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Ossola P, Borasi A, Barberis A, Marola S, Ghiglione F, Pentassuglia G, Puligheddu B, Brustio PR, Messuti I, Bononi M, Leli R, Lanfranco F. Early parathyroid hormone (PTH) level as a predictor of post-surgical hypoparathyroidism. Acta Chir Belg 2024:1-11. [PMID: 38547111 DOI: 10.1080/00015458.2024.2336676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/26/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Post-operative hypocalcemia and postoperative persistent hypoparathyroidism remain the most common complications after thyroidectomy. Many approaches have been developed to prevent them, but actually, a common protocol is not yet individuated. MATERIALS AND METHODS We retrospectively analyzed the results of a prospectively collected database. We dosed PTH preoperatively and 4 h after surgery (PTH_4); calcium was evaluated preoperatively, on the first (I_POD) and on the second postoperative day (II_POD). Hypocalcemia was defined when calcium <8 mg/dl. PTH_4 and I_POD calcium serum levels are identified to predict postoperative hypocalcemia. RESULTS Three hundred and forty-eight patients were enrolled, 37 patients resulted as hypocalcemic on I_POD and 41 on the II_POD. PTH_4 is related to I_POD (p < 0.001, r = 0.45) and II_POD (p < 0.001, r = 0.44) calcemia. PTH_4-cut-off predicting I_POD hypocalcemia was 10.50 pg/ml (sensitivity: 78.7%, specificity: 72.7%). A PTH_4 value of 11.5 pg/ml is able to predict hypocalcemia during II_POD (sensitivity: 76.5%, specificity: 69.2%). We set up a combined test to predict II_POD hypocalcemia, using PTH_4 and I_POD calcium (sensitivity: 77.8%, specificity: 89.9%). CONCLUSION This research shows the association between PTH_4 and postoperative hypocalcemia. The PTH_4 cut-off to predict I_POD-hypocalcemia was 10.5 pg/ml. We analyzed the calcemia trend during the postoperative period and we realized a combined test using PTH_4 and I_POD-calcemia. This test improves the accuracy of the previous test. Further studies, in particular multicentric, with a larger sample are necessary to validate the combined model.
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Affiliation(s)
- Paolo Ossola
- Department of Surgery, Humanitas Gradenigo, Turin, Italy
- Pietro Valdoni-Department of Surgery, Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Andrea Borasi
- Department of Surgery, Humanitas Gradenigo, Turin, Italy
| | | | - Silvia Marola
- Department of Surgery, Humanitas Gradenigo, Turin, Italy
| | | | | | - Barbara Puligheddu
- Division of Endocrinology, Andrology and Metabolism, Department of Medical Sciences, Humanitas Gradenigo, University of Turin, Turin, Italy
| | | | - Ilaria Messuti
- Division of Endocrinology, Andrology and Metabolism, Department of Medical Sciences, Humanitas Gradenigo, University of Turin, Turin, Italy
| | - Marco Bononi
- Pietro Valdoni-Department of Surgery, Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Renzo Leli
- Department of Surgery, Humanitas Gradenigo, Turin, Italy
| | - Fabio Lanfranco
- Division of Endocrinology, Andrology and Metabolism, Department of Medical Sciences, Humanitas Gradenigo, University of Turin, Turin, Italy
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Lelli G, Micalizzi A, Gurrado A, Bononi M, Iossa A, De Angelis F, Di Meo D, Fassari A, Testini M, Cavallaro G. 5-year Follow-up of Reimplanted Parathyroid Glands in Forearm Subcutaneous Tissue During Thyroidectomy. A Confirmation of Graft Vitality in a Large Series of Patients. Am Surg 2024:31348241244631. [PMID: 38557257 DOI: 10.1177/00031348241244631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
INTRODUCTION The aim of this study is to assess the outcomes of parathyroid gland reimplantation with PR-FaST technique in patients undergoing thyroid surgery, focusing on graft functionality over a 5-year follow-up period. MATERIALS AND METHODS We analyzed data from 131 patients who underwent parathyroid reimplantation using the PR-FaST technique during thyroid surgery due to inadvertent parathyroid removal or evident vascular damage. Postoperative evaluations included serum calcium (Ca), magnesium (Mg), and phosphorus (P) analyses on the 1st and 2nd postoperative days, at 10 days, and at 1, 3, 6 months, 1 year, and 5 years of follow-up. Additionally, the mean values of serum intact parathyroid hormone (iPTH) concentration were measured from blood samples collected from both the reimplanted arm (iPTH RA) and non-reimplanted arm (iPTH NRA) within the same period. RESULTS Among 131 patients, at 10 days post-surgery, only 46 patients (35.1%) out of 131 exhibited graft viability (iPTH ratio >1.5). This percentage increased to 72.8% (94 patients) after 1 month and further to 87.8% (108 patients) after 3 months post-surgery. At 1 year, 84.7% of patients showed good graft functionality. After 5 years, the percentage remained stable, with graft viability observed in 81.3% of patients. Only 91 of the initial 131 patients completed follow-up up to 5 years, with a dropout rate of 30.5 %. CONCLUSIONS Parathyroid reimplantation using the PR-FaST technique is a viable option for patients undergoing thyroidectomy and has been shown to be a reproducible and effective technique in most patients, with sustained graft functionality and parathyroid hormone production over a 5-year follow-up period.
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Affiliation(s)
- Giulio Lelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Alessandra Micalizzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Angela Gurrado
- Department of Precision and Regenerative Medicine and Ionian Area, Aldo Moro University, Bari, Italy
| | - Marco Bononi
- Department of Surgery, Sapienza University, Rome, Italy
| | - Angelo Iossa
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Francesco De Angelis
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Diletta Di Meo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Alessia Fassari
- General Surgery Unit, Luxembourg Hospital Center, Luxembourg, Europe
| | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Aldo Moro University, Bari, Italy
| | - Giuseppe Cavallaro
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
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Fassari A, Gurrado A, Iossa A, Micalizzi A, Polistena A, Sibio S, Crocetti D, Bononi M, Testini M, Avenia N, Cavallaro G. Definition of learning curve for thyroidectomy: systematic review on the different approaches. Gland Surg 2023; 12:989-1006. [PMID: 37727342 PMCID: PMC10506114 DOI: 10.21037/gs-22-730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/29/2023] [Indexed: 09/21/2023]
Abstract
Background Thyroidectomy is one of the most common surgical procedures carried out worldwide and it has evolved in recent years with alternative approaches. With the advent of minimally invasive techniques, the learning curve (LC) concept has become a fundamental "dogma". Methods A literature search, according to the PRISMA guidelines, was performed via PubMed (MEDLINE), Scopus, Cochrane Library, EMBASE, and Web of Science. Only studies assessing the learning process to thyroidectomy (including hemi- and total thyroidectomy), reporting a minimum of 30 procedures and describing clearly the minimum number of performances required to achieve proficiency and the main evaluation items used to establish it, were included. Conventional, endoscopic and robotic approaches were separately analyzed. Only English-language studies were considered. Results Forty-five relevant studies were selected for the analysis [respectively 16 concerning robotic thyroidectomy (RT), 22 endoscopic thyroidectomy (ET), 6 mini-invasive video assisted thyroidectomy (MIVAT), 1 conventional thyroidectomy (CT)]. The number of procedures required for a single surgeon to achieve competence and the parameters used to define surgical proficiency were fully investigated for each individual technique. Conclusions Our research shows how the current literature lacks an objective definition of the LC concept. The heterogeneity of analysis methodologies and parameters evaluated, the various surgical techniques and training background of single surgeons, make it impossible to draw univocal results. Future studies should consider confounding factors and establish criteria that should be consensually recognized in the assessment of surgical performances and skills.
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Affiliation(s)
- Alessia Fassari
- General Surgery Unit, Luxembourg Hospital Center, Luxembourg, Luxembourg
| | - Angela Gurrado
- Department of Precision and Regenerative Medicine and Ionian Area, Aldo Moro University, Bari, Italy
| | - Angelo Iossa
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Alessandra Micalizzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | | | - Simone Sibio
- Department of Surgery, Sapienza University, Rome, Italy
| | | | - Marco Bononi
- Department of Surgery, Sapienza University, Rome, Italy
| | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Aldo Moro University, Bari, Italy
| | - Nicola Avenia
- Department of Surgery, University of Perugia, Perugia, Italy
| | - Giuseppe Cavallaro
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
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Medas F, Dobrinja C, Al-Suhaimi EA, Altmeier J, Anajar S, Arikan AE, Azaryan I, Bains L, Basili G, Bolukbasi H, Bononi M, Borumandi F, Bozan MB, Brenta G, Brunaud L, Brunner M, Buemi A, Canu GL, Cappellacci F, Cartwright SB, Castells Fusté I, Cavalheiro B, Cavallaro G, Chala A, Chan SYB, Chaplin J, Cheema MS, Chiapponi C, Chiofalo MG, Chrysos E, D'Amore A, de Cillia M, De Crea C, de Manzini N, de Matos LL, De Pasquale L, Del Rio P, Demarchi MS, Dhiwakar M, Donatini G, Dora JM, D'Orazi V, Doulatram Gamgaram VK, Eismontas V, Kabiri EH, El Malki HO, Elzahaby I, Enciu O, Eskander A, Feroci F, Figueroa-Bohorquez D, Filis D, François G, Frías-Fernández P, Gamboa-Dominguez A, Genc V, Giordano D, Gómez-Pedraza A, Graceffa G, Griffin J, Guerreiro SC, Gupta K, Gupta KK, Gurrado A, Hajiioannou J, Hakala T, Harahap WA, Hargitai L, Hartl D, Hellmann A, Hlozek J, Hoang VT, Iacobone M, Innaro N, Ioannidis O, Jang JHI, Xavier-Junior JC, Jovanovic M, Kaderli RM, Kakamad F, Kaliszewski K, Karamanliev M, Katoh H, Košec A, Kovacevic B, Kowalski LP, Králik R, Yadav SK, Kumorová A, Lampridis S, Lasithiotakis K, Leclere JC, Leong EKF, Leow MKS, Lim JY, Lino-Silva LS, Liu SYW, Llorach NP, Lombardi CP, López-Gómez J, Lori E, Quintanilla-Dieck L, Lucchini R, Madani A, Manatakis D, Markovic I, Materazzi G, Mazeh H, Mercante G, Meyer-Rochow GY, Mihaljevic O, Miller JA, Minuto M, Monacelli M, Mulita F, Mullineris B, Muñoz-de-Nova JL, Muradás Girardi F, Nader S, Napadon T, Nastos C, Offi C, Ronen O, Oragano L, Orois A, Pan Y, Panagiotidis E, Panchangam RB, Papavramidis T, Parida PK, Paspala A, Pérez ÒV, Petrovic S, Raffaelli M, Ramacciotti CF, Ratia Gimenez T, Rivo Vázquez Á, Roh JL, Rossi L, Sanabria A, Santeerapharp A, Semenov A, Seneviratne S, Serdar A, Sheahan P, Sheppard SC, Slotcavage RL, Smaxwil C, Kim SY, Sorrenti S, Spartalis E, Sriphrapradang C, Testini M, Turk Y, Tzikos G, Vabalayte K, Vargas-Osorio K, Vázquez Rentería RS, Velázquez-Fernández D, Vithana SMP, Yücel L, Yulian ED, Zahradnikova P, Zarogoulidis P, Ziablitskaia E, Zolotoukho A, Calò PG. Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study. Lancet Diabetes Endocrinol 2023; 11:402-413. [PMID: 37127041 PMCID: PMC10147315 DOI: 10.1016/s2213-8587(23)00094-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/02/2023] [Accepted: 03/15/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. METHODS In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. FINDINGS Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039). INTERPRETATION Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation. FUNDING None.
