4,146 research outputs found
Valutazione dei parametri clinico-patologici in una casistica di 1148 pazienti affetti da carcinoma papillifero della tiroide
No full textBackground: Le Linee Guida Internazionali, riportano numerose variabili capaci di predire il rischio di recidive e la ripresa della malattia. L'obiettivo è quello di valutare i parametri a disposizione, in un’ampia casistica di pazienti affetti da carcinoma papillifero della tiroide, come migliori indici per determinare l’intervallo libero da malattia ed il rischio di recidiva dopo chirurgia tiroidea.
Materiali e Metodi: Sono stati arruolati 1148 pazienti sottoposti a intervento di tiroidectomia per carcinoma papillifero della tiroide dal 1995 al 2018. Per ogni paziente sono stati valutati: sesso; età; varianti del carcinoma; tiroidite autoimmune; TNM e stadiazione; multifocalità; invasione capsulare; infiltrazione muscolare; invasione vascolare; recidiva di malattia e follow-up.
Risultati: Le curve di Kaplan-Meier mostrano riduzione dell’intervallo libero da malattia in presenza di: sesso maschile (P=0,001); variante sclerosante (P<0,001); T3 (P=0,002); N1b (P<0,001); stadio II (P<0,001); invasione capsulare (P=0,001); infiltrazione muscolare (P=0,006); invasione vascolare (P<0,001); multifocalità (P=0,049). Le analisi univariate, dimostrano che il rischio di recidiva è associato al genere maschile (p=0,002), alla variante sclerosante (p=0,0001), alla maggiore dimensione del tumore (p=0,001), alla presenza di ripetizioni metastatiche a livello linfonodale (p<0,0001), all’invasione della capsula (p=0,001), all’infiltrazione muscolare (p=0,003) ed all’invasione vascolare (p=0,003). L’analisi multivariata evidenzia che la multifocalità (HR = 2,45; p<0,02), la variante sclerosante (HR=2,82; p<0,02) e l’invasione della capsula (HR=3,39; p<0,001) rappresentano fattori di rischio indipendenti per lo sviluppo di recidive da carcinoma papillifero della tiroide.
Conclusioni: I dati di questo studio evidenziano che la presenza della multifocalità, della variante istologica sclerosante e dell’invasione capsulare rappresentano dei parametri utili per una stratificazione prognostica dei pazienti affetti da carcinoma papillifero della tiroide
Resection vs radiofrequency ablation for HCC from 3 to 5 cm: A single centre experience on 101 child- pugh class A-B naive patients
No full textBackground: The optimal therapy for HCC seems to be transplantation. For all those patients not eligible for transplantation (or waiting for it) the treatment of choice has been restricted in the last years to resection (RES) or radiofrequency ablation (RFA). RFA is supposed to lose part of its efficacy for HCC ranging over 3 cm. ltuly
S108 POSTERS Aim of this study is to compare RFA to RES in a restricted cohort of patients with a first diagnosis of single HCC ranging from 3 to 5 cm and with not end stage liver disease.
Patients and Methods: 10 I patients never treated before were enrolled. Those patients whose HCC position required too parenchimal lost at RES (central or close to main vascular structures) were treated with RFA (60), others underwent RES (41). The two groups were similar for HCC size (mean RES:RFA = 40:36 mm) and liver disease status. The outcome was considered in terms of overall survival (O.S.) and disease free survival (DFS) calculated with Kaplan-Meier method. Differences among groups were validated by Log-rank test.
Results: O.S.% in RESIRFA at I, 2, 3, 4, 5 years: 91/96, 72177, 55153, 45135,42130. DFS% in RESIRFA at I, 2, 3, 4, 5 years: 76167,44142, 3511 8, 18113, 1510. Even if RES group seems to present a better long term O.S. and DFS this difference does not reach a statistical significance. Patients with worse Child-Pugh score (B vs A) and patients that have a recurrence within the first 12 month after treatment show a worse long term survival.
Conclusion: It seems that Resection and RFA have the same efficacy in treating HCC ranging from 3 to 5 cm. Survival may be mostly related to nature of HCC itself and to liver disease on the background. A larger sample size is required to confirm this observation
Central neck dissection in papillary thyroid carcinoma: results of a retrospective study.
No full textAims of the study: The aim of this retrospective study was to appraise the impact of central neck
dissection (CND) when treating papillary thyroid carcinoma (PTC) and identifying predictors of tumour
recurrence by analysing the results and complications related to this surgical procedure.
