1,720,984 research outputs found
The choice of the intervention in the surgical treatment of nontoxic diffuse multinodular goiter
No full textThe choice between sub-total (STT) and total (TT) thyroidectomy in surgical management of multinodular goitre should be based on the disease pathophysiology and the critical review of short and long-term results of these treatments. In order to make a comparative evaluation the authors carried out a retrospective analysis on a series of patients operated from 1970 to 1993 and on the results of a 16.3 years mean follow-up. Of 551 patients operated on the thyroid gland, 389 (70.6%) affected by multinodular goitre were considered. 340 were female and 49 male (39 years medium age). 341 (87.6%) underwent STT and 48 (12.4%) TT. Post-operative opotherapy was adjusted according to hormonal assays. Post-operative vocal cord motility and calcemia were assessed. A routine endocrinological follow-up protocol has been carried out on all patients since 1980. Transitory vocal cord palsy and hypocalcemia were significantly more frequent in TT, while permanent damage was not. Of 40 TT (complete 5 years mean follow-up, 97.5% of the patients reached euthyroidism with replacement therapy. Of 189 STT (complete 16.3 years mean follow-up), 61.4% of the patients received opotherapy. A recurrent goitre was ascertained in 39.1% of the total (73.3% in the patients not receiving opotherapy) and operated in 16.2% of the cases. According to the authors their results support the choice of TT as it matches the rationale of surgical treatment of multinodular non-toxic goitre based on the pathophysiology of the disease. Moreover it allows easy achievement of euthyroidism avoiding goitre relapse and subsequently re-operation, with an incidence of permanent recurrent nerve palsy and hypoparathyroidism not significantly different from that after STT
Surgery of the obstructive complication of carcinoma of the left colon. The clinical problems and the authors' personal experience with 56 surgical cases
No full textA retrospective analysis was carried out on 56 pts., (37 M, 19 F), mean age 64 yrs., operated for moderate to severe obstruction due to left colon carcinoma. Clinical and pathological features, treatment and results were compared with those of 108 pts. with left colon cancer who underwent elective surgery. Mean duration of obstructive symptoms was 5.3 days and mean delay between admission and operation was 1.15 days. Site and nature of the obstruction were assessed pre-operatively in 80.3% of the pts. Distribution of tumor localization was similar in the two groups. ASA risk was statistically higher in pts. with obstruction. Staging according to the Astler-Coller (mod. 1978) classification, showed a greater incidence of more advanced stages in the obstructing tumors. In the group with obstruction a three stage surgery was carried out in 18 pts. (32.1%), a two stage in 6 (10.7%), a primary resection in 6 (10.7%) and a decompressive colostomy in 26 (46.5%). Radicality and resectability rates were 50% and 53.6% vs 69.4% and 82.4% in elective surgery. Mean post-operative stay was 42 and 21 days respectively in the two groups. Overall post-operative death rate was 19.6% vs 9.2%, and 3.3% vs 7.8% after resective surgery. Post-operative complications accounted for 21.4% vs 21.3%. 5-year survival rate after curative surgery was 47.8% vs 76.8%. On the basis of their results and on Literature reports the Authors suggest a reevaluation of a staged surgical treatment for obstructing left colon cancer based on primary decompression following an E.L. when needed. Consequent resection and intestinal reconstruction should be performed after 2-3 weeks.(ABSTRACT TRUNCATED AT 250 WORDS
Surgical treatment of perforated diverticular disease: evaluation of factors predicting prognosis in the elderly
No full textDiverticulitis free perforation carries a high mortality rate in the elderly, and this motivates the search for specific prognostic factors. The aim of this study was to assess prognostic factors in patients over 70 years of age that were operated on for generalized peritonitis caused by perforated colonic diverticulitis. A retrospective study in 22 patients was performed: demographic data, American Society of Anaesthesiology grading, site and diameter, degree of perforation according to Hinchey's classification, duration of symptoms, Manheim Peritonitis Index (MPI) score, and surgical treatment were evaluated. Patients over 70 years of age were grouped in deceased and not deceased. In this subgroup, postoperative mortality rate was 40%, and diameter of perforation, duration of symptoms, and MPI score seemed significantly related to postoperative death. In the elderly, prognosis is strongly related to duration of symptoms, and treatment delay is caused by late hospitalization because of a low sensibility to the disease symptoms in old people
Inflammatory pseudotumor of the liver. A report of two cases with unusual histologic picture
No full textTwo cases of inflammatory pseudotumor (IPT) of the liver are reported. Clinical presentation was vague and aspecific. Laboratory tests and data from imaging techniques provided no specific information on the actual nature of the lesions and were misleading, suggesting a malignant lesion in one patient and a complicated hydatid cyst in the other. On gross examination, the tumors appeared yellowish ore grey-yellow in color, with a firm cut surface and well circumscribed from the surrounding parenchyma, although a true capsule was not evident. Variability in the histological pattern was also observed, even though the major finding was in both cases an admixture of lymphocytes, plasmacells, granulocytes and monocytes. Lymphocytes were immunohistochemically heterogeneous; monocytes showed in one case large hyperchromic atypical nuclei, confirming the previously, reported possibility that some cases of IPT may be mistaken for sarcomas. Further evidence is added in support of the hypothesis that some liver IPT may result from the evolution of cholangitic abscesses
Coexisting Hashimoto's thyroiditis with differentiated thyroid cancer and benign thyroid diseases: indications for thyroidectomy.
