No Coil® placement in patients undergoing left hemicolectomy and low anterior resection for colorectal cancer.

BACKGROUND: Colorectal cancer (CRC) is the most common tumor of the gastrointestinal tract. Anastomotic leak (AL) and prolonged postoperative ileus (PPOI) are two important complications of colorectal surgery. In this observational retrospective study, we evaluated the positive effects of transanal tube No Coil® in patients with CRC undergoing low anterior resection (LAR) and left hemicolectomy (LC). METHODS: Thirty-eight cases and forty controls resulted eligible for the final sample. No Coil® placement (SapiMed Spa, Alessandria, Italy) was considered an inclusion criteria for the case group. No Coil® was placed immediately after the end of surgical treatment. RESULTS: PPOI was significantly more frequent in the control group. AL was evident in 1 patient (2.6%) of cases and 3 patients (7.5%) of controls. No statistical difference was found in AL occurrence between groups. POI days and AL resulted associated with hospital stay. POI days were negatively associated with No Coil placement and positively with AL. CONCLUSION: With our preliminary data, we suggest that No Coil® placement can be considered as a valuable procedure assisting colorectal surgery, but further studies are required to confirm and enlarge actual evidence.

Gallstone ileus of the sigmoid colon. A case repor.

Gallstone ileus is a complication of cholelithiasis which is due to gallstone migration through a fistula between the gallbladder and the gastrointestinal tract followed by intraluminal impaction. This uncommon form of mechanical bowel obstruction occurs in <1% of patients with cholelithiasis. Gallstone ileus due to cholecystocolonic fistula is rare, and therefore appropriate surgical treatment is still a matter of debate. We describe a unusual case of gallstone ileus in a 74-year-old man with a history of cholelithiasis, admitted to our hospital with suspected largebowel obstruction. The diagnosis was made with abdominal computed tomography scan that showed a very large gallstone impacted in the sigmoid causing mechanical bowel obstruction. After endoscopic removal was attempted but proved unsuccessful, enterotomy was performed to remove the gallstone. At surgery a Meckel's diverticulum was discovered incidentally and removed and trasversostomy was performed. The patient was discharged on postoperative day 10. KEY WORDS: Gallstone ileus, Endoscopy, Large bowel obstruction, Cholecystocolonic fistula, Meckel's diverticulum.

Surgical treatment of intrathyroid metastases: preliminary results of a multicentric study.

BACKGROUND: Intrathyroid metastases (ITM) are rare and usually have a dismal prognosis. The aim of this study was to detect which neoplasms metastasize most often to the thyroid gland, their clinical features and treatment options. MATERIALS AND METHODS: Retrospective analysis of clinical files of 17,122 patients submitted to surgery for thyroid disease between 1995 and 2005. Twenty-five patients (median age 61 years) were affected by ITM. RESULTS: The site of the primary tumor was: kidney (15), lung (4), colon (3), breast (1), melanoma (1), and unknown in 1 patient. Ten patients (40%) complained of preoperative symptoms, in the others, thyroid involvement was incidentally discovered during the follow-up for the primary cancer. Twenty patients (80%) underwent total thyroidectomy, 3 received thyroid lobectomy and 2 palliative procedures. Morbidity was 16%, mortality was nil. The median follow-up was 24 months. CONCLUSION: ITM should always be suspected in any patient with a previous history of malignancy. Fine-needle agobiopsy (FNAB) with immunohistochemical stains may help in preoperative workup. A long delay between the primary tumor and the recurrence warrants surgery and total thyroidectomy seems to be the treatment of choice because of the multifocality of metastasis to the thyroid gland.

Long-term outcome after colorectal cancer resection. Patients' self-reported quality of life, sexual dysfunction and surgeons' awareness of patients' needs.

AIMS AND BACKGROUND: Current follow-up care programs focus mainly on detection of tumor recurrence or metachronous cancer. Other aspects that affect the quality of life (QoL) of long-term survivors, such as sexual dysfunction, psychological distress or depressive symptoms, have been poorly investigated. We studied these issues, and also investigated the surgeons' awareness of their patients' needs in order to determine how to improve follow-up care programs. METHODS: QoL of 62 colorectal cancer patients was assessed during follow-up using the European Organization for Research and Treatment of Cancer (EORTC) questionnaire QLQ-C30 and the symptom-specific module (QLQ-CR38). Postoperative sexual problems were evaluated with a 6-item questionnaire. Relevant needs to be examined during follow-up were investigated among patients and surgeons, by filling in the same checklist. RESULTS: During long-term follow-up (range,14-74 months), rectal cancer patients reported lower QoL than colon cancer patients regarding defecation-related problems (P = 0.0001). Sixty-one percent of colon cancer patients reported no sexual dysfunction, whereas only 24% of individuals with rectal cancer reported no problems (P = 0.007). Patients reporting no sexual problems had significantly better QoL than the others, particularly with respect to physical functioning (P = 0.001), social functioning (P = 0.05), financial problems (P = 0.01) and body image (P = 0.0001). Addressing emotional problems during follow-up was important for 26% of the patients, while this was neglected by surgeons (P = 0.03). CONCLUSIONS: QoL measurement in a clinical setting may help to detect QoL problems that could otherwise go unnoticed in the routine of follow-up care. Specifically, it was useful to detect defecation-related problems, sexual dysfunction and a mismatch in judging the importance of psychological distress between patients and their doctors. Neglecting these issues may cause long-term postoperative dissatisfaction.