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Affiliation(s)
- Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Chiara Dobrinja
- Department of Medical and Surgical Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste, Italy
| | - Ebtesam Abdullah Al-Suhaimi
- Biology Department, College of Science, Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Julia Altmeier
- Endocrine Surgery, Diakonie-Klinikum Stuttgart, Stuttgart, Germany
| | - Said Anajar
- Department of Otolaryngology-Head and Neck Surgery, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Akif Enes Arikan
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Türkiye
| | - Irina Azaryan
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Giancarlo Basili
- Azienda USL Toscana Nord-Ovest, UOSD Chirurgia della Tiroide, Toscana, Italy
| | - Hakan Bolukbasi
- General Surgery, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Türkiye
| | - Marco Bononi
- Dipartimento di Chirurgia Pietro Valdoni, Policlinico Umberto I Sapienza, Rome, Italy
| | - Farzad Borumandi
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St Richard's Hospital, Chichester and Worthing Hospital, Worthing, UK
| | - Mehmet Buğra Bozan
- General Surgery, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Türkiye
| | - Gabriela Brenta
- Endocrinology Department, Unidad Asistencial Dr César Milstein, Buenos Aires, Argentina
| | - Laurent Brunaud
- Department of Surgery CVMC, CHU Nancy-Brabois, Université de Lorraine, Nancy, France
| | - Maximilian Brunner
- Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Antoine Buemi
- Department of Surgery, Cliniques Universitaires Saint Luc, Bruxelles, Belgium
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | | | | | | | - Beatriz Cavalheiro
- Departamento de Cirurgia de Cabeça e Pescoço, Hospital São Camilo Oncologia-Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil
| | | | - Andres Chala
- Head and Neck Department Oncologos del Occidente, Universidad de Caldas, Manizales, Colombia
| | - Shun Yan Bryant Chan
- Department of Surgery, Tseung Kwan O Hospital, Hong Kong Special Administrative Region, China
| | - John Chaplin
- Department of Otolaryngology Head and Neck Surgery, Auckland City Hospital, Auckland, New Zealand
| | | | - Costanza Chiapponi
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital Cologne, Cologne, Germany; Department of Endocrine Surgery, Evangelisches Klinikum Cologne Weyertal, Cologne, Germany
| | - Maria Grazia Chiofalo
- Head and Neck Cancer Medical Oncology Department, Istituto Nazionale Tumori, IRCCS Fondazione G Pascale, Napoli, Italy
| | - Emmanuel Chrysos
- Department of Surgery, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece
| | - Annamaria D'Amore
- Division of Endocrine Surgery, Department of Gastroenterologic, Endocrine-Metabolic and Nephro-Urologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Michael de Cillia
- Department of Surgery, Saint John of God Hospital, Salzburg, Austria
| | - Carmela De Crea
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Nicolò de Manzini
- Department of Medical and Surgical Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste, Italy
| | - Leandro Luongo de Matos
- Department of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Loredana De Pasquale
- Thyroid and Parathyroid Surgery Unit-Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Paolo Del Rio
- General Surgery Unit, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
| | - Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Muthuswamy Dhiwakar
- Department of Otolaryngology-Head and Neck Surgery, Kovai Medical Center and Hospital, Coimbatore, India
| | | | - Jose Miguel Dora
- Thyroid Unit, Hospital de Clínicas de Porto Alegre and Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Valerio D'Orazi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy; Division of General Surgery-Section of Endocrine and Diabetic Foot Surgery, "Fabia Mater" Hospital, Rome, Italy
| | | | - Vitalijus Eismontas
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania; Health Research and Innovation Science Center, Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania
| | - El Hassane Kabiri
- Department of Thoracic Surgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Hadj Omar El Malki
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University, Rabat, Morocco
| | | | - Octavian Enciu
- Elias University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Francesco Feroci
- Department of Surgery, General Surgery Unit, S Stefano Hospital, Prato, Italy
| | | | - Dimitrios Filis
- Department of Surgery, Saint Andrew Hospital of Patras, Patras, Greece
| | - Gorostidi François
- Otolaryngology and Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Armando Gamboa-Dominguez
- Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Volkan Genc
- Department of Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Davide Giordano
- Otorhinolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Giuseppa Graceffa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - James Griffin
- Otolaryngology, Midlands Regional Hospital Tullamore, Tullamore, Ireland
| | - Sofia Cuco Guerreiro
- Endocrine Surgery, University Hospital Center of Central Lisbon, Hospital Curry Cabral, Lisboa, Portugal
| | - Karan Gupta
- Department of Head and Neck Surgery, Medanta, Gurugram, India
| | - Keshav Kumar Gupta
- Department of ENT, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Angela Gurrado
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy
| | | | - Tommi Hakala
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Wirsma Arif Harahap
- Department of Surgery, Faculty of Medicine, Universitas Andalas, Padang City, Indonesia
| | - Lindsay Hargitai
- Department of General Surgery, Division of Visceral Surgery, Medical University Vienna, Vienna, Austria
| | - Dana Hartl
- Department of Surgery, Anesthesia and Interventional Radiology, Head and Neck Oncology Service, Thyroid Surgery Unit, Gustave Roussy, Villejuif, France
| | - Andrzej Hellmann
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Jiri Hlozek
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, Prague, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Van Trung Hoang
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
| | - Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Nadia Innaro
- Unit of Endocrine Surgery, AOU Mater Domini, Catanzaro, Italy
| | - Orestis Ioannidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital "Georgios Papanikolaou", Thessaloniki, Greece
| | - J H Isabelle Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore
| | | | - Milan Jovanovic
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade, Serbia
| | - Reto Martin Kaderli
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fahmi Kakamad
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Iraq
| | - Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Martin Karamanliev
- Department of Surgical Oncology, University Hospital "Georgi Stranski", Faculty of Medicine, Medical University of Pleven, Pleven, Bulgaria
| | - Hiroshi Katoh
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, Sagamihara, Japan
| | - Andro Košec
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Bozidar Kovacevic
- Institute of Pathology and Forensic Medicine, Medical Military Academy, Belgrade, Serbia
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgry and Otorhinolaryngology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Robert Králik
- Department of Surgical Oncology, St Elisabeth Cancer Institute, Medical Faculty of Comenius University, Bratislava, Slovakia
| | | | - Adriána Kumorová
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Central Military Hospital Ružomberok, Ružomberok, Slovakia
| | - Savvas Lampridis
- Department of Thoracic Surgery, 424 General Military Hospital, Thessaloniki, Greece
| | - Konstantinos Lasithiotakis
- Department of Surgery, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece
| | | | | | | | - James Y Lim
- Department of Surgery and Otolaryngology, Oregon Health and Science University, Portland, OR, USA
| | | | - Shirley Yuk Wah Liu
- Department of Surgery, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Núria Perucho Llorach
- Unit of Endocrine Surgery Head and Neck Parc Tauli, Hospital Universitari, Sabadell, Spain
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, Department of Gastroenterologic, Endocrine-Metabolic and Nephro-Urologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Javier López-Gómez
- Head and Neck Department, Hospital de Oncología Centro Médico Nacional Siglo XXI, Mexico City, Mexico
| | - Eleonora Lori
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Lourdes Quintanilla-Dieck
- Department of Pediatric Otolaryngology, Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Roberta Lucchini
- Endocrine Surgery Unit, University of Perugia, Santa Maria Hospital, Terni, Italy
| | - Amin Madani
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Dimitrios Manatakis
- Second Department of Surgery, Athens Naval and Veterans Hospital, Athens, Greece
| | - Ivan Markovic
- Clinic for Surgical Oncology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | | | - Haggi Mazeh
- Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Olgica Mihaljevic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Julie A Miller
- The Royal Melbourne Hospital and Epworth Hospital, Melbourne, VIC, Australia
| | - Michele Minuto
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genova, Italy
| | | | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Barbara Mullineris
- Department of General, Emergency and New Technologies, University Hospital of Modena, Baggiovara Civil Hospital, Modena, Italy
| | - José Luis Muñoz-de-Nova
- Department of General and Digestive Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Saki Nader
- Otolaryngology Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | - Chiara Offi
- Department of Endocrine and Ultrasound-Guided Surgery, Ospedale del Mare, ASl Napoli 1 Centro, Naples, Italy
| | - Ohad Ronen
- Galilee Medical Center, Azrieli Faculty of Medicine Bar Ilan University, Safed, Israel
| | | | - Aida Orois
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Yongqin Pan
- Department of Thyroid Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Emmanouil Panagiotidis
- Department of Nuclear Medicine/PET CT, Theageneio Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - Theodosios Papavramidis
- First Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Pradipta Kumar Parida
- Department of ENT-Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Anna Paspala
- Department of Surgery, Eugenideio Hospital, Athens, Greece
| | - Òscar Vidal Pérez
- General Surgery Department, Universitat de Barcelona, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Marco Raffaelli
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | | | - Tomas Ratia Gimenez
- General Surgery, Hospital Universitario Principe de Asturias, Alcala de Henares, Spain
| | - Ángel Rivo Vázquez
- Department of General and Digestive Surgery, Division of Endocrine Surgery, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Leonardo Rossi
- Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia, CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Alena Santeerapharp
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Arseny Semenov
- Endocrine Surgery Department, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | | | - Altinay Serdar
- Department of Endocrin Pathology Unit, University of Health Sciences, Faculty of Medicine, Bakırköy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | - Sean C Sheppard
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Rachel L Slotcavage
- Department of Surgery and Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Soo Young Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Chutintorn Sriphrapradang
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy
| | - Yigit Turk
- Division of Endocrine Surgery, General Surgery Department, Ege University Hospital, Izmir, Turkey
| | - George Tzikos
- First Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Kristina Vabalayte
- Endocrine Surgery Department, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | - Kelly Vargas-Osorio
- Clinical University Hospital Santiago de Compostela University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - David Velázquez-Fernández
- Endocrine Surgery Unit, Department of Surgery, National Institute for Medical Sciences and Nutrition, Mexico City, Mexico
| | | | - Levent Yücel
- Department of Otorhinolaryngology, University of Health Sciences, Gülhane Research and Training Hospital, Ankara, Turkey
| | - Erwin Danil Yulian
- Division of Surgical Oncology, Department of Surgery, Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Petra Zahradnikova
- Department of Paediatric Surgery, Medical Faculty of Comenius University, National Institute of Children's Diseases, Bratislava, Slovakia
| | - Paul Zarogoulidis
- Third Surgery Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evgeniia Ziablitskaia
- Central Research Laboratory, Clinical Medical Multidisciplinary Center of St Luke VI Vernadsky Crimean Federal University, Simferopol, Russia
| | - Anna Zolotoukho
- Endocrine Surgery Department, Saint Petersburg State University Hospital, Saint Petersburg, Russia
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Rosati D, Bononi M, Ruscito P, Radici M, Cavaliere C, Minni A. Bilateral and Ipsilateral Central Neck Dissection in Total Thyroidectomy: a Long Term Comparison of Complications. Indian J Otolaryngol Head Neck Surg 2022; 74:6206-6212. [PMID: 36742527 PMCID: PMC9895597 DOI: 10.1007/s12070-021-02904-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 10/02/2021] [Indexed: 02/07/2023] Open
Abstract
The role of prophylactic central compartment neck dissection (CCND) in total thyroidectomy (TT) is controversial in patients without clinically evident lymph nodes metastasis (cN0) because of association with transient and permanent hypoparathyroidism (HPT) as well as transient and permanent recurrent laryngeal nerve (RLN) injury. Instead of bilateral central neck dissection (bCCND), ipsilateral central compartment neck dissection (iCCND) has recently been proposed as a safer, alternative treatment for selected patients. The aim of this study is to characterize the morbidity that CCND (ipsilateral and bilateral) adds to TT. We enrolled 453 patients: Group A (316 patients) underwent TT alone, Group B (86 patients) underwent TT + iCCND, Group C (51 patients) underwent TT + bCCND. We compared the rates of RLN injury and HPT in three groups and data analysis showed that iCCND was associated with increased rate of transient HPT but not permanent HPT and bCCND was associated with increased rate of transient and permanent HPT, when compared with TT alone. Further studies are needed to evaluate the clear advantages of CCND (both ipsilateral and bilateral), but this should be considered in the context of an higher risk of surgical complications (especially transient and permanent hypoparathyroidism), in comparison with TT alone.
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Affiliation(s)
- Davide Rosati
- Department of Otorhinolaryngology and Cervico-facial Surgery, Ospedale San Camillo de Lellis, via John Fitzgerald Kennedy, 02100 Rieti, Italy
| | - Marco Bononi
- Department of Surgery “P. Valdoni”, Sapienza” University of Rome, Azienda Policlinico Umberto I, Rome, Italy
| | - Paolo Ruscito
- Department of Otorhinolaryngology and Cervico-facial Surgery, Ospedale San Camillo de Lellis, via John Fitzgerald Kennedy, 02100 Rieti, Italy
| | - Marco Radici
- Department of Otorhinolaryngology and Cervico-facial Surgery, Ospedale San Giovanni Calibita - Fatebenefratelli, Isola Tiberina, Rome, Italy
| | - Carlo Cavaliere
- Department of Sensory Organs, Sapienza” University of Rome, Azienda Policlinico Umberto I, Rome, Italy
| | - Antonio Minni
- Department of Sensory Organs, Sapienza” University of Rome, Azienda Policlinico Umberto I, Rome, Italy
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6
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Tarallo M, Crocetti D, Gurrado A, Iorio O, Iossa A, Caruso D, Bononi M, Stabilini C, Bracale U, Chiappini A, Testini M, Avenia N, Polistena A, Cavallaro G. Achieving the learning curve in total thyroidectomy: a prospective evaluation on resident's training by CUSUM and KPSS analysis. Ann R Coll Surg Engl 2022; 104:414-420. [PMID: 35175830 PMCID: PMC9157995 DOI: 10.1308/rcsann.2021.0318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Total thyroidectomy (TT) is one of the most common procedures among general and endocrine surgeons worldwide. The conventional approach by neck incision is still the most frequently used, despite the growth of mini-invasive approaches. Controversies exist about the optimal learning curve for resident surgeons approaching this procedure. The aim of this study was to compare TT performed by experienced surgeons and residents in two academic hospitals, to define the correct shape of the specific learning curve. METHODS Between January 2016 and December 2018 patients undergoing TT in two academic departments were prospectively enrolled. In each department patients were divided into four groups: a reference group (A), consisting of 50 consecutive patients operated on by a senior surgeon, and three other groups (B, C, D) of 50 patients each where thyroidectomy was carried out by three different general surgery residents in their last 3 years of residency, respectively. Data were analysed by CUSUM and KPSS tests in order to compare operative time (OT) and its stabilisation during the learning curve. RESULTS Data from CUSUM test reported that residents could perform TT with OT similar to the senior surgeon after approximately 25-30 procedures, while the KPSS test showed that residents became more stable after 30 procedures, with no increase in perioperative complications. CONCLUSIONS This prospective study shows how a specific training in thyroid surgery can be reliable thanks to experienced tutors, and confirmed that the effect of dedicated and programmed training may result in positive outcomes for patients requiring thyroidectomy.
