Real world effectiveness of subcutaneous semaglutide in type 2 diabetes: A retrospective, cohort study (Sema-MiDiab01).

Introduction: Aim of the present study was to evaluate the real-world impact of once-weekly (OW) subcutaneous semaglutide on different end-points indicative of metabolic control, cardiovascular risk factors, and beta-cell function in type 2 diabetes (T2D). Methods: This was a retrospective, observational study conducted in 5 diabetes clinics in Italy. Changes in HbA1c, fasting blood glucose (FBG), body weight, blood pressure, lipid profile, renal function, and beta-cell function (HOMA-B) during 12 months were evaluated. Results: Overall, 594 patients (97% GLP-1RA naïve) were identified (mean age 63.9 ± 9.5 years, 58.7% men, diabetes duration 11.4 ± 8.0 years). After 6 months of treatment with OW semaglutide, HbA1c levels were reduced by 0.90%, FBG by 26 mg/dl, and body weight by 3.43 kg. Systolic blood pressure, total and LDL-cholesterol significantly improved. Benefits were sustained at 12 months. Renal safety was documented. HOMA-B increased from 40.2% to 57.8% after 6 months (p<0.0001). Discussion: The study highlighted benefits of semaglutide on metabolic control, multiple CV risk factors, and renal safety in the real-world. Semaglutide seems to be an advisable option for preservation of ß-cell function and early evidence suggests it might have a role in modifying insulin resistance (HOMA-IR), the pathogenetic basis of prediabetes and T2D.

Obesity Is Strongly Associated With Low Testosterone and Reduced Penis Growth During Development.

CONTEXT: Growth of male genitalia represents an important marker of sexual development. Testicle size is the primary measure and little is known regards penile length changes during puberty. OBJECTIVE: This work aims to assess penis growth and testosterone levels in obese vs normal-weight children and adolescents, to evaluate a possible influence of obesity on genital development in boys, and to establish a new method for measuring penis length that allows comparison of normal-weight and overweight boys. METHODS: We assessed anthropometric and genital development in 1130 boys from birth to age 20 years. Testosterone levels were also measured. A new method for penile length measurement was employed to minimize errors when comparing obese and nonobese children. Penis length was measured with a gentle, painless, straight positioning on a centimetric ruler without stretching, which is doable from the first years of life until the end of adolescence. RESULTS: Penis length and testosterone are strongly related in children during puberty. Penile length growth is significantly decreased (by about 10%) in obese boys when compared to normal-weight boys, with concomitantly reduced testosterone levels, across puberal phases. CONCLUSION: Childhood obesity represents an important determinant of lower testosterone level and reduced penis development. A new method should be employed to improve penis measurement in normal-weight and overweight/obese boys. The possible significance of these observations for adult genital development and reproductive potential will require large longitudinal studies.

Telemedicine and urban diabetes during COVID-19 pandemic in Milano, Italy during lock-down: epidemiological and sociodemographic picture.

