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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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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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Nilsson E, Olsson S, Regner S, Polistena A, Ali A, Dedey F, Avenia N, Wu L, Banka Johnson L. Surgical intervention for intestinal typhoid perforation. G Chir 2019; 40:105-111. [PMID: 31131808] [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: 06/09/2023]
Abstract
AIM Typhoid perforation is the most fatal complication of typhoid fever in developing countries and is most often caused by the bacteria Salmonella Typhi. There are conflicting views as to which type of surgical intervention gives the best outcome. The aim of this study was to determine the mortality associated with the different types of surgical interventions employed in patients with typhoid perforation. METHOD This was a retrospective review of the medical records of adult and paediatric surgical patients treated in the general and paediatric surgical units of the Korle Bu Teaching Hospital. Information was obtained from medical records at the Korle Bu Teaching Hospital in Accra, Ghana, between January 2009 and April 2012. The data was analysed using IBM SPSS Statistics version 20 and 22. RESULTS 133 patients (median age of 21 years, 72.2% males) with typhoid perforation were included in the study. The typhoid perforation specific mortality rate was 12.8%. Males had a significantly lower mortality rate (7.3%) compared to females (27%). Simple bowel closure (85.7% of total) was the most common surgical intervention performed and patients operated upon with this method had a significantly lower mortality rate (9.6%) compared to patients with bowel resection (31.6%). CONCLUSIONS In this study, patients treated with intestinal resection were more likely to die from typhoid perforation and female gender was a risk factor for death. Simple bowel closure was the predominant surgical procedure.
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Gambardella C, Allaria A, Siciliano G, Mauriello C, Patrone R, Avenia N, Polistena A, Sanguinetti A, Napolitano S, Conzo G. Recurrent esophageal stricture from previous caustic ingestion treated with 40-year self-dilation: case report and review of literature. BMC Gastroenterol 2018; 18:68. [PMID: 29788901 PMCID: PMC5964928 DOI: 10.1186/s12876-018-0801-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 05/15/2018] [Indexed: 12/14/2022] Open
Abstract
Background Corrosive esophageal strictures are common. The severity of the strictures depends on type, quantity, duration of contact and concentration of the caustic substance ingested. Endoscopic balloon dilation and endoscopic bougienage are a cornerstone in the management of the benign esophageal strictures and are the most widely used treatments, but are expensive and invasive procedures. Case Presentation We report the case of an 82-year-old patient with a corrosive esophageal stricture treated for over 40 years by means of home self-bougienage. The procedure has been carried out for the longest lapse of time described in literature, with an excellent control of symptoms. In the case reported, after being carried out for more than 40 years, self-dilation allowed good quality of life and symptoms management, ensuring an excellent nutritional status. Conclusions Following an adequate patient training, self-dilatation can be a safe and effective option of treatment, avoiding frequent expensive hospital admissions for endoscopic esophageal dilatation.
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Affiliation(s)
- C Gambardella
- Department of Cardiothoracic Sciences - University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy.
| | - A Allaria
- Department of Cardiothoracic Sciences - University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - G Siciliano
- Department of Cardiothoracic Sciences - University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - C Mauriello
- Department of Cardiothoracic Sciences - University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - R Patrone
- Department of Cardiothoracic Sciences - University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - N Avenia
- Endocrine Surgery Unit, University of Perugia, Perugia, Italy
| | - A Polistena
- Endocrine Surgery Unit, University of Perugia, Perugia, Italy
| | - A Sanguinetti
- Endocrine Surgery Unit, University of Perugia, Perugia, Italy
| | - S Napolitano
- Italian Air Force Medical Corps, Ministry of Defence, Rome, Italy
| | - G Conzo
- Department of Cardiothoracic Sciences - University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
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Gambardella C, Polistena A, Sanguinetti A, Patrone R, Napolitano S, Esposito D, Testa D, Marotta V, Faggiano A, Calò PG, Avenia N, Conzo G. Unintentional recurrent laryngeal nerve injuries following thyroidectomy: Is it the surgeon who pays the bill? Int J Surg 2018; 41 Suppl 1:S55-S59. [PMID: 28506414 DOI: 10.1016/j.ijsu.2017.01.112] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 12/19/2016] [Revised: 01/27/2017] [Accepted: 01/30/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Thyroidectomy is one of the most common intervention in general surgery and, after the turn of the century, its rate has sharply increased, along with a worldwide increased incidence of differentiated thyroid cancers. Therefore, injuries of the recurrent laryngeal nerve have become one of the most frequent cause of surgical malpractice claims, mostly following surgery for benign pathology. MAIN BODY Even if the incidence of definitive paralysis is generally lower than 3%, during the last 20 years in Italy, the number of claims for damages has sharply raised. As a consequence, a lot of defensive medicine has been caused by this issue, and a witch-hunt has been accordingly triggered, so determining mostly a painful and lasting frustration for the surgeons, who sometimes are compelled to pay a lot of money for increasing insurance premiums and lawyers fees. Recurrent laryngeal nerve injury should be considered as a potentially catastrophic predictable but not preventable event, rather than the result of a surgical mistake. CONCLUSION Purposes of the Authors are analyzing incidence, conditions of risk, and mechanisms of recurrent laryngeal nerve injuries, underlining notes of surgical technique and defining medical practice recommendations useful to reduce the risk of malpractice lawsuits and judgments against surgeons.
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Affiliation(s)
- C Gambardella
- Division of General and Oncologic Surgery, Via Pansini 5, 80131, Napoli, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - A Polistena
- Endocrine Surgery Unit, University of Perugia, Perugia, Italy
| | - A Sanguinetti
- Endocrine Surgery Unit, University of Perugia, Perugia, Italy
| | - R Patrone
- Division of General and Oncologic Surgery, Via Pansini 5, 80131, Napoli, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - S Napolitano
- Medical Officer, Italian Air Force Medical Corps, Ministry of Defence, Rome, Italy
| | - D Esposito
- Division of General and Oncologic Surgery, Via Pansini 5, 80131, Napoli, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - D Testa
- Otolaryngology - Head and Neck Surgery Unit, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - V Marotta
- Department of Molecular and Clinical Endocrinology and Oncology, Federico II University, Naples, Italy
| | - A Faggiano
- Department of Molecular and Clinical Endocrinology and Oncology, Federico II University, Naples, Italy
| | - P G Calò
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042 Monserrato, CA, Italy
| | - N Avenia
- Endocrine Surgery Unit, University of Perugia, Perugia, Italy
| | - G Conzo
- Division of General and Oncologic Surgery, Via Pansini 5, 80131, Napoli, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy.
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Sanguinetti A, Polistena A, Luchini R, Monacelli M, Avenia S, Galasse S, Cirocchi R, Avenia N. Correct information to patients undergoing breast-conserving surgery: the medicolegal significance. G Chir 2017; 38:61-65. [PMID: 28691668 DOI: 10.11138/gchir/2017.38.2.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many of the women newly diagnosed with breast cancer not have access to all the information they need to make the surgical and treatment choices that are most appropriate for them. Research clearly shows that lumpectomy and other breast-conserving surgeries are just as safe as mastectomy for most women with early stage disease, and yet approximately half will undergo the more disfiguring procedures, but many healthy women who have strong family histories of breast cancer consider prophylactic mastectomies, and their decisions are also based on very limited information, because there are few studies showing the effectiveness of that procedure. This paper delineates how to avoid limited information and biased recommendations is important for a conscious and informed choice by the patients.
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Bugiantella W, Rondelli F, Mariani L, Polistena A, Sanguinetti A, Avenia N, Mariani E. Cost-effectiveness analysis of the temporary percutaneous ileostomy for faecal diversion after colorectal resection in elderly. Aging Clin Exp Res 2017; 29:47-53. [PMID: 27832466 DOI: 10.1007/s40520-016-0658-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/12/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Conventional loop ileostomy (CLI) is a suitable procedure for transitory faecal diversion after colorectal anastomosis, but it causes relevant morbidities (dehydration, discomfort, peristomal infections) and requires a second operation to be closed. We already described an alternative technique of temporary percutaneous ileostomy (TPI), which can be removed without surgery. AIMS We analyse the outcomes and the costs of the TPI in protecting low colorectal anastomosis in elderly, compared to the CLI. METHODS Data of patients underwent elective anterior rectal resection for rectal cancer with extra-peritoneal colorectal anastomosis protected by ileostomy from January 2011 to December 2015 were reviewed. Sixty-one out of 132 patients were older than 70; 35 underwent faecal diversion by TPI and 26 by CLI. RESULTS The two groups resulted homogenous about age, sex, operative time, short-term post-operative complications. None of the patients reported anastomotic leakage. The hospital stay and the cost for the first surgical procedure did not show statistically significant differences between TPI and CLI. When comparing the overall hospital stay and costs the differences are statistically significant: the TPI showed a shorter hospital stay (12.4 vs 19.3 days, -35.7%) and a lower cost of hospitalization (7954.0 vs 14,372.1€, -44.7%), compared to CLI. DISCUSSION The limited duration of the faecal diversion and the uselessness of a second surgical procedure to remove the TPI are the most important advantages of TPI, especially in elderly. CONCLUSION The TPI not only improved the post-operative outcome of the patients, but also allowed a remarkable saving for the National Health System.
