Cryotherapy versus radiofrequency ablation in the treatment of dysplastic Barrett's esophagus with or without early esophageal neoplasia: a systematic review and meta-analysis.

BACKGROUND/AIMS: Radiofrequency ablation (RFA) is the first-line therapy for dysplastic Barrett's esophagus (BE). Therefore, cryotherapy has emerged as an alternative treatment option. This study aimed to compare the efficacies of these two techniques based on the rates of complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D). Adverse events and recurrence have also been reported. METHODS: An electronic search was conducted using the Medline (PubMed), Embase, LILACS, and Google Scholar databases until December 2022. Studies were included comparing cryotherapy and RFA for treating dysplastic BE with or without early esophageal neoplasia. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Three retrospective cohort studies involving 627 patients were included. Of these, 399 patients underwent RFA, and 228 were treated with cryotherapy. There was no difference in CE-IM (risk difference [RD], -0.03; 95% confidence interval [CI], -0.25 to 0.19; p=0.78; I2=86%) as well as in CE-D (RD, -0.03; 95% CI, -0.15 to 0.09; p=0.64; I2=70%) between the groups. The absolute number of adverse events was low, and there was no difference in the recurrence rate. CONCLUSION: Cryotherapy and RFA were equally effective in treating dysplastic BE, with or without early esophageal neoplasia.

Efficacy, Feasibility, and Safety of the X-Tack Endoscopic HeliX Tacking System: A Multicenter Experience.

BACKGROUND AND AIMS: The application of endoscopic suturing has revolutionized defect closures. Conventional over-the-scope suturing necessitates removal of the scope, placement of the device, and reinsertion. A single channel, single sequence, through-the-scope suturing device has been developed to improve this process. This study aims to describe the efficacy, feasibility, and safety of a through-the-scope suturing device for gastrointestinal defect closure. METHODS: This was a retrospective multicenter study involving 9 centers of consecutive adult patients who underwent suturing using the X-Tack Endoscopic HeliX Tacking System (Apollo Endosurgery). The primary outcomes were technical success and long-term clinical success. Secondary outcomes included adverse events, recurrence, and reintervention rates. RESULTS: In all, 56 patients (mean age 53.8, 33 women) were included. Suturing indications included fistula repair (n=22), leak repair (n=7), polypectomy defect closure (n=12), peroral endoscopic myotomy (POEM) site closure (n=7), perforation repair (n=6), and ulcers (n=2). Patients were followed at a mean duration of 74 days. Overall technical and long-term clinical success rates were 92.9% and 75%, respectively. Both technical and clinical success rates were 100% for polypectomies, POEM-site closures, and ulcers. Success rates were lower for the repair of fistulas (95.5% technical, 54.5% clinical), leaks (57.1%, 28.6%), and perforations (100%, 66.7%). No immediate adverse events were noted. CONCLUSION: This novel, through-the-scope endoscopic suturing system, is a safe and feasible method to repair defects that are ≤3 cm. The efficacy of this device may be better suited for superficial defects as opposed to full-thickness defects. Larger defects will need more sutures and probably a double closure technique to provide a reinforcement layer.

Endoscopic ultrasound artificial intelligence-assisted for prediction of gastrointestinal stromal tumors diagnosis: A systematic review and meta-analysis.