BACKGROUND: Since 2010, more than half of World population lives in Urban Environments. Urban Diabetes has arisen as a novel nosological entity in Medicine. Urbanization leads to the accrual of a number of factors increasing the vulnerability to diabetes mellitus and related diseases. Herein we report clinical-epidemiological data of the Milano Metropolitan Area in the contest of the Cities Changing Diabetes Program. Since the epidemiological picture was taken in January 2020, on the edge of COVID-19 outbreak in the Milano Metropolitan Area, a perspective addressing potential interactions between diabetes and obesity prevalence and COVID-19 outbreak, morbidity and mortality will be presented. To counteract lock-down isolation and, in general, social distancing a pilot study was conducted to assess the feasibility and efficacy of tele-monitoring via Flash Glucose control in a cohort of diabetic patients in ASST North Milano. METHODS: Data presented derive from 1. ISTAT (National Institute of Statistics of Italy), 2. Milano ATS web site (Health Agency of Metropolitan Milano Area), which entails five ASST (Health Agencies in the Territories). A pilot study was conducted in 65 screened diabetic patients (only 40 were enrolled in the study of those 36 were affected by type 2 diabetes and 4 were affected by type 1 diabetes) of ASST North Milano utilizing Flash Glucose Monitoring for 3 months (mean age 65 years, HbA1c 7,9%. Patients were subdivided in 3 groups using glycemic Variability Coefficient (VC): a. High risk, VC > 36, n. 8 patients; Intermediate risk 20 < VC < 36, n. 26 patients; Low risk VC < 20, n. 4 patients. The control group was constituted by 26 diabetic patients non utilizing Flash Glucose monitoring. RESULTS: In a total population of 3.227.264 (23% is over 65 y) there is an overall prevalence of 5.65% with a significant difference between Downtown ASST (5.31%) and peripheral ASST (ASST North Milano, 6.8%). Obesity and overweight account for a prevalence of 7.8% and 27.7%, respectively, in Milano Metropolitan Area. We found a linear relationship (R = 0.36) between prevalence of diabetes and aging index. Similarly, correlations between diabetes prevalence and both older people depending index and structural dependence index (R = 0.75 and R = 0.93, respectively), were found. A positive correlation (R = 0.46) with percent of unoccupied people and diabetes prevalence was also found. A reverse relationship between diabetes prevalence and University level instruction rate was finally identified (R = - 0.82). Our preliminary study demonstrated a reduction of Glycated Hemoglobin (p = 0.047) at 3 months follow-up during the lock-down period, indicating Flash Glucose Monitoring and remote control as a potential methodology for diabetes management during COVID-19 lock-down. HYPOTHESIS AND DISCUSSION: The increase in diabetes and obesity prevalence in Milano Metropolitan Area, which took place over 30 years, is related to several environmental factors. We hypothesize that some of those factors may have also determined the high incidence and virulence of COVID-19 in the Milano area. Health Agencies of Milano Metropolitan Area are presently taking care of diabetic patients facing the new challenge of maintaining sustainable diabetes care costs in light of an increase in urban population and of the new life-style. The COVID-19 pandemic will modify the management of diabetic and obese patients permanently, via the implementation of approaches that entail telemedicine technology. The pilot study conducted during the lock-down period indicates an improvement of glucose control utilizing a remote glucose control system in the Milano Metropolitan Area, suggesting a wider utilization of similar methodologies during the present "second wave" lock-down.

Liraglutide and cardiovascular outcomes in a real world type 2 diabetes cohort.

In the last years, due to new regulatory guidelines requiring a stringent documentation of cardiovascular (CV) safety of novel drugs for type 2 diabetes, cardiovascular outcomes safety trials (CVOTs) are requested. CVOTs increase the knowledge about the safety profile of the new drugs, but they have intrinsic limits that make difficult their transferability to clinical practice. For this reason, real world evidence is considered an important complement to experimental data. Among the glucagon-like peptide-1 receptor agonists, liraglutide in the LEADER CVOT demonstrated superiority in reducing the risk of major CV events (MACEs) vs. placebo. We conducted an observational, retrospective, longitudinal study based on 307 patients with T2DM treated with liraglutide under routine clinical practice conditions. Real world impact of liraglutide on metabolic control, CV risk factors, hypoglycemia and CV events was assessed. Improvements during 36 months were found in HbA1c (-1.0%; p < 0.0001), fasting blood glucose (-17.6 mg/dL; p < 0.0001), body weight (-3.2 kg; p < 0.0001), waist circumference (-1.45 cm; p = 0.004), systolic blood pressure (-10.41 mmHg; p < 0.0001), diastolic blood pressure (-3.69 mmHg; p < 0.0001), total cholesterol (-7.96 mg/dL; p =0.008) and triglycerides (-20.60 mg/dl; p = 0.01). No severe hypoglycemia occurred. Incidence of MACEs in this cohort was lower than in the LEADER study (2.59 vs. 3.4 events per 100 person-years), confirming CV safety of liraglutide even in the real world. On the other hand, a higher incidence of CV event in patients with established CV disease was documented (8.1 events per 100 person-years), in spite of the use of liraglutide. In conclusion, 36-month durability and CV safety of liraglutide were documented in a real world cohort of T2DM patients, with sustained benefits on a large array of CV risk factors.

Outpatient hysteroscopy.