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Rosato L, De Crea C, Bellantone R, Brandi ML, De Toma G, Filetti S, Miccoli P, Pacini F, Pelizzo MR, Pontecorvi A, Avenia N, De Pasquale L, Chiofalo MG, Gurrado A, Innaro N, La Valle G, Lombardi CP, Marini PL, Mondini G, Mullineris B, Pezzullo L, Raffaelli M, Testini M, De Palma M. Diagnostic, therapeutic and health-care management protocol in thyroid surgery: a position statement of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB). J Endocrinol Invest 2016; 39:939-53. [PMID: 27059212 DOI: 10.1007/s40618-016-0455-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 10/09/2015] [Accepted: 03/08/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE The diagnostic, therapeutic and health-care management protocol (Protocollo Gestionale Diagnostico-Terapeutico-Assistenziale, PDTA) by the Association of the Italian Endocrine Surgery Units (U.E.C. CLUB) aims to help treat the patient in a topical, rational way that can be shared by health-care professionals. METHODS This fourth consensus conference involved: a selected group of experts in the preliminary phase; all members, via e-mail, in the elaboration phase; all the participants of the XI National Congress of the U.E.C. CLUB held in Naples in the final phase. The following were examined: diagnostic pathway and clinical evaluation; mode of admission and waiting time; therapeutic pathway (patient preparation for surgery, surgical treatment, postoperative management, management of major complications); hospital discharge and patient information; outpatient care and follow-up. RESULTS A clear and concise style was adopted to illustrate the reasons and scientific rationales behind behaviors and to provide health-care professionals with a guide as complete as possible on who, when, how and why to act. The protocol is meant to help the surgeon to treat the patient in a topical, rational way that can be shared by health-care professionals, but without influencing in any way the physician-patient relationship, which is based on trust and clinical judgment in each individual case. CONCLUSIONS The PDTA in thyroid surgery approved by the fourth consensus conference (June 2015) is the official PDTA of U.E.C. CLUB.
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Affiliation(s)
- L Rosato
- Department of Surgery, ASL TO4, Ivrea Hospital, School of Medicine, Turin University, Turin, Italy
| | - C De Crea
- Endocrine and Metabolic Surgery, Policlinico Agostino Gemelli, Catholic University, Rome, Italy.
| | - R Bellantone
- Endocrine and Metabolic Surgery, Policlinico Agostino Gemelli, Catholic University, Rome, Italy
| | - M L Brandi
- Clinical Unit on Metabolic Bone Disorders, University Hospital of Florence, Florence, Italy
| | - G De Toma
- Endocrine Surgery, Department of Surgery "P. Valdoni", "La Sapienza" University, Rome, Italy
| | - S Filetti
- Department of Clinical Sciences, "La Sapienza" University, Rome, Italy
| | - P Miccoli
- Endocrine Surgery, Department of Surgery, Pisa University, Rome, Italy
| | - F Pacini
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - M R Pelizzo
- Endocrine Surgery, Department of Surgery, Padua University, Padua, Italy
| | - A Pontecorvi
- Department of Endocrinology, Catholic University, Rome, Italy
| | - N Avenia
- Department of Surgery, "S. Maria" Terni Hospital, Perugia University, Perugia, Italy
| | - L De Pasquale
- Endocrine and Breast Surgical Unit, Department of Surgery, "S. Paolo" Hospital, Milan, Italy
| | - M G Chiofalo
- Thyroid Surgery, Department of Surgery, I.N.T. "Pascale" of Naples, Naples, Italy
| | - A Gurrado
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Bari University, Bari, Italy
| | - N Innaro
- Endocrine Surgery, Department of Surgery, "Mater Domini" Hospital, Catanzaro, Italy
| | - G La Valle
- Health Management, Piedmont Region, ASL TO4, School of Medicine, Turin University, Turin, Italy
| | - C P Lombardi
- Endocrine and Metabolic Surgery, Policlinico Agostino Gemelli, Catholic University, Rome, Italy
| | - P L Marini
- Endocrine Surgery, Department of Surgery, "S. Camillo-Forlanini" Hospital, Rome, Italy
| | - G Mondini
- General Surgery, Endocrine and Breast Surgical Unit, Department of Surgery, ASL TO4, Ivrea Hospital, Turin, Italy
| | - B Mullineris
- General Surgery and Endocrine Surgical Unit, Department of Surgery, Sant'Agostino-Estense NOCSAE, Modena, Italy
| | - L Pezzullo
- Thyroid Surgery, Department of Surgery, I.N.T. "Pascale" of Naples, Naples, Italy
| | - M Raffaelli
- Endocrine and Metabolic Surgery, Policlinico Agostino Gemelli, Catholic University, Rome, Italy
| | - M Testini
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Bari University, Bari, Italy
| | - M De Palma
- Department of Surgery, A.O.R.N. "Cardarelli" Hospital, Naples, Italy
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Sanguinetti A, Polistena A, Lucchini R, Monacelli M, Galasse S, Avenia S, Bugiantella W, Triola R, Cirocchi R, Rondelli F, Avenia N. Myoblastoma of the breast: Our experience and review of literature. Int J Surg Case Rep 2016; 20S:5-7. [PMID: 26971123 PMCID: PMC4883056 DOI: 10.1016/j.ijscr.2016.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Breast myoblastoma or granular cell tumor involving the breast parenchyma has been described in detail for the first time since Abrikossoff in 1931. The location of this injury to the breast is very rare, accounting for between 5% and 15% of all cases of cancer of the granular cells. We present our experience regarding the identification of two cases because of the relative rarity of this tumor. It is often confused with breast cancer on clinical and radiological, and its diagnosis can then be difficult for physicians, radiologists and pathologists. PRESENTATION OF CASES We report the cases of two young women who came to our attention because of the presence of mass shoveled breast, mobile and accompanied by pain cycle independent. In both cases, mammography and ultrasound revealed the presence of heterogeneous mass and irregular, but in one of two such mass located at the Union of external quadrants of the left breast and was in contact with his serratus anterior and suspicion for malignancy. In both cases the 'histology combined with immunohistochemical study proved to be a granular cell tumor. CONCLUSION Although a granular cell tumor of the breast is a rare tumor breast, should be considered in the differential diagnosis of benign and malignant lesions. Surgeons and pathologists should keep in mind when considering a granular cell tumor cells with abundant granular cytoplasm containing materials to avoid misdiagnosing breast cancer, which could lead to unnecessary surgery.
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Affiliation(s)
| | | | - R Lucchini
- S. Maria University Hospital, Terni, Italy.
| | | | | | - S Avenia
- Medical School University of Perugia, Italy.
| | | | - R Triola
- S. Maria University Hospital, Terni, Italy.
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Polistena A, Monacelli M, Lucchini R, Triola R, Conti C, Avenia S, Sole Di Patrizi M, Barillaro I, Boccolini A, Sanguinetti A, Avenia N. Thyroid anaplastic carcinoma: the impact of multimodality treatment on survival. The experience of a referral center for endocrine surgery. MINERVA CHIR 2014; 69:261-269. [PMID: 25052058] [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: 06/03/2023]
Abstract
AIM Anaplastic thyroid carcinoma (ATC) is characterized by local invasiveness, risk of recurrence and very poor prognosis. METHODS We retrospectively reviewed 79 consecutive patients treated between 1996 and 2012. We analysed the multimodality treatment of ATC considering the impact of surgery and radiotherapy on survival. RESULTS Patients were divided in groups A and B (tumor less and larger than 5 cm). Surgery was carried out in 44 patients, radiotherapy in 48 patients. Tracheostomy and endoprosthesis were used respectively in 48.1% and in 25.3% of patients. The mean survival was 5.35 (± 3.2) months with no significant difference in group A vs. group B. Considering patients undergone surgery, significant impact on survival was observed comparing A vs. B (P=0.013). Combination of surgery and radiotherapy significantly improves outcome comparing A vs. B (P=0.017). Improvement in survival compared to no treatment at all was observed in both groups respectively for surgery (P=0.001 and P=0.0001) and radiotherapy (P=0.047 and P=0.0001). CONCLUSION Although the severity of prognosis of ATC, multimodality treatment still significantly improves local control of the disease achieving acceptable survival in selected patients and adequate palliation of symptoms for the others. Surgery is still a fundamental treatment.
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Affiliation(s)
- A Polistena
- University of Perugia, Medical School Endocrine Surgery Unit S. Maria University Hospital Terni, Terni, Italy - apolis74yahoo.it
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Rondelli F, Bugiantella W, Villa F, Sanguinetti A, Boni M, Mariani E, Avenia N. Robot-assisted or conventional laparoscoic rectopexy for rectal prolapse? Systematic review and meta-analysis. Int J Surg 2014; 12 Suppl 2:S153-S159. [PMID: 25157988 DOI: 10.1016/j.ijsu.2014.08.359] [Citation(s) in RCA: 22] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/05/2014] [Accepted: 06/15/2014] [Indexed: 02/08/2023]
Abstract
AIM The use of robotic technology has proved to be safe and effective, arising as a helpful alternative to standard laparoscopy in a variety of surgical procedures. However the role of robotic assistance in laparoscopic rectopexy is still not demonstrated. METHODS A systematic review of the literature was carried out performing an unrestricted search in MEDLINE, EMBASE, the Cochrane Library, and Google Scholar up to 30th June 2014. Reference lists of retrieved articles and review articles were manually searched for other relevant studies. We meta-analyzed the data currently available regarding the incidence of recurrence rate of rectal prolapse, conversion rate, operative time, intra-operative blood loss, post-operative complications, re-operation rate and hospital stay in robot-assisted rectopexy (RC) compared to conventional laparoscopic rectopexy (LR). RESULTS Six studies were included resulting in 340 patients. The meta-analysis showed that the RR does not influence the recurrence rate of rectal prolapse, the conversion rate and the re-operation rate, whereas it decreases the intra-operative blood loss, the post-operative complications and the hospital stay. Yet, the RR resulted to be longer than the LR. Post-operative ano-rectal and the sexual functionality and procedural costs could not meta-analyzed because the data from included studies about these issues were heterogeneous and incomplete. CONCLUSION The meta-analysis showed that the RR may ensure limited improvements in post-operative outcomes if compared to the LR. However, RCTs are needed to compare RR to LR in terms of short-term and long-term outcomes, specially investigating the functional outcomes that may confirm the cost-effectiveness of the robotic assisted rectopexy.
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Affiliation(s)
- F Rondelli
- "San Giovanni Battista" Hospital, General Surgery, USL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy; University of Perugia, Department of Surgical and Biomedical Sciences, Via G. Dottori, 06100, Perugia, Italy.
| | - W Bugiantella
- "San Giovanni Battista" Hospital, General Surgery, USL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy; University of Perugia, PhD School in Biotechnologies, Italy.
| | - F Villa
- "Bellinzona e Valli" Regional Hospital, 6500, Bellinzona, Switzerland.
| | - A Sanguinetti
- General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100, Terni, Italy.
| | - M Boni
- "San Giovanni Battista" Hospital, General Surgery, USL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy.
| | - E Mariani
- "San Giovanni Battista" Hospital, General Surgery, USL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy.
| | - N Avenia
- University of Perugia, Department of Surgical and Biomedical Sciences, Via G. Dottori, 06100, Perugia, Italy.
