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Prior studies have shown that among patients with chronic kidney disease not yet on dialysis, the faster progression of kidney injury in men than in women is, at least partly, explained by sex differences in ambulatory blood pressure (BP) control. The present study aimed to investigate potential differences in the levels of ambulatory BP and intensity of antihypertensive treatment between men and women with end-stage kidney disease undergoing long-term peritoneal dialysis (PD). In a case-control design, 48 male PD patients were matched for age and heart failure status with 48 female patients in a 1:1 ratio. Ambulatory BP monitoring was performed with an oscillometric device, the Mobil-O-Graph (IEM, Stolberg, Germany). The BP-lowering medications actually taken by the patients were prospectively recorded. No gender-related differences were observed in 24 h systolic BP (129.0 ± 17.9 vs. 128.5 ± 17.6 mmHg, p = 0.890). In contrast, 24 h diastolic BP was higher in men than in women (81.5 ± 12.1 vs. 76.8 ± 10.3 mmHg, p = 0.042). As compared with women, men were being treated with a higher average number of antihypertensive medications daily (2.4 ± 1.1 vs. 1.9 ± 1.1, p = 0.019) and were more commonly receiving calcium-channel-blockers (70.8% vs. 43.8%, p = 0.007) and β-blockers (85.4% vs. 66.7%, p = 0.031). In conclusion, the present study shows that among PD patients, the levels of ambulatory BP and intensity of antihypertensive treatment are higher in men than in women. Longitudinal studies are needed to explore whether these gender-related differences in the severity of hypertension are associated with worse cardiovascular outcomes for male patients undergoing PD.

Context Next to a large body of epidemiological observational studies showing that the Mediterranean diet (MD) is an important lifestyle determinant of cardiovascular risk, there is less relevant evidence from well-conducted randomized controlled trials (RCTs) with hard cardiovascular outcomes. Objective The objective of the study was to identify the most effective dietary intervention for reducing cardiovascular morbidity and mortality. Data Sources A systematic approach following PRISMA network meta-analyses reporting guidelines was applied to a search of electronic databases (MEDLINE, Cochrane Central Register of Controlled Trials, and Embase) without language restrictions, supplemented by scanning through bibliographies of studies and meetings' abstract material. Inclusion criteria were RCTs conducted in an adult population, investigating the effects of different type of diets or dietary patterns on all-cause mortality and cardiovascular outcomes of interest. Data Extraction Data extraction for each study was conducted by 2 independent reviewers. Data Analysis A frequentist network meta-analysis using a random-effects model was conducted. Death from any cardiovascular cause was defined as the primary outcome. A total of 17 trials incorporating 83 280 participants were included in the systematic review. Twelve articles (n = 80 550 participants) contributed to the network meta-analysis for the primary outcome. When compared with the control diet, only the MD showed a reduction in cardiovascular deaths (risk ratio = 0.59; 95% confidence interval, 0.42–0.82). Additionally, MD was the sole dietary strategy that decreased the risk of major cardiovascular events, myocardial infarction, angina, and all-cause mortality. Conclusions MD may play a protective role against cardiovascular disease and death for primary and also secondary prevention. Systematic Review Registration Center for Open Science, https://doi.org/10.17605/OSF.IO/5KX83 [ABSTRACT FROM AUTHOR]

The aim of this study is to describe the clinicopathological characteristics of intranasal pleomorphic adenomas (PAs), as well as the role and outcomes of endoscopic endonasal resection. A retrospective review of the clinical data from patients with PA of the nasal cavity who were treated by the authors at three tertiary medical centers between June 1998 and December 2019. A total of five patients with PA were found. Three patients were male, two were female and their mean age was 62.2 years. All cases were resected “en bloc” with endoscopic endonasal approach. No evidence of disease was observed during a mean follow-up of 10.6 years. No case presented with malignant transformation into carcinoma ex-PA. PA of the sinonasal tract and the nasopharynx is difficult to diagnose due to nonspecific clinical and radiological findings. Endoscopic endonasal approaches can be considered the gold standard in the treatment of these tumors and provide excellent visual control of the surgical field and clear margins.

