Surgical treatment of anaplastic thyroid carcinoma. Our experience.

BACKGROUND: In anaplastic thyroid carcinoma (ATC) surgical resection associated to radiotherapy and chemotherapy can ameliorate local disease control with occasional long-term survivals. PATIENTS AND METHODS: Resection of the tumor was accomplished in 20 ATC patients, with no macroscopic (13 cases) or minimal residual neck disease infiltrating vital structures (7 cases). Ten of these patients (50%) had distant metastases. Sixteen cases were also treated with radiotherapy and chemotherapy, while in one patient only chemotherapy was possible; 2 patients refused further therapy; the last one is starting adjuvant treatment. Morbidity and survival were analysed, and compared with other 15 ATCs submitted to partial tumor debulking or not operated at all (control group). RESULTS: Function of at least one laryngeal recurrent nerve was preserved in all 20 patients; none experienced permanent hypoparathyroidism. At last follow-up examination 17 patients had died and 3 were alive 1, 6 and 80 months after the operation, the latter being free of disease. Survival of dead patients ranged from 3 to 28 months (mean: 8 months). In the control group all patients died, survival ranging from 1 to 13 months (mean: 4 months). Actuarial analysis of survival showed a significant difference between the two groups (p = 0.0112); multivariate analysis of several prognostic factors confirmed that complete or near complete tumour resection was the most relevant. CONCLUSIONS: Surgical resection is an important component of the multimodal treatment of ATC and should be attempted whenever possible.

Neurofunctional effects of developmental sodium fluoride exposure in rats.

Contrasting studies on the toxic effects of sodium fluoride (NaF) during developmental stages of Wistar rats, lead us to investigate the neurofunctional effects caused by its perinatal exposure, devoid of any overt sign of toxicity and/or gross malformation. NaF solution was administered to pregnant rats by intragastric gavage at a daily dose of 2.5 and 5.0 mg/kg from gestational day 0 to day 9 after parturition. Developmental NaF exposure caused sex and dose specific behavioural deficits which affected males more than females in the majority of the evaluated end-points. In particular, the perinatal exposure to NaF 5.0 mg/kg, significantly affected learning, memory, motor coordination and blood pressure only in male rats. Conversely, a lack of habituation upon the second presentation of the objects and failure in the ability to discriminate between the novel and the familiar object were observed only in NaF 5.0 mg/kg female rats. Finally, a significant impairment of sexual behaviour was observed in male rats at both NaF dose levels. The present data indicate that perinatal rat exposure to NaF results in long lasting functional sex-specific alterations which occur at fluoride levels approaching those experienced by offspring of mothers.

[Surgical treatment of Graves' disease: results in 108 patients]. / Trattamento chirurgico del morbo di basedow: risultati in 108 pazienti.

AIM OF THE STUDY: To evaluate morbidity and functional results of surgical treatment in patients with Graves' disease. METHODS: A retrospective study was performed in 108 patients operated on during 1993-2003. Main indications for surgery were failure of treatment with antithyroid drugs (80.6%), large goiter (46.3%) and/or severe ophthalmopathy (23.1%). Surgical procedures were extensive subtotal thyroidectomy (EST; n = 33; uni- or bilateral remnant of <2 g) or total thyroidectomy (TT; n=75). Functional results were established in 89 patients (27 EST patients and 62 TT patients) after a mean follow-up of 5.9 years. RESULTS: Operative mortality was zero. There were 4 (3.7%) transient unilateral recurrent laryngeal nerve (RLN) palsies and no cases of permanent RLN palsy. Temporary hypocalcemia occurred in 15 patients (13.9%) and permanent hypoparathyroidism resulted in two (1.9%). Four patients (3.7%) developed a postoperative hematoma that required reoperation. There was no significant difference in the rate of complications between EST and TT, although temporary hypocalcemia was more common following TT than EST (17.3% vs. 6.1%) and permanent hypoparathyroidism affected only TT patients. None of the patients developed recurrent hyperthyroidism; all patients are maintained on levothyroxine. CONCLUSIONS: Surgery is an effective therapy for selected cases of Graves' disease. When performed by experienced surgeons, it can be carried out with no mortality and minimal morbidity. EST (with uni- or bilateral remnant of <2 g) and TT are both effective in order to achieve a definitive cure of hyperthyroidism.

[Ulcerative rectocolitis: review of clinical characteristics in patients with distal colitis and extended colitis]. / Rettocolite ulcerosa: revisione delle caratteristiche cliniche nei pazienti con colite distale e colite estesa.