Modern hysteroscopy represents a copernical revolution for the diagnosis and treatment of uterine pathology. Traditionally hysteroscopy was performed in a conventional operation room under general anaesthesia (in-patient hysteroscopy). Recent advances in technology and techniques made hysteroscopy less painful and invasive allowing it to be performed in an ambulatory setting (outpatient hysteroscopy). The so called "see & treat hysteroscopy", has reduced the distinction between diagnostic and operative procedure, thus, introducing the concept of a single procedure in which the operative part is perfectly integrated within the diagnostic work-up. The "digital hysteroscopic clinic" (DHC) on the other hand combines ultrasound with hysteroscopy, ideal for a one stop diagnostic procedure and surgical approach, outlasting laparoscopy with ultrasound, for increased surgical performance in outpatient settings. The aim of this paper is to describe the "state of the art" in an outpatient hysteroscopy setting.

Obesity in pregnancy as a model to identify women at risk for later metabolic syndrome.

The aim of our study is to identify - in a cohort of obese women - cardiovascular and clinical risk factors in women with previous complicated pregnancies and protective factors in women with previous physiological pregnancies. A total of 135 nonpregnant obese women referring to Policlinico Gemelli in Rome were prospectively collected in 2009-2010. Thirty-two women matched inclusion criteria: 16 reported a previous physiological pregnancy and 16 reported previous obstetric complications. A clinical, instrumental and laboratory evaluation has been performed for each patient. Statistical analysis was performed using StatView Software. Values are expressed as mean ± standard error (SEM). All tests were two-tailed with a confidence level of 95% (p < .05). Statistically significant reduced flow-mediated dilatation (p = .0338), increased serum values of vascular cell adhesion molecule (p = .0154) and higher systolic blood pressure values (p = .0427) have been detected in obese women with previous complicated pregnancies due to gestational diabetes and/or hypertension. In conclusion, obese patients with previous complicated pregnancies develop signs of endothelial dysfunction in the postpartum period. Future research should focus on the early identification of possible molecular mechanisms implicated in the development of glyco-metabolic and cardiovascular diseases in obese patients, since they are at higher risk of metabolic syndrome.

Slow changing postural cues cancel visual field dependence on self-tilt detection.

Interindividual differences influence the multisensory integration process involved in spatial perception. Here, we assessed the effect of visual field dependence on self-tilt detection relative to upright, as a function of static vs. slow changing visual or postural cues. To that aim, we manipulated slow rotations (i.e., 0.05° s(-1)) of the body and/or the visual scene in pitch. Participants had to indicate whether they felt being tilted forward at successive angles. Results show that thresholds for self-tilt detection substantially differed between visual field dependent/independent subjects, when only the visual scene was rotated. This difference was no longer present when the body was actually rotated, whatever the visual scene condition (i.e., absent, static or rotated relative to the observer). These results suggest that the cancellation of visual field dependence by dynamic postural cues may rely on a multisensory reweighting process, where slow changing vestibular/somatosensory inputs may prevail over visual inputs.

How do visual and postural cues combine for self-tilt perception during slow pitch rotations?

Self-orientation perception relies on the integration of multiple sensory inputs which convey spatially-related visual and postural cues. In the present study, an experimental set-up was used to tilt the body and/or the visual scene to investigate how these postural and visual cues are integrated for self-tilt perception (the subjective sensation of being tilted). Participants were required to repeatedly rate a confidence level for self-tilt perception during slow (0.05°·s(-1)) body and/or visual scene pitch tilts up to 19° relative to vertical. Concurrently, subjects also had to perform arm reaching movements toward a body-fixed target at certain specific angles of tilt. While performance of a concurrent motor task did not influence the main perceptual task, self-tilt detection did vary according to the visuo-postural stimuli. Slow forward or backward tilts of the visual scene alone did not induce a marked sensation of self-tilt contrary to actual body tilt. However, combined body and visual scene tilt influenced self-tilt perception more strongly, although this effect was dependent on the direction of visual scene tilt: only a forward visual scene tilt combined with a forward body tilt facilitated self-tilt detection. In such a case, visual scene tilt did not seem to induce vection but rather may have produced a deviation of the perceived orientation of the longitudinal body axis in the forward direction, which may have lowered the self-tilt detection threshold during actual forward body tilt.

Influence of postural constraints on eye and head latency during voluntary rotations.