BACKGROUND: Subepithelial lesions (SELs) are gastrointestinal tumors with heterogeneous malignant potential. Endoscopic ultrasonography (EUS) is the leading method for evaluation, but without histopathological analysis, precise differentiation of SEL risk is limited. Artificial intelligence (AI) is a promising aid for the diagnosis of gastrointestinal lesions in the absence of histopathology. AIM: To determine the diagnostic accuracy of AI-assisted EUS in diagnosing SELs, especially lesions originating from the muscularis propria layer. METHODS: Electronic databases including PubMed, EMBASE, and Cochrane Library were searched. Patients of any sex and > 18 years, with SELs assessed by EUS AI-assisted, with previous histopathological diagnosis, and presented sufficient data values which were extracted to construct a 2 × 2 table. The reference standard was histopathology. The primary outcome was the accuracy of AI for gastrointestinal stromal tumor (GIST). Secondary outcomes were AI-assisted EUS diagnosis for GIST vs gastrointestinal leiomyoma (GIL), the diagnostic performance of experienced endoscopists for GIST, and GIST vs GIL. Pooled sensitivity, specificity, positive, and negative predictive values were calculated. The corresponding summary receiver operating characteristic curve and post-test probability were also analyzed. RESULTS: Eight retrospective studies with a total of 2355 patients and 44154 images were included in this meta-analysis. The AI-assisted EUS for GIST diagnosis showed a sensitivity of 92% [95% confidence interval (CI): 0.89-0.95; P < 0.01), specificity of 80% (95%CI: 0.75-0.85; P < 0.01), and area under the curve (AUC) of 0.949. For diagnosis of GIST vs GIL by AI-assisted EUS, specificity was 90% (95%CI: 0.88-0.95; P = 0.02) and AUC of 0.966. The experienced endoscopists' values were sensitivity of 72% (95%CI: 0.67-0.76; P < 0.01), specificity of 70% (95%CI: 0.64-0.76; P < 0.01), and AUC of 0.777 for GIST. Evaluating GIST vs GIL, the experts achieved a sensitivity of 73% (95%CI: 0.65-0.80; P < 0.01) and an AUC of 0.819. CONCLUSION: AI-assisted EUS has high diagnostic accuracy for fourth-layer SELs, especially for GIST, demonstrating superiority compared to experienced endoscopists' and improving their diagnostic performance in the absence of invasive procedures.

Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas: Basic principles and recommendations.

Post-surgical leaks and fistulas are the most feared complication of bariatric surgery. They have become more common in clinical practice given the increasing number of these procedures and can be very difficult to treat. These two related conditions must be distinguished and characterized to guide the appropriate treatment. Leak is defined as a transmural defect with communication between the intra and extraluminal compartments, while fistula is defined as an abnormal communication between two epithelialized surfaces. Traditionally, surgical treatment was the preferred approach for leaks and fistulas and was associated with high morbidity with significant mortality rates. However, with the development of novel devices and techniques, endoscopic therapy plays an increasingly essential role in managing these conditions. Early diagnosis and endoscopic therapy initiation after clinical stabilization are crucial to success since clinical success rates are higher for acute leaks and fistulas when compared to late and chronic leaks and fistulas. Several endoscopic techniques are available with different mechanisms of action, including direct closure, covering/diverting or draining. The treatment should be individualized by considering the characteristics of both the patient and the defect. Although there is a lack of high-quality studies to provide standardized treatment algorithms, this narrative review aims to provide a summary of the current scientific evidence and, based on this data and our extensive experience, make recommendations to help choose the best endoscopic approach for the management of post-bariatric surgical leaks and fistulas.

First report of two Asian invasive mosquito species, Aedes japonicus and Aedes koreicus, in Piedmont, northwest Italy.

INTRODUCTION: Aedes japonicus japonicus and Aedes koreicus are two invasive mosquitoes recently reported in various parts of Europe, including areas very close to Piedmont where, since 2012, specific tools have been implemented to allow the early detection of invasive mosquitoes, through the surveillance of the main points of entry. RESULTS: Thanks to the regional surveillance system, Ae. j. japonicus was intercepted in Piedmont for the first time in 2019, in the northernmost part of the region and now it is reported in six provinces. Ae. koreicus was intercepted for the first time in 2012 in three provinces. DISCUSSION AND CONCLUSION: The spread of these two invasive mosquitoes in Europe is still ongoing. Where Aedes albopictus is abundant, probably their presence goes undetected, therefore, it is crucial to begin surveillance early in the season. Due to their competence for several arboviruses and tolerance to the cold temperatures Ae. j. japonicus and Ae. koreicus represent a further concern for Public Health. A longer seasonal period for surveillance and response to mosquito-borne diseases, as well as a shift up of these activities to previously uncovered altitudes are indeed needed.

Assessing the distribution of invasive Asian mosquitoes in Northern Italy and modelling the potential spread of Aedes koreicus in Europe.