Abstract Background Encapsulating-peritoneal-sclerosis (EPS) is a rare, but serious and life-threatening complication of peritoneal dialysis (PD). Treatment of EPS consists of discontinuation of PD and maintenance of nutritional status, whereas the role of corticosteroids, tamoxifen and other immunosuppresive agents is not yet fully elucidated. Case-presentation We report the case of a 28-year-old patient, who developed a severe form of calcifying EPS after a 6-year-long therapy with automated PD. The clinical presentation was severe with repeated episodes of total bowel obstruction, weight loss and malnutrition that mandated his prolonged hospitalization. Initial treatment included corticosteroids and tamoxifen (20 mg/day) with a clinically meaningful improvement in gastrointestinal function and nutritional status over the first 6–12 months. Corticosteroids were discontinued at 18 months, but owing to persistence of calcifying lesions and peritoneal thickening in repeated computed-tomography (CT) scans, tamoxifen remained unmodified at a low-dose of 20 mg/day for a 10-year-long period. During follow-up, the patient remained symptoms-free in an excellent clinical condition and the CT findings were unchanged. Conclusions Long-term administration of tamoxifen was not accompanied by any drug-related adverse effects and potentially exerted a beneficial action on down-regulation of inflammatory and fibrotic processes and improvement of gastrointestinal function, nutritional status and overall health-related quality of life.

Objective: Petrous apex cholesterol granuloma (PACG) is a lesion that can give rise to different symptoms, and correlations with etiopathology are ambiguous. The aim of this study is to analyze the association between PACG symptoms and radiological findings at presentation, in order to establish a reproduceable pre-operative radiological evaluation and guide the surgical indication. Methods: PACG patients were collected in two tertiary care hospitals. All cases underwent CT/MRI to evaluate the cyst localization and erosion of surrounding structures. Typical and atypical symptoms were then analyzed and compared to radiologic findings established in accordance with the literature. Results: Twenty-nine patients were recruited; the most common symptoms were headache (69%), diplopia (20.7%) and fainting (24.1%), an atypical clinical manifestation related to jugular tubercle involvement. Significant associations between symptoms and radiologic findings were noted in terms of headache and temporal lobe compression (p = 0.04), fainting and jugular tubercle erosion (p < 0.001), vestibular symptoms and internal auditory canal erosion (p = 0.02), facial paresthesia and Meckel’s cave compression (p = 0.03), diplopia and Dorello canal involvement (p = 0.001), and tinnitus and cochlear basal turn erosion (p < 0.001). All patients were treated via an endoscopic–endonasal approach, in which extension was tailored to each case. At a median follow-up of 46 months, 93.1% of patients experienced resolution of symptoms. Conclusions: This clinico-radiological series demonstrates associations between symptoms and anatomical subsites involved with PACG. Hence, it may guide the surgeon at the time of surgical decision, since it asserts that typical and atypical symptoms are actually related to PACG.

Whether hemodialysis patients should be allowed or even encouraged to eat during dialysis remains a controversial topic. This cross-over study aimed to evaluate the impact of feeding during dialysis on intradialytic blood pressure (BP) profile and dialysis adequacy in 26 patients receiving thrice-weekly, in-center hemodialysis. Over three consecutive mid-week dialysis sessions, intradialytic BP was monitored using the Mobil-O-Graph device (IEM, Stolberg, Germany). Blood samples were also obtained for the determination of the urea reduction ratio (URR). At baseline, patients underwent dialysis without the provision of a meal. In phases A and B, a meal with either high-protein (1.5 gr/kg of body weight) or low-protein (0.7 gr/kg of body weight) content was administered 1 h after the initiation of dialysis. The sequence of meals (high-protein and low-protein or vice versa) was randomized. Average intradialytic systolic BP (SBP) was similar on all three occasions. However, compared with baseline, the standard deviation (SD) (11.7 ± 4.1 vs. 15.6 ± 7.6 mmHg, p < 0.01), coefficient of variation (CV) (9.5 ± 3.7% vs. 12.4 ± 6.0%, p < 0.01) and average real variability (ARV) (9.4 ± 3.9 vs. 12.1 ± 5.2 mmHg, p < 0.01) of intradialytic SBP were higher in phase A. Similarly, compared with the baseline evaluation, all three indices of intradialytic SBP variability were higher in phase B (SD: 11.7 ± 4.1 vs. 14.1 ± 4.5 mmHg, p < 0.05; CV: 9.5 ± 3.7% vs. 11.1 ± 3.8%, p < 0.05; ARV: 9.4 ± 3.9 vs. 10.9 ± 3.9 mmHg, p < 0.05). Compared with dialysis without a meal, the consumption of a high-protein or low-protein meal resulted in a lower URR (73.4 ± 4.3% vs. 65.7 ± 10.7%, p < 0.001 in phase A and 73.4 ± 4.3% vs. 67.6 ± 4.3%, p < 0.001 in phase B, respectively). In conclusion, in the present study, feeding during dialysis was associated with higher intradialytic SBP variability and reduced adequacy of the delivered dialysis.