Redirecting gaze towards new targets often requires not only eye movements, but also synergistic rotations of the head, trunk and feet. This study investigates the influence of postural constraints on eye and head latency during voluntary refixations in the horizontal plane in 14 normal subjects. Three postural conditions were presented, (1) sitting in a chair using only eye and head movements, (2) standing without feet movements and (3) standing with feet movement. Head-eye reorientations towards eccentric un-predictable locations were performed towards ±45° and ±90° targets and back towards a central, spatially predictable target. Results showed that postural constraints affected eye latency but only when subjects knew the future location of the target (recentering "return" trials). Specifically, relatively longer eye latencies were observed when subjects had to turn their feet back towards the predictable central target. These findings suggest that the additional CNS processing required to reduce degrees of freedom during predictive motion introduces delays to the eye movement in order to efficiently assemble the components of a new motor synergy.

Effect of pravastatin on endothelial function and endothelial progenitor cells in healthy postmenopausal women.

PURPOSE: Coronary heart disease is the leading cause of morbidity and mortality in postmenopausal women. Among statins, pravastatin has been shown to significantly reduce fatal and non-fatal cardiovascular events in primary and secondary prevention trials. The aim of the present research was to investigate whether treatment with pravastatin can modify some indices of cardiovascular risk in healthy postmenopausal women such as significant reductions in total and LDL cholesterol and triglyceride levels. METHODS: 20 patients were randomized in double-blind fashion to treatment for eight weeks with either pravastatin 40 mg/day or placebo, and subsequently, after one-week wash-out, crossed-over to the alternative treatment (placebo or pravastatin) for the following eight weeks. We performed clinical and laboratory investigations, before and at the end of each treatment period, to evaluate patient response to the treatment with pravastatin. RESULTS: After eight weeks pravastatin therapy reduced the median low density lipoprotein (LDL) and total cholesterol (p < 0.01 in both cases). In contrast, insulin level and insulin sensitivity did not show any difference with regard to values observed after placebo treatment. The absolute number of endothelial progenitor cells-colony forming unit (EPC-CFU) was significantly increased by pravastatin treatment (30.6% increase, p < 0.05) and the number of senescent cells was significantly decreased. However pravastatin did not increase tube-like formation by EPC and did not improve endothelial function. CONCLUSIONS: Despite beneficial effect on lipids and EPC, short term pravastatin does not seem to improve other cardiovascular risk factors, at least in healthy postmenopausal women.

Spatial localization investigated by continuous pointing during visual and gravitoinertial changes.

In order to accurately localize an object, human observers must integrate multiple sensory cues related to the environment and/or to the body. Such multisensory integration must be repeated over time, so that spatial localization is constantly updated according to environmental changes. In the present experimental study, we examined the multisensory integration processes underlying spatial updating by investigating how gradual modifications of gravitoinertial cues (i.e., somatosensory and vestibular cues) and visual cues affect target localization skills. These were assessed by using a continuous pointing task toward a body-fixed visual target. The "single" rotation of the gravitoinertial vector (produced by off-axis centrifugation) resulted in downward pointing errors, which likely were related to a combination of oculogravic and somatogravic illusions. The "single" downward pitch rotation of the visual background produced an elevation of the arm relative to the visual target, suggesting that the rotation of the visual background caused an illusory target elevation (induced-motion phenomenon). Strikingly, the errors observed during the "combined" rotation of the visual background and of the gravitoinertial vector appeared as a linear combination of the errors independently observed during "single" rotations. In other words, the centrifugation effect on target localization was reduced by the visual background rotation. The observed linear combination indicates that the weights of visual and gravitoinertial cues were similar and remained constant throughout the stimulation.

[Doppler-guided transanal haemorrhoidal dearterialisation: a casuistic contribution]. / Dearterializzazione emorroidaria transanale Doppler-guidata: contributo casistico.

The search of innovative procedures, able to associate the possibility of treating the hemorrhoidal disease with of "mini-invasiveness", is of growing interest. This paper reports the results obtained during our experience in threating the hemorrhoidal disease with Doppler-guided THD (Transanal Hemorroidal Dearterialisation), which is a technique improved in the last 4 years (February 2004 - November 2009) on a sample of 408 patients. The aim of this study is to evaluate, in a short-term follow-up period, the level of satisfaction and post-operative pain, normal working routine recovery time and the incidence of early and late post-operative complications in our patients. Our results encourage the use of this technique which appears to be safe, quickly performed and characterized by minimal pain and low incidence of complications in the post-operative period.

Lipid composition of meat and backfat from Casertana purebred and crossbred pigs reared outdoors.