Materials and methods: The study examined the histories of 347 patients with PTC, divided into two
groups: group A including 284 patients who underwent total thyroidectomy (TT) only; group B including
63 patients who underwent TT and CND and possible lateral neck dissection (LND).
Results: The patients in the B group were younger than those in the A group (an average of 44.5 vs. 48.6;
p 1⁄4 0.03) and their tumours were larger (1.91 cm vs 1.27 cm, p 1⁄4 0.001). Multifocality, extra-capsular
extensions of the neoplastic mass and high cell histological variant were more prevalent in the B
group. The incidence of permanent hyperparathyroidism was higher in group B than in group A (25.4% vs
9.5%, p 1⁄4 0.0006). Recurrence of disease and the numbers requiring reoperation were also higher in
group B: (24.1% in group B vs 6.6 in group A, p < 0.0001). Patients classified as clinically N0 at their first
operation and who were most probably clinically N1, totalled 6.6%.
Conclusions: Our data show that only extra-capsular extension may be considered a predictor of recurrence.
The findings of our study support the idea of carrying out “therapeutic” CND only in cases of
preoperative or macroscopic intraoperative clinical evidence of lymph-node involvement.Aims of the study: The aim of this retrospective study was to appraise the impact of central neck
dissection (CND) when treating papillary thyroid carcinoma (PTC) and identifying predictors of tumour
recurrence by analysing the results and complications related to this surgical procedure.
Materials and methods: The study examined the histories of 347 patients with PTC, divided into two
groups: group A including 284 patients who underwent total thyroidectomy (TT) only; group B including
63 patients who underwent TT and CND and possible lateral neck dissection (LND).
Results: The patients in the B group were younger than those in the A group (an average of 44.5 vs. 48.6;
p 1⁄4 0.03) and their tumours were larger (1.91 cm vs 1.27 cm, p 1⁄4 0.001). Multifocality, extra-capsular
extensions of the neoplastic mass and high cell histological variant were more prevalent in the B
group. The incidence of permanent hyperparathyroidism was higher in group B than in group A (25.4% vs
9.5%, p 1⁄4 0.0006). Recurrence of disease and the numbers requiring reoperation were also higher in
group B: (24.1% in group B vs 6.6 in group A, p < 0.0001). Patients classified as clinically N0 at their first
operation and who were most probably clinically N1, totalled 6.6%.
Conclusions: Our data show that only extra-capsular extension may be considered a predictor of recurrence.
The findings of our study support the idea of carrying out “therapeutic” CND only in cases of
preoperative or macroscopic intraoperative clinical evidence of lymph-node involvement
The role of sleeve gastrectomy in reducing cardiovascular risk
No full textBACKGROUND:
Obesity is an independent cardiovascular risk factor and a catalyst of other cardiovascular risk factors, such as hypertension, dyslipidemia, type 2 diabetes mellitus (DM2) and metabolic syndrome.
METHODS:
We analyzed cardiovascular risk in obese patients before and after sleeve gastrectomy (SG). To this end, we studied changes in body mass index (BMI), blood chemistry parameters that characterize the risk of atherosclerosis and instrumental parameters (objective markers of this risk), namely intima-media thickness (IMT) and flow-mediated dilation (FMD), the latter reflecting endothelial function. We also considered purely cardiac parameters-mitral annular plane systolic excursion (MAPSE) and tricuspid annular plane systolic excursion (TAPSE)-which describe cardiac risk more specifically than the ejection fraction. Alteration of one or more of these parameters determines an increase in cardiovascular morbidity and mortality.
RESULTS:
The results showed that weight loss, in patients undergoing SG, is accompanied by a reduced BMI and a marked improvement in blood chemistry, confirming what has already been shown in many other studies, but the most interesting finding was the effect of SG on the instrumental markers of atherosclerosis. In particular, carotid IMT was significantly reduced (p < 0.001) and FMD significantly improved. MAPSE and TAPSE also improved significantly at both follow-up assessments (p < 0.001).
CONCLUSIONS:
This study suggests that SG should be considered from a broader perspective, i.e. as a weight loss treatment that also improves obesity-related morbidity and mortality, benefitting both the patient and, in an economic sense, the society as a whole.BACKGROUND:
Obesity is an independent cardiovascular risk factor and a catalyst of other cardiovascular risk factors, such as hypertension, dyslipidemia, type 2 diabetes mellitus (DM2) and metabolic syndrome.
