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Bandeira F.,University of Pernambuco | Cassibba S.,Papa Giovanni XXIII Hospital
Current Rheumatology Reports | Year: 2015

Bone pain, proximal muscle weakness, skeletal deformities, and pathological fractures are features of osteitis fibrosa cystica which occur in severe primary hyperparathyroidism (PHPT). In this condition, bone mineral density is usually extremely low, but may be reversible after parathyroidectomy. On X-ray, bone abnormalities are described as having a salt-and-pepper appearance in the skull, with bone erosions and resorption of the phalanges, brown tumors and cysts, as well as diffuse demineralization, along with pathological fractures, particularly in the long bones of the extremities. A marked elevation of the serum calcium and PTH concentrations is seen, and renal involvement is manifested by nephrolithiasis and nephrocalcinosis. In asymptomatic PHPT, the absence of clinically significant bone involvement has led to much more data on bone mineral density becoming available by dual X-ray absorptiometry (DXA) and also on new technologies such as trabecular bone score (TBS), which is a gray-level textural analysis of DXA images that provides an indirect index of trabecular microarchitecture. In addition, high-resolution peripheral computed tomography (HRpQCT), which has a low radiation exposure, provides further understanding of the microstructural skeletal features at both trabecular and cortical sites. © 2015, Springer Science+Business Media New York. Source


Bogani G.,Mayo Medical School | Dowdy S.C.,Mayo Medical School | Cliby W.A.,Mayo Medical School | Ghezzi F.,University of Insubria | And 2 more authors.
Journal of Obstetrics and Gynaecology Research | Year: 2014

The aim of the present review is to summarize the current evidence on the role of pelvic and para-aortic lymphadenectomy in endometrial cancer. In 1988, the International Federation of Obstetrics and Gynecology recommended surgical staging for endometrial cancer patients. However, 25 years later, the role of lymph node dissection remains controversial. Although the findings of two large independent randomized trials suggested that pelvic lymphadenectomy provides only adjunctive morbidity with no clear influence on survival outcomes, the studies have many pitfalls that limit interpretation of the results. Theoretically, lymphadenectomy may help identify patients with metastatic dissemination, who may benefit from adjuvant therapy, thus reducing radiation-related morbidity. Also, lymphadenectomy may eradicate metastatic disease. Because lymphatic spread is relatively uncommon, our main effort should be directed at identifying patients who may potentially benefit from lymph node dissection, thus reducing the rate of unnecessary treatment and associated morbidity. This review will discuss the role of lymphadenectomy in endometrial cancer, focusing on patient selection, extension of the surgical procedure, postoperative outcomes, quality of life and costs. The need for new surgical studies and efficacious systemic drugs is recommended. © 2014 Japan Society of Obstetrics and Gynecology. Source


Andreassi M.G.,CNR Institute of Clinical Physiology | Piccaluga E.,Niguarda Ca Granda Hospital Milan | Guagliumi G.,Papa Giovanni XXIII Hospital | Del Greco M.,S Chiara Hospital | And 2 more authors.
Circulation: Cardiovascular Interventions | Year: 2016

Background - Orthopedic strain and radiation exposure are recognized risk factors in personnel staff performing fluoroscopically guided cardiovascular procedures. However, the potential occupational health effects are still unclear. The purpose of this study was to examine the prevalence of health problems among personnel staff working in interventional cardiology/cardiac electrophysiology and correlate them with the length of occupational radiation exposure. Methods and Results - We used a self-administered questionnaire to collect demographic information, work-related information, lifestyle-confounding factors, all current medications, and health status. A total number of 746 questionnaires were properly filled comprising 466 exposed staff (281 males; 44±9 years) and 280 unexposed subjects (179 males; 43±7years). Exposed personnel included 218 interventional cardiologists and electrophysiologists (168 males; 46±9 years); 191 nurses (76 males; 42±7 years), and 57 technicians (37 males; 40±12 years) working for a median of 10 years (quartiles: 5-24 years). Skin lesions (P=0.002), orthopedic illness (P<0.001), cataract (P=0.003), hypertension (P=0.02), and hypercholesterolemia (P<0.001) were all significantly higher in exposed versus nonexposed group, with a clear gradient unfavorable for physicians over technicians and nurses and for longer history of work (>16 years). In highly exposed physicians, adjusted odds ratio ranged from 1.7 for hypertension (95% confidence interval: 1-3; P=0.05), 2.9 for hypercholesterolemia (95% confidence interval: 1-5; P=0.004), 4.5 for cancer (95% confidence interval: 0.9-25; P=0.06), to 9 for cataract (95% confidence interval: 2-41; P=0.004). Conclusions - Health problems are more frequently observed in workers performing fluoroscopically guided cardiovascular procedures than in unexposed controls, raising the need to spread the culture of safety in the cath laboratory. © 2016 American Heart Association, Inc. Source


Merelli B.,Unit of Medical Oncology | Massi D.,University of Florence | Cattaneo L.,Papa Giovanni XXIII Hospital | Mandala M.,Unit of Medical Oncology
Critical Reviews in Oncology/Hematology | Year: 2014

A dynamic interplay exists between host and tumor, and the ability of the tumor to evade immune recognition often determines the clinical course of the disease. Significant enthusiasm currently exists for a new immunotherapeutic strategy: the use of immunomodulatory monoclonal antibodies that directly enhance the function of components of the anti-tumor immune response such as T cells, or block immunologic checkpoints that would otherwise restrain effective anti-tumor immunity. This strategy is based on the evidence that development of cancer is facilitated by the dis-regulation and exploitation of otherwise physiological pathways that, under normal circumstances, down-regulate immune activation and maintain tolerance to self. Among these pathways an important role is covered by the Programmed death-1 (PD-1)/PD-Ligand (L) 1 axis. An emerging concept in cancer immunology is that inhibitory ligands such as PD-L1 are induced in response to immune attack, a mechanism termed "adaptive resistance". This potential mechanism of immune resistance by tumors suggests that therapy directed at blocking the interaction between PD-1 and PD-L1 might synergize with other treatments that enhance endogenous antitumor immunity. The anti-PD-1 strategy can be effective in several solid tumors such as renal cell carcinoma (RCC) or non-small cell lung cancer (NSCLC), however in this review we summarize the biological role of PD-1/PD-L1 on cancer by focusing our attention in the biological rationale, clinical challenges and opportunities to target the PD-1/PD-L1 axis in melanoma. © 2013 Elsevier Ireland Ltd. Source


Barbui T.,Research Foundation | Thiele J.,University of Cologne | Carobbio A.,Research Foundation | Guglielmelli P.,University of Florence | And 3 more authors.
American Journal of Hematology | Year: 2014

In patients not meeting the required hematocrit (HCT) or hemoglobin (Hb) thresholds according to BCSH and the WHO diagnostic criteria, the diagnosis of masked polycythemia vera (mPV) has been proposed. A comparison of HCT or Hb values with the expression of JAK2V617F, JAK2 exon 12, and CALR mutations in strictly WHO-defined 257 overt PV and 140 mPV (59 mPV according to BCSH) and 397 patients with essential thrombocythemia (ET) was performed. Hb and HCT thresholds of mPV patients were significantly higher than JAK2V617F ET (P<0.0001). The best cut-off for Hb to discriminate JAK2-mutated ET from PV was 16.5 g/dL for males and 16.0 g/dL for females. For HCT, this was 49% in males and 48% in females. The proportion of patients correctly classified as ET or PV when regarding Hb or HCT levels was 95% in males and 93% in females and 94% in both males and females, respectively. © 2014 Wiley Periodicals, Inc. Source

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