In the last decade, Aedes koreicus and Aedes japonicus japonicus mosquitoes, which are competent vectors for various arboviruses of public health relevance, colonised Italy and other European countries. Nevertheless, information about their current and potential distribution is partial. Accordingly, in this study four regions of Northern Italy (Lombardy, Liguria, Piedmont and Aosta Valley) were surveyed during 2021 for the presence of eggs, larvae and pupae of these two invasive species. We found evidence for a widespread presence of Ae. koreicus in pre-Alpine territories of Lombardy and Piedmont. Larvae from the invasive subspecies of Ae. j. japonicus were also collected in the same geographic areas, though they were less frequent. Occurrence data from this study and results from previous monitoring campaigns were used to generate a Maxent model for the prediction of habitat suitability for Ae. koreicus mosquitoes in Northern Italy and the rest of Europe. Peri-urban areas located in proximity to forests, pastures and vineyards were revealed as highly suitable environments for colonisation by this invasive species. Maps of the potential distribution also suggest the presence of further suitable areas in currently uncolonized countries. We conclude that this invasive mosquito species has the potential for a broad expansion at the European level in the coming decades.

Mosquitoes of the Maculipennis complex in Northern Italy.

The correct identification of mosquito vectors is often hampered by the presence of morphologically indiscernible sibling species. The Maculipennis complex is one of these groups that include both malaria vectors of primary importance and species of low/negligible epidemiological relevance, of which distribution data in Italy are outdated. Our study was aimed at providing an updated distribution of Maculipennis complex in Northern Italy through the sampling and morphological/molecular identification of specimens from five regions. The most abundant species was Anopheles messeae (2032), followed by Anopheles maculipennis s.s. (418), Anopheles atroparvus (28) and Anopheles melanoon (13). Taking advantage of ITS2 barcoding, we were able to finely characterize tested mosquitoes, classifying all the Anopheles messeae specimens as Anopheles daciae, a taxon with debated rank to which we referred as species inquirenda (sp. inq.). The distribution of species was characterized by Ecological Niche Models (ENMs), fed by recorded points of presence. ENMs provided clues on the ecological preferences of the detected species, with An. daciae sp. inq. linked to stable breeding sites and An. maculipennis s.s. more associated to ephemeral breeding sites. We demonstrate that historical Anopheles malaria vectors are still present in Northern Italy.

¿Ocio o trabajo?: La actuación de músicos bajo el prisma del ocio serio / Trabalho ou lazer?: A atuação de músicos por meio do lazer sério / Work or leisure?: The performance of musicians through the topic of serious leisure / Travail ou loisirs?: La performance de musiciens à travers le prisme du serious leisure

El artículo tiene como objetivo general analizar la relación entre ocio y trabajo en la actuación de músicos en la ciudad de São Paulo, Brasil, bajo el prisma del concepto de serious leisure. Serious leisure se define como actividades practicadas por aficionados, voluntarios y practicantes de hobbys. Para tales individuos estas actividades son inmensamente importantes y gratificantes, y que en algunos casos pueden significar el inicio de una carrera centrada en la adquisición y expresión de habilidades especiales, conocimientos y experiencias. Este concepto también se define por la perseverancia que los participantes deben poseer para superar los eventuales momentos de dificultad relacionada al desarrollo del serious leisure y los beneficios tanto personales como sociales que acompañan esta práctica tal como la auto-realización, el auto-enriquecimiento, el sentimiento de pertenencia y la interacción social. Cuando las habilidades y los conocimientos adquiridos permiten que los participantes sean considerados "serios", en algunos casos, en la medida en que las oportunidades aparecen, algunos de estos participantes pueden salir de la condición de aficionados, volviéndose profesionales. Los objetivos específicos son los siguientes: a) investigar los motivos que llevaron a estos músicos a transformar esa actividad, inicialmente considerada una actividad de ocio, en un ejercicio profesional; b) comprender cómo las seis características fundamentales del sistema serious leisure se presentan en la actuación de los músicos. La metodología utilizada fue una investigación de tipo cualitativo, en un estudio de caso entendiéndolo cómo el método apropiado a la determinación de características únicas de individuos de instituciones o comunidades. La investigación posee un carácter exploratorio que combina los enfoques bibliográficos y de campo. La dimensión bibliográfica abarca artículos científicos, libros y demás publicaciones sobre el concepto de serious leisure. Y la de campo, con investigaciones in loco a través de entrevistas semiestructuradas realizadas con músicos que actúan en la ciudad de São Paulo. Los resultados de la investigación indican que el placer proporcionado por la música, así como la remuneración obtenida a través de ella, son los factores que más influenciaron a los entrevistados en la elección de la música como profesión. Se concluye también que la relación establecida entre el contenido artístico y la música es evidente ya que la música como arte se remite principalmente a la subjetividad de las personas, traduciendo sentimientos, expresando deseos y manifestando ideas. Las ideas como destino, predestinación, el talento innato, contribuyen a formar en las personas la concepción de que un músico, así como artistas de otras ramas, ya nació 'sabiendo' realizar esa actividad y, por lo tanto, son personas únicas y especiales. En este sentido, el artista ejerce un cierto "lenguaje especial", en este caso por la música, que tiende a obtener cierto reconocimiento por la sociedad como un todo. Los datos refuerzan que el ocio se caracteriza por resultar de una elección libre que no puede estar sometido a ningún fin lucrativo, utilitario o ideológico. Debe ser marcado por la búsqueda de un estado de satisfacción, tomando como fin en sí mismo, respondiendo a las necesidades individuales, frente a las obligaciones impuestas por la sociedad.