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Affiliation(s)
| | | | | | - O Iorio
- A. Spaziani Hospital, Frosinone (FR), Italy
| | - A Iossa
- Sapienza University, Rome, Italy
| | - D Caruso
- Sapienza University, Rome, Italy
| | - M Bononi
- Sapienza University, Rome, Italy
| | | | - U Bracale
- Federico II University Hospital, Naples, Italy
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7
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Ossola P, Mascioli F, Coletta D, Pizzato M, Bononi M. Evidence on postoperative abdominal binding: A systematic review with meta-analysis of randomized controlled trials. Surgeon 2021; 19:244-251. [DOI: 10.1016/j.surge.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/01/2020] [Accepted: 07/13/2020] [Indexed: 12/27/2022]
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8
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Medas F, Ansaldo GL, Avenia N, Basili G, Bononi M, Bove A, Carcoforo P, Casaril A, Cavallaro G, Conzo G, De Pasquale L, Del Rio P, Dionigi G, Dobrinja C, Docimo G, Graceffa G, Iacobone M, Innaro N, Lombardi CP, Novelli G, Palestini N, Pedicini F, Perigli G, Pezzolla A, Pezzullo L, Scerrino G, Spiezia S, Testini M, Calò PG. Impact of the COVID-19 pandemic on surgery for thyroid cancer in Italy: nationwide retrospective study. Br J Surg 2021; 108:e166-e167. [PMID: 33659983 PMCID: PMC7989577 DOI: 10.1093/bjs/znab012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/19/2020] [Accepted: 01/06/2021] [Indexed: 12/25/2022]
Affiliation(s)
- F Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - G L Ansaldo
- Endocrine Surgery Unit, Ospedale Policlinico San Martino, Genoa, Italy
| | - N Avenia
- General Surgery and Surgical Specialties Unit, Santa Maria University Hospital Terni and University of Perugia, Medical School, Terni, Italy
| | - G Basili
- General Surgery Department, Endocrine Surgery Unit, Azienda USL Toscana Nord-Ovest, Pontedera, Italy
| | - M Bononi
- Department of Surgery, Pietro Valdoni, Sapienza University of Rome, Rome, Italy
| | - A Bove
- Department of Medicine, Dentistry and Biotechnology, University 'G. D'Annunzio', Chieti, Italy
| | - P Carcoforo
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy
| | - A Casaril
- Endocrine Surgery Unit, Pederzoli Hospital, Peschiera del Garda, Italy
| | - G Cavallaro
- Department of Surgery, Pietro Valdoni, Sapienza University of Rome, Rome, Italy
| | - G Conzo
- Division of General and Oncological Surgery, Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - L De Pasquale
- Endocrine Surgery, ASST Santi Paolo e Carlo University of Milan, Milan, Italy
| | - P Del Rio
- General Surgery Unit, Parma University Hospital, Parma, Italy
| | - G Dionigi
- Division for Minimally Invasive and Endocrine Surgery, University of Messina, Messina, Italy
| | - C Dobrinja
- Department of Medicine, Surgery and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - G Docimo
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - G Graceffa
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - M Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - N Innaro
- Unit of Endocrine Surgery, AOU Mater Domini, Catanzaro, Italy
| | - C P Lombardi
- Division of Endocrine Surgery, Department of Gastroenterological, Endocrine-Metabolic and Nephro-Urologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - G Novelli
- Endocrine Surgery Unit, Department of Oncological-Mininvasive Surgery, Niguarda Hospital, Milan, Italy
| | - N Palestini
- Head and Neck Oncological Surgery, Candiolo Cancer Institute, Candiolo, Italy
| | - F Pedicini
- Thyroid Endocrine Surgery, Sant'Eugenio Hospital, Rome, Italy
| | - G Perigli
- Endocrine Surgery Unit, University of Florence, Florence, Italy
| | - A Pezzolla
- Division of Videolaparoscopic Surgery, Department of Emergency and Organ Transplantation, University of Bari 'A. Moro', Bari, Italy
| | - L Pezzullo
- Thyroid Surgery Unit, INT IRCSS Fondazione Pascale, Naples, Italy
| | - G Scerrino
- Department of Surgical Oncology and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - S Spiezia
- Endocine and Ultrasound-Guided Surgery Operative Unit, Ospedale del Mare, Naples, Italy
| | - M Testini
- Unit of Academic General Surgery 'V. Bonomo', Department of Biomedical Sciences and Human Oncology, University of Bari 'A. Moro', Bari, Italy
| | - P G Calò
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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9
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Medas F, Ansaldo GL, Avenia N, Basili G, Boniardi M, Bononi M, Bove A, Carcoforo P, Casaril A, Cavallaro G, Chiofalo MG, Conzo G, De Pasquale L, Del Rio P, Dionigi G, Dobrinja C, Docimo G, Graceffa G, Iacobone M, Innaro N, Lombardi CP, Palestini N, Pedicini F, Perigli G, Pezzolla A, Scerrino G, Spiezia S, Testini M, Calò PG. The THYCOVIT (Thyroid Surgery during COVID-19 pandemic in Italy) study: results from a nationwide, multicentric, case-controlled study. Updates Surg 2021; 73:1467-1475. [PMID: 33861400 PMCID: PMC8050989 DOI: 10.1007/s13304-021-01051-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/05/2021] [Indexed: 11/29/2022]
Abstract
The outbreak of the COVID-19 pandemic has led to a disruption of surgical care. The aim of this multi-centric, retrospective study was to evaluate the impact of the pandemic on surgical activity for thyroid disease among the Italian Units of Endocrine Surgery. Three phases of the pandemic were identified based on the epidemiological situation and the public measures adopted from the Italian Government (1st phase: from 9th March to 3rd May 2020; 2nd phase: from 4th May to 14th June; 3rd phase: from 15th June to 31st). The patients operated upon during these phases were compared to those who underwent surgery during the same period of the previous year. Overall, 3892 patients from 28 Italian endocrine surgical units were included in the study, 1478 (38%) operated upon during COVID-19 pandemic, and 2414 (62%) during the corresponding period of 2019. The decrease in the number of operations was by 64.8%, 44.7% and 5.1% during the three phases of COVID-19 pandemic, compared to 2019, respectively. During the first and the second phases, the surgical activity was dedicated mainly to oncological patients. No differences in post-operative complications were noted between the two periods. Oncological activity for thyroid cancer was adequately maintained during the COVID-19 pandemic.
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Affiliation(s)
- Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Via Università 40, 09124, Cagliari, Italy.
| | - Gian Luca Ansaldo
- Endocrine Surgery Unit, Ospedale Policlinico San Martino, Genoa, Italy
| | - Nicola Avenia
- General Surgery and Surgical Specialties Unit, Medical School, S. Maria University Hospital Terni and University of Perugia, Terni, Italy
| | - Giancarlo Basili
- General Surgery Department, Endocrine Surgery Unit, Azienda USL Toscana Nord-Ovest, Pontedera, Italy
| | - Marco Boniardi
- Endocrine Surgery Unit, Department of Oncological-Mininvasive Surgery, Niguarda Hospital-Milan, Milan, Italy
| | - Marco Bononi
- Pietro Valdoni, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Aldo Bove
- Department of Medicine, Dentistry and Biotechnology, University ``G. D'Annunzio'', Chieti, Italy
| | - Paolo Carcoforo
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy
| | - Andrea Casaril
- Endocrine Surgery Unit, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Giuseppe Cavallaro
- Pietro Valdoni, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | | | - Giovanni Conzo
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania ``Luigi Vanvitelli'', Naples, Italy
| | | | - Paolo Del Rio
- General Surgery Unit, Parma University Hospital, Parma, Italy
| | - Gianlorenzo Dionigi
- Division for Minimally Invasive and Endocrine Surgery, University of Messina, Messina, Italy
| | - Chiara Dobrinja
- Department of Medicine, Surgery and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Giovanni Docimo
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania ``Luigi Vanvitelli'', Naples, Italy
| | - Giuseppa Graceffa
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University Of Padova, Padova, Italy
| | - Nadia Innaro
- Unit of Endocrine Surgery, A.O.U. Mater Domini, Catanzaro, Italy
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, Department of Gastroenterologic, Endocrine-Metabolic and Nephro-Urologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Nicola Palestini
- Head and Neck Oncological Surgery, Candiolo Cancer Institute, Candiolo, Italy
| | | | | | - Angela Pezzolla
- Division of Videolaparoscopic Surgery, Department of Emergency and Organ Transplantation, University of Bari ``A.Moro'', Bari, Italy
| | - Gregorio Scerrino
- Department of Surgical Oncology and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Via L. Giuffré, 5, 90127, Palermo, Italy
| | - Stefano Spiezia
- Endocrine & US Guided Surgery OU, Ospedale del Mare, Napoli, Italy
| | - Mario Testini
- Unit of Academic General Surgery ``V. Bonomo'', Department of Biomedical Sciences and Human Oncology, University of Bari ``A. Moro'', Bari, Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, Via Università 40, 09124, Cagliari, Italy
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10
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Ossola P, Mascioli F, Coletta D, Bononi M. Laparoscopic Mesogastrium Excision for Gastric Cancer: Only the Beginning. J Laparoendosc Adv Surg Tech A 2020; 31:371-374. [PMID: 33052765 DOI: 10.1089/lap.2020.0743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Surgery, with the aid of chemotherapy and radiotherapy, is the only curative chance for gastric cancer. Unfortunately, gastric cancer had an elevated recurrence rate, primarily locally. Mesogastrium excision (MGE) during D2 lymphadenectomy has the aim to remove all possible contaminated tissue around the stomach. Methods: PubMed, EMBASE, and the Web of Science (WOS) were systematically searched for MGE reports in gastric cancer up to March 2020. The outcome reported were the number of lymph nodes retrieved, operative time (OT), overall morbidity, intra- and postoperative complications, conversion rate, and length of hospital stay. Results: A total of six studies, including 518 patients, were considered eligible for this analysis. All the studies reported laparoscopic cases. The mean number of lymph nodes retrieved was 36.7 ± 10.1. Mean OT was 240.7 ± 10.1 minutes. One case of conversion is reported. Overall morbidity was 6%. Medium estimated blood loss was 50.2 ± 39.6 mL. Overall length of stay was 10.7 ± 0.7 days. Mean follow-up was 11 ± 1.4 months. Conclusions: Only few studies evaluated this item, and according to the available evidence, MGE is a feasible technique that could be performed, also laparoscopically, in all surgical resections for gastric cancer with curative intent. Further studies are essential to establish the clear indication of this invasive procedure.
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Affiliation(s)
- Paolo Ossola
- Pietro Valdoni-Department of Surgery, Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Federico Mascioli
- Pietro Valdoni-Department of Surgery, Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Diego Coletta
- Division of Emergency and Trauma Surgery, Department of General Surgery, Emergency Department, Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Marco Bononi
- Pietro Valdoni-Department of Surgery, Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
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11
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Bononi M, Viviana F, De Feo MS, Sollaku S, Pani A, Falconi R, Pani R, Cavallaro G, Brozzetti S, De Vincentis G. Gonioprobe, an Innovative Gamma-probe to Guide Parathyroid Radioguided Surgery: First Clinical Experiences with Navigator and Lock-ontarget Functions. Curr Radiopharm 2020; 14:161-169. [PMID: 32693772 DOI: 10.2174/1874471013666200721013903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Radioguided surgery represents a validated technique for the detection and the excision of abnormal parathyroid glands responsible for primary hyperparathyroidism (PHPT). To date little attention has been paid as to how the characteristics of gamma-probes can influence surgical procedure and time, thus having an impact on postoperative morbidity, hospitalization and costs. METHODS We designed a new prototype of gamma-probe, the Gonioprobe, and tested its clinical utility in the operating room. Gonioprobe, thanks to its 5 scintillating independent crystals, performs the dual function of Navigator and Lock-on-target. These characteristics allow the immediate guidance of the surgeon's hand towards the source with very high precision, and with a much higher spatial resolution than commercial probes. Gonioprobe was used during intervention to detect abnormal parathyroid tissue, and to ensure no radioactivity in surgery bed after adenoma removal. RESULTS We tested our gamma-probe on parathyroid adenomas particularly difficult to identify at a visual inspection due to anatomy modifications from previous neck surgery and/or characterized by uncommon localization. Moreover, parathyroid adenomas were hardly removable due to the proximity to the esophagus, neck vessels and/or recurrent laryngeal nerve (RLN). An intraoperative nerve monitoring system was used to protect the recurrent laryngeal nerve from injuries. Parathyroid hormone (PTH) assay and frozen biopsy confirmed the successful excision of the adenomas. CONCLUSION The intraoperative use of the innovative Gonioprobe along with the nerve monitoring system allowed an accurate and safe removal of parathyroid adenomas and offered a significant advantage by reducing surgical time and postoperative complications, as well as hospitalization and costs.
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Affiliation(s)
- Marco Bononi
- Department of General and Plastic Surgery "Pietro Valdoni", "Sapienza" University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy
| | - Frantellizzi Viviana
- Department of Molecular Medicine, Sapienza, "Sapienza" University of Rome, Viale Regina Elena,324, 00161 Rome, Italy
| | - Maria Silvia De Feo
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza, "Sapienza" University of Rome, Viale Regina Elena,324, 00161 Rome, Italy
| | - Saadi Sollaku
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza, "Sapienza" University of Rome, Viale Regina Elena,324, 00161 Rome, Italy
| | - Arianna Pani
- Department of oncology and hemato- oncology, University of Milan "Statale", Italy
| | - Rita Falconi
- Specialty School in Medical Physics, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Roberto Pani
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Cavallaro
- Department of General and Plastic Surgery "Pietro Valdoni", "Sapienza" University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy
| | - Stefania Brozzetti
- Department of General and Plastic Surgery "Pietro Valdoni", "Sapienza" University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy
| | - Giuseppe De Vincentis
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza, "Sapienza" University of Rome, Viale Regina Elena,324, 00161 Rome, Italy
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Minni A, Rosati D, Cavaliere C, Ralli M, Sementilli G, Gallo A, Brozzetti S, Ossola P, Cavallaro G, Bononi M. Total Versus Completion Thyroidectomy: A Multidimensional Evaluation of Long-Term Vocal Alterations. Ear Nose Throat J 2019; 100:562S-568S. [PMID: 31801365 DOI: 10.1177/0145561319886156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Total thyroidectomy (TT) and completion thyroidectomy (CT) are two common surgical operations that are frequently followed by vocal symptoms despite preservation of the recurrent laryngeal nerve (RLN) and of the external branch of superior laryngeal nerve (EBSLN). The aim of this study was to analyze vocal alterations through endoscopic findings, videolaryngostroboscopy (VLS), acoustic vocal parameters and impact on patients' quality of life after surgery in the absence of laryngeal nerve injury. METHODS We enrolled 198 patients who underwent thyroidectomy by the same surgeon. One hundred twenty-six patients underwent TT (group TT) while 72 underwent CT (group CT). All patients underwent preoperative VLS and Voice Handicap Index (VHI) assessment and postoperative VHI, VLS and Acoustic Voice Analysis with Multidimensional Voice Program Analysis 12 to 18 months after surgery. RESULTS We observed a statistically significant higher rate of EBSLN injury in CT compared to TT. Even in the absence of RLN and EBSLN injury, patients who underwent TT and CT presented slightly worse acoustic vocal parameters and VHI scores compared to healthy controls. Interestingly, some acoustic vocal parameters and VHI scores were significantly worse in group CT compared to group TT. CONCLUSIONS The higher rate of EBSLN injury in CT rather than in TT suggests a higher surgical risk in CT. The vocal parameters of loudness and self-perception of voice were significantly worse after CT, suggesting a larger trauma in patients' vocal outcome in CT if compared to TT, although these alterations were not reported as psychologically limiting daily life of patients. Nevertheless, the existence of multiple factors contributing to vocal alterations after thyroidectomy highlight the importance of a routine comprehensive functional voice analysis before and after surgery.
