[Definitive breast cancer surgery as an outpatient: rationale and our experience]. / La chirurgia maggiore della mammella in day-surgery: razionale e nostra esperienza.

INTRODUCTION: The objective of this study was to evaluate the feasibility of outpatient breast definitive surgery. CASE AND METHODS: Between January 2001 and September 2003 181 definitive breast cancer surgical approaches were performed at Surgical Department of Genoa University on 173 patients. Mean age was 60 years (28-92). All the patients were discharged the day of surgery or the day after in the morning. RESULTS: There were no major complications or deaths. The specific complication rate was similar to inpatient setting and there was no readmission. The patients' quality of life and satisfaction were satisfactory or good. DISCUSSION: In conclusion, holding in due consideration some philosophical and technical changes, breast cancer surgery can be safely and comfortably performed on an outpatient basis.

Diagnostic and therapeutic approach to multiple endocrine neoplasia type 2B in pediatric patients.

Multiple endocrine neoplasia (MEN) 2B is a hereditary syndrome including medullary thyroid carcinoma (MTC), pheochromocytoma, gastrointestinal (GI) disorders, marfanoid facies, and multiple ganglioneuromas. MTC is the major cause of mortality, and often appears during the 1st decade of life. RET proto-oncogene mutations are responsible for MEN 2B. Other RET mutations cause MEN 2A syndrome, familial MTC, or Hirschsprung's disease. We studied three MEN 2B patients with the aim of delineating the best diagnostic and therapeutic protocol. The gold standards for diagnosis are histochemical study of the rectal mucosa and molecular analysis of RET, which in familial cases detects MEN 2B at a preclinical stage so that early total prophylactic thyroidectomy can be performed. In non-familial cases, the diagnosis can be suggested by the presence of GI symptoms, ganglioneuromas, and/or the typical facies. The intestinal innervation pattern, analyzed with the acetylcholinesterase technique, is pathognomonic for MEN 2B. In our protocol a rectal biopsy is, therefore, the first measure. The surgical treatment of MEN 2B is total thyroidectomy with cervical lymphadenectomy of the central compartment of the neck. When possible, this intervention should be performed prophylactically before 1 year of age.

Use of the new US90 standards for TW-RUS skeletal maturity scores in youths from the Italian population.

Recently, 1997, Tanner and co-workers provided a new scale converting TW-RUS standard maturity scores to skeletal age for European North American youths (US90). The aim of the present study was to test if the accuracy of TW-RUS bone age assessments in the Italian population could be improved by evaluating the estimates obtained with this new scale in comparison with other standards (UK60: original British series, B70: Belgian series and S80: Spanish series). 1,831 hand-wrist radiographs (Italian healthy subjects aged from 8 to 16.8 years) were evaluated. The US90 reference values are resulted the most suitable TW-RUS standards. Therefore, it seems useful to update the reference values of TW-RUS SMS in Italian youths, using this new scale.