Primary malignant fibrous histiocytoma of the mesocolon transversum.

Primary malignant fibrous histiocytoma (MFH) is a rare and biologically aggressive tumor. Differential diagnosis must include cystic neoplasms of the pancreas (mucinous and serous cystoadenoma or cystocarcinoma), cystic lymphangioma or mesothelioma and retroperitoneal haematoma. Making the right diagnosis preoperatively may be often difficult, but MFH may be suspected when a huge retroperitoneal mass is found at imaging in elderly patients. We report a case of a primary abdominal MFH originating from the mesocolon transversum.

Role and clinical importance of Helicobacter pylori infection in hemodialysis patients.

Dyspepsia is an extrarenal symptom frequently found in hemodialysed patients; it is due to chronic renal failure, and uremic gastritis is a specific associated condition in chronic renal failure (CRF). On the other hand, in the general population, Helicobacter pylori infection is an important dyspepsia-related risk factor; its close connections with gastro-duodenal pathology are already known, above all the peptic disease in a really exclusive way. By observation of a dyalitic group of patients, opportunely matched with a no CRF group, we evaluated CRF-associated uremia and Helicobacter pylori infection which could eventually interact causing symptoms and lesions. A statistical analysis of obtained data allowed us to conclude that, although there is not, from an epidemiological view-point, a larger diffusion of Helicobacter pylori among dyalitic patients compared to general population, moreover the infection is uremia-synergic in causing gastro-duodenal symptoms and lesions. These findings, therefore, suggest systematically investigation a possible Helicobacter pylori infection in CRF patients and its relation to gastritis grading, and searching for probable active peptic lesions.

Iatrogenic hypoparathyroidism after surgery for retrosternal goitre. A single centre retrospective analysis.

AIM: The aim of this study is to assess, retrospectively, the incidence of secondary hypoparathyroidism after total thyroidectomy in patients with retrosternal goitre. MATERIAL AND METHODS: From January 2009 to September 2015, 622 patients who undergone total thyroidectomy for goitre, were retrospectively observed. The patients were divided into two group: Group A, including 58 patients with retrosternal goitre and Group B, including 562 patients with in situ goitre. Those patients with diseases of the parathyroid glands, assumption of drugs modifying calcium metabolism and who received blood transfusions before or after surgery, were excluded from the study. In both groups, a total thyroidectomy was performed under general anaesthesia. The upper and lower parathyroid glands in both groups were observed in situ as well. All surgical specimens underwent histological examination. RESULTS: Transient hypocalcaemia was observed in a higher percentage in group A (15% vs 7%, P <0.05). The mean hospital stay was greater in group A (P <0.05). There were no statistically differences between the two groups in terms of permanent hypocalcaemia and post-operative blood ionized calcium (72hours and 1 month). CONCLUSIONS: Many efforts should be made to respect parathyroids during total thyroidectomy in retrosternal goitre; greater attention should be given to inferior parathyroid glands that should be displayed, respecting the vasculature and performing a terminal lower thyroid artery ligation in order to reduce the risk of transient hypocalcaemia and - as a consequence - the average hospital stay.

Ultrasound-guided port-a-cath positioning with the new one-shoot technique: thoracic complications.

OBJECTIVES: Port-a-cath catheterization is often required for those patients who need long-term therapies (malnutrition, neoplasm, renal failure, other severe diseases). The use of ports for a wide range of indications is not exempt from complications. Ultrasound-guided central venous catheterization (CVC) is a safe and fast technique for the introduction of the catheter inside a central vein. This retrospective study reports our experience with US-guided CVC in patient eligible for port-a-cath implantation. MATERIALS AND METHODS: From January 2007 to March 2017, 108 CVC (out of 770 procedures), were positioned using an ultrasound guide, with the new "one-shoot technique" (group 1) and the classic Seldinger technique (group 2). RESULTS: One-shoot techniques showed a reduced operative time, in comparison to Seldinger technique, with a negligible minor complication rate. No major complication were evidenced. CONCLUSIONS: CVC is a safe procedure, although not free from complications. Ultrasonography enhances safety of the procedure by decreasing puncture attempts and complications; it is helpful in patients with vascular anatomical variations, with no visualized or palpable landmarks or for patients with coagulation disorders.