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Affiliation(s)
- Antonio Minni
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Davide Rosati
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Carlo Cavaliere
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Giulio Sementilli
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Andrea Gallo
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Stefania Brozzetti
- Department of Surgery "P. Valdoni", 9311Sapienza University of Rome, Rome, Italy
| | - Paolo Ossola
- Department of Surgery "P. Valdoni", 9311Sapienza University of Rome, Rome, Italy
| | - Giuseppe Cavallaro
- Department of Surgery "P. Valdoni", 9311Sapienza University of Rome, Rome, Italy
| | - Marco Bononi
- Department of Surgery "P. Valdoni", 9311Sapienza University of Rome, Rome, Italy
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Zafonte SJ, Rafkin L, Sosenko JM, Kenyon NS, Santiago I, Krischer JP, Bundy B, Abbondondolo M, Dixit S, Pasha M, King K, Adcock H, Atterberry L, Fox K, Englert N, Mauras J, Permuy K, Sikes T, Adams T, Berhe B, Guendling L, McLennan L, Paganessi C, Murphy M, Draznin M, Kamboj S, Sheppard V, Lewis L, Coates W, Amado D, Moore G, Babar J, Bedard D, Brenson-Hughes J, Cernich M, Clements R, Duprau S, Goodman L, Hester L, Huerta-Saenz A, Asif I, Karmazin T, Letjen S, Raman D, Morin W, Bestermann E, Morawski J, White A, Brockmyer R, Bays S, Campbell A, Boonstra M, Stapleton N, Stone A, Donoho H, Everett H, Hensley M, Johnson C, Marshall N, Skirvin P, Taylor R, Williams L, Burroughs C, Ray C, Wolverton D, Nickels C, Dothard P, Speiser M, Pellizzari L, Bokor K, Izuora S, Abdelnour P, Cummings S, Cuthbertson D, Paynor M, Leahy M, Riedl S, Shockley R, Saad T, Briones S, Casella C, Herz K, Walsh J, Greening F, Deemer M, Hay S, Hunt N, Sikotra L, Simons D, Karounos R, Oremus L, Dye L, Myers D, 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G, Browning T, Coughenour M, Sulk E, Tsalikan M, Tansey J, Cabbage N. Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes. Diabetes Care 2019; 42:192-199. [PMID: 30061316 PMCID: PMC6341285 DOI: 10.2337/dc18-0288] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/28/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings. RESEARCH DESIGN AND METHODS Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years. RESULTS At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects. CONCLUSIONS Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.
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Affiliation(s)
- Taylor M. Triolo
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Alexandra Fouts
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Liping Yu
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Peter A. Gottlieb
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Andrea K. Steck
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
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14
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Falcone R, Ramundo V, Lamartina L, Ascoli V, Bosco D, Di Gioia C, Montesano T, Biffoni M, Bononi M, Giacomelli L, Minni A, Segni M, Maranghi M, Cantisani V, Durante C, Grani G. Sonographic Presentation of Metastases to the Thyroid Gland: A Case Series. J Endocr Soc 2018; 2:855-859. [PMID: 30019024 PMCID: PMC6041777 DOI: 10.1210/js.2018-00124] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/18/2018] [Indexed: 02/08/2023] Open
Abstract
Incidental sonographic discovery of thyroid nodules is an increasingly common event. The vast majority is benign, and those that are malignant, are generally associated with an indolent course and low mortality. Sonographic scoring systems have been developed to help clinicians identify nodules that warrant prompt fine-needle aspiration cytology (FNAC), but they are based largely on experience with papillary thyroid cancers. We analyzed the performance of four scoring systems widely used for this purpose (American Thyroid Association Guidelines, American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi Guidelines, European Thyroid Imaging Reporting and Data System, and Korean Thyroid Imaging Reporting and Data System) in patients whose nodules proved to be metastases from other solid cancers. Such nodules reportedly account for 0.2% to 3% of all thyroid malignancies. Each scoring system was used to assess retrospectively the malignancy risk and indications for FNAC of five patients’ thyroid nodules that were ultimately diagnosed as metastases (from renal cell carcinoma, breast cancer, and lung cancer in two cases and esophageal cancer). The primaries identified in these cases are those most commonly reported to metastasize to the thyroid. In two cases, the thyroid metastases were the first sign of undetected neoplastic disease. Although sonography alone cannot distinguish thyroid metastases from primary thyroid malignancies, all four scoring systems classified the metastatic nodules as suspicious enough to require FNAC. The five cases accounted for 0.2% of those cytologically examined in our center. In most cases, cytology provided useful guidance for the subsequent management of these lesions, which differs from that of primary thyroid cancers and requires multidisciplinary input.
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Affiliation(s)
- Rosa Falcone
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - Valeria Ramundo
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - Livia Lamartina
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - Valeria Ascoli
- Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo Patologiche, Sapienza Università di Roma, Rome, Italy
| | - Daniela Bosco
- Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo Patologiche, Sapienza Università di Roma, Rome, Italy
| | - Cira Di Gioia
- Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo Patologiche, Sapienza Università di Roma, Rome, Italy
| | - Teresa Montesano
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - Marco Biffoni
- Dipartimento di Scienze Chirurgiche, Sapienza Università di Roma, Rome, Italy
| | - Marco Bononi
- Dipartimento di Chirurgia "P. Valdoni," Sapienza Università di Roma, Rome, Italy
| | - Laura Giacomelli
- Dipartimento di Scienze Chirurgiche, Sapienza Università di Roma, Rome, Italy
| | - Antonio Minni
- Dipartimento Organi di Senso, Sapienza Università di Roma, Rome, Italy
| | - Maria Segni
- Dipartimento di Pediatria e Neuropsichiatria infantile, Sapienza Università di Roma, Rome, Italy
| | - Marianna Maranghi
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - Vito Cantisani
- Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo Patologiche, Sapienza Università di Roma, Rome, Italy
| | - Cosimo Durante
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - Giorgio Grani
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
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15
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Iorio O, Petrozza V, De Gori A, Bononi M, Porta N, De Toma G, Cavallaro G. Parathyroid Autotransplantation During thyroid Surgery. Where we are? A Systematic Review on Indications and Results. J INVEST SURG 2018; 32:594-601. [PMID: 29658811 DOI: 10.1080/08941939.2018.1441344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Introduction: Hypoparathyroidism still represents an important concern in thyroid surgery. Careful dissection with identification and preservation of parathyroid glands in situ remains the best way to maintain gland vitality and avoid post-operative failure. Nevertheless, parathyroid glands are still inadvertently removed in up to 11% of cases. Parathyroid autotransplantation may represent the only way to restore parathyroid gland functionality in case of inadvertent removal or devascularization during thyroid surgery. Despite this, there is still no agreement on the effectiveness of this procedure. The present systematic review is focused on the mainly debated matters regarding the procedure, indications, technique and results. Methods: This review has been carried out according to PRISMA statement and checklist. The research item was: (((parathyroid autotransplantation[Title]) OR parathyroid reimplantation[Title]) NOT hyperparathyroidism[Title]) AND english[Language]. Results: A total of 31 studies have been found according to limitations already described, reporting from 4 to 890 procedures, with a total amount of 4088 PA. Among these studies, there are only 7 prospective case-series evaluations, 2 prospective randomized trials, while the other 22 studies are retrospective evaluations. The main concerns are: when and how to perform autotransplantation; in which anatomical site; which result to be expected, and how to manage and control the graft. Conslusions: Parathyroid autotransplantatin is an important tool to avoid or minimize the risk for hypoparathyroidism following thyroid surgery in selected cases. Parathormone assay can help the surgeon to determine when reimplantation is indicated or not. Further studies could theoretically give definitive results.
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Affiliation(s)
- Olga Iorio
- Department of Surgery, Casa di Cura "Città di Aprilia" , Aprilia ( LT ), Italy
| | - Vincenzo Petrozza
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University , Rome , Italy.,Pathology Unit, I.C.O.T. Hospital , Latina , Italy
| | | | - Marco Bononi
- Department of Surgery "P. Valdoni", Sapienza University , Rome , Italy
| | - Natale Porta
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University , Rome , Italy.,Pathology Unit, I.C.O.T. Hospital , Latina , Italy
| | - Giorgio De Toma
- Department of Surgery "P. Valdoni", Sapienza University , Rome , Italy
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16
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Grande R, Ossola P, Ferrer C, Venturini L, Bononi M, Della Rocca C, di Marzo L. Spontaneous Deep Femoral Artery False Aneurysm Simulating a Neoplasm: A Rare Case and Literature Review. Ann Vasc Surg 2018. [PMID: 29518517 DOI: 10.1016/j.avsg.2018.01.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 70-year-old woman presented to our attention with a painless pulsating mass at the level of the upper left thigh without any previous history of trauma, arterial surgery, or puncture of the femoral artery. Duplex ultrasound showed a nodular angiomatous-like formation with deep venous compression; computed tomographic angiography and magnetic resonance imaging reported the presence of capsulated lesion vascularized by muscular branch of deep femoral artery (DFA). The patient underwent surgical excision of a very rare thrombized DFA branch false aneurysm. Spontaneous DFA false aneurysm, although rare, will be considered in absence of trauma or vascular catheterization or previous aneurysmal rupture.
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Affiliation(s)
- Raffaele Grande
- Department of Surgery "PietroValdoni", "Sapienza" University, Rome, Italy.
| | - Paolo Ossola
- Department of Surgery "PietroValdoni", "Sapienza" University, Rome, Italy
| | - Ciro Ferrer
- Department of Surgery "PietroValdoni", "Sapienza" University, Rome, Italy
| | - Luigi Venturini
- Department of Surgery "PietroValdoni", "Sapienza" University, Rome, Italy
| | - Marco Bononi
- Department of Surgery "PietroValdoni", "Sapienza" University, Rome, Italy
| | - Carlo Della Rocca
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University, Rome, Italy
| | - Luca di Marzo
- Department of Surgery "PietroValdoni", "Sapienza" University, Rome, Italy
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17
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Tuccilli C, Baldini E, Arlot-Bonnemains Y, Chesnel F, Sorrenti S, De Vito C, D'Armiento E, Antonelli A, Fallahi P, Watutantrige S, Tartaglia F, Barollo S, Mian C, Arcieri S, Mascagni D, Pironi D, Bononi M, Vergine M, Monti M, Filippini A, Ulisse S. Expression and prognostic value of the cell polarity PAR complex members in thyroid cancer. Int J Oncol 2017; 50:1413-1422. [PMID: 28350047 DOI: 10.3892/ijo.2017.3907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/11/2017] [Indexed: 11/05/2022] Open
Abstract
Establishment and maintenance of the apical-basal cell polarity, required for proper replication, migration, specialized functions and tissue morphogenesis, relies on three evolutionary conserved complexes: PAR, CRUMBS and SCRIBBLE. Loss of cell polarity/cohesiveness (LOP/C) is implicated in cancer progression, and members of the polarity complex have been described as either oncogenes or oncosuppressors. However, no information on their role in thyroid cancer (TC) progression is available. In the present study, we evaluated the gene expression of the PAR complex members aPKCι, PARD3α/β and PARD6α/β/γ in 95 papillary TC (PTC), compared to their normal matched tissues and in 12 anaplastic TC (ATC). The mRNA and protein levels of investigated genes were altered in the majority of PTC and ATC tissues. In PTC, univariate analysis showed that reduced expression of aPKCι, PARD3β and PARD6γ mRNAs is associated with increased tumor size, and the reduced expression of PARD3β mRNA is associated also with recurrences. Multivariate analysis demonstrated that the presence of lymph node metastasis at diagnosis and the reduced expression of PARD3β are independent risk factors for recurrences, with hazard ratio, respectively, of 8.21 (p=0.006) and 3.04 (p=0.029). The latter result was confirmed by the Kaplan-Meier analysis, which evidenced the association between decreased PARD3β mRNA levels and shorter disease-free interval. In conclusion, we demonstrated that the expression of PAR complex components is deregulated in the majority of PTC and there is a general trend towards their reduction in ATC tissues. Moreover, a prognostic value for the PARD3β gene in PTCs is suggested.
