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Adenoma pleomorfo plurirecidivante: una sfida terapeutica.L’adenoma pleomorfo è il tumore più frequente delle ghiandole salivari. È caratterizzato da un elevato rischio di recidiva anche dopo un’accurata chirurgia. L’estensione ed il corretto timing della chirurgia è controverso sopratutto nei casi di tumori plurirecidivanti. In questo lavoro abbiamo valutato tutti i casi di adenoma pleomorfo plurirecidivante (RPAs) trattati presso l’Helsinki University Hospital dal 2004 al 2013. I dati di follow-up sono stati raccolti sino al gennaio 2018. Dei 47 pazienti considerati, 70% erano donne con un’età media di 33,5 anni. La maggior parte dei RPAs erano localizzati a livello della ghiandola parotide (87%), sei (13%) a livello delle ghiandole sottomandibolari. Un terzo (17/47) dei tumori sono stati rimossi chirurgicamente. All’interno di questa popolazione di pazienti sono stati documentati 75 eventi di recidiva di malattia, 14 pazienti (30%) hanno avuto 2 o più recidive. L’intervallo di tempo intercorso fra le singole recidive si è gradualmente accorciato con un incremento progressivo del rischio che il tumore si ripresentasse a livello multifocale. Al termine del periodo di follow up, 15% dei pazienti hanno avuto recidiva di malattia, nel 6% si è verificata la degenerazione maligna del tumore. Il trattamento dell’adenoma pleomorfo plurirecidivante rappresenta una sfida terapeutica e richiede un management centralizzato. I pazienti affetti da RPA sono spesso di giovane età, il trattamento delle forme plurirecidivanti è gravato da un’elevata morbidità negli anni. L’impiego ed il timing di un’eventuale radioterapia post operatoria nonchè il rischio di degenerazione maligna sono parametri da prendere in considerazione per una corretta gestione multidisciplinare dei RPA.Pleomorphic adenoma (PA) is the most common tumour of the salivary glands, and can recur even after proper surgery. The extent and timing of surgery for recurrent tumours remains controversial, and multiple recurrences pose a special challenge. We evaluated all recurrent PAs (RPAs) treated at the Helsinki University Hospital through 2004-2013 focusing on patients with multiple recurrences. Follow-up data were obtained until January 2018. Of the 47 patients, 70% were women and the median age was 33.5 years. Most of the RPAs were located in the parotid gland (87%), and six (13%) in the submandibular gland. One-third (17/47) of tumours had been primarily excised. This patient population experienced 75 recurrent events in total with two or more recurrences in 14 patients (30%). The time interval between recurrences shortened after each recurrent event and the tumour was more likely to be multifocal. At the end of the follow-up period, 15% had recurrent disease and malignant transformation had occurred in 6%. Treatment for PA and RPA is challenging and requires centralised management. Patients with RPA are often young and recurrences may cause lifelong morbidity, especially when the tumour recurs repeatedly. The utilisation and timing of postoperative radiotherapy needs to be discussed as well as the potential risk for malignant transformation in this patient population.

SommarioUn aumento del numero di pazienti acromegalici anziani è atteso nei prossimi anni grazie ai miglioramenti apportati in campo diagnostico e terapeutico. La diagnosi di acromegalia nell’anziano può risultare insidiosa a causa di quadri clinici sfumati che possono sovrapporsi alle manifestazioni tipiche dell’invecchiamento. Non esistono criteri diagnostici specifici per l’anziano. La chirurgia si è dimostrata efficace e relativamente sicura anche nel paziente anziano che, tuttavia, presenta una buona risposta agli analoghi della somatostatina.

With both antimicrobial and sealing properties, premixed bioceramic materials are unique materials available in endodontics that contribute to the success of both the microbial control phase (instrumentation, irrigation, intra-canal medication) and the filling phase (root and top filling) of root canal treatment. Bioceramic material may be an essential element in the indirect and direct pulp capping and pulpotomy procedures that are an integral part of endodontic therapy's goal of maintaining the vital pulp to ensure a healthy periradicular periodontium. For all these reasons, premixed bioceramic materials are now the material of choice for pulp capping, pulpotomy, perforation repair, root-end filling, and obturation of immature teeth with open apices, as well as for sealing root canal fillings of mature teeth with closed apices.