Advantage of eradication therapy for Helicobacter pylori before kidney transplantation in uremic patients.

From January 1999 to February 2007, 61 end-stage renal disease (ESRD) candidates for kidney transplantation underwent an esophagogastroduodenoscopy (EGDS) to detect Helicobacter pylori (HP). We correlated treatment for HP before transplantation and upper digestive tract hemorrhagic complications and possible recurrence of peptic disease posttransplantation. The 32 (52.4%) HP-Positive cases were divided into 2 groups: (1) 17 patients who underwent treatment for the eradication of the infection with 40 mg/d omeprazole for 4 weeks, 500 mg claritromycin twice daily for 7 days, and 2 g/d amoxicillin for 7 days; and (2) 15 untreated patients. No significant differences were found in the hemorrhagic erosive gastritis of patients with regard to the treated HP-Positive and nontreated HP-Positive patients (2 vs 3) and between the HP-negative patients and the nontreated HP-Positive patients (2 vs 3). The presence of gastric or duodenal ulcers was significantly higher in the nontreated patient than in the treated HP-positive patients (5 vs 1; P=.05) and significantly higher in the nontreated HP-Positive patients than in the HP-negative patients (5 vs 0; P=.05). We concluded that HP-positive patients should therefore be treated for the infection to avoid a long-term significant increase of gastric and/or duodenal peptic disease subsequent to renal transplantation in these immunodepressed subjects.

Use of monitoring intraoperative parathyroid hormone during parathyroidectomy in patients on waiting list for renal transplantation.

This report describes the use of intraoperative parathyroid hormone (ioPTH) assay during parathyroidectomy for patients with secondary hyperparathyroidism on the waiting list for renal transplantation. The levels of ioPTH were determined among waiting list patients undergoing subtotal parathyroidectomy and tertiary hyperparathyroidism patients undergoing procedures. The levels of ioPTH were significantly reduced at 10 minutes by 59.7,3% among with secondary hyperparathyroidism and 68.9% among tertiary hyperparathyroidism. A 15 minutes it was 85% in secondary hyperparathyroidism and 89.7% in tertiary hyperparathyroidism. A decrement of 50% in basal values at 10 minutes and 85% decrement or more at 15 minutes was predictive for the success of abnormal parathyroid gland removal. The application of this technique during subtotal parathyroidectomy results was useful to predict a correct excision of abnormal parathyroid glands among patients with secondary hyperparathyroidism on the waiting list and for tertiary hyperparathyroidism patients.

[The role of colonoscopy in patient follow-up after surgery for colorectal cancer. A retrospective study and review of the literature]. / L'utilità della colonscopia nel follow-up dei pazienti operati per cancro del colon-retto. Analisi retrospettiva e revisione della letteratura.

To improve survival rate after colon or rectum resection for cancer patients should be strictly followed up in order to identify possible local disease relapse or metachronous neoplasia. From October 2002 to January 2006, 864 patients had undergone colonoscopy and 68 were treated surgically for colorectal adenocarcinoma. Of these, 36 were men and 32 women, with a mean age of 63 years. Nineteen of the patients underwent a left colectomy, 28 an anterior resection, 18 a right colectomy and 3 a resection of the transverse colon. For all these patients follow-up program include a colonoscopy performed annually for the first two years, and subsequently, if the results were negative, after a further three and then five years. Out of 68 patients, 2 showed suspect anastomotic recurrence, which proved to be granulomas at the histological examination. In addition, in 11 cases, there were 3 right colon adenomatous polyps, 2 transverse colon polyps (one villous and the other tubular), 5 descending colon polyps (three tubular and two villous) and 1 tubulo-villous polyp of the rectum. No metachronous neoplasias were observed. An examination of the data resulting from our own 68 cases shows that, in spite of the fact that no local disease relapse or metachronous neoplasia was observed, the identification of 11 polyps would suggest that the use of colonoscopy in such patients might be the gold standard for early diagnosis of recurrences and new polyps.