No full textHashimoto's thyroiditis is a medical disease that affects about 5% of the population. In cases of goitre, hashitoxicosis or associated differentiated thyroid cancer, surgical treatment is recommended. The aim of this study was to evaluate the indications for thyroidectomy in Hashimoto's thyroiditis, the frequency of coexistence of Hashimoto's thyroiditis and differentiated thyroid cancer, and the impact of Hashimoto's thyroiditis on the management of differentiated thyroid cancer. From January 1998 to May 2002, 344 patients underwent thyroidectomy in our department. Among 44 patients with HT, the authors carried out a retrospective comparative study of 33 patients with a cytological diagnosis of differentiated thyroid cancer (group A) and 11 patients with non-neoplastic conditions (group B). Surgical indications based on cytological findings and management characteristics were considered. The frequency of the association of Hashimoto's thyroiditis and differentiated thyroid cancer was 23.8% as compared to a 6.7% frequency of coexisting Hashimoto's thyroiditis and benign thyroid diseases (P = 0.000). The sensitivity of cytology in the diagnosis of papillary carcinoma in Hashimoto's thyroiditis was 92%. Cytological diagnosis of hyperplastic follicular and hyperplastic Hürthle cell nodules in Hashimoto's thyroiditis was impossible in some cases. Intraoperatively distinguishing between chronic lymph-node reactivity and tumour involvement was difficult, but the morbidity rate was not increased very much by Hashimoto's thyroiditis. In conclusion, an adequate follow up of patients with Hashimoto's thyroiditis may permit an early diagnosis of differentiated thyroid cancer and its appropriate management
Can intraoperative cholangiography be avoided during laparoscopic cholecystectomy?
No full textControversy exists as to whether intraoperative cholangiography should be performed routinely or selectively during laparoscopic cholecystectomy. The aim of the present study was to assess in which circumstances intraoperative cholangiography can be avoided during laparoscopic cholecystectomy. From January 1999 to June 2002, 168 patients undergoing laparoscopic cholecystectomy for cholelithiasis without intraoperative cholangiography were prospectively evaluated at our Department. Inclusion criteria were established according to a preoperative diagnostic protocol, considering only those patients with normal liver function tests and ultrasound common bile duct diameters < or = 5 mm or > 5 mm, but with normal magnetic resonance cholangiopancreatography findings. Laparoscopic cholecystectomy was carried out without intraoperative cholangiography and postoperative results and follow-up data were recorded and analysed. No major biliary injuries were encountered and no patients had residual bile duct stones after at least a one-year postoperative follow-up. A complete preoperative diagnostic work-up proved to be of fundamental importance for decreasing the incidence of residual bile duct stones. When protocol criteria are satisfied, intraoperative cholangiography may be safely omitted during laparoscopic cholecystectomy and meticulous laparoscopic technique is the main way to reduce the incidence of iatrogenic biliary lesions to a minimum
Predictive factors for malignancy in Hürthle-cell thyroid neoplasia. Effect of surgical treatment
No full textThe aim of this study has been to evaluate factors predicting malignancy in patients with Hürthle cell neoplasms. Medical records from 36 patients who underwent thyroidectomy for Hürthle cell neoplasms between January 1998 and December 2002 were analyzed. Of the 36 patients, 19 had carcinomas and 17 had adenomas, resulting in a 52.7% prevalence of malignancy. Both fine-needle aspiration and intraoperative frozen section had low sensitivities in cancer detection (22.2% and 33.3% respectively). Hürthle cell carcinomas were significantly larger than adenomas (30.3 mm +/- 3.9 vs 17.6 mm +/- 2.3, P = 0.012), however 42% of carcinomas had a diameter between 10 and 20 mm. Size of Hürthle cell tumors is predictive of malignancy, but it is not the only factor to make surgical decision effective. Because of these uncertainties, authors believe that total thyroidectomy is the treatment of choice of all Hürthle cell neoplasms
