Acta Biomedica de l''Ateneo Parmense最新文献

We report the case of a 52-year-old marathon runner admitted to our emergency department for exertional heat stroke (EHS). The electrocardiogram (ECG) showed a supraventricular tachycardia, probably an atrial flutter with 2:1 block, conducted with left bundle branch block. After 10 minutes of aggressive fluid management and rapid external cooling, the ECG returned to normal. As the high-sensitivity cardiac troponin I was elevated, coronary angiography and an electrophysiological study were performed, revealing normal coronary arteries and excluding inducible arrhythmias. As reported in the current literature, our findings confirm that the electrocardiographic changes and elevation of cardiac markers in EHS do not reflect cardiac ischemia, but rather a myocardial injury due to the pathophysiological response to dehydration and hyperthermia, which markedly impaired stroke volume and cardiac output. EHS is a life-threatening condition with a complex pathophysiology caused by thermoregulatory failure. Diagnosis is not always straightforward, but early recognition and timely management (the "golden hour") with rapid cooling and intravenous fluids are crucial to prevent irreversible and fatal organ damage. EHS is defined by a rectal temperature > 40.5 °C with symptoms or signs of neurological dysfunction, such as confusion, drowsiness, or seizures, which can rapidly worsen with delirium, coma, and cardiac arrest. With this case report, we want to remind emergency physicians that early diagnosis and appropriate management of EHS can avoid death and inappropriate treatment. (www.actabiomedica.it).

Accessory cardiac bronchus (ACB) has been described mainly as case reports finding (frequency 0.08%-0.39%). Even though 50% of all ACBs have a blind extremity, imaging studies have demonstrated that some develop into a series of bronchioles with cystic degeneration or a ventilated lobule demarcated by an anomalous fissure and extremely rare with an abnormal pulmonary artery. In this case, ACB was demonstrated on several imaging methods arising from the intermediate bronchus's medial wall with correspondent blood vessels and fissure. Although an ACB is not a pathological entity and most patients with ACB are asymptomatic, it can become symptomatic due to recurrent infection, empyema, hemoptysis, and malignant transformation.  In conclusion, both pulmonologists and radiologists should recognize normal bronchial anatomy and developmental bronchial anomalies, as these may be important to establish a correct diagnosis.

Basal cell carcinoma (BCC) of the prostate is a very rare histologic variant of prostate cancer, of difficult diagnosis and uncertain prognosis. In fact, despite the frequency of prostate cancer, only 100 cases have been described in the literature, and most of the data derived from case reports. Because of the rarity of this disease, therapeutic options for these patients are scarce and no randomized trials are available. Here, we report the case of a 63-year-old man treated for a prostatic BCC (pBCC) that was challenging in terms of both diagnosis and treatment. We also performed a review of the literature to provide an overview of the therapeutic options for this rare tumor type and to better understand the role of molecular characterization in rare prostate cancer histologies. Given the rarity of pBCC worldwide, further collection of real-world data is needed to better understand the optimal diagnostic and therapeutic strategies for this rare disease.

Background and aim: Revision total knee arthroplasty(rTKA) is a challenging and expensive treatment for orthopedic surgeons who have to deal with poor bone quality and bone loss. This study aims to retrospectively evaluate the clinical and radiological results of patients undergoing rTKA and porous metaphyseal sleeves in AORI type II and III bone defects.

Methods: We conducted a retrospective series of continuous patients treated for mechanical failure of TKA. All patients with aseptic loosening of TKR underwent revision arthroplasty. We included only patients with AORI type IIa/b and III bone defects. The Septic revision or other grades of bone defect or patients lost at follow-up or with less than 2 years follow-up were excluded. We evaluated knee function with Oxford Knee Score (OKS) pain with Visual Analogue Scale (VAS) and range of motion (flex-ext), while radiological evaluation was performed to evaluate any sign of loosening.

Results: The mean preoperative OKS was 13.85 +/- 5.39 (range 5 -22), and it improved to 33.89 +/- 3.98 (range 20 - 40) (p<0.00001). The mean preoperative VAS was 7.77 +/- 1.33 (range 5 - 9), and it improved to 1.89 +/- 0.92 (range 0 - 4) (p<0.00001). ROM improved from 62.23° +/- 13.71° (range 40° - 90°) to 100.53° +/- 6.93° (range 90° - 120°) (p<0.00001). No signs of loosening or implant migration were reported.

Conclusions: Metaphyseal sleeves made knee revision in large bone defects reliable and effective with good results. Good implant stability was reached in all the cases treated with metaphyseal sleeves.

Background and aim: Short sleep duration causes many changes in several hormones (leptin, ghrelin, insulin, cortisol, growth hormone) and increases sympathetic activity with elevated levels of catecholamines, which causes an energy imbalance and leads to overweight or obesity and insulin resistance. The present study aimed to analyze the relationship between sleep duration and insulin resistance in obese adolescents with metabolic syndrome.