[Risk factors' analysis of transient and permanent hypoparathyroidism after thyroidectomy].

AIMS: This review evaluates those main risk factors that can affect patients undergoing thyroidectomy, to reach a better pre- and post-operative management of transient and permanent hypoparathyroidism. DISCUSSION: The transient hypoparathyroidism is a potentially severe complication of thyroidectomy, including a wide range of signs and symptoms that persists for a few weeks. The definitive hypoparathyroidism occurs when a medical treatment is necessary over 12 months. Risk factors that may influence the onset of this condition after thyroidectomy include: pre- and post-operative biochemical factors, such as serum calcium levels, vitamin D blood concentrations and intact PTH. Other involved factors could be summarized as follow: female sex, Graves' or thyroid neoplastic diseases, surgeon's dexterity and surgical technique. The medical treatment includes the administration of calcium, vitamin D and magnesium sometimes. CONCLUSIONS: Although biological and biochemical factors could be related to iatrogenic hypoparathyroidism, the surgeon's experience and the used surgical technique still maintain a crucial role in the aetiology of this important complication.

The medical and surgical treatment in secondary and tertiary hyperparathyroidism. Review.

INTRODUCTION: Hyperparathyroidism is an alteration of the pathophysiological parathyroid hormone (PTH) secretion due or an independent and abnormal release (primary or tertiary hyperparathyroidism) by the parathyroid or an alteration of calcium homeostasis that stimulates the excessive production of parathyroid hormone (secondary hyperparathyroidism). AIMS: There is not a standard, clinical or surgical, treatment for hyperparathyroidism. We review current diagnostic and therapeutic methods. DISCUSSION: In secondary hyperparathyroidism (2HPT) there is a progressive hyperplasia of the parathyroid glands and an increased production of parathyroid hormone. Several causes are proposed: chronic renal insufficiency, vitamin D deficiency, malabsorption syndrome. The tertiary hyperparathyroidism (3HPT) is considered a state of excessive autonomous secretion of PTH due to long-standing 2HPT and it's usually the result of a lack of suppression in the production of PTH. The pathophysiological implications are both skeletal and extraskeletal: it damages the cardiovascular system, nervous system, immune, hematopoietic and endocrine system. The introduction of new drugs has improved the survival of these patients, allowing the inhibition of the synthesis of PTH. Indication for surgical treatment is unresponsive medical therapy. CONCLUSIONS: There are no large prospective studies that comparing the medical and surgical treatment. The choice is not unique and we have to consider the singolar case and the clinical condition of the patient.

[Laparoscopic treatment of adrenal myelolipoma: case report and review of the literature]. / Trattamento laparoscopico del mielolipoma surrenalico: caso clinico e revisione della letteratura.

Adrenal myelolipoma is a rare benign, non-functioning tumor consisting of fat and hematopoietic tissues. In January 2005 we had observed an adrenal myelolipoma in 70 year old man. During the follow-up for bladder urothelioma, an abdominal CT revaled a well delineated 4x4 cm homogeneous fatty mass in the right suprarenal area with negative attenuation values. The functional study of adrenal gland was normal. The patient underwent videolaparoscopic right adrenalectomy (Gagner technique). Postoperative course was uneventful. The istological diagnosis showed adrenal myelolipoma. We conclude that videolaparoscopic adrenalectomy should be considered the gold standard treatment for benign adrenal lesions.

[Laparoscopic cholecystectomy in uremic patients]. / La colecistectomia laparoscopica nel paziente uremico.

