[Hormone replacement therapy after total thyroidectomy. Can the combined treatment be considered effective to get metabolic adequacy? Preliminary results]. / Terapia ormonale sostitutiva dopo tiroidectomia totale. Il trattamento ormonale combinato può essere considerato efficace strumento di adeguatezza metabolica? Risultati preliminari.

INTRODUCTION: Even if T4 is standard treatment for hypothyroidism after thyroidectomy, a treatment with T4 plus T3 has been proposed as an alternative reproducing carefully the physiology of the thyroid. We performed an observational study about the effects of the combined replacement therapy with T4 and T3 in patients who underwent total thyroidectomy. PATIENTS AND METHODS: Fifty thyroidectomized patients (not for cancer), in T4 replacement therapy, were included in the study. Such a therapy has been changed by administering T3 and T4 in proportion 1/16. Adverse effects, clinical parameters and general health perceptions (SF36 Questionnaire) have been considered at the time of enrollment (T0), after 30 days (T1) and after 60 days (T2). RESULTS: No differences in weight, cardiac frequency and blood pression have been found between T0 and T2. A not statistically significant reduction has been found in total cholesterol (3 mg/dL) and triglycerides (3.29 mg/dL) levels. A reduction of complaints referred by the patients at T0 has been revealed in T2: anxiety from 21 to 13 patients; headache from 22 to 13; tiredness from 17 to 8 (p<0.05); sleepiness from 25 to 15 (p<0.05). About the questionnaire, in the General Health Perception sub-score has been found a not significant increase of the parameter. DISCUSSION AND CONCLUSIONS: T4 replacement therapy is of proved efficacy, notwithstanding some complaints afflict a share of patients. To improve the quality of life of these patients, we consider relevant the reduction of complaints and the improvement of well-being and cognitive function obtained by the combined T4 and T3 treatment. Moreover, even if the production of T3 from T4 usually ensures euthyroidism in all tissues, contemporary pathologies and alterations determined by the oldness can disturb the enzymatic activity, which is the essential requirement of T4 therapy. These preliminary findings in a small group of patients encourage further studies on a larger patient population.

Locoregional IL-2 therapy in the treatment of colon cancer. Cell-induced lesions of a murine model.

BACKGROUND: Local therapy with IL-2 may be very effective in the treatment of different forms of cancer. The aim of this study was to determine the effectiveness of IL-2 locoregional application in the treatment of colon cancer. MATERIALS AND METHODS: Twenty eight syngenic BDIX rats were utilized in this study. The rats were divided into two groups of fourteen animals: group T (treatment) and group C (control). All rats of both groups were injected, under the splenic capsule, with T 10(7) DHD/K2/ TRb neoplastic cells. Then, within and around the site of the previous inoculation, the T group was injected with 1 ml of glucosate solutions + 0.1% albumin (BSA) containing 2.5 x 10(6) IU of IL-2 ( Proleukin-Chiron), whereas the C group was injected with 1 ml of BSA alone. After three weeks, rats were sacrificed and the liver and spleen were removed. The following parameters were considered: volume and weight, neoplastic-non neoplastic tissue index of the spleen, mitotic index and vascular density of splenic and hepatic lesions. RESULTS: All the studied parameters showed statistically significant differences in treated and untreated animals. CONCLUSION: This study of a murine model demonstrated that IL-2 locoregional therapy may be effective in the treatment of colon cancer.

[Muscle metastasis of bronchopulmonary carcinoma]. / Le metastasi muscolari da carcinoma broncopolmonare.

Typical sites of bronchogenic carcinoma metastases are liver, brain, bones or adrenal glands. Rarely and in advanced dissemination phase it could involve the skeletal muscle. Two cases of metastases in the skeletal muscle from bronchogenic carcinoma, one of which revealed this neoplasia, are reported.

[Endometriosis of the abdominal wall: a clinical case report and a review of the literature]. / Endometriosi della parete addominale: presentazione di un caso clinico e revisione della letteratura.

The authors report one case of abdominal wall endometriosis secondary to cesarean section. They emphasize the rarity of this localization and discuss about the incidence of extrapelvic endometriosis stressing the importance of this pathology in the differential diagnosis with other disease.

[Superior laryngeal nerve in thyroid surgery]. / Il nervo laringeo superiore nella chirurgia della tiroide.

In this paper, the authors discuss the risks of lesions to the external branch of the superior laryngeal nerve during surgical procedures on the thyroid gland. These lesions result in significant functional impairment consisting on the patients' impossibility of emitting high-pitched sounds, an easy tiredness in vocalizing, huskiness, or a combination of these symptoms. Recently, in effect, with the increasing use pre and postoperatively of newer diagnostic tools such as electromyography (EMG) of the cricothyroid muscle, a fairly high incidence of permanent or temporary, including single or bilateral lesions to this nerve was demonstrated. The necessity of using appropriate surgical techