1,765 research outputs found
Risultati della terapia con Idebenone nell’atassia di Friederich: studio con strain rate imaging
No full textInsufficienza aortica congenital: valutazione della funzione longitudinale e radiale mediante nuove tecniche ecocardiografiche
No full textRobotic thymectomy
No full textThymectomy is the most frequent surgical operation involving the mediastinum, both for the treatment of thymic tumors and for the multidisciplinary management of myasthenia gravis (MG). Different surgical approaches have been described, either traditional open approaches or minimally invasive ones. Robotic thymectomy represents a further step in the evolution of minimally invasive surgery. Available data show that robotic thymectomy may be considered a safe and feasible operation, with encouraging long-term results in myasthenic patients and promising results in patients with early stage thymoma, both in terms of surgical and oncological outcomes. We present the surgical technique of robotic thymectomy that we apply for patients affected by myasthenia gravis and early stage thymoma
Video assisted thoracic surgery (VATS) for recurrent thymoma
No full textBetween 10-30% of patients that undergo a radical operation for thymoma develop a recurrence in a variable range of time. The surgical treatment of thymoma relapses is an established and effective therapeutic approach, particularly for a single intrathoracic recurrence; however, no agreement has been reached on the best surgical approach and the extent of surgical resection, particularly in the most common event of pleural relapses. In the era of minimally invasive approach for most thoracic pathologies, the role of the video assisted thoracic surgery (VATS) approach for thymoma recurrence resection is still unclear and controversial: to date, only few authors have reported in their series a thoracoscopic resection of pleuro-pulmonary relapses, mostly when a single lesion was present. Furthermore, a thoracoscopic approach for mediastinal recurrence has been rarely reported after a previous sternotomy to resect the primary tumor. It is likely that in the future, the role of VATS for thymic recurrence resection will be better defined and extensively studied
Comparing medication persistence among patients with type 2 diabetes using sodium-glucose cotransporter 2 inhibitors or glucagon-like peptide-1 receptor agonists in real-world setting
No full textAim: To assess and compare the persistence with drug therapy between patients treated with glucagon-like peptide-1 receptor agonists (GLP1-RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2-I) therapy. Methods: The 126,493 residents of the Lombardy Region (Italy) aged > 40 years newly treated with metformin during 2007-2015 were followed until 2017 to identify those who started therapy with GLP1-RA or SGLT2-I. To make GLP1-RA and SGLT2-I users more comparable, a 1:1 matched cohort design was adopted. Matching variables were sex, age, and adherence to the first-line therapy with metformin. Log-binomial regression models were fitted to estimate the propensity to 1-year treatment persistence in relation to the therapeutic strategy. Results: The final matched cohort was composed by 1,276 GLP1-RASGLT2-I pairs. About 24% and 29% of cohort members respectively on GLP1-RA and SGLT2-I discontinued the drug treatment. Compared with patients starting SGLT2-I, those on GLP1-RA had 15% (95% confidence interval, 3-25%) lower risk of discontinuation of the treatments of interest and 45% (28-57%) lower risk of discontinuing any antidiabetic drug therapy. Persistence was better among GLP1-RA users who received a once-weekly administration. Conclusions: In a real-life setting, patients who were prescribed a GLP1-RA exhibited more frequently better persistence to treatment than those prescribed a SGLT2-I therapy. CO 2021 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Use of initial and subsequent antihypertensive combination treatment in the last decade: analysis of a large Italian database
No full textObjective: The aim of the study was to assess the use of antihypertensive combination treatment, both as the initial and as a subsequent therapeutic step, in a large Italian population. Methods: The residents of the Lombardy Region (Italy), aged 40 years or older, who were newly treated with antihypertensive drugs during 2012, 2015 and 2018 were identified and the drug treatment strategy (monotherapy and combination of two, three and more than three antihypertensive drugs) was assessed at treatment initiation, and after 6 months, 1, 2, and 3 years of treatment. Data were also analysed after stratification for demographic and clinical categories. Results: About 100 000 patients were identified for each cohort. Monotherapy was the most common initial treatment strategy (75%), followed by two-drug single-pill combination (16%), two-drug free combination (6%), and combination of at least three drugs (3%). Use of two and three or more antihypertensive drugs increased during follow-up and reached about 32% (two drugs) and 11% (>2 drugs) of the patients after 3 years from treatment initiation. Among patients prescribed a two-drug combination, the single-pill was the most common approach, whereas the use of the three-drug single-pill combination was extremely rare. There were no substantial differences in the use of combination treatment between the three cohorts and the results were similar in all demographic and clinical categories. Conclusion: Our data show that in a real-life population use of antihypertensive drug combinations is low. They also show that, contrary to guideline recommendations, antihypertensive combination treatment did not show any noticeable increase in recent years
Survival and prognostic factors following pulmonary metastasectomy for sarcoma
No full textSarcomas are a heterogeneous group of malignancies with a marked propensity to metastasize to the lungs. Chemotherapy offers only a limited benefit in metastatic disease, whereas lung metastasectomy, in selected cases, can lead to long-term survival. Other local ablative techniques and hybrid therapies have been proposed. A multidisciplinary setting is of paramount importance for choosing the most appropriate treatment for each case. There is no randomized controlled trial providing formal evidence of the effectiveness of lung metastasectomy. Main areas of controversy concern the selection of surgical candidates, the operative approach and the role of chemotherapy. Five-year survival rates range from 15% to 50.9%, as reported mainly in retrospective case-series in which several prognostic factors were identified. In this article, the authors review the surgical management of sarcoma metastases to the lung, with a particular focus on the outcomes and prognostic factors associated with long-term survival after resection. The role of chemotherapy and other adjunctive therapies is also discussed
Beyond Blame—Mens Rea and Regulatory Crime
No full textIn the first part of this Article, the Author briefly outlines the conceptual underpinnings of the common law approach to mens rea, with its blame focus, and the Supreme Court\u27s early efforts to develop a different approach in interpreting regulatory criminal statutes. The Author begins the second part of this Article with Lambert v. California, in which the Court staked out the constitutional limits for the employment of strict liability in public welfare or regulatory crimes, and, first employed notice-based mens rea. This part goes on to examine the ensuing cases in which the Court, at least implicitly, fleshes out the notice analysis that should guide the courts in deciding whether Congress intended strict liability or some level of mens rea in enacting regulatory criminal statutes. The Author concludes with Liparota v. United States, the case in which the Court departed from the emerging construct, which had distinguished blame-based and notice-based mens rea. This part then charts the doctrinal confusion that has resulted from this conflation of blame and notice in the Court\u27s mens rea analysis, confusion that is apparent not only in its own cases but also those of the circuit courts as they confront this vexatious problem
Pleural recurrences of thymoma: Role and effectiveness of intrathoracic chemohyperthermia
No full textThymoma is a rare tumor of the anterior mediastinum characterized by a relatively indolent behavior. Surgery is the cornerstone in the treatment of this tumor and completeness of resection is the main prognostic facto
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