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Tax management procedures include particular obligations of tax authorities, with the main goal to solve legal occurrences. The taxpayer, as a rights holder, has a series of legal instruments, with litigant contain to ensure the public institution's obligations to commit. [ABSTRACT FROM AUTHOR]

Background: Our study underline scarcity of isolated case reports or small case series of parathyroid adenoma (PA) published in autochthonous medical literature,their variable clinical expression among the "historic" varieties but also the diagnostic difficulties and delays of diagnosis as well consecration of surgery as the golden therapeutic standard of this disorder., Patients and Method: Demographic, clinical presentations, laboratory and imaging data, operative findings and procedures together with pathology account and outcome from the case reports of 18 patients with documented PHP were retrospectively analyzed. Results: The male/female ratio was 1/5, with ages ranging from 16 to 58 (mean 46) years. Renal stones (n=9) and bone sufferings (n=6) were the most common modes of presentation. To these were added psychiatric and neuromuscular complaints, digestive disorders (pancreatitis and peptic ulcer) arterial hypertension and presence of a palpable nodule. Mean serum calcium and phospho-rus, alkaline phosphatase and PTH dosage together with parathyroid ultrasound and 99m Tc sestamibi scintigraphy are the most useful parameters for diagnosis. Eighteen adenomectomies were performed of which bilateral neck exploration was done in 16 patients and minimally invasive approach in the remaining two cases. In 9 situations concomitant thyroid exeresis for associated lesions or tactical purpose were done. Pathology revealed single adenoma consisting of main and oxyphil cells in 17 cases. In one case an atypical adenoma was identified and in another case three years after removal of a benign adenoma the subject presented a clinical ipsilateral recurrence which provided to be a carcinoma. Postoperative clinical and humoral outcome was favorable in all situations less the case of carcinoma which died after 14 months. Conclusions: Despite the rarity and difficulties of diagnosis in cases of PA, practitioners must be aware of potential existence of these lesions in order to apply as early and appropriate treatment where surgery is the gold standard., (Celsius.)

Primary thyroid lymphomas account for less than 5% of all thyroid malignancies and the majority of cases concern non- Hodgkin's lymphoma of B and T-cell origin as well as Hodgkin's lymphoma. Mucosa-associated lymphoid tissue (MALT) lymphoma are a relatively recently described subset of low grade B-cell non-Hodgkin's lymphoma representing between 6 and 27% of the patients with thyroid lymphomas. These cases occur usually in patients with Hashimoto's thyroiditis having a long indolent course and delayed diagnosis, actually benefit from several therapeutic opportunities among them even surgery and a favorable prognostic. Herein we present a 42-year-old female admitted in our unit for a right firm sensitive thyroid swelling, nonhomogeneous on ultrasound images. FNAB showed cellular smears of mixed follicular cells on a background of mature lymphocytes displaying some nuclear atypia and scanty cytoplasm but no definite malignant elements. Intraoperatively, in addition to the "banal" goiter that was found, some subcentimeter cervical lymph nodes were evidenced. Frozen section showed no evidence of malignant or even suspected cellular elements. However a total right lobectomy and lymph node excision was performed. Microscopy revealed a diffuse lymphoproliferative infiltrate in a background of lymphocytic thyroiditis suggesting a diagnosis of B-cell lymphoma of MALT type and the patient was referred to chemotherapy. She was currently under follow-up without recurrences or metastases after two years from surgery., (Celsius.)

Vaginal hysterectomy was mentioned before our era by Soranus of Ephesus, and it is one of the most frequent surgical interventions in gynecologic practice; performed for the first time by Sauter of Constance, in 1822, who practiced a vaginal hysterectomy without ligation of vessels, carrying out the hemostasis with a swab dipped in alum. The essential argument for vaginal surgery is the advantage it brings. Current indications and contraindications encourage the frequent use of vaginal hysterectomy in benign pathology of the uterus, while the indication (Crossen, Rouhier, Campbell techniques) depends most of the times on the surgeon's experience and preference rather than on the critic evaluation of results. Material and methods: The study group included 84 patients, hospitalized from January 2013 to December 2015 in the Third Obstetrics Clinic. For the evaluation of results, we used longitudinal retrospective clinical-statistical method. Results and discussion: Practicing the surgery on vaginal route is mainly indicated in patients with severe anemias and different organic tares. When removal of the cervix is not indicated, or when or when there is an enlarged uterus or one with a small diameter, it is recommended to use laparoscopic hysterectomy. Conclusions: Vaginal hysterectomy is a technique that allows rapid removal of the uterus, with a minimal impact on the patient, indicated in the pathology benign uterine tumors (uterine fibromatosis associated with metrorrhagia, fibromatous uterus with cervical dysplasia, or fibromatous uterus associated with different degr4ees of uterine prolapse).