Ulcerative colitis is an inflammatory disease which, starting from the rectum, affects more or less extended tracts of the colon. Given that distal and extended forms are generally described as a single nosological entity, the authors aimed to verify whether there are any clinical differences between the two groups of patients with varying extents of disease. A retrospective review was made of data relating to 189 patients suffering from ulcerative colitis observed over a 90-months period. Only 111 cases were included in the study: all patients had undergone an endoscopic and histological diagnosis with a follow-up of over one year. Seventy-eight patients (41.26%) were excluded from the study because they had been lost during follow-up, or follow-up had lasted less than one year, or it had not been possible to perform pancolonoscopy. The 111 patients examined were subdivided into 2 groups: one (39 patients) with distal colitis, namely involving the rectum or recto-sigmoid, and the other (72 patients) with more extended disease. The extension of disease was evaluated on the basis of histological findings. The mean follow-up was 5 years and 11 months. The two groups were comparable for age, sex, number of annual attacks, maximum duration of disease-free periods, clinical evolution, predominant symptoms, extraintestinal symptoms and surgical treatment. Results were processed using Student's t test and the chi-square test.(ABSTRACT TRUNCATED AT 250 WORDS)

Psychological distress and levels of disease activity in inflammatory bowel disease.

The aim of this study was to evaluate the association between anxiety and depression, and levels of disease activity (LDA) in IBD patients. One hundred and fifty IBD patients (91 males and 59 females) were assessed by means of the Hospital Anxiety and Depression scale, and divided into three LDA groups according to standard clinical criteria: LDA1 = absence, LDA2 = mild, LDA3 = moderate and severe. Using the analysis of variance and the Scheffé test, a significant difference was found in the anxiety score, but not in the depression score, between LDA1 and LDA3 (p < 0.005). The risk of developing anxiety and depression in relation to LDA was estimated by multiple logistic regression. A significant linear trend (p < 0.01) to develop anxiety was found in the highest LDA. Our study showed that anxiety was significantly associated with a higher disease activity and suggested that anxiety should be appropriately evaluated and treated with the exacerbated symptoms in IBD patients.

[Body Image Index in the Rorschach test in ulcerative proctocolitis]. / Body-Image Index al test di Rorschach nella rettocolite ulcerosa.

The use of the Rorschach test allows the body image to be examined using the Body-Image Index formulated by Fisher-Cleveland. This index is obtained by calculating the responses to Penetration and Barrier. The hypothesis is that the diseases which affect the inside of the body are more greatly correlated to a high P score and a low B score (high P-low B type personality). The paper examines the Body-Image Index in a sample of 41 patients suffering from ulcerous rectocolitis comprising 24 males and 17 females with a mean age of 32 years. The personality profile obtained is of the "high P-low B" type with a P/R% ratio which is clearly higher than the central mean value (28.7% vs 8%) and a B/R% ratio which is clearly lower than the central mean value (4.2% vs 18%). The personality of the patients in this group was marked by a tendency to anxiety and a tendency to express aggression within their bodies (anger-in) which was field-dependent, difficulty in tolerating stress, a tendency to react somatically to conflicts, a low degree of body image stability and a constant need for an external holding object.

Venous and arteriovenous vascular malformations: diagnostic and therapeutic considerations regarding 239 patients observed in the 1978-1991 period.

The Authors report their experience in the treatment of venous and arteriovenous malformations, which in this paper are divided into two subgroups, pure venous malformations (VMs) and arteriovenous malformations (AVMs). A pure surgical indication was evident in less than 50% of cases (48.1%), while more conservative treatments were performed in remaining patients. Considering the particular characteristics of the disease, a complete surgical radicality isn't always possible, so surgery must be considered in selected cases.

[Pathology of adaptation according to Sami-Ali and index of conformity to the Rorschach test in ulcerative rectocolitis]. / Patologia dell'adattamento secondo Sami-Ali e indice di conformismo al test di rorschach nella rettocolite ulcerosa.

According to Sami-Ali's theoretical model the psychosomatic personality is characterised by an adaptation pathology whose main elements are the repression of imaginative thought and conformity to socio-cultural standards. This study examines adaptation pathology using the Rorschach test. The Authors have formulated a conformity index by relating kinestheses (M) and banal perceptions (BAN). The study was carried out on a sample of 41 patients suffering from ulcerous rectocolitis comprising 24 males and 17 women with a mean age of 32 years. As expected in the hypothesis 97.6% of the sample showed M values below the norm, and 68.3% had Ban values higher than normal, whereas the conformity index was positive and tendentially positive in 65.9% of cases. These findings confirm Sami-Ali's theory. Subjects with ulcerous rectocolitis form part of the adaptation pathology which characterised the psychosomatic personality, with an inverse proportionality between imaginative activity (kinesthesia below normal) and conformism (banal perceptions above the norm).

