Cardiovascular features of possible autonomous cortisol secretion in patients with adrenal incidentalomas

Background: Low-grade incomplete post-dexamethasone cortisol suppression in patients with adrenal incidentalomas – recently defined as possible autonomous cortisol secretion (pACS) – has been associated with increased cardiovascular events and mortality. However, prospective studies documenting cardiac abnormalities in these patients are lacking. Subjects and methods: Between July 2016 and September 2017, 71 consecutive patients with adrenal lesions were prospectively screened for hypercortisolism by dexamethasone suppression test (NCT 02611258). Complete anthropometric, metabolic and hormonal parameters were recorded along with full cardiac ultrasound assessment and noninvasive measurement of arterial stiffness. All patients underwent chemical-shift magnetic resonance imaging to characterize the lesions. Cardiovascular outcomes were recorded in blind. Results: According to post-dexamethasone suppression cortisol values (post-DST), 34 patients had pACS and 37 nonfunctioning adenomas (NFA). The two groups were similar in sex, BMI, age distribution, cardiovascular risk factors and comorbidities. Left ventricular mass index (LVMIBSA) was increased in pACS compared to NFA (P=0.006) and mildly correlated to the post-DST cortisol level (rho=0.347; P=0.004). The post-DST cortisol levels explained up to 13.7% of LVMIBSAvariance (P=0.002). Compared to NFA, patients with pACS had a higher prevalence of diastolic dysfunction (35.1% vs 82.6%; P=0.001) and worse arterial stiffness assessed by pulse wave velocity (P=0.033). Conclusions: In apparently asymptomatic patients, mild autonomous cortisol secretion can sustain early cardiac and vascular remodeling, independently of other risk factors. The morphological and functional cardiovascular changes observed in pACS underline the need for further studies to correctly define the long-term management of this relatively common condition

Implementing the environmental dimension of the EU’s urban agenda 2014-2020

This work illustrates the planning experience carried out Sustainable Urban Development (SSUD), whose general objectives are strengthening territorial cohesion and to increase accessibility to the local resources. The SSUD action plan, being funded with around 70 millions euro, through which such objectives can be better achieved and reciprocally integrated. After a brief description of the territory targeted by the concept within the broader debate on sustainable mobility. In section 3, a series of evidences are provided to identify the demand and potential for the development the fourth section, after describing the expceted results is suggested why in this area a greenway is the better solution to increase accessibility to a broad range of natural resources and functions (natural sites, landscapes, cultural heritage, urban functions)

Leptomeningeal carcinomatosis, an emerging disease in internal medicine departments with a generally poor prognosis: two case reports

As a result of improved diagnostic methods and higher cancer patient survival rates, leptomeningeal carcinomatosis is being found in internal medicine departments more frequently. Melanoma, lung cancer, and breast adenocarcinoma are the three cancers that are most commonly associated. When the main tumor diffuses through the bloodstream, cerebrospinal fluid, or direct diffusion and causes multiple focal neurological symptoms, it is known as leptomeningeal involvement; the prognosis is usually not good. Despite multimodal treatment, leptomeningeal carcinomatosis is an advanced form of cancer that frequently results in rapid death. Treatment is typically palliative and consists primarily of intrathecal or systemic radiation and/or chemotherapy. New experimental therapies and immunotherapy are promising means of lowering morbidity and mortality. Clinical cases of leptomeningeal carcinomatosis are reported; both cases were identified at the Ospedale dei Castelli’s Department of Internal Medicine and resulted from primary breast patholog

Incidence, mortality and survival of pleural mesothelioma in Zurich between 1981 and 2019, Switzerland