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12
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Bugiantella W, Rondelli F, Mariani L, Boni M, Ermili F, Avenia N, Mariani E. Temporary percutaneous ileostomy for faecal diversion after intestinal resection for acute abdomen in elderly: how to avoid the conventional loop ileostomy. Int J Surg 2014; 12 Suppl 2:S144-S147. [PMID: 25157995 DOI: 10.1016/j.ijsu.2014.08.361] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 05/15/2014] [Revised: 08/05/2014] [Accepted: 06/15/2014] [Indexed: 01/15/2023]
Abstract
Conventional loop ileostomy (CLI) is a suitable procedure for transitory faecal diversion after colocolic or colorectal anastomosis, but it causes relevant morbidities (dehydration, discomfort, peristomal infections) and requires a second operation to be closed. We already described an alternative technique of temporary percutaneous ileostomy (TPI), which can be removed without surgery, as faecal diversion in low colorectal anastomosis. Now we report our experience with the TPI in protecting colocolic and colorectal anastomosis in urgency in elderly. From January 2012 to June 2014, 45 patients underwent urgent surgical procedures for acute abdomen with colonic and/or rectal resections and colocolic or colorectal anastomosis with faecal diversion by TPI. Nineteen out of 45 patients were older than 70. Four low colorectal anastomoses, 10 intra-peritoneal colorectal anastomosis and 4 colocolic anastomosis were performed. Neither intra-operative complications nor post-operative deaths were observed. None of the 19 patients treated had evidence of clinical or radiological leakage of the anastomosis. Post-operative complications occurred in 7 patients and nobody required re-intervention. No intestinal obstruction was reported in the early (30 days) post-operative period. The TPI seems to be a valid alternative to standard ileostomy, ensuring an optimal faecal diversion both in elective surgery and in urgency. The TPI also ensures less patient discomfort and it can be easily removed without surgery, unlike the CLI. The limited duration of the faecal diversion and the uselessness of a second surgical procedure to remove the TPI are the most important advantages of this new technique, especially in elderly.
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Affiliation(s)
- W Bugiantella
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034 Foligno, Perugia, Italy; University of Perugia, PhD School in Biotechnologies, Italy.
| | - F Rondelli
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034 Foligno, Perugia, Italy; University of Perugia, Department of Surgical and Biomedical Sciences, Via G. Dottori, 06100 Perugia, Italy.
| | - L Mariani
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034 Foligno, Perugia, Italy.
| | - M Boni
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034 Foligno, Perugia, Italy.
| | - F Ermili
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034 Foligno, Perugia, Italy.
| | - N Avenia
- General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100 Terni, Italy.
| | - E Mariani
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034 Foligno, Perugia, Italy.
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13
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Polistena A, Cavallaro G, D'Ermo G, Avenia N, De Toma G. Fournier's gangrene: early diagnosis. How to diagnose, how to manage it. MINERVA CHIR 2014; 69:113-119. [PMID: 24847898] [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: 06/03/2023]
Abstract
Fournier's gangrene (FG) is a rare surgical emergency and a life-threatening condition with a rapidly progressive gangrene defined as a necrotizing fasciitis of the perineal or genital areas leading to septic shock and death if untreated. Risk factors are diabetes, immune compromise, obesity, drug use, or genital trauma. Patients are treated by incision and drainage. Aim of the study is to analyze cases of early manifestations of FG and consider aspect of diagnosis based on clinical presentation and the importance of precocious surgical treatment. We had experience of early lesions of FG in 22 cases. We report three cases in which the initial clinical presentation was typical of precocious signs referable to FG. Foley catheter was used in all cases, no diverting colostomy was performed. The patients were treated by artificial i.v. feeding. No extensive demolition of perineal tissues were operated, neither plastic surgery was required. Antibiotic therapy combined to surgical treatment with incision and drainage were performed in all cases. Admission in the intensive care unit was effective when indicated. No mortality was registered in all 22 cases of the series. FG is rare, severe condition requiring a multidisciplinary approach. An early diagnosis and an aggressive surgical treatment, improved by antibiotic therapy, hyperbaric oxygen therapy and proper wound care are the key points of FG management. In selected patients, colostomy or cystostomy must be considered when simple catheterization is not sufficient. Severe cases must be therefore referred to high-volume and specialized centres with specialist professional and intensive care facilities.
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Affiliation(s)
- A Polistena
- Department of Surgery "Pietro Valdoni" La Sapienza University, Rome, Italy -
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14
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Rosato L, Raffaelli M, Bellantone R, Pontecorvi A, Avenia N, Boniardi M, Brandi ML, Cetani F, Chiofalo MG, Conzo G, De Palma M, Gasparri G, Giordano A, Innaro N, Leopaldi E, Mariani G, Marcocci C, Marini P, Miccoli P, Nasi P, Pacini F, Paragliola R, Pelizzo MR, Testini M, De Toma G. Diagnostic, therapeutic and healthcare management protocols in parathyroid surgery: II Consensus Conference of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB). J Endocrinol Invest 2014; 37:149-65. [PMID: 24497214 DOI: 10.1007/s40618-013-0022-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 10/06/2013] [Accepted: 11/16/2013] [Indexed: 02/08/2023]
Abstract
AIM To update the Diagnostic-Therapeutic-Healthcare Protocol (Protocollo Diagnostico-Terapeutico-Assistenziale, PDTA) created by the U.E.C. CLUB (Association of the Italian Endocrine Surgery Units) during the I Consensus Conference in 2008. METHODS In the preliminary phase, the II Consensus involved a selected group of experts; the elaboration phase was conducted via e-mail among all members; the conclusion phase took place during the X National Congress of the U.E.C. CLUB. The following were examined: diagnostic pathway and clinical evaluation; mode of admission and waiting time; therapeutic pathway (patient preparation for surgery, surgical treatment, postoperative management, management of major complications); hospital discharge and patient information; outpatient care and follow-up. CONCLUSIONS The PDTA for parathyroid surgery approved by the II Consensus Conference (June 2013) is the official PDTA of the U.E.C. CLUB.
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Affiliation(s)
- L Rosato
- Department of Surgery, ASL TO/4 Ivrea Hospital (TO), Piazza della Credenza, 2, 10015, IVREA, TO, Italy,
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15
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Rondelli F, Bugiantella W, Vedovati MC, Balzarotti R, Avenia N, Mariani E, Agnelli G, Becattini C. To drain or not to drain extraperitoneal colorectal anastomosis? A systematic review and meta-analysis. Colorectal Dis 2014; 16:O35-42. [PMID: 24245821 DOI: 10.1111/codi.12491] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 09/30/2013] [Indexed: 12/13/2022]
Abstract
AIM Anastomotic leakage is the one of the most serious complications in rectal cancer surgery and is associated with high mortality, morbidity and an increased incidence of local recurrence. Although many studies have compared drained and undrained colorectal anastomoses, to date the role of pelvic drainage in extraperitoneal colorectal anastomosis remains undefined. METHOD We carried out a systematic review of the literature, performing an unrestricted search in MEDLINE and Embase up to 30 October 2012. Reference lists of retrieved articles and review articles were manually searched for other relevant studies. We performed a meta-analysis of the data currently available on the incidence of extraperitoneal anastomotic leakage, according to the presence or absence of pelvic drainage. RESULTS Overall, eight studies - three randomized clinical trials (RCTs) and five non-RCTs, comprising a total of 2277 patients - were included in the meta-analysis. Pelvic drainage was demonstrated to reduce both the leak rate and the rate of reintervention in patients who underwent anterior rectal resection with extraperitoneal colorectal anastomosis (OR = 0.51, 95% CI: 0.36-0.73; and OR = 0.29, 95% CI: 0.18-0.46, respectively) compared with patients without drainage. Overall mortality and infection rates were also evaluated, but a nonsignificant correlation was found with the presence of drainage. CONCLUSION The meta-analysis shows that the presence of a pelvic drain reduces the incidence of extraperitoneal colorectal anastomotic leakage and the rate of reintervention after anterior rectal resection.
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Affiliation(s)
- F Rondelli
- "San Giovanni Battista" Hospital, Foligno, Perugia, Italy; Department of Surgery, School of Medicine, University of Perugia, Perugia, Italy
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16
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Lucchini R, Monacelli M, Santoprete S, Triola R, Conti C, Pecoriello R, Favoriti P, Di Patrizi MS, Barillaro I, Boccolini A, Avenia S, D'Ajello M, Sanguinetti A, Avenia N. Differentiated thyroid tumors: surgical indications. G Chir 2013; 34:153-7. [PMID: 23837952 DOI: 10.11138/gchir/2013.34.5.153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Thyroid gland tumors represent 1% of malignant tumors. In Italy their incidence is in constant growth. The aggressiveness depends on the histological type. The relative non-aggressive grade of different forms of tumors is the basis for discussing the treatment of choice: total thyroidectomy vs lobectomy with or without lymphadenectomy of the sixth level in the absence of metastasis. Authors report about their experience, and they advocate, given the high percentage of multicentric forms, total thyroidectomy as treatment of choice.
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17
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Lucchini R, Sanguinetti A, Monacelli M, Triola R, Avenia S, Conti C, Santoprete S, Avenia N. Health technology assessment and thyroid surgery. G Chir 2013; 34:198-201. [PMID: 24091174 DOI: 10.11138/gchir/2013.34.7.198] [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: 11/17/2022]
Abstract
The growth of technological innovation, the request for assistance, the rising patient's expectations and the interest of the industry have led to a rise in the cost of health care systems. In this context the role of the National Health System is not to delay the development or adoption of new technologies, but rather to drive the development selecting priorities and promoting its use. Health Technology Assessment (HTA) is a multidisciplinary and multidimensional approach for analyzing the medical-clinical, social, organizational, economic, ethical and legal implications of a technology (devices, drugs, procedures) through the assessment of multiple parameters such as effectiveness, safety, costs of the social and organizational impact. A health technology assessment is a comprehensive, systematic evaluation of the prerequisites for estimating the consequences of using health technology. Main characteristic of HTA is that the problem is tackled using an approach focused on four main elements: - technology; - patient; - organization; - economy. The authors have applied the HTA method for the analysis of the ultrasonic focus dissector on thyroid surgery. They compared the cost of the surgical procedure using the ultrasonic dissector and without it in a case study of 440 patients who underwent thyroidectomy.
