Management of surgical diseases of thyroid gland indications of the United Italian Society of Endocrine Surgery (SIUEC).

A task force of the United Italian society of Endocrine Surgery (SIUEC) was commissioned to review the position statement on diagnostic, therapeutic and health­care management protocol in thyroid surgery published in 2016, at the light of new technologies, recent oncological concepts, and tailored approaches. The objective of this publication was to support surgeons with modern rational protocols of treatment that can be shared by health-care professionals, taking into account important clinical, healthcare and therapeutic aspects, as well as potential sequelae and complications. The task force consists of 13 members of the SIUEC highly trained and experienced in thyroid surgery. The main topics concern clinical evaluation and preoperative workup, patient preparation for surgery, surgical treatment, non-surgical options, postoperative management, prevention and management of major complications, outpatient care and follow-up.

Hemithyroidectomy versus total thyroidectomy in the intermediate-risk differentiated thyroid cancer: the Italian Societies of Endocrine Surgeons and Surgical Oncology Multicentric Study.

The surgical treatment of the intermediate-risk DTC (1-4 cm) remains still controversial. We analyzed the current practice in Italy regarding the surgical management of intermediate-risk unilateral DTC to evaluate risk factors for recurrence and to identify a group of patients to whom propose a total thyroidectomy (TT) vs. hemithyroidectomy (HT). Among 1896 patients operated for thyroid cancer between January 2017 and December 2019, we evaluated 564 (29.7%) patients with unilateral intermediate-risk DTC (1-4 cm) without contralateral nodular lesions on the preoperative exams, chronic autoimmune thyroiditis, familiarity or radiance exposure. Data were collected retrospectively from the clinical register from 16 referral centers. The patients were followed for at least 14 months (median time 29.21 months). In our cohort 499 patients (88.4%) underwent total thyroidectomy whereas 65 patients (11.6%) underwent hemithyroidectomy. 151 (26.8%) patients had a multifocal DTC of whom 57 (10.1%) were bilateral. 21/66 (32.3%) patients were reoperated within 2 months from the first intervention (completion thyroidectomy). Three patients (3/564) developed regional lymph node recurrence 2 years after surgery and required a lymph nodal neck dissection. The single factor related to the risk of reoperation was the histological diameter (HR = 1.05 (1.00-1-09), p = 0.026). Risk stratification is the key to differentiating treatment options and achieving better outcomes. According to the present study, tumor diameter is a strong predictive risk factor to proper choose initial surgical management for intermediate-risk DTC.

Electron-phonon interaction and thermal boundary resistance at the interfaces of Ge2Sb2Te5 with metals and dielectrics.

The Ge2Sb2Te5 compound is of interest for applications in phase change non-volatile memories. First-principles calculations of phonon dispersion relations and electron-phonon coupling constant provide an estimate of the electron-phonon contribution to the thermal boundary resistance at the interfaces of Ge2Sb2Te5 with dielectrics (silica) and metal electrodes (Al and TiN). The diffuse mismatch model including full phononic dispersion has been used to compute the phononic contribution to the thermal boundary resistance. The calculated value of the electron-phonon contribution to the TBR at 300 K of about 14 m(2)K GW(-1) would dominate the TBR at the interfaces of hexagonal Ge2Sb2Te5 with the surrounding dielectrics and metals considered here once interdiffusion at the boundaries could be minimized.

Validity of shape memory NiTi colon ring BioDynamix ColonRing™ (or NiTi CAR 27™) to prevent anastomotic colorectal strictures. Preliminary results.

PURPOSE: Anastomotic strictures occur in 3-30% of colorectal anastomosis and one of the main causes may be a reaction to the presence of the metal staples used for suturing. The aim of this study was to evaluate the efficacy of a compression anastomosis ring using the memory shaped device in initial, i.e. nickel-titanium alloy (NiTi) for the prevention of colorectal anastomotic strictures. PATIENTS AND METHODS: A compression anastomosis ring device (NiTi CAR 27™) was used to perform compression anastomosis in 20 patients underwent left hemicolectomy and anterior resection of the rectum for carcinoma. An endoscopic check of the anastomosis was carried out at one month and at six months after surgery. RESULTS: In 2 patients (10%) a dehiscence of the anastomosis occurred on the fifth and the eighth postoperative day. No anastomotic strictures were observed in any of the other 18 patients at six months follow-up after surgery. CONCLUSION: Our preliminary results suggest that the use of a compression anastomosis ring might well be a valid method of preventing anastomotic strictures in colorectal surgery. Further studies involving a larger number of patients are needed in order to confirm these preliminary results.