Methods: An observational cross-sectional research design concluded 124 obese adolescents with metabolic syndrome (MetS) aged 13-18 years. Anthropometry, blood pressure, and blood tests were conducted to determine obesity according to CDC 2000. MetS determination based on International Diabetes Federation 2007. Insulin resistance was assessed using HOMA-IR. Sleep duration was determined based on direct interviews with the research subjects. The obtained data were analyzed using the Spearman correlation test, Chi-Square, Mann-Whitney, and T-test (significant at P <0.05).

Results: The subjects were dominated by male adolescents 67.5%. There was a strong relationship between age and sleep duration (p = 0.035). Subjects were divided into two age groups based on sleep duration: those with < 8 hours and > 8 hours of sleep. There was a significant difference in fasting insulin levels and HOMA IR value between the two groups, higher in the subjects with < 8 hours of sleep than the subjects with > 8 hours of sleep. Sleep duration and HOMA-IR values ​​as a marker of insulin resistance had a significant negative correlation (rs= -0.581; P <0.001) and insulin levels (rs=-0.565, P <0.001).

Conclusions: Sleep duration has a robust negative correlation with the HOMA-IR value, which is a parameter of insulin resistance. (www.actabiomedica.it).

Background and aim: Free flaps or pedicle flaps are the mainstay of cancer surgery in the head and neck area. However, their long-term sequelae are still poorly understood. Among these, the development of a secondary primary tumor on a flap is a rare and uncertain reported event.   Methods: A computer-aided systematic literature search was performed by using the PubMed, EMBASE and Cochrane Library databases. A systematic review of the literature, following the PRISMA checklist, was carried out with the aim of analyzing all the citations reporting this second primary, with attention to risk factors, behavior, etiological causes.   Results: Overall, 27 cases of second primary squamous cell carcinoma arising on a pedicle or free flap were identified. In addition, other three cases were discussed.   Conclusions: Persistent exposure to oral stimuli such saliva, oral microbiome, smoke or a colonization by the adjacent mucosa were considered as a possible cause of second primary carcinoma. Although rare, a new neoplasm onset should know and considered as a new concept in the follow-up of patients undergoing reconstruction with free or pedicle flaps.

Background and aim: Hypogonadism and abnormalities of glucose homeostasis, resulting from iron-induced pituitary and pancreatic β-cell dysfunction respectively, are the most frequently reported endocrine abnormalities in patients with ß-thalassemia major (β-TM), also identified as transfusion-dependent thalassemia (TDT).

Study design and patients: The aim of the present retrospective study was to evaluate the long-term effects of hormone replacement therapy (HRT) on glucose metabolism and insulin secretion/sensitivity during 3-h oral glucose tolerance test (OGTT) in adolescent and young β-TM women with acquired hypogonadototropic -hypogonadism (AHH).Twelve hypogonadal β-TM females with AHH on HRT were followed for 8.26 ± 1.49 years.

Results: At baseline, 10 patients (83.3%) had normal OGTT, 1 patient presented with impaired glucose tolerance (IGT) and 1 patient had an isolated PG level of 165 mg/dL at 1-h during OGTT (H-NGT). At last evaluation, 7 patients (58.4 %) had normal OGTT, while 5 patients (41.6%) had abnormal OGTT. Reduced insulin sensitivity and impaired first-phase insulin secretion were also documented. Three of 4 β-TM patients on treatment with estradiol hemihydrate MX 50 patches plus oral medroxyprogesterone acetate (MPA), associated with a very effective iron chelation therapy, maintained normal glucose tolerance from baseline to last evaluation. Significant adverse events due to HRT or additional endocrine complications were not documented in any cases during the follow-up.

Conclusion: Deterioration of glycemia (dysglycemia) occurred in 45.4% (5/11) of thalassemic females on long-term HRT. Additional studies are needed to elucidate the validity of our preliminary observations.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the nose and the paranasal sinuses characterized by the presence of nasal polyps and persistent symptoms of nasal obstruction, anterior or posterior rhinorrhea, facial pain or pressure, and reduction or loss of smell, lasting longer than 12 weeks. Several therapeutic strategies are nowadays available to treat CRSwNP as a function of disease severity. However, a standardized therapeutic algorithm has not yet been proposed. Since CRSwNP severity can be assessed by the Clinical-Cytological Grading (CCG) and the consequent reduction in patients' Quality of Life can be defined with the Sino Nasal Outcome Test-22 (SNOT-22), we aimed to propose a new diagnostic-therapeutic algorithm, that takes into consideration both the characteristics of the patients, including the CCG, nasal obstruction, and SNOT-22, and all the therapies available today.

Background and aim: endobronchial ultrasound has gained widespread popularity in the last decade, becoming the primary technique for minimally invasive evaluation of the mediastinum and staging of lung cancer. Several tertiary and quaternary care institutes use this method, performed by trained and accredited specialists. Its main indications are (I) diagnosis and staging of lung cancer, (II) mediastinal lymphadenopathy diagnosis (III) sampling peripheral pulmonary lesions.

Conclusions: this manuscript aims to describe the operational potential of both convex endobronchial ultrasound probe and radial endobronchial ultrasound probe technology, focusing on lung cancer. This narrative review is complemented with by the description of peculiar clinical cases in which endobronchial ultrasound played a pivotal role in reaching the diagnosis.