spatial resolution for superficial anatomic structures, a low cost and the lack of health risks. Thyroid US is a pivotal tool for the diagnosis and follow-up of autoimmune thyroid diseases, for assessing nodule size and echostructure and defining the risk of malignancy in thyroid nodules. The main limitation of US is the poor reproducibility, due to the variable experience of the operators and the different performance and settings of the equipments. Aim of this consensus statement is to standardize the report of thyroid US through the definition of common minimum requirements and a correct terminology. US patterns of autoimmune thyroid diseases are defined. US signs of malignancy in thyroid nodules are classified and scored in each nodule. We also propose a simplified nodule risk stratification, based on the predictive value of each US sign, classified and scored according to the strength of association with malignancy, but also to the estimated reproducibility among different operators

Parametrização do modelo DSSAT/CANEGRO para as cultivares brasileiras de cana-de-açúcar.

A parametrização do modelo DSSAT/CANEGRO para a realidade brasileira tem grande importância para a obtenção de uma ferramenta capaz de otimizar o planejamento da produção sucroalcooleira nacional e analisar os impactos do aquecimento global na cultura da cana-de-açúcar no Brasil. O trabalho foi realizado com as cultivares IAC 91-1099 e SP 89-1115. Os dados biométricos foram coletados na APTA em Piracicaba-SP e analisados na Embrapa Informática Agropecuária em Campinas-SP, comparando-se com os dados gerados pelo modelo. Verificou-se que é possível parametrizar os dados de perfilhamento e altura de colmo, com bons resultados, porém a parametrização do IAF necessita de mais estudos. Essas análises indicam possibilidades promissoras para o uso do modelo CANEGRO para as cultivares brasileiras.CBA 2009

Arquitetura foliar e coeficiente de extinção de radiacao solar para duas variedades de cana-de-açúcar.

O objetivo do trabalho foi avaliar um método computacional para a determinação do ângulo de inserção foliar (AIF) em cana-de-açúcar com base em imagens digitais, em comparação com medidas de campo segundo uma metodologia tradicional, para duas cultivares de cana-de-açúcar (IAC91-1099 e SP89-1115). Além dessa comparação, estimou-se o coeficiente de extinção (K) para radiação solar, observando-se a propagação do erro de estimativa do AIF nesta estimativa. Os ângulos medidos e os estimados não tiveram diferença estatisticamente significativa a 5% de probabilidade com o teste Tukey, com exceção da folha +2 na cultivar SP89-1115. Isso, contudo, não resultou em diferença na determinação do K medido e estimado. A cultivar SP89-1115 obteve K maior do que o estimado para a cultivar IAC91-1099, variando entre 0,44 e 0,74 considerando valores calculados para as 12:00. Considerando a variação horária de K, os valores oscilaram entre 0,5 e 6,5. Podemos concluir que o método computacional é valido para estimar o ângulo de inserção foliar e existe diferença entre as duas cultivares no ângulo de inserção ocasionando diferença no cálculo do K.CBA 2009

Tumour sublines with different metastatic capacity induce similar blood coagulation changes in the host.

This paper is aimed at investigating how metastatic tumour growth influenced the haemostatic system of the host. Blood platelet count, blood fibrinogen level, the activated partial thromboplastin time (APTT) and the prothrombin time (PT) were determined at various intervals during growth and metastasis of a murine fibrosarcoma (mFS6) or one of its sublines with different metastatic capacity. Progressive thrombocytopenia and increase in fibrinogen level were observed during development of the tumour in all the animal groups studied, irrespective of the metastatic potential of the various sublines. No significant changes were observed in the PT or APTT values. These data support the concept that primary rather than metastatic growth influences the haemostatic system of tumour-bearing animals

ACTION CAMS AND LOW-COST MULTI-FREQUENCY ANTENNAS FOR GNSS ASSISTED PHOTOGRAMMETRIC APPLICATIONS WITHOUT GROUND CONTROL POINTS