Introduction: Retropharyngeal space schwannomas are rare entities. About 20-45% of schwannomas occur in the head and neck region; however, they represent less than 1% of all head and neck tumors. Case Report: We present the case of a 36-year-old woman complaining of dysphagia caused by a large schwannoma arising in the posterior pharyngeal wall with remarkable reduction of the oropharyngeal space. The tumor was resected through a combined transoral and cervicotomic transmandibular approach due to its dimension. No recurrence was observed after a two-year follow up. This case represents the thirteenth case reported in international literature. Conclusion: Preoperative settings for rare tumors such as retropharyngeal schwannomas should include radiological investigations and preoperative biopsy. In order to obtain a successful result in terms of radicality, a combined surgical approach may be necessary to completely control the extension of the lesion.

Background: Choanal atresia is a congenital obstruction of the posterior nasal aperture. Endoscopic endonasal surgery has led to successful choanal atresia repair. This paper describes our surgical technique using septal mucosal flaps without the need for stenting. Methods: This study comprised a multicentre retrospective review of patient notes. A cross-over septal technique is described, whereby bilateral vertical mucosal incisions are made at the posterior third of the septum, and the atretic plate and posterior vomer are removed. One flap is pedicled superiorly and rotated over the bare skull base and sphenoid bone; the contralateral flap is pedicled inferiorly to cover the exposed vomer remnant and hard palate. Results: There were 12 patients from 2013 to 2020, aged 0.07–50 years, with a male to female ratio of 1:5. Ten patients had unilateral and two had bilateral choanal atresia. Nine patients had bony choanal atresia, with the remainder mixed. Conclusion: The cross-over technique for choanal atresia has low morbidity and 100 per cent success in our series. The use of mucoperiosteal flaps to cover exposed bone and minimal instrumentation to the lateral nasal wall reduce post-operative stenosis. [ABSTRACT FROM AUTHOR]

