[Thyroidectomy using the intra-operative neuromonitoring and the surgeon's confidence]. / Tiroidectomia totale con neuromonitoring. Esperienza sulla compliance dei chirurghi.

AIM: Reporting our experience with NIM-response 2.0 and 3.0 system in a series of 127 thyroidectomies. MATERIALS OF STUDY: 127 patients were operated at the "Magna Graecia" University (Catanzaro) from 2009 September to 2010 December, using the technique of IntraOperative NeuroMonitoring (IONM). For each patient the surgeon charge filled in a "questionnaire" assessing his/her compliance with the apparatus. RESULTS: We report 0.8% permanent and 0.4% transient recurrent laryngeal nerve paralysis. All surgeons have been fully satisfied from IONM technique. DISCUSSION: A recurrent laryngeal nerve lesion may occur in patients operated on total thyroidectomy between 5-8% for transient palsies and 1-3% for the permanent ones. The use of IONM seems to contribute to a reduction of transient paralysis, even if this method is still not widely accepted Nevertheless the compliance of the surgeons with IONM seems to develop very highly. CONCLUSIONS: NIM-response is helpful in protecting recurrent laryngeal nerve function. Advantages were observed in reduction of postoperative dysphonia and in improving the surgeon's confidence in performing a total thyroidectomy.

Solitary fibrous tumor of the pelvis: an uncommon soft-tissue tumor. A case report.

A rare case of Solitary fibrous tumor (SFT) of the pelvis is reported. A 76-years-old man presented with a low abdominal pain, acute urine retention and constipation. Imaging studies (US, CT MR) showed an 17 x 10 x 9 ovoid mass in the pelvis, dislocating bladder and rectum. Finally, trans-rectal needle biopsy suggested the diagnosis of SFT. En bloc excision of tumor and rectum (because of strong adhesions) was performed. Histological examination showed spindle and fibroblastic-like cells dispersed in collagenous areas with positive stains for CD34, bcl-2, CD99 and it confirmed diagnosis of SFT. No postoperative complications occurred, only vesico-sphincter dyssynergia was found by urodynamics. After 5 years, patient is disease-free. SFT is, usually, benign tumor with slow growth and excellent prognosis. Complete surgical resection is the only curative treatment. However, 10-15% of SFT are malignant and histological findings cannot always predict clinical behaviour. For this reason, careful and long term follow-up is necessary after surgery.

[Congenital diaphragmatic hernia in an adult: case report of acute abdomen]. / Ernia diaframmatica congenita nell'adulto: un caso di addome acuto.

Bochdalek diaphragmatic hernia usually begins during childhood, but may be an occasional finding even in adults. The treatment of choice is surgical repair to avoid herniated bowel complications. The operation often requires a combined approach consisting in thoracotomy and laparotomy. This is a convenient solution to eliminate the vascular risks (if there are additional concomitant embryonic defects, such as intestinal malrotation). We report a case of a female, aged 45 years, with epigastric cramp-like pain for 4 days and tenderness in the right abdominal quadrants during physical examination; the standard laboratory data showed decreased blood levels of calcium and potassium. Chest and abdominal X-rays revealed significant, widespread colic distension and the presence of a colic loop in the chest. We confirmed these results by CT and barium enema and proceeded with urgent surgery consisting in a right hemicolectomy (extended as far as the left part of the tranverse colon) for volvulus and with stitching of the diaphragmatic gap. We also discovered incomplete intestinal malrotation. After surgery, complete remission of the clinical symptoms was achieved. This case report demonstrates that, despite the apparent clinical silence, congenital diaphragmatic hernia in an adult may often manifest itself with particular gravity calling for urgent surgery.

[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.

[Relief of gastric cancer with an electromagnetic interaction system (TRIMprob) in outpatients]. / Rilievo di carcinoma gastrico mediante sistema di interazioni elettromagnetiche (TRIMprob) in pazienti ambulatoriali.

Gastric cancer is currently an important clinical and social problem. TRIMprob is a portable system for the non-invasive diagnosis of gastric cancer, designed to differentiate between normal and pathological tissues on the basis of their electromagnetic characteristics. The aim of our study was to evaluate the accuracy and feasibility of use of the TRIMprob system in diagnosing gastric neoplasms. From January to September 2006 we screened 28 symptomatic patients with TRIMprob; afterwards they underwent an endoscopic and bioptic examination. On the basis of the histological diagnosis these patients were divided into 2 groups: group A (patients with a diagnosis of gastric malignancies) and group B (patients with inflammatory disease). There also was a group C, which was a control group of 15 asymptomatic volunteers. The TRIMprob system located all cases of gastric cancer (group A) with 100% sensitivity, specificity and accuracy. The TRIMprob examination seems to be extremely accurate in diagnosing gastric malignancies. If these results are confirmed, TRIMprob could be used for the early diagnosis of gastric cancer and for selecting symptomatic subjects for gastroscopy.