The aim of this study was to evaluate the effectiveness of the laparoscopic cholecystectomy performed in two uremic patients with gallstones. From January to July 2004, 15 patients with gallstones underwent to laparoscopic cholecystectomy (LC). Two patients had chronic renal failure on haemodyalisis: a symptomatic fourty-two old woman, which had primitive hyperparathyroidism and primitive hyperaldosteronism, and asymptomatic transplant candidate fifty-five old man. No minor and major complications occurred and both patients were discharged 4 days after LC. Even in uremic patients the L. C. must be the gold standard for the treatment of gallstones both symptomatic and asymptomatic.

Does FAD-dependent polyamine oxidase contribute to the metabolism of milacemide?

Milacemide, a secondary amine derivative, was previously demonstrated to be a substrate of MAO-B and to be insensitive to the action of copper-dependent amine oxidases. In the present study, it was investigated whether the FAD-dependent secondary amine metabolizing enzyme polyamine oxidase (PAO), could participate in the metabolism of milacemide. For this purpose, the urinary metabolic pattern of oral 14C-milacemide was determined in rats with and without pretreatment with the irreversible PAO inhibitor MDL 72527 and, for comparison, after inhibition of MAO-B by l-deprenyl. While l-deprenyl was shown to significantly decrease the urinary excretion of glycinamide and of an unknown metabolite (UK1), pretreatment with MDL 72527 did not modify the elimination of milacemide as glycinamide but produced a decrease in UK1 equal to that induced by l-deprenyl. The percent of the dose of milacemide eliminated as unchanged drug was slightly but significantly increased after PAO inhibition, though considerably less than after l-deprenyl. These data suggest that milacemide might be a substrate of PAO. If confirmed, this result would constitute the first example of the involvement of the FAD-dependent PAO in drug metabolism.

MAO activity, metabolism and anticonvulsant activity of milacemide in rats and mice.

Milacemide was found to protect Swiss albino CD1 mice but not Sprague Dawley rats against bicuculline-induced lethality. Since it had been previously suggested that the anticonvulsant activity of milacemide might be related to MAO-B- mediated glycine formation, brain and liver MAO-A and-B activities and the urinary metabolic pattern of milacemide were determined in the same mice and rat strains. Similar brain and liver MAO activities were found in the two species, except for liver MAO-A activity which was higher in rats. After the same oral dose of milacemide, the percent of the dose excreted as glycinamide was significantly higher in mice than in rats, whereas that excreted as metabolite UK1 was significantly higher in rats. These results support the hypothesis of a glycine-mediated anticonvulsant activity for milacemide and suggest that the increased formation of UK1 to the detriment of glycinamide might account for the lack of protection against bicuculline-induced lethality by milacemide in rats.

Excretion balance and urinary metabolic pattern of [3H]cabergoline in man.

After oral administration of [3H]cabergoline to man at a single nominal dose of 0.6 mg/subject radioactivity is mainly eliminated by the faecal route (72% of the dose after 10 days). Urine contains 18% of the dose after the same period. The unchanged drug and metabolites present in urine were identified by comparison with reference compounds and quantified by radio-TLC analysis. Cabergoline is extensively metabolized. Unchanged drug in 0-24 h urine represents less than 14% of urinary radioactivity, reaching 20% in 0-96 h urine. The acid derivative FCE 21589 is the main metabolite, amounting to 38% and 30% of the urinary radioactivity in 0-24 h and 0-96 h urine, respectively. The amide derivative FCE 21590 appears to be present in only a small amount, accounting for no more than 4% of the urinary radioactivity in the urine of the first 24 hours after administration and increasing to about 8% in the 0-96 h urine.

Metabolic fate of FCE 22716, a new antihypertensive agent, and of its N-oxide (FCE 24220) in the rat.

