Primary hyperparathyroidism: diagnostic features and surgical outcomes.

BACKGROUND: Primary hyperparathyroidism is characterized by elevated plasma calcium levels due to inappropriate secretion of parathyroid hormone (PTH) in most cases by an adenomatous or hyperplastic parathyroid. We present a retrospective analysis of a large cohort of patients operated on of parathyroidectomy in our center analyzing their diagnostic characteristics, intraoperative match and surgical outcomes. METHODS: We included patients with benign parathyroid disease who underwent parathyroidectomy associated or not with hemi- or total thyroidectomy at the Sant'Anna University Hospital of Ferrara between September 2003 and September 2022. RESULTS: In our study 371 patients fulfilled the inclusion criteria. The most widely used preoperative imaging method was ultrasound, followed by 99mTc-sestamibi scintigraphy. In most cases, preoperative imaging correctly localized the affected parathyroid. Considering the intraoperative site of the pathologically affected parathyroid, the majority of pathological parathyroids were located in the lower districts of the neck and a smaller percentage in the upper, intermediate, and ectopic sites. Postoperative complications were infrequent. CONCLUSIONS: The main challenge in parathyroid surgery lies in the difficulty in localizing the pathological parathyroid at the surgical site, which can lengthen the surgical time by increasing comorbidities. Currently, the results on pathological parathyroid localization are good. Technology needs to be developed toward greater diagnostic accuracy and minimally invasive surgical approaches.

Nutraceutical formulation for immune system modulation: Active constituents, in vitro antibacterial and immunomodulatory activity, and metabolomics analysis.

There is a large demand for nutraceuticals in the market and studies related to their action are needed. In this paper, the antimicrobial activity and the immunomodulatory effect of a nutraceutical formulation containing 14.39% of ascorbic acid, 7.17% of coenzyme Q10, 1.33% of Echinacea polyphenols, 0.99% of pine flavan-3-ols, 0.69% of resveratrol and 0.023% of Echinacea alkylamides were studied using in vitro assays and cell-based metabolomics. Chromatographic analysis allowed us to study the nutraceutical composition. The antibacterial activity was evaluated on S. aureus, K. pneumoniae, P. aeruginosa, E. coli, H. influenzae, S. pyogenes, S. pneumoniae and M. catarrhalis. The immunomodulatory activity was assessed on human macrophages and dendritic cells. The production of IL-1ß, IL-12p70, IL-10 and IL-8 was evaluated on culture medium by ELISA and the activation/maturation of dendritic cells with cytofluorimetric analysis. Treated and untreated macrophages and dendritic cell lysates were analysed by liquid chromatography coupled with high-resolution mass spectrometry, and results were compared using multivariate data analysis to identify biological markers related to the treatment with the food supplement. The food supplement decreased K. pneumoniae, P. aeruginosa, E. coli, Methicillin-resistant Staphylococcus aureus (MRSA) and M. catharralis growth, reduced the inflammatory response in macrophages exposed to lipopolysaccharide (LPS) and modulated the activation and maturation of the dendritic cells. Oxidized phospholipids were identified as the main biological markers of treated cell lysates, compared with controls.

Mitral regurgitation worsens cardiac remodeling in ischemic cardiomyopathy in an experimental model.

OBJECTIVE: Mitral regurgitation (MR) developing concomitant with ischemic cardiomyopathy is a frequently diagnosed valvular lesion, for which an optimal therapeutic strategy is unknown. The contribution of MR to the ongoing cardiac remodeling from myocardial infarction (MI) remains controversial. We have developed a novel experimental model in which MI and severe MR can be independently introduced, to study the role of MR in chronic remodeling of the ischemic heart. METHODS: A total of 98 rats were induced with MI+MR (group 1), MI (group 2), MR (group 3), or sham surgery (group 4). MR was induced by inserting a needle into the anterior mitral leaflet via the ventricular apex in a beating heart. MI was induced by ligating the left coronary artery. Biweekly ultrasound examinations were performed after surgery, and invasive hemodynamic assessments were performed in some rats at 2, 10, and 20 weeks. RESULTS: At 2 weeks postsurgery, the mean end-diastolic volume was 432 ± 103 µL in ischemic hearts with MR, compared with 390 ± 76.3 µL in ischemic hearts without MR (a 10.76% difference). By 20 weeks, the mean volume was significantly greater in the former group (767 ± 246 µL vs 580 ± 85 µL; a 32.24% difference). At 2 weeks, mean end-systolic volume was 147 ± 46.8 µL in the ischemic hearts with MR and 147 ± 45.7 µL in those without MR. By 20 weeks, the mean volumes had increased to 357 ± 136.4 µL and 271 ± 82.3 µL, respectively (a 31.73% difference). CONCLUSIONS: MR in ischemic hearts significantly increased end-diastolic and end-systolic volumes of the left ventricle, indicating adverse cardiac remodeling and worse systolic function.