Introduction: The significant increase in the average lifespan of the general population lead to a proportional enhacement in the prevalence of benign and malignant thyroid conditions and equally the number of surgeries for this pathology., Patients and Method: In a personal series of 464 thyroid disorders undergoing surgery over a two decades period we registered 51 patients (10.9%) aged over 65 years of which 11 (2.4%) having over 75 years. Demographic, clinical and diagnostic characteristics of these cases were analysed together with indications, management practice and outcome. Retrospective statistical analysis reaearching risk factor and confidence interval has not identified factors predicting higher risk of complication in this age group., Results: There have been recorded 33 females and 18 males (R1=1,8/1) with clinically, laboratory and histologically confirmed diagnosis of 24 (multi)nodular goiters (47.0%), 18 thyrotoxicosis (35.2%) and also 9 (17.6%) thyroid carcinomas. Thirty-four total or near total thyroidectomies and 17 conservative exeresis were performed. There were not postoperative deaths but we recorded three cases of prolonged hypocalcemia, and two cases each of recurrent laryngeal nerve paresis and recurrences. In all benign cases we obtained a stable in time cure while in carcinomas survivals of 3-5 years were obtained in only 4 papillary tumors., Conclusions: Despite some difficulties in diagnostic and additional risks related to comorbidity benign and malignant pathology installed in patients over 65 years, may benefit of all types of conservative or radical thyroidectomies in terms of strict monitoring individualized in each case., (Celsius.)

Increased dietary ratios of ω6/ω3 polyunsaturated fatty acids have been implicated in the pathogenesis of Crohn's disease (CD), but epidemiologic data are limited. We investigated whether variants of genes that control polyunsaturated fatty acid metabolism (CYP4F3, FADS1, and FADS2), along with the dietary ratio of ω6/ω3, confers susceptibility to CD. Based on data from 182 children newly diagnosed with CD and 250 controls, we found that children who consumed a higher dietary ratio of ω6/ω3 were susceptible for CD if they were also carriers of specific variants of CYP4F3 and FADS2 genes. Our findings implicate diet-gene interactions in the pathogenesis of CD., (Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Background: Although genome-wide association studies (GWAS) and subsequent meta-analyses have confirmed associations between the PTPN2 (protein tyrosine phosphatase, nonreceptor type 2) gene and Crohn's disease (CD), the potential causal variants remain unidentified. We aimed to dissect potential causal CD-associated PTPN2 variants, assess their functional significance, and relate PTPN2 protein expression with inflammation in CD., Methods: A 3-stage study was carried out. In stage 1, we genotyped tagging single nucleotide polymorphisms (tag-SNPs) in the PTPN2 gene in a sample of patients with CD (<20 years, n = 556) and controls (n = 602). In stage 2, we resequenced the putative promoter, target exons and introns in the PTPN2 gene, and examined associations with high-frequency variants with CD in the stage 1 cohort. In stage 3 we studied the relationship between PTPN2 protein expression and mucosal inflammation and carried out in silico analyses to study the functional characteristics of the PTPN2 CD-associated SNPs., Results: In stage 1, we observed associations between 5 intronic SNPs and CD including rs1893217 (P = 2 × 10⁻⁴), the SNP that is in perfect linkage disequilibrium with the lead genome-wide association studies SNP rs2542151. Resequencing revealed 2 known promoter polymorphisms. No associations between these promoter SNPs and CD were evident. In silico analyses revealed that the 5 associated intronic SNPs influenced PTPN2 expression and binding to important transcription factors. PTPN2 protein was overexpressed in inflamed intestinal tissues of patients with CD., Conclusions: Our findings suggest that noncoding variation in the PTPN2 gene may represent the causal variations influencing susceptibility for CD.

Background: Genome-wide association studies (GWAS) in Crohn's disease (CD) have identified associations with single-nucleotide polymorphism (SNP) rs11175593 at chromosome 12q12. The MUC19 and LRRK2 genes reside close to the GWAS signal, but it is as yet unclear which of the 2 genes represent the CD susceptibility genes., Methods: We studied associations between nonsynonymous coding variants in the MUC19 (5) and LRRK2 (3) genes in a case-control sample comprising CD cases aged <18 years at diagnosis. The GWAS lead SNP rs11175593 was also investigated. Allelic, genotype, and haplotype associations were examined assuming different models of inheritance., Results: A total of 530 cases and 600 controls were studied. The mean (±SD) age at diagnosis was 12.4 (±3.3). Most cases were male (57.4%). Most patients had ileocolonic disease location (48.8%) and inflammatory behavior at diagnosis (87.0%). Three MUC19 SNPs were nominally significantly associated with CD (rs11564245, Asp→His: P = 0.02; rs4768261, Ser→Phe: P = 0.0008; and rs2933353, Glu→Ala: P = 0.01). Associations with rs4768261 were maintained after corrections for multiple comparisons (permuted, P = 0.007). None of the LRRK2 SNPs were associated with CD. Haplotype analysis supported the single SNP associations noted with the MUC19 gene., Conclusions: GWAS signal at chromosome 12q12 for CD may represent associations with the MUC19 gene.

