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Objective: The aim of this study was to assess non-invasively endothelial function of young women with polycystic ovary syndrome (PCOS) in comparison with healthy age-matched women and a group of young women with idiopathic hirsutism (IH). The possible role of metabolic and hormonal parameters on endothelial function was also examined. Design: Descriptive clinical trial. Methods: Fifty-six women, 27 with PCOS, 16 with IH and 13 healthy age-matched women were studied. Endothelial function of resistance arteries was assessed by venous occlusion plethysmography. Metabolic and hormonal parameters were estimated in this study population. Results: The duration of reactive hyperemia (durRH) was shorter in PCOS group when compared with normal controls (63.75G13.33 s vs 113.18G20.92 s, PZ0.036). A similar finding was observed when PCOS were compared with IH group (63.75G13.33 s vs 105G17.20 s, PZ0.05). The durRH did not differ between IH and control group (105G17.20 s vs 113.18G20.92 s, ns). A significant positive linear correlation was found between the durRH and dehydroepiandrosterone-sulfate (DHEA-S) levels (rZC0.48, PZ0.04) in the PCOS group. The basal insulin resistance index (HOMA) differed significantly between PCOS, IH and control groups. There was no significant correlation between durRH and HOMA index or testosterone levels in the PCOS group. Conclusions: Endothelial dysfunction may be an early sign of cardiovascular system abnormalities in young PCOS women. It is possible that increased DHEA-S levels may offer a cardioprotective advantage that attenuates the effects of cardiovascular risk factors that accompany PCOS.European Journal of Endocrinology 154 883-890

This review focuses on complications linked to trans-oral endoscopic thyroidectomy via vestibular approach (TOETVA) and aimed to elucidate the procedure's initial safety profile. According to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), Pubmed, Embase, and the Cochrane databases were screened till May 2021. Twenty-eight articles, nine cohorts and nineteen case series, met the inclusion criteria. Procedure-related complications were analyzed, the most important being hypoparathyroidism: transient (range=0.94-22.2%), permanent (range=1.33-2.22%), and recurrent laryngeal nerve injury: transient (range=1.9-8.8%) and permanent (range=0.59-1.42%). Surgical trauma related complications, the most prevalent being seroma, emphysema, and hematoma accounted for 2.91%. Null mortality was reported. Although current evolving experience indicates that TOETVA is safe and linked to acceptable complication rates, the method needs to be compared with the gold standard of traditional thyroidectomy in the context of sufficiently numbered cohorts and ultimately randomized controlled trials.

Although D2 constitutes the level of lymph node dissection which most surgical associations endorse in their treatment guidelines for gastric cancer more extended D3 dissection has also been attempted to improve oncologic outcomes. Existing literature pertinent with the provisional therapeutic impact of D3 lymphadenectomy in advanced gastric cancer is studied in this mini review. Seven non-randomized comparisons, three randomized trials and five meta-analyses, almost exclusively of Asian origin, were identified and examined. D3 compared to D2 lymphadenectomy consistently and significantly proved to be associated with a “heavier” iatrogenic surgical trauma translated to more blood loss, prolonged operative time, higher relaparotomy rates and post-procedural surgical and non-surgical morbidity. Oddly mortality in most of these series did not reach statistical significance a fact probably attributed to Asian surgical expertise and/or methodologic drawbacks. All existing evidence and their meta-analyses, including a well-designed RCT from Japan (JCOG), failed to support a clear overall survival benefit linked to D3 dissection thus excluding the procedure from current treatment algorithms. The Italian GC research group, analyzing their database, proposed tumor histology, macroscopic type, size and location as selection criteria for D3 dissection provided surgical expertise is available. Recently, a phase II clinical trial from Japan reported a 3 -year survival rate of 59% in patients with clinically involved para-aortic nodes treated with neoadjuvant chemotherapy followed by D3 lymphadenectomy, rekindled the issue. Future multicenter randomized trials should test the extend and after effect of lymphadenectomy in gastric cancer combined with modern chemotherapeutic agents in multimodal treatments.

The anteromedial diaphragmatic hernias of Morgagni and Larrey are the least common defects that occur in this organ. Simultaneous occurrence has been described but remains an absolute rarity. We herein present a case of this bilateral herniation with a unique presentation. The paper refers to the basic anatomic, diagnostic and therapeutic considerations for this entity.