O artigo tem como objetivo analisar a relação entre lazer e trabalho no desempenho de músicos na cidade de São Paulo, Brasil, sob o prisma do conceito de lazer sério. Lazer sério é definido como atividade praticada por voluntários e amadores. Para tais indivíduos essas atividades são imensamente importantes e gratificantes. Em alguns casos, podem significar o início de uma carreira voltada para a aquisição e expressão de habilidades, conhecimentos e experiências especiais. Esse conceito também é definido pela perseverança que os participantes devem possuir para superar todos os momentos de dificuldade relacionados com o desenvolvimento do lazer e ambos os benefícios, pessoais e sociais, que acompanham essa prática, como autorrealização, autoenriquecimento, sensação de pertencimento e interação social. Quando as habilidades e conhecimentos adquiridos permitem que os participantes sejam considerados "sérios", em alguns casos, à medida que as oportunidades aparecem, alguns desses participantes podem deixar o status de amador, tornando-se profissionais. Os objetivos específicos são os seguintes: a) investigar as razões que levaram esses músicos a transformar essa atividade, inicialmente considerada uma atividade de lazer, em um exercício profissional; b) entender como as seis características fundamentais do conceito atrelado ao lazer sério são apresentadas no desempenho dos músicos. A metodologia utilizada foi uma pesquisa qualitativa, por meio de um estudo de caso, entendendo-se como método apropriado para determinar as características únicas de indivíduos de instituições ou comunidades. A pesquisa possui caráter exploratório, que combina as abordagens bibliográfica e de campo. A dimensão bibliográfica inclui artigos científicos, livros e outras publicações sobre o conceito de lazer sério, e a de campo, inclui investigações in loco através de entrevistas semiestruturadas realizadas com músicos que atuam na cidade de São Paulo. Os resultados da pesquisa indicam que o prazer proporcionado pela música, bem como a remuneração obtida através dessa arte, são os fatores que mais influenciaram os entrevistados na escolha da música como uma profissão. Conclui-se também que a relação estabelecida entre o conteúdo artístico e a música é evidente, pois a música como arte refere-se, principalmente, à subjetividade das pessoas, traduzindo sentimentos e expressando desejos e ideias. Tem-se, nessa conjuntura, as ideias associadas aos elementos de predestinação e talento inato, contribuindo para a concepção de que um músico, bem como artistas de outros ramos, são pessoas únicas e especiais pela arte desenvolvida. Nesse sentido, o artista exerce uma certa "linguagem especial" (nesse caso, a música), e tende a obter certo reconhecimento pela sociedade como um todo. Os dados reforçam que o lazer é caracterizado pelo resultado de um livre arbítrio que não deveria estar sujeito a qualquer finalidade lucrativa, utilitária ou ideológica. O lazer deveria ser marcado pela busca de um estado de satisfação, tomando como fim em si mesmo, respondendo às necessidades individuais frente às obrigações impostas pela sociedade.

