Search

Background: The aim of this study was to evaluate the impact of the intraoperative PTH (ioPTH) monitoring in the success of parathyroidectomy based on the concordant or indeterminate preoperative imaging studies of localization and the performed surgical choices., Methods: Fourthy-seven patients who received parathyroidectomy operations were divided in four groups: concordance of the imaging and ioPTH, concordance of the imaging and no ioPTH, indeterminate imaging and ioPTH and indeterminate imaging and no ioPTH., Results: Overall, patients in whom ioPTH monitoring was not performed were healed in 89.47% of cases, while the percentage of recovery in patients receiving ioPTH was 85.71%. There were no differences in the changes in strategy or in the cure rates with the use of ioPTH., Conclusions: No significant differences were found, independently from the preoperative imaging agreement, in either the cure rate or in the change of intraoperative strategy using the ioPTH dosage.

Background: Therapeutic exercise (TE) is recommended in multimodal treatment for patients with non-specific chronic back pain (cLBP)., Objective: The aim of this study is to identify an exercise or a spectrum of exercises, well described and reproducible by the clinician, for cLBP patients., Methods: Systematic review by researching in the databases MEDLINE, EMBASE, PEDro, CINAHL, and Scopus. Evidence from Randomized Controlled Trials (RCTs) supported the TE in patients with non-specific cLBP, provided that it was well described and could be repeated by another therapist. Methodological evaluation was performed using the PEDro scale and only studies with a score of ⩾ 6 were included. The assessment of the intervention description was carried out with the TIDieR checklist. The risk of bias was examined., Results: Twenty-one articles were included in this systematic review. The defective description and the poorly reporting of the intervention makes it more difficult for the clinician to include the TE into clinical practice., Conclusions: The findings of this study showed that the reporting of the intervention in high quality RCT on chronic low back pain is low, threatening the external validity of the results.

We examine the H 2 O ice phase on the surface of Dione, one of Saturn's icy satellites, to investigate whether it might harbor cryovolcanic activity induced by a subcrustal body of water. Several studies have searched for such a signature, as summarized in Buratti et al.; however, none has yet produced sufficient evidence to dissipate doubts. In the radiation environment characteristic of Saturn's icy moons, the presence of crystalline H 2 O ice has been used as a marker of a high-temperature region. Because ion bombardment will, over time, drive crystalline ice toward an increasingly amorphous state, the current phase of the H 2 O ice can be used to gauge the temporal temperature evolution of the surface. We adopt a technique described by Dalle Ore et al. to map the fraction of amorphous to crystalline H 2 O ice on Dione's surface, observed by the Cassini Visible and Infrared Mapping Spectrometer, and provide an ice exposure age. We focus on a region observed at high spatial resolution and centered on one of the faults of the Wispy Terrain, which is measured to be fully crystalline. By assuming an amorphous to crystalline ice fraction of 5% (i.e., 95% crystallinity), significantly higher than the actual measurement, we obtain an upper limit for the age of the fault of 152 Ma. This implies that the studied fault has been active in the last ~100 Ma, supporting the hypothesis that Dione might still be active or was active a very short time ago, and similarly to Enceladus, might still be harboring a body of liquid water under its crust.

We report the detection of ammonia (NH 3 ) on Pluto's surface in spectral images obtained with the New Horizons spacecraft that show absorption bands at 1.65 and 2.2 μm. The ammonia signature is spatially coincident with a region of past extensional tectonic activity (Virgil Fossae) where the presence of H 2 O ice is prominent. Ammonia in liquid water profoundly depresses the freezing point of the mixture. Ammoniated ices are believed to be geologically short lived when irradiated with ultraviolet photons or charged particles. Thus, the presence of NH 3 on a planetary surface is indicative of a relatively recent deposition or possibly through exposure by some geological process. In the present case, the areal distribution is more suggestive of cryovolcanic emplacement, however, adding to the evidence for ongoing geological activity on Pluto and the possible presence of liquid water at depth today., (Copyright © 2019 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC).)