[Intraoperative microbiological monitoring in abdominal aortic aneurysms in elective surgery. A review of the literature and the authors' personal experience]. / Il monitoraggio microbiologico intraoperatorio negli aneurismi dell'aorta addominale operati in elezione. Revisione della letteratura ed esperienza personale.

Thirty-one patients, ranging in age from 57 to 78 years (mean 66), with the exclusion of cases with doubtful possible results, underwent abdominal aortic aneurysmectomy for asymptomatic AAA and had cultures from the aneurysmal wall and endovascular thrombus to identify possible microbiological source of future graft infection; 5 (16%) of 31 cultures yielded bacterial growth and the most common organism isolated was staphylococcus epidermidis. During an average follow-up of 15.4 months no graft infection was noted in patients with positive or negative aortic cultured. A literature review stresses the same disparity between positive cultures obtained at the aneurysmectomy and subsequent low graft-infection rate. It is concluded that the aneurysm wall itself does not represent an important source of early or late graft infection and it's suggested that the bacterial presence both in the wall and thrombus could be explained by an exogenous contamination at the operation time.

[The clinical and socioeconomic aspects of cerebrovascular diseases in Europe (a study in Turin on patients during 12 years of hospitalization)]. / Consideraciones clínicas y socioeconómicas sobre las enfermedades cerebrovasculares en Europa (estudio en Torino efectuado en enfermos durante 12 años de hospitalización).

During the period 1976-1987, 295,718 patients affected by vascular diseases have been admitted into all the public and private hospitals of Piemonte (Italy): 172,483 patients were affected by arteriopathies. 95,231 (55.2%) have been admitted because of cerebrovascular diseases: 73,511 (42.6%) were affected by diffuse form (T), 18,258 (26.5%) by TIA and 3,462 (2%) by precerebral stenosis and occlusions. (TSA). These data have been compared to the incidence of cerebrovascular disease in Europe and risk factors, sex, age, department of hospitalizations, kind of therapy and results have been investigated. In Piemonte cerebrovascular diseases show not only the highest incidence among all the vascular diseases, but they seem to be the highest cause of morbidity among all the patients admitted into the hospitals.

[Psychological disorders in patients with enterostomy. The influence of age]. / Disturbi psicologici in pazienti portatori di enterostomia. Influenza dell'età.

A retrospective study of patients who had undergone enterostomy and subsequent follow-up in the past 9 years was carried out with the aim of identifying differences with relation to symptoms of depression, the deterioration of social relations and sexual disturbances between elderly (age greater than or equal to 65) and non-elderly patients (age less than 65). Depressive symptoms were present to a greater extent in elderly (48.6%) than in non-elderly patients (34.8%), whereas sexual disturbances were experienced more in non-elderly (34.8%) than elderly (21.6%) patients. No striking differences were noted with regard to the deterioration of social relations. The differences observed, although marked in terms of percentage, were not statistically significant given the relatively small number of cases examined.

[Incidence of aortic aneurysms in Piedmont]. / Incidenza degli aneurismi aortici in Piemonte.

A retrospective clinico-epidemiological study of the incidence of all arteriopathy hospitalization in the Region of Piemonte over a twelve year period (1976-1987) has been performed: among all the cases, patients affected by aortic aneurysm show an average of hospitalization of 0.8 cases per 24 hours. The prevalence of the sex has been pointed out for males (75.5% versus 24.3% of females): the men showed a higher rate independently from the age. The most involved age groups are for population between 70 and 74 years, but, from 1976 up to 1987 we have observed a more homogeneous distribution than in the first considered cases when it was mainly for patients aged more than 70 years. We have to stress a curious and not under standable datum regarding the kind of therapy: patients were treated medically in 69.4% of cases, while surgery was carried out only in 27.9%, but, fortunately, since 1976, we have noticed a continuous increase of surgery up to 40% in 1987. Hospitalizations have regarded the wards of Internal medicine in 24% of cases, while both General Surgery and Vascular Surgery showed rates of 23% and 25%. The average hospitalization time has been lower if compared to that of all the arteriopathies: 14.4 days versus 22.5. Furthermore we have to point out a decrease in average days of hospitalization for aneurysms of the aorta and a decrease in the costs for this pathology. Mortality is still high, also if referred to the non-operated patients: in fact the mean is 25.5% with a low rate of necropsies (mean 29%).

