1,721,006 research outputs found
Postoperative Hypoparathyroidism
No full textHypoparathyroidism is a pathological clinical condition characterized by low serum
calcium levels in the presence of absent or inappropriately low parathyroid hormone
(PTH) levels. It is usually caused by reduced parathyroid gland (PG) function due
to secondary (and often iatrogenic) causes (>75%); less frequently, it occurs as a
primary disorder caused by intrinsic genetic defects (Di George syndrome) or an
autoimmune diseas
Excess aldosterone as a mechanism of resistant salt-sensitive arterial hypertension
Full text linkAlbeit vastly underdiagnosed, primary aldosteronism is the most common cause of arterial hypertension and particularly of drug-resistant arterial hypertension, a high-risk condition with a poor prognosis. A timely diagnosis followed by targeted treatment is pivotal to prevent the cardiovascular morbidity and mortality related to the detrimental consequences of aldosterone excess. This doctoral thesis highlights the importance of the screening for primary aldosteronism in patients with resistant hypertension, even if they are on multiple drugs potentially confounding the diagnosis. These patients can benefit from surgical treatment, resolve their resistance to treatment and improve their quality of life. Moreover, for the first time, the sodium accumulation in the skin of these patients was evaluated, which was found to be reversible after surgery, suggesting the presence of tissue-specific regulatory mechanisms that act in the pathophysiology of hypertension. In this regard, it has been speculated that tissue sodium storage might represent an independent cardiovascular risk factor and that it might be responsible of the target organ damage in patients with primary aldosteronism
Cure and survival of sporadic medullary thyroid carcinoma following systematic preoperative calcitonin screening
Full text linkBackground: The improvement in outcome of sporadic medullary thyroid carcinoma (MTC) during the last decades remains controversial, even if a trend toward a better prognosis has been recently proposed. This study was aimed to determine the time trend cure and survival rates in sporadic MTC according to the use of systematic preoperative calcitonin screening. Methods: Retrospective analysis of 178 sporadic MTC patients operated between 1980 and 2017 was performed. The impact of prognostic factors on cure and survival following the introduction of routine preoperative calcitonin screening in 2001 was evaluated according to the year of surgery. Results: Since 2001, a significant decline of node-positive tumors (from 56.1 to 34.7%) and advanced stage at diagnosis (stage III/IV from 56.1 to 34.7%) occurred, with a concomitant significant increase in cure rate (64.5% vs 38.6%; p = 0.0012) and survival (p < 0.05). At univariate analysis, the cure was achieved more frequently in more recently operated patients (64.5% vs 38.6%; p = 0.0012), in disease staging I/II (86.5% vs 13.5%; p < 0.0001), in patients undergoing preoperative calcitonin screening (63.8% vs 23.5%; p < 0.0001) and in the absence of lymph node metastases (86.5% vs 13.5%; p < 0.0001). At multivariate analysis, only preoperative calcitonin screening and stage at diagnosis turned out to be significant independent prognostic factors for cure and survival. Conclusion: The outcome of sporadic MTC improved in the new millennium; diagnosis was achieved earlier, at a less advanced stage. Routine preoperative calcitonin screening may have contributed to improve cure and survival rates
- …
