Retroperitoneal liposarcoma associated with small plaque parapsoriasis

<p>Abstract</p> <p>Background</p> <p>Extremely rare cases of paraneoplastic syndromes or ectopic production of proteins associated with liposarcoma are reported in literature. Production of Granulocyte-Colony Stimulating Factor, alpha-fetoprotein, paraneoplastic pemphigus and leucocytosis, Acrokeratosis paraneoplastica (Bazex's syndrome) are reported.</p> <p>The present report describes a case of retroperitoneal liposarcoma associated with small plaque parapsoriasis. Our search in the English literature of such a kind of association did not reveal any case reported.</p> <p>Case presentation</p> <p>A 74 year male patient was admitted to our hospital because of the presence of an abdominal mass in right iliac fossa. He also complained of a two-year history of psoriasiform eruptions. The CT scan showed a retroperitoneal pelvic mass. Therefore surgical resection of the tumor was performed. After surgery, the skin eruptions disappeared completely in seven days and so a diagnosis of parapsoriasis syndrome was done.</p> <p>Conclusion</p> <p>Parallel disappearing of skin eruptions after surgery, typical clinical picture and not specific histology of the cutaneous lesions suggest the diagnosis of small plaque parapsoriasis. Therefore we propose to add Small Plaque Parapsoriasis to the list of paraneoplastic syndromes associated to liposarcoma.</p

Randomized study on the effects of different strategies of intermittent pneumatic compression for lower limb claudication

Riassunto: Studio randomizzato sugli effetti delle differenti strategie della compressione pneumatica intermittente per il trattamento della claudicatio degli arti inferiori. A. Berni, L. Tromba, L. Falvo, F. Tartaglia, M. Sgueglia, S. Blasi, P. Polichetti Introduzione. Lo scopo di questo studio è di valutare l’efficacia di differenti strategie di compressione pneumatica intermittente (IPC) per il trattamento della claudicatio degli arti inferiori. Metodi. Sono stati analizzati in prospettiva cinque gruppi di studio. Gruppo 1: 9 pz non sottoposti ad IPC; gruppo 2: sei pazienti sottoposti ad IPC per un’ora tre volte al giorno per quattro mesi; gruppo 3: sei pazienti sottoposti ad IPC per due ore una volta al giorno per quattro mesi; gruppo 4: sei pazienti sottoposti ad IPC per un’ora tre volte al giorno per due mesi; gruppo 5: sei pazienti sottoposti ad IPC per due ore una volta al giorno per due mesi. Risultati. Tutti i pazienti hanno completato il programma di trattamento e hanno dichiarato una compliance del 33% nel gruppo 2, dell’83% nel gruppo 3, del 66% nel gruppo 4 e del 100% nel gruppo 5. Il picco di velocità sistolica del flusso dell’arteria poplitea è cresciuto oltre i valori base in particolare laddove la durata della terapia è stata di 4 mesi ( gruppo 2 : 85%,gruppo 3 :81% vs gruppo 4:76%;gruppo 5 : 73%). Questi effetti benefici si sono protratti per circa 14 mesi e sono svaniti dopo 14 mesi dalla fine del trattamento con IPC. La distanza assoluta di percorrenza senza claudicatio è cresciuta alla fine del trattamento oltre il 101% nel gruppo 2, del 94% nel gruppo 3, dell’86% nel gruppo 4 e dell’83% nel gruppo 5 ed inoltre è aumentata oltre il valore di base dopo 14 mesi dalla fine della terapia. Nessuna differenza è stata osservata se il trattamento IPC è stato fatto una o tre volte al giorno. Conclusioni. La terapia compressiva pneumatica intermittente effettuata due volte al giorno per quattro mesi ha fornito risultati eccellenti con soddisfacente compliance. Tuttavia questi benefici effetti non sono durevoli e svaniscono a distanza di circa un anno dalla fine del trattamento

Unicentric localization of Castleman’s disease treated with laparoscopic and traditional approach. Report of two cases

Castleman’s disease (CD) is a rare lymphoproliferative disorder. Clinically CD has been subdivided in two forms: unicentric and multicentric. The unicentric type is limited to a single anatomic lymph-node-bearing region. The present report describes two cases of unicentric CD: the first was an abdominal localization treated with a laparoscopic approach; the second was a submaxillary localization treated with a classical approach. In case 1 the laparoscopic approach permitted to reach diagnosis, not clear after diagnostic imaging procedures, and enabled a total and excellent resolution of the patology because our patient,after eight months of follow up, has had no evidence of recurrence of the disease. In case 2 we want to highlight that CD should be considered in the differential diagnosis of a solitary neck mass and that the surgical treatment is diagnostic and curative at the same time

Randomized study on the effects of different strategies of intermittent pneumatic compression for lower limb claudication.