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18
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Conzo G, Perna A, Avenia N, De Santo RM, Della Pietra C, Palazzo A, Sinisi AA, Stanzione F, Santini L. Evaluation of the 'putative' role of intraoperative intact parathyroid hormone assay during parathyroidectomy for secondary hyperparathyroidism. A retrospective study on 35 consecutive patients: intraoperative iPTH assay during parathyroidectomy. Endocrine 2012; 42:606-11. [PMID: 22418689 DOI: 10.1007/s12020-012-9648-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [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: 01/05/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
Abstract
In the surgical treatment of secondary hyperparathyroidism (2HPT) of chronic kidney disease (CKD), a parathyroidectomy (PTx) of 4 glands can only be presumed as 'total', and indications for autoimplantation are complex. Intraoperative rapid parathyroid hormone assay could be useful to predict a radical resection. We evaluated iPTH levels 20 min and 24 h after a 4-gland PTx in 35 patients to determine the predictive value of intraoperative iPTH assay. We analysed retrospectively 35 patients affected by 2HPT of CKD, 13 undergoing total parathyroidectomy (TP) and 22 TP + autoimplantation (TPai), after removing 4 glands in 33 cases and 5 glands in 2. Intact PTH assays were acquired after 40 min before induction of anaesthesia, after removing both ipselateral glands, at 20 min after surgery and on postoperative day 1. 20 min after 4-gland PTx, a decrease of iPTH levels >80 % of the preoperative value was observed in 27 of 35 cases (77.1 %) and <80 % in 8 of 35 cases (22.8 %). In 6 of these 8 patients, iPTH levels were within the normal range 24 h after surgery. Although the intraoperative iPTH assays are of interest in the treatment of 2HPT, the predictive value of this method is not entirely satisfactory. In fact, a 4-gland PTx ensures euparathyroidism in most cases, even when intraoperative iPTH assays are not trustworthy; however, intraoperative iPTH assay, although not a perfect 'tool', is a proved aid for the surgeon in making his decision.
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Affiliation(s)
- G Conzo
- Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery and Endocrine Surgery, Second University of Naples-Italy, Via Pansini 5, Ed. 17, 80131, Naples, Italy.
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19
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Rondelli F, Trastulli S, Cirocchi R, Avenia N, Mariani E, Sciannameo F, Noya G. Rectal washout and local recurrence in rectal resection for cancer: a meta-analysis. Colorectal Dis 2012; 14:1313-21. [PMID: 22150936 DOI: 10.1111/j.1463-1318.2011.02903.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM The effectiveness of rectal washout was compared with no washout for the prevention of local recurrence after anterior rectal resection for rectal cancer. METHOD The following electronic databases were searched: PubMed, OVID Medline, Cochrane Database of Systematic Reviews, EBM Reviews, CINAHL and EMBASE. RESULTS Five nonrandomized studies including a total of 5012 patients were identified. Meta-analysis suggested that rectal washout significantly reduced the local recurrence rate (P < 0.0001; OR 0.57; 95% CI 0.43-0.74). It was also significantly lower after washout in patients having radical resection only (P = 0.0004; OR 0.54; 95% CI 0.39-0.76), patients treated by a curative resection (P < 0.0001; OR 0.55; 95% CI 0.42-0.72) and those undergoing preoperative radiotherapy (P = 0.04; OR 0.62; 95% CI 0.39-0.98). CONCLUSION Taking into account the limitations of the design of the included studies the meta-analysis showed that rectal washout is associated with reduced local recurrence and therefore should be routine during anterior resection for rectal cancer.
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Affiliation(s)
- F Rondelli
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy
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20
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Rosato L, De Toma G, Bellantone R, Avenia N, Cavallaro G, Dobrinja C, Chiofalo MG, De Crea C, De Palma M, Gasparri G, Gurrado A, Lombardi C, Miccoli P, Mullineris B, Nasi PG, Pelizzo MR, Pezzullo L, Perigli G, Testini M. [Diagnostic, therapeutic and healthcare management protocols in thyroid surgery: 3rd consensus conference of the Italian association of endocrine surgery units (U.E.C. CLUB)]. MINERVA CHIR 2012; 67:365-379. [PMID: 23232474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- L Rosato
- Dipartimento di Chirurgia, ASL TO/4 Ospedale di Ivrea, Torino, Italia.
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21
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Rondelli F, Trastulli S, Avenia N, Schillaci G, Cirocchi R, Gullà N, Mariani E, Bistoni G, Noya G. Is laparoscopic right colectomy more effective than open resection? A meta-analysis of randomized and nonrandomized studies. Colorectal Dis 2012; 14:e447-69. [PMID: 22540533 DOI: 10.1111/j.1463-1318.2012.03054.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM The aim of this systematic review was to compare laparoscopic and/or laparoscopic-assisted right colectomy (LRC) with open right colectomy (ORC). Many randomized clinical trial have shown that laparoscopic colectomy benefits patients with improved short-term outcomes and comparable overall survival in respect to the open approach. These results, however, could not be applied to right colectomy owing to its wide range of resection and more complicated vascular regional anatomy. METHOD We performed a meta-analysis of the literature in order to compare LRC vs ORC by examining 21 end-points including operative and recovery outcomes, early postoperative mortality and morbidity, and oncological parameters. A subgroup analysis of patients undergoing right colectomy for cancer was carried out. The meta-analysis was conducted following all aspects of the Cochrane Handbook for systematic reviews and Preferred Reporting Items for Systematic Reviews and Metanalysis (PRISMA) statement. The search strategies were developed using the following electronic databases: PubMed, EMBASE, OVID, Medline, Cochrane Database of Systematic Reviews, EBM reviews and CINAHL until March 2011. We included randomized and non randomized studies that compared the LRC vs ORC for benign disease and malignant neoplasm irrespective of publication status. Only studies in English, French, German, Spanish and Italian languages were considered for inclusion. Emergency right colectomies were excluded. To perform the statistical analysis we used the odds ratio (OR) for categorical variables and the weighted mean difference (WMD) for continuous variables. An intention-to-treat analysis was performed. RESULTS Seventeen studies, 15 nonrandomized clinical trials and two randomized clinical trials, involving a total of 1489 patients, were identified. The mean operative time was longer in the group of patients undergoing LRC [weighted mean difference (WMD) = 37.94, 95% CI: 25.01 to 50.88; P < 0.00001]. Intra-operative blood loss (WMD = -96.61; 95% CI: -150.68 to -42.54; P = 0.0005), length of hospital stay (WMD = -2.29; 95% CI: -3.96 to -0.63; P = 0.007) and short-term postoperative morbidity (OR = 0.64; 95% CI: 0.49 to 0.83; P = 0.0009) were significantly in favour of LRC. CONCLUSION Laparoscopic-assisted right colectomy results in less blood loss, a shorter length of hospital stay and lower postoperative short-term morbidity compared with ORC.
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Affiliation(s)
- F Rondelli
- Department of General Surgery, S.Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
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22
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Trastulli S, Cirocchi R, Listorti C, Cavaliere D, Avenia N, Gullà N, Giustozzi G, Sciannameo F, Noya G, Boselli C. Laparoscopic vs open resection for rectal cancer: a meta-analysis of randomized clinical trials. Colorectal Dis 2012; 14:e277-96. [PMID: 22330061 DOI: 10.1111/j.1463-1318.2012.02985.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM Laparoscopic and open rectal resection for cancer were compared by analysing a total of 26 end points which included intraoperative and postoperative recovery, short-term morbidity and mortality, late morbidity and long-term oncological outcomes. METHOD We searched for published randomized clinical trials, presenting a comparison between laparoscopic and open rectal resection for cancer using the following electronic databases: PubMed, OVID, Medline, Cochrane Database of Systematic Reviews, EBM Reviews, CINAHL and EMBASE. RESULTS Nine randomized clinical trials (RCTs) were included in the meta-analysis incorporating a total of 1544 patients, having laparoscopic (N = 841) and open rectal resection (N = 703) for cancer. Laparoscopic surgery for rectal cancer was associated with a statistically significant reduction in intraoperative blood loss and in the number of blood transfusions, earlier resuming solid diet, return of bowel function and a shorter duration of hospital stay. We also found a significant advantage for laparoscopy in the reduction of post-operative abdominal bleeding, late intestinal adhesion obstruction and late morbidity. No differences were found in terms of intra-operative and late oncological outcomes. CONCLUSION The meta-analysis indicates that laparoscopy benefits patients with shorter hospital stay, earlier return of bowel function, reduced blood loss and number of blood transfusions and lower rates of abdominal postoperative bleeding, late intestinal adhesion obstruction and other late morbidities.
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Affiliation(s)
- S Trastulli
- Department of General Surgery, S Maria Hospital, University of Perugia, Terni, Italy.
