An evaluation on management of carotid body tumour (CBT). A twelve years experience.

Objectives. Carotid Body Tumor (CBT) is a rare lesion of the neuroendocrine system but it is the most common form of head and neck paraganglioma (PGL). Our objective is to discuss the optimal management of these lesions to provide the best outcome of patients treated by surgical resection. Patients and Methods. A retrospective evaluation was obtained by review of the records of 20 patients with 26 CBT treated at our institution between 2000 and 2012. Primary tumor characteristics, diagnostic protocols, surgical treatment, short and long-term outcomes were collected and analyzed. Results. A total of 26 CBTs resections were performed on 20 patients; the age range was 21-89 years. There was a female prevalence (14 women-80% and 6 men-20%). Familial cases occurred in 6 patients (30%); of these, 3 patients had bilateral lesions and 1 patient multiple paragangliomas. In all cases no lymph node metastasis was found. All lesions were grouped into three groups according to the latero-lateral diameter: Group I < 3 cm; Group II 3<>5cm; Group III >5cm. All patients were managed by surgical resection of the CBT. There were no operative deaths. Overall we found transitory neurological impairment in 15,3% and permanent neurological deficit in 7,6% of cases. No complications occurred in all resections of Group I tumors. In Group II only 1 resection was followed by dysphonia by recurrent nerve palsy (after vagal nerve en-bloc resection). In Group III only 1 resection was followed by permanent vagus nerve palsy. Conclusions. Surgical removal of the tumor is the only treatment that can ensure a complete eradication of the disease. Family screening is of great importance in patients with hereditary forms. Careful preoperative planning of surgical procedure by integrated diagnostic imaging and a full mastery of the surgical technique can minimize the risk of the most common postoperative complications. Lifelong follow-up is mandatory to make early diagnosis of recurrent disease.

Risedronate's efficacy: from randomized clinical trials to real clinical practice.

Osteoporosis represents the most common human bone disorder with a large medical and economical burden on the Health Care System. Bisphosphonates are the major drugs used for the treatment of osteoporosis. Differences in their chemical structures and pharmacokinetic actions can explain the different clinical efficacy among these molecules. Risedronate is a potent inhibitor of farnesyl pyrophosphate synthase, but does not bind strongly to mineral; this lower mineral binding may enable risedronate to have a wider distribution in bone. Its antifracture efficacy has been established in several randomized phase III controlled studies that showed its value in the reduction of vertebral, non vertebral and hip fractures. Randomized controlled trials and observational studies demonstrated risedronate efficacy and safety in different subsets of patients, therefore risedronate is configured, among oral therapies currently available for osteoporosis, as a drug of first choice.