Il trattamento chirurgico dei tumori maligni nasosinusali estesi al basicranio anteriore si è evoluto nel corso degli ultimi decenni, passando dalla resezione craniofacciale tradizionale agli approcci endoscopici endonasali. In questi approcci mini-invasivi, il basicranio anteriore viene generalmente ricostruito con tecnica multistrato, utilizzando innesti di materiale autologo (fascia lata o tratto ileo-tibiale), che determinano la produzione di abbondanti crostosità a livello della neocavità chirurgica con conseguente disagio e fastidio per il paziente. In casi selezionati, proponiamo di allestire un lembo di mucopericondrio e mucoperiostio di setto nasale controlateralmente rispetto alla neoplasia, peduncolato sui rami settali delle arterie etmoidali anteriore e posteriore (Septal Flip-Flap, SFF), che può essere ruotato a ricostruire il difetto del basicranio anteriore. Criteri di esclusione per l’allestimento di questo lembo locale sono: tumori con estensione bilaterale ad interessare entrambi i complessi etmoidali; infiltrazione neoplastica del setto nasale e/o del planum sfeno-etmoidale; tumore maligno nasosinusale con istologia potenzialmente multifocale. Nel nostro centro di riferimento di terzo livello, la ricostruzione del basicranio mediante SFF è stata eseguita in 4 pazienti affetti dalle seguenti patologie: teratocarcinosarcoma etmoidale in un caso, persistenza di carcinoma indifferenziato nasosinusale (in esiti di trattamento radio-chemioterapico) in un caso, estesioneuroblastoma della fessura olfattoria in un caso, e carcinoma spinocellulare etmoidale in un caso. Non si sono verificate complicanze intra/post-operatorie, ottenendo il successo della ricostruzione del basicranio nella totalità dei casi. Nel postoperatorio si è osservata una netta riduzione delle crostosità intranasali, con rapida guarigione della neocavità chirurgica. Attualmente, non si sono registrate recidive di malattia, con un follow-up medio di 15 mesi. La ricostruzione del basicranio anteriore mediante SFF si è dimostrata sicura ed efficace, con percentuali di successo elevate, simili a quelle ottenute con altri lembi locali peduncolati. Il SFF garantisce inoltre una maggiore rapidità nel processo di guarigione della plastica del basicranio, con una diminuzione delle crostosità nasali nel postoperatorio e conseguente miglioramento della qualità di vita del paziente. Questa tecnica appare essere valida anche dal punto di vista oncologico per casi estremamente selezionati di tumore maligno nasosinusale. Casistiche più ampie con follow-up a lungo termine sono necessarie per validare i risultati preliminari di questa innovativa e promettente tecnica chirurgica.

Le lesioni fibro-ossee benigne raramente colpiscono i seni paranasali e sono suddivise in 3 entità: osteoma, displasia fibrosa e fibroma ossificante. Questi presentano simili caratteristiche cliniche, radiologiche e istologiche ma hanno un comportamento diverso. Il fibroma ossificante, in particolare la variante istologica giovanile, può presentare un comportamento aggressivo con un alto rischio di recidiva se rimosso in modo incompleto. Lo scopo dello studio è quello di paragonare il comportamento clinico del fibroma ossificante con quello delle altre lesioni fibro-ossee; di evidenziare un eventuale comportamento differente tra i vari sottotipi istologici; di descrivere i vantaggi, i limiti e i risultati della chirurgia endoscopica endonasale rispetto ai dati presenti in letteratura. Abbiamo analizzato retrospettivamente 11 pazienti affetti da fibroma ossificante naso-sinusale e trattati in un centro ospedaliero di terzo livello. Tutti i pazienti sono stati sottoposti a TC. La RM è stata eseguita in caso di coinvolgimento del basicranio o in caso di recidiva. Una biopsia pre-operatoria è stata effettuata nei casi in cui la massa era raggiungibile per via endoscopica. Un paziente è stato sottoposto a embolizzazione pre-operatoria ed ha riportato una cecità monolaterale al termine della procedure. In base alla localizzazione, l’exeresi del tumore è stata eseguita con un approccio endoscopico (7 pazienti), esterno (3), combinato (1). Istologicamente 5 pazienti hanno riportato un sottotipo convenzionale, 5 la variante giovanile psammomatoide associata in un caso a cisti aneurismatica ossea, e un paziente la variante giovanile trabecolare. Tre pazienti affetti dalla variante istologica giovanile psammomatoide hanno presentato un’invasione del basicranio e sono stati sottoposti ad exeresi subtotale per via endoscopica che ha richiesto in seguito, a causa di un aumento di volume del residuo, un secondo intervento per via transbasale. I reperti clinici, radiologici e istologici dovrebbero essere considerati insieme per una accurata diagnosi differenziale tra le lesioni fibro-ossee. Ulteriori studi sono necessari per concludere se la localizzazione e l’estensione del fibroma ossificante al momento della diagnosi sono più importanti della variante istologica. L’approccio endoscopico è la prima opzione nella maggior parte dei casi anche se in alcuni selezionati pazienti l’approccio esterno risulta ancora necessario.