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Atti della Accademia Peloritana dei Pericolanti - Classe di Scienze Medico-Biologiche
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ISSN (Online) 1828-6550
Published by Accademia Peloritana dei Pericolanti Homepage  [1 journal]
  • Endoscopic thyroidectomy: why we need a transoral approach

    • Authors: Antonina Catalfamo, Fausto Famà, Francesca Pia Pergolizzi, Maribel Cristina Sanchez Cruz, Giorgio De Pasquale, Sam Mahli, Gianlorenzo Dionigi
      First page: 1
      Abstract: Transoral thyroidectomy (TT) is a feasible novel surgical procedure that does not need visible incisions, a truly scar-free surgery. Inclusion criteria are (a) patients who have a ultrasonographically (US) estimated thyroid diameter not larger than 10 cm, (b) US estimated gland volume ≤45 mL, (c) nodule size ≤50 mm, (d) a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter, (e) follicular neoplasm, (f) papillary microcarcinoma without evidence of metastasis. The procedure is carried out through three-port technique placed at the  oral vestibule, one 10-mm port for 30° endoscope and two additional 5-mm ports for dissecting and coagulating instruments. CO2insufflation pressure is set at 6 mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch, laterally to the sterncleidomuscles. TT is done fully endoscopically using conventional endoscopic instruments. TT represents probably the best scarless approach to the thyroid due to the short distance between the thyroid and the incisions, respecting the surgical planes.
      PubDate: 2017-12-21
      Issue No: Vol. 105, No. 2 (2017)
       
  • Atypical Presentation of Chronic Granulomatous Disease in a Child

    • Authors: Chiara Cuzzupè, Simona Santucci, Elda Pitrolo, Celeste Casto, Irene Viola, Claudio Romano, Mariella Valenzise, Filippo De Luca
      First page: 1
      Abstract: Chronic granulomatous disease is a rare, inherited immunodeficiency caused by deletions or mutations in genes that encode subunits of the NADPH oxidase complex. The pattern of chronic granulomatous disease inheritance can be X-linked (about 70% of cases) or autosomal recessive. The basic defect lies in phagocytic cells (neutrophils and monocytes) which fail to effectively destroy invading bacteria and fungi. Also, a dysregulated immune response, characterized by extensive granulomatous inflammation of visceral organs, develops in patients. This immunodeficiency is characterized by repeated suppurative infections mainly located in the lungs, skin, and lymph nodes, but also affecting other organs. The major agents involved in the infections are catalase positive bacteria, mycobacteria, fungi, and other opportunistic germs. Diagnosis is based on clinical suspicion and confirmed by nitroblue tetrazolium test or flow cytometry that demonstrate the inability of phagocytes from affected individuals to produce superoxides. The treatment of chronic granulomatous disease involves, in addition to general care such as the prevention of infections and vaccinations, the use of sulfamethoxazole–trimethoprim in combination with itraconazole for prophylaxis. We report the case of a 3-year-old boy with medical history of recurrent respiratory infections, anemia, growth failure, elevated inflammatory markers and occasional rectal bleeding. He was admitted to our department for a suspected chronic bowel inflammatory disease. Clinical history, lymph nodes involvement and the discovery of intestinal granulomas on biopsies confirmed the diagnosis of chronic granulomatous disease.
      PubDate: 2017-12-21
      Issue No: Vol. 105, No. 2 (2017)
       
  • Psychological factors may impacton postmenopausal women fracture risk

    • Authors: Federica Bellone, Antonino Catalano, Gabriella Martino, Carmen Lasco, Annamaria Pugliese, Nunziata Morabito
      First page: 1
      Abstract: Anxiety and osteoporosis are common diseases and major public health problems. The association between  anxiety levels and bone loss was poorly investigated, thus we aimed to explore whether anxiety severity could be considered as an independent fracture risk. In a setting of postmenopausal women we measured anxiety levels by Hamilton Anxiety Rating Scale (HAMA), depressive symptoms by Beck Depression Inventory and evaluated quality of life by the 36-Item Short Form Health Survey (SF-36) questionnaire. Women with higher anxiety levels showed lower BMD at lumbar spine and femoral neck, and exhibited a poorer quality of life after grouping our population in tertiles of HAMA score. Anxiety levels were predictive of reduced BMD after correcting for other known clinical risk of fractures.
      PubDate: 2017-12-21
      Issue No: Vol. 105, No. 2 (2017)
       
