Rejected

Emerging data suggest a significant association between migraine and endometriosis, however the relationship between migraine and endometriosis severity or adenomyosis is unclear. Our objectives were to explore the relationship between migraine and endometriosis, according to the endometriosis severity and co-exist with adenomyosis or not.

Desmoid tumor is a rare disease, which is histologically characterized by local invasion, monoclonality, and fibroblast proliferation; and clinically characterized by a variable and often unpredictable course. The treatment of desmoid tumor is mainly surgical resection, but the recurrence rate is high. In recent years, a variety of treatment methods, including endocrine therapy, surgery, radiotherapy, chemotherapy, non-steroidal anti-inflammatory drugs, targeted drugs, interferon and more, have been used and achieved certain curative effects. In addition, in view of the inertia characteristics of desmoid tumor, observation is also a first-line scheme recommended by multiple guidelines. In the past, the research progress of targeted therapy for desmoid tumor is relatively slow and the curative effect is limited. Thus, targeted therapy is usually used as a remedial treatment after the failure of other conventional treatment methods. However, in recent years, with the rapid progress in the basic research of targeted therapy, some new targeted drugs are increasingly used for the clinical treatment of desmoid tumor and have achieved good results. Herein, we described a patient with aggressive fibromatosis in the abdominal cavity. Following a combined treatment using anlotinib and celecoxib, the patient achieved a partial response with mild toxicity. Simultaneously, the patient's pain symptoms completely disappeared. This case indicates that the combination of anlotinib and NSAIDs could be an effective treatment for desmoid tumor.

The objective of this study is to present the rare case of a young girl with idiopathic intracranial hypertension secondary to hypoparathyroidism. Idiopathic intracranial hypertension is a neurological syndrome characterized by elevated intracranial pressure (> 25 cmHO) in the absence of intracerebral abnormalities or hydrocephalus. The pathophysiology of idiopathic intracranial hypertension is unknown, and rare cases of idiopathic intracranial hypertension secondary to hypoparathyroidism have been described. It is supposed that hypocalcemia causes decrease in the absorption of cerebrospinal fluid in arachnoidal granulations. The workup of the girl with idiopathic intracranial hypertension and hypoparathyroidism included physical examination, blood tests, diagnostic imaging, and lumbar puncture. We present a 9-year-old female patient who was hospitalized for headache associated with nausea and vomiting for 3 weeks. She underwent an ophthalmologic examination that revealed papilledema. Lumbar puncture revealed an opening pressure of 65 cm HO; cerebrospinal fluid analysis and brain computed tomography scan were normal. The patient started taking acetazolamide. Blood tests revealed hypocalcemia associated with high phosphorus level and undetectable PTH hormone, which led us to suspect hypoparathyroidism. She had never had cramps, paraesthesias, or tetany. Chvostek's and Trousseau's signs were positive. In the neck ultrasonography, parathyroids were not visible. Oral supplementation with calcitriol and calcium was started. Headache, nausea, and vomiting immediately disappeared after the lumbar puncture, and the papilledema improved gradually. Several anecdotal cases of idiopathic intracranial hypertension secondary to hypoparathyroidism have been described. However, our case report is of particular interest, since the child did not present with typical neurological hypoparathyroidism symptoms. Therefore, we recommend that hypoparathyroidism should be included in diagnostic investigations on children with clinical findings of idiopathic intracranial hypertension, because clinical manifestations of hypoparathyroidism are variable and may involve almost all organ systems.

Comparing the effect of two different -receptor agonists, nalbuphine and oxycodone, and regular morphine in patients for prophylactic analgesia of acute pain after daytime laparoscopic cholecystectomy.

The purpose of the study was to study the possibility of computer stabilometric diagnostics for the objectification of vertigo in elderly patients with vestibular migraine. The study included 57 elderly patients with vestibular migraine and 57 elderly patients with central vestibular vertigo, without migraine. Specialized tests of functional computer stabilometry were used to objectify vertigo. The study revealed the features of the basic stabilometric parameters in specialized tests in elderly patients, which can be used to obtain a quantitative assessment of vestibular dysfunction and objectification of vertigo.

Mechano-transcription is a process whereby mechanical stress alters gene expression. The gastrointestinal (GI) tract is composed of a series of hollow organs, often encountered by transient or persistent mechanical stress. Recent studies have revealed that persistent mechanical stress is present in obstructive, functional, and inflammatory disorders and alters gene transcription in these conditions. Mechano-transcription of inflammatory molecules, pain mediators, pro-fibrotic and growth factors has been shown to play a key role in the development of motility dysfunction, visceral hypersensitivity, inflammation, and fibrosis in the gut. In particular, mechanical stress-induced cyclooxygenase-2 (COX-2) and certain pro-inflammatory mediators in gut smooth muscle cells are responsible for motility dysfunction and inflammatory process. Mechano-transcription of pain mediators such as nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) may lead to visceral hypersensitivity. Emerging evidence suggests that mechanical stress in the gut also leads to up-regulation of certain proliferative and pro-fibrotic mediators such as connective tissue growth factor (CTGF) and osteopontin (OPN), which may contribute to fibrostenotic Crohn's disease. In this review, we will discuss the pathophysiological significance of mechanical stress-induced expression of pro-inflammatory molecules, pain mediators, pro-fibrotic and growth factors in obstructive, inflammatory, and functional bowel disorders. We will also evaluate potential therapeutic targets of mechano-transcription process for the management of these disorders.

