247 research outputs found
Il concordato preventivo con riserva nella prassi del tribunale di Brescia
No full textIl presente articolo ha per oggetto il concordato preventivo con riserva, disciplinato dall’articolo 161 del Regio Decreto 267/1942: esso espone le risultanze dell’analisi quali-quantitativa di tutte le 106 domande di concordato con riserva presentate al Tribunale di Brescia nel primo semestre di vigenza dell’istituto, compreso fra il settembre 2012 e il febbraio 2013.
Attraverso il presente lavoro si è cercato di accertare, con riferimento al campione esaminato, i gradi di funzionalità e di efficacia del concordato preventivo con riserva, verificando se esso abbia concretamente e significativamente migliorato le possibilità di gestione della crisi di impresa.
Infine, muovendo dai risultati dell’indagine, si è ragionato sull’impatto che potranno avere due importanti novità introdotte dal D.L. 83/2015:
- la previsione di una percentuale minima di pagamento (20%) da assicurare ai crediti chirografari nei concordati liquidatori;
- l’abrogazione del meccanismo del silenzio-assenso previsto dall’art. 178 LF
Spironolactone in the treatment of Polycystic ovary syndrome:effects on clinical and metabolic parameters
No full text
HLA and hormonal data for identification of heterozygotes in 11 beta- and 17 alpha-hydroxylase deficiency syndromes.
No full text1. In previous studies, baseline and ACTH-stimulated hormone levels, plus HLA genotyping, have been used to detect heterozygous carriers in congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21-OHDS). 2. In the present study similar parameters were determined in a family of four including two children with CAH due to 11 beta-hydroxylase deficiency (11-OHDS), and a family of twelve including three sibs (two females, one genotypically male) with CAH due to 17 alpha-hydroxylase deficiency (17-OHDS). 3. HLA typing showed affected sibs with 11-OHDS to differ in one of their haplotypes. No significant differences in basal and ACTH-stimulated steroid levels were seen between the parents (obligate heterozygotes) and the general population. 4. In 17-OHDS, affected members differed from one another in one to two haplotypes; one patient had identical HLA profiles with two of the normal siblings, as did the genotypically male patient with two others; each of the other healthy siblings had one haplotype found in two of the affected subjects. The genes responsible for 11-OHDS and 17-OHDS--in contrast with 21-OHDS--do not appear to be HLA-linked. However, the measurement of ACTH-stimulated corticosterone levels may be useful, since the gene responsible for 17-OHDS seems to be expressed hormonally in the heterozygous state
Role of Estrogen and Estrogen Receptor in GH-Secreting Adenomas
No full textAcromegaly is a rare disease with several systemic complications that may lead to increased overall morbidity and mortality. Despite several available treatments, ranging from transsphenoidal resection of GH-producing adenomas to different medical therapies, complete hormonal control is not achieved in some cases. Some decades ago, estrogens were first used to treat acromegaly, resulting in a significant decrease in IGF1 levels. However, due to the consequent side effects of the high dose utilized, this treatment was later abandoned. The evidence that estrogens are able to blunt GH activity also derives from the evidence that women with GH deficiency taking oral estro-progestins pills need higher doses of GH replacement therapy. In recent years, the role of estrogens and Selective Estrogens Receptor Modulators (SERMs) in acromegaly treatment has been re-evaluated, especially considering poor control of the disease under first- and second-line medical treatment. In this review, we analyze the state of the art concerning the impact of estrogen and SERMs on the GH/IGF1 axis, focusing on molecular pathways and the possible implications for acromegaly treatment
Clinical and genetic aspects of phaechromocytoma
No full textPhaeochromocytoma is a tumour of the adrenal medulla, which, although rare, is a major cause of correctable hypertension with a prevalence of 0.1-0.5% in the hypertensive population. Clinical symptoms include attacks of paroxysmal headache, sweating, palpitations, stress and a sense of imminent death. Often associated with the above is an increase in blood pressure. Despite the fact that the underlying genetic mechanisms of phaeochromocytoma have been well investigated, they are still incompletely understood. In approximately 80% of cases the tumour occurs sporadically, but it may occur in association with type 2 multiple endocrine neoplasia, type 1 neurofibromatosis or von Hippel-Lindau disease. Molecular evidence suggests that other genes such as SDHD or SDHB may control its development; the possibility of other putative phaeochromocytoma genes is currently being investigated
Complications and mortality of Cushing’s disease: report on data collected over a 20-year period at a referral centre
