1,721,014 research outputs found
The role of cervical mediastinoscopy and video assisted thoracoscopy in the diagnosis and staging of thoraco-mediastinal neoplastic diseases
No full textINTRODUCTION: In this work we evaluate the role of mediastinoscopy and video-assisted thoracoscopy in the diagnosis and staging of coin lesion of the lung and of mediastinal masses.
MATERIALS AND METHODS: 72 patients, 55 males and 17 females, affected by lung coin lesion without any previous histological diagnosis have been admitted to our Institution from 1997 to 2007. Mean age was 59.4 for males (range 29-82) and 57.2 for females (range 14-79).
RESULTS: Mediastinoscopy resulted to be diagnostic in 95% of cases. In just one case mediastinoscopy failed and video assisted thoracoscopy was performed, which permitted to obtain diagnosis. Video assisted thoracoscopy was able to lead to diagnosis in 98.1% of cases, as we observed only one failure. In this single case we converted the thoracoscopic approach to open, but although the conversion it was not possible to make diagnosis.
DISCUSSION: In these ten years, thanks to adequate indication for mediastinoscopy and video assisted thoracoscopy, the use of thoracotomy for diagnosis and staging of pulmonary neoplastic diseases has been reduced: thus we avoided 80% of unnecessary thoracotomies in patients affected by not resectable lung cancer, metastases (treated by atypical thoracoscopic resection) or benign diseases.
CONCLUSION: The minimally invasive surgical exploration of mediastinum and thoracic cavity allows to obtain all necessary informations (in terms of histology and staging) to programme an adequate therapeutic protocol, reducing postoperative pain and hospital stay, in comparison to thoracotomy
Correction of an end colostomy prolapse with the Delorme technique: A case report
No full text" INTRODUCTION: We report a case of correction of an end colostomy prolapse with Delorme technique in an advanced stage oncologic patient to emphasize the clinical implications and advantages of this procedure. CASE REPORT: A 51-year-old male patient with a stage IV rectal adenocarcinoma underwent laparoscopy for a palliative end colostomy at our institution. Approximately 6 months later, a prolapse of the colostomy occurred during chemotherapeutic treatment. The patient complained of progressive onset of pain and bleeding during defecation as well as difficulty managing the pouch system. Given the stage of the disease and the on-going chemotherapy, a minimally invasive approach was desirable for prolapse correction and we opted for the Delorme procedure under local anesthesia. The postoperative course was excellent with no complications, the symptoms regressed rapidly, and defecation was normal immediately after surgery. The patient was discharged on the second post-operative day. After discharge the stoma was periodically controlled, confirming the success of the procedure. The last clinical evaluation was performed 3 months after surgery and stability was observed. CONCLUSIONS: The Delorme technique is a minimally invasive procedure used to correct an end colostomy prolapse. This technique guarantees excellent results in selected patients and permits the avoidance of more invasive procedures.
Single Access Videothoracoscopic Biopsy and Talc Pleurodesis in Patients With Malignant Pleural Effusion
No full textAim-Background: Recurrent pleural effusion is frequently observed in clinical experience and malignancy is one of the most frequent causes. Although it is generally necessary to prevent the recurrence of effusion in patients with disseminated neoplastic disease, in others, a diagnosis is required. The aim of this study was to determine the efficacy and safety of biopsy and pleurodesis by a single access videothoracoscopic approach. Methods: We report a consecutive series of 20 patients (12 men, 8 women, aged 39 to 83 years) who underwent single access videothoracoscopy with pleural biopsy and talc pleurodesis for recurrent pleural effusion. In all cases, indication for the procedure was a recurrent pleural effusion, suspicious for malignancy.
Videothoracoscopy was performed under general anaesthesia. For pleurodesis, an average of 8g of sterile talc powder was used. A six-month follow-up was completed for all patients, and efficacy was judged by clinical examination and chest X-ray.