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23
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Trastulli S, Farinella E, Cirocchi R, Cavaliere D, Avenia N, Sciannameo F, Gullà N, Noya G, Boselli C. Robotic resection compared with laparoscopic rectal resection for cancer: systematic review and meta-analysis of short-term outcome. Colorectal Dis 2012; 14:e134-56. [PMID: 22151033 DOI: 10.1111/j.1463-1318.2011.02907.x] [Citation(s) in RCA: 217] [Impact Index Per Article: 18.1] [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] [Indexed: 12/14/2022]
Abstract
AIM The study aimed to compare robotic rectal resection with laparoscopic rectal resection for cancer. Robotic surgery has been used successfully in many branches of surgery but there is little evidence in the literature on its use in rectal cancer. METHODS We performed a systematic review of the available literature in order to evaluate the feasibility, safety and effectiveness of robotic versus laparoscopic surgery for rectal cancer. We compared robotic and laparoscopic surgery with respect to twelve end-points including operative and recovery outcomes, early postoperative mortality and morbidity, and oncological parameters. A subgroup analysis of patients undergoing full-robotic or robot-assisted rectal resection and robotic total mesorectal excision was carried out. All aspects of Cochrane Handbook for systematic reviews and Preferred Reporting Items for Systematic Reviews and Metanalysis (PRISMA) statement were followed to conduct this systematic review. Comprehensive electronic search strategies were developed using the following electronic databases: PubMed, EMBASE, OVID, Medline, Cochrane Database of Systematic Reviews, EBM reviews and CINAHL. Randomized and nonrandomized clinical trials comparing robotic and laparoscopic resection for rectal cancer were included. No language or publication status restrictions were imposed. A data-extraction sheet was developed based on the data extraction template of the Cochrane Group. The statistical analysis was performed using the odd ratio (OR) for categorical variables and the weighted mean difference (WMD) for continuous variables. RESULTS Eight non randomized studies were identified that included 854 patients in total, 344 (40.2%) in the robotic group and 510 (59.7%) in the laparoscopic group. Meta-analysis suggested that the conversion rate to open surgery in the robotic group was significantly lower than that with laparoscopic surgery (OR = 0.26, 95% CI: 0.12-0.57, P = 0.0007). There were no significant differences in operation time, length of hospital stay, time to resume regular diet, postoperative morbidity and mortality, and the oncological accuracy of resection. CONCLUSION Robotic surgery for rectal cancer has a lower conversion rate and a similar operative time compared with laparoscopic surgery, with no difference in recovery, oncological and postoperative outcomes.
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Affiliation(s)
- S Trastulli
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy
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Papi A, Guarnieri T, Storci G, Santini D, Ceccarelli C, Taffurelli M, De Carolis S, Avenia N, Sanguinetti A, Sidoni A, Orlandi M, Bonafé M. Nuclear receptors agonists exert opposing effects on the inflammation dependent survival of breast cancer stem cells. Cell Death Differ 2012; 229:1595-606. [PMID: 22261616 DOI: 10.1002/jcp.24601] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 03/03/2014] [Indexed: 12/19/2022] Open
Abstract
Recent literature highlights the importance of pro-inflammatory cytokines in the biology of breast cancer stem cells (CSCs), unraveling differences with respect to their normal counterparts. Expansion of mammospheres (MS) is a valuable tool for the in vitro study of normal and cancer mammary gland stem cells. Here, we expanded MSs from human breast cancer and normal mammary gland tissues, as well from tumorigenic (MCF7) and non-tumorigenic (MCF10) breast cell lines. We observed that agonists for the retinoid X receptor (6-OH-11-O-hydroxyphenanthrene), retinoic acid receptor (all-trans retinoic acid (RA)) and peroxisome proliferator-activated receptor (PPAR)-γ (pioglitazone (PGZ)), reduce the survival of MS generated from breast cancer tissues and MCF7 cells, but not from normal mammary gland or MCF10 cells. This phenomenon is paralleled by the hampering of pro-inflammatory Nuclear Factor-κB (NF-κB)/Interleukin-6 (IL6) axis that is hyperactive in breast cancer-derived MS. The hindrance of such pathway associates with the downregulation of MS regulatory genes (SLUG, Notch3, Jagged1) and with the upregulation of the differentiation markers estrogen receptor-α and keratin18. At variance, the PPARα agonist Wy14643 promotes MS formation, upregulating NF-κB/IL6 axis and MS regulatory genes. These data reveal that nuclear receptors agonists (6-OH-11-O-hydroxyphenanthrene, RA, PGZ) reduce the inflammation dependent survival of breast CSCs and that PPARα agonist Wy14643 exerts opposite effects on this phenotype.
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Affiliation(s)
- A Papi
- Department of Evolutionary Experimental Biology, University of Bologna, Italy
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Sanguinetti A, Bistoni G, Avenia N. Stem cells and breast cancer, where we are? A concise review of literature. G Chir 2011; 32:438-446. [PMID: 22018221] [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: 05/31/2023]
Abstract
There is an analogy between embryogenesis and cancer and the attention is on increasing the rate of cell division and on a small percentage of perennial cells . The key to understanding is to be found in the properties of these cells developed in the form of perennial totipotency, multipotency and unipotent. The normal life cycle involves epigenetic mechanisms that are deregulated in cancer cells, these tumor cells appear to belong to deregulation since its progeny. Here is a review of the literature on embryogenesis of the breast, endocrine system interactions Delna the proper development and functioning of the various cell lines and to the importance of cancer stem cells.
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Sanguinetti A, Fioriti L, Brugia M, Roila F, Farabi R, Sidoni A, Avenia N. Juvenile papillomatosis of the breast in young male: a case report. G Chir 2011; 32:374-375. [PMID: 22018260] [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: 05/31/2023]
Abstract
Juvenile papillomatosis of the breast ("Swiss cheese disease'') is a benign localized proliferative condition of the breast which occurs almost exclusively in young adult women. Patients with this lesion often have a family history of breast carcinoma, but rarely carcinoma may coexist with the lesion at the time of diagnosis. We present a case of a young male with juvenile papillomatosis of the breast. The pathology and clinical management of this rare lesion is discussed.
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Avenia N, Sanguinetti A, Santoprete S, Monacelli M, Cirocchi R, Lucchini R, Galasse S, Calzolari F, Urbani M, D'Ajello F, Puma F. [Complications of thyroid surgery: cervical thoracic duct injuries]. G Chir 2010; 31:447-450. [PMID: 20939953] [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: 05/30/2023]
Abstract
Thoracic duct injury is uncommon in surgery of the neck: relatively more common after laryngeal and esophageal surgery, rare in thyroid surgery. From January 1986 to June 2009 were treated 14 patients with lesions of the cervical thoracic duct undergo surgery for thyroid disease: 4 goitre cervico-mediastinal and 10 total thyroidectomy for cancer, 9 of which have laterocervical left lymphadenectomy. In 2 cases, the intraoperative detection has allowed immediate ligature. In 12 patients a cervical chylous fistula without chilothorax was found: 5 low-flow fistulas and 7 high-flow fistulas. Of the 5 cases of low-flow fistula, 4 were recovered after 1 month of conservative treatment, only 1 patient required surgical correction. The 7 patients with high-flow fistula were undergoing surgery: 4 in the first week post-operative and 3 after a period of more than 30 days of medical therapy. In patients with high-flow fistula prolonged medical treatment does not provide benefit and increase the risk of complications during and after surgery.
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Affiliation(s)
- N Avenia
- AFOI Endocrinochirurgia, Università degli Studi di Perugia
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Parmeggiani D, Avenia N, De Falco M, Bilancio G, Ruggero R, Docimo G, Gubitosi A, Fiore A, Atelli P, Misso C, Mordente S, Parmeggiani U. [Retroperitoneal dedifferentiated liposarcoma (DDLS) with hyperglycemic activity: case report and literature review]. MINERVA CHIR 2010; 65:479-484. [PMID: 20802435] [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
The authors describe a Retroperitoneal De Differentiated LipoSarcomas (DDLs), that for its clinical behavior shows peculiar characteristics and original aspects: typical is the recurrence due to local invasiveness, but absolutely original seems to be the surviving time, maybe correlated to its histological evolution (dedifferentiation from leiomyosarcoma to liposarcoma) and an interesting correlation from the tumor recurrence and the glycemic curve first and after the surgical treatments. A 66-year-old woman, presenting typically with very big abdominal masses, treated three times in almost three years, every time with aggressive surgical treatments. Histological response was leiomyo-sarcoma in the first two operations and liposarcoma in the last treatment and in every preoperative phase the patient, normally prediabetic, started to have problem of glycemia balancing, needing an insulin support until the postoperative phases when its glycemia was coming back in normal value without insulin needs, of course until a new tumor recurrence. This last aspect, not depending on pancreas involvement or hormonal activity (immune-histo-chemistry was never conforming a neuro-endocrine activity), seems probably due directly to a mass and metabolic effect of the tumor. Beginning from the description of this case and its interesting biology and reviewing most of the literature on the argument, authors hope to give our support to still debated and partially unknown aspects of these kinds of tumors.
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Affiliation(s)
- D Parmeggiani
- VI Division of General Surgery, Department of Emergency Surgery, Naples, Italy.
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29
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Sanguinetti A, Ragusa M, Calzolari F, D'Ajello F, Fioriti L, Papini D, Sidoni A, Roila F, Avenia N. Invasive ductal carcinoma arising in ectopic breast tissue of the axilla. Case report and review of the literature. G Chir 2010; 31:383-386. [PMID: 20843442] [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
Mammary carcinoma arising in ectopic breast tissue is an uncommon occurrence. Most reported cases have involved ductal carcinoma, but other types, such as medullary, papillary, and lobular carcinomas, have been described. For pathologists, the diagnosis of mammary carcinoma arising in ectopic breast tissue can be difficult, especially in the axilla, where carcinoma of adnexal origin must be excluded. We describe a 51-year-old woman who developed invasive secretory ductal carcinoma in ectopic left axillary breast tissue and micrometastatic carcinoma in an ipsilateral axillary lymph node. The carcinoma arose in a left axillary mass that had been present for several years, from which she had secreted fluid during prior menstrual periods.
