Response to Stanich et al.: Correspondence regarding-PTEN hamartoma tumor syndromes in childhood-Description of two cases and a proposal for follow-up protocol

The follow-up protocol, which we describe in this study can serve as a practical proposal for clinicians, and as a basis for future studies. We strongly urge the clinician to start an early surveillance of the gastrointestinal tract including regular endoscopy. The main management goals in PHTS patients are to detect colon cancer early, and to prevent polyp-related complications (bowel obstruction from intussusception). The presence of multiple nonmalignant polyps in patients with PTEN mutations may complicate noninvasive methods of colon evaluation [Tan et al., 2012]. In addition, there is a high variability in severity of polyps progression, and the malignant potential of these lesions is…

Computerised tomography and magnetic resonance imaging of laryngeal squamous cell carcinoma: A practical approach

Squamous cell carcinoma is the most common head and neck cancer. This review describes the state-of-the-art computerised tomography and magnetic resonance imaging protocols of the neck and the normal larynx anatomy, and provides a practical approach for the diagnosis and staging of laryngeal squamous cell carcinoma.

Ipoacusia neurosensoriale causata da scoppio di petardo. Aspetti medico-legali

Gli Autori illustrano un caso di ipoacusia neurosensoriale permanente rilevata all’orecchio di sinistra con un deficit uditivo pantonale pari a 70 dB. La lesione è stata determinata dallo scoppio di un petardo, lanciato in vicinanza della persona lesa. Vengono valutati i risvolti medico-legali in ambito penale e civile. Per quanto concerne la sfera penalistica l’ipotesi di reato è quella di lesione personale grave, in ragione dell’indebolimento permanente della funzione uditiva; relativamente al contesto civilistico, si pone particolare attenzione alla questione inerente al risarcimento cui il soggetto danneggiante è obbligato, considerando in particolar modo gli effetti che la lesione ha d…

The value of a network in the digital era: insights about Doctor Chat case study

Networks are ubiquitous in our lives in their social, physical, and digital forms. A growing number of firms today rely entirely on networking and lack a physical location or material infrastructure; they are, so to speak, 'liquid'. Through a theoretical analysis and its application to the case of Doctor Chat mobile app, this paper aims to analyse the fundamental laws of networks and to answer the following questions: 1) are the traditional methods to estimate the network value still valid in the current digital age and in particular for mobile applications?; 2) how do the laws of networks work when networks expand? We conclude with some suggestions for a research agenda in order to inspire…

The Videofluorographic Swallowing Study in Rheumatologic Diseases: A Comprehensive Review

Autoimmune connective tissue diseases are a heterogeneous group of pathologies that affect about 10% of world population with chronic evolution in 20%–80%. Inflammation in autoimmune diseases may lead to serious damage to other organs including the gastrointestinal tract. Gastrointestinal tract involvement in these patients may also due to both a direct action of antibodies against organs and pharmacological therapies. Dysphagia is one of the most important symptom, and it is caused by failure of the swallowing function and may lead to aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction. The videofluorographic swallowing study is a key diagnostic tool in the…

Bilateral lung and liver hydatid cyst

Introduction. Thymomas (THs) are rare epithelial tumors of the thymus gland. In this study we report our personal experience in the management and surgical treatment of THs. Case reports. We report two clinical cases treated with combined therapy (surgery followed by adjuvant therapy). Results. Total transternal thymectomy was performed in both patients. The post-operative course was uneventful. The patients received adjuvant radiotherapy and chemotherapy. No relapse has been observed during follow-up. Discussion. THs are usually slowly growing tumors with similar incidence in both sexes. They occur through a wide age range, with a peak in the fifth and sixth decades. Distinctive features r…

Trattamento chirurgico del carcinoma midollare della tiroide. Esperienza personale

Introduction: Medullary Thyroid Carcinoma (MTC) is a rare malignancy of the parafollicular C cells of the thyroid gland. Aim of our study is reporting retrospective analysis of our experience about the surgical treatment of MTC, especially pointing on limphadenectomy. Patients and methods: from January 2000 to March 2006, were performed 546 thyroidectomy, 6 of them for MTC (1.09%): 5 sporadic and 1 familiar. All the patients were operated with standard technique (total thyroidectomy) and submitted to endocrinologic and instrumental follow-up. Results: in our experience, we do not registered early or late complications as bleeding, laryngeal nerves lesions and parathyroid lesions or intra-po…

Swallowing disorders after thyroidectomy: What we know and where we are. A systematic review.

