[Radio-guided parathyroidectomy]. / La paratiroidectomia radioguidata.

The Authors, after a careful review of literature about the instrumental diagnostic techniques (with particular attention to the nuclear-medical ones) and the surgical therapy of parathyroid diseases, report their experience on the use of the radio-guided mininvasive surgery with MIBI and gamma-probe for intraoperative localization of pathological glands. Once exposed their experience, the Authors conclude asserting that this technique is fast, slightly invasive and expensive, and certainly useful for the detection of pathological or ectopic glands. It can be widely employed because, in comparison to its numerous advantages, such as the reduction of the operating time and of the hospital-stay, the greater radicality and the possibility to use mininvasive techniques, it does not present significant technical limitations and/or radio-protectionistic problems.

Does the margin width influence recurrence rate in liver surgery for hepatocellular carcinoma smaller than 5 cm?

OBJECTIVE: Liver surgery is considered a curative treatment for hepatocellular carcinoma (HCC) but the importance of resection margin width remains controversial. The aim of this study is to clarify the role of 5-10 mm surgical margin width on post-operative recurrence and overall survival after resection. PATIENTS AND METHODS: We analyzed recurrence rate and overall survival rate of 72 patients who underwent curative hepatic resection for HCC smaller than 5 cm with 5-10 mm surgical margin width between January 2005 and December 2014. RESULTS: The mean follow-up period was 36 months. Among the seventy-two patients, thirty-one (31/72; 43%) developed recurrence but only eleven (11/31; 15.3%) along the resection margin. The disease-free survival was 77.2%, 50%, 41.4% at 1, 3 and 5 years respectively, and the overall survival was 89.9%, 78.8%, 60% at 1, 3 and 5 years respectively. CONCLUSIONS: 5-10 mm surgical resection margin for HCC smaller than 5 cm seems to be safe as a wider surgical margin because does not increase the risk of marginal recurrence and does not decrease overall survival rate. Further prospective and randomized studies are required to definitively clarify the importance of surgical margin width in hepatic resection for HCC.

Laparoscopic cholecystectomy in cirrhotic patients.

BACKGROUND: This study aimed to evaluate the safety of laparoscopic cholecystectomy for patients with cirrhosis. METHODS: The records of 22 laparoscopic cholecystectomies performed in patients with cirrhosis Child-Pugh A and B, from January 1995 to July 2001 were retrospectively reviewed. RESULTS: No deaths occurred. Conversion to open cholecystectomy was necessary in two cases. The average operative time was 115 min, which was significantly shorter than that for patients undergoing open cholecystectomy. None of the patients required blood transfusion. Intraoperative problems occurred in two patients who experienced liver bed bleeding. Postoperative morbidity occurred in 36% of the patients and included hemorrhage, wound complications, intraabdominal collections, and cardiopulmonary complications, but all were controlled. The patients were dismissed after an average of 4 days. CONCLUSION: The authors believe laparoscopic cholecystectomy can be performed safely in selected patients with cirrhosis Child-Pugh A and B who manifest indication for surgery. Laparoscopic cholecystectomy offers several advantages over open cholecystectomy: lower morbidity, shorter operative time, and reduced hospital stay.

[Intraperitoneal neoplastic dissemination of incidental gallbladder carcinoma after laparoscopic surgery]. / La disseminazione neoplastica intraperitoneale da carcinoma incidentale della colecisti dopo chirurgia laparoscopica.

BACKGROUND: Several laboratory and clinical studies have raised the concern that laparoscopic procedures might worsen the prognosis of patient with malignant disease due to premature intraperitoneal cancer cell dissemination. The aim of the study was to examine the risk of the dissemination in patients with unsuspected gallbladder cancer diagnosed after laparoscopic cholecystectomy (LC). METHODS: A retrospective clinicopathologic study was performed on 5 patients with unsuspected gallbladder cancer without preoperatively diagnosis among 1280 patients that underwent LC in the period 1993-2002. The possible neoplastic dissemination was compared to that reported in 8 patients affected from unsuspected gallbladder cancer diagnosed after open cholecystectomy. RESULTS: Two patients with unsuspected gallbladder cancer (T1a-T2) presented a port-site recurrence after respectively six and four months. There was not statistically significant difference between types of cholecystectomy (LC or OC). Survival rate did not change according to whether the operation was carried out using LC or OC. CONCLUSION: After an accurate checking of the factors indicated to explain the early neoplastic dissemination frequently observed in the patients undergone LC and an analysis of their own experience the Authors conclude that LC does not worsen the prognosis of unsuspected gallbladder cancer.

Human blood oscillating axially in a tube.

Experiments were performed to study the rheological response of human blood at hematocrit ratios of 0 to 0.45 in axial oscillatory flow in a tube of uniform bore. Three principal regimes of flow were identified, depending on the amplitude of oscillation. At the highest amplitudes (and therefore the largest range of shear rates in the blood) there was turbulent motion and the friction coefficient increased in proportion to the square of the hematocrit. At small amplitudes the friction decreased with increase in amplitude, the rate of decrease increasing with hematocrit. At intermediate amplitudes the friction increased in proportion to the square of the hematocrit. Glutaraldehyde fixation of the red cells caused increase in the friction, and reduced the rate of decrease of friction with amplitude at small amplitudes. With a stenosis of very modest degree and span the friction in normal blood increased disproportionately, and a small blind hole in the lumen of the stenosis caused additional and disproportionate increase in friction.

