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Trimboli P, Peloni G, Confalonieri D, Gamarra E, Piticchio T, Frasca F, Makovac P, Piccardo A, Ruinelli L. Determinants of circulating calcitonin value: analysis of thyroid features, demographic data, anthropometric characteristics, comorbidities, medications, and smoking habits in a population with histological full exclusion of medullary thyroid carcinoma. Front Oncol 2024; 14:1278816. [PMID: 38347847 PMCID: PMC10859508 DOI: 10.3389/fonc.2024.1278816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/08/2024] [Indexed: 02/15/2024] Open
Abstract
Objective Calcitonin (Ctn) measurement is crucial for the early diagnosis of medullary thyroid carcinoma (MTC). However, Ctn levels can be skewed/elevated due to other reasons, and the Ctn upper reference value remains controversial. In this field, studies have heterogeneous settings, published data are controversial, and no evidence has been achieved. The study's aim was to evaluate all previously investigated Ctn determinants in a population with histological exclusion of MTC. Methods The institutional records from 2010 to 2022 were reviewed to select patients with thyroid nodules who had undergone total thyroidectomy with histological exclusion of MTC and who had tested for Ctn just before surgery. Thyroid features, demographic and anthropometric data, comorbidities, medications, and lifestyle information were collected. Univariate and multivariate analyses were performed. Results A total of 127 cases were included. The median age for thyroidectomy was 51 years. Median Ctn was 1.04 pg/mL (interquartile range (IQR) 1.04-2.77), with two cases having values above 10 pg/mL. In univariate analysis, Ctn was correlated with gender (p < 0.001), body weight (p = 0.016), height (p = 0.031), body surface area (p = 0.016), thyroid size (p = 0.03), thyroglobulin (p < 0.001), and chronic kidney disease (p < 0.001). After multivariate analysis, the model with the highest accuracy included gender, chronic kidney disease, and thyroid-stimulating hormone (TSH) with an adjusted R-squared of 0.4. Conclusions This study demonstrates, in a population histologically proven as MTC-free, that the Ctn value is mainly influenced by gender, anthropometric/thyroid features, and chronic kidney disease, with the further impact of TSH.
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Affiliation(s)
- Pierpaolo Trimboli
- Servizio di Endocrinologia e Diabetologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Giuseppe Peloni
- Servizio di Chirurgia, Ospedale Regionale di Mendrisio, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Dorotea Confalonieri
- Servizio di Chirurgia, Ospedale Regionale di Mendrisio, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Elena Gamarra
- Servizio di Endocrinologia e Diabetologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Tommaso Piticchio
- Endocrinology Section, Department of Clinical and Experimental Medicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Francesco Frasca
- Endocrinology Section, Department of Clinical and Experimental Medicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Petra Makovac
- Servizio di Chirurgia, Ospedale Regionale di Mendrisio, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Genoa, Italy
| | - Lorenzo Ruinelli
- Servizio di Endocrinologia e Diabetologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Team Data Science & Research, Area ICT, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinical Trial Unit, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
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Mathieson T, Jimaja W, Triponez F, Licker M, Karenovics W, Makovac P, Muradbegovic M, Belfontali V, Bédat B, Demarchi MS. Safety of continuous intraoperative vagus nerve neuromonitoring during thyroid surgery. BJS Open 2023; 7:zrad039. [PMID: 37289251 PMCID: PMC10249491 DOI: 10.1093/bjsopen/zrad039] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 02/02/2023] [Accepted: 03/08/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Continuous intraoperative neuromonitoring has successfully demonstrated to predict impending damage to the recurrent laryngeal nerve, by detecting changes in electromyographic recordings. Despite the apparent benefits associated with continuous intraoperative neuromonitoring, its safety is still a debate. The aim of this study was to investigate the electrophysiological impact of continuous intraoperative neuromonitoring on the vagus nerve. METHODS In this prospective study, the amplitude of the electromyographic wave of the vagus nerve-recurrent laryngeal nerve axis was measured both proximally and distally to the stimulation electrode placed upon the vagus nerve. Electromyographic signal amplitudes were collected at three distinct events during the operation: during the dissection of the vagus nerve, before application of the continuous stimulation electrode onto the vagus nerve and after its removal. RESULTS In total, 169 vagus nerves were analysed, among 108 included patients undergoing continuous intraoperative neuromonitoring-enhanced endocrine neck surgeries. Electrode application resulted in a significant overall decrease in measured proximo-distal amplitudes of -10.94 µV (95 per cent c.i. -17.06 to -4.82 µV) (P < 0.005), corresponding to a mean(s.d.) decrease of -1.4(5.4) per cent. Before the removal of the electrode, the measured proximo-distal difference in amplitudes was -18.58 µV (95 per cent c.i. -28.31 to -8.86 µV) (P < 0.005), corresponding to a mean(s.d.) decrease of -2.50(9.59) per cent. Seven nerves suffered a loss of amplitude greater than 20 per cent of the baseline measurement. CONCLUSION In addition to supporting claims that continuous intraoperative neuromonitoring exposes the vagus nerve to injury, this study shows a mild electrophysiological impact of continuous intraoperative neuromonitoring electrode placement on the vagus nerve-recurrent laryngeal nerve axis. However, the small observed differences are negligible and were not associated with a clinically relevant outcome, making continuous intraoperative neuromonitoring a safe adjunct in selected thyroid surgeries.