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Affiliation(s)
- Chiara Tuccilli
- Department of Experimental Medicine, 'Sapienza' University of Rome, Rome, Italy
| | - Enke Baldini
- Department of Surgical Sciences, 'Sapienza' University of Rome, Rome, Italy
| | | | - Frank Chesnel
- CNRS-UMR 6290 (IGDR) Université Rennes 1, Rennes, France
| | - Salvatore Sorrenti
- Department of Surgical Sciences, 'Sapienza' University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Rome, Italy
| | - Eleonora D'Armiento
- Department of Experimental Medicine, 'Sapienza' University of Rome, Rome, Italy
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Poupak Fallahi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | - Susi Barollo
- Department of Medicine, University of Padua, Padua, Italy
| | - Caterina Mian
- Department of Medicine, University of Padua, Padua, Italy
| | - Stefano Arcieri
- Department of Surgical Sciences, 'Sapienza' University of Rome, Rome, Italy
| | - Domenico Mascagni
- Department of Surgical Sciences, 'Sapienza' University of Rome, Rome, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, 'Sapienza' University of Rome, Rome, Italy
| | - Marco Bononi
- Department of Surgery 'Pietro Valdoni', 'Sapienza' University of Rome, Rome, Italy
| | - Massimo Vergine
- Department of Surgical Sciences, 'Sapienza' University of Rome, Rome, Italy
| | - Massimo Monti
- Department of Surgical Sciences, 'Sapienza' University of Rome, Rome, Italy
| | - Angelo Filippini
- Department of Surgical Sciences, 'Sapienza' University of Rome, Rome, Italy
| | - Salvatore Ulisse
- Department of Surgical Sciences, 'Sapienza' University of Rome, Rome, Italy
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18
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Baldini E, Tuccilli C, Arlot-Bonnemains Y, Chesnel F, Sorrenti S, De Vito C, Catania A, D'Armiento E, Antonelli A, Fallahi P, Watutantrige-Fernando S, Tartaglia F, Barollo S, Mian C, Bononi M, Arceri S, Mascagni D, Vergine M, Pironi D, Monti M, Filippini A, Ulisse S. Deregulated expression of VHL mRNA variants in papillary thyroid cancer. Mol Cell Endocrinol 2017; 443:121-127. [PMID: 28089820 DOI: 10.1016/j.mce.2017.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 01/11/2017] [Accepted: 01/11/2017] [Indexed: 01/08/2023]
Abstract
Recent findings demonstrated that a subset of papillary thyroid cancers (PTCs) is characterized by reduced expression of the von Hippel-Lindau (VHL) tumor suppressor gene, and that lowest levels associated with more aggressive PTCs. In the present study, the levels of the two VHL mRNA splicing variants, VHL-213 (V1) and VHL-172 (V2), were measured in a series of 96 PTC and corresponding normal matched tissues by means of quantitative RT-PCR. Variations in the mRNA levels were correlated with patients' clinicopathological parameters and disease-free interval (DFI). The analysis of VHL mRNA in tumor tissues, compared to normal matched tissues, revealed that its expression was either up- or down-regulated in the majority of PTC. In particular, V1 and V2 mRNA levels were altered, respectively, in 78 (81.3%) and 65 (67.7%) out of the 96 PTCs analyzed. A significant positive correlation between the two mRNA variants was observed (p < 0.001). Univariate analysis documented the lack of association between each variant and clinicopathological parameters such as age, tumor size, histology, TNM stage, lymph node metastases, and BRAF mutational status. However, a strong correlation was found between altered V1 or V2 mRNA levels and DFI. Multivariate regression analysis indicated higher V1 mRNA values, along with lymph node metastases at diagnosis, as independent prognostic factors predicting DFI. In conclusion, the data reported demonstrate that VHL gene expression is deregulated in the majority of PTC tissues. Of particular interest is the apparent protective role exerted by VHL transcripts against PTC recurrences.
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Affiliation(s)
- Enke Baldini
- Department of Surgical Sciences, "Sapienza" University of Rome, Italy
| | - Chiara Tuccilli
- Department of Experimental Medicine, "Sapienza" University of Rome, Italy
| | | | - Frank Chesnel
- CNRS-UMR 6290 (IGDR) Université Rennes 1, Rennes, France
| | | | - Corrado De Vito
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy
| | - Antonio Catania
- Department of Surgical Sciences, "Sapienza" University of Rome, Italy
| | | | | | - Poupak Fallahi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | | | - Susi Barollo
- Department of Medicine, University of Padua, Italy
| | | | - Marco Bononi
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Italy
| | - Stefano Arceri
- Department of Surgical Sciences, "Sapienza" University of Rome, Italy
| | - Domenico Mascagni
- Department of Surgical Sciences, "Sapienza" University of Rome, Italy
| | - Massimo Vergine
- Department of Surgical Sciences, "Sapienza" University of Rome, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, "Sapienza" University of Rome, Italy
| | - Massimo Monti
- Department of Surgical Sciences, "Sapienza" University of Rome, Italy
| | - Angelo Filippini
- Department of Surgical Sciences, "Sapienza" University of Rome, Italy
| | - Salvatore Ulisse
- Department of Surgical Sciences, "Sapienza" University of Rome, Italy.
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Coccaro C, Tuccilli C, Prinzi N, D'Armiento E, Pepe M, Del Maestro F, Cacciola G, Forlini B, Verdolotti S, Bononi M, Nacca R, Baldini E, Cirillo G, Ulisse S. Consumption of iodized salt may not represent a reliable indicator of iodine adequacy: Evidence from a cross-sectional study on schoolchildren living in an urban area of central Italy. Nutrition 2015; 32:662-6. [PMID: 26897110 DOI: 10.1016/j.nut.2015.12.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/01/2015] [Accepted: 12/12/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE It has been established that iodine prophylaxis prevents endemic goiter. In this study we reported the amount of iodized salt sold by the retailers of Cassino, a city of central Italy. The aim of the study was to evaluate the effects of an iodine prophylaxis program started in 2005 on urinary iodine concentration (UIC) and thyroid volume (TV), and their correlation with anthropometric parameters in a population of schoolchildren. METHODS The study included 234 schoolchildren (119 girls and 115 boys) ages 13 to 14 y. Each student provided a morning urine sample for UIC determination, and TV was evaluated by ultrasonography. Body weight and height also were measured. Each participant completed a questionnaire reporting the presence of thyroid disease and the consumption of iodized salt and iodine-rich food. RESULTS The percentage of iodized salt sold by local markets was 42.4%. Median UIC in schoolchildren was 133.9 μg/L (range 33.2-819.5 μg/L), with 71 children having mild (range 50.1-99.9 μg/L) and 10 moderate (range 33.2-48.8 μg/L) iodine deficiency. Eleven children showed excessive iodine intake (range 300.4-819.5 μg/L). Median UIC was higher in children using iodized salt or consuming milk. Goiter prevalence was 3.8%. A positive correlation between TV and body weight, height, and surface was observed. CONCLUSIONS The data reported may suggest the presence of an adequate iodine intake in the population of Cassino despite the low percentage of iodized salt sold by local retailers. This indicates that silent iodine prophylaxis through the consumption of iodine-rich or iodine-enriched food is of importance in the prevention of iodine deficiency disorders.
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Affiliation(s)
- Carmela Coccaro
- Department of Experimental Medicine, "Sapienza" University of Rome, Italy
| | - Chiara Tuccilli
- Department of Experimental Medicine, "Sapienza" University of Rome, Italy
| | - Natalie Prinzi
- Department of Experimental Medicine, "Sapienza" University of Rome, Italy
| | | | - Mario Pepe
- Department of Experimental Medicine, "Sapienza" University of Rome, Italy
| | - Francesca Del Maestro
- Nursing School of Cassino, "Sapienza" University of Rome and University of Cassino and South Lazio, Italy
| | - Giovanni Cacciola
- UOC of Radiology, Department of Diagnostic, ASL Frosinone, "Santa Scolastica" Hospital, Cassino, Italy
| | - Benedetto Forlini
- UOC of Radiology, Department of Diagnostic, ASL Frosinone, "Santa Scolastica" Hospital, Cassino, Italy
| | - Sergio Verdolotti
- UOC of Radiology, Department of Diagnostic, ASL Frosinone, "Santa Scolastica" Hospital, Cassino, Italy
| | - Marco Bononi
- Nursing School of Cassino, "Sapienza" University of Rome and University of Cassino and South Lazio, Italy
| | - Remo Nacca
- UOC of Nephrology and Dialysis, ASL Frosinone, "Santa Scolastica" Hospital, Cassino, Italy
| | - Enke Baldini
- Department of Experimental Medicine, "Sapienza" University of Rome, Italy
| | - Giovanni Cirillo
- UOC of Clinical Pathology, ASL Frosinone, "Santa Scolastica" Hospital, Cassino, Italy
| | - Salvatore Ulisse
- Department of Experimental Medicine, "Sapienza" University of Rome, Italy.
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Haeussler K, Marcellusi A, Mennini FS, Favato G, Picardo M, Garganese G, Bononi M, Costa S, Scambia G, Zweifel P, Capone A, Baio G. Cost-Effectiveness Analysis of Universal Human Papillomavirus Vaccination Using a Dynamic Bayesian Methodology: The BEST II Study. Value Health 2015; 18:956-68. [PMID: 26686779 DOI: 10.1016/j.jval.2015.08.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 08/05/2015] [Accepted: 08/08/2015] [Indexed: 05/23/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) plays a role in the development of benign and malign neoplasms in both sexes. The Italian recommendations for HPV vaccines consider only females. The BEST II study (Bayesian modelling to assess the Effectiveness of a vaccination Strategy to prevent HPV-related diseases) evaluates 1) the cost-effectiveness of immunization strategies targeting universal vaccination compared with cervical cancer screening and female-only vaccination and 2) the economic impact of immunization on various HPV-induced diseases. OBJECTIVE The objective of this study was to evaluate whether female-only vaccination or universal vaccination is the most cost-effective intervention against HPV. METHODS We present a dynamic Bayesian Markov model to investigate transmission dynamics in cohorts of females and males in a follow-up period of 55 years. We assumed that quadrivalent vaccination (against HPV 16, 18, 6, and 11) is available for 12-year-old individuals. The model accounts for the progression of subjects across HPV-induced health states (cervical, vaginal, vulvar, anal, penile, and head/neck cancer as well as anogenital warts). The sexual mixing is modeled on the basis of age-, sex-, and sexual behavioral-specific matrices to obtain the dynamic force of infection. RESULTS In comparison to cervical cancer screening, universal vaccination results in an incremental cost-effectiveness ratio of €1,500. When universal immunization is compared with female-only vaccination, it is cost-effective with an incremental cost-effectiveness ratio of €11,600. Probabilistic sensitivity analysis shows a relatively large amount of parameter uncertainty, which interestingly has, however, no substantial impact on the decision-making process. The intervention being assessed seems to be associated with an attractive cost-effectiveness profile. CONCLUSIONS Universal HPV vaccination is found to be a cost-effective choice when compared with either cervical cancer screening or female-only vaccination within the Italian context.
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Affiliation(s)
- Katrin Haeussler
- Department of Statistical Science, University College London, London, UK.
| | - Andrea Marcellusi
- Economic Evaluation and HTA, Faculty of Economics, University of Rome "Tor Vergata," Rome, Italy; Department of Demography, University of Rome "La Sapienza," Rome, Italy
| | - Francesco Saverio Mennini
- Economic Evaluation and HTA, Faculty of Economics, University of Rome "Tor Vergata," Rome, Italy; Institute of Leadership and Management in Health, Kingston University London, London, UK
| | - Giampiero Favato
- Institute of Leadership and Management in Health, Kingston University London, London, UK
| | - Mauro Picardo
- Laboratory of Cutaneous Pathophysiology, San Gallicano Dermatological Institute (IRCCS), Rome, Italy
| | - Giorgia Garganese
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Bononi
- Department of Surgery Pietro Valdoni, University of Rome "La Sapienza," Rome, Italy
| | - Silvano Costa
- Department of Gynecology and Obstetrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Peter Zweifel
- Socioeconomic Institute, University of Zurich, Zurich, Switzerland
| | - Alessandro Capone
- Institute of Leadership and Management in Health, Kingston University London, London, UK
| | - Gianluca Baio
- Department of Statistical Science, University College London, London, UK
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Tuccilli C, Baldini E, Sorrenti S, Di Gioia C, Bosco D, Ascoli V, Mian C, Barollo S, Rendina R, Coccaro C, Pepe M, Catania A, Bononi M, Tartaglia F, De Antoni E, D'Armiento M, Ulisse S. PAPILLARY THYROID CANCER IS CHARACTERIZED BY ALTERED EXPRESSION OF GENES INVOLVED IN THE SUMOYLATION PROCESS. J BIOL REG HOMEOS AG 2015; 29:655-662. [PMID: 26403403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Small Ubiquitinlike MOdifier (SUMO) proteins are small protein modifiers capable of regulating cellular localization and function of target proteins. Over the last few years, a relevant role has been demonstrated for sumoylation in the modulation of important cellular processes, including gene transcription, DNA repair, cell-cycle regulation and apoptosis. Components of the sumoylation machinery have been found deregulated in different human cancers, and are thought to significantly affect cancer cell progression. In the present study we sought to analyze the expression of all the components of the sumoylation machinery in a case study comprising 77 papillary thyroid cancers (PTC) and normal matched tissues. In particular, we evaluated the expression of the SENP1 to SENP8 (SENtrin-specific proteases), SAE1 (SUMO1 activating enzyme subunit 1), UBA2 (UBiquitin-like modifier activating enzyme 2), UBC9 (UBiquitin conjugating enzyme 9), RanBP2 (RAN binding protein 2), MSMCE2 (Non- SMC element 2), CBX4 (ChromoBoX homolog 4), PIAS1 to PIAS4 (protein inhibitor of activated STAT), ZMIZ1 (zinc finger, MIZ-type containing 1) and ZMIZ2 (Zinc finger, MIZ-type containing 2) by means of quantitative RT-PCR. In most of the PTC examined we observed a significant alteration in the mRNAs of SENP8, ZMIZ1, SAE1, PIAS1 and PIAS2. These tended to be reduced in about 50 to 66% of cases, and unchanged or increased in the remaining ones. Univariate and Kaplan-Mayer analyses documented the lack of association between the expression of the above 5 genes and clinicopathological parameters. Only SAE1 was significantly higher in female PTC tissues, in respect to male PTC tissues (p=0.021), and SENP8 was significantly lower in TNM stages III-V, with respect to stages I-II (p=0.047). In conclusion, we demonstrated that the expression of SENP8, SAE1, PIAS1, PIAS2 and ZMIZ1 is deregulated in the majority of PTC tissues, likely contributing to the PTC phenotype. However, differently from other human cancers, their mRNA level does not represent a prognostic biomarker in PTC patients.