BACKGROUND: The aim of the present study was to evaluate the efficacy of different strategies of intermittent pneumatic compression (IPC) for the treatment of lower limb claudication. METHODS: Five study groups were prospectively studied. Group 1: 9 patients not undergoing IPC; Group 2; six patients undergoing IPC 1 hour/thrice-a-day/4 months; Group 3: six patients undergoing IPC 2 hours/once-a-day/4 months; Group 4; six patients undergoing IPC 1 hour/thrice-a-day/2 months; Group 5: six patients undergoing IPC 2 hours/once-a-day/2 months. RESULTS: All patients completed the planned treatment schedule and stated a compliance of 33% in group 2, 83% in group 3, 66% in group 4 and 100% in group 5. Peak systolic velocity of the popliteal artery blood flow increased over baseline values particularly when IPC lasted 4 months (group 2: 85%, group 3: 81% vs. group 4: 76%, group 5: 73%). These beneficial effects lasted 10 months and vanished 14 months after the end of IPC treatment. The absolute claudication distance increased at the end of the treatment of 101% in group 2, 94% in group 3, 86% in group 4, and 83% in group 5, and it was still increased over the baseline values 14 months after the end of the treatment. No differences have been observed whether the treatment was performed once- or thrice-a-day. CONCLUSIONS: ICP treatment performed two hours once-a-day for four months provide excellent results with satisfactory treatment compliance. However, these effects are not durable and vanish about one year after the end of IPC treatment

Preoperative embolization of thyroid arteries in a patient with a large cervicomediastinal hyperfunctioning goiter

We present the case of a 61-year-old male patient with chronic obstructive pulmonary disease and a large cervicomediastinal multinodular hyperfunctioning goiter that made thyroidectomy a daunting task, especially considering the risk of intraoperative bleeding. The preoperative computed tomographic (CT) scan showed the right thyroid lobe very deeply rooted in the mediastinum, below the horizontal plane passing through the aortic arch. The thyroid mass imprinted the arterious and venous innominate trunks. To avoid a median sternotomy and remove the enlarged thyroid through a cervical approach alone, we decided to reduce the goiter in volume preoperatively by embolizing the thyroid arteries. We embolized the superior and inferior left, and the inferior right thyroid arteries. We spared the superior right thyroid artery because its blood supply contributed little to thyroid perfusion. After embolization, the patient was treated with antithyroid agents and corticosteroid drug therapy. At the same time, severe leukocytosis developed, thyroid hormone values increased, and a CT scan obtained 7 days after embolization showed the thyroid unchanged in volume. We therefore discharged the patient and were waiting for his laboratory blood chemical findings to return to normal. Thirty days later the patient was readmitted to hospital, and a new CT scan showed that the thyroid mass had diminished to half its initial volume. We could therefore perform a total thyroidectomy through a cervical approach alone. The only problem arose in dissecting tight right inferior laryngeal nerve adhesions to the thyroid capsule, probably sequelae of postembolization thyroiditis. Even though preoperative thyroid-artery embolization cannot be considered a routine technique in cervicomediastinal goiter surgery, in a rare patient who presents with a voluminous goiter such as the one we describe here, it is a useful procedure

Randomized study on oral administration of calcitriol to prevent. symptomatic hypocalcemia after total thyroidectomy

