[Hürthle cell neoplasms of the thyroid gland]. / Le neoplasie della tiroide a cellule di Hürthle.

From 1986 to 1996 the Authors have surgically treated 34 patients affected with Hürthle cell neoplasm of the thyroid (23 benign and 11 malignant). Preoperative diagnosis was obtained mainly by fine needle aspiration biopsy. In thyroid surgery we routinely prepare laryngeal nerve and take great care to avoid devascularization fo the parathyroid glands. Operative procedures performed were hemithyroidectomy plus isthmectomy (18), subtotal thyroidectomy (2) and total thyroidectomy (14). No cervical lymph node dissection was requested, neither we observed post-operative morbidity. Mean follow-up was 116 months. During observation period we documented. No hematogenous metastasis was observed. All patients are now well and alive free of disease. This series stresses the favourable behavior of Hürthle cell neoplasm of the thyroid--even through a prolonged follow-up. A thorough review of the Literature on the topic is conducted. The Authors are in favour of total thyroidectomy as first choice procedure for lesions larger than 40 mm in order to reduce the need of completion thyroidectomy and the potential morbidity.

[Clinico-pathological study of microcarcinoma of the thyroid]. / Studio clinico-patologico del microcarcinoma della tiroide.

We have analysed the results of surgical treatment for microcarcinoma of the thyroid (MCT). In sixteen patient clinical and follow-up data were retrospectively evaluated during a 35.1-month follow-up. Thyroid hyperfunctional state us was present in two subjects. A single nodule was detected by echotomography in 11 patients, while multinodular diffuse goitre was revealed in 3 patients. In the last two subjects, thyroid gland appeared completely normal at ultrasonography, despite laterocervical lymph node metastases. Fine-needle aspiration biopsy was performed in 6 patients and its diagnostic accuracy was high (83,3%). MCT was classified as "incidental" in 12 patients and "occult" in the remaining 4 patients. Eight subjects underwent total thyroidectomy and 8 hemithyroidectomy plus isthmectomy. No postoperative complications were recorded. In 10 patients MCT histotype was papillar adenocarcinoma, in 5 was follicular adenocarcinoma and in the remaining case it was medullary carcinoma. Goitre was associated in 75% of the cases. Only in a patient disease progressed to death because of hematogenous metastases. In conclusion, we believe that incidental MCT is a low-grade malignancy with a benign biological behaviour. Occult MCT is a potentially lethal disease. We did not observe differences in the long-term results between different surgical treatments of MCT.

[Medullary carcinoma of the thyroid. A report of 4 clinical cases and a review of the literature]. / Il carcinoma midollare della tiroide. Presentazione di quattro casi clinici e revisione della letteratura.

Medullary thyroid carcinoma is an uncommon neoplasia among other differentiated carcinomas or the thyroid gland. We have retrospectively analysed four new cases of medullary thyroid carcinoma and a careful review or the literature on the subject has been conducted.

[The surgical treatment of a differentiated thyroid carcinoma infiltrating the large mediastinal veins]. / II trattamento chirurgico del carcinoma tiroideo differenziato infiltrante i grandi vasi venosi mediastinici.

The authors report on 2 patients affected by well-differentiated, locally advanced, thyroid carcinoma infiltrating the major mediastinal veins. Removal of the neoplastic mass was possible through a combined cervical and trans-sternal approach. Surgical indication, operative strategy and follow up are discussed. A review of the literature is also reported.

[Regional hemodynamic evaluation of heterotopic liver transplantation by the determination of the hepatic artery resistance index]. / Valutazione emodinamica distrettuale nel trapianto eterotopico de fegato attraverso la determinazione dell'indice di resistenza dell'arteria epatica.

Hepatic artery resistance index (I.R.) was evaluated in six pigs through Doppler scan after progressive gauge reduction of the portal vein up to complete clamping. The I.R. values were (mean +/- S.D.): 0.48 +/- 0.01 in basal conditions; 0.37 +/- 0.03, and 0.33 +/- 0.01 with a reduction of 1/3 and 2/3 respectively; 0.27 +/- 0.02 after complete portal clamping. These data confirm the close relationship existing in the hepatic circulation between changes of the arterious resistence and those of the portal flow. The same animals, subsequently, underwent heterotopic liver transplantation in the right paracolic gutter. Immediately after surgery the I.R. values of the transplanted hepatic artery were recorded without clamping (basal portal flow 0.52 +/- 0.02) and after clamping of the transplanted portal vein (0.33 +/- 0.03), while maintaining clamped the recipient portal vein at the hilus. These values were comparable to those obtained in the recipient hepatic artery. These data suggest that, in spite of parenchymal damages secondary to surgical procedure and of the haemodynamically unfavorable site in which the organ is transplanted, heterotopic liver transplantation does not produce significant changes in hepatic arterious resistance.