Background: Hypocalcemia is the most common complication following total thyroidectomy. Few factors may relate with increased risk of postoperative hypocalcemia. Preoperative vitamin D values have been evaluated in few studies, but reports present conflicting data. Aim of our study is to evaluate the association of preoperative vitamin D values and hypocalcemia following total thyroidectomy., Methods: A retrospective analysis of patients undergoing total thyroidectomy in our department of endocrine surgery between November 2012 and November 2015 was performed., Results: Mean age of patients was 56.2 years (±14.0) and sex ratio (F:M) was 4.3:1. Sixty-four patients (17.4%) had preoperative vitamin D insufficiency (x<25 nmol/L), 138 patients (37.5%) vitamin D deficiency (2550 nmol/L). Following total thyroidectomy for both benign and malignant pathology, 66 patients (17.9%) had symptomatic hypocalcemia (x<2.0 mmol/L) requiring medical treatment (group 1), 64 patients (17.4%) biochemical hypocalcemia (22.1 mmol/L, group 3). Mean postoperative PTH value was 25.4 pg/ml (range 2-61). No statistical correlation between postoperative serum calcium and preoperative vitamin D values (R=-0.001, P=0.9849) was found nor associations were found regarding age, sex, type of thyroid disease or BMI., Conclusions: In our cohort of patients, preoperative vitamin D levels were not associated with a higher risk of hypocalcemia following total thyroidectomy. Postoperative PTH appears to be the most sensible item to predict the risk of postoperative symptomatic hypocalcemia.

Introduction: Desmoid tumors are defined as a rare fibroblastic proliferative disease and may occur in any musculoaponeurotic or fascial tissue ., Case Report: A 54-year-old man with FAP referred to our institution presenting fever and abdominal pain. Four years before a prophylactic colectomy with ileal-rectal anastomosis was done. Three years later a wide intraabdominal mass with desmoid characteristics was detected. In spite of therapy with tamoxifene the RM control showed an increase of mass dimension. Few days later the patient arrived in our istitute with fever and abdominal pain. Medical therapy didn't improve clinical symptoms and the patient underwent surgery., Discussion: Desmoid tumors are benign tumors, but not a benign disease. Most of these tumors occur sporadically, but about 5% arise in association with familial adenomatous polyposis. Intra-abdominal desmoid tumors remain asymptomatic until their growth and infiltration causes visceral compression. They can cause serious complications and treatment is often unsuccessful. Aggressive fibromatosis treatment should be evaluated and managed by a multidisciplinary team with expertise and experience in sarcoma, prior to initiation of therapy. In FAP, surgery has been recommended for abdominal wall tumors but there are only few indications for intra-abdominal disease like pain, bowel obstruction and desmoids perforation.

Aim: Reporting our experience in the treatment of duodenal neoplasms., Material of Study: Management and treatment of four patients presenting a duodenal neoplasm., Results: Three out of four patients died after surgery for dehiscence and/or bleeding. One, who underwent palliative bypass, died after four months from unknown causes., Discussion: Duodenal neoplasms are rare and their diagnosis is difficult and late. In literature, there is no standardized management of this kind of neoplasm; the commonest surgical approaches are pancreaticoduodenectomy, segmental duodenal resection and palliative operations. The surgical choice is based on site and stage, both in Literature than in our experience. Regardless of the surgical decision, the patients have a poor outcome because of an advanced stage at diagnosis., Conclusions: It can be asserted that duodenal neoplasia offers many diagnostic and therapeutic difficulties. This may be due to its rarity, which does not allow the definition of a standard course of treatment, resulting in the inability to have a unique diagnostic and therapeutic approach. There is often a late diagnosis and the need to perform emergency surgery. Therefore prognosis is greatly aggravated by the high incidence of postoperative complications, in part due to the urgency in which the surgeries are carried out.