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Affiliation(s)
- Timothy Mathieson
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Wedali Jimaja
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Frédéric Triponez
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Marc Licker
- Department of Anaesthesiology and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Wolfram Karenovics
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Petra Makovac
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Mirza Muradbegovic
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Valentina Belfontali
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Benoît Bédat
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
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Makovac P, Muradbegovic M, Mathieson T, Demarchi MS, Triponez F. Preliminary experience with the EleVision IR system in detection of parathyroid glands autofluorescence and perfusion assessment with ICG. Front Endocrinol (Lausanne) 2022; 13:1030007. [PMID: 36325460 PMCID: PMC9619109 DOI: 10.3389/fendo.2022.1030007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/27/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Postoperative hypoparathyroidism remains the most frequent complication of neck endocrine surgery. In order to reduce the incidence of this feared complication, several systems for imaging of near infrared autofluorescence (NIRAF) have been invented to help surgeons identify parathyroid glands (PTGs) and evaluate their vascularization. We evaluated the efficacy of the EleVision IR system in thyroid and parathyroid surgery. METHODS We used the EleVision IR system in 25 patients who underwent thyroid/parathyroid surgery or both at our institution between December 2020 and July 2021. At various stages of the surgery, the surgeon first looked for PTGs with the naked eye and then completed the visual inspection with NIRAF imaging. We then compared both the naked eye and NIRAF-supported PTGs detection rates. At the end of surgery, we performed indocyanine green angiography of PTGs in 17 patients. RESULTS In total, we identified 80% of PTGs: 65% with the naked eye only and additional 15% with the assistance of the EleVision IR system. 14 of 17 patients evaluated by ICG angiography had at least one well-vascularized PTG. Only one of these patients (a case of subtotal parathyroidectomy for tertiary hyperparathyroidism) developed symptomatic postoperative hypocalcemia despite a normal parathormone level. The three other patients had at least one remaining moderately-vascularized PTG and only one patient developed transient postoperative hypoparathyroidism. CONCLUSION We concluded that EleVision IR provides an efficient support for identification and evaluation of PTGs, and may be of great assistance in endocrine surgery. The images are easy to interpret even for less experienced surgeons thanks to the different types of color visualization and the possibility to measure the relative fluorescence intensity of PTGs and surrounding tissues.
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Makovac P, Potié A, Roukain A, Pucci L, Rutz T, Kopp PA, Matter M. Hypnosis and superficial cervical anesthesia for total thyroidectomy in a high-risk patient - A case report. Int J Surg Case Rep 2020; 72:133-136. [PMID: 32535527 PMCID: PMC7298319 DOI: 10.1016/j.ijscr.2020.05.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 11/06/2022] Open
Abstract
Total thyroidectomy can be challenging in high-risk patients. Local superficial anesthesia combined with a hypnosis-analgesia technique instead of intravenous sedation. Because of difficulties controlling the thyrotoxic state. Given the multiple cardiac and large vessel malformations, a possible variant of the inferior laryngeal nerve was expected. Locoregional deep cervical anesthesia can be associated with breathing problems when performed bilaterally.
Introduction Total thyroidectomy can be challenging in high-risk patients. Local cervical anesthesia with sedation is an alternative to general anesthesia. Case presentation A 33-year old male patient with cyanotic congenital heart disease due to unrepaired tricuspid atresia type Ic and associated pulmonary arterial hypertension presented with tachycardic atrial fibrillation and amiodarone-induced thyrotoxicosis resulting in recurrent hemodynamic instability. Because of difficulties controlling the thyrotoxic state, the indication for total thyroidectomy was established. Total thyroidectomy was subsequently performed using local anesthesia combined using a hypnosis-analgesia technique instead of intravenous sedation. The intervention and the post-operative course were uneventful. Discussion A well-established therapist-patient relationship is crucial for a successful induction of hypnosis. Patient motivation and expectations are equally important for a successful implementation of this approach. Conclusion We conclude that hypnosis combined with local anesthesia provides an effective alternative in selected patients with very high anesthesiological risk.