No full textContext: Cushing’s disease (CD) is rare condition burdened by several systemic complications correlated to higher mortality rates. The primary goal of clinicians is to achieve remission, but it is unclear if treatment can also increase life expectancy. Aim: To assess the prevalence of cortisol-related complications and mortality in a large cohort of CD patients attending a single referral centre. Materials and methods: The clinical charts of CD patients attending a referral hospital between 2001 and 2021 were reviewed. Results: 126 CD patients (median age at diagnosis 39 years) were included. At the last examination, 78/126 (61.9%) of the patients were in remission regardless of previous treatment strategies. Patients in remission showed a significant improvement in all the cardiovascular (CV) comorbidities (p < 0.05). The CV events were more frequent in older patients (p = 0.003), smokers and persistent CD groups (p < 0.05). Most of the thromboembolic (TE) and infective events occurred during active stages of the disease. The CV events were the most frequent cause of death. The standardized mortality ratio (SMR) resulted increased in persistent cases at the last follow-up (SMR 4.99, 95%CI [2.15; 9.83], p < 0.001) whilst it was not higher in those in remission (SMR 1.66, 95%CI [0.34; 4.85], p = 0.543) regardless of the timing or number of treatments carried out. A younger age at diagnosis (p = 0.005), a microadenoma (p = 0.002), and remission status at the last follow-up (p = 0.027) all increased survival. Furthermore, an elevated number of comorbidities, in particular arterial hypertension, increased mortality rates. Conclusions: Patients with active CD presented a poor survival outcome. Remission restored the patients’ life expectancy regardless of the timing or the types of treatments used to achieve it. Persistent CD-related comorbidities remained major risk factors
Corneal thickness mapping by 3D swept-source anterior segment optical coherence tomography
No full text{PURPOSE:} To assess accuracy and repeatability of central corneal thickness ({CCT)} measurements obtained by swept-source anterior segment optical coherence tomography ({AS-OCT)}, spectral-domain retinal {OCT} with corneal module and ultrasound pachymetry ({USP)}, and to assess repeatability of pachymetric mapping with {AS-OCT.} {METHODS:} 50 healthy volunteers were recruited. A single, experienced operator analysed the right eye of each participant twice in the same session with {AS-OCT} ('corneal map' routine), retinal {OCT} and {USP.} {CCT} measurements were compared using repeated-measures analysis of variance, Bonferroni test, Pearson correlation and Bland-Altman plots. Repeatability of thickness maps and {CCT} measurements were assessed using Alpha of Cronbach, intraclass correlation coefficient ({ICC)} and coefficient of repeatability. {RESULTS:} Mean {CCT±SD} was 540±28.9 μm for {AS-OCT}, 544±29.5 μm for retinal {OCT} and 549.3±31.7 μm for {USP;} the differences were statistically significant (p{\textless}0.01). {CCT} measurements obtained with the three instruments were highly correlated: r was 0.965 for {AS-OCT/USP}, 0.962 for retinal {OCT/USP} and 0.984 for {AS-OCT/retinal} {OCT} comparison. The repeatability of {CCT} measurements was higher for {AS-OCT} than for the other devices (p{\textless}0.001). Repeatability of pachymetric maps was excellent ({ICC=0.999).} {CONCLUSIONS:} Pachymetric maps by swept-source {AS-OCT} showed excellent repeatability. {CCT} measurements obtained by {AS-OCT}, {USP} and retinal {OCT} were highly correlated although not identical
Circadian secretion of ACTH, cortisol, and mineralocorticoids in Cushing's syndrome.
No full textThe behaviour of plasma levels of ACTH was studied in five untreated patients with pituitary-dependent Cushing's syndrome, with blood samples taken every half an hour for a total period of 24 hours; plasma cortisol, corticosterone, deoxycorticosterone (DOC) and aldosterone were also measured simultaneously. In all cases, above normal secretory impulses of ACTH and cortisol, at approximately the same height, were present throughout the day, while between these peaks the levels were in the normal range. Few peaks of ACTH and cortisol were simultaneous and rare secretory impulses of corticosterone, and deoxycorticosterone were in synchrony with those of ACTH or cortisol. DOC levels were found to have some peaks above normal levels while corticosterone levels presented rare elevated peaks during the day. Plasma aldosterone values on the other hand, were extremely low in all except in one case, where the variations may be interpreted as pure fluctuations. These findings confirm that: 1) In a number of cases, multiple samples of ACTH and cortisol (during the 24 hrs.) appear to be essential in order to distinguish pituitary-dependent Cushing's syndrome from normal; 2) In conditions of ACTH excess, DOC and corticosterone secretion seems to become progressively less ACTH-dependent as we proceed down the biosynthetic chain towards aldosterone, which is suppressed in most cases
- …