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Affiliation(s)
- A Sanguinetti
- Department of Radiology, University of Perugia, Italy
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30
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D'Ajello F, Cirocchi R, Docimo G, Catania A, Ardito G, Rosato L, Avenia N. Thyroidectomy with ultrasonic dissector: a multicentric experience. G Chir 2010; 31:289-292. [PMID: 20646373] [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 We have conducted a clinical controlled trial (CCT) on patients who had undergone thyroidectomy for goitre or thyroid carcinoma. The endpoint of this study was to evaluate the benefits of ultrasonic dissector vs conventional technique (vessel ligation and tight) in patients undergoing thyroid surgery. PATIENT AND METHODS Between January 2007 and December 2009 a CCT was conducted on 2.736 consecutive patients admitted to our clinical wards, who had undergone thyroidectomy for goitre or thyroid carcinoma. They were divided in two group: 1.021 patients (203 male and 818 female) underwent thyroidectomy with ultrasonic dissector (UAS) and 1.715 patients (369 male and 1.346 female) underwent throidectomy with conventional technique (vessel ligation and tight) (CT). RESULTS The operative time (UAS 80 minutes mean, 50 to 120 min., vs CT 120 minutes, 70 to 180 minutes) was much lower in the thryoidectomy with UAS group. The incidence of transient laryngeal nerve palsy (UAS 17/1.021 patients. 1.6% vs CT 16/1.715 patients, 0.9%) was higher in the thyroidectomy with UAS group; the incidence of permanent laryngeal nerve palsy was similar in two groups(UAS group; there are no relevant difference in the incidence of permanent hypocalcemia (UAS 26/1.021 patients, 2.5% vs 35/1.715 patients, 2%) which was similar in two groups. Also the average post-operative hospitalization was similar in two groups (2 days). CONCLUSIONS Actually, the only significant advantage shown from this CCT is represented in terms of cost-effectiveness (reduction of the usage of operating room and hospitalization) for patients treated with UAS, subsequent to the significant reduction of operative duration. Although the analysis showed that the patients who were treated with ultrasonic dissection don't present more favourable results in incidence of post-operative transient complication:transient laryngeal nerve palsy (1.6% in UAS vs 0.9% in CT) and transient hypocalcaemia (9.5% in UAS vs 7.7% in CT). There is no significant difference in the incidence of permanent laryngeal nerve palsy (0.9% in UAS vs in 1% CT). The experience of surgeon is the only important factor which can influence the appearance of these complications; the usage of Ultrasonic dissector can only help surgical action but can't repair the experience of the operator.
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Affiliation(s)
- F D'Ajello
- Endocrine Surgincal Unit, University of Perugia, Italy
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31
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Sanguinetti A, Catania A, Docimo G, Avenia N. Radical axillary dissection in sentinel lymph node biopsy era: it's still a considerable technique in breast cancer management? G Chir 2010; 31:344-346. [PMID: 20646390] [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
The new staging technique of sentinel node biopsy facilitates the identification of pathological node negative patients in whom axillary dissection may be avoided; however, patients with a positive sentinel node biopsy would require a thorough examination of their nodal status. Axillary dissection provides good local control, accurate staging and prognostic information for decisions about adjuvant therapy. We describe a technique of radical axillary clearance that includes levels I, II and III; this isn't associated with additional morbidity to patients and involves minimal extension of operative time.
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Sanguinetti A, Docimo G, Ragusa M, Calzolari F, D'Ajello F, Ruggiero R, Parmeggiani D, Pezzolla A, Procaccini E, Avenia N. Ultrasound scissors versus electrocautery in axillary dissection: our experience. G Chir 2010; 31:151-153. [PMID: 20444331] [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
The ultrasound scissors are recently emerging as an alternative surgical tool for dissection and haemostasis and have been extensively used in the field of minimally invasive surgery. We studied the utility and advantages of this instrument compared with electrocautery to perform axillary dissection. The operative and morbidity details of thirty-five breast cancer patients who underwent axillary dissection using the ultrasound scissors were compared with 35 matched controls operated with electrocautery by the same surgical team. There was no significant difference in the operating time between the ultrasound scissors and electrocautery group (36 and 30 mins, p>0.05). The blood loss (60 +/- 35 ml and 294 +/- 155 ml, p<0.001) and drainage volume (200 +/- 130 ml and 450 +/- 230 ml, p<0.001) were significantly lower in the ultrasound scissors group. There was a significant reduction of draining days in ultrasound scissors group (mean one and four days, respectively p<0.05). There was significant difference in the seroma rate between the two groups (10% and 30%, respectively). Axillary dissection using harmonic scalpel is feasible and the learning curve is short. Ultrasound scissor significantly reduces the blood loss and duration of drainage as compared to electrocautery.
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Parmeggiani D, Cimmino G, Cerbone D, Avenia N, Ruggero R, Gubitosi A, Docimo G, Mordente S, Misso C, Parmeggiani U. Biliary tract injuries during laparoscopic cholecystectomy: three case reports and literature review. G Chir 2010; 31:16-19. [PMID: 20298660] [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 Biliary tract injuries (BTI) represent the most serious and potentially life-threatening complication of cholecystectomy. During open cholecystectomies (OC), the prevalence of bile duct injuries has been estimated at only 0.1-0.2%. We report 3 cases of BTI during laparoscopic cholecystectomy (LC). CASE 1: Ascalesi Hospital, Naples 2003-2007, 875 LC (BTI 0,11%). During the dissection of triangle of Calot a partial resection of biliary common duct was made. Immediately the lesion was evident and sheltered in laparoscopy, suturing with a spin reabsorbable, without biliar drainage. The post-operative outcome was good, without alteration of the some parameters, and the patient was discharged after three days. At the last follow-up (January 2006) the cholangiography didn't show stricture or leakage. CASE 2: General and Laparoscopic Surgical Unit San Giovanni di Dio Hospital Frattamaggiore 2004-2007, 720 LC (BTI 0,13%). Patient affected by cholecystitis with gallstones. The patient did not present jaundice, but abdominal pain, leucocitosis, fever and US evidence of parietal gallbladder inflammation. LC was performed after 36 h; during operation, common biliar duct was misidentified for subverted anatomy caused by inflammation. The common bile duct was clipped, and the patient presented jaundice after three days after operation. The colangiography was performed showing the stop. Therefore a reoperation was needed and laparotomic Roux-en-Y hepaticojejunostomy was performed. CASE 3: Dpt of Emergency Surgery, Second University of Naples 2000-2007, LC 520 (BTI 0,19%). Patient affected by more than 20 years symptomatic cholelithiasis, with only obesity risk factor; she underwent laparoscopic cholecystectomy and sudden bleeding of the cystic artery, poor vision and probably the long history of symptoms, producing a flogistic alteration of the anatomy, caused a misidentification of the cystic duct and the common bile duct with complete or lateral clipping of the common hepatic duct. The error was unrecognized intra-operatively but after progressive jaundice the postoperative colangiography showed a nearly complete stop by two clips. Roux-en-Y hepaticojejunostomy with intraoperative cholangiographic control was performed. DISCUSSION The most common cause of BTI is the failure to recognize the anatomy of the triangle of Calot. This is attributed to factors inherent to the laparoscopic approach, to inadequate training of the surgeon and to local anatomical risk factors. The laparoscopic "learning curve" of the surgeon is the most important factor of bile ducts injury. But also local anatomical risk factors are important such as acute cholecystitis, severe chronic scarring of the gallbladder and bleeding or excessive fat in the hepatic hilum. These local risk factors seem to be present in 15% to 35% of BTI. Abnormal biliary anatomy, such as a short cystic duct or a cystic duct entering into the right hepatic duct also may increase the incidence of BTI. Schematic representation of the common mechanisms of BTI during LC are: misidentification of the cystic duct and the common biliary duct, lateral clipping of the common biliary duct, traumatic avulsion the cystic duct junction, diatermic injury of common biliary duct during dissection of the Calot triangle or during the cholecystectomy, injury of anomalous right hepatic duct. CONCLUSION Conversion to laparotomy, in difficult cases involving inflammatory changes, aberrant anatomy or excessive bleeding, is not to be considered as a failure but rather as good surgical decision in order to ensure the patient's safety.
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Affiliation(s)
- D Parmeggiani
- Second University of Naples, Dpt. of Emergency Surgery
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34
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Ruggiero R, Procaccini E, Gili S, Cremone C, Parmeggiani D, Conzo G, Docimo L, Sparavigna L, Gubitosi A, Docimo G, Sanguinetti A, Avenia N. New trends on fibrin glue in seroma after axillary lymphadenectomy for breast cancer. G Chir 2009; 30:306-310. [PMID: 19580713] [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: 05/28/2023]
Abstract
BACKGROUND Axillary lymphadenectomy remains an integral part of breast cancer treatment, yet seroma formation occurs in 15-85% of cases. Among methods to reduce seroma magnitude and duration, fibrin glue has been proposed in several studies with controversial results. PATIENTS AND METHODS Ninety patients underwent quadrantectomy or mastectomy with level I/II axillary lymphadenectomy; a suction drain was fitted in all patients. Fibrin glue spray were applied to the axillary fossa in 45 patients; the other 45 patients were treated conventionally. RESULTS Suction drainage was removed between post-operative (p.o.) days 3 and 4. Seroma magnitude and duration were significantly reduced (p 0.004 and 0.02, respectively), and there were fewer evacuative punctures, in patients receiving fibrin glue compared with the conventional treatment group. CONCLUSIONS Use of fibrin glue does not always prevent seroma formation, but does reduce seroma magnitude, duration and evacuative punctures.
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Affiliation(s)
- R Ruggiero
- General and Specialistic Surgery, Second University of Naples
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35
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Avenia N. Primary thyroid lymphomas. G Chir 2009; 30:197-200. [PMID: 19505411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
MESH Headings
- Calcinosis
- Chemotherapy, Adjuvant
- Humans
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Lymphoma, T-Cell/diagnosis
- Lymphoma, T-Cell/pathology
- Lymphoma, T-Cell/therapy
- Necrosis
- Neoplasm Invasiveness
- Neoplasm Staging
- Practice Guidelines as Topic
- Prognosis
- Radiotherapy, Adjuvant
- Risk Factors
- Sex Distribution
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/therapy
- Thyroidectomy
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36
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Cavaliere A, Colella R, Puxeddu E, Gambelunghe G, Falorni A, Stracci F, d'Ajello M, Avenia N, De Feo P. A useful ultrasound score to select thyroid nodules requiring fine needle aspiration in an iodine-deficient area. J Endocrinol Invest 2009; 32:440-4. [PMID: 19494709 DOI: 10.1007/bf03346483] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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] [Indexed: 11/27/2022]
Abstract
BACKGROUND The high prevalence of thyroid nodules in iodine-deficient areas is a practical problem because of the large number of patients requiring fine needle aspiration (FNA) to detect malignant nodules. AIM To obtain an ultrasound (US) score for predicting malignant nodules and reduce the number of unnecessary and expensive FNA. SUBJECT AND METHOD All nodules observed from September 2001 to March 2006 were evaluated by US: echostructure, echogenicity, halo, microcalcifications and ratio between antero-posterior and transversal diameters (AP/TR). Two thousand six hundred and forty-two consecutive patients underwent US-guided FNA for a total of 3645 nodules. RESULTS Logistic regression analysis showed a potent predictive role for solitary nodules and absence/ incomplete halo (p=0.000). A significant predictive role for microcalcifications and AP/TR ratio was also observed. A 10-point score was constructed using the standardized regression coefficient. Nodules with US score <or=2.4, those between 2.5-5.4 and >or=5.5 had a frequency of malignancy of 0.4, 1.1 and 5.6% (p<0.001), respectively. Nodules with >or=5.5 US score were characterized by a 66% sensitivity and a 76% specificity compared to the diagnostic values of single parameters which were either sensitive or specific. CONCLUSIONS According to our data, we suggest FNA for nodules reaching a >5.4 US score, whereas a clinical judgement should be used for the intermediate category nodules. When the score is lower than 2.5 we do not recommend FNA. The practical use of this US score can help reduce unnecessary and expensive FNA in iodine-deficient areas.