[Biliary peritonitis caused hy hydatid disease]. / Peritonite biliare da malattia idatidea.

After specifying that rupture of a hydatid cyst in the peritoneal cavity is one of the most serious and rarest complications of hepatic hydatidosis, attention is paid to the peritoneal hydatid (o chole-hydatid). The aetiopathogenetic mechanisms and the anatomo-pathological features of this type of lesion are described in brief. Finally, the personally employed diagnostic protocol and therapeutic strategy in the face of this feared complication are reported.

[The usefulness of cytodiagnosis in nonpalpable breast lesions]. / Utilità della citodiagnostica nelle lesioni non palpabili della mammella.

The paper underlines the importance of early diagnosis in the treatment of breast tumours and emphasises the value of cytodiagnosis as a very sensitive and specific predictive method for detecting impalpable lesions. In conclusion, the Authors affirm that cytodiagnosis, together with the introduction of new diagnostic instruments such as the TRC Mammotest, allows the diagnostic and therapeutical approach to impalpable breast tumours to be improved. It adds to the already high sensitivity of mammography and to the high predictive specificity of cytology, thus contributing to the reduction of the so-called "bioptic cost".

[Subclavicular localization of Castleman's disease]. / La malattia di Castelman a localizzazione sottoclaveare.

Castelman disease is a rare disease of lymph nodes. There are 2 pathological types: hyalo-vascular asymptomatic form and plasmacytic symptomatic form. Authors report a case of Castelman disease of a subclavicular lymph nodes that underwent surgical operation. Ethiopathogenesis and treatment of the disease are reported.

[Nuclear risk and thyroid neoplasms in infancy]. / Rischio nucleare e carcinoma tiroideo nell'infanzia.

Thyroid carcinoma is a disease with low incidence in adult and rare in child. The authors give oncogenic risk factors of the disease and underline environment factors as iodine deficiency and radiation pollution that, as shown in certain world areas, has a strong effect in the epidemiology of this disease. Eventually radiation's are the most important oncogenic risk factors but and adequate iodine prophylactic program can be considered a valid shield to prevent this disease.

[Treatment of occlusions caused by carcinoma of the left colon in the aged]. / Il trattamento delle occlusioni da carcinoma del colon sinistro in età geriatrica.

The Authors, after pointing out that, in geriatric age, the incidence of left colon carcinoma has significantly increased, and this, in a high quantity of cases, goes unnoticed in precocious stage, but appears "d'emblée" pith an occlusive situation, state their experience concerning the surgical treatment of occlusions due to left colon carcinoma in patients aged over sixty. From the evaluation of the results they obtained, the Authors assert that, if the operation is performed after a correct appraisal of the patient's general conditions and after an adequate counterbalancing of the metabolic and functional alterations, often present in old people, the operative mortality, the postoperative complications and the indices of survival are not so significantly different from those remarked in the young subjects.

[Surgical management of hereditary medullary carcinoma of the thyroid in patients with "RET" proto-oncogene mutation]. / Strategia chirurgica nel carcinoma midollare della tiroide ereditario in portatori di mutazione del proto-oncogene "RET".

The authors report their results in 64 individuals belonging to 11 families with MEN 2 and familial medullary carcinoma of thyroid (CMT) syndromes. They show amplification and restriction techniques, type, site and incidence of genetic alteration in the observed cases; besides they illustrate the adopted surgical management related to the mutation. They stress the concept that genetic test allows to detect the population with altered gene before laboratory or clinical evidence, with the great advantage to indicate an early surgical approach. If it is shown a multi-organ disease, as in one patient with CMT associated with bilateral pheocromocytoma, the two diseases must be treated during the same operative time.

[Malignant melanoma of the skin: current diagnostic and therapeutic approaches]. / Il melanoma maligno cutaneo: attuali orientamenti diagnostici e terapeutici.

The Authors claim that the treatment of malignant melanosis of the skin is a problem of undiminished topical interest owing to its highly aggressive characteristics. Risk factors and pre-neoplastic lesions are reviewed, and the signs of malignant transformation are described along with the appropriate treatment. The Authors stress the importance, for therapeutic and prognostic purposes, of accurate clinical staging and macro- and microscopic study of the primary tumour. They also describe their own therapeutic approach, which involves the use of a CO2 laser for resecting the primary tumour. They present their patient population and conclude by observing that the progress achieved over the past decade is due both to earlier diagnosis and to improvements in the various therapeutic means available.

[Use of tumor markers in monitoring thyroid carcinoma]. / L'impiego dei markers tumorali nel monitoraggio del carcinoma tiroideo.