The study aimed to evaluate, with regard to the human nutrition, the lipid profile of meat and backfat from gilts and barrows of the Italian autochthonous genotype Casertana and its crossbreed (Casertana×Large White) slaughtered at two different live weights. Meat from the Casertana cross was nutritionally comparable to that from the purebreed and both would be considered healthy, irrespective of sex and weight, due to the relatively low levels of intramuscular lipids and cholesterol. Muscle cholesterol was considerably lower in the heavy pigs than in the light ones and, as weight increased, cholesterol decreased but only in gilts. Females supply meat with higher polyunsaturated fatty acids (PUFA) and slightly lower saturated fatty acids (SFA) respect to barrows and, thus, higher PUFA/SFA ratio. Casertana crossbreds can represent a good alternative to pure Casertana, mainly in the production of Colonnata lard, due to the better fatty acid profile of the subcutaneous adipose tissue. From the nutritional point of view, the optimal slaughtering weight was about 150kg for both genotypes. Heavy pigs, compared to the light ones, produced loin with lower atherogenic and thrombogenic indexes, lower SFA/unsaturated fatty acids ratio, and higher PUFA/SFA ratio.

Best site on right ventricle for open-chest biventricular pacing.

Cardiac resynchronization therapy is effective in patients with a low ejection fraction and left bundle branch block, but 20%-30% do not respond despite selection of the optimal site for pacing on the left ventricle. We investigated whether optimizing the site for placement of the pacing lead on the right ventricle could further improve left ventricular function during cardiac resynchronization in 19 patients (mean age, 63 +/- 5 years) undergoing coronary artery bypass with post-ischemic dilated myocardiopathy (ejection fraction, 25.8% +/- 2%) and left bundle branch block. The hemodynamic response to pacing was tested with the right ventricular lead positioned at the interventricular septum, atrioventricular junction, acute margin, and the pulmonary trunk. Biventricular stimulation improved left ventricular function. When the right ventricular lead was sited at the interventricular septum, a significant improvement in all hemodynamic parameters compared to the other sites was obtained. Biventricular pacing is important to optimize cardiac resynchronization. Although further studies are needed to confirm these findings, accurate lead placement is recommended for cardiac resynchronization therapy in patients with poor cardiac function and left bundle branch block.

Effect of age on fatty acid composition of Italian Merino suckling lambs.

The present study was undertaken to evaluate the effect of age on lipid content and composition of lamb meat. Thirty suckling ram lambs of the Italian Merino breed, reared according to a traditional semi-extensive management, were slaughtered at 30, 50 and 70 days of age to evaluate total lipids and fatty acid profile in three different muscles: longissimus dorsi (LD), semimembranosus (SM) and quadriceps femoris (QF). Age did not dramatically modify lipid content and composition, even if effects of nutritional interest were observed. Meat from lambs slaughtered at 70 days of age presented the best fatty acid profile, because they had the highest PUFA content and ratio to SFA, as well as the lowest thrombogenic index. The SM muscle had better nutritional quality than the LD and the QF, as a result of a higher PUFA percentage and PUFA/SFA ratio, together with a lower thrombogenic index. These characteristics were also associated with slightly lower amounts of intramuscular lipids and SFA.

Fatty acid composition and cholesterol content of muscles as related to genotype and vitamin E treatment in crossbred lambs.

Various factors (weight, sex, diet and breed) influence meat lamb fatty acid composition. The present study was undertaken to evaluate the lipid profile in two different lamb types. Sixty crossbred lambs (Ile de France×Pagliarola and Gentile di Puglia×Sopravissana) were used to determine cholesterol, lipid content and fatty acid profile of Longissimus dorsi, Semimembranosus and Gluteobiceps muscles. Moreover, the effect of vitamin E treatment in vivo on propensity of the lamb meat to lipoperoxidation was assessed. In both crossbreeds total muscle lipids ranged between 2.4 and 4.0 mg/100 g. In the Ile de France×Pagliarola lambs a lower percentage of saturated fatty acids and a low atherogenic index were found. The vitamin E treatment reduced significantly the lipoperoxidation, without difference between the two crossbreeds.

Tumor progression is accompanied by significant changes in the levels of expression of polyamine metabolism regulatory genes and clusterin (sulfated glycoprotein 2) in human prostate cancer specimens.