  • What do we know about occult hepatitis B virus infection'

    • Authors: Francesca Saffioti, Giovanni Raimondo
      First page: 2
      Abstract: Occult hepatitis B virus (HBV) infection (OBI) is recognized as one of the phases in the natural history of chronic HBV infection and defines the persistence of HBV genomes in the hepatocytes of individuals testing negative for HBV surface antigen (HBsAg) and detectable or undetectable HBV DNA in the serum. Occasionally, OBI is related to the infection with mutant viruses producing a modified HBsAg undetectable by diagnostic kits or with replication-defective variants. However, in most cases OBI is due to replication-competent viruses that are strongly suppressed in their activities by the host’s defence mechanisms. Growing evidence indicates that genetic, epigenetic and post-transcriptional mechanisms may be involved in the control of HBV activities and in the OBI occurrence.  OBI may be involved in several different clinical contexts, which can be grouped in four main categories: 1) transmission of the “occult” virus (mainly, through blood transfusion and orthotopic liver transplantation from OBI donors) causing classic forms of hepatitis B in the HBV naïve recipients; 2) reactivation of the HBV infection following the development of an immunosuppressive status, resulting in acute and occasionally fulminant hepatitis; 3) contribution to the progression of patients with various causes of liver disease toward cirrhosis; 4) involvement in hepatocarcinogenesis, likely through the maintenance of the direct and indirect pro-oncogenic properties typical of the overt HBV infection (such as the capacity to integrate in the host’s genome and to synthesize pro-oncogenic proteins) and by provoking a mild but persisting necroinflammation which favours cirrhosis development.
      PubDate: 2017-12-21
      Issue No: Vol. 105, No. 2 (2017)
       
  • Thyroid dysfunction in patients treated with the immune checkpoint
           inhibitor nivolumab: different clinical features

    • Authors: Giuseppe Giuffrida, Alfredo Campennì, Francesco Trimarchi, Rosaria M. Ruggeri
      First page: 2
      Abstract: Rationale. Immune Checkpoint Inhibitors (ICIs) are approved for some advanced neoplasms, increasing survival. ICIs block inhibitor receptors cytotoxic T lymphocyte antigen 4 (CTLA4) and programmed death-1 (PD-1) and trigger T cell-mediated immunity against tumor. Their action is accompanied by several immunity-related adverse events (IRAEs), also involving the endocrine system (pituitary, thyroid, adrenals). We report two different cases of thyrotoxicosis following administration of the anti-PD-1 nivolumab. Patients. Patient 1, M, 75 years-old, treated for non-small cell lung carcinoma (NSCLC) since September 2016, with euthyroid multinodular goiter. In January 2017 (12 weeks from baseline), he developed frank hyperthyroidism, with positive TSH-receptor antibodies (TRAb) and thyroperoxidase antibodies (TPOAb). A Tc99m thyroid scintiscan showed diffuse uptake and “cold” areas. After nivolumab withdrawal, treatment with metimazole (MMI) 5 mg per day was started and euthyroidism was resumed, so to restart the drug in May 2017. Patient 2, M, 80 years-old, treated for a left-eye choroid melanoma since January 2017, with euthyroid nodular goiter. In April 2017 (6 weeks from baseline), thyrotoxicosis was detected, with positive thyroglobulin antibodies (Tg-Ab, 244 IU/ml, nv <4) and no scintiscan uptake, as in destructive thyroiditis. Scalar-dose prednisone was initiated, and after 3 months TSH was >4.5 µIU/ml (subclinical hypothyroidism). Patient was treated with replacement doses of levothyroxine (LT-4), and continued nivolumab infusions. Conclusions. Two forms of thyrotoxicosis were reported: the first with thyroid hyperfunction and positive TRAb, the latter as a destructive thyroiditis. In both cases (mean onset after 9 weeks), the moderate severity and the appropriate management of endocrine IRAEs allowed treatment continuation.
      PubDate: 2017-12-21
      Issue No: Vol. 105, No. 2 (2017)
       