In civil, architectural and environmental fields photogrammetry is one of the most common solutions for deriving geometric information about many kind of objects of interest. Photogrammetric surveys suffer for the need of ground control points (GCPs), well distributed over the survey area, to scale and georeference the produced 3D data. The placement of GCPs is both time-consuming and sometimes infeasible because of environmental constraints, such as vegetation on river sides. For aerial surveys with unmanned aerial vehicles (UAV), several studies have been proposed to use the UAV GNSS antenna to reduce or eliminate the need of GCPs. This technique, called GNSS-aided photogrammetry, has been little explored for terrestrial applications despite its potential in reducing surveying time, or for integrating terrestrial and aerial surveying. This gap has been partly caused by the high cost of topographic-grade GNSS, but in recent years the market has offered receivers, such as the ublox ZED-F9P, which can achieve high accuracy at low cost. In this work we propose a simple and fast GNSS-aided methodology for terrestrial photogrammetric surveys using low-cost GNSS and image sensors. The final aim is to create a general procedure to minimize survey costs and time, and derive a scaled and georeferenced 3D information without GCPs

Impact of Baseline Retinal Nonperfusion and Macular Retinal Capillary Nonperfusion on Outcomes in the COPERNICUS and GALILEO Studies

To evaluate the impact of baseline retinal capillary nonperfusion (RNP) and macular retinal capillary nonperfusion (MNP) status on outcomes at week 24 (W24)

Lung recurrence of papillary thyroid cancer diagnosed with antithyroglobulin antibodies after 10 years from initial treatment.

Introduction: Papillary thyroid cancer (PTC) is the most common endocrine malignancy. More than 98% of patients achieve an excellent response with no evidence of clinical, biochemical, or structural disease after initial treatment. In these patients structural recurrence is rare, more frequently diagnosed in the first 5 years from initial treatment and almost invariably localized in neck lymph nodes. Patient: We report the case of a woman affected by PTC who presented with rapidly rising anti-thyroglobulin antibodies (TgAb) level after 10 years from clinical, morphological and biochemical remission. Diagnosis and Treatment: In 2003, a 56 year old patient was treated with total thyroidectomy and radioiodine remnant ablation (RRA) for a PTC (2 cm) with minimal extrathyroidal extension (T3N1aM0 according to the 6th AJCC TNM staging system) associated with diffuse lymphocytic thyroiditis. In 2004 the patient was free of disease defined as undetectable Tg after recombinant human TSH administration in the absence of TgAb and structural disease. Since February 2012 the appearance and progressive increase of TgAb titer was observed and in 2014 a18FDG-PET scan documented three hypermetabolic lesions suggestive of lung micrometastases. The lung lesions were cytologically confirmed as PTC metastases. Both the primary tissue and the lung metastasis were positive for BRAF V600E mutation. The patient was treated with 131-radioiodine that showed radioiodine avid lung lesions that lose the ability to take up iodine at the following treatment. The patient is still alive and the lung lesions are growing slowly. Conclusions: Structural recurrence in patients that demonstrated an excellent response after initial treatment for PTC is extremely rare, and distant metastases exceptional but possible. This case is peculiar because recurrence was early identified after 10 years from initial treatment for the presence of detectable TgAb in a patient that had an histological diagnosis of lymphocytic thyroiditis but with an atypical clinical presentation (normal thyroid at neck ultrasound and undetectable TgAb and anti-thyroid peroxidase antibodies). For this reason TgAb should be tested with Tg in patients with a history of lymphocytic thyroiditis, either histological or humoral, also when TgAb is in the normal range and not suggestive of autoimmune thyroiditis

Efeito do parcelamento e época de fornecimento de nitrogênio na produção de materia seca na cultura do milho (Zea mays L.).

Pretendeu-se com este trabalho avaliar o efeito da época e do parcelamento do nitrogênio sobre a produção de materia seca total (raiz, colmo e folhas) na cultura do milho