Abstract Introduction Dysphagia and hoarseness are possible complications that can be observed in patients undergoing thyroidectomy or other neck surgery procedures. These complaints are usually related to superior and inferior laryngeal nerves dysfunction, but these can appear even after uncomplicated surgical procedure. Methods We reviewed the current literature available on MEDLINE database, concerning the swallowing disorders appearing after the thyroidectomy. The articles included in the review reported pathophysiology and diagnostic concerns. Results Twenty articles were selected for inclusion in the review. Depends on the possible causes of the difficulty swallowing (related to nerve…

Giant subcutaneous lipomatosis in Myoclonic Epilepsy with Ragged Red Fibers syndrome: The first literature report of “laparoscopic” excision

Background MERRF (Myoclonic Epilepsy with Ragged Red Fibers) is a rare multisystem clinical disorder due to a pathogenic variant of the mitochondrial DNA. Rare symptoms of MERRF include multiple systemic lipomatosis with symmetric uncapsulated lipomas occurs generally on the posterior cervical region and upper back. Methods We report the clinical case of a 46 years-old Caucasian man with MERRF syndrome who presented with MSL on the right cervical region. We decided to perform a mini-invasive approach using laparoscopic instruments. We performed a 10-mm incision about 5 cm under the mass and conducted a blunt dissection of the subcutaneous plane. Then we positioned a 10-mm port and started C…

Un caso di disfonia severa provocata da una lesione monolaterale iatrogena del nervo laringeo ricorrente Considerazioni medicolegali

di un intervento di emitiroidectomia, a causa di una lesione del nervo laringeo ricorrente di sinistra, riferibile ad una condotta colposa del chirurgo. Vengono considerati i risvolti medicolegali, porgendo particolare attenzione alla questione relativa al risarcimento cui l’operatore sanitario è obbligato, nei confronti del soggetto danneggiato. Tale compenso è stabilito in rapporto alla menomazione della funzione fonatoria subita dalla persona lesa e, pertanto, si riferisce non solo all’alterazione dell’integrità psicofisica e alle eventuali ripercussioni esistenziali che una tale condizione può determinare sulla qualità della vita, ma finanche alle conseguenze economicamente valutabili d…

Local neck symptoms before and after thyroidectomy: a possible correlation with reflux laryngopharyngitis

Objective Local symptoms in the neck such as swallowing, voice disorders and throat discomfort might be related to a goiter if present, but are also reported by patients suffering from reflux laryngopharyngitis. The aim of our study was to investigate the presence of reflux laryngopharyngitis in patients with nodular goiter before and after uncomplicated total thyroidectomy (TT) in order to evaluate if its presence could have any role in the origin of swallowing and voice alterations and throat discomfort. Study Design case series prospective study Setting hospitalized care in University Hospital Patients and Methods We consider twenty-five patients, affected by non-toxic nodular goiter and…

PTEN hamartoma tumor syndromes in childhood: description of two cases and a proposal for follow-up protocol

PTEN hamartoma tumor syndromes (PHTS) are a spectrum of hamartomatous overgrowth syndromes associated with germ-line mutations in the tumor suppressor PTEN gene located on 10q23.3. It is widely accepted that two of these disorders, Cowden syndrome and Bannayan-Riley-Ruvalcaba syndrome, are allelic conditions. Because PTEN mutations are not identifiable in every case of the PHTS phenotype, the inability to detect a mutation within the PTEN gene does not invalidate the clinical diagnosis of Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, in patients who meet diagnostic criteria for these disorders. PTEN mutations are associated with an increased risk for developing breast, thyroid, end…

