66 research outputs found
Transsphenoidal hypophysectomy as treatment for macro-adenomas in dogs: case series.
No full textTRANSSPHENOIDAL HYPOPHYSECTOMY AS TREATMENT FOR MACRO-ADENOMAS IN THE DOG: CASE SERIES
Pisoni L, Del Magno S, Foglia A, Fracassi F, Corradini S, Joechler M.
Introduction
Pituitary tumors can be classified according to the ratio between the pituitary height and the brain area (P/B value) with a cut-off of 0.31 mm-1 between micro and macroadenomas1.
The aim of the study is to retrospectively review the surgical therapy and the related complications of the cases of transsphenoidal hypophysectomy in dogs with macroadenomas performed at the DIMEVET of the University of Bologna.
Material and methods
In the study dogs with a pituitary adenoma diagnosed by CT or MRI and treated surgically between 2011 and January 2015 were included.
For transsphenoidal hypophysectomy all the dog were sedated with midazolam and fentanyl, the induction was executed with propofol and after oro-tracheal intubation, anesthesia was maintained by propofol in costant rate infusion and isolfuorane. Analgesia was provided by fentanyl.
All the surgical procedures were performed according to the microsurgical technique described by Meij in 19972.
In the post-operative period the dogs were monitored for neurological deterioration, electrolytes and fluid balance. Antibiotics, gastroprotection and opioids were administered. Hormonal supplementation consisted of desmopressin, corticosteroids and thyroxine.
The histological evaluation of the masses removed was carried out.
Results
Seven dogs were included in the study and 8 surgeries were performed. The main represented breed was the Labrador Retriever (2/7 dogs), the median body weight was 34,5 kg, the median age was 7,5 years and 6/7 dogs were male.
Of the 7 dogs included, 4 had pituitary-dependent hypercortisolism. One dog had hypopituitarism and 4 dogs showed severe neurological signs.
All the 7 cases had an enlarged pituitary gland, the median P/B value was 0,8 mm-1 .
In one dog the first surgical approach to the sphenoid bone resulted too caudal, in one dog there was a moderated bleeding during surgery and one dog had septic shock when recovered from anesthesia.
In the post-operative period, complications were hypernatremia and hypertension (5/8 cases), neurological deterioration (4/8), exophthalmos (2/8), agitation (2/8) and venous thrombus (2/8), one in the splenic vein and one in the cranial vena cava.
Four dogs were discharged, while 1 dog died due to sepsis and 3 dogs were euthanized for deterioration of clinical and neurological conditions. The histological diagnosis was adenoma in all cases.
Discussion and conclusion
Transsphenoidal hypophysectomy represents a solution to decrease the mass effect in enlarged pituitary adenomas, however better results were observed in microadenomas. A surgical learning curve is necessary for the surgeon. Nevertheless the complete removal of the mass is not always possible.
In surgery the main difficulties were the exact locatization of the fossa hypophysalys and to recognize and completely remove the neoplastic tissue.
All the cases presented had macroadenomas, some of them with very enlarged pituitary glands. In these dogs more complications were encountered in the post-operative period.
Surgery represents a curative therapy, in cases of complete removal of the mass, both for the neurological signs and the eventual endocrinological disease.