The authors propose a minimally invasive procedure for treating type-A3 amyelic thoracolumbar fractures according to Magerl classification (compression burst fractures). The procedure, percutaneous kyphoplasty, allows the fracture to be reduced and vertebral height to be restored by injecting bone cement into a cavity created in the vertebral body by an inflatable balloon introduced with the percutaneous approach. Four patients were successfully treated, with clinical and functional benefit in all cases. There were no complications.

La formazione di calcoli urinari è una delle complicanze più comuni delle derivazioni urinarie sia incontinenti (ure-terocutaneostomie, condotti ileali e colici) che continenti (ureterosigmoidostomia, vescica rettale, neovescica ortotopica e tasche continenti). Le cause ed i fattori di rischio per la formazione di calcoli urinari in pazienti con derivazione urinaria sono molteplici e diverse per ogni tipo di derivazione: stasi urinaria, corpi estranei (suture, staples e cateteri) ed alterazioni metaboliche. Le complicanze metaboliche (ridotto volume urinario giornaliero con urine concentrate, iperossaluria, ipercalciuria e ipocitraturia) possono essere conseguenti al prelievo di un tratto intestinale e/o al contatto del tratto di intestino con l'urina. Le indicazioni al trattamento dei calcoli urinari nei pazienti con derivazione urinaria non sono diverse da quelle per i pazienti con integrità delle vie urinarie, tuttavia la strumentazione endourologica può risultare più difficoltosa. La prof lassi si basa sulla correzione di eventuali fattori di stasi, un buon apporto idrico e la correzione dell'acidosi con somministrazione cronica di citrato di potassio e/o bicarbonato o di sodio e sulla eventuale supplementazione di calcio in presenza di iperossaluria enterica.

The range of osteoporosis treatments is increasingly large and, like any disease, the pharmacological management of patients should involve a risk/benefit evaluation to attain the greatest reduction in risk of fracture with the lowest incidence of adverse events. The aim of this review is to critically appraise the literature about the safety issues of the main pharmacological treatments of osteoporosis. This document is the result of a consensus of experts based on a systematic review of regulatory documents, randomized controlled trials, metaanalyses, pharmacovigilance surveys and case series related to possible adverse drug reactions to osteoporosis treatment with calcium and vitamin D supplements, bisphosphonates, strontium ranelate, selective estrogen receptor modulators, denosumab, and teriparatide. As expected, randomized controlled trials showed only the most common adverse events due to the samples size and the short observation time. Case series and observational studies are able to provide data about uncommon side effects, but in some cases a sure cause-effect relationship needs still to be confirmed. Consistently with methodological limitations, the newer drugs have a tolerance profile that has not been fully explored yet. Osteoporosis treatments showed an overall good tolerance profile with rare serious adverse events that, however, must be well known by the clinician who prescribes these drugs. The concern about possible adverse events should be weighed against the reduction of morbidity and mortality associated with a significant fracture risk reduction.

Echinococcosis or hydatid disease (HD) is a zoonosis caused by the larval stages of taeniid cestodes belonging to the genus Echinococcus. Hepatic echinococcosis is a life-threatening disease, mainly differentiated into alveolar and cystic forms, associated with Echinoccus multilocularis (E. multilocularis) and Echinococcus granulosus (E. granulosus) infection, respectively. Cystic echinococcosis (CE) has a worldwide distribution, while hepatic alveolar echinococcosis (AE) is endemic in the Northern hemisphere, including North America and several Asian and European countries, like France, Germany and Austria. E. granulosus young cysts are spherical, unilocular vesicles, consisting of an internal germinal layer and an outer acellular layer. Cyst expansion is associated with a host immune reaction and the subsequent development of a fibrous layer, called the pericyst; old cysts typically present internal septations and daughter cysts. E. multilocularis has a tumor-like, infiltrative behavior, which is responsible for tissue destruction and finally for liver failure. The liver is the main site of HD involvement, for both alveolar and cystic hydatidosis. HD is usually asymptomatic for a long period of time, because cyst growth is commonly slow; the most frequent symptoms are fatigue and abdominal pain. Patients may also present jaundice, hepatomegaly or anaphylaxis, due to cyst leakage or rupture. HD diagnosis is usually accomplished with the combined use of ultrasonography and immunodiagnosis; furthermore, the improvement of surgical techniques, the introduction of minimally invasive treatments [such as puncture, aspiration, injection, re-aspiration (PAIR)] and more effective drugs (such as benzoimidazoles) have deeply changed life expectancy and quality of life of patients with HD. The aim of this article is to provide an up-to-date review of biological, diagnostic, clinical and therapeutic aspects of hepatic echinococcosis.