[Atrial fibrillation and thyroid nodules]. / Fibrillazione atriale e noduli tiroidei.

Our previous papers reported an association between atrial fibrillation and supracentimeter thyroid nodules. Recently we noticed that the number of patients admitted to our ward presenting this relationship, was higher than average data relating to whole world's population. In this study we tried to prove the existence of this association in a selected group of inpatients aged between 71 and 80. This to rule-out any age-related confounding factor. We enrolled one hundred inpatients, aged between 71-80. Each patient underwent TSH, FT3, FT4 determination, ECG and thyroid ultrasound examination. 55 males and 45 females: 25 with atrial fibrillation (group A) and 75 without atrial fibrillation (group B). In group A, 80% had supracentimeter thyroid nodules, whereas in group B, only the 6.7% showed supracentimeter thyroid nodules. The rate of supracentimeter thyroid nodules in inpatients without atrial fibrillation (group B) was in line with that found in many studies about whole world's population (4-10%). On the contrary, subjects with atrial fibrillation (group A) showed a rate of supracentimeter thyroid nodules significantly higher (p < 0.001). These findings confirm our previous studies even in more age homogeneous peoples. Moreover, they suggest a link between atrial fibrillation and thyroid nodules. Cytokines and growth factors (IGF-1, EGF, FGF) might act like a connection between nodule goitre and atrial fibrillation.

[Celiac disease and myelodysplastic syndrome. A case report]. / Un paziente con malattia celiaca e sindrome mielodisplastica.

Celiac disease is an immune-mediated disorder induced by the intake of gluten proteins involving primarily the gastrointestinal tract. Myelodysplastic syndromes are clonal hematologic disorders, expanded from myeloid stem cells of uncertain pathogenesis. Anaemia is a common finding in patients with celiac disease. Frequently it is secondary to malabsorption of iron, folic acid or vitamin B12 and usually disappears completely with a strict adherence to a gluten-free diet and supplement of deficient factors. To the best of our knowledge, in medical literature only two cases of myelodysplastic syndrome associated with celiac disease have been described. Here we describe the case of a patient affected by adult celiac disease who went into remission following a gluten free diet. Later a macrocytic anaemia without vitamin B12 or folate deficiency appeared. Hematologic tests showed findings consistent with refractory anemia with ring sideroblasts. The association of celiac disease with myelodysplastic syndromes seems not to be casual. It raises the hypothesis of a primitive immunological disorder in both diseases.

[Hypokalemia from ectopic ACTH secretion and hypothiroidism in patient affected by small cell lung cancer]. / Ipokaliemia da produzione ectopica di ACTH ed ipotiroidismo in paziente affetto da microcitoma.

Endocrin paraneoplastic syndromes are characterized by an ectopic hormonal production. The ectopic adrenocorticotropic hormone (ACTH) secretion is often associated with small cell lung cancer. We report the case of 64-years-old man with persistent hypokalemia in Cushing's syndrome due to ectopic ACTH secretion. The patient was affected by small cell lung cancer and presented an hypothiroidism too. A proper chemotherapy resulted in remission of the hypokalemia, but the hypothiroidism was not influenced during our observation period.

[Pure red cell anaemia secondary to medullary B cell chronic lymphoproliferative disorders. A rare case]. / Aplasia eritroide pura secondaria a disturbo linfoproliferativo cronico midollare primario a cellule B. Un caso inusuale.

Acquired erythroblastopenia is rather rare, more frequent in adult or old male. In absence of anti EPO antibody, it's associate to inhibition of the erythroid growth mediated by suppressive T lymphocytes, generally T8 or NK or mediated by IgG antibody in association with timoma, lymphoproliferative or immunological disorders, and other diseases. The course usually is chronic and follows that of the associate pathology. We report a case with pure red cell anaemia associated to non classified medullary B cell lymphoproliferative disorder in an old woman with complete remission after steroid therapy.

[NT-proBNP in elderly inpatients: an useful marker for detecting heart failure?]. / NT-proBNP nei pazienti anziani: un valido marcatore per la diagnosi di scompenso cardiaco?