1. Kooistra et al, J Endocrinol, 1997
2. Meij et al, Vet Surg, 199
Acromegaly in a non-diabetic cat
No full textCase summary A 14-year-old, neutered male European shorthair cat was evaluated for a routine health check. The owner did not report any clinical signs except for respiratory stridor. On physical examination the main findings were broad facial features and increased interdental spaces. On haematology, a mild, non-regenerative anaemia was detected, whereas the serum biochemistry profile and urinalysis were unremarkable. The serum glucose concentration was within the reference interval. Serum insulin-like growth factor-1 concentration was markedly elevated (>1600 ng/ml). The basal serum growth hormone concentration was elevated and decreased only mildly after somatostatin administration. Basal serum insulin concentration was high, and the insulin concentration increased considerably after glucose loading, consistent with insulin resistance. CT scanning of the skull showed an enlarged pituitary gland and increased skull bone thickness. The final diagnosis was acromegaly. Relevance and novel information These findings demonstrate that acromegaly should be pursued and suspected in cats other than those with diabetes mellitus
Extended depth-of-field optical reader exploiting digital image deconvolution
No full textNon contact barcode readers usually rely on fixed focus optical systems, which are effected by defocus blurring as the optical code is moved away from the focal position. In this paper we will descirbe the implementation of image deconvolution algorithms in a DSP-based imaging module. The parameters of the inverse filtering process have been tuned to suit the great part of the operative conditions. The performances of the miniature imaging module will be presented along with a discussion of the improvement to be ascribed to the image deconvolution process
Comparazione fra due approcci interpretativi nella valutazione dello stato acido-base in 126 cani in condizioni cliniche critiche
No full text126 dogs in critical condition were included in this study in order to evaluate the acid-base imbalances with the traditional approach (Henderson-Hasselbalch) and the strong ion approach proposed by Stewart and adapted for the veterinary medicine. The aim of the study is the comparison of the two interpretative approaches and, according with the literature, we found that the modified Stewart approach is helpful and more precise in interpreting mixed metabolic disorders
Pharmacodynamics of Oral Cholecalciferol in Healthy Individuals with Vitamin D Deficiency: A Randomized Open-Label Study
No full textComparative pharmacodynamic (PD) analyses on different dosing schedules for cholecalciferol supplementation are limited. This was an open-label, randomized, parallel-group study involving 75 healthy individuals deficient in vitamin D (baseline 25OHD < 20 ng/mL) receiving oral cholecalciferol with three different dosing regimens: Group A: 10,000 IU/day for 8 weeks followed by 1000 IU/day for 4 weeks; Group B: 50,000 IU/week for 12 weeks and Group C: 100,000 IU every other week for 12 weeks. Regulators of calcium and phosphate homeostasis, bone turnover markers and Wnt inhibitors were measured at baseline, Day 28, 53, 84, and 112. The 1,25OH2D increased at each time point. The increase was greater (p < 0.05) for group A vs. B and C at Day 28, and vs. group B at Day 56. No significant difference among groups was observed for the other biomarkers. The 24,25OH2D remained stable over time. PTH decreased at Day 84 and FGF-23 increased at all time points. CTX-I and PINP increased slightly at Day 28. BALP decreased from Day 56 onward. Dkk-1 increased from Day 56 onward, while sclerostin did not show significant changes. In healthy individuals deficient in vitamin D, vitamin D supplementation exerted effects on multiple regulators of calcium, phosphate and bone metabolism, without marked differences using the three regimens
Role of the hydrophilic spacer of glucosylated amphiphiles included in liposome formulations in the recognition of Concanavalin A
No full textThe functionalization of liposomes with glycosylated amphiphiles is an optimal strategy for targeted drug delivery, leading to enhanced efficacy as well as to reduced side effects of drugs. In fact, the presence of natural or synthetic glycolipids in vesicle formulations might increase their specificity toward lectins, a class of non-enzymatic sugar-binding proteins involved in cellular recognition and adhesion. The capability of a new glucosylated synthetic amphiphile to interact with Concanavalin A (Con A), a plant lectin used as model system, was investigated by a synergic experimental and computational approach, both as pure component and in formulation with a natural phospholipid. The comparison of the affinity with Con A of the new glucosylated amphiphile with respect to that of a previously described structural analogue demonstrates that the hydrophilic spacer length controls the exposure of the glucose residue on liposome surface, and consequently the recognition by the lectin. © 2015 Elsevier B.V
Open innovation in sanità in contesti d’emergenza. La conversione di maschere da snorkeling in dispositivi di ventilazione per i pazienti covid
No full textLa pandemia da Covid-19 ha causato un'interruzione di diversi servizi sanitari. L'Italia è stata duramente colpita dalla prima ondata della pandemia all'inizio del 2020. In particolar modo, la Lombardia si è posizionata come una delle Regioni più colpite, dovendo far fronte a un rilevante numero di pazienti con difficoltà respiratorie con scarsità di risorse per soddisfare tali esigenze cliniche. La mancanza di valvole respiratorie denominate "Venturi" ha portato uno degli ospedali maggiormente colpiti, quello di Chiari (Brescia) a immaginare l'autoproduzione delle valvole utilizzando un'innovativa tecnologia di stampa 3D. La necessità di studiare il prototipo di valvola da stampare, e di autoprodurre significative quantità di valvole ha spinto la Direzione a cercare un partner privato. Un appello attraverso un quotidiano locale ha permesso ai dirigenti pubblici di incontrare un giovane imprenditore alla guida di una startup innovativa. La partnership tra ente pubblico e azienda privata ha portato non solo alla produzione delle valvole Venturi necessarie, ma all’ideazione e prototipazione di un diverso tipo di valvole (in seguito chiamato "Charlotte") per consentire la conversione di una popolare maschera da snorkeling economica del rivenditore francese di prodotti sportivi Decathlon in un efficace dispositivo di ventilazione per i pazienti con difficoltà respiratorie. I progetti 3D relativi ai due progetti sono stati condivisi liberamente online per produrre e stampare tali valvole in tutto il mondo. Il caso delle valvole Venturi e Charlotte e la conversione della maschera da snorkelling in efficace dispositivo di ventilazione si è affermato come una best practice di open innovation durante la pandemia di Covid-19, con effetto su pazienti e ospedali in tutto il mondo.