[Hemostatic effectiveness of TachoSil® patches in radiofrequency assisted minor hepatic resection]. / Efficacia emostatica del TachoSil® nelle resezioni epatiche minori eseguite con device bipolare a radiofrequenza.

AIM: Intra- and postoperative bleeding represents an extremely serious and frequent complication of hepatic surgery. The aim of this study was to evaluate the effectiveness of TachoSil® to improve hemostasis in radiofrequency assisted minor hepatic resection. METHODS: Between July 2008 and June 2010, 31 patients underwent radiofrequency assisted minor hepatic resection. At the end of the liver resection a sponge of TachoSil® was applied on the liver. RESULTS: The mean intraoperative bleeding from the liver was 56.1 mL (range 0-300 mL). No patients received intra- and postoperative blood transfusion. Surgical drains were removed between the first and the sixth-eight postoperative day. CONCLUSION: According to the authors Tacho-sil® is helpful to improve hemostasis and biliary leakage in patients undergoing radiofrequency assisted minor hepatic resection.

[Esophageal digital videofluorography with water siphon test in the post-operative evaluation of the anti-reflux laparoscopic surgery]. / La videofluorografia esofagea digitale con water siphon test nella valutazione postoperatoria della chirurgia antireflusso laparoscopica.

BACKGROUND: In recent years digital videofluorography (VFG) with water siphon test (WST) has been proposed just for diagnosing hiatal hernia and/or gastroesophageal reflux. PATIENTS AND METHODS: Fifteen patients undergone Laparoscopic Nissen (LN) for complicated GERD associated to hiatal hernia, were referred for VFG and WST in order to evaluate the functional results of surgery. At one-month videofluorographic control thirteen patients had just a minimal prolonged esophageal transit time but only six of these had an early postoperative dysphagia, whereas at six months control the prolonged esophageal transit time was present in three patients two of which complained a very light dysphagia. One patient at one month control had a severe dysphagia, her videofluorography showed a very prolonged esophageal transit time and she had to redo surgery. She had a complete resolution of dyspagia and at the six months videofluorographic control she had a normal esophageal and esophagogastric transit time. One patient, underwent surgery in another hospital, complained a persistent and moderate dysphagia and at one month videofluorografic control was evident a malposition of wrap around the upper part of the stomach and a WST positive for reflux and at six months control clinical finding was worst. He will be evaluated for further endoscopic or surgical treatment. CONCLUSIONS: In our experience we believe that VFG is a valid test to identificate the postoperative outcomes giving the surgeons a visual evaluation of their work.

[The use of stereotaxic cytology in the diagnosis of nonpalpable breast lesions. Our experience]. / L'impiego della citologia stereotassica nella diagnostica delle lesioni non palpabili della mammella. Nostra esperienza.

BACKGROUND AND AIMS: The increasingly frequent use of mammography for the early diagnosis of breast cancer and the consequent identification of mammary lesions at a preclinical stage raises the fundamental problem of the differential diagnosis between non-suspected non-palpable lesions (NPL) which can therefore be monitored over time and suspected NPL or definite carcinoma requiring histological confirmation and surgical biopsy. The diagnostic accuracy of mammography alone is not sufficiently high to differentiate benign lesions from malignant or strongly suspected ones. The use of surgical biopsy in the event of suspected NPL could be significantly reduced by the use of stereotaxic cytology which would improve the diagnostic accuracy of mammography. METHODS: The study refers to 72 suspected NPL undergoing surgical biopsy after having performed stereotaxic cytology on a sample taken with a dedicated mammographic device (Mammotest-TRC). RESULTS: The rate of inadequate samples for correct cytological evaluation was 16.1%. Of the 72 NPL undergoing surgical biopsy, 40 (55.5%) were found to be carcinomas and 32 (44.5%) were benign lesions. The sensitivities of mammography alone and cytology alone in identifying infraclinical breast carcinoma were respectively 0.85 and 0.95. If the results of the two methods were evaluated together, the level of sensitivity was 0.98. CONCLUSIONS: The use of stereotaxic cytology enables a marked improvement to be achieved in the diagnostic accuracy of mammography for the identification of suspected NPL to undergo surgical biopsy, notably reducing the cost of biopsy (number of benign lesions for each carcinoma diagnosed) and consequent discomfort for patients.