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Affiliation(s)
- P Makovac
- Department of Visceral Surgery, University Hospital of Lausanne and University of Lausanne Switzerland.
| | - A Potié
- Department of Anesthesiology, University Hospital of Lausanne and University of Lausanne Switzerland
| | - A Roukain
- Division of Endocrinology, Diabetology and Metabolism, University Hospital of Lausanne and University of Lausanne Switzerland
| | - L Pucci
- Service of Cardiology, University Hospital of Lausanne and University of Lausanne Switzerland
| | - T Rutz
- Service of Cardiology, University Hospital of Lausanne and University of Lausanne Switzerland
| | - P A Kopp
- Division of Endocrinology, Diabetology and Metabolism, University Hospital of Lausanne and University of Lausanne Switzerland
| | - M Matter
- Department of Visceral Surgery, University Hospital of Lausanne and University of Lausanne Switzerland
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Dobrinja C, Troian M, Cipolat Mis T, Rebez G, Bernardi S, Fabris B, Piscopello L, Makovac P, Di Gregorio F, de Manzini N. Rationality in prophylactic central neck dissection in clinically node-negative (cN0) papillary thyroid carcinoma: Is there anything more to say? A decade experience in a single-center. Int J Surg 2018; 41 Suppl 1:S40-S47. [PMID: 28506412 DOI: 10.1016/j.ijsu.2017.01.113] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/27/2017] [Accepted: 01/30/2017] [Indexed: 01/22/2023]
Abstract
AIM Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy. Despite its extremely favorable prognosis, cervical lymph node metastases are a common feature of PTC and a known independent risk factor for local recurrence. However, the role of prophylactic central neck dissection (PCND) remains a matter of debate in patients with clinically node-negative (cN0) PTC. To better clarify the current role of PCND in the surgical treatment of PTC, evaluating advantages and disadvantages of PCND and outcome of cN0 PTC patients who have been treated with either total thyroidectomy alone or in combination with PCND. A review of recent literature data is performed. METHODS Between January 2000 and December 2015, 186 consecutive patients with cN0 PTC were identified to be included in the present study. 74 of these underwent total thyroidectomy associated with PCND, while 112 patients underwent total thyroidectomy alone. The epidemiological and clinical-pathological data of all patients included were collected at diagnosis and during follow-up. RESULTS Overall complication rate was significantly higher in the group of patients undergoing PCND (39.2% vs. 17.8%, p = 0.0006). To be specific, they presented a considerably increased risk of temporary recurrent laryngeal nerve injury (p = 0.009) and of permanent hypothyroidism (p = 0.016). Overall survival and recurrence rates did not differ between those undergoing PCND and those undergoing total thyroidectomy alone (p = 1.000 and p = 0.715, respectively). CONCLUSIONS The results of the present study do not support the routine use of PCND in the treatment of cN0 PTC patients.
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Affiliation(s)
- C Dobrinja
- Division of General Surgery, Department of Medical, Surgical and Health Sciences, Cattinara Teaching Hospital, Strada di Fiume, 34149, Trieste, Italy.