Introduction: Inflammatory processes of the thyroid represents a main proportion of the gland's pathology but the majority of them are treated by medical methods, surgery being indicated., Patients and Methods: In 14 cases (3%) from 464 operations for different thyroid conditions we have encountered authentic inflammatory lesions in 9 cases of Hashimoto's thyroiditis (two associated with papillary thyroid carcinoma and one with malignant lymphoma), two cases of Riedel's thyroiditis and respectively de Quervain thyoiditis, tuberculous thyroiditis and actynomicosis one case each. The common lymphoplasmacytic infiltration in Basedow's disease was not considered likewise as the inflammatory nespecific lesions encountered in benign and malignant pathology of the gland. The clinical and imagistic data, biological evaluation and titer of anticorps but particularly the paraffine examination together with intraoperative estimations are decisive for the diagnosis., Results and Discussions: Firm diagnosis of thyroiditis was rarely affirmed before operation, surgical indication being formulated on clinical criterions dominated by cancer suspicion. Among these are diffuse or (multi)nodular thyromegaly with a dominant nodule with recent appearance and rapid growing in temporal and geographic proximity of Chemobyl disaster, with hard consistence, celsian or compressive features and adenopathy. More added the imagistic signs but especially suspect aspects of the FNAB (follicular or with Hürthle cells smears) and also of the frozen sections. Certainty diagnosis was established by paraffine examination not always without hesitations or reexamination (Hashimoto's thyroiditis diagnosed in one case was finally a malignant lymphoma). Large removal decided after intraoperative findings induced for the most of patients a definitive hypothyroidism., Conclusion: All the diagnosis resources must be exhausted for the diagnosis of the inflammatory lesions of the thyroid to avoid unnecessary surgery. On the other side the chronic overstimulation by the TSH of the glandular tissue affected by the immune process, represent an important factor of producing neoplasia.

Background: Genome-wide association studies (GWAS) and replication studies have shown conflicting associations between the NELL1, NCF4, and FAM92B genes and susceptibility for Crohn's disease (CD). We sought to examine whether these genes were associated with CD in Canadian children and young adults., Methods: A case-control study was carried out at three pediatric gastroenterology clinics across Canada. Patients, ≤20 years at diagnosis, along with controls representative of the general population were selected. Study subjects were genotyped for 22 single nucleotide polymorphisms (SNPs) across the target genes. Allelic and haplotype associations were examined. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated., Results: In all, 566 CD cases and 602 controls were investigated. The mean (±SD) age of the patients was 12.3 (±3.3) years. Most patients were male (57.8%), of Caucasian ancestry (98.2%), and had ileocolonic disease location (48.8%). Barring nominal associations with one FAM92B SNP, none of the other 21 SNPs analyzed were associated with CD either at the allelic or haplotype level. Separate analysis for ileal CD (L1 plus L3) also did not reveal significant associations with any of the SNPs. Similarly, a pooled analysis using data from two recent studies did not demonstrate associations between the NCF4 (OR = 1.10, 95% CI = 0.91-1.32, P = 0.32) and FAM92B (OR = 1.05, 95% CI = 0.95-1.17, P = 0.36) GWAS lead SNPs and ileal CD., Conclusions: GWAS-reported associations in the NELL1, NCF4, and FAM92B genes could not be replicated in Canadian children and young adults. Further investigation in other populations will be required to confirm the presence/absence of associations, if any., (Copyright © 2011 Crohn's & Colitis Foundation of America, Inc.)

Background: The optimal treatment of tumors of Vater's region represents a permanent interest of every physician involved in the treating of malignant diseases with such localization., Aim: This presentation proposes a pancreaticoduodenectomy (DPC) evaluation in the surgical treatment of tumors of Vater's ampulla., Materials and Methods: Between 1999 - 2009 our clinic has treated a number of 37 cases with mechanic jaundice by malignant diseases (JMN). Out of these, 5 cases (13.5%) have been hospitalized with JMN (preoperative diagnose) by malignant tumors of Vater' region: 4 men and a woman, aged 46 to 72, from rural medium, who represent the aim of this paper. RESULTS., Discussion: In 4 cases (10,.8%), intra-operatory exploration confirms the existence of tumors of Vater's ampulla or duodenal papilla (diagnosis having been established by preoperatory duodenoscopy) using DPC (Child Procedure). Postoperative evolution, either immediate or distanced, was favorable, implying no deaths. The microscopic exam of the extirpated piece confirms Vater's Ampulloma in two cases (5.4%); in the other two cases, the above mentioned exam reveals the small bowel's carcinoma at duodenal papilla. In the last 2.7% cases intra-operatory lymph node and visceral metastases have been observed, choledochoscopy revealing cholangiocarcinoma (confirmed by microscopic exam), the patient having suffered only a choledochoduodenostomy., Conclusions: Without being endowed with great experience in the field, the results of DPC treatment in these first cases of malignant tumors of Vater's region allow us to found the reasoning of the righteousness of surgical indication. DPC draws the hope of radical healing intention in the cancer with this localization.