The article aims to analyze the relationship between leisure and work in the performance of musicians in the city of Sao Paulo, Brazil, under the prism of the concept of serious leisure. Serious leisure is defined as activities practiced by hobbyists and volunteers. For such individuals these activities are immensely important and rewarding, and in some cases it can mean the beginning of a career focused on the acquisition and expression of special skills, knowledge and experiences. This concept is also defined by the perseverance that participants must possess to overcome the eventual moments of difficulty related to the development of serious leisure and the personal and social benefits that accompany this practice such as self-realization, self-enrichment, feeling of belonging and social interaction. When the skills and knowledge acquired allow participants to be considered "serious", in some cases, to the extent that the opportunities appear, some of these participants can leave amateur status, becoming professionals. The specific objectives of this research: a) investigate the reasons that led these musicians to transform this activity, initially considered a leisure activity, into a professional exercise; b) understand how the six fundamental characteristics of the serious leisure system are presented in the performance of the musicians. The methodology used was a qualitative research, in a case study understanding it as the appropriate method to determine the unique characteristics of individuals from institutions or communities. The research has an exploratory character that combines bibliographical and field approaches. The bibliographical dimension includes scientific articles, books and other publications on the concept of serious leisure. As a field research, it was used an in loco investigations with semi-structured interviews conducted with musicians who perform in the city of Sao Paulo. The results of this research indicate that the pleasure provided by the music, as well as the remuneration obtained through it, are the factors that most influenced the interviewees in the choice of music as a profession. It is also concluded that the relationship established between artistic content and music is evident since music as art refers mainly to the subjectivity of people, translating feelings, expressing desires and expressing ideas. Ideas as destiny, predestination, innate talent, contribute to forming in people the conception that a musician, as well as artists from other similar activities, was already born 'knowing' that activity and, therefore, they are unique and special people . From this vision, due the fact that the artist work with a 'special language', in this case music, is evident its projection before society as a whole. The data reinforce that leisure is characterized by the result of a free choice that cannot be subjected to any lucrative, utilitarian or ideological purpose. It must be marked by the search for a state of satisfaction, taking as an end in itself, responding to individual needs, facing the obligations imposed by society.

L'article vise à analyser la relation entre les loisirs et le travail dans l'interprétation de musiciens dans la ville de São Paulo, au Brésil, sous le prisme du concept de loisir sérieux. Les loisirs sérieux sont définis comme des activités pratiquées par des passionnés, des bénévoles et des passionnés. Pour ces personnes, ces activités sont extrêmement importantes et enrichissantes. Dans certains cas, cela peut signifier le début d'une carrière axée sur l'acquisition et l'expression de compétences, de connaissances et d'expériences spécifiques. Ce concept est également défini par la persévérance que les participants doivent posséder pour surmonter les moments de difficulté éventuels liés au développement de loisirs sérieux et les avantages personnels et sociaux qui accompagnent cette pratique tels que la réalisation de soi, l'enrichissement de soi, la sensation d'appartenance et d'interaction sociale. Lorsque les compétences et les connaissances acquises permettent aux participants d'être considérés comme «sérieux¼, dans certains cas, dans la mesure où les opportunités se présentent, certains d'entre eux peuvent quitter le statut d'amateur pour devenir des professionnels. Ils sont divisés en objectifs spécifiques: a) rechercher les raisons qui ont amené ces musiciens à transformer cette activité, considérée à l'origine comme une activité de loisir, en un exercice professionnel; b) comprendre comment les six caractéristiques fondamentales du système de loisirs sérieux sont présentées dans l'interprétation des musiciens. La méthodologie utilisée était une recherche qualitative; dans une étude de cas, il s'agissait de la méthode appropriée pour déterminer les caractéristiques uniques d'individus, d'institutions ou de communautés. La recherche a un caractère exploratoire qui combine des approches bibliographiques et de terrain. La dimension bibliographique comprend des articles scientifiques, des livres et d'autres publications sur le concept de loisir sérieux. Et sur le terrain, des enquêtes in situ avec des entretiens semi-structurés menés avec des musiciens qui travaillent dans la ville de São Paulo. Les résultats de la recherche indiquent que le plaisir procuré par la musique, ainsi que la rémunération obtenue, sont les facteurs qui ont le plus influencé les personnes interrogées dans le choix de la musique en tant que profession. Il est également conclu que la relation établie entre le contenu artistique et la musique est évidente puisque la musique en tant qu'art se réfère principalement à la subjectivité des personnes, à la traduction des sentiments, à l'expression des désirs et à l'expression des idées. Les idées comme destin, prédestination, talent inné contribuent à faire croire aux gens qu'un musicien, ainsi que des artistes d'autres branches, est déjà né en «sachant¼ cette activité et qu'ils sont donc uniques et spéciaux. . À partir de cette vision, l'artiste doit travailler avec un «langage spécial¼, en l'occurrence la musique, avant la société dans son ensemble. Les données confirment que les loisirs se caractérisent par le résultat d'un choix libre qui ne peut être soumis à aucune fin lucrative, utilitaire ou idéologique. Il doit être marqué par la recherche d'un état de satisfaction, prenant pour finalité, de répondre aux besoins individuels, de faire face aux obligations imposées par la société.