BACKGROUND: Pleural mesothelioma is mainly caused by (occupational) asbestos exposure. Since 1990, the import and use of asbestos is prohibited in Switzerland. However, due to the long latency time between exposure and the development of disease, incidence in Switzerland was expected to further increase for years after the ban. The aim of the present study was to analyse incidence, mortality, and survival of patients diagnosed with malignant pleural mesothelioma in the canton of Zurich in Switzerland. METHODS: Population-based cancer registry data and cause of death statistics of the canton of Zurich from 1981 to 2019 were used to calculate age-standardized incidence and mortality rates. Time trends were investigated with joinpoint regression and net survival was computed using the Pohar-Perme method. RESULTS: In men, the incidence rate increased from 1981 to 2002 {annual percentage change (APC) 4.7 [95% confidence interval (CI): 2.6 to 6.8]} and then decreased until 2019 [APC: -2.3 (95% CI: -4.2 to -0.3)], while in women it increased over the whole period [APC 6.2 (95% CI: -1.3 to 14.4)]. Mortality rates were stable in men and women. Three-year net survival was 9.7% (95% CI: 7.8% to 12.2%) for men and 22.1% (95% CI: 15.3% to 32.1%) for women. Men with stage I or II pleural mesothelioma had a net survival of 25.4% (95% CI: 17.2% to 37.5%) after three years whereas men with stage III or IV experienced a net survival of 7.4% (95% CI: 3.9% to 13.8%) after three years. CONCLUSIONS: Malignant pleural mesothelioma incidence seems to have reached the peak in the canton of Zurich in men, but not yet in women. Mortality rates were stable in men and women, and net survival was poor for both sexes, particularly in men

Breast Fistula Repair after Autologous Fat Graft: A Case Report

We report the case of a 55-year-old female patient who attended our clinic for the presence of a scar retraction in the upper pole of the left breast as a complication of breast augmentation. In the scar area, we observed an orifice that probing revealed to be a fistula. The patient was referred to surgical intervention under general anesthesia to obtain scar contracture release using autologous fat graft; one month after autologous fat injection, following healing of the fistula, the patient underwent a second surgical procedure to replace the left breast implant. Unexpectedly, two weeks after the surgical procedure, complete healing of the breast fistula within the scar area was observed; this observation was confirmed during the second surgical step for left breast implant repositioning, when we observed the absence of the fistula orifice in the breast implant cavity. Upon clinical examination at 1-year followup, tissue integrity was preserved. The patient's satisfaction was excellent. We have observed a possible additional effect of fat graft

Acute epiploic appendagitis : ultrasound and computed tomography findings of a rare case of acute abdominal pain and the role of other imaging techniques

Purpose: Acute epiploic appendagitis (EA) is a relatively rare, benign and local inflammatory disease involving the epiploic appendices. Unlike its mimics, EA is generally a self-limiting inflammatory disease and can be treated conservatively. Case presentation: A 33-year-old Caucasian man presented to our emergency department with a sever and sharp left iliac fossa pain. He underwent abdominal X-ray, ultrasound (US) and computed tomography (CT) evaluations. Conclusion: We illustrate US and CT findings to increase the radiologists’ awareness of this condition and to avoid diagnostic delay and unnecessary use of antibiotics, hospitalization and surgery

Harmonisation of datasets of Energy Performance Certificates of buildings across Europe

Nowadays, datasets of Energy Performance Certificates (EPC) of buildings in Europe are highly heterogeneous: they follow different EPC schemes making their comparison challenging. This report shows in the first place how a European-wide harmonised EPC scheme would be very beneficial to compare EPC datasets across countries and regions. Secondly, it showcases how Regional Energy Agencies can actively support energy efficiency policies. The study proposes a European data model named EPC4EU, reusing a methodology developed in 2017 to harmonise EPC in Italy and testing it with real EPC datasets from Castilla y León (Spain). The methodology can be reused to generate new versions of the EPC4EU data model to harmonise EPC datasets from any Member State. Furthermore, the study documents a series of difficulties encountered during the harmonisation process and the solutions adopted to overcome them. Finally, the study also includes suggestions to use the resulting harmonised data in the QGIS software and documents the development of a web application designed to make available the harmonised dataset to non-GIS experts. The issues encountered in the web app adaptation and respective solutions adopted have been documented to ease possible future web app extensions.JRC.B.6 - Digital Econom