  • The influence of cognitive factors on pathological gambling

    • Authors: Tindara Caprì, Angela Foti, Rosa Angela Fabio, Annamaria Pugliese, Gabriella Martino
      First page: 2
      Abstract: The purpose of this study wasto examine the role of cognitive factors, such as superstition, locus of control, decision-making and unrealistic optimism,on gambling.Eighty-six subjects participated in this study. They were divided into four groups: non-players, social players, problem gamblers, and pathological gamblers. Groups were formed on the basis of South Oaks Gambling Screen  Scale. Results showed that pathological gamblers group obtained a high superstition index. With reference to unrealistic optimism, gambler groupbelieved that they had a better chance of success compared to non-gamblers. They also showed a higher impulsivity index in decision making than non-gamblers. This study supports the idea that cognitive factors such as superstition, unrealistic optimism, impulsivity and external locus of control are involved in gambling.
      PubDate: 2017-12-21
      Issue No: Vol. 105, No. 2 (2017)
       
  • Chronic paroxysmal hemicrania in an adult responding to valproate: a case
           report

    • Authors: Daniela Parisi, Giuseppe Vita, Massimo Autunno
      First page: 3
      Abstract: Chronic paroxysmal hemicrania (CPH) is a rare primary headache syndrome classified as a trigeminal autonomic cephalalgia. It is characterized by repeated attacks of severe, strictly unilateral and short-lasting pain occurring with cranial autonomic features. The absolute response to indomethacin represents the diagnostic key. Unfortunately, often, treatment with indomethacin may cause adverse events, mostly gastrointestinal. We report the case of a 53-year-old male affected by CPH responding to indomethacin, which had to be withdrawn because of gastric side effects. He had a subsequent good and prolonged response to valproate. Our observation suggests the potential use of valproate as a treatment option in patients with CPH with contraindications or intolerance to indomethacin.
      PubDate: 2017-12-21
      Issue No: Vol. 105, No. 2 (2017)
       
  • In GH-treated girls with Turner syndrome height prognosis may sometimes
           exceed target height: a case report

    • Authors: Giorgia Pepe, Tommaso Aversa, Rosy Civa, Domenico Corica, Letteria Morabito, Filippo De Luca, Malgorzata Wasniewska
      First page: 4
      Abstract: A 5-years-old girl was diagnosed with Turner syndrome (TS) during a diagnostic work-up for short stature and dysmorphic features. Chromosome analysis revealed rare X-chromosomal abnormalities 46 Xt (13:X) (p12:q24). GH therapy was started at the age of 5.5 years, and continued for 7 years with a fixed dose of 0.33 mg/kg/week, until adult height (AH) achievement. Six-monthly assessment of height standard deviation score and height velocity was performed under therapy, evaluating a prepubertal height gain of 31.7 cm and pubertal height gain of 20 cm. She achieved an AH of 159.3 cm, better than her target height (156.8 cm). In addition, she underwent spontaneous puberty at the age of 9.6 years, completed with menarche at 11.6 years and followed by regular menstrual cycles.  During GH treatment, IGF-1, insulin and glucose blood levels remained within a normal range. The early onset of GH therapy may have allowed such a successful height outcome, with the achievement of full stature recovery during childhood and puberty in this TS case. The rare karyotype of our patient may also positively influenced her height final result.
      PubDate: 2017-12-21
      Issue No: Vol. 105, No. 2 (2017)
       