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Affiliation(s)
- C Tuccilli
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - E Baldini
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - S Sorrenti
- Department of Surgical Sciences, Sapienza University of Rome, Italy
| | - C Di Gioia
- Department of Radiology, Oncology and Pathological Anatomy, Sapienza University of Rome, Italy
| | - D Bosco
- Department of Radiology, Oncology and Pathological Anatomy, Sapienza University of Rome, Italy
| | - V Ascoli
- Department of Radiology, Oncology and Pathological Anatomy, Sapienza University of Rome, Italy
| | - C Mian
- Department of Medicine, University of Padua, Italy
| | - S Barollo
- Department of Medicine, University of Padua, Italy
| | - R Rendina
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - C Coccaro
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - M Pepe
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - A Catania
- Department of Surgical Sciences, Sapienza University of Rome, Italy
| | - M Bononi
- Department of Surgery Pietro Valdoni, Sapienza University of Rome, Italy
| | - F Tartaglia
- Department of Surgical Sciences, Sapienza University of Rome, Italy
| | - E De Antoni
- Department of Surgical Sciences, Sapienza University of Rome, Italy
| | - M D'Armiento
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - S Ulisse
- Department of Experimental Medicine, Sapienza University of Rome, Italy
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22
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De Cesare A, Fiori E, Bononi M, Ferraro D. Phytobezoar-induced small bowel obstruction associated with a concomitant gastric phytobezoar and ulcer in an elderly woman. Ann Ital Chir 2015; 86:70-77. [PMID: 25817461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Bezoars are aggregates of indigested foreign material that accumulate in the gastroenteric tract, expecially in the stomach and in the narrowest points of the small bowel. They often occur in subjects who follow a diet rich in fruit and vegetables and in those one who previously underwent gastric resective surgery for peptic ulcer. Bezoar formation has even been observed in case of reduced gastric motility and secretion due to diabetes, hypothyroidism, pernicious anemia, myotonic syndromes, and Guillain-Barré syndrome. As they are an uncommon cause of small bowel obstruction, phytobezoars are often not considered in the differential diagnosis of occlusive intestinal syndromes and so frequently come as an intraoperative finding. A consequence of this missed diagnosis in the preoperative period is an unnecessary diagnostic delay that can significantly increase morbidity and mortality. This case report illustrates the need to include phytobezoars in the preoperative diagnostic workout of intestinal obstruction in order to rule out the presence of multiple bezoars and prevent recurrent obstruction. Now that phytobezoars are becoming a less infrequent cause of small bowel obstruction than previously thought, such a diagnostic possibility should always be considered.
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23
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Sapienza P, Borrelli V, Sterpetti AV, Biacchi D, Venturini L, Tartaglia E, Bononi M, Di Marzo L. Statins reduce levels of metalloproteinases in patients with carotid occlusive disease. INT ANGIOL 2014; 33:530-539. [PMID: 25491403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Pharmaceutical stabilization of an unstable low-grade carotid artery stenosis delays surgery and improve outcome. Statins can be used to reduce intimal media thickness. Our aim was to determine the clinical and biological effects of rosuvastatin on plaque stabilization or regression. METHODS Forty-two consecutive male patients presenting with an asymptomatic internal carotid artery plaque uniformly anechogenic (group 1) 40-50% lumen diameter reduction formed the basis of the study. A group of 35 patients affected with a uniformly echogenic carotid artery stenosis (40-50%) served as control (group 2). Patients were followed-up every 8-month for 2 years with B-mode ultrasonography and color imaging. A computed tomography angiography (CTA) was performed before the initiation of the study period and at the end to confirm plaque characteristics and the degree of stenosis. Ticlopidine (250 mg/day) and rosuvastatin (10 mg/day) were administered. One blood sample was drawn at every control to assess the release of matrix metallopoteinases (MMPs)-1, -2, -3, -9, tissue inhibitors of metalloproteinases (TIMPs)-1 and -2. RESULTS After the administration of rosuvastatin plasma level of MMP-1, -2, -3 and -9 significantly decreased in both groups (P<0.001). Conversely, plasma level of TIMP-1 and -2 significantly increased in both groups (P<0.001). B-mode ultrasonography and color imaging and CTA failed to demonstrate a stabilization or regression of uniformly anehogenic carotid plaque during follow-up. CONCLUSION Rosuvastatin decreases the plasma level of MMPs and increases those of TIMPs. However, neither progression nor stabilization of low-grade unstable carotid plaques was seen.
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Affiliation(s)
- P Sapienza
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy -
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24
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Haeussler K, Marcellusi A, Mennini FS, Favato G, Picardo M, Garganese G, Bononi M, Scambia G, Capone A, Baio G. The Effect of Herd Immunity in Different Human Papillomavirus Vaccination Strategies: An Economic Evaluation of the Best Ii Study. Value Health 2014; 17:A674. [PMID: 27202477 DOI: 10.1016/j.jval.2014.08.2500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - F S Mennini
- University of Rome "Tor Vergata", Italy, Rome, Italy
| | - G Favato
- Kingston University, Kingston, UK, Kingston, UK
| | - M Picardo
- San Gallicano Dermatological Institute, Rome, Italy
| | - G Garganese
- Catholic University of the Sacred Heart, Rome, Italy
| | | | - G Scambia
- Catholic University of the Sacred Heart, Rome, Italy
| | - A Capone
- Kingston University London, London, UK
| | - G Baio
- University College London, London, UK
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25
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Baldini E, Tuccilli C, Prinzi N, Sorrenti S, Antonelli A, Gnessi L, Morrone S, Moretti C, Bononi M, Arlot-Bonnemains Y, D'Armiento M, Ulisse S. Effects of selective inhibitors of Aurora kinases on anaplastic thyroid carcinoma cell lines. Endocr Relat Cancer 2014; 21:797-811. [PMID: 25074669 DOI: 10.1530/erc-14-0299] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aurora kinases are serine/threonine kinases that play an essential role in cell division. Their aberrant expression and/or function induce severe mitotic abnormalities, resulting in either cell death or aneuploidy. Overexpression of Aurora kinases is often found in several malignancies, among which is anaplastic thyroid carcinoma (ATC). We have previously demonstrated the in vitro efficacy of Aurora kinase inhibitors in restraining cell growth and survival of different ATC cell lines. In this study, we sought to establish which Aurora might represent the preferential drug target for ATC. To this end, the effects of two selective inhibitors of Aurora-A (MLN8237) and Aurora-B (AZD1152) on four human ATC cell lines (CAL-62, BHT-101, 8305C, and 8505C) were analysed. Both inhibitors reduced cell proliferation in a time- and dose-dependent manner, with IC50 ranges of 44.3-134.2 nM for MLN8237 and of 9.2-461.3 nM for AZD1152. Immunofluorescence experiments and time-lapse videomicroscopy yielded evidence that each inhibitor induced distinct mitotic phenotypes, but both of them prevented the completion of cytokinesis. As a result, poliploidy increased in all AZD1152-treated cells, and in two out of four cell lines treated with MLN8237. Apoptosis was induced in all the cells by MLN8237, and in BHT-101, 8305C, and 8505C by AZD1152, while CAL-62 exposed to AZD1152 died through necrosis after multiple rounds of endoreplication. Both inhibitors were capable of blocking anchorage-independent cell growth. In conclusion, we demonstrated that either Aurora-A or Aurora-B might represent therapeutic targets for the ATC treatment, but inhibition of Aurora-A appears more effective for suppressing ATC cell proliferation and for inducing the apoptotic pathway.
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Affiliation(s)
- Enke Baldini
- Departments of Experimental MedicineSurgical Sciences'Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyDepartment of Internal MedicineUniversity of Pisa, Pisa, ItalyDepartment of Systems' MedicineUniversity of Rome Tor Vergata, Rome, ItalyDepartment of Surgery 'Pietro Valdoni''Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyCNRS - UMR 6290 (IGDR)University of Rennes 1, Rennes, France
| | - Chiara Tuccilli
- Departments of Experimental MedicineSurgical Sciences'Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyDepartment of Internal MedicineUniversity of Pisa, Pisa, ItalyDepartment of Systems' MedicineUniversity of Rome Tor Vergata, Rome, ItalyDepartment of Surgery 'Pietro Valdoni''Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyCNRS - UMR 6290 (IGDR)University of Rennes 1, Rennes, France
| | - Natalie Prinzi
- Departments of Experimental MedicineSurgical Sciences'Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyDepartment of Internal MedicineUniversity of Pisa, Pisa, ItalyDepartment of Systems' MedicineUniversity of Rome Tor Vergata, Rome, ItalyDepartment of Surgery 'Pietro Valdoni''Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyCNRS - UMR 6290 (IGDR)University of Rennes 1, Rennes, France
| | - Salvatore Sorrenti
- Departments of Experimental MedicineSurgical Sciences'Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyDepartment of Internal MedicineUniversity of Pisa, Pisa, ItalyDepartment of Systems' MedicineUniversity of Rome Tor Vergata, Rome, ItalyDepartment of Surgery 'Pietro Valdoni''Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyCNRS - UMR 6290 (IGDR)University of Rennes 1, Rennes, France
| | - Alessandro Antonelli
- Departments of Experimental MedicineSurgical Sciences'Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyDepartment of Internal MedicineUniversity of Pisa, Pisa, ItalyDepartment of Systems' MedicineUniversity of Rome Tor Vergata, Rome, ItalyDepartment of Surgery 'Pietro Valdoni''Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyCNRS - UMR 6290 (IGDR)University of Rennes 1, Rennes, France
| | - Lucio Gnessi
- Departments of Experimental MedicineSurgical Sciences'Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyDepartment of Internal MedicineUniversity of Pisa, Pisa, ItalyDepartment of Systems' MedicineUniversity of Rome Tor Vergata, Rome, ItalyDepartment of Surgery 'Pietro Valdoni''Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyCNRS - UMR 6290 (IGDR)University of Rennes 1, Rennes, France
| | - Stefania Morrone
- Departments of Experimental MedicineSurgical Sciences'Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyDepartment of Internal MedicineUniversity of Pisa, Pisa, ItalyDepartment of Systems' MedicineUniversity of Rome Tor Vergata, Rome, ItalyDepartment of Surgery 'Pietro Valdoni''Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyCNRS - UMR 6290 (IGDR)University of Rennes 1, Rennes, France
| | - Costanzo Moretti
- Departments of Experimental MedicineSurgical Sciences'Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyDepartment of Internal MedicineUniversity of Pisa, Pisa, ItalyDepartment of Systems' MedicineUniversity of Rome Tor Vergata, Rome, ItalyDepartment of Surgery 'Pietro Valdoni''Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyCNRS - UMR 6290 (IGDR)University of Rennes 1, Rennes, France
| | - Marco Bononi
- Departments of Experimental MedicineSurgical Sciences'Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyDepartment of Internal MedicineUniversity of Pisa, Pisa, ItalyDepartment of Systems' MedicineUniversity of Rome Tor Vergata, Rome, ItalyDepartment of Surgery 'Pietro Valdoni''Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyCNRS - UMR 6290 (IGDR)University of Rennes 1, Rennes, France
| | - Yannick Arlot-Bonnemains
- Departments of Experimental MedicineSurgical Sciences'Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyDepartment of Internal MedicineUniversity of Pisa, Pisa, ItalyDepartment of Systems' MedicineUniversity of Rome Tor Vergata, Rome, ItalyDepartment of Surgery 'Pietro Valdoni''Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyCNRS - UMR 6290 (IGDR)University of Rennes 1, Rennes, France
| | - Massimino D'Armiento
- Departments of Experimental MedicineSurgical Sciences'Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyDepartment of Internal MedicineUniversity of Pisa, Pisa, ItalyDepartment of Systems' MedicineUniversity of Rome Tor Vergata, Rome, ItalyDepartment of Surgery 'Pietro Valdoni''Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyCNRS - UMR 6290 (IGDR)University of Rennes 1, Rennes, France
| | - Salvatore Ulisse
- Departments of Experimental MedicineSurgical Sciences'Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyDepartment of Internal MedicineUniversity of Pisa, Pisa, ItalyDepartment of Systems' MedicineUniversity of Rome Tor Vergata, Rome, ItalyDepartment of Surgery 'Pietro Valdoni''Sapienza' University of Rome, Viale Regina Elena, 324, 00161 Rome, ItalyCNRS - UMR 6290 (IGDR)University of Rennes 1, Rennes, France
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Affiliation(s)
- Ottavia Borghese
- Department of Surgery Pietro Valdoni, Sapienza University, Rome, Italy
| | - Paolo Sapienza
- Department of Surgery Pietro Valdoni, Sapienza University, Rome, Italy
| | - Luigi Venturini
- Department of Surgery Pietro Valdoni, Sapienza University, Rome, Italy
| | - Marco Bononi
- Department of Surgery Pietro Valdoni, Sapienza University, Rome, Italy
| | - Luca di Marzo
- Department of Surgery Pietro Valdoni, Sapienza University, Rome, Italy
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Baldini E, Sorrenti S, Tuccilli C, Prinzi N, Coccaro C, Catania A, Filippini A, Bononi M, De Antoni E, D'Armiento M, Ulisse S. Emerging molecular markers for the prognosis of differentiated thyroid cancer patients. Int J Surg 2014; 12 Suppl 1:S52-6. [PMID: 24862669 DOI: 10.1016/j.ijsu.2014.05.054] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 01/08/2023]
Abstract
Epithelial thyroid cancers are represented by the differentiated papillary and follicular thyroid carcinomas which, following dedifferentiation, are thought to give rise to the highly aggressive and incurable anaplastic thyroid carcinomas. Although derived from the same cell type, the different thyroid tumors show specific histological features, biological behavior and degree of differentiation as a consequence of different genetic alterations. Over the last few years, our knowledge regarding the molecular alterations underlying thyroid cell malignant transformation and cancer progression has considerably increased; however, the prognosis of differentiated thyroid cancer patients still relies on high-risk clinic-pathological variables. In particular, the actual staging systems provides only a rough prediction for cancer mortality and risk of recurrences, including in each risk group patients with highly different tumor-specific progression, disease-free interval and survival time. In order to improve DTC patient's risk stratification, both the European and the American Thyroid Associations proposed practical guidelines to integrate the actual staging systems with additional clinical features such as the tumor histological variant, the results of post-ablative whole body scan and the serum thyroglobulin levels. Despite that, patients within the same risk group still show a very heterogeneous behavior in terms of disease-free interval. As a consequence, the identification of new prognostic molecular biomarkers able to testify tumor aggressiveness is highly required. Here we'll review recently characterized new molecular markers potentially able to ameliorate the prognosis in DTC patients.