| | - M Troian
- Division of General Surgery, Department of Medical, Surgical and Health Sciences, Cattinara Teaching Hospital, Strada di Fiume, 34149, Trieste, Italy
| | - T Cipolat Mis
- Division of General Surgery, Department of Medical, Surgical and Health Sciences, Cattinara Teaching Hospital, Strada di Fiume, 34149, Trieste, Italy
| | - G Rebez
- Division of General Surgery, Department of Medical, Surgical and Health Sciences, Cattinara Teaching Hospital, Strada di Fiume, 34149, Trieste, Italy
| | - S Bernardi
- SS Endocrinologia (UCO Medicina Clinica), Azienda Ospedaliero-Universitaria di Trieste, Department of Medical, Surgical and Health Sciences, Cattinara Teaching Hospital, Strada di Fiume, 34149, Trieste, Italy
| | - B Fabris
- SS Endocrinologia (UCO Medicina Clinica), Azienda Ospedaliero-Universitaria di Trieste, Department of Medical, Surgical and Health Sciences, Cattinara Teaching Hospital, Strada di Fiume, 34149, Trieste, Italy
| | - L Piscopello
- Division of Endocrinology, Azienda Ospedaliero-Universitaria di Trieste, Maggiore Hospital, Piazza dell'Ospitale, Trieste, Italy
| | - P Makovac
- Division of General Surgery, Department of Medical, Surgical and Health Sciences, Cattinara Teaching Hospital, Strada di Fiume, 34149, Trieste, Italy
| | - F Di Gregorio
- Nuclear Medicine Unit, Ospedale S. Misericordia Udine, Italy
| | - N de Manzini
- Division of General Surgery, Department of Medical, Surgical and Health Sciences, Cattinara Teaching Hospital, Strada di Fiume, 34149, Trieste, Italy
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Dobrinja C, Bernardi S, Fabris B, Eramo R, Makovac P, Bazzocchi G, Zanconati F, Stacul F. Surgical and pathological changes after radiofrequency ablation of thyroid nodules. ACTA ACUST UNITED AC 2015. [DOI: 10.1530/endoabs.37.ep960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dobrinja C, Bernardi S, Fabris B, Eramo R, Makovac P, Bazzocchi G, Piscopello L, Barro E, de Manzini N, Bonazza D, Pinamonti M, Zanconati F, Stacul F. Surgical and Pathological Changes after Radiofrequency Ablation of Thyroid Nodules. Int J Endocrinol 2015; 2015:576576. [PMID: 26265914 PMCID: PMC4523654 DOI: 10.1155/2015/576576] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/14/2015] [Accepted: 07/01/2015] [Indexed: 01/22/2023] Open
Abstract
Background. Radiofrequency ablation (RFA) has been recently advocated as an effective technique for the treatment of symptomatic benign thyroid nodules. It is not known to what extent it may affect any subsequent thyroid surgery and/or histological diagnosis. Materials and Methods. RFA was performed on 64 symptomatic Thy2 nodules (benign nodules) and 6 symptomatic Thy3 nodules (follicular lesions/follicular neoplasms). Two Thy3 nodules regrew after the procedure, and these patients accepted to undergo a total thyroidectomy. Here we present how RFA has affected the operation and the final pathological features of the surgically removed nodules. Results and Conclusions. RFA is effective for the treatment of Thy2 nodules, but it should not be recommended as first-line therapy for the treatment of Thy3 nodules (irrespective of their mutational status), as it delays surgery in case of malignancy. Moreover, it is unknown whether RFA might promote residual tumor progression or neoplastic progression of Thy3 lesions. Nevertheless, here we show for the first time that one session of RFA does not affect subsequent thyroid surgery and/or histological diagnosis.
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Affiliation(s)
- Chiara Dobrinja
- UCO Chirurgia Generale, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
| | - Stella Bernardi
- SS Endocrinologia (UCO Medicina Clinica), Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
- *Stella Bernardi:
| | - Bruno Fabris
- SS Endocrinologia (UCO Medicina Clinica), Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
| | - Rita Eramo
- UCO Chirurgia Generale, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
| | - Petra Makovac
- UCO Chirurgia Generale, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
| | - Gabriele Bazzocchi
- SC Radiologia, Maggiore Hospital, Piazza dell'Ospitale, 34100 Trieste, Italy
| | - Lanfranco Piscopello
- SS Endocrinologia (III Medica), Maggiore Hospital, Piazza dell'Ospitale, 34100 Trieste, Italy
| | - Enrica Barro
- SS Endocrinologia (UCO Medicina Clinica), Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
| | - Nicolò de Manzini
- UCO Chirurgia Generale, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
| | - Deborah Bonazza
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
- UCO Anatomia e Istologia Patologica, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
| | - Maurizio Pinamonti
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
- UCO Anatomia e Istologia Patologica, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
| | - Fabrizio Zanconati
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
- UCO Anatomia e Istologia Patologica, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
| | - Fulvio Stacul
- SC Radiologia, Maggiore Hospital, Piazza dell'Ospitale, 34100 Trieste, Italy
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Makovac P, Dobrinja C, Guerrini J, de Manzini N. Co-existing chronic lymphocytic thyroiditis and papillary thyroid carcinoma. Impact on presentation, management, and outcome. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.100] [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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Dobrinja C, Guerrini J, Makovac P, de Manzini N. Prophylactic central lymph node dissection for papillary thyroid carcinoma: What role today? Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.098] [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: 11/16/2022] Open
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Fava M, Turoldo A, Roseano M, Makovac P, Liguori G. Does the routine histological examination of the inferior mesenteric artery lymph nodes have a prognostic value in elderly patients with sigmoid colon and rectum tumors? BMC Geriatr 2009. [PMCID: PMC4291044 DOI: 10.1186/1471-2318-9-s1-a85] [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: 11/10/2022] Open
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