METHODS:
We analyzed cardiovascular risk in obese patients before and after sleeve gastrectomy (SG). To this end, we studied changes in body mass index (BMI), blood chemistry parameters that characterize the risk of atherosclerosis and instrumental parameters (objective markers of this risk), namely intima-media thickness (IMT) and flow-mediated dilation (FMD), the latter reflecting endothelial function. We also considered purely cardiac parameters-mitral annular plane systolic excursion (MAPSE) and tricuspid annular plane systolic excursion (TAPSE)-which describe cardiac risk more specifically than the ejection fraction. Alteration of one or more of these parameters determines an increase in cardiovascular morbidity and mortality.
RESULTS:
The results showed that weight loss, in patients undergoing SG, is accompanied by a reduced BMI and a marked improvement in blood chemistry, confirming what has already been shown in many other studies, but the most interesting finding was the effect of SG on the instrumental markers of atherosclerosis. In particular, carotid IMT was significantly reduced (p < 0.001) and FMD significantly improved. MAPSE and TAPSE also improved significantly at both follow-up assessments (p < 0.001).
CONCLUSIONS:
This study suggests that SG should be considered from a broader perspective, i.e. as a weight loss treatment that also improves obesity-related morbidity and mortality, benefitting both the patient and, in an economic sense, the society as a whole
Is carotid stenosis in women a gender-related condition?
No full textWe set out to study, through ultrasound examinations, the carotid bifurcation in men and women with/without carotid stenosis to look for anatomical and electrophysiologic differences. We evaluated other variables to look for differences that might explain the dissimilar behavior of this disease in the two sexes and the presence and impact of risk factors.Background: We set out to study, through ultrasound examinations, the carotid bifurcation in men and women
with/without carotid stenosis to look for anatomical and electrophysiologic differences. We evaluated other
variables to look for differences that might explain the dissimilar behavior of this disease in the two sexes and
the presence and impact of risk factors.
Methods: We examined 974 subjects aged 25 to 88 years (478 men and 496 women) in whom we considered heart
rate, smoking status, and the presence of hypertension, diabetes, hypercholesterolemia, and hypertriglyceridemia.
Ultrasound examination of the neck vessels included measurement of intimal medial thickness (IMT), vessel
diameter, and outflow area/inflow area ratio. We established plaque location, echogenicity and echostructure, and
the percentage of stenosis owing to plaque andmeasured systolic velocity, flow direction, and the depth of detection
of these parameters. We used the apnea and hyperpnea test to assess cerebrovascular reactivity.
Results: Hypertension and hypercholesterolemia were the most frequent risk factors. Women had a higher heart
rate, whereas men had significantly greater IMT. The presence of atheromatous plaque was significantly
correlated with age in both sexes, with men having a higher prevalence of carotid plaques. The sexes differed
significantly with regard to plaque location, echogenicity, echostructure, and intracranial circulation. Women
had a slightly higher blood flow velocity in the intracranial arteries. Risk factors affected plaque formation and
extent more in men than in women.
Conclusions: These findings suggest that carotid stenosis is a gender-related trait
Enucleation for gastrointestinal stromal tumors at the esophagogastic junction: Is this an adequate solution?
