Search

Background: Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. Its pathophysiology is mainly due to hyperphosphatemia and vitamin D deficiency and resistance. When medical treatment fails, subtotal and total parathyroidectomy with autotransplantation are the standard procedures, although both are associated with high recurrence rates. Methods and Results: 4 patients experienced persistence and 9 relapse. The first 4 were subjected to reoperation after 6 months for the persistence of symptoms due to the finding of a supernumerary adenomatous gland while the remaining patients at the reoperation showed in 5 cases 2 more glands in over thymic position, and 4 an hyperplasia of the residual glandular tissue. A classic cervicotomy was sufficient to remove the residual parathyroid in patients with persistent hyperparathyroidism. For cases of recurrent hyperparathyroidism it was enough a medial approach and sometimes lateral for the complete excision of the hyperplastic tissue. The advent of the intraoperative technique of parathyroid hormone dosage allowed a better performance of the surgical technique for the last 3 patients undergoing reoperation. After reoperation all patients had immediate regression of clinical symptoms with normalization of serum calcium and PTH levels. Conclusions: On the basis of these considerations, diagnostic imaging has a not negligible role because during the first intervention helps to have an idea of the possible location of the glands and thus to avoid the risk of recurrence and relapse due to ectopic or supernumerary tissue. (www.actabiomedica.it)

With the high occurrence of cardiovascular disease and increasing numbers of patients requiring vascular access, there is a significant need for small-diameter (

The aim of this study was to isolate and characterize rat adipose Derived Mesenchymal Stem Cells (AD-MSCs) in order to evaluate their proliferative potential and their ability to different cell types. AD-MSCs and Derived Mesenchymal Stem Cells (BM-MSCs) have the same characteristic in terms of plasticity. The advantage of adipose tissue is that it is an easier accessible source and it offers a large amount of MSCs by less invasive surgical tecniques. MSCs were obtained from subcutaneous adipose tissue of Wistar rats. first of all microbiological controls were made to exclude the presence of bacteria of fungi in then tissue. Adipose tissue was mechanically and enzimatically fragmented and stromal cell fraction was seeded in adherent culture flasks in DMEM 20% FBS. After 48 h the medium was replaced. Cells were characterized by evaluating:1)their ability tho adhere to the plastic; 2) the clonogenic potential by Colony Forming Unit (CFU) assay, 3) their ability to differentiate in 3 mesodermal lineages (adipocytes, osteocytes and chondrocytes). AD-MSCs are able to differentiate in adipocytes, osteocytes and chondrocytes as confirmed by oil red'O staining, von Kossa staining and histological analuysis respectively. This first characterization is essential for the second part of our study in which we are planning to use AD-MSCs in vivo to restore renal function after an induced ischemic damage in experimental animals.

Inflammatory Bowel disease (IBD), such as Crohn's disease and ulcerative colitis, are pathologies characterized by a chronic inflammation of the gastrointestinal tract. Their etiopathogenesis is not yet fully understood. Immune system and heat shock proteins (HSPs) dysfunctions are considered to be among the most likely causes of these diseases. Butyrate is a short-chain fatty acid produced by intestinal microflora. It has a trophic, benefical and protective role in the colonic mucosa, and it also induces changes in Hsp levels and localization. It may therefore be a valuable complementary therapeutic agent when used alongside trraditional drugs (mesalazine and corticosteroids) to treat the production of butyrate in the endoluminal environment may promote clinical remission in IBD patients. Due to these characteristics, there has been keen interest in the use of butyrate as a novel therapeutic supplement in the recent years. The current findings need to be validated through further clinical trials to better define the bbiomolecular dynamics of butyrate in the colonocytes of IBD patients.

Colonic leiomyoma is a mesenchymal tumor that arises from the muscularis mucosae or muscularis propria and is composed of well-differentiated smooth muscle cells with no atypia. It is often incidentally found since its growth affects the submucosal layer and the lesion is covered with normal epithelium. Endoscopic ultrasonography is recommended to define the grade of infiltration of the tumor and eventually lymph node involvement. Histological examination is critical to establish the nature of the tumor and its behaviour. In the case of a voluminous tumor surgical treatment is needed. we report case of a patient that underwent colonoscopy showing the presence of a neoformation at 70 cm from ileocecal valve occupying half lumen of transverse colon. A surgical resection was performed and histological analysis confirmed the presence of a leiomyoma.

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 guaranted to the patient.