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The Covid-19 pandemic has disrupted several health services. Italy was hit hard by the first wave of the pandemic at the beginning of 2020. In particular, Lombardy positioned itself as one of the worst affected regions, having to cope with a significant number of patients with respiratory difficulties with a scarcity of resources to meet these clinical needs. The lack of respiratory valves called "Venturi" led one of the most affected hospitals, that of Chiari (Brescia) to imagine the self-production of the valves using an innovative 3D printing technology. The need to study the valve prototype to be printed and self-produce significant valves quantities prompted the Management to look for a private partner. An appeal through a local newspaper allowed public executives to meet a young entrepreneur leading an innovative startup. The partnership between the public body and a private company led to the study and the following production of the necessary Venturi valves and the design and prototyping of different types of valves (later called "Charlotte") to allow the conversion of a famous inexpensive snorkelling mask from French sports retailer Decathlon into an effective ventilation device for patients with breathing difficulties. The 3D designs related to the two projects were freely shared online to produce and print such valves worldwide. The case of the Venturi and Charlotte valves and the conversion of the snorkelling mask into an effective ventilation device has established itself as an open innovation best practice during the Covid-19 pandemic, affecting patients and hospitals around the world
Changes in bone turnover markers and bone modulators during abatacept treatment
No full text: Rheumatoid arthritis (RA) causes bone loss, only partly related to inflammation. The impact of RA treatments on bone metabolism and their ability to mitigate bone loss remains uncertain. The primary goal of our study was to examine the influence of abatacept on serum levels of markers and regulators involved in bone turnover. Secondary objectives included evaluating changes in bone mineral density (BMD), bone health parameters, erosions, and exploring potential correlations among these parameters. We conducted a prospective observational study on patients with active seropositive RA failure to biological disease modifying anti-rheumatic drugs initiating treatment with abatacept. We measured at baseline and after 1, 2, 3, 6, 9 and 12 months: serum bone turnover markers (CTX, P1nP, B-ALP), bone modulators (Dkk-1, sclerostin, vitamin D, PTH, OPG and RANKL), BMD and radiographic parameters (modified Sharp van der Heijde score [mSvdH], bone health index [BHI] and metacarpal index [MCI]). Disease activity and glucocorticoid intake was monitored. 33 patients were enrolled in the study. We found a significant increase in markers of bone formation (B-ALP and P1nP) from baseline to M6 and M12. PTH increased significantly at M6 but not at M12. All other bone markers and modulators did not change. We found a significant decrease in BHI and MCI from baseline to M12 (median difference - 0.17 95% CI - 0.42 to - 0.10, p 0.001 and - 0.09 95% CI - 0.23 to - 0.07, respectively). BMD at femoral neck transitorily decreased at M6 (mean difference - 0.019 g/cm2 95% CI - 0.036 to - 0.001 p 0.04). BMD at total hip, lumbar spine and mSvdH score did not change significantly. P1nP delta at M12 correlated with delta mSvdH. Treatment with abatacept was associated with a significant increase in bone formation markers. The secondary and transient increase in PTH serum levels may be responsible of the transitory bone loss
Prediction of vascular invasion using a 7‐point scale computed tomography grading system in adrenal tumors in dogs
