Abnormal Thyroid Function Laboratory Results Caused by Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressant Treatment.

Mental health issues, especially depressive disorders, are major burdens to the health care systems. This has been more pronounced since the onset of the COVID-19 pandemic. Selective serotonin reuptake inhibitors (SSRIs) are often prescribed for depression. Uncommonly appreciated, however, are the adverse effects these agents may have on thyroid function laboratory test results as well as the clinical thyroidal functional status of such patients, which may lead to erroneous diagnoses and inappropriate treatments. We report on a depressed woman who developed abnormal thyroid biochemical laboratory reports during fluoxetine therapy. After changing to the serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine, the thyroid laboratory reports were normalized. In light of this, we wish to alert treating clinicians to this potential significant adverse effect.

Disinfecting Slush Machines by an Innovative Near Ultraviolet Light Emitting Diode (UV LED) Technological System.

Background: Microbial contamination of food and beverages is a topic of great interest. The most innovative technologies take advantage from UV light. This study aimed to evaluate a possible configuration of a nUV LED device at a wavelength of 405 nm installed on slush machines in order to reduce the microbial contamination. Study Design and Methods: Study Design and Methods. The study was conducted in the Department of Molecular and Developmental Medicine, University of Siena, Italy. A nUV LED device with 408 nm wavelength was installed and used on the slush machines. The inner walls of the machine tanks were fouled with contaminated slush, to evaluate the effectiveness of nUV radiation in reducing microbial contamination over time. Results: Experiment results on the slush machine showed a statistically significant logarithmic microbial reduction, in relation with the distance from the nUV LED light source. It has also been shown that the reduction of microbes is possible with a proper management of some parameters: the exposure time, the power and wavelength of the light source, the distance and the obstacles between the light source and the target to be irradiated. Conclusion: To reduce the incidence of foodborne diseases it is necessary to take all necessary precautionary measures, and the use of nUV technology has proved to be a crucial element in achieving this goal.

Factitiously Elevated Total Triiodothyronine in a Euthyroid Patient with Multiple Myeloma.

Sporadic reports of factitious elevations of thyroid hormones related to laboratory interference from autoantibodies and multiple myeloma paraproteins have appeared in the literature. Such clinically confusing laboratory results can lead to erroneous diagnoses and inappropriate treatments. We report an additional case of a patient with multiple myeloma and an IgG paraproteinemia who had such a spurious elevation of total T3 complicating her levothyroxine management of hypothyroidism. In addition, we alert clinicians that differences in performance characteristics between various manufacturers' test platforms may also cause spurious reports.

Our supramicrosurgical experience of lymphaticovenular anastomosis in lymphoedema patients to prevent cellulitis.

OBJECTIVE: Aim of this paper is to present our reduction of the frequency of cellulitis before and after supramicrosurgical lymphaticovenular anastomosis (s-LVA) in lymphoedema patients, and discuss the possibility to perform this technique outside Japan. PATIENTS AND METHODS: 37 patients affected by lymphoedema were enrolled. All patients received preoperative indocyanine green lymphography. Under local anaesthesia s-LVA was performed on all patients. All patients were followed for 1 year. Lymphoedema was staged using the lymphoedema staging classification recommended by the International Society of Lymphology. Cellulitis rate was recorded for all patients the year before and after the s-LVA. A t-test was used to evaluate differences in the frequency of cellulitis the year before surgery and the year following surgery. RESULTS: Cellulitis incidence decreased in all patients, with a mean 1.7 cases the year before s-LVA and 0.1 the year after s-LVA. A significant difference between preoperative and postoperative cellulitis rate was found (p = 0.0012). CONCLUSIONS: This study reports our s-LVA case series of lymphoedema patients. With the proper learning curve, s-LVA may be reproduced and lymphoedema patients may gain a better quality of life and a reduced cellulitis rate.

Supramicrosurgical lymphatico-venular anastomosis (LVA) in treating lymphoedema: 36-months preliminary report.

OBJECTIVE: Lymphoedema of the extremities is a widespread pathological condition that mostly occurs as a complication of cancer resections, especially in women. Conventional therapy refers to conservative and physiotherapeutic approaches. Surgical strategies have been widely reported in the literature and are still challenging. Part of this literature focuses on the supra microsurgical lymphaticovenular anastomosis (LVA) technique. LVA is characterized by a high success rate, minimal invasivity and broad indications. Furthermore, this procedure can be performed under local anesthesia. PATIENTS AND METHODS: From October 2011 through October 2014, 69 patients affected by lymphedema underwent LVA surgery in Siena University Hospital, Italy. Preoperative and postoperative evaluations were taken. RESULTS: Totally, 366 anastomosis have been performed. The average rate was 5.3 anastomosis per patient. All patients registered a decrease in the size of the affected side. The average volume reduction was 50%. Patients also showed a reduction of lymphangitis episodes and reduction of compression garments class. Moreover, a satisfaction index was evaluated. The majority of patients (72.5%) was extremely satisfied of the surgery. CONCLUSIONS: LVA has demonstrated to be an effective surgical strategy to treat lymphoedema, especially in secondary cases in early stages. Although LVA is widely discussed in the literature, the majority of works relates to Japanese authors and few reports exist outside Japan. This paper represents the very first retrospective analysis of the adoption of LVA technique in Italy and one of the few outside Japan.

Nonislet cell tumor hypoglycemia.

Nonislet cell tumor hypoglycemia (NICTH) is a rare cause of hypoglycemia. It is characterized by increased glucose utilization by tissues mediated by a tumor resulting in hypoglycemia. NICTH is usually seen in large mesenchymal tumors including tumors involving the GI tract. Here we will discuss a case, its pathophysiology, and recent advances in the management of NICTH. Our patient was diagnosed with poorly differentiated squamous cell carcinoma of esophagus. He continued to be hypoglycemic even after starting continuous tube feeds and D5W. General workup for hypoglycemia was negative and insulin-like growth factor II (IGF II) was in the normal range. Hypoglycemia secondary to "big" IGF II was considered, and patient was started on steroids. His hypoglycemia resolved within a day of treatment with steroids. Initially patient had hypoglycemia unawareness, which he regained after maintaining euglycemia for 48 hours.