Rivista europea per le scienze mediche e farmacologiche = European review for medical and pharmacological sciences = Revue europeenne pour les sciences medicales et pharmacologiques最新文献

Hypoparathyroidism following neck surgery, mainly thyroidectomy, is not a rare event, well known since many years. Post-surgical hypoparathyroidism may occur in form of two clinical syndromes of different etiology and prognosis. The first disease is a transitory hypoparathyroidism that might spontaneously recover within a few weeks or months. The second disease is a permanent hypoparathyroidism needing a definitive opoterapic treatment. Anyhow in both cases, hypocalcemic symptoms begin always within a short time from surgery, usually after an asymptomatic period elapsing from days to months. Only few cases of hypoparathyroidism clinically conclamate after many years from surgery have been reported. Description of a patient with hypoparathyroidism that became clinically evident thirty years after the thyroid surgery is herewith described. Our findings and review of a few cases reported by medical literature, can suggest a third form of post-surgical hypoparathyroidism with the distinctive feature of a very late beginning, probably following a long period of a latent parathyroid insufficiency.

To investigate on the presence and significance of Helicobacter pylori (Hp) in Barrett's mucosa, esophageal biopsy specimens from 34 patients with columnar-lined epithelium were retrospectively examined. The incidence of colonization was compared with that observed in a control group of 76 subjects with normal esophageal mucosa or moderate esophagitis. Three of the 34 Barrett's specimens were Hp-positive and only 1 of these showed evidence of inflamed mucosa (p = NS). We do not find in this study any evidence to support the existence of association between Hp and Barrett's esophagus or esophageal inflammation. The presence of Hp in antral mucosa of all positive cases suggest the possibility that esophageal colonisation might merely be a consequence of reflux from the gastric antrum.

The non-Hodgkin's lymphomas (NHL) are usually generalized diseases and can involve almost any organ or tissue. Nevertheless also primary extranodal disease is frequent in NHL and some localizations are accomplished by a worse prognosis (brain, testicle) other, in particular primary gastrointestinal involvement, can be cured in a high percentage of cases with surgery, chemotherapy and radiotherapy. The gastrointestinal localization's symptomatology is not characteristic: abdominal pain is frequent and other symptoms can be present in other gastrointestinal diseases. Endoscopy, radiology and surgery are the most important diagnostic procedures. The first gives important information about the disease and it permits pre-operative diagnosis. The second is useful to detect both nodal extension (CT scan and MRI imaging) and intrinsic stomach or bowel involvement (contrast radiology of the gastrointestinal tract). The third is an important diagnostic and therapeutic moment. Some Authors recently don't agree with this invasive procedures routinely because of its potential morbidity and mortality. The determination of the extent of disease in patients with NHL is very important and serves multiple purposes: information regarding the imminence of potential complications, indication of prognosis and treatment planning. The most used staging system is the Ann Arbor scheme, originally designed for HG disease. This scheme is inadequate in particular for primary gastrointestinal NHL. Others, like Blackledge or Mushoff schemes show more correlation between tumor burden, nodal and extranodal involvement. An exact diagnosis, precise staging and a correct treatment bring to a potential curability.

In the staging of gastric lymphoma, the radiologist has very important role, because he has many means to define correctly the stage. Conventional radiology is useful for detection of the lesion. Moreover, Ultrasound, Computed Tomography, and Magnetic Resonance are useful to define parietal extension and eventual nodal involvement. Lymphography remains a study kept to negative or doubt cases. In the future, the Magnetic Resonance will have a bigger role than now, in the definition of abdominal and pelvis nodal involvement.

Primary gastrointestinal Lymphoma is a relatively infrequent tumor, who could be effectively treated with both surgery and chemotherapy or radiotherapy. The design of treatment depends on prognostic factors, namely stage and histologic grade. The most functional staging system seems that of Mushoff, while the recent concept of "Mucosa-associated lymphoid tissue" has allowed to correlate the histologic grading with prognosis. Surgery is the most used therapeutic approach in IE and IIE stages, but both chemotherapy and radiotherapy or their combination seem to have similar activity. Adjuvant chemo- and/or radio-therapy after surgery increases survival compared to surgery alone. Chemotherapy is the treatment of choice in more advanced stages.

The incidence of hypotension in patients treated with thrombolytic agents for myocardial infarction was investigated in a series of 71 patients, 17 treated with urokinase, 35 with rtPA and 19 with APSAC. Hypotension was observed in 23.5% of the first group, in 5.5% of the second, and in 42.10% of the third (p < 0.002 between rtPA and APSAC). In the inferior location hypotensive reaction was much more frequent than in anterior one (p < 007) especially if a right ventricular involvement was associated. Even if hypotension is a minor and generally harmless complication, it poses many practical problems, and its occurrence must be taken into account when choosing a fibrinolytic treatment.

In a group of 80 patients (50 male and 30 female) aged between 44 and 65, affected by alcoholic liver disease (46 with steatosis and 34 with liver cirrhosis) the Authors examined the relationship between the plasma lipid, in particular of Lp(a), and the incidence of vascular atherosclerotic plaques. The results were compared with those found in the controls (50 subjects of similar age, social and working status to that of the above patients but nondrinkers without liver or other metabolic disease). In the patients with steatosis we found a moderate increase in plasma lipid fractions including total, HDL and LDL cholesterol, but low levels of Lp(a), with an incidence of arterial plaques of 10.86%. In those with liver cirrhosis the findings were characterized by low levels of lipids and in particular of Lp(a), with an incidence of arterial plaques of 8.82%, decidedly less marked than in the controls (16%). In both cases the low incidence of vascular involvement appears to be in some way linked with low levels of Lp(a) and the severity of liver disease and not with the behaviour of HDL cholesterol.

Lymphomas can be localized to the gastrointestinal tract and can be primitive or secondary to a systemic lymphoma. Lymphomas can be classified as Hodgkin's and non-Hodgkin's. The latter include IPSID (all of the B-cell) and non-IPSID lymphomas. The involvement of the small intestine in its entire length is a feature of IPSID lymphomas. Non-IPSID lymphomas include MALT-type, which is a B-cell lymphoma, and EATCL, a T-cell lymphoma which is a not infrequent complication of coeliac disease. There are several classifications of lymphomas: the one by Isaacson is the most widely used at present.

Ascites often appears as a complication of several illnesses. The therapy is essentially based on the use of low-sodium diet, plasma or albumin infusion, diuretics and low-dosed ACE-inhibitors. To use the simple paracentesis or special techniques as Rhodiascit or Lee Veen Shunt means not to resolve definitively the problem and sometimes to cause undesirable complications. The authors present a new therapeutic tactics that joins the use of technique of double filtration of ascitic fluid and reinfusion of concentrated proteins (DFAF) with the injection in the peritoneal cavity of beta-interferon and the venous infusion of ATIII. Twenty patients affected by hepatic cirrhosis with the presence of ascitic fluid not treatable with the usual therapy have been subjected to this treatment. All the patients showed an immediate improvement of the clinical situation. After one year of observation, we describe our results. Twelve patients needed a further treatment with the DFAF technique, two patients died for the original pathology and six patients just needed an adjustment of pharmacologic therapy.