No full textBackground: Previous studies evaluating the accuracy of computed tomography (CT) in detecting caudal vena cava (CVC) invasion by adrenal tumors (AT) used a binary system and did not evaluate for other vessels. Objective: Test a 7-point scale CT grading system for accuracy in predicting vascular invasion and for repeatability among radiologists. Build a decision tree based on CT criteria to predict tumor type. Methods: Retrospective observational cross-sectional case study. Abdominal CT studies were analyzed by 3 radiologists using a 7-point CT grading scale for vascular invasion and by 1 radiologist for CT features of AT. Animals: Dogs with AT that underwent adrenalectomy and had pre- and postcontrast CT. Results: Ninety-one dogs; 45 adrenocortical carcinomas (50%), 36 pheochromocytomas (40%), 9 adrenocortical adenomas (10%) and 1 unknown tumor. Carcinoma and pheochromocytoma differed in pre- and postcontrast attenuation, contralateral adrenal size, tumor thrombus short- and long-axis, and tumor and thrombus mineralization. A decision tree was built based on these differences. Adenoma and malignant tumors differed in contour irregularity. Probability of vascular invasion was dependent on CT grading scale, and a large equivocal zone existed between 3 and 6 scores, lowering CT accuracy to detect vascular invasion. Radiologists' agreement for detecting abnormalities (evaluated by chance-corrected weighted kappa statistics) was excellent for CVC and good to moderate for other vessels. The quality of postcontrast CT study had a negative impact on radiologists' performance and agreement. Conclusions and Clinical Importance: Features of CT may help radiologists predict AT type and provide probabilistic information on vascular invasion
Profile of bazedoxifene/conjugated estrogens for the treatment of estrogen deficiency symptoms and osteoporosis in women at risk of fracture
No full textMaurizio Rossini,1 Stefano Lello,2 Ignazio Sblendorio,3 Ombretta Viapiana,1 Elena Fracassi,1 Silvano Adami,1 Davide Gatti11Department of Medicine, Rheumatology Unit, University of Verona, Italy; 2Endocrinological Gynecology, Pathophysiology of Menopause and Osteoporosis, Dermopathic Institute of Immacolata, Roma, Italy; 3Medical Coach Italia Center, Bari, ItalyAbstract: Decreasing levels of estrogens during menopause are associated with reduced bone density and an increased risk of osteoporosis. Many women also experience bothersome vasomotor and vaginal symptoms during the menopausal transition. Results of systematic reviews and meta-analyses of randomized controlled trials have shown that both systemic estrogen therapy or hormone therapy (estrogen combined with a progestin) are useful to prevent bone loss, and they are the most effective treatment for such climacteric symptoms as hot flushes, sweating, vaginal dryness, and dyspareunia. Unfortunately, estrogen therapy and hormone therapy increase the risk of endometrial and breast cancer, respectively. The selective estrogen receptor modulators (SERMs) result in positive estrogenic effects on bone, with no negative effects on the endometrium and breast but do not provide relief from postmenopausal symptoms. The combination of a SERM with estrogen as a tissue selective estrogen complex (TSEC) is a new strategy for the prevention of bone loss and the treatment of climacteric symptoms. This combination is particularly interesting from a clinical point of view, taking into account that estrogen alone did not increase breast cancer risk by the Women's Health Initiative. TSEC is hypothesized to provide the benefits of estrogen-alone therapy, with an improved tolerability profile because the SERM component can make possible the elimination of progestin. The objective of this review was to critically evaluate the evidence from the reports published to date on the use of bazedoxifene (a third-generation SERM) in combination with conjugated estrogens in postmenopausal women. The conclusion is that effectively, the combination of bazedoxifene and conjugated estrogens may be a promising alternative to hormone therapy for the prevention of osteoporosis and the treatment of postmenopausal symptoms in non-hysterectomized postmenopausal women.Keywords: tissue selective estrogen complex, menopause, bone mineral density, bone turnover markers, climacteric symptom
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