Background: Symptomatic hypocalcemia remains the main postoperative complication, after total thyroidectomy. The aim of the present study was to evaluate the role of oral supplementation of calcitriol and calcium salts in preventing severe postoperative hypocalcemia after total thyroidectomy. Methods: A. consecutive series. of patients undergoing total thyroidectomy followed by administration of 500 mg of calcium salts 3 times per day were randomized to 3 different postoperative medical treatments: in group A, .5 mu g of calcitriol twice per day was administered to 104 patients; in group B,. 1 mu g of calcitriol twice per day was administered to 111 patients; and in group C, 202 patients did not receive calcitriol. Results: The rate of postoperative tetany in group A was 2.9 %, in group B was 0 %, and in group C was 7.4 % (P = .03) and the rate of paresthesias was 28.8 %, 17.1 %, and 22.3 %, respectively (P = .19). At discontinuation of calcitriol/calcium salts treatment, intact parathyroid hormone levels did not significantly differ from the preoperative levels. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve for serum concentration of calcium in predicting postoperative tetany was .749, .858 and.862 on the first, second, and third postoperative day, respectively. The best cut-off value of calcemia for prediction tetany was 7.5 mg/dL, and the rate of severe hypocalcemia on the third postoperative day was 23.1 % in group A, 9.9 % in group B, and 27.2 % in group C (P = .001). Conclusions: Oral administration of 1 mu g of calcitriol twice per day and 500 mg of calcium salts 3 times per day after total thyroidectomy significantly decreases the risk of severe postoperative hypocalcemia. (c) 2005 Excerpta Medica Inc. All rights reserved

Effect of vascular risk factors on increase in carotid and femoral intima-media thickness. Identification of a risk scale

Background: The well established correlation between intima-media thickness (IMT) and the risk of cardiovascular and cerebrovascular events and death is usually measured in subjects with multiple vascular risk factors, which makes it difficult, after application of the usual analysis-of-variance linear combination of effects model, to establish whether each cardiovascular risk factor has, per se, an effect on IMT. Method and results: In this study we investigated five "pure" groups of patients (865), i.e. each presenting only one of the following risk factors: hypertension, obesity, overweight, smoking, hypercholesterolaemia and a control group of 37 healthy subjects. We measured, both as discrete and as continuous variables, the following indices: intima-media thickening of the common carotid artery (IMT(C)) and of the common femoral artery (IMT(F)) and the ankle-brachial index (ABI). Descriptive statistics were used to analyse the prevalence of pathological values for the three indices in the different groups. Subsequently the entire group of 902 subjects was included in a correlation analysis in which the Pearson correlation coefficient for each pair of variables was computed. In order to assign the risk factors a continuous ranking, and obtain a more general idea of the correlation structure, principal component analysis (PCA) was used. The scores obtained from PCA made it possible to build a scale of severity of the vascular risk factors considered. All the risk factors considered were demonstrated to strongly affect the studied indices. Overweight was shown to be the least important risk factor with regard to intima-media thickening, followed by smoking, hypercholesterolaemia, hypertension and finally obesity, which emerged as the greatest risk factor. Conclusions: The strong correlation between the indices made it possible to compute a composite general score, which provides an univocal risk estimation at single-patient level. IMT(F) was demonstrated to be the most sensitive descriptor. The construction of this risk scale has implications for preventive treatment and the frequency of instrumental examinations, allowing clear quantitative definition of the extent of the damage. (C) 2011 Elsevier Ireland Ltd. All rights reserved

[Surgical treatment of Basedow's disease: total thyroidectomy].

The Authors report their experience in the treatment of Graves disease. After a short review of the literature, the Authors stress the medical trait of such disease with possible spontaneous resolution. Therefore the number of cases surgically treated is necessarily low. Thirty patients, all with specific antibodies, were treated with total thyroidectomy. The therapy chosen and the results obtained are herein shown. No definitive hypoparathyroidism and inferior laryngeal nerve injuries were registered

Selective Embolization of Thyroid Arteries for Preresection or Palliative Treatment of Large Cervicomediastinal Goiters

Background: The authors have applied the selective embolization of thyroid arteries in the treatment of voluminous cervicomediastinal goiters, especially in patients at high surgical risk or reluctant to undergo surgical intervention and radioiodine therapy. Method: Selective arteriography was used to embolize the thyroid arteries in 2 patients with voluminous hyperfunctioning cervicomediastinal goiters and mediastinal compressive symptoms. The first patient had already undergone unsuccessful radioiodine metabolic therapy and had severe left ventricular insufficiency contraindicating surgery. The second patient, despite having no contraindications, declined surgery and radioiodine metabolic therapy. Results: Radiological embolization markedly reduced the goiters in volume, resolved the compressive symptoms, and also normalized thyroid hyperfunction. The second patient needed a second embolization procedure because the embolized arterial branches had partly recanalized. Conclusion: Selective embolization of thyroid arteries can be successfully used to treat selected patients as a preoperative procedure and as an alternative to thyroid resection. Embolization can be repeated to achieve the required therapeutic aims