  • An unusual evolution of pneumonia in a child

    • Authors: Simona Santucci, Chiara Cuzzupè, Elda Pitrolo, Francesco Monaco, Carmelo Romeo, Concetta Sferlazzas, Mariella Valenzise, Filippo De Luca
      First page: 5
      Abstract: Pleural empyema represents a severe complication of community acquired pneumonia with an incidence of 0.6% among hospitalized children.  Clinical manifestations of picture may be different in infants and young children and it should always be suspected in a child with pneumonia without significant clinical improvement after 48 hours of antibiotic treatment.  The most common microorganism associated with empyema is Streptococcus pneumoniae, especially in children under 5 years of age. Chest radiograph is the gold standard for diagnosis but chest ultrasonography,  and in some cases chestCT,  may be necessary to study features and evolution of the pleural fluid in order to guide therapeutic choices.  In most cases small pleural empyema responds to antibiotics alone. However in severe and extensive cases, drainage and invasive treatments, like video-assisted thoracic surgery (VATS) and thoracotomy, became necessary.  Due to the early start of antibiotic therapy, blood and pleural fluid cultures may result negative; in these cases only the use of molecular techniques, like polymerase chain reaction in biological fluids, may determine the etiology of the infection.  Here we report the case of previously healthy 8-years-old boy with an important and severe pleural empyema as a complication of S. Pneumoniae pneumonia, that did not respond to antibiotic therapy and thoracocentesis and for which decortication has been necessary. In our patient only molecular analysis on pleuric fluid has allowed us to define the etiology of the process.
      PubDate: 2017-12-21
      Issue No: Vol. 105, No. 2 (2017)
       
  • A case of amiodarone-induced hypothyroidism in a mild to moderate iodine
           deficiency area

    • Authors: Roberto Vita, Salvatore Benvenga
      First page: 6
      Abstract: Thyroid dysfunction associated to amiodarone treatment depends on iodine intake, as thyrotoxicosis occurs more frequently in iodine deficiency areas, whereas hypothyroidism in iodine sufficient areas. We present here a case of severe overt hypothyroidism induced by prolonged treatment with amiodarone for atrial fibrillation in a man living in a low iodine intake area. The case was managed with levothyroxine (LT4) replacement and amiodarone withdrawal. Euthyroidism was restored after two months, and atrial fibrillation has not relapsed to date.
      PubDate: 2017-12-21
      Issue No: Vol. 105, No. 2 (2017)
       
  • Corneal dystrophy in a cocker spaniel dog: a case report

    • Authors: Monica Ragusa, Michela Pugliese, Domenico Britti, Ernesto Palma, Antonio Pugliese
      First page: 7
      Abstract: A 1-year-old female Cocker Spaniel dog was examined at the ophthalmology service of the Veterinary Teaching Hospital - University of Messina (Italy) for evaluation of symmetrical white spots in both corneas and “red eyes”. Dog was clinically healthy, haematological and biochemical examination were unremarkable, Leishmania PCR was negative. After a complete ophthalmic examination, the clinical diagnosis was corneal stromal dystrophy with uveitis-induced. In dogs, corneal stromal dystrophy is a primary, inherited, bilateral opacity of the corneanot associated with ocular inflammation or systemic disease. Detailed description of corneal dystrophy are available only for few breeds. This lesion is not progressive and treatment is not usually recommended unless vision is impaired or the deposits become irritating.
      PubDate: 2017-12-21
      Issue No: Vol. 105, No. 2 (2017)
       
  • Glaucoma and lens subluxation in a crossbred Puli X Pumi dog: a case
           report

    • Authors: Monica Ragusa, Michela Pugliese, Domenico Britti, Ernesto Palma, Antonio Pugliese
      First page: 8
      Abstract: The Pumi is a rare sheep-herding terrier breed dog selected in Hungary from the Puli breed mixed with French and German herding dogs since the 17th century. The current case report described a 9.5 years old, cross-breed Puli/Pumi, male dog with clinical signs of glaucoma and intraocular inflammation accompanied  by lens subluxation and no abnormal gonioscopic findings in the left eye. At the presentation,  the dog appeared painful and blind in the left eye. Diagnose of glaucoma was made at the ophthalmological examination. Furthermore, glaucoma was suspected to be caused by a primary subluxation and vitreous debris. An intensive medical treatment was performed without considerable improve of eye condition, and disruption of ciliary body was finally performed through gentamicin injection. One week after surgery, there was a severe reduction of IOP in the left eye from the preoperative value of 50 mmHg to 9 mmHg. Persistent intraocular inflammation justified postoperative treatment with topical corticoids. So far there are no published reports of inherited ocular conditions in Pumi and in this crossbreed and/or the numbers of individuals for which examinations are recorded are too low to identify the presence of significant ocular disorders. Examinations are encouraged to accumulate information and reduce the likelihood of undetected conditions becoming problematic.
      PubDate: 2017-12-21
      Issue No: Vol. 105, No. 2 (2017)
       
 
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