Sacral nerve stimulation in the treatment of fecal incontinence - the experience of a pelvic floor center : short term results.

OBJECTIVES: The aim of this paper is to present the data pertinent to the experiences of our Pelvic Floor Center on the utilisation of SNS in the treatment of fecal incontinence and compare these data to the data of current literature. METHODS: All patients who had had SNS treatment for fecal incontinence between the dates of 1st April 2008 and 1st April 2011 were enrolled in the study. We considered a 50% reduction of fecal incontinence episodes as a success of the test phase. The score used for assessment was the Cleveland Clinic Florida-Fecal Incontinence score (CCF-FI). RESULTS: The 21 patients treated for fecal incontinence (19 ♀ and 2 ♂, average age 59.7 [ 26-73] years) were sub-divided on the basis of the presence or absence of sphincter damage (group A1 had damage while group A2 did not). A patient (group A1) was excluded from the study as the result of the external connector breaking during the test phase. Of the 20 remaining patients (9 from group A1 and 11 from A2), 14 (70%) felt benefit and subsequently underwent definitive stimulator implantation. The variation between the pre-operative CCF-FI and the value at 6 months was statistically significant both in group A1 (p=0.009) and in group A2 (p=0.003). The only complication reported was one case (7.1%) of infection of the definitive stimulator. CONCLUSION: SNS represents an effective treatment for patients with fecal incontinence. The results have been encouraging, and in line with current literature.

Altemeier operation associated with dynamic graciloplasty: a case report.

INTRODUCTION: More than 80% of patients with full-thickness rectal prolapse have co-existing fecal incontinence. Choosing the ideal surgical strategy is always a difficult task. We combined an Altemeier rectosigmoid resection with anal dynamic graciloplasty to provide a functional neosphincter. We found no published reports describing this surgical association. CASE PRESENTATION: We report the case of a 72-year-old Caucasian woman with full-thickness rectal prolapse associated with fecal incontinence from severe neuromuscular damage. CONCLUSION: Combined dynamic graciloplasty and an Altemeier operation could be a valid therapeutic option in patients with severe rectal prolapse with fecal incontinence from severe neurogenic damage.

Selective growth of epithelial basal cells from human prostate in a three-dimensional organ culture.

BACKGROUND: A three-dimensional organotypic culture method has been developed for selectively growing epithelial basal cells from human benign prostate. METHODS: Tissue fragments were cultured on sponges for several weeks and the viability of luminal and basal epithelium and cellular responses to 4,5alpha-dihydrotesterone (DHT) stimulation were studied. RESULTS: The gland tissue could be successfully maintained showing preservation of ducts and lobules as in vivo. Without DHT, a progressive hyperplasia of basal cells was observed: these cells proliferated with retention of the lumen or forming nests with squamous differentiation, lining the surface of the fragment and migrating to the underlying sponge. In contrast, secretory cells disappeared. Epithelial cells isolated from long-term cultures showed a typical basal cell-immunophenotype. DHT-treated tissues maintained a much higher percentage of luminal cells than untreated tissues. CONCLUSIONS: These systems allow the study of proliferation and differentiation of basal cells within their natural microenvironment as well as prostate pathobiology.

[Thyroid anaplastic tumor: our experience]. / Il tumore anaplastico della tiroide: nostra esperienza.

We report our experience over the past 10 years in the treatment of thyroid anaplastic carcinoma analysing retrospectively 21 cases of surgical treatment (7 total thyroidectomies, 12 partial resection of the tumours and 2 biopsies). We consider the prognosis, which is invariably fatal, with no survival at 19 months and a mean survival of only 9 months, and assess the validity of a combined therapeutic approach (surgery + radiotherapy + chemotherapy) to increase survival and, above all, the patient's quality of life. The importance is stressed of through monitoring of risk factors consisting in concomitant or previous benign or malignant thyroid disease, considering total thyroidectomy to be necessary in principle for any variety of thyroid cancer. Lastly, we examine the survival trend in terms of residual disease and the presence or otherwise of remote metastases.