[Care of the patient after biliopancreatic diversion (BPD) surgery]. / L'assistenza al paziente operato di diversione biliopancreatica (BPD).

The authors report their experience in the care of severely obese patients undergoing biliopancreatic diversion (BPD) surgery. The success of this surgical technique not only depends on its correct application but also on correct postoperative management, both immediately and over time. After a short summary of the methods of management used immediately after surgery, the authors focus in greater detail on the most frequent complications in this type of surgery: these are divided into early and late. Among the former, the authors discuss thromboembolic disease, the most severe complications and bronchopneumonia disorders. The authors illustrate the methods of treating both as well as therapies for their prevention. The most frequent and potentially dangerous late complications are examined in detail: protein malnutrition, sideropenic anemia and diarrhea. Lastly, the authors underline the need for a constant rather than episodic approach to the problem of severe obesity since, in their opinion, only continuous and long term application ensures the best results with the fewest complications.

[Organization of a center for prevention and treatment of obesity]. / Organizzazione di un Centro per la prevenzione e cura dell'obesità.

Obesity, a pathology with a multifactorial etiopathogenesis currently has an incidence of around 6% in the adult population in Italy. Considering that this disease provokes a statistically significant reduction of life expectancy, there is an evidence need to create structures which can deal with this problem. For this purpose, the Centre for the prevention and cure of obesity was set up by the Department of Surgery and Anatomy at the University of Palermo in 1990. It makes use of the specialist skills of experts in internal medicine, dieticians, cardiologists, psychologists and surgeons. In particular the authors give a detailed description of the diagnostic iter used and the methods of follow-up adopted for patients undergoing biliopancreatic diversion (BPD) surgery. In conclusion, the authors emphasize the need for a multidisciplinary approach to this pathology since this is the only way of minimizing complications arising during BPD surgery and obtaining the best results.

[Prognostic factors of local recurrence after conservative surgery in breast carcinoma. Our experience]. / Fattori prognostici della recidiva locale dopo chirurgia conservativa per carcinoma della mammella. Nostra esperienza.

One of the most important problems linked to the conservative surgery of breast cancer consists of local recurrences (LR), even if it has now been proven that the appearance of LR has no influence on overall survival of the patients operated for breast cancer. We have considered 108 patients suffering from breast cancer and treated with quadrantectomy plus axillary dissection. In these patients were found 4 LR (3.7%), that in two cases appeared in the residual mammary gland and in other two cases were found on the skin scar. The mean time of occurrence of the LR was of 43 month (range 18-90 month). The authors have correlated the appearance of LR with some characteristics of the tumor, as the pT, the histologic type, the histologic Grading, the estrogen receptor status and the extensive intraductal component of the tumor (EIC). No particular correlations were found between the pT, histologic type, histologic Grading, estrogen receptor status of the tumor and the onset of LR. Instead a significant correlation was found between the LR appearance and the EIC of the tumor. In fact, for the tumors with a rich EIC there was found a 11.5% incidence of LR against a 1.2% impact of LR for the tumors with a low EIC. The authors conclude that is impossible now to assert that exist really some prognostic factor but is most important to note that there are many data in the literature that seems ever more to point at the rich EIC of the tumor as an important prognostic factor of LR.

[The role of galactography in the diagnosis of breast diseases. Our experience]. / Il ruolo della galattografia nella diagnostica senologica. Nostra esperienza.

Following a description of the most common galactographic semeiotics in relation to the different types of secretion, the Authors report their personal experience in the use of galactography to diagnose breast cancer. Histopathological tests revealed the presence of carcinoma in 14 (29.2%) out of a total 48 galactographic examinations. In conclusion, the Authors underline the high degree of diagnostic precision of galactography, a test which contributes to the identification of a considerable number of carcinomas during the preclinical stage.

[Staging of gastric carcinoma and consequential therapeutic protocols]. / La stadiazione del carcinoma dello stomaco e protocolli terapeutici consequenziali.

The Authors examine the most recent diagnostic methods of studying gastric carcinoma illustrating their limits and peculiarities. It is underlined that only an integrated use of these diagnostic methods may allow a right staging of the disease, which is very important for a correct therapeutic approach. After a review of the literature the Authors discuss on the extent gastric resection and lymphadenectomy must have to be considered radical and, at the same time, curative.

[The treatment of nonpalpable breast lesions. Our experience]. / Il trattamento delle lesioni non palpabili della mammella. Nostra esperienza.