The authors report on their experience regarding the use of tumours markers for the pre-operative monitoring and subsequent follow-up of patients suffering from thyroid carcinoma. All patients were subjected to radio-immuno-assay for circulating thyroglobulin, a valuable indicator of residual and metastatic thyroid tissue. The patients suffering from medullary carcinoma of the thyroid and their immediate families were also monitored by periodic thyrocalcitonin assay. A further tumour marker assayed was CEA, levels of which are raised in the presence of thyroid neoplasms at an advanced or metastasizing stage. The authors conclude by presenting the results obtained and confirm the usefulness of these tumour markers in the study and follow-up of patients with thyroid carcinoma.

[Sequential therapy with antiestrogens and progestational drugs in carcinoma of the breast in an advanced stage]. / La terapia sequenziale con antiestrogeni e progestinici nel carcinoma della mammella in fase avanzata.

After discussing the mechanism of action of antioestrogens and medroxy-progesterone-acetate, the authors report on their experience with the sequential use of these two hormones in a group of patients with advanced cancer of the breast. After illustrating the results of their study, the authors conclude by stressing that the sequential use of these drugs appears to improve the quality of life of the patients with a significant increase in rates of complete or partial remission of the neoplastic disease.

[Endoscopy in non-neoplastic cholestasis]. / L'endoscopia nella colestasi non neoplastica.

The role of endoscopic treatment of cholestasis is well codified as an alternative or adjuvant therapy to surgery, particularly in those cases where non malignant cause has been identified. Non-neoplastic cholestasis therefore benefits very substantially from endoscopic treatment in a context where the traditional surgical approach presents limitations in terms of morbidity and mortality. It should be borne in mind, however, that the two approaches are strictly complementary for the correct management of these patients.

[Primary adenocarcinoma of the duodenum]. / L'adenocarcinoma primitivo del duodeno.

Adenocarcinoma of the duodenum represents a rare neoplasia characterized by an indefinite symptomatology, at least early, and deceitful, that, therefore, arrives at surgeon, almost always, in advanced stage. The Authors, taking from a clinical case, recently observed, as a starting point, review the literature, referring the etiopathogenetic hypothesis that explain the relative rarity of this neoplasia. They therefore report the diagnostic and therapeutic procedure to carry out in these patients.

[Ambulatory treatment of inguinal hernia]. / Il trattamento ambulatoriale dell'ernia inguinale.

The Authors report their experience about the inguinal hernioplasty operation by implantation of prostheses in prolene following the Licthenstein technique. Prolene mesh strengthens the inguinal canal wall, with no suture tension point. The technique is performed under local anesthesia, in day-hospital system, consenting the patient a rapid reinstatement in the social-working ambit.

[US or CT-guided percutaneous drainage of pancreatic pseudocyst]. / Il drenaggio percutaneo Eco o T.C. guidato delle pseudocisti pancreatiche.

Authors, after illustrating the pathogenesis of Pancreatic Pseudocysts (PPC) and classifying them into secondary to acute pancreatitis and arising in course of chronic pancreatitis, underline that the use of Ultrasound (US), CT-scan, Magnetic Resonance, Endoscopic Retrograde CholangioPancreatography and, above all, percutaneous drainage of the cysts has modified the therapeutic approach to this pathology. They describe indications and technique of US or CT-guided percutaneous drainage, and report their experience about 12 cases of PPC secondary to acute pancreatitis and 4 of PPC arising during chronic pancreatitis. They analyze the limits of this technique (risk of infections, recurrences, fistulas), and conclude that Percutaneous Drainage of Pancreatic Pseudocysts is a useful therapeutic approach in the treatment of PPC secondary to acute pancreatitis, while its use is complementary to surgery in the treatment of PPC due to chronic pancreatitis.

[Alpha-glucosidase and alanine-amino-peptidase in the early diagnosis of renal failure in obstructive jaundice]. / Il ruolo dell'alfa-glucosidasi e dell'alanina-amino-peptidasi nella diagnosi precoce dell'insufficienza renale in corso di ittero ostruttivo.

Renal failure is a serious complication of obstructive jaundice. Early diagnosis and prevention of spontaneous evolution of the disease can improve prognosis, otherwise very poor in many cases. The Authors, on the basis of experimental researches from literature, expose their clinical experience about the validity of the determination of Alpha-Glucosidase and Alanine-Amino-Peptidase for early diagnosis and differentiation between organic or functional forms of renal failure. They conclude that determination of urinary levels of AGS and AAP is a valid aid for the evaluation of renal function in patients with obstructive jaundice.

[Changes in serum levels of folic acid after total gastrectomy]. / Le modificazioni dei livelli sierici di acido folico dopo gastrectomia totale.

The Authors, in consideration that Folic Acid is assimilated in the upper alimentary tract, effected a comparative study between its seric levels in normal patients and in patients submitted to gastrectomy for gastric cancer, at different times from the operation. In the patients of the first group, Folic Acid levels were not correlated with sex, but to age, decreasing with the increasing of it. In gastrectomized patients, serum levels, also if acceptable, were always lower than in control cases, and gradually decreasing with the increasing of the age. The Authors conclude that, obviously, intestinal assimilation and endogenous reserves are able to counterbalance for enough long time the insufficient alimentary absorption.