Temporal changes in myocardial collagen, matrix metalloproteinases, and their tissue inhibitors in the left ventricular myocardium in experimental chronic mitral regurgitation in rodents.

Mitral regurgitation (MR) imposes left ventricular volume overload, triggering rapid ventricular dilatation, increased myocardial compliance, and, ultimately, cardiac dysfunction. Breakdown of the extracellular matrix has been hypothesized to drive these rapid changes, partially from an imbalance in the matrix metalloproteinases (MMPs) and their tissue inhibitors [tissue inhibitors of metalloproteinase (TIMPs)]. In the present study, we developed a rat model of severe MR that mimics the human condition and investigated the temporal changes in extracellular matrix-related genes, collagen biosynthesis proteins, and proteolytic enzymes over a 20-wk period. Male Sprague-Dawley rats were anesthetized to a surgical plane with mechanical ventilation, and a thoracotomy was performed to expose the apex. Using transesophageal ultrasound guidance, a needle was inserted into the beating heart to perforate the anterior mitral leaflet and create severe MR. Animals were survived for 20 wk, with some animals terminated at 2, 10, and 20 wk for analysis of left ventricular tissue. A sham group that underwent the same surgery without mitral leaflet perforation and MR were used as controls. At 2 wk post-MR, increased collagen gene expression was measured, but protein levels of collagen did not corroborate this finding. In parallel, MMP-1-to-TIMP-4, MMP-2-to-TIMP-1, and MMP-2-to-TIMP-3 ratios were significantly elevated, indicating a proteolytic milieu in the myocardium, possibly causing collagen degradation. By 20 wk, many of the initial differences seen in the proteolytic ratios were not observed, with an increase in collagen compared with the 2-wk time point. Altogether, this data indicates that an imbalance in the MMP-to-TIMP ratio may occur early and potentially contribute to the early dilatation and compliance observed structurally. NEW & NOTEWORTHY In this rodent model of severe mitral regurgitation that mimics the human condition, eccentric left ventricular dilatation occurred rapidly and persisted over the 20-wk period with parallel changes in myocardial collagen and matrix metalloproteinases that may drive the extracellular matrix breakdown.

Secondary malignant tumors of the parotid gland: not a secondary problem!

PURPOSE: To present the clinical features of patients with parotid gland metastasis, and compare the results with previously published series. Most of the relevant literature arises from case reports, while there are only few series reported, as secondary neoplastic lesions of the parotid gland are uncommon. METHODS: The medical records of patients with parotid gland metastasis, treated at the ENT Department of the University Hospital of Ferrara, between January 1st 1965 and December 31th 2014, were retrospectively reviewed. Fine needle aspiration cytology (FNAC) and biopsy results were compared. Localization of the primary tumor was searched in all cases. Lymphomatous lesions have been excluded from the study. RESULTS: A total of 66 patients with parotid gland metastasis were evaluated. There were 53 males and 13 females with mean age 68.2 ± 13.5 years. Histopathologic analysis of the lesions revealed that 47 (71.2%) were parotid gland metastasis from cutaneous head and neck tumors, 8 (12.1%) from the upper aero-digestive tract, 7 (12.1%) from locations out of facial-cervical region, 1 from a conjunctival melanoma, while in 3 (4.5%) cases the primary tumor origin remained unknown. FNAC results were compared with the final histopathologic diagnosis, showing an overall concordance of 71.9%. CONCLUSION: The present study is one of the largest series of parotid gland metastasis available so far. During the diagnostic work-up of a parotid tumor, the possibility of a metastasis should also be considered. FNAC can be a useful tool for the preoperative assessment of parotid lesions.

Supracricoid partial laryngectomy: oncological and functional results.