Results: Diagnosis was obtained in all cases. In five cases, the diagnosis was a pleural involvement by breast cancer metastasis, and in four cases, a primary lung cancer was detected. Eight were mesotheliomas and one a parapneumonic collection. In two cases, an unknown-malignancy recurrent pleural effusion was observed. No deaths, talc-induced ARDS or malignant
invasion of the scar occurred, but only a postoperative empyema and two subcutaneous emphysemas treated successfully without further operation. Conclusions: Single access videothoracoscopic pleural biopsy and talc pleurodesis is a safe and effective
method for the diagnosis and treatment of malignant pleural effusions
VATS Thymectomy with 3D Vision: A Chance to Further Improve the Outcomes of Thymus Minimally Invasive Surgery
No full textWarthin-like papillary carcinoma of the thyroid gland: case report and review of the literature
No full textWe present a case of Warthin-like papillary thyroid carcinoma in a 22-year-old woman and a review of the literature on the topic. The patient had the occasional discovery of a hypoechoic thyroid nodule of approximately 18 mm, characterized by irregular margins, hyperechoic spots, rich intra- and perilesional vascularization, and a suspicious enlarged right laterocervical lymph node. Fine-needle aspiration was performed for both lesions and the diagnosis of papillary thyroid carcinoma without lymph node involvement was made. The patient underwent thyroidectomy and central neck lymphadenectomy without complications. Histopathological examination suggested a Warthin-like papillary carcinoma of the thyroid gland, with all the removed lymph nodes being free of disease. The patient subsequently underwent iodine ablative therapy and she remains free of disease one year after surgery. Warthin-like papillary thyroid carcinoma is a recently described variant of papillary thyroid cancer that is frequently associated with lymphocytic thyroiditis. Morphologically, it resembles Warthin tumors of the salivary glands, with T and B lymphocytes infiltrating the stalks of papillae lined with oncocytic cells. Surgical and postoperative management is identical to that of classic differentiated thyroid cancer, while prognosis seems to be favourable
Lung Cancer Epidemiology in North Sardinia, Italy
No full textBackground: The aim of this study was to analyze and describe the epidemiological characteristics and trends of lung cancer in North Sardinia, Italy, in the period 1992–2010. Methods: Data were obtained from the tumor registry of Sassari province which is a part of a wider registry web, coordinated today by the Italian Association for Tumor Registries. Results: The overall number of lung cancer cases registered was 4,325. The male-to-female ratio was 4.6:1 and the mean age 68.1 years for males and 67 years for females. The standardized incidence rates were 73.1/100,000 and 13.5/100,000 and the standardized mortality rates 55.7/100,000 and 9.9/100,000 for males and females, respectively. An increasing trend in incidence of lung cancer in women was evidenced. Conversely, incidence was found to decrease in males. Relative survival at 5 years from diagnosis was low (8.8% for males and 14.9% for females). Furthermore, an increase in mortality rates was observed in both sexes in the period under investigation. Conclusions: Our data show an increasing trend of lung cancer incidence in women in North Sardinia in the last decades. Conversely, a reduction of incidence rates was observed in males. Furthermore, a slightly increasing trend in mortality rates was observed in both sexes, suggesting the need to enhance smoking control strategies, consider adoption of effective surveillance policies, and improve diagnosis and treatment methods
[IPTH dosage as a prognosis predictor of postoperatory hypocalcemia in patients submitted to total thyroidectomy]
No full textIntroduction: Hypocalcemia is the most frequent complication after total thyroidectomy (TT) and represents the main cause of prolonged hospital stay because of the need to monitor the calcemic status of the patients. The aim of this study is to evaluate the role of serum iPTH as a predictor of post-thyroidectomy hypocalcemia in order to allow patients' early and safe discharge. Materials and methods: Fifty patients who underwent TT without autotransplantation of parathyroid tissue were prospectively included in the study The mean age was 52 years and the male/female ratio was 1/6. The iPTH serum level were determined 1 hour after the operation and the calcium serum values after 24 and 48 hours. The cut-off value assumed for testing the sensitivity, specificity, PPV and NPV was 16 pg/ml. Results: Nineteen patients (38%) presented hypocalcemia within 48 hours after TT and 16 of them (84.2%) had iPTH serum levels lower than 16 pg/ml. The normocalcemic patients were 31 (62%) and only 4 of them had iPTH serum levels inferior to the cut-off value. Postoperative iPTH serum level determined 1 hour after the operation had a sensibility of 84.2%, specificity of 87.1%, PPV and NPV of 90% and 80% respectively. Conclusions: The dosage of iPTH serum levels after total thyroidectomy reliably predicts patients who are likely to develop hypocalcaemia. It may be useful in clinical practice in order to reduce the number of postoperative blood tests and the hospital length of stay for the patients who are not at risk of postoperative hypocalcemia
Cystic pancreatic tumor treated by distal spleno-pancreatectomy with occasional diagnosis of neuroendocrine tumor: case report
No full textINTRODUCTION: Cystic and neuroendocrine pancreatic neoplasms are quite rare tumors which diagnosis is often difficult due to their non specific symptomatology and limited diagnostic accuracy of conventional diagnostic instruments. Their treatment is still controversial.
CASE REPORT: A young woman is admitted with abdominal pain and dyspepsia. Instrumental diagnosis reveals a cystic pancreatic lesion which seems to be malignant as CEA of pancreatic liquid is increased. The patient undergoes distal spleno-pancreatectomy and postoperative histological examination found IPMN associated with MCN and furthermore there was occasional diagnosis of a small neuroendocrine tumor in the pancreatic tail.
DISCUSSION: A correct diagnostic approach is indispensable for a correct therapeutic approach. Radical surgical treatment is indicated in all cases of main- and branch duct IPMN and in case of MCN with signs of malignant transformation. Surgical treatment is also the gold standard for pancreatic neuroendocrine tumors if they are singular and in M0 stage.
CONCLUSIONS: In case of cystic and neuroendocrine neoplasms of the pancreas the preoperative diagnostic approach is often not enough to obtain a definite diagnosis. Review of literature and this case report show that a definite diagnosis can only be done after postoperative histological examination. Recent prospective studies suggest the possibility for a follow up instead of surgical treatment for some neuroendocrine tumors
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