Thanks to the diffusion of the clinico-mammographic screening, in the last ten years a considerable increase of breast carcinomas diagnosed in a subclinical stage has been registered. The authors report the preliminary results of their experience in nonpalpable lesions of the breast and confirm the validity of conservative surgery for their treatment. Nonpalpable breast carcinomas must be considered as an early stage of palpable T1 tumors, for which validity of conservative surgery is largely demonstrated. Moreover, results are not compromised by possible multicentricity and/or positivity of axillary lymph nodes.

[Importance of early diagnosis in the improvement of prognosis in breast carcinoma: non-palpable lesions. Preliminary results]. / Importanza della diagnosi precoce per il miglioramento della prognosi del carcinoma mammario: le "lesioni non palpabili". Risultati preliminari.

There are still marked differences in the current indications for breast screening proposed by the various international school of oncology. Epidemiological data to the effect that breast screening in asymptomatic women aged over 50 reduces the death rate due to breast cancer now appears to be widely accepted, but an analogous finding for women aged between 40-49 has not yet been confirmed. Following a brief analysis of the most important breast screening programmes carried out to date, the Authors report the preliminary results regarding the identification and biopsy of non-palpable breast lesions during the course of a screening programme in 1986 by the Dept. of Cancer Surgery. Of a total of 1128 breast scans in asymptomatic patients aged between 40 and 73, 24 suspect (1.9%) non-palpable lesions were found of which 5 (20.8%) proved to be carcinomas.

[The value of the triad: clinical examination, mammography and needle aspiration cytology in the diagnosis of breast carcinoma. Our experience]. / Validità della tripletta: esame clinico, mammografia e citologia per agoaspirazione nella diagnosi del carcinoma della mammella. Nostra esperienza.

Based on the authors' personal experience of the use of the triad, clinical examination, mammography and needle-aspiration cytology, in the strategic diagnosis of breast cancer, the paper emphasizes the importance of early diagnosis as the sole means of obtaining an improved outcome. Using this integrated methodology the authors have obtained a specificity of 99%, sensitivity of 97.8%, and a diagnostic accuracy and prognostic value for positive tests of 98%. In conclusion, the authors affirm that the comparative interpretation of clinical examination, mammography and cytology appears to be an extremely efficacious and reliable method for the diagnosis of the nature of breast nodules.

[The value and limits of the follow-up in patients operated on for breast carcinoma. Our experience]. / Validità e limiti del follow-up delle pazienti operate per carcinoma mammario. Nostra esperienza.

The aim of follow-up is essentially that of diagnosing possible recidivation at a relatively early and practically asymptomatic stage in order to optimise the results of appropriate treatment and to improve both the overall survival rate and the patient's quality of life. In spite of the correct and systematic planning of controls, the authors underline that in their experience only 64.7% of relapses are diagnosed during the asymptomatic phase. However, the authors have confirmed that the expectation of relapse has a barely significant influence on survival. After five years of first receiving treatment, 83% of patients with relapses diagnosed in a symptomatic phase had died, compared to 81.7% of those with relapses diagnosed during the asymptomatic phase. In conclusion, in spite of the fact that it is possible to obtain early diagnosis of recidivation during follow-up, it is equally true that this has no influence at all on the survival rate. However, irrespective of these results, the authors maintain that it is useful to follow patients undergoing breast surgery through a periodic follow-up to evaluate the evolution of disease and acquire an increasingly precise and definite knowledge of its natural history. The authors put forward a protocol for follow-up in which patients are divided into groups on the basis of lymph node status and pre- or postmenopause.

[Role of ultrasonography in the diagnosis of carcinoma of the breast]. / II ruolo dell'ecografia nella diagnosi del carcinoma della mammella.

Breast ultrasonography is today a diagnostic technique whose results are either under or overestimated by different Authors. In this paper the Authors report their experience with ultrasound for the diagnosis of breast cancer. In 214 patients with palpable breast nodule ultrasonography employed as the only diagnostic technique allowed the diagnosis of breast cancer in 89.7% (61/68 patients), and in particular in 82.4% of T1 in 96.9% of T2 and in 100% of T3 tumors. From these data it can be resumed that breast ultrasonography reaches a good diagnostic reliability. Unfortunately the limits in defining malignancy of solid appearing mass don't allow its routine use as the gold standard for breast cancer diagnosis. We believe indeed that ultrasonography has an important role as an integrative diagnostic method among those commonly used in this field.