PURPOSE: The purpose of this study was to evaluate the oncological and functional results of patients affected by laryngeal squamous cell carcinoma (SCC) and surgically treated by supracricoid partial laryngectomy (SCPL) at the ENT Department of the University Hospital of Ferrara. METHODS: In this retrospective study a total of 155 patients (149 males/l96.1% and 6 females/3.9%), have been included. All patients were treated between January 1st 1998 and December 31st 2010, by SCPL, including 126 cricohyoidopexies (CHP) and 29 cricohyoidoepiglottopexies (CHEP). RESULTS: The overall survival (OS) at 3 and 5 years was 88.77 and 83.24%, respectively and the disease-free survival (DFS) at 3 and 5 years was 84.4 and 81.55%, respectively.The recurrence rate was 17.5%, with local recurrences in 12.1% of the cases, regional in 4.7% and distant metastasis in 0.7% of the cases. Synchronous second primary tumors were 0.7% and metachronous second primary cancers (MSPCs) 5.4%. Removal of nasogastric feeding tube (NGT) or percutaneous endoscopic gastrostomy (PEG) was performed in 98.7% of the patients and lasted 22 days on average after SCPL (range 9-60), while decannulation was performed in all of patients at the 27th day on average after surgery. CONCLUSIONS: Oncological outcomes of this series are consistent with those of the literature, showing that SCPL is an effective and safe procedure in terms of survival rate and disease control. Functional outcomes confirmed that SCPL allows a good organ preservation and recovery of laryngeal functions.

Potencial zoonótico de las infecciones por helmintos intestinales en perros callejeros de Ciudad de La Habana / Zoonotic potential of intestinal helminth infections in stray dogs from City of Havana

Se determinó la prevalencia de infección intestinal con helmintos en 461 perros en 2 períodos de tiempo, con la finalidad de evaluar el potencial zoonótico de los perros callejeros en Ciudad de La Habana. Los helmintos identificados fueron: Ancylostoma spp. en 97 animales (21,04 por ciento); Dipylidium caninum en 75 (16,26 por ciento) y Toxocara canis en 91 (19,73 por ciento). Las infecciones con Ancylostoma spp. tuvieron una frecuencia mayor en la estación de lluvia, mayo-octubre de 2005 (p< 0,01); mientras que D. caninum fue más común en la estación seca, noviembre-abril de 2006 (p< 0,01). T. canis fue más prevalente en animales jóvenes (< 1 año), mientras que en adultos (> 1 año) fueron Ancylostoma spp. y D. caninum. En cuanto al sexo, las perras hembras estaban más parasitadas por T. canis, mientras que D. caninum fue más frecuente en los machos. La asociación parasitaria que más se observó fue A. caninum y T. canis. Estos resultados permitieron un conocimiento actualizado sobre las principales especies de helmintos que afectan a los perros callejeros y algunas características de estas infecciones, que sirve de alerta sobre este potencial zoonótico.

The objective of the present study was to evaluate the zoonotic potential of the 461 stray dogs from the City of Havana, as well as, the prevalence of intestinal helminth infection in two periods. The identified helminths were Ancylostoma spp. in 97 dogs (21.04 percent), Dipylidium caninum in 75 (16.26 percent). and Toxocara canis in 91 dos (19.73 percent). Ancylostoma spp. infections were the most frequent in the rainy season,that is, May to October, 2005 (p< 0.01) whereas D. caninum was more common in the dry season, that is, November to April, 2006. (p< 0.01). T. canis was more prevalent in young animals (< 1 year), but in older dogs(> 1 year) were Ancylostoma spp. and D. caninum. Female dogs were more infected by T. canis, and D. caninum was more frequent in males. The most observed association was A. caninum -T. canis. These results allowed updating knowledge about helminth species affecting stray dogs and some characteristics of these infections, all of which can serve as a warning about this zoonotic potential.