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Affiliation(s)
- A Cavaliere
- Institute of Pathological Anatomy, Perugia University, Perugia, Italy
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37
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Lucchini R, Sanguinetti A, Calzolari F, d'Ajello M, d'Ajello F, Monacelli M, Avenia N. Is the patient's age contraindication to thyroid surgery? BMC Geriatr 2009. [PMCID: PMC4291022 DOI: 10.1186/1471-2318-9-s1-a72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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38
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Ruggiero R, Procaccini E, Sanguinetti A, Cremone C, Gili S, Docimo G, Docimo L, Sparavigna L, Gubitosi A, Parmeggiani D, Avenia N. Ductal carcinoma in situ of the breast: our experience. G Chir 2009; 30:121-124. [PMID: 19351465] [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: 05/27/2023]
Abstract
AIM The ductal carcinoma in situ (DCIS) is a more and more frequent neoplasia, representing over 25% of diagnosed breast cancer in recent surveys.It is particularly interesting as concerns several aspects of which the most important are issues linked to clinical diagnosis and the difficulties of histopathological classification, with evident and important therapeutic implications. PATIENTS AND METHODS The authors report their experience about 161 ductal carcinoma in situ of the breast. Guidelines for surgical treatment are: radiological or clinical diagnosis, tumor's extension, histological classification, grading and margin status. At the present the authors prefer breast conserving surgery with tumor margin's study. They report their experience in the last seven years about sentinel lymph node biopsy. RESULTS The most frequent histotype resulted comedocarcinoma (61,8%) followed by non comedo (38,2%). Local recurrence after DCIS therapy is 6,1%. CONCLUSIONS 80-90% of the patients currently treated for DCIS present non-palpable breast lesions at diagnosis. Breast conserving surgery is the first choice and radiotherapy and endocrine therapy are indicated for selected patients.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents, Hormonal/therapeutic use
- Breast Neoplasms/diagnosis
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Breast Neoplasms/therapy
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Chemotherapy, Adjuvant
- Female
- Follow-Up Studies
- Humans
- Mastectomy, Segmental/methods
- Middle Aged
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/prevention & control
- Practice Guidelines as Topic
- Radiotherapy, Adjuvant
- Retrospective Studies
- Sentinel Lymph Node Biopsy
- Treatment Outcome
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Affiliation(s)
- R Ruggiero
- Department of General and Specialistic Surgery, Second University of Naples, Italy
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39
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Rosato L, Miccoli P, Pinchera A, Lombardi G, Romano M, Avenia N, Bastagli A, Bellantone R, De Palma M, De Toma G, Gasparri G, Lampugnani R, Marini PL, Nasi PG, Pellizzo MR, Pezzullo L, Piccoli M, Testini M. [Diagnostic, therapeutic and healthcare management protocols in thyroid surgery. 2nd Consensus Conference (U.E.C. CLUB)]. G Chir 2009; 30:73-86. [PMID: 19351456] [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: 05/27/2023]
Abstract
AIM To review and to update the management protocols in thyroid surgery proposed two years ago by 1st Consensus Conference called on the topic by the Italian Association of Endocrine Surgery Units (UEC Club). METHOD The 2nd Consensus Conference took place November 30, 2008 in Pisa within the framework of the 7th National Congress of the UEC Club. A selected board of endocrinologists and endocrine surgeons (chairmans: Paolo Miccoli and Aldo Pinchera; speaker: Lodovico Rosato) examined the individual chapters and submitted the consensus text for the approval of several experts. This plain and concise text provides the rationale of the thyroid patient management and wants to be the most complete possible tool for the physicians and other professionals in the field. CONCLUSIONS The diagnostic, therapeutic and healthcare management protocols in thyroid surgery approved by the 2nd Consensus Conference are officially those proposed by the Italian Association of Endocrine Surgery Units (UEC Club) and are subject to review by two years.
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Affiliation(s)
- L Rosato
- Dipartimento di Chirurgia - ASL TO/4, Ospedale di Ivrea, Italy
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40
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Faggiano A, Grimaldi F, Pezzullo L, Chiofalo MG, Caracò C, Mozzillo N, Angeletti G, Santeusanio F, Lombardi G, Colao A, Avenia N, Ferolla P. Secretive and proliferative tumor profile helps to select the best imaging technique to identify postoperative persistent or relapsing medullary thyroid cancer. Endocr Relat Cancer 2009; 16:225-31. [PMID: 19004986 DOI: 10.1677/erc-08-0152] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [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] [Indexed: 11/27/2022]
Abstract
In patients with postoperative persistent medullary thyroid cancer (MTC), the tumor detection rate is generally low for most of the imaging techniques now available. The aim of this study was to investigate if the clinico-biological profile of the tumor may indicate which imaging technique to perform in order to identify postoperative persistent or relapsing MTC foci. Thirty-five consecutive MTC patients with detectable and progressively increasing postoperative serum concentrations of calcitonin were enrolled in the study. The detection rates of 18F-deoxy-d-glucose (FDG)-positron emission tomography (PET), somatostatin receptor scintigraphy (SRS), and 131I-metaiodobenzylguanidine scintigraphy (MIBG) were compared in relation with calcitonin and carcinoembryonic antigen serum concentrations, Ki-67 score and results of conventional imaging techniques (CIT). FDG-PET positivity was significantly associated with calcitonin serum concentrations >400 pg/ml and Ki-67 score >2.0% (P<0.05), while SRS positivity was associated with calcitonin serum concentrations >800 pg/ml (P<0.05). SRS positivity significantly correlated with tumor appearance at CIT (P<0.01), while FDG-PET was positive in nine CIT-negative patients. The secretive and proliferative tumor profile may guide the choice of the imaging technique to use in the follow-up of patients with MTC. A Ki-67 score >2.0% suggests to perform a FDG-PET in addition to conventional imaging. Calcitonin secretion predicts both FDG-PET and SRS uptake but SRS positivity is generally found only in patients with well defined MTC lesions that are also detectable at the conventional imaging examination. MIBG outcome is not predicted by any clinico-biological factors here investigated.
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Affiliation(s)
- A Faggiano
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
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41
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Gubitosi A, Moccia G, Malinconico FA, Docimo G, Ruggiero R, Iside G, Avenia N, Docimo L, Foroni F, Gilio F, Sparavigna L, Agresti M. [Conservative anal fistula treatment with collagenic plug and human fibrin sealant. Preliminary results]. G Chir 2009; 30:46-50. [PMID: 19272233] [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: 05/27/2023]
Abstract
The authors, on the basis of a long clinical experience with human fibrin glue in general surgery, compared two different extracellular matrix (collagen), Surgisis and TissueDura, with human fibrin glue, applied during the operation, and sometimes in postoperative, to obtain the healing of perianal fistulas. The collagenic extracellular matrix provides, according to the rationale suggested, an optimal three-dimensional structure for the fibroblastic implant and neoangiogenesis, hence for the fistula "fibrotizzation" and closure. The encouraging results for transphincteric fistulas and a simple and easy technique push to researchers on samples statistically significant.
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Affiliation(s)
- A Gubitosi
- Seconda Università degli Studi di Napoli, Azienda Ospedaliera Universitaria, DAI di Chirurgia Generale e dei Trapianti
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42
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Docimo G, Avenia N, Ragusa M, Gili S, Parmeggiani D, Casalino G, Gubitosi A, Procaccini E, Ruggiero R, Sparavigna L, Docimo L. [Non recurrent inferior laryngeal nerve: our surgical experience]. Clin Ter 2009; 160:347-349. [PMID: 19997678] [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: 05/28/2023]
Abstract
AIM Iatrogenic damage to the recurrent laringeal nerve is the most feared complication in thyroid surgery and the main cause for vocal cord palsy. Prevention of such a lesion is based upon the thorough search for the nerve along its anatomic pathway. In the present study the Authors discuss an important anatomic variation: non-recurrent inferior laryngeal nerve, emphasizing the aspects of surgical anatomy, on the basis of their own experience in neck surgery. MATERIALS AND METHODS The study takes into conideration 301 surgical interventions on the thyroid gland, in 268 women and 33 men; consisting in 256 total thyroidectomies and 45 loboisthmectomies, as follows: 186 for nodular goiter, 48 for follicular nodule, 34 for papillifer carcinoma, 33 for toxic goiter. The identification and exposure of inferior laryngeal nerve was performed according to the principles and technique by Lahey. RESULTS The overall prevalence of non recurrent inferior laryngeal nerve was equal to 0.33% (1/301 operations). The anomaly is prevailing on the right side, being due by an anomalous reabsorption of the IV ventral arch. This is the cause of the formation of a subclavian artery that is responsible for dysphagia lusoria. CONCLUSIONS The rationale for the preservation of recurrent nerve is its systematic identification and exposure along all its course from its laryngeal entry. Diagnosis of non recurrent inferior laryngeal nerve is exclusively intra-operative. The anomaly is clinically asymptomatic and its suspicion can be posed in case of vascular anomalies or dysphagia. In such a circumstance the golden diagnostic tool is the angio Tc-RMN, while both the EGDS and baritate esophagous can be of some diagnostic help.
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Affiliation(s)
- G Docimo
- Dipartimento Assistenziale Integrato di Chirurgia Generale e Specialistica, Seconda Università di Napoli, Italia.