Clinical and imaging findings of rare symptomatic giant killian-jamieson diverticulum (KJD)

Describe the clinical and imaging findings of rare symptomatic giant Killian-Jamieson diverticulum (KJD) detected in a 97 year old female patient and discuss diagnostic and therapeutic protocols to be implemented. Methods. The clinical history began implementing anamnesis and physical examination, followed by laryngoscopy, esophagogastroduodenoscopy, sonographic examination and subsequently a double-contrast pharyngoesophagram evaluations, to our symptomatic old patient with results of typically KJD, with maximal dimension of 5 cm. The KJD was successfully treated with a surgical approach, esophagomyotomy in addition to a diverticulopexy; these techniques were used for adequate visualizatio…

Anaplastic thyroid cancer: A case series with a wide spectrum of treatment in emergency

Anaplastic thyroid carcinoma (ATC) is one of the most aggressive malignancies of the neck, and for the majority of these patients the cause of death is a compromised airway, metastatic disease, superior vena cava syndrome, asphyxiation, or exsanguination. In case of the airway being compromised, emergency treatment is mandatory but not well defined. We report 4 different kinds of acute presentation of complications. Anaplastic thyroid cancer; diagnostic, clinical and prognostic indication, evaluation of choice of treatment are discussed. The spectrum of treatment varies from observation and preservation of the airway from a tracheostomy to extensive surgery. When a potentially curative rese…

Juxtapapillary duodenal diverticular bezor as an exceptional cause of biliary stent obstruction. Case report.

INTRODUCTION: we describe the first case in literature of biliary stent obstruction by bezoar impaction in a iuxtapapillary duodenal diverticulum. CASE REPORT: this case illustrates an juxtapapillary duodenal diverticulum and bezoar in it causing obstructive jaundice in subject with two biliary stents for cholangiocarcinoma (Klatskin's tumor) in the absence of bile duct stones. RESULT: successful treatment with endoscopic stent removal and diverticulum toilette. Obstructive jaundice was cured after endoscopic removal of the bezoar and stent substitution. DISCUSSION: the presence of a bezoar and its possible contribution to the pathogenesis of pancreatitis in the presence of periampullary ex…

Esophageal Motility Changes after Thyroidectomy; Possible Associations with Postoperative Voice and Swallowing Disorders: Preliminary Results

Objective Swallowing and voice impairment are common after thyroidectomy. We evaluated short-term functional changes in esophageal motility in a series of patients who had undergone total thyroidectomy. Several studies have investigated these symptoms by means of interviews or questionnaires. Study Design Prospective study. Setting Academic research. Materials and Methods Thirty-six consenting patients were prospectively recruited. Eligibility criteria were thyroid volume ≤60 mL, benign disease, and age between 18 and 65 years. Exclusion criteria were previous neck surgery, severe thyroiditis, hyperthyroidism, and pre- or postoperative vocal cord palsy. Voice impairment score, swallowing im…

La valutazione foniatricologopedica nella selezione pre impianto cocleare nel bambino

Simple and fast orotracheal intubation procedure in rat

Introduction: Endotracheal intubation in the rat is difficult because of extremely small size of anatomical structures (oral cavity, epiglottis and vocal cords), small inlet for an endotracheal tube and the lack of proper techniacal instruments. Matherial and Methods: In this study we used seventy rats weighthing 400-500 g. The equipment needed for intubation was an operating table, a longish of cotton, a cotton tip, orotracheal tube, neonatal laryngoscope KTR4, small animal ventilator, and isoflurane for inhalation anaesthesia. Premedication was carried out by medetomidine hydrochloride 1 mg/mL; then, thanks to a closed glass chamber, a mixture of oxygen and isoflurane was administered. By…