[3H]-FCE 22716 and [3H]-FCE 24220 were given both orally and intravenously to the rat. Radioactivity was mainly eliminated by the faecal route after oral administration in both cases. After intravenous administration, renal excretion was twice the faecal one in the case of FCE 22716, whereas for FCE 24220 the two routes were equal. In urine FCE 22716 was eliminated almost completely unchanged after both oral and intravenous administration. FCE 24220 was extensively reduced to FCE 22716 after oral administration, whereas after intravenous treatment, this reduction, although important, was not complete.

Comparison of the disposition and of the metabolic pattern of Reboxetine, a new antidepressant, in the rat, dog, monkey and man.

The purpose of this study was to compare the disposition and the metabolic pattern of Reboxetine in several species, including man. [14C]-Reboxetine was given orally to the rat, the dog, the monkey (5 mg/kg) and man (2 and 4 mg/kg). Radioactivity was eliminated both by the renal and faecal route in the rat and the dog, mainly in urine in the monkey and man. Reboxetine was extensively metabolized. A number of urinary metabolites were quantified by radio-HPLC and tentatively identified by comparison with the retention times of reference compounds. Suggested routes of metabolic transformation are: 2-O-dealkylation; hydroxylation of the ethoxyphenoxy ring; oxidation of the morpholine ring; morpholine ring-opening; and combinations of these. Metabolites were partially or completely conjugated with glucuronic acid and/or sulphuric acid.

[Advantages in the ultrasound guided central venous catherization (new notes of technique)]. / Vantaggi degli ultrasuoni nel posizionamento di un agocannula nella vena giugulare interna (nuove note di tecnica).

The authors analyzed the results of 175 central venous catheterization CVC of internal jugular vein performed with the ultrasound guide (US) from January 1998 to October 2002. The average performing time was 4.5 minutes, 98.2% of success and 4% of complications (one vagal hypotension, one artery puncture, four catheter dislocation, one haematoma). The US guide CVC is a safe procedure with short performing time, low rate of failures and complications and high rate of success; it is helpful in all patients with vascular anatomical variations, with not visualized or palpable landmarks and with coagulation disorders.

[The surgical treatment of nodular thyroid lesions: our experience. Analysis of 462 cases]. / Il trattamento chirurgico delle lesioni nodulari tiroidee: nostra esperienza. Analisi di 462 casi.

Nodular thyroid lesions are the most frequent endocrine diseases in the general population. The surgical procedure is indicated for nodular thyroid tissue degeneration, or when the suppressive pharmacologic therapy is less efficient, even if sometimes both factors are associated. In Authors' study 462 patients were observed who underwent surgical procedures for thyroid diseases between January 1997-April 2003. In the thyroid pathology, either uninodular or multinodular, the surgical therapy adopted is total thyroidectomy, according to other Authors. The aim of total thyroidectomy is to avoid recurrence and simplify long term pharmacologic treatment. Although the question about the surgical approach (total thyroidectomy vs lobectomy) is still open in the case of single monolateral lesions, on the basis of their experience the Authors believe that the first is the best procedure. For diffused or malignant nodular thyroid pathology, on the contrary, total thyroidectomy is widely adopted.

A simple technique to improve residual skin plasticity for scrotal reconstruction in Fournier's Gangrene.

A 50 years-old man developed 24 hours after hemorrhoidectomy a severe Fournier's gangrene of the scrotum necessitating surgical exeresis of more than 2/3 of scrotal skin followed by hyperbaric oxygen therapy. After the resolution of the septic phase, scrotum reconstruction was obtained by tissue expansion to avoid more invasive advanced reconstructive techniques. The procedure consisted of an enzymatic and mechanical debridement and progressive skin expansion by package of gauzes of increasing volume covered with a collagenasecloramphenicol ointment (Iruxol®- Smith and Nephew, Italy), then closing the wound edges by temporary stitches to put under tension the skin. The reestablishment of the natural elasticity of the scrotal skin was obtained in ten days and at the final closure of the wound edges an acceptable optimal aesthetic result was achieved.