Potencial zoonótico de las infecciones por helmintos intestinales en perros callejeros de Ciudad de La Habana / Zoonotic potential of intestinal helminth infections in stray dogs from City of Havana

Se determinó la prevalencia de infección intestinal con helmintos en 461 perros en 2 períodos de tiempo, con la finalidad de evaluar el potencial zoonótico de los perros callejeros en Ciudad de La Habana. Los helmintos identificados fueron: Ancylostoma spp. en 97 animales (21,04 por ciento); Dipylidium caninum en 75 (16,26 por ciento) y Toxocara canis en 91 (19,73 por ciento). Las infecciones con Ancylostoma spp. tuvieron una frecuencia mayor en la estación de lluvia, mayo-octubre de 2005 (p< 0,01); mientras que D. caninum fue más común en la estación seca, noviembre-abril de 2006 (p< 0,01). T. canis fue más prevalente en animales jóvenes (< 1 año), mientras que en adultos (> 1 año) fueron Ancylostoma spp. y D. caninum. En cuanto al sexo, las perras hembras estaban más parasitadas por T. canis, mientras que D. caninum fue más frecuente en los machos. La asociación parasitaria que más se observó fue A. caninum y T. canis. Estos resultados permitieron un conocimiento actualizado sobre las principales especies de helmintos que afectan a los perros callejeros y algunas características de estas infecciones, que sirve de alerta sobre este potencial zoonótico(AU)

The objective of the present study was to evaluate the zoonotic potential of the 461 stray dogs from the City of Havana, as well as, the prevalence of intestinal helminth infection in two periods. The identified helminths were Ancylostoma spp. in 97 dogs (21.04 percent), Dipylidium caninum in 75 (16.26 percent). and Toxocara canis in 91 dos (19.73 percent). Ancylostoma spp. infections were the most frequent in the rainy season,that is, May to October, 2005 (p< 0.01) whereas D. caninum was more common in the dry season, that is, November to April, 2006. (p< 0.01). T. canis was more prevalent in young animals (< 1 year), but in older dogs(> 1 year) were Ancylostoma spp. and D. caninum. Female dogs were more infected by T. canis, and D. caninum was more frequent in males. The most observed association was A. caninum -T. canis. These results allowed updating knowledge about helminth species affecting stray dogs and some characteristics of these infections, all of which can serve as a warning about this zoonotic potential(AU)

[Zoonotic potential of intestinal helminth infections in stray dogs from City of Havana]. / Potencial zoonótico de las infecciones por helmintos intestinales en perros callejeros de Ciudad de La Habana.

The objective of the present study was to evaluate the zoonotic potential of the 461 stray dogs from the City of Havana, as well as, the prevalence of intestinal helminth infection in two periods. The identified helminths were Ancylostoma spp. in 97 dogs (21, 04%), Dipylidium caninum in 75 (16, 26%). and Toxocara canis in 91 dos (19, 73%). Ancylostoma spp. infections were the most frequent in the rainy season, that is, May to October, 2005 (P < 0,01) whereas D. caninum was more common in the dry season, that is, November to April, 2006. (p < 0,01). T. canis was more prevalent in young animals (< 1 year), but in older dogs (> 1 year) were Ancylostoma spp. and D. caninum. Female dogs were more infected by T. canis, and D. caninum was more frequent in males. The most observed association was A. caninum--T. canis. These results allowed updating knowledge about helminth species affecting stray dogs and some characteristics of these infections, all of which can serve as a warning about this zoonotic potential.

Prognostic evaluation in supracricoid partial laryngectomy with cricohyoidopexy.

Identification of prognostic factors related to supracricoid partial laryngectomy may optimise indications for this surgical technique. We analysed several clinical and histopathological variables in a series of 81 patients treated with SPL at our department. Attention was focused on neoplastic spread of the anterior commissure, thyroid cartilage and prelaryngeal soft tissue of the neck. Statistical analysis (Kaplan-Meier method and Cox regression test) showed a significant decrease in survival for prelaryngeal soft tissue invasion. Due to the fact that the survival rate is not modified by the anterior commissure and thyroid cartilage infiltration, the prognostic value of prelaryngeal invasion is extremely relevant. Therefore, we suggest the oncological value of SPL even in cases of invasion of the anterior commissure or thyroid cartilage, but not beyond the outer perichondrium.

[Porocarcinoma of the parotid area. Report of a case]. / Porocarcinoma della regione parotidea. Descrizione di un caso.

The Authors describe the case of a 55 years old man, affected by ipercolesterolemy, ipertension and glaucoma, observed because of an important left parotid and laterocervical erythema with a small brown area measuring less than 1 cm inside. In the last two years the patient underwent resection of two basaliomas and of a porocarcinoma, with infiltration of margins, in the same region. Clinical and instrumental findings indicated the presence of reactive parotid's nodes; no evident lesions appeared at the examination of the ENT regions. The Authors describe and support their therapeutic approach.