[Surgical treatment of sinus pilonidalis by Dufourmentel's flap technique]. / Il trattamento chirurgico del sinus pilonidalis con trasposizione di lembo secondo Dufourmentel.

The present study reports the results of surgical treatment of 175 consecutive chronic pilonidalis sinus cases by excision alone, excision and primary closure, excision and Dufourmentel's flap technique. The analysis of hospital stay , average recovery time, patient compliance and percentages of failures and recurrences enables us to state that Dufourmentel's technique is the best choice, allowing fast recovery with minimal discomfort and lower rate of recurrence. Moreover the good compliance of the technique and the use of recently introduced more effective local anaesthetics have allowed us to plan the treatment in a day-surgery setting with good clinical results.

[Post-thyroidectomy hypocalcemia. Personal experience]. / L'ipocalcemia post-tiroidectomia. La nostra esperienza.

BACKGROUND: The study evaluates the incidence of both early and protracted post-thyroidectomy hypocalcemia over a 6-year period (1995-2000) in a series of 330 consecutive thryoid operations. The aim was to identify the profile of patients with the greatest risk of permanent parathyroid functional insufficiency and a suitable treatment protocol. METHODS: Having performed a statistical ana-lysis of all the variables, we divided the entire population of 330 patients into 4 groups based on the extent of demolition, the method of organotherapeutic replacement with L-Thyroxine and the (eco-radioguided) procedure used to identify the parathyroids: 59 patients undergoing subtotal thyroidectomy; 155 patients undergoing total thyroidectomy who commenced replacement organotherapy from postoperative day 15-30; 94 patients undergoing total thyroidectomy who commenced replacement organotherapy from postoperative day 1; 22 patients undergoing total thyroidectomy who underwent routine intraoperative parathyroid assay. RESULTS: The results show that the impact of more radical surgery in determining hypocalcemia, in particular protracted hypocalcemia, represents the most striking characteristic of patients with the greatest probability of permanent parathyroid insufficiency. We emphasise that early correction of postoperative hypothyroidism can drastically reduce the incidence of both early and protracted hypocalcemia. CONCLUSIONS: In conclusion, hypoparathyroidism is an exceptional event, whereas hypocalcemia is relatively common after total thyroidectomy. The effects of the early correction of postoperative hypothyroidism are undoubtedly beneficial, as is the use of eco- and radioguided methods for the intraoperative identification of the parathyroid glands, although they are not free from limits and criticism.

[Differentiated thyroid carcinoma. Prognosis and therapy]. / Cancri differenziati della tiroide. Prognosi e terapia.

BACKGROUND: We have conducted retrospective analysis of 90 cases of Differentiated Thyroid Cancer (DTC) operated between 1978 and 1998. The aim of this study was to verify the most widely used prognostic factors and to try to identify differences in the development of these tumors. METHODS: The DTCs, selected from the histopathologic reports of the Institute of Pathologic Anatomy, were divided into high, intermediate and low malignancy tumors according to the classification of Carcangiu and Rosai. RESULTS: We found that age >45 years associated with a cancer larger than 1.5 cm and intermediate malignancy was related to the most dismal prognosis. Ten of the 90 cases had a dismal prognosis; 6/10 (60%) had disease recurrence. Four of those six patients died; one has disease recurrence 5 months after surgery, and one patient with disease recurrence after one year was lost to follow-up. The identification of metastases at the primary operation is of course an unfavourable prognostic factor. In fact, all of the six cases with metastases had disease recurrence after the treatment: three patients have died; two survive (one have a disease period of 5 months and the other a disease period of 2 years); one patient with disease recurrence one year after surgery was lost to follow-up. CONCLUSIONS: The most significant negative factors for prognosis purposes were the higher degrees of T, the presence of metastases at diagnosis or their appearance at follow-up, age greater than 45, male sex and areas of dedifferentiation within the histological pattern. Total thyroidectomy remains the treatment of choice.

[Primary lymphoma of the gastrointestinal tract]. / Linfomi primitivi gastrointestinali.

BACKGROUND: A retrospective analysis of 12 years' experience (1987-1999), concerning gastro-intestinal lymphomas (LNH-GI) has been performed, to offer a contribution for the identification of the diagnostic and prognostic criteria. METHODS: During this period, 11 cases (9 male and 2 female) have been treated: 8 with gastric localization and 3 with intestinal localization, with age ranging between 12 and 78 years. Most of the analyzed cases (5 cases out of 8 with gastric localization and all the cases with intestinal localization) underwent surgical treatment without a sure understanding of the nature of lymphoma. Clinical observation showed forms in an advanced state of local development. RESULTS: However, the low specifity of available diagnostic tools and the therapeutic delay are factors that seems do not influence the prognosis, as well as the stage of the disease determined with traditional classification methods. The aspect that seems to be crucial for the prognosis of the disease is the histotype (5 low grade cases free of desease from 36 months to 10 years, vs 4 high grade cases died between 46 days and 40 months after the surgical treatment). CONCLUSIONS: Some interesting considerations arise from the analysis of the diagnostic procedure and from the method of treatment: the specifity and precocity of the diagnosis could be improved by a large use of endoscopic ultrasonography that allow to obtain deep biopsy; the identification of histotype before surgical treatment can address and modulate the therapeutic strategy eliminating the over treatment for L.G. forms.