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San Francesco al Campo, Italy

Agosta C.,Casa di Cura San Clemente | Atlante M.,Regina Apostolorum Hospital | Benvenuti C.,Rottapharm Madaus
Minerva Ginecologica | Year: 2011

Aim. The aim of this paper was to evaluate the activity of magnolia bark extract added to isoflavones and lactobacilli in menopausal women with typical menopausal symptoms and concomitant borderline psychoaffective and/or sleep alterations, of severity not requiring a psychopharmacological therapy. Methods. Menopausal women were enrolled in a multicenter, controlled, parallel-group study and randomized to E (isoflavones 60 mg + Lactobacillus sporogenes + calcium and vitamin D3 - Estromineral, Rottapharm Madaus) versus ES (magnolia bark extract + E - Estromineral serena) 1 tablet/night for 12 weeks. Results. In 91 gynecological centers, 634 women were treated (300 with E and 334 with ES), mean age 53.1 years and Body Mass Index (BMI) 25.2 kg/m2; 28% were past hormone replacement therapy HRT users and 3.3% had had a previous breast cancer. Both treatments significantly reduced versus baseline the symptoms tested at 0, 4, 8 and 12 weeks. E and ES showed a similar efficacy on hot flushing, nocturnal sweating with awakenings, palpitations and vaginal dryness. ES was more active on insomnia, irritability, anxiety, depressed mood, asthenia and loss of libido. Woman's well-being and physician's final judgment were positive in >70% in both groups. The rate of adverse events was 1% with E (metrorrhagia, cramps and constipation) and 1.2% with ES (gastralgia, blood loss, constipation and breast tension). Conclusion. Isoflavones are effective in improving the classical menopause symptoms. The clinical activity of magnolia bark extract on the relevant psycho-affective symptoms, particularly anxiety, irritability and insomnia, was evident. ES in the mild psychical alterations that can occur in climacterium avoids to run the known dependence risks linked to psychopharmacological agents withdrawals. Source


Papini E.,Regina Apostolorum Hospital | Pacella C.M.,Interventional Imaging | Hegedus L.,University of Southern Denmark
European Journal of Endocrinology | Year: 2014

In patients with thyroid nodules, ultrasound (US) imaging represents an indispensable tool for assessment of the risk of malignancy. Over approximately four decades, innovative technology and successive improvements have facilitated its entry into the routine management and greatly improved its predictive value. When US features cannot reliably rule out thyroid cancer, US guidance allows a correct and safe sampling also of small or deeply located thyroid lesions. Obtained in this way, cytological or microhistological specimens may reliably define the nature of most thyroid nodules, and the information from histochemical or molecular markers shows promise in the classification of the remaining indeterminate cases. While a prompt surgical treatment can be offered in the minority of suspicious or definitely malignant cases, most individuals warrant only a follow-up. However, at initial evaluation, or over the years, a fraction of these benign lesions may grow and/or become symptomatic. Such cases may benefit from US-guided minimally invasive procedures as an alternative to surgery. Image-guided percutaneous treatments most often achieve relief of neck complaints, are inexpensive, and can be performed on an outpatient basis. The risk of major complications, after adequate training, is very low. Importantly, thyroid function is preserved. Currently, percutaneous ethanol injection for cystic lesions and thermal ablation, with laser or radiofrequency, for solid nodules are increasingly used and disseminated beyond the initial core facilities. In centres with expertise and high patient volume, their use should be considered as first-line treatment alternatives to surgery for selected patients with benign enlarging or symptomatic thyroid lesions. © 2014 European Society of Endocrinology Printed in Great Britain. Source


Pacella C.M.,Interventional Imaging | Papini E.,Regina Apostolorum Hospital
Journal of Endocrinological Investigation | Year: 2013

The incidence of thyroid carcinoma has increased steadily over the last few decades. Most differentiated thyroid carcinomas (DTC) are cured thanks to the initial treatment with surgery and radioiodine therapy. Nevertheless, neck lymph node metastases are found in a few of these patients during their long-term clinical and ultrasound follow-up. In some of these cases radioiodine treatment may not be effective in eradicating nodal metastases due to scant 131-I uptake. Additionally, a few of these patients undergo repeated neck explorations and/or resections. Based on these considerations and on the frequently indolent course of DTC neck metastases, a non-surgical therapeutic approach should be considered to control small local foci of DTC. There is increasing interest in mini-invasive image-guided procedures that can be performed under local anesthesia which do not affect the performance status of the patient. Image-guided minimally invasive ablative therapies delivered by using needle-like applicators include both thermal and non-thermal source techniques. Over the past 25 years, these therapies have gained widespread attention and, in many cases, broad clinical acceptance as methods for treating focal malignancies. In an attempt to overcome the limitations of treating certain unresectable tumor types not amenable to a further surgical treatment, a few investigators have reported successfully combining percutaneous therapies with other oncologic treatment strategies (combined treatments). In this review, we reported mini-invasive techniques more commonly employed in selected cases to ameliorate local compressive symptoms, control hormonal production, and reduce the volume of neoplastic tissue prior to traditional palliative treatment. © 2013, Editrice Kurtis. Source


