Recenti progressi in medicina
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Case Reports Comparative Study
[Panhypopituitarism from pituitary metastases of breast cancer].
Metastases to the pituitary gland are uncommon causes of hypopituitarism, to be particularly considered in patients affected with disseminated cancers, arising in the breast or in the lung. Differential diagnosis could be correctly addressed by the concomitant presence of diabetes insipidus, due to the prominent involvement of the posterior lobe, and by some neuroradiological findings. ⋯ Magnetic resonance images showed diffuse encephalic metastatic lesions, with a thickened pituitary stalk, loss of high signal intensity of posterior lobe and a mildly enlarged and inhomogeneously enhanced adenohypophysis. Substitutive hormonal therapy was started, but the patient died five months later due to the progression of the neoplastic disease.
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In this paper we try to define the future goals of the clinical research, with particular reference to methodological and policy issues. There is an increasing tension between the real drivers of clinical research and its scientific and ethical aims. To consumers the goal is to strengthen the relevance and usefulness of clinical research. ⋯ Finally the scientific community should reflect on its own conflicts of interests and analyse the causes of the ethical divide between the needs and the market. Scientists too often seem to loose sight of the original cumulative nature of research and of the idea of research as a collective good. More non-commercial research is needed, integrated with the health care systems, to support a transparent, more realistic and valid information useful for patient care, scientific information.
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The rediscovery of palliative care in oncology represents an important aspect in the clinical assistance of cancer patients with advanced or terminal disease. The main characteristic aspects of the renewed medical discipline are: the inclusion of palliative care within the comprehensive care of the oncologic patient (simultaneous care); the inclusion of the palliative care institutions (Hospices and Home Care Units) within the oncologic departments; the comprehensive approach towards the sick person and his family in a model of global care; the identification of quality of life as the main end point of a palliative approach. ⋯ Future aims for palliative care will be: the identification of foundation confirmed by basic or translational research, the conduction of trials that could validate the results of biological research in the clinical context, and the large application of the results of clinical research in clinical practice. Nevertheless, all the efforts to improve the quality of clinical research in palliative care will have to be focused on protocols of global interventions.
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Acute pancreatitis represents the 0.15-1.5% of all diagnoses in the Emergency Room. Biliary diseases and alcohol abuse are the two mainly etiological factors of this illness in Italy. ⋯ On the other hand, the identification of alcoholic origin of pancreatitis can prevent interventional procedures not useful in this kind of patients. In this paper we will assess the markers able to early identify the etiology of this acute illness such as the liver function tests and the lipase/amylase ratio.