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Affiliation(s)
- Enke Baldini
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | | | - Chiara Tuccilli
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Natalie Prinzi
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Carmela Coccaro
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Antonio Catania
- Department of Surgical Sciences, "Sapienza" University of Rome, Italy
| | - Angelo Filippini
- Department of Surgical Sciences, "Sapienza" University of Rome, Italy
| | - Marco Bononi
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Italy
| | - Enrico De Antoni
- Department of Surgical Sciences, "Sapienza" University of Rome, Italy
| | - Massimino D'Armiento
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Salvatore Ulisse
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy.
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De Cesare A, Cangemi B, Fiori E, Bononi M, Cangemi R, Basso L. Early and long-term clinical outcomes of bilio-intestinal diversion in morbidly obese patients. Surg Today 2014; 44:1424-33. [PMID: 24519396 DOI: 10.1007/s00595-014-0856-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/18/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate the early and long-term postoperative results of malabsorptive surgery in morbidly obese patients. METHODS Between 2000 and 2007, 102 morbidly obese patients were referred to the Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Policlinico "Umberto I°", Rome, Italy for malabsorptive surgery. All patients underwent derivative biliodigestive surgery after they had been reviewed by a team of surgeons, physicians, dieticians, and psychologists. RESULTS There were no intra-operative complications, but two patients suffered postoperative pulmonary embolisms, which resolved with medical treatment. The mean postoperative hospital stay was 7 days, with no early or late mortality. Maximum weight loss was reached 12-24 months after surgery, while the mean percentage excess weight loss at 3-5 years ranged from 45 to 64 %. Specific postoperative complications in the first 2 years after surgery were abdominal abscess (n = 2), gastroduodenal reflux (n = 4), and incisional hernia (n = 6). Diabetes resolved in 98 % of the diabetic patients within a few weeks after surgery and blood pressure normalised in 86.4 % of those who had had hypertension preoperatively. Obstructive sleep apnoea and obesity hypoventilation syndrome also improved significantly in 92 % of the patients. CONCLUSIONS Morbidly obese patients can undergo biliodigestive surgery safely with good long-term weight loss and quality of life expectancy.
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Affiliation(s)
- Alessandro De Cesare
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Faculty of Medicine and Dentistry, viale del Policlinico 155, 00161, Rome, Italy
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Minni A, Ruoppolo G, Barbaro M, Di Lorenzo E, Sementilli G, Bononi M. Long-term (12 to 18 months) functional voice assessment to detect voice alterations after thyroidectomy. Eur Rev Med Pharmacol Sci 2014; 18:1704-1708. [PMID: 24992610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Even when thyroidectomy preserves vocal cord motility it may leave patients with changes in voice quality. Although superior laryngeal nerve (LSN) damage after thyroidectomy manifests with aspecific symptoms, laryngoscopy discloses only slight morphological changes that are difficult to assess. We want to investigate the voice function in asymptomatic patients one year after thyroidectomy and to compare the obtained data against those of a healthy control group. PATIENTS AND METHODS Thirty adult patients who had undergone thyroidectomy, all of them euphonic before and after the operation, were submitted to a complete voice assessment including voice self-evaluation tools, videolaryngostroboscopy and spectrographic analysis of voice. Primary outcome measures were differences between surgical patients and control group in terms of microperturbation of voice intensity and amplitude as measured by spectrographic analysis. RESULTS In patients who had undergone thyroidectomy, acoustic parameters indicating amplitude microperturbations resulted slightly altered. All these values exceeded normal MDVP thresholds. Another interesting finding in our study sample concerns the lower F0 values we recorded in women patients after surgery than in healthy controls. Voice alterations may reflect prelaryngeal muscle scarring or fibrosis. Consider the possible alterations of vocal quality caused by scarring after surgery therefore strongly recommend surgery when the situation allows it, not to dissect the prelaryngeal muscles but only to spread apart. CONCLUSIONS Our study conducted at least one year after thyroid surgery underlines that surgery-related slight voice deficits can persist over time. More refined phoniatric testing discloses voice alterations that normalize without specific rehabilitation therapy, therefore confirming that certain acoustic changes are clinically unimportant.
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Affiliation(s)
- A Minni
- Department of Sensory Organs, "Sapienza" University of Rome, Azienda Policlinico Umberto I, Rome, Italy.
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Brozzetti S, Miccini M, Bononi M, Al Mansour M, Borghese O, Gregori M, Fraioli F, De Toma G, Tocchi A. Treatment of congenital liver cysts. A surgical technique tailored through a 35-year experience. Ann Ital Chir 2013; 84:93-98. [PMID: 23445783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The most important aims of the treatment of CLC are long-term relief of symptoms and elimination of cysts. Treatment of choice is yet debated. METHODS Data of patients treated for CLC during a 35-years experience were retrospectively analyzed. Variables analyzed were: age, sex, hepatic cyst location, cyst diameter, symptoms, surgical procedure, short and long-term outcomes. RESULTS We examined 49 consecutive patients treated for CLC (mean follow-up, 76 months). The study was divided into two periods: 1975-1999 and 2000-2010. Procedures performed in the first period were needle aspiration and sclerotherapy (n= 6), hepatic resections (9), cystojejunostomy (4), open unroofing (10), and laparoscopic unroofing (8). Omentopexy within the residual cystic cavity was associated with seven open and two laparoscopic unroofing cases. Rates of morbidity and recurrence were 23.5% and 44.1%, respectively. One patient died in the peri-operative period. Procedures performed in the second period were open unroofing (9), laparoscopic unroofing (5), and hepatic resection (1). Omentopexy was associated with all open procedures and two laparoscopic procedures. Overall morbidity in this group was 16.6%, and recurrence occurred in one patient (6.7%). CONCLUSIONS Cyst unroofing and omentopexy is a safe and highly effective procedure for the treatment of CLC. Laparoscopy is confirmed as the procedure of choice except for cases in which the cysts are in the posterior right liver, where a wide mobilization of the liver is necessary.
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Frega A, Lorenzon L, Bononi M, De Cesare A, Ciardi A, Lombardi D, Assorgi C, Gentile M, Moscarini M, Torrisi MR, French D. Evaluation of E6 and E7 mRNA expression in HPV DNA positive breast cancer. EUR J GYNAECOL ONCOL 2012; 33:164-167. [PMID: 22611956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Several studies have suggested a possible role for HPV in the pathogenesis of the breast cancer. We investigated the presence of the HPV DNA in breast cancers and non malignant disease breast tissues by the use of a standard HPV detection method (INNO-Lipa HPV), in order to detect HPV DNA in metastatic nodes, to investigate a possible cervical HPV co-infection, and to evaluate the E6/E7 mRNA expression in HPV DNA positive breast cancer tissues. The rate of HPV infection was significantly higher in the cancer group than in controls (9/31 vs. 0/12, p = 0.04). One out of eight metastatic axillary nodes was positive for HPV infection; 2/3 of the positive HPV breast cancer patients were co-infected at the cervical site. The role of the virus in breast oncogenesis is still unclear, since our analysis failed in demonstrating the expression of viral E6 and E7 in positive HPV positive breast tumor tissues.
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Affiliation(s)
- A Frega
- Department of Woman's Health and Territorial Medicine, Sant' Andrea Hospital, Faculty of Medicine and Psychology, Italy
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Bononi M, Amore Bonapasta S, Vari A, Scarpini M, De Cesare A, Miccini M, Meucci M, Tocchi A. Incidence and circumstances of cervical hematoma complicating thyroidectomy and its relationship to postoperative vomiting. Head Neck 2010; 32:1173-7. [PMID: 20029984 DOI: 10.1002/hed.21313] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cervical hematoma is hardly a predictable complication of thyroid surgery. Postoperative vomiting has been reported as a likely risk factor. METHODS Five hundred sixty-two patients undergoing thyroidectomy were prospectively enrolled in the study and divided into 2 groups. Patients in group A received ondansetron to prevent postoperative vomiting. In group B, patients with low vomiting risk received ondansetron whereas patients at high risk received ondansetron plus dexamethasone. Postoperative outcomes of the groups were analyzed and compared. RESULTS Cervical hematomas developed in 3 patients (0.53%): 2 in group A and 1 in group B. All hematomas occurred after 6 hours. The incidence of postoperative vomiting was 11.4% in group A and 6.4% in group B (p = .04). CONCLUSION Careful hemostasis remains of prime importance in preventing cervical hematoma. Postoperative vomiting has not been confirmed by this study as a risk factor for the development of hematoma. Ambulatory thyroid surgery is not advisable.
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Affiliation(s)
- Marco Bononi
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
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Miccini M, Amore Bonapasta S, Gregori M, Bononi M, Fornasari V, Tocchi A. Indications and results for transduodenal sphincteroplasty in the era of endoscopic sphincterotomy. Am J Surg 2010; 200:247-51. [PMID: 20678620 DOI: 10.1016/j.amjsurg.2009.08.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 07/22/2009] [Accepted: 08/04/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transduodenal sphincterotomy (TS) has fallen into disuse since endoscopists developed techniques to treat sphincter problems nonsurgically. However, some patients experience recurrent sphincter strictures after endoscopic sphincterotomy (ES), with the ampulla endoscopically inaccessible, and pancreas divisum (PD); these patients are referred to a surgeon because they are unsuitable for ES. METHODS The medical records of patients who underwent TS at the First Department of Surgery of the Medical School, University of Rome "La Sapienza," between January 1997 and December 2005 were reviewed. A total of 82 patients, including 47 women and 35 men with a mean age of 47 years (range, 26-67 y), underwent TS in our unit in the aforementioned period. Previous unsuccessful endoscopic retrograde cholangiography and ES were the indications for TS in 44 patients, and previous gastric surgery with duodenal bypass was the indication for TS in 21 patients. Five patients underwent TS because of a PD and 10 because of the intraoperative findings of daughter hydatid cysts in the common bile duct and of a wide communication between the cyst cavity and the intrahepatic biliary tree. Two patients were referred to our institution after a surgical papillotomy performed elsewhere. Symptoms included abdominal pain in 100% of patients, nausea and/or vomiting in 78% of patients, and referred back pain in 56% of patients. Acute pancreatitis was present in the history of 26 patients, including 23 with previous ES. All patients underwent TS. Sphincteroplasty of the accessory papilla was performed in all patients with PD. Cornerstones of a successful TS are depicted. RESULTS Asymptomatic hyperamylasemia was observed in 37 patients, and cholangitis and pancreatitis, which was resolved with conservative management, occurred in 2 patients. One patient developed an intra-abdominal abscess that was treated with image-guided percutaneous drainage. No perioperative deaths occurred in this series. The mean length of follow-up evaluation was 84.4 months (range, 16-115 mo). Good results were achieved in 53 patients (73.6%), fair results in 17 patients (23.6%), and poor results in 2 patients (2.7%). Both patients with poor results required reoperation because of recurrent pancreatitis and pancreatic pseudocyst. CONCLUSIONS TS still represents, although undoubtedly with updated indications compared with the past, a surgical procedure that must be up to date, ensuring absolutely satisfactory results.
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Bononi M, De Toma G, Scarpini M, Miccini M, De Cesare A, Meucci M, Amore Bonapasta S, Celotto A, Tocchi A. [Hormone replacement therapy after total thyroidectomy. Can the combined treatment be considered effective to get metabolic adequacy? Preliminary results]. G Chir 2010; 31:303-307. [PMID: 20646377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Even if T4 is standard treatment for hypothyroidism after thyroidectomy, a treatment with T4 plus T3 has been proposed as an alternative reproducing carefully the physiology of the thyroid. We performed an observational study about the effects of the combined replacement therapy with T4 and T3 in patients who underwent total thyroidectomy. PATIENTS AND METHODS Fifty thyroidectomized patients (not for cancer), in T4 replacement therapy, were included in the study. Such a therapy has been changed by administering T3 and T4 in proportion 1/16. Adverse effects, clinical parameters and general health perceptions (SF36 Questionnaire) have been considered at the time of enrollment (T0), after 30 days (T1) and after 60 days (T2). RESULTS No differences in weight, cardiac frequency and blood pression have been found between T0 and T2. A not statistically significant reduction has been found in total cholesterol (3 mg/dL) and triglycerides (3.29 mg/dL) levels. A reduction of complaints referred by the patients at T0 has been revealed in T2: anxiety from 21 to 13 patients; headache from 22 to 13; tiredness from 17 to 8 (p<0.05); sleepiness from 25 to 15 (p<0.05). About the questionnaire, in the General Health Perception sub-score has been found a not significant increase of the parameter. DISCUSSION AND CONCLUSIONS T4 replacement therapy is of proved efficacy, notwithstanding some complaints afflict a share of patients. To improve the quality of life of these patients, we consider relevant the reduction of complaints and the improvement of well-being and cognitive function obtained by the combined T4 and T3 treatment. Moreover, even if the production of T3 from T4 usually ensures euthyroidism in all tissues, contemporary pathologies and alterations determined by the oldness can disturb the enzymatic activity, which is the essential requirement of T4 therapy. These preliminary findings in a small group of patients encourage further studies on a larger patient population.
