Il craniofaringioma nel bambino e nell'adolescente. Luci ed ombre durante il follow-up

Introduction. Craniopharyngioma (CF) is a malformation of the hypothalamicpituitary region and it is the most common nonglial cerebral tumor in children with an high overall survival rate. In some case severe endocrinologic and metabolic sequelae may occur during follow up. 50% of patients (pts), in particular those with radical removal of suprasellar lesions, develop intractable hyperphagia and morbid obesity, with dyslypidemia and high cardiovascular risk. We studied the auxological and metabolic features of a series of 29 patients (18 males) treated at a mean age of 7,6 years, followed up in our Centre from 1973 to 2008 with a mean follow up of 8,3 years. Patients features at the onset. 62% of pts showed as first symptoms of disease visual impairment and neurological disturbancies (headache); 34% growth arrest; 24% signs of raised intracranial pressure and 7% diabetes insipidus. Diagnosis. Diagnosis of CF was reached finally by TC or MRI scans which showed endo-suprasellar lesion in 23 cases and endosellar tumour in 6 cases. Treatment and outcome. 25/29 pts underwent surgical removal of CF (19 by transcranial approach and 6 by endoscopic surgery); 4 pts underwent stereotactic surgery as first line therapy. 3 pts underwent local irradiation with yttrium-90, 5 pts post surgery radiotherapy. 45% of pts needed more than one treatment procedure. Results. After CF treatment all patients suffered from 3 or more pituitary hormone deficiencies and diabetes insipidus. They underwent promptly substitutive therapy with corticosteroids, l-thyroxine and desmopressin. In 28/29 pts we found growth hormone (GH) deficiency. 20/28 pts started GH substitutive therapy and 15 pts reached final height(FH) near target height(TH). 8 pts were not GH treated for good growth velocity, even without GH, or for tumour residual. They reached in 2 cases FH over TH showing the already known phenomenon of growth without GH. 38% of patients showed BMI SDS >2 SDS at last assessment, in particular pts not GH treated (BMI 2,5 SDS) are more obese than GH treated (BMI 1,2 SDS). Lipid panel of 16 examined pts showed significative differencies among GH treated (9 pts) and not treated (7 pts) with better profile in GH treated ones for Total Cholesterol/C-HDL and C-LDL/C-HDL. We examined intima media thickness of common carotid arteries in 11 pts. 3/4 not GH treated pts showed ultrasonographic abnormalities: calcifications in 2 and plaque in 1 case. Of them 1 pt was only 12,6 years old and already showed hypothalamic obesity with hyperphagia, high HOMA index and dyslipidemia. In the GH treated group (7) we found calcifications in 1 case and a plaque in another one. GH therapy was started in the young pt with carotid calcifications, with good improvement within 6 months of treatment. 5/29 pts showed hypothalamic obesity, related to hypothalamic damage (type of surgical treatment, endo-suprasellar primitive lesion, recurrences). 48% of patients recurred during follow up ( mean time from treatment: 3 years) and underwent, in some cases up to 4 transcranial surgical treatments. GH seems not to increase recurrence rate since 40% of GH treated recurred vs 66,6% of not GH treated pts. Discussion. Our data show the extereme difficulties that occur during follow up of craniopharyngioma treated patients. GH therapy should be offered to all patients even with good growth velocity after CF treatment, to avoid dislypidemia and reduce cardiovascular risk. The optimal therapy is not completely understood and whether gross tumor removal or partial surgery is the best option remains to be decided only on one patient tumour features and hypothalamic involvement. In conclusion the gold standard treatment of CF remains complete tumour removal, when feasible, or partial resection to preserve hypothalamic function in endosuprasellar large neoplasms.

Essays on Bank Risk

This PhD Thesis is composed of three chapters, each discussing a specific type of risk that banks face. The first chapter talks about Systemic Risk and how banks get exposed to it through the Interbank Funding Market. Exposures in the said market have Systemic Risk implications because the market creates linkages, where the failure of one party can affect the others in the market. By showing that CDS Spreads, as bank risk indicators, are positively related to their Net Interbank Funding Market Exposures, this chapter establishes the above Systemic Risk Implications of Interbank Funding. Meanwhile, the second chapter discusses how banks may handle Illiquidity Risk, defined as the possibility of having sudden funding needs. Illiquidity Risk is embodied in this chapter through Loan Commitments as they oblige banks to lend to its clients, up to a certain amount of funds at any time. This chapter points out that using Securitization as funding facility, could allow the banks to manage this Illiquidity Risk. To make this case, this chapter demonstrates empirically that banks having an increase in Loan Commitments, may experience an increase in risk profile but such can be offset by an accompanying increase in Securitization Activity. Lastly, the third chapter focuses on how banks manage Credit Risk also through Securitization. Securitization has a Credit Risk management property by allowing the offloading of risk. This chapter investigates how banks use such property by looking at the effect of securitization on the banks’ loan portfolios and overall risk and returns. The findings are that securitization is positively related to loan portfolio size and the portfolio share of risky loans, which translates to higher risk and returns. Thus, this chapter points out that Credit Risk management through Securitization may be have been done towards higher risk taking for high returns.

Verso una sociologia della sostenibilità: il caso delle Città in Transizione. Prospettive e limiti di un percorso bottom-up

Oggetto di indagine del lavoro è il movimento ambientalista e culturale delle Città in Transizione che rappresentano esperimenti di ri-localizzazione delle risorse volte a preparare le comunità (paesi, città, quartieri) ad affrontare la duplice sfida del cambiamento climatico e del picco del petrolio. A partire dal Regno Unito, la rete delle Transition Towns si è in pochi anni estesa significativamente e conta oggi più di mille iniziative. L’indagine di tale movimento ha richiesto in prima battuta di focalizzare l’attenzione sul campo disciplinare della sociologia dell’ambiente. L’attenzione si è concentrata sul percorso di riconoscimento che ha reso la sociologia dell’ambiente una branca autonoma e sul percorso teorico-concettuale che ha caratterizzato la profonda spaccatura paradigmatica proposta da Catton e Dunlap, che hanno introdotto nel dibattito sociologico il Nuovo Paradigma Ecologico, prendendo le distanze dalla tradizionale visione antropocentrica della sociologia classica. Vengono poi presentate due delle più influenti prospettive teoriche della disciplina, quella del Treadmill of Production e la più attuale teoria della modernizzazione ecologica. La visione che viene adottata nel lavoro di tesi è quella proposta da Spaargaren, fautore della teoria della modernizzazione ecologica, secondo il quale la sociologia dell’ambiente può essere collocata in uno spazio intermedio che sta tra le scienze ambientali e la sociologia generale, evidenziando una vocazione interdisciplinare richiamata anche dal dibattito odierno sulla sostenibilità. Ma le evidenze empiriche progressivamente scaturite dallo studio di questo movimento che si autodefinisce culturale ed ambientalista hanno richiesto una cornice teorica più ampia, quella della modernità riflessiva e della società del rischio, in grado di fornire categorie concettuali spendibili nella descrizione dei problemi ambientali e nell’indagine del mutamento socio-culturale e dei suoi attori. I riferimenti empirici dello studio sono tre specifiche realtà locali in Transizione: York in Transition per il Regno Unito, Monteveglio (Bo) e Scandiano (Re) in Transizione per l’Italia.