[Preoperative diagnosis of incidental carcinoma in multinodular goitre by means of electromagnetic interactions]. / Diagnosi preoperatoria di carcinoma incidentale della tiroide in gozzo multinodulare mediante interazioni elettromagnetiche.

In the evaluation of multinodular goitre, finding a malignant neoplasia is often an unexpected result of the histological diagnosis. TRIMprob (Tissue Resonance Interaction Method Probe) is a portable system for non-invasive diagnosis, that utilises the different electromagnetic properties of healthy and pathological tissues, producing a low-power magnetic field that interacts with the molecular structure of tissues. The interference levels are detected by a receiver device and are elaborated with software in a graph consisting of 3 easily interpretable bands. The objective of our study was to assess the usefulness of the TRIMprob system in the preoperative diagnosis of carcinoma in patients with multinodular goitre. Over the period from January 2005 to March 2006 we used TRIMprob to screen 51 patients with a clinical diagnosis of multinodular goitre, later operated on by total thyroidectomy. We then compared the TRIMprob response with the histological diagnosis on the surgical specimen. The TRIMprob results suggested 46 cases compatible with non-malignant goitre and 5 suspected cancers. The final histological diagnosis confirmed these results with 46 cases of multinodular goitre and 5 papillary carcinomas. The sensitivity, specificity and diagnostic accuracy of the procedure were all 100%. On the basis of these preliminary results, TRIMprob seems to be a highly accurate method for the detection of suspected carcinomas in the context of multinodular goitre. If these results are confirmed, new prospects could be opened up in the diagnosis of thyroid diseases.

Gallstone ileus. A case treated with minilaparotomy and a review of the literature.

Gallstone ileus is a rare complication of cholelithiasis which occurs in less than 1% of patients and is the cause of 1- 4% of cases of small bowel obstruction. The pathogenesis involves the formation of a bilioenteric fistula. We report the case of gallstone ileus in an 81-year old woman with typical abdominal pain, arterial hypertension and coronary artery disease. An abdominal computed tomography (CT) scan showed pneumobilia, dilated loops of small bowel and an ectopic gallstone obstructing the intestinal lumen. The patient underwent enterolithotomy and a 5-cm stone 20 cm from the ileocecal valve was removed. In the literature enterolithotomy alone is the procedure most frequently used for gallstone ileus. Enterolithotomy plus cholecystectomy and/or fistulectomy is only indicated in selected patients. The clinical signs and symptoms depend on the site of the obstruction and usually include abdominal pain, nausea and vomiting. The diagnostic test of choice is an abdominal CT scan. KEY WORDS: Cholecystoenteric fistula, Gallstone ileus, Minilaparotomy.

The ACTIVE (Acute Cholecystitis Trial Invasive Versus Endoscopic) study: multicenter randomized, double-blind, controlled trial of laparoscopic (LC) versus open (LTC) surgery for acute cholecystitis (AC) in adults.

BACKGROUND: In some randomized trials successful laparoscopic cholecystectomy for cholecystitis is associated with an earlier recovery and shorter hospital stay when compared with open cholecystectomy. Other studies did not confirm these results and showed that the potential advantages of laparoscopic cholecystectomy for cholecystitis can be offset by a high conversion rate to open surgery. Moreover in these studies a similar postoperative programme to optimize recovery comparing laparoscopic and open approaches was not standardized. These studies also do not report all eligible patients and are not double blinded. DESIGN: The present study project is a prospective, randomized investigation. The study will be performed in the Department of General, Emergency and Transplant Surgery St Orsola-Malpighi University Hospital (Bologna, Italy), a large teaching institutions, with the participation of all surgeons who accept to be involved in (and together with other selected centers). The patients will be divided in two groups: in the first group the patient will be submitted to laparoscopic cholecystectomy within 72 hours after the diagnosis while in the second group will be submitted to laparotomic cholecystectomy within 72 hours after the diagnosis. TRIAL REGISTRATION: TRIAL REGISTRATION NUMBER ISRCTN27929536 - The ACTIVE (Acute Cholecystitis Trial Invasive Versus Endoscopic) study. A multicentre randomised, double-blind, controlled trial of laparoscopic versus open surgery for acute cholecystitis in adults.