La disfonia infantile nella scuola dell'infanzia e primaria:un progetto operativo dall'indagine alla prevenzione

ANALISI VOCALE DI EMISSIONI FONATORIE SOTTO SFORZO SUB-MASSIMALE: UN CASO STUDIO

La laringe rappresenta il principale organo vocale, ma riveste anche un ruolo determinante nell'attività muscolare. E' noto infatti che la funzione di fissazione della laringe partecipi alla stabilizzazione dell'intera gabbia toracica, durante il compimento di uno sforzo attraverso l'accollamento cordale e la manovra di Valsalva, la laringe, dunque, ricopre un ruolo primario anche in questa funzione, come dimostrato dagli studi sui soggetti laringectomizzati, i quali riferiscono difficoltà nel sollevare oggetti pesanti dopo l'intervento (1). In ambito sportivo atleti ed istruttori possono evidenziare, durante la pratica, emissioni di sforzo sfocianti nel malmenage vocale esponendosi al risc…

RECURRENT RENAL CARCINOMA MIMICKING A GOITRE: A CASE REPORT

Although the thyroid is a high vascularised gland, it is not common terget of metastases from extraglandular cancer. We reported a case of a 70 year-old woman who underwnt total thyroidectomy for multinodular goitre. In the patient's clinical hystory a nephrectomy was carried out 2 years before due to unspecified causes. The histopathological examination of the thyiroid showed a pattern compatible with clear cell renal carcinoma metastasis. The patient's relatives revealed, when questioned again, that the nephrectomy was due to the presence of a clear renal cell carcinoma keep concealed to the patients. Thanks to a timely intervention, the mass was removed and a better survival was guarante…

Voce e Sport: la disfonia muscolo-tensiva da malmenage vocale nell'atleta e nel coaching (Studio preliminare)

Le indagini sperimentali sono state condotte al fine di indagare l'utilizzo della voce in am- bito sportivo, in un'ottica di prevenzione e di educazione/rieducazione della voce di pro- fessionisti e dilettanti del settore. Al fine di identificare correlazioni e fattori di rischio legati alle singole discipline, abbiamo formulato e applicato il "Protocollo di Valutazione per i Di- sturbi della Voce in Ambito Sportivo", conducendo un'analisi statistica descrittiva, svolta attraverso i questionari di consapevolezza vocale, su un campione di 44 istruttori e 100 atleti e, successivamente, testando un gruppo di 34 sportivi con una valutazione clinica, percettiva e spettro-acustica digitale degli …

Esophageal motility changes after thyroidectomy: possible associations with postoperative voice and swallowing disorders

Papillary Thyroid Microcarcinoma: Active Surveillance Against Surgery. Considerations of an Italian Working Group From a Systematic Review

IntroductionActive surveillance is considered a viable option for papillary thyroid microcarcinoma. Since the last decade of the 20th century, this method has spread from Japan to other countries, but has not yet been fully accepted and validated by the major Western Scientific Societies. In 2016, a systematic review on the results of active surveillance was published, based on two articles that showed encouraging results. Other reviews published subsequently, were mainly based on articles from the Far East. The aim of this review is to assess the most recent results published from 2017 to 2020 on this subject.Materials and MethodsA systematic literature search was performed on MEDLINE via …

Pneumotorace da frattura del terzo laterale della clavivola. Caso clinico e revisione della letteratura

INTRODUCTION: the clavicle is one of the most commonly fractured bones, accounting for up to 4-10% of all adult's fractures. These fractures are comparatively easy to manage and typically heal with routine immobilisation. CASE REPORT: a 28 year old man had direct driving trauma to the left shoulder and reported a displaced fracture of the third lateral of left clavicle and an apical pneumothorax. The pneumothorax was treated by the insertion of a chest drain under local anaesthesia. The chest drain was removed 12 days after the injury and the patient was transferred in Traumatology for specific therapy. RESULT: 6 months after the accident, the clavicular fracture had united and the chest ra…