[Disabling outcomes and psychological disorders in the patient with an enterostomy]. / Esiti invalidanti e disturbi psicologici nel paziente portatore di enterostomia.

The authors carried out a retrospective study of patients undergoing enterostomy during the past 9 years. From 1981 to present a total of 60 patients (39 males and 21 females) were operated and subsequently followed-up. The aim of the study was to examine the following factors: the diagnosis which led to operation, the type of stoma used, early and late complications, the behaviour of the alvus, psychological disorders and Karnofsky's Performance-Status Index. After having presented the findings, the surgical results obtained are discussed together with the patient's psychological reactions to stoma. All types of early surgical complications were absent in 66.6% of patients, whereas late complications were absent in 41.6%. Even in those cases where surgical techniques and prostheses permitted a satisfactory post-operative outcome, the sociopsychological and sexual problems relating to the wound and the perceived difference between the real and ideal Ego are highlighted.

[Prevention of duodenal ulcer recurrence by the use of anti H2. Comparison of continuous long-term and seasonal therapy]. / Prevenzione della recidiva di ulcera duodenale con anti H2. Confronto tra terapia a lungo termine continua e stagionale.

The Authors have assessed the incidence of ulcer recidivation in patients with cicatrized bulbar ulcers following anti H2 treatment using two maintenance therapy protocols: 1) 400 mg/day of cimetidine in a single evening dose for 1 year (continuous therapy); 2) the same dose of cimetidine administered at the same time but only for 4 months a year (February-March and September-October) (seasonal therapy). Ninety patients with cicatrized ulcers which had been diagnosed using endoscopy were randomly assigned to the two treatment protocols. Protocols were followed for a least one year with endoscopic controls every 6 months. There were no significant differences between continuous and seasonal therapy in relation to the recurrence of duodenal ulcers (Log Rank test p less than 0.05). Cox's proportional hazard model was used to assess the effect of the two treatment protocols on ulcer recurrence eliminating the influence of sex, age and smoking; it was seen that only smoking influenced the incidence of recidivation (p less than 0.05). These results suggest that seasonal maintenance therapy with anti H2 is as efficacious as continuous therapy in preventing the recurrence of ulcers.

[Evaluation of pre- and postoperative cerebral hemodynamics in extracranial carotid surgery using transcranial Doppler. Preliminary note]. / Valoración de la hemodinámica cerebral pre- y postoperatoria en la cirugía de las carótidas extracraneales mediante Doppler transcraneano. Nota preliminar.

The Authors report their preliminary experiences concerning the use of transcranial Doppler (TCD) in the pre- and postoperative monitoring of extracranial carotid surgery. TCD is a non invasive method of investigation able to give informations about the distribution of cerebral blood flow and about the mechanisms of compensation of Willis' circle. Furthermore, TCD showed itself to be very useful in the postoperative qualitative evaluation of surgery, pointing out, as a general rule, an increased flow in the middle cerebral artery after thromboendarterectomy of internal carotid artery. This haemodynamic modification, if present, is perceptible since the immediate postoperative period and becomes more evident and definitely stable at a distance of 20-30 days after operation, likewise the definitive stabilization of Willis' circle's haemodynamics.

[Intestinal occlusion caused by ileo-colic invagination in a patient with intestinal metastasis of melanoma]. / Occlusione intestinale da invaginazione ileo-colica in un paziente con metastasi intestinale da melanoma.

An unusual case of intestinal obstruction due to ileal metastatic melanoma is reported. An ileocolic intussusception led to intestinal obstruction. The patient underwent palliative surgery to re-establish intestinal continuity.

[Bandage of the common femoral artery after intervention of disobliteration or aneurysmectomy (considerations on surgical technic apropos of 4 cases)]. / Bendaggio dell'arteria femorale comune dopo interventi di disobliterazione o di aneurismectomia (considerazioni di tecnica chirurgica a proposito di 4 casi).

The Authors refer their surgical experience in those particular cases in which, after performing an aneurysmectomy or an endarterectomy of common femoral artery, the residual arterial wall appears too thin and weakened. In these not very rare cases, can be indicated, as an additional and prudent manoeuver in order to avoid a possible evolution towards suture disruption or pseudoaneurysm formation, the wrapping or banding of the endarterectomized tract of artery by the mean of dacron prosthesis, sutured around the artery longitudinally. This simple technique, performed in 4 patients, appears easy and safe to perform, offering the advantage to guarantee a biological arterial lumen.