Inflammatory Bowel Disease (IBD) is a chronic disorder characterized by a relapsing-remitting course, which alternates between active and quiescent states, ultimately impairing a patients' quality of life.The two main types of IBD are Crohn's disease (CD) and Ulcerative Colitis (UC). CD Shows a transmural granulomatous inflammation that can involve any segment of the intestine affecting all layers of the intestinal wall, while UC is limited to the mucosa and superficial submucosa of the colon. In physiological conditions the gut is costantly exposed to various antigens, commensal microflora and pathogens and the inflammatory response is finely balanced. Anyhow i some individuals with genetic susceptibility an anomalous inflammatory response can arise due to the deregulation of the negative feedback mechanism implicated in its self-regulation. It is though that a vast number of environmental risk factors may be implicated in the development of IBD, including smoking, dietary factors, psychological stress, use of non-steroidal anti-inflammatory drugs and oral contraceptives, appendectomy, brestfeeding, as well as infections. Nutritional support as a primary therapy ha a crucial role in the management of patients with IBD since it can control the inflammatory process, treat malnutrition and its consequences, and avoid the use of immune-modulating drugs and their side effects. The gut microbiota is clearly manipulated by dietary components such as n-3 PUFA and coniugated linoleic acid (CLA) which favorably reduce endotoxin load via shifts in the composition and metabolic activity of the microbial community. In particular, the beneficial effect of n-3 polyunsaturated fatty acids (PUFAs)and fermentable fiber, during the remission/quiescent phase of both CD and UC is highligheted.In fact, PUFAs are associated with a less grade of inflammation since they are metabolized to 3-series prostaglandins and tromboxanes and 5-series leukotrienes and, in addition, exert antiinflammatory effects when compared with their n-6 PUFA counterparts. In similar action to dietary n-3 PUFA, coniugated linoleic acid (CLA) have been reported to ameliorate intestinal inflammation in animal models of IBD. in contrast to corticosteroids, CLA suppresses gut inflammatory responses while enhancing antigen specific responsiveness of t cells against viral and bacterial pathogens.Available data about nutritional interventions do not always match due to the incomplete knowledge of pathogenic mechanisms underlying IBD development. Further studies are therefore needed to improve nutritional therapeutic approach. In particular, is still unclear the role of the fiber in helping the remission of the disease. There are mainly two theories. on one hand, dietary fibers can act as effective prebiotics by altering the intestinal microbial composition and promoting the growth of beneficial bacterial communities within the large intestine. Some authors reported a positive effect associated with the production by colonic microflora of short chain fatty acids (SCFA), able to down-regulate the production of pro-inflammatory cytokines, to promote the restoration of intracellular Reactive Oxygen Specie (ROS) balance, and the activation of NF-KB. On the other hand, fibers can promote diarrhea, pain and gas aggravating the clinical state. we suggest that the consumption on fermentable fibers may have a good impact on patients' health. Now is well known that various SNPs are linked to the risk of IBD development and therefore there is the possibility of predict if an individual is predisposed to the disease. The identification of some polymorphism has essential role because it allows the modification of diet in the hope of controlling symptoms or preventing relapse. As a consequence, that can potentially exacerbate symptoms are eliminated and substituted with those that promote a well being state.

It has been recently highlighted the link between vitamin D and metabolic and immunological pro- cesses, which established its role as an essential component of human health preservation. Vitamin D has been defined as natural immune modulators, and through the activation of its receptors (VDRs), it regulates calcium metabolism, cellular growth, proliferation and apoptosis, and other immunological functions. In this setting, vita- min D has also been reported to influence glucose regulation via effects on insulin secretion and action. Vitamin D deficiency is strongly associated with obesity mostly due to the storage of vitamin D in adipose tissue because of its lipophilic properties. The decrease in vitamin D levels may occur through several mechanisms such as a decrease in the calcium concentration, an increase in PTH, or a direct effect of vitamin D on worsening insulin resistance and secretion, augmenting the risk of developing type 2 diabetes. On the other hand, retrospective analysis and observational studies demonstrated high prevalence of vitamin D deficiency in patients with type 1 diabetes and suggested a contributory role in the pathogenesis of type 1 diabetes, specially with certain allelic variations of the VDR. Vitamin D supplementation during pregnancy and early childhood decreased the risk of autoimmune dia- betes and perhaps, even after the onset of diabetes, it may improve glycemic control. In addition, in subjects that are affected by a high risk of developing diabetes (impaired fasting glucose and/or glucose tolerance, possibly without obesity) vitamin D supplementation could be helpful on the prevention of type 2 diabetes

Background: there are no standard practice in the induction of colitis by 2,4,6-trinitrobenzene sulfonic (TNBS) acid. Usually, the repeated administration of TNBS is preferred, because it will result in a local Th1 response that has the characteristics of Crohn's disease. material and Methods: A total of 30 rats were randomized into two groups, consisting of a saline control group of ten rats and a TNBS groups of 20 rats. After the animals were anesthesized, 0,5 ml of either 0,9 % saline 8controls) or TNBS 50 mg/Kg dissolved in 50% ethanol were instilled into the colon through a rubber catheter. The experiment was repeated weekly for four weeks, then, the rats were killed at day 40, and the distal colon removed. results: At day 40, the bowel wall basically normal in the control group. In the TNBS group, the bowel lumen became narrow with tickened wall, and the mucosal surface presented adherent membrane with brown black, linear ulcers, proliferous lymphocites tissue, inflammatory granulomas and submucosal neutrophil infiltration. The median score of the severity of the colonic damage was 0 in the control group, and 4,75 (range 4-5) in the TNBS group; the mean weight of the rats was 180+35 g in the TNBS group, while it was 215+25 in the control group. Conclusions: The presented experiment is a cost-effective and safe method to induce Crohn-like colonic damage using a lower dose of TNBS, thus avoiding the risk of a massive loss of rats. This model is rather suitable for the assessment of the effects of potential therapeutic agent.