Using Northern blotting, the expression levels of the genes for polyamine metabolism regulatory proteins and clusterin have been measured in a series of 23 human prostate cancers (CaPs) dissected from radical prostatectomy specimens. Patient matched, nontumor tissue was dissected from benign areas of the gland. The results indicate that transcripts encoding ornithine decarboxylase (ODC), ODC antizyme, adenosylmethionine decarboxylase, and spermidine/spermine N1-acetyltransferase (SSAT) were significantly higher, whereas clusterin (sulfated glycoprotein 2) mRNA was significantly lower in tumors compared with the benign tissue. All mRNA levels were compared with those of histone H3 and growth arrest-specific gene 1, markers of cell proliferation and cell quiescence, respectively, and glyceraldehyde 3-phosphate dehydrogenase, a housekeeping gene. In poorly differentiated and locally invasive CaPs and in tumors with unfavorable prognosis or total prostate-specific antigen (PSA) levels > 10.0 ng/ml at diagnosis, an overall increase in the levels of H3 mRNA and a decrease in growth arrest-specific gene 1 mRNA was detected, indicative of higher proliferation activity, whereas the differences in expression levels for the polyamine metabolism and clusterin genes were higher. ODC and SSAT changes were positively correlated in normal tissue but not in high-grade cancer, whereas ODC antizyme and SSAT changes were positively correlated in more malignant CaPs but not in normal tissue. Tumor classification based on the changes in expression levels of all of the genes studied could be correlated to differentiation grade and local invasiveness classification systems in 72.2 and 83.3% of the cases, respectively. In a 1-year follow-up period, three patients whose CaPs ranked as less aggressive according to clinical staging, but classified as advanced cancers with the proposed molecular classification, showed increases in total PSA levels, indicative of tumor relapse. Thus, molecular classification, based on gene expression, may enhance the available prognostic tools for prostate tumors.

Total anorectal reconstruction by double graciloplasty: experience with delayed, selective use of implantable pulse generators.

This study reports our experience with total anorectal reconstruction (TAR), supported at a later phase, whenever necessary, by an implantable pulse generator. Thirteen patients underwent total anorectal reconstruction by double graciloplasty, diverting loop colostomy, and implantation of temporary electrodes. External-source, short-term, intermittent electrostimulation and biofeedback were used for neosphincter voluntary control training. After abdominal stoma closure, 6 months after initial surgery in disease-free patients, functional results were evaluated by a scoring system and anomanometry. A pulse generator was implanted whenever continence was judged unsatisfactory. After continuous electrostimulation training, neosphincter function was reassessed. Major graciloplasty complications (partial muscle necrosis and perineal colostomy necrosis) were treated successfully by surgery. One death of myocardial infarction occurred after discharge. Three patients refused further surgery. One patient did not undergo abdominal stoma closure because of early hepatic metastases. Functional evaluation after closure (eight patients) showed the following results: two "excellent" (no pulse generator implanted), three "good" (two stimulator implantations, with an "excellent" result), two "fair", and one "poor" (3 implantations, with a "good" result). In addition to improving clinical results (P=0.042), resting anal pressures were also increased significantly by active an implantable pulse generator (P=0.043). Although stimulators, whenever implanted, improved the neosphincter function, delayed, selective use of these in some cases rendered an implantable pulse generator either unnecessary from a functional viewpoint or redundant because of cancer recurrence or infectious complications. Drawbacks to the procedure were poor patient compliance to neosphincter training and to multiple surgical procedures, and excessive wasting of human resources during training for intermittent electrostimulation and biofeedback.

[Tumefaction of the parotid region. The clinico-surgical experience of 3 years]. / Tumefazioni della regione parotidea. Esperienza clinico-chirurgica di un triennio.

The pathologic processes involving the parotid gland area include a vast, heterogeneous group of lesions, consisting of dysembryopathies, traumas, acute and chronic inflammation, degenerative manifestations, benign tumours and both primary and secondary malignancies. This gland, or rather the whole parotid gland area, can be a site of secondary invasion, due to the presence of intra- and peri-parotid lymph nodes; the metastases usually deriving from small, sometimes unrevealed tumours. Treatment of parotid gland tumours is mainly surgical; in most cases the choice of therapy depends on the clinical features and the results of preoperative diagnostic tests. This paper presents our experience during the last three years of clinico-surgical activity in this field and discusses the treatment of primary and secondary tumours of the parotid gland area.