No full textKnowledge of iodoprophylaxis and iodized salt consumption among medical students in Italy
No full textObjectives. Iodine deficiency is still a notable health-care problem in several regions of Europe and can be responsible for maternal and fetal goiter, miscarriages, stillbirths, reduced fetal growth, congenital hypothyroidisms, damaged reproduction in adult life, and inadequate development and maturation of the fetal brain, which is the major preventable cause of mental defects. The aim of this study was to assess the medical students' knowledge and practices regarding the program of iodized-salt-use and active iodine prophylaxis program launched by the Italian Ministry of Health. Materials and Methods. A self-administered, anonymous, 19 single-item questionnaire was developed. We have collected 294 filled forms: 86 from first-year, 118 from fourth-year and 90 from sixth-year medical students at the First Medical School of 'Sapienza' University of Rome, Italy, in May 2009. Results. Two hundred eighty four students (96.6%) affirm that they know of the existence iodized salt, even though only 199 (67.7%) report personal consumption. This level is quite far from the target (consumption by almost 80% of the general population) suggested by the international literature. No statistically relevant difference was observed between the answers of male and female students. Conclusions. Our study proves that clinical students have a more detailed knowledge on iodized salt if compared with pre-clinical students, but such knowledge remains overall defective and in sonic cases absolutely incorrect. Additional education is probably needed to prepare physicians to play a critical role in counseling about iodine prophylaxis. Clin Ter 2011; 162(5):409-41
Cardiovascular risk in chronic autoimmune thyroiditis and subclinical hypothyroidism patients. A cluster analysis
No full textBackground Subclinical hypothyroidism (SCH) and chronic autoimmune thyroiditis (CAT) are linked to an increased risk of atherosclerosis and coronary heart disease (CHD). The aim of this study was to look for positive markers of CHD and correlations with thyroid blood tests in patients with SCH or CAT, but no symptoms of CHD, so as to identify CHD risk conditions that otherwise would likely be missed. Methods We measured a series of thyroid, clinical-metabolic and cardiovascular parameters in 30 consecutive endocrinology patients enrolled in our ambulatory endocrinological referral center of “Sapienza” University of Rome. (19 with CAT, 11 with SCH) from January 2015 to March 2015. 13 asymptomatic subjects were enrolled as controls. In each patient, we measured a series of 34 thyroid, clinical-metabolic and cardiovascular parameters. Results in the statistical analysis of collected data, the oblique principal components clustering procedure (OPC) revealed the presence of an interesting mixed cluster, composed of a thyroid parameter (TPO-Ab), a metabolic parameter (homocysteine level) and a cardiovascular parameter (MAPSE), in which we assessed the relationships between the single components. Our preliminary results indicate that in both groups of patients elevated TPO-Ab, when accompanied by reduced MAPSE and increased IMT and homocysteine values, may be taken to indicate the presence of clinically unrecognized CHD. Conclusions Confirmation of these results in larger series of patients could justify hormone therapy for prevention of CHD in these thyroid patients versus placebo treatmentBackground Subclinical hypothyroidism (SCH) and chronic autoimmune thyroiditis (CAT) are linked to an increased risk of atherosclerosis and coronary heart disease (CHD). The aim of this study was to look for positive markers of CHD and correlations with thyroid blood tests in patients with SCH or CAT, but no symptoms of CHD, so as to identify CHD risk conditions that otherwise would likely be missed. Methods We measured a series of thyroid, clinical-metabolic and cardiovascular parameters in 30 consecutive endocrinology patients enrolled in our ambulatory endocrinological referral center of “Sapienza” University of Rome. (19 with CAT, 11 with SCH) from January 2015 to March 2015. 13 asymptomatic subjects were enrolled as controls. In each patient, we measured a series of 34 thyroid, clinical-metabolic and cardiovascular parameters. Results in the statistical analysis of collected data, the oblique principal components clustering procedure (OPC) revealed the presence of an interesting mixed cluster, composed of a thyroid parameter (TPO-Ab), a metabolic parameter (homocysteine level) and a cardiovascular parameter (MAPSE), in which we assessed the relationships between the single components. Our preliminary results indicate that in both groups of patients elevated TPO-Ab, when accompanied by reduced MAPSE and increased IMT and homocysteine values, may be taken to indicate the presence of clinically unrecognized CHD. Conclusions Confirmation of these results in larger series of patients could justify hormone therapy for prevention of CHD in these thyroid patients versus placebo treatmen
Le «buone letture». 2. Giovanni Casati
No full textIl saggio è costituito da due parti, la prima delle quali, dedicata alla fondazione della Federazione italiana delle biblioteche circolanti cattoliche, è stata pubblicata nel precedente numero dei «Nuovi Annali», XXVII (2013), pp. 137-163. In questa seconda parte viene delineata la figura intellettuale di Giovanni Casati, che diresse la «Rivista di letture» dal 1912 al 1944, trasformando il periodico della Federazione in una rivista impegnata nella divulgazione della cultura cattolica. A questo impegno militante Casati fece corrispondere un intenso programma editoriale, che trovò espressione nella pubblicazione di saggi letterari, di manuali e opere repertoriali.The study consists of two parts; the first is dedicated to the history of the Federazione italiana delle biblioteche circolanti cattoliche since its foundation (1904) up to 1912 and was published in the previous volume of the «Nuovi Annali », XXVII (2013), pp. 137-163. In this second part, the author outlines the intellectual figure of Giovanni Casati, who directed the «Rivista di letture» from 1912 to 1944, transforming the magazine of the Federation in a journal engaged in the spreading of Catholic culture. To this militant engagement Casati matched an intense publishing program, which found its expression in the publication of literary essays, manuals and reference works
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