Surgical indications for toxic multinodular goitre
No full textThe aim of this study was to clarify the surgical indications and the effectiveness of total thyroidectomy in the treatment of toxic multinodular goitre. From January 1998 to May 2004, 70 patients underwent total thyroidectomy in our department because of toxic multinodular goitre. In 46 patients (65.7%) the indications for total thyroidectomy were: 25 compressive goitres, 12 cervico-mediastinal goitres, 2 cases of Pemberton's sign, 5 follicular nodules with cytological atypia, and 2 cases of suspected papillary carcinoma. In 24 patients (34.3%) with failure or intolerance of previous treatment, surgical indications were: 9 persistent and 5 recurrent hyperthyroidism after medical treatment; 6 patients with cardiotoxicity; 3 patients with recurrent disease after percutaneous ethanol injection; 1 patient with antithyroid drug intolerance. The mean postoperative hospital stay was 3.2 days (range: 2-9). Transient hypocalcaemia occurred in 6 patients (8.6%) and transient unilateral recurrent laryngeal nerve injury in another 3 patients (4.2%). None of the patients had permanent hypocalcaemia or permanent recurrent laryngeal nerve injury. All 70 treated patients relieved their symptoms and became biochemically hypothyroid after the operation. Total thyroidectomy results in a rapid, reliable resolution of hyperthyroidism and removal of multinodular goitre, requires no re-treatment, removes any coexisting malignancy, and post-surgical hypothyroidism is simple to treat
Gastric cancer in the young: is it a different clinical entity? A retrospective cohort study
No full textBackground. The rate of gastric cancer in young patients has increased over the past few decades. The aim of this study was to
search for independent risk factors related to patients of younger age. Methods. From January 1996 to December 2012, a series
of 179 consecutive patients were admitted to our surgical department because of a gastric cancer. We carried out a retrospective
cohort study in 20 patients younger than 50 and in 112 patients aged 50 and older treated by curative gastrectomy.The comparison
involved the evaluation of patient and tumor characteristics. Results. Younger patients had significantly less comorbidities and a
more favorable American Society of Anesthesiology score; they had significantly less preoperative weight loss and a significantly
longer duration of symptoms; Helicobacter pylori infection and diffuse histological type were significantly associated with younger
age. There was no statistically significant difference regarding overall and cancer-related 5-year survival; advanced cancer stage and
diffuse histological type were the independent negative prognostic factors influencing cancer-related survival. Conclusions. We do
not have sufficient evidence to consider gastric cancer in younger patients as a different clinical entity. Further studies are needed
to understand carcinogenesis in younger patients and to improve gastric cancer classification
Hypocalcemia following total thyroidectomy: early factors predicting long-term outcome.
No full textHypocalcemia following total thyroidectomy (TT) must be considered permanent in patients requiring calcium replacement after one year. The aim of this study was to identify early risk factors predicting long-term outcome of postoperative hypocalcemia. Among 453 patients who underwent TT from January 1998 to May 2003, a cross-sectional study between 44 patients with transient hypocalcemia (9.7%) and 3 patients with permanent hypocalcemia (0.7%) was carried out. Both low serum calcium level (< 8 mg/dl) and high serum phosphorus level (> 4.5 mg/dl), measured on postoperative day 7, were predictive for outcome. Central neck lymph node dissection, performed for thyroid carcinoma, also correlated with outcome. Serum phosphorus level > 4.5 mg/dl on postoperative day 7 resulted the only independent factor predicting permanent hypoparathyroidism. Therefore indication for central dissection would be very strict. When serum phosphorus level is unfavorable a correct replacement therapy is mandatory to prevent the consequences of permanent hypocalcemia
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