Pedrazzini L.,Busto Arsizio Hospital | Baroli A.,Busto Arsizio Hospital | Marzoli L.,Busto Arsizio Hospital | Guglielmi R.,Regina Apostolorum Hospital | Papini E.,Regina Apostolorum Hospital
Minerva Endocrinologica | Year: 2013

Aim. Papillary thyroid microcarcinoma (PMC) is considered a common disease with a good prognosis and low rate of recurrence but the extension of initial surgical treatment and the need of completion thyroidectomy are still controversial. Aim of this study is the assessment of the prognostic factors that are predictive of cancer recurrence on a large controlled series of patients with a prolonged follow-up. Methods. A total of 231 patients with PMC were followed up for a median period of 12 years (range 5-35 years). The patients included 54 males and 177 females, with a mean age at the time of first diagnosis of 45.7±12.7 years. Results. At presentation 158 patients had no metastases, whereas 73 had lymph node metastases and 1 had bone metastases. Surgery included 177 total thyroidectomies and 54 lobectomies. Eighty-four patients underwent lymph node dissection, and 131 patients were treated with radioiodine therapy. The disease recurred in 15 patients (6.5%): 5 cases of local recurrence, all of which in the contralateral lobe after lobectomy, 13 cases of lymph-node metastases, and 2 cases of lung metastases. Multivariate analysis showed that two parameters were predictive for local recurrence: age <45 years (P=0.05; RR: 6.9; 95% CI: 1.59-29.9) and evidence of lymph-node metastases at presentation (P=0.03; RR: 3.24; 95% CI: 1.17-8.55) Conclusion. Total or near-total thyroidectomy seems to reduce the risk of local recurrences in non-incidental PMC. Prophylactic dissection of central compartment nodes in the absence of clinically evident metastases seems not to change the risk of recurrence. In incidental PTMC without multifocality, extracapsular extension or histologically-proven lymph node metastases, lobectomy is associated with a very low risk of recurrence. Follow-up with neck ultrasonography seems advisable at yearly intervals, as recurrences may present from less than one year until several years after thyroidectomy. Radioiodine ablation of thyroid remnants should be considered only in young patients in presence of multifocal tumors, histologically-proven metastatic lymph nodes to the significantly higher risk of recurrence. Source


Mauri G.,Interventional Imaging | Cova L.,Interventional Imaging | Tondolo T.,Interventional Imaging | Ierace T.,Interventional Imaging | And 5 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2013

Context: Percutaneous laser ablation (PLA) may be useful in treating patients with metachronous metastatic lymph nodes in the neck. Objective: Our objective was to assess PLA as a treatment of difficult-to-treat metachronous cervical lymph node metastases from papillary thyroid carcinoma. Design and Setting: We conducted a retrospective analysis of prospectively collected data at a public hospital. Patients: Fifteen patients with previous resection of papillary thyroid carcinoma with elevated serum levels of thyroglobulin (Tg) or anti-Tg antibodies (TgAbs) and 24 metachronous nodal metastases treated between September 2010 and April 2012 were followed with [18F] fluorodeoxyglucose (18FDG) positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced ultrasound (CEUS). Intervention: Intervention was PLA. Outcome Measures: Technique feasibility and technical success were evaluated. Tg/TgAb serum levels and 18FDG-PET/ CT, and CEUS appearance were assessed at 6 and 12 months and compared with baseline. Complications were recorded. Results: PLA was always feasible, and technical success was achieved in all patients. At 6 months, local control was achieved in 11 of 15 patients (73%), with 6 (40%) having serum Tg/TgAb normalized (P = .017 vs baseline). Whereas 20 of 24 (83%) nodes were negative at 18FDG-PET/CT and CEUS (P < .001 vs baseline), 4 were 18FDG-PET/CT-positive (3 also CEUS-positive). At the 12-month follow-up, local control was achieved in 10 of 14 patients (71.4%). Sixteen of 20 nodes (80%) were negative at 18FDG-PET/CT and CEUS (P < .001 vs baseline), 4 were 18FDG-PET/CT-positive (2 also CEUS-positive). Four of 10 (40%) patients had normalization of serum Tg/TgAb (P = .098 vs baseline). No major complications occurred. Conclusions: PLA is potentially feasible, safe, and effective for the treatment of metachronous cervical nodal metastases from papillary thyroid carcinoma. This procedure may reduce or delay a large number of highly invasive repeat neck dissections. Copyright © 2013 by The Endocrine Society. Source

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