The impaired renal blood flow is one of the main pathogenesis mechanisms of urolithiasis (UL) development. Therefore, the rehabilitation programs involving non-drug methods for abnormal renal blood flow, including those after extracorporeal shock wave lithotripsy (ECSWL), still play a significant role. It is due to ECSWL, despite being noninvasive, is often associated with renal trauma, leading to various disorders, including impaired blood flow and renal function. To prevent complications after extracorporeal lithotripsy, relieve pain, improve renal blood flow, relieve spasm and facilitate excretion of fragments of broken concrements, we applied a combined vacuum-interference therapy, exerting an analgesic, antispasmodic and vascular effect.

During this pandemic Italy was deeply hit by the burden of the COVID-19. Current studies reveal that respiratory symptoms of COVID-19 represent the most common manifestations at presentation. The incidence of less common gastrointestinal symptoms varies significantly among different study populations. Liver injury is also described at different degree. We describe the case of a 20-year-old woman confirmed as SARS-CoV-2 positive by nasopharyngeal swab-PCR test, admitted to the COVID-only-Psychiatric Ward, set up in Niguarda Hospital in Milan on March 2020, for a depressive episode characterized by depressed mood and anorexia. In comorbidity we report a previous avoidant/restrictive food intake disorder present since childhood and a Border Personality Disorder according to the DSM V. On the admission to the ward we administered the Hamilton Depression Rating Scale with a total score of 29 suggesting severe depression. During the hospitalization she developed a clinical picture with increasing vomiting and diarrhea, nausea, abdominal pain along with fever and no respiratory symptoms. She also showed abnormalities in liver function indices. At the same time she showed clinophilia and persistent food avoidance that, initially, led to attribute all the symptoms to her psychiatric disorders. We prescribed the already ongoing therapy with lithium carbonate and SSRI. On the second day of hospitalization, along with the worsening of the gastrointestinal symptoms, we started therapy with hydroxychloroquine with a no significant remission of nausea and vomiting but with a further increase in liver function indices suggesting liver damage. This led us to suspend the treatment with hydroxychloroquine for the suspect of a drug induced injury. The depressive symptoms improved rapidly as opposed to the patient's overall condition. The gastrointestinal symptoms resolved with the evidence of the recovery from infection. In this report we underline the importance of investigating the physical symptoms in a patient with a history of mental disorder especially during an undergoing pandemic. During this pandemic, specialists from various fields were called upon to support teams working with COVID patients and to acquire new skills out of necessity, fostering a multidisciplinary approach and cooperation.

A-68-year-old man, who has allergic rhinitis with peripheral blood eosinophilia, hospitalized because of fever of unknown origin in May 2020. Five days after antibiotics were given, itchy exanthema occurred, followed by gland glass opacity on both lungs with bilateral pleural effusions. Since acute respiratory failure developed, bronchoscopy was hard to carry out. However, this case was considered acute eosinophilic pneumonia induced by antibiotics, based on radiological findings and laboratory data. Therefore, steroid pulse therapy using intravenous administration of methylprednisolone started, and this therapy was effective. Since these chest shadows and hypoxia were disappeared in two weeks, the amount of steroid was gradually reduced, however, eosinophilic pneumonia recurred once during this course. After discharge in June 2020, this patient came to the outpatient department. When oral administration of prednisolone was decreased less than 2.5mg/day, redness and swelling with slight itch were appeared in the left forearm in September 2020. Histological findings from shin biopsy showed that eosinophils excessively invade to the dermis without angiitis. Although flame figure was not observed in the specimen, we considered that this case has developed eosinophilic cellulitis, based on the clinical manifestation and pathological findings. When prednisolone was increased to 30mg/day, these symptoms were improved, and then prednisolone was gradually reduced. After that, recurrences of these diseases did not occur during the observation period. This case may be diagnosed as hypereosinophilic syndrome since eosinophilic pneumonia and eosinophilic cellulitis caused continuously by recruitment of eosinophils to lung and skin.

Paraganglioma occurs rarely in the sellar/parasellar region. Here, we report a patient with malignant paraganglioma with primary sellar location with unusual genetic and imaging features.