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Misso C, Calzolari F, Puxeddu E, Lucchini R, Monacelli M, D'Ajello F, Giammartino C, D'Ajello M, Ragusa M, Avenia N. Surgical treatment of sporadic medullary thyroid carcinoma: strategy and outcome. G Chir 2008; 29:475-478. [PMID: 19068183] [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: 05/27/2023]
Abstract
BACKGROUND Medullary Thyroid Carcinoma (MTC) originates from the thyroid C cells and accounts for approximately 5-9% of all thyroid cancers. Aim of this study was to retrospectively evaluate the outcomes of 41 patients with MTC who underwent treatment at our institution. PATIENTS AND METHODS. We reviewed the records of 41 patients who underwent surgery between 1995 and 2004. The patients were divided into two groups: A) patients (n 30) without any previous surgery. B) patients (n 11) previously thyroidectomized and high calcitonin levels with or without radiological evidence of local regional or distant metastases. We performed total thyroidectomy with central compartment lymphadenectomy and ipsilateral modified radical neck dissection in group A patients. Group B patients underwent re-excision of the central neck compartment and bilateral modified radical neck dissection if it had not been previously performed. RESULTS Most patients had major reduction in postoperative calcitonin levels. Compartmental dissection of the cervical node significantly improved the results of primary surgery and calcitonin returned to normal levels in approximately 60% of the patients in group A, but only the 30% of the patients in group B. CONCLUSIONS The extent of the primary surgical resection and the evidence of local or distant metastases significantly influence the outcome of MTC patients. An extensive lymphadenectomy performed early in the treatment and re-operative cervical lymphadenectomy in patients with persistently high calcitonin levels after thyroidectomy significantly improved the outcome, although re-operation rarely results in normalized calcitonin levels and is associated with a higher incidence of complications.
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Affiliation(s)
- C Misso
- University of Perugia, Endocrine Surgical Unit
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44
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Ruggiero R, Procaccini E, Cuccurullo V, Mansi L, Gili S, Cremone C, Docimo G, Docimo L, Sparavigna L, Gubitosi A, Iovino F, Parmeggiani D, Avenia N. Plurifocal breast cancer and double lymphatic spread. G Chir 2008; 29:424-426. [PMID: 18947466] [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: 05/27/2023]
Abstract
BACKGROUND Sentinel node (SN) has been proved to be a reliable technique in predicting the lymph nodes state of the axilla in breast cancer. For the majority of the authors the intradermal and peritumoral injection is the best way. PATIENTS AND METHODS Our experience, from 1997, includes 587 cases of SN in women with resectable breast cancer less than 3 cm of diameter. We performed the lymphoscintigraphy after a peritumoral injection of radioactive tracer and, if the lesion was superficial, we associated an intradermal injection on the skin above the lesion itself. Two patients had multifocal right breast cancer. We did two separate injections around each tumor. RESULTS The radioactive tracer spread towards the internal mammary chain and homolateral axillary nodes. CONCLUSIONS We consider the peritumoral injection as essential in tumors located deeply in the breast (under ultrasound guide if not palpable) together with intradermal injection in superficial ones. Using this technique the possibility of a mis-identification of the SN is reduced.
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Affiliation(s)
- R Ruggiero
- Second University of Naples, Department of General and Specialistic Surgery, Naples
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45
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Lucchini R, Puxeddu E, Calzolari F, Burzelli F, Monacelli M, D'Ajello F, Macaluso R, Giammartino C, Ragusa M, De Feo P, Cavaliere A, Avenia N. Recurrences of thyroid well differentiated cancer: ultrasonography-guided surgical treatment. MINERVA CHIR 2008; 63:257-260. [PMID: 18607320] [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: 05/26/2023]
Abstract
AIM Differentiated thyroid carcinomas (DTC) have a favourable outlook overall. Cornerstone of treatment is total thyroidectomy (TT), followed, if needed, by radiometabolic therapy. Such lesions however show a definite tendency to recur (about 35% of cases), generally in the first decade of follow-up: in 70% of patients such recurrence is local. Surgical resection is the only curative treatment option for local recurrence of well-differentiated thyroid cancer. Intraoperative ultrasonography (US) can be of significant help in facilitating localization and complete resection of lesions. The aim of the study was to review the authors' own experience with the use of such diagnostic method in the clinical setting of thyroid neoplasm recurrence. METHODS Between January 2005 and March 2008 31 patients with DTC recurrences underwent intraoperative US exploration. Recurrences were easily identified and resected in all patients. Postoperative tireoglobuline (TG) was undetectable. RESULTS In all 31 patients preoperative US confirmed the presence of the lesion. In 26 patients digital exploration of the surgical field did not yield a definitively positive finding, whereas in 5 the lesion was easily palpable. Intraoperative US revealed the presence of pathologic tissue in all cases, with examination time ranging from 4 to 14 minutes (median 8 minutes). In all cases surgical resection was complete, with pathologic confirmation of the sample, and no necessity to extend ablation. CONCLUSION Intraoperative US can be of significant help in the identification of DTC recurrences, in particular when lesion dimensions are smaller than 10 mm in diameter and can facilitate a more radical excision of the tumor in a surgical field were anatomical landmarks can be altered by previous surgery and/or radiometabolic therapy.
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Affiliation(s)
- R Lucchini
- Inter-Hospital Functional Area of Endocrine Surgery, University of Perugia, Perugia, Italy.
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Pucci G, Mannarino M, Avenia N, Monacelli M, Fabbriciani G, Pirro M, Scarponi A, Mannarino E, Schillaci G. 12.25 Aortic Stiffness: a Reversible Marker of Cardiovascular Risk in Primary Hyperparathyroidism? High Blood Press Cardiovasc Prev 2008. [DOI: 10.1007/bf03263746] [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: 10/27/2022] Open
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47
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Ruggiero R, Procaccini E, Gili S, Cremone C, Docimo G, Iovino F, Docimo L, Sparavigna L, Gubitosi A, Parmeggiani D, Avenia N. Fibrin glue to reduce seroma after axillary lymphadenectomy for breast cancer. MINERVA CHIR 2008; 63:249-254. [PMID: 18577912] [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: 05/26/2023]
Abstract
UNLABELLED Axillary lymphadenectomy remains an integral part of breast cancer treatment, yet seroma formation occurs in 15-85% of cases. Among the methods employed to reduce seroma magnitude and duration, fibrin glue has been proposed in numerous studies with controversial RESULTS Sixty patients underwent quadrantectomy or mastectomy with level I/II axillary lymphadenectomy; a suction drain was fitted in all patients. Fibrin glue spray was applied to the axillary fossa in 30 patients; the other 30 patients were treated conventionally. Suction drainage was removed between postoperative days III and IV. Seroma magnitude and duration were significantly reduced (P=0.004 and 0.02, respectively), and there were fewer evacuative punctures, in patients receiving fibrin glue compared with the conventional treatment group. The authors conclude that the use of fibrin glue does not always prevent seroma formation, but does reduce seroma magnitude, duration and necessary evacuative punctures.
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Affiliation(s)
- R Ruggiero
- General and Specialistic Surgery, Second University of Naples, Naples, Italy.
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48
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Pucci G, Mannarino M, Avenia N, Monacelli M, Fabbriciani G, Pirro M, Scarponi A, Schillaci G, Mannarino E. AORTIC STIFFNESS: A REVERSIBLE MARKER OF CARDIOVASCULAR RISK IN PRIMARY HYPERPARATHYROIDISM? ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)70602-0] [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: 11/24/2022]
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49
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Sanguinetti A, Ragusa M, Lucchini R, Monacelli M, Calzolari F, Misso C, Avenia N. Primary breast lymphoma: case reports and review of the literature. G Chir 2008; 29:230-232. [PMID: 18507958] [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: 05/26/2023]
Abstract
As the prevalence of breast cancer has increased over recent years many cases with unusual presentation are emerging. This review attempts to identify different types of primary malignancies that can affect the breast. A five years review was undertaken at the Breast Unit of Azienda Ospedaliera "Santa Maria", Terni (Italy). All cases of breast malignancy admitted to the Breast Unit between 2001 and 2005 were reviewed: 750 patients were diagnosed with malignant breast disease. Primary breast lymphoma (was found only in two cases accounting for an incidence of 0,26%. The pre-operative diagnosis was infiltrating carcinoma in both cases and the patients were treated with surgery and systemic chemotherapy; currently they are disease- free.
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50
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Daddi N, Urbani M, Semeraro A, Capozzi R, Scarpelli G, Avenia N, Puma F, Ferolla P, Ribacchi R, Daddi G. [Surgical treatment of well differentiated neuroendocrine tumours of the lung]. G Chir 2008; 29:246-249. [PMID: 18507963] [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: 05/26/2023]
Abstract
The bronchial tree represents the most frequent site of origin of carcinoids (around 25% of the total). The spectrum of differentiation of lung neuroendocrine tumors ranges from low-malignancy (carcinoids) to highly aggressive forms (small cell lung carcinoma) Diagnostic and therapeutic strategies therefore vary greatly. In well differentiated tumors (carcinoids) signs and symptoms are related to the airways obstruction in central forms, while peripheral forms are mostly discovered accidentally if asymptomatic. Clinical or subclinical paraneoplastic syndromes are associated in a minority of cases. Diagnostic work-up includes CT multislice, bronchial endoscopy and Octreoscan with chest Single Photon Emission Computed Tomography (SPECT). Further contribute may be added by the (68), Ga-DOTA-D-Phe(1)-Tyr(3)-ocreotide (DOTATOC) and 5-hydroxytryptophan (5-HTP) PET-CT, at present available only in a few centres, and by endobronchial ultrasound (EBUS), fluorescence bronchoscopy and virtual bronchoscopy. Surgery is the treatment of choice, while medical therapy is useful to treat the hypersecretion in paraneoplastic syndromes and to control tumor proliferation in metastatic or/and inoperable disease.
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Affiliation(s)
- N Daddi
- Centro di Riferimento Oncologico, Grupo Multidisciplinare Regionale per la Patologia Neuroendocrina: A.F.O.I. Perugia-Terni e Università degli Studi di Perugia, Chirurgia Toracica, Dipartimento Medicina Interna e Scienze Endocrine, Italy
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