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Affiliation(s)
- M Bononi
- Dipartimento di Chirurgia, Sapienza, Univesitá di Eoma, Policlinico Umberto I, Roma
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Bononi M, Gallone F, Tateo F. Validation data for HPLC/FLD determinations of ochratoxin A in red paprika and black pepper adopting a one-step clean-up procedure. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2010; 27:249-54. [DOI: 10.1080/19440040903384182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Scarpini M, Bonapasta SA, Ruperto M, Vestri A, Bononi M, Caporale A. Retrograde Parotidectomy for Pleomorphic Adenoma of the Parotid Gland. J Craniofac Surg 2009; 20:967-9. [DOI: 10.1097/scs.0b013e3181a86ead] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Tocchi A, Mazzoni G, Bononi M, Fornasari V, Miccini M, Drumo A, Colace L. Outcome of chronic pilonidal disease treatment after ambulatory plain midline excision and primary suture. Am J Surg 2008; 196:28-33. [DOI: 10.1016/j.amjsurg.2007.05.051] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 05/10/2007] [Accepted: 05/10/2007] [Indexed: 10/21/2022]
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Bononi M, Tateo F. Erratum to: “Liquid chromatography/tandem mass spectrometry analysis of chloramphenicol in propolis extracts available on the Italian market” [J. Food Comp. Anal. 21 (2008) 84]. J Food Compost Anal 2008. [DOI: 10.1016/j.jfca.2007.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bononi M, Tateo F. Liquid chromatography/tandem mass spectrometry analysis of chloramphenicol in propolis extracts available on the Italian market. J Food Compost Anal 2008. [DOI: 10.1016/j.jfca.2007.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
A series of disposable aluminium foil containers designed for cooking and packaging foods and available on the Italian market were investigated. Using different analytical techniques (near infrared (NIR), High Resolution Gas Chromatography (HRGC), gas chromatography/mass spectrometry (GC/MS)), organic substances used as lubricants in the manufacturing of the containers were detected on the aluminium layer in contact with the food. These contaminants were not mineral hydrocarbon fractions used for the shaping of can lids and bodies, but had an organic structure identifiable as esters derived by synthesis between fatty acids C8 and C10 with glycerine, and between C16 and C18 with butyl alcohol. Mixtures of higher esters were also identified as contaminants. Twelve samples were analysed, and the total amount of contaminant substances was found to range from 900 to 1200 microg dm-2. It is recommended, for safety and compliance with European Community (EC) Regulation No. 1935/2004 (27 October 2004), that the use of aluminium foil containers be subject to appropriate regulation concerning substances adopted for technological purposes.
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Affiliation(s)
- F Tateo
- University of Milan, Di. Pro. Ve., Via Celoria, 2, Milan, I-20133, Italy.
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Brozzetti S, Polistena A, De Angelis M, Bononi M, Miccini M, Mazzoni G, Tocchi A. Treatment of giant intramuscular hemangioma: a multistep approach in three patients. Anticancer Res 2005; 25:2417-21. [PMID: 16080468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Giant intramuscular hemangioma (GIH) is a rare, progressively enlarging benign tumor, characterized by variable presentation and usually initially diagnosed in childhood. Large volume, rapid enlargement and particular radiologic imaging create suspicion of malignancy. Radiologic investigations and needle or small excisional biopsy are not always reliable for an accurate diagnosis; therefore, histology on a large surgical specimen is often requested. The timing and modality of treatment of these tumors is a matter of debate. PATIENTS AND METHODS Data on 3 patients with GIH of the upper trunk and neck are reported. Associated vascular anomalies were found in all patients. All 3 patients had surgery because of the effect of the growth on their function, the severe symptoms and suspicion of malignancy. RESULTS A one-step excision of an enormous tumor was carried out in one patient, who died from severe postoperative complications. A second patient was successfully treated by a multistep surgical and multidisciplinary approach. An uneventful removal of part of the tumor was performed on the third patient, who is currently in follow-up for completion of treatment. CONCLUSION Surgery remains the most effective mode of treatment for GIH and often results in permanent cure. The authors suggest performing the surgical removal of these tumors at first diagnosis, when their smaller size requires less demanding procedures, presents lower rates of morbidity and offers a better chance of complete excision.
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Affiliation(s)
- Stefania Brozzetti
- First Department of Surgery, University of Rome La Sapienza Medical School, Rome, Italy.
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De Cesare A, Fiori E, Burza A, Ciardi A, Bononi M, Izzo L, Volpino P, Cavallaro A, Cangemi V. Malignant fibrous histiocytoma of the breast. Report of two cases and review of the literature. Anticancer Res 2005; 25:505-8. [PMID: 15816619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Sarcomas of the breast are uncommon, accounting for less than 1% of all primary malignancies. Among these tumors, malignant fibrous histiocytoma (MFH) is very rare. Two cases of this neoplasm are reported, with histological findings and surgical treatment. The issue of radiation-induced lesions after surgery for carcinoma and the necessity for a correct preoperative diagnosis is examined. A review of the available literature evaluates the histopathological and biological features of MFH of the breast, for which there are no prospective trials, owing to the rarity of this kind of neoplasm. The extent of surgery or role of axillary lymph nodes dissection and multimodality therapy are discussed.
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Affiliation(s)
- Alessandro De Cesare
- Department of Surgery "Pietro Valdoni", University of Rome "La Sapienza", Italy.
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Bononi M, Tocchi A, Cangemi V, Vecchione A, Giovagnoli MR, De Cesare A, Fiori E, Volpino P, Brozzetti S, Meucci M, Scozzafava S, Cavallaro A. Lymph node dissection in papillary or follicular thyroid carcinoma. Anticancer Res 2004; 24:2439-42. [PMID: 15330196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND Prospective randomized studies aimed at evaluating the different therapeutic protocols for the treatment of papillary or follicular carcinoma are lacking at the moment. Although total thyroidectomy is widely accepted, indication to locoregional lymphadenectomy is strongly debated. MATERIALS AND METHODS Fifty-four patients with papillary or follicular thyroid carcinoma (45 papillary and 9 follicular) underwent functional evaluation of the gland before intervention, FNAB included Surgical management was carried out as follows: 41 total thyroidectomy, 6 lobectomy with further totalization in 5, 6 total thyroidectomy plus central compartment lymphadenectomy and 1 left laterocervical lymphadenectomy (papillary carcinoma, treated elsewhere through total thyroidectomy plus central and right laterocervical lymphadenectomy). All operated patients were submitted to whole body scintigraphy and treated thereafter by radiometabolic therapy and chronic hormone suppressive therapy. RESULTS Fifty-one patients are currently alive, 3 died from non-related causes; surgical complications included 1 permanent impairment of inferior laryngeal nerve function and 1 case of hypoparathyroidism. The follow-up was from 1 to 139 months. DISCUSSION The optimal treatment of lymph node metastases, especially for papillary carcinomas, has not yet been defined. Two trends are evident concerning lymphadenectomy: the first one suggests routine lymphadenectomy, the second supports lymphadenectomy by necessity. In follicular carcinoma lymphadenectomy is recommended only in the presence of clinical evidence of lymph node involvement. Occult differentiated carcinoma does not require any further treatment of lymph nodes. CONCLUSION Considering the high efficacy of radiometabolic treatment after total thyroidectomy combined with chronic TSH inhibition through L-tyrosine administration, lymphadenectomy is suggested only by necessity.
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Affiliation(s)
- Marco Bononi
- Department of General Surgery P. Valdoni, First School of Medicine, University of Rome La Sapienza, Italy.
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Fiori E, Cavallaro G, Paparelli C, Decesare A, Bononi M, Galati G, Tiziano G, Cavallaro A, Cangemi V. Significance of T stadium and grading as prognostic factors in transitional cell carcinoma of the ureter. Anticancer Res 2004; 24:1921-4. [PMID: 15274377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND Surgery is nowadays the standard treatment for carcinoma of the ureter, even if adjuvant therapies can modify the prognosis in selected patients. Because of the small number of patients in the literature series, the significance of prognostic factors that can be used in clinical practice is still controversial, as is the choice of the most suitable surgical and adjuvant treatment. PATIENTS AND METHODS We considered 27 consecutive patients (Ta-T2 N0 M0) who underwent radical surgery (nephroureterectomy with bladder cuff excision and lymphoadenectomy) for transitional cell carcinoma of the ureter, from 1982 through 1992. Seven patients (25.9%) had Ta tumors, 7 patients (25.9%) had T1 tumors and 13 patients (48.2%) had T2 tumors. In 4 cases (14.8%) the tumor was well-differentiated (G1), in 14 cases (51.8%) it was mildly-differentiated (G2), and in 9 cases (33.4%) it was poorly-differentiated. RESULTS Thirteen of the 14 patients affected by Ta-T1 tumors were alive 10 years after surgery (one patient lost at follow-up); in the T2 tumor group the 5-year survival rate was 84.6% and 10-year survival rate was 69.2%. According to grading, the 10-year survival rate was 100% for G1 tumors, the 3, 5 and 10-year survival rates were, respectively, 100%, 92.8% G3 tumors. CONCLUSION Data from our study show the significance of the T stage and grading as prognostic factors.
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Affiliation(s)
- Enrico Fiori
- Department of Surgery P. Valdoni, Policlinico Umberto I, University La Sapienza, Rome, Italy.
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de Capoa A, Grappelli C, Volpino P, Bononi M, Musolino A, Ciardi A, Cavallaro A, Cangemi V. Nuclear methylation levels in normal and cancerous thyroid cells. Anticancer Res 2004; 24:1495-500. [PMID: 15274315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND Most cancers show abnormal DNA methylation and a positive correlation between hypomethylation and tumour progression. PATIENTS AND METHODS In our laboratory the extent of DNA methylation in individual nuclei in normal, cancer and non-cancer thyroid tissue samples was quantified according to a previously described method of computer-assisted semi-quantitative analysis. Cancer and non-cancer samples were obtained from nine patients with different thyroid pathologies (one multinodular goitre and eight carcinomas). Quantitative analysis was performed in two sets of samples, i.e. individual nuclei from touch preparations and from tissue sections. RESULTS In all cancer specimens a statistically significant decrease of heterochromatin methylation was consistently observed. In both sets of samples a direct correlation was consistently observed between the extent of chromatin demethylation and the degree of malignancy. CONCLUSION Our preliminary results suggest that our method of cell-by-cell detection of intranuclear methylation abnormalities may be a useful tool in early identification of thyroid cancer lesions.
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Affiliation(s)
- Adriana de Capoa
- Department of Genetics and Molecular Biology, University of Rome La Sapienza, Rome, Italy
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Abstract
The Commission Decision of EC dated 20 June 2003, on emergency measures concerning hot chilli and hot chilli products coming into any EC member state, required that the consignments of such products should be accompanied by an analytical report showing that they are free of artificial dye Sudan I. The opportunity to set a confirmatory method is evident, and the paper proposes a HPLC/APCI-MS method useful for identification and quantitation of Sudan I, also at very low levels in hot chilli, other spices, and oven-baked foods. Validation data are reported.
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Affiliation(s)
- F Tateo
- Dipartimento di Produzione Vegetale, Università degli Studi di Milano, Via Celoria, 2 - 20133 Milano, Italy.
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Fiori E, Lamazza A, De Cesare A, Bononi M, Volpino P, Schillaci A, Cavallaro A, Cangemi V. Palliative management of malignant rectosigmoidal obstruction. Colostomy vs. endoscopic stenting. A randomized prospective trial. Anticancer Res 2004; 24:265-8. [PMID: 15015606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Colostomy was the palliative treatment of choice in patients with malignant unresectable rectosigmoid obstruction. Palliative endoscopic treatment of malignant rectosigmoid obstruction by endoluminal self-expanding metallic stents is nowadays a well-established procedure. PATIENTS AND METHODS Twenty-two patients, referred for treatment with diagnosis of malignant obstruction of the rectosigmoid region presenting an advanced unresectable stage, were enrolled. Patients were randomly assigned into two treatment groups (endoscopic stenting vs colostomy) according to random-number tables. The length of procedure, morbidity and mortality rate, canalization of the gastrointestinal tract, restoration of oral intake and hospital stay were assessed. RESULTS Endoscopic group: The median length of procedure was 36 minutes. No death was observed. None of the patients reported complications. All patients resumed bowel function within 24 hours. The restoration of oral intake was achieved one day after stent placement. The median hospital stay was 2.6 days. Colostomy group: The median length of the operation was 75.4 minutes. No mortality was reported. In 1 patient (9.1%) stoma prolapse was observed 3 days after the operation. Canalization of the gastrointestinal tract was restored when colostomy was opened (on postoperative day 3). All patients were able to resume oral feedings on postoperative day 3. The median hospital stay was 8.1 days. CONCLUSION There were no statistically significant differences between the 2 groups concerning morbidity and mortality. Endoscopic stenting was significantly more effective concerning operative time, restoration of bowel function and oral intake and median hospitalization. Our results would suggest that endoscopically placed metal stents offer an effective alternative to surgical palliation in patients suffering from unresectable malignant rectosigmoid obstruction.
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Affiliation(s)
- Enrico Fiori
- Department of Surgery Pietro Valdoni, University of Rome La Sapienza, Italy.
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