In this study we try to determine a cut off for detecting heart failure (HF) with the highest sensitivity and specificity in a population of hospitalized people aged > or = 65 years and to identify potential confounding variables for the interpretation of plasma concentration of the marker. We evaluated 212 consecutive patients admitted to our Department of Medicine, the only inclusion criterion being an age > or = 65 years. We identified a group with clinical and/or instrumental HF, and among remaining patients we selected a normal group without obvious cardiac disease. The strongest predictors of higher levels of NT-proBNP resulted age and free-triiodothyronine as in all models they were strongly associated with Log NT-proBNP. Using receiver-operating characteristics (ROC) curves, we found an optimal discriminatory value for detecting HF in 879 pg/ml for subjects aged between 65 and 74 years and 1658 pg/ml for subjects aged > or = 75 years. In elderly hospitalized patients the discriminatory cut offs of NT-proBNP for the diagnosis of HF are significantly higher than community derived reference values. Adjustments for the independent effects of age and other confounding variables appear necessary.

[Abdominal ultrasound features in heart failure]. / Reperti in corso di ecografia addominale di pazienti con scompenso di cuore.

Heart failure involves many organs and systems. Because of heart failure is one of the most common admission diagnosis in a Medical Ward, we sought their abdominal ultrasound features in addition to the cardiac ones.

[Venous thromboembolism risk in medical inpatients]. / Rischio di tromboembolismo venoso nel paziente internistico.

Venous thromboembolism is one of the main causes of morbidity and mortality in many diseases, either in medical or in surgical wards. The aim of this study is to determine its frequency in a medical ward and to find all the patients who need a prophylaxys. We examined all the inpatients admitted in our Department during a period of three years, selecting all subjects affected by venous thromboembolism. Patients affected by metastatic cancer, namely pancreatic one, or congestive heart failure showed higher risk to develope venous thromboembolism. A prompt heparinic prophylaxys could reduce thromboembolic events. Male gender could be a further risk factor.

Stroke is related to lower serum thyrotropin levels in patients with diabetes mellitus.

INTRODUCTION: Low serum thyrotropin has been related to the presence of stroke as well as to a higher incidence of cardiovascular disease in the general population. Furthermore, abnormalities in serum thyrotropin have been observed in diabetic patients even if unaffected by known thyroid illness. On this basis we investigated whether stroke is associated with altered thyrotropin concentrations in a hospitalised population categorised for the presence of diabetes. PATIENTS AND METHODS: This study used a database concerning all patients consecutively admitted to hospital and discharged alive with a diagnosis of stroke or of transient ischemic attacks (TIA) confirmed by clinical and CT criteria during an 18-month period. The study group was composed of 698 (392 M/306 F) patients, aged 74+/-12(SD) years of whom 372 were affected with TIA and 326 with stroke. RESULTS: The median thyrotropin level was significantly lower in diabetic patients (0.91 mU/l) than in the non-diabetic group (1.3 mU/l; P=0.0001). Patients with stroke, compared to those with TIA, were older, had higher blood pressure, higher prevalence of diabetes and lower serum thyrotropin (median value in TIA group: 1.30 mU/l (95% CI 0.25-4.63) vs. 1.04 (95% CI 0.18-3.76) in the stroke group, P=0.03), stroke being significantly associated with reduced median thyrotropin only in diabetic patients (n=239; 0.82 mU/l, vs. 1.09 mU/l in diabetic group; P<0.05, and 1.21 mU/l vs. 1.37 mU/l in the non-diabetic group; P=NS). Stroke severity, as assessed by NIHSS, was weakly inversely related to thyrotropin levels. Finally, after adjusting for main confounders, the odds ratio for stroke in the first thyrotropin quartile was significantly higher only in diabetic patients (OR: 3.56; 95% CI: 1.55-8.19; P<0.01 by trend test). CONCLUSIONS: In conclusion, our findings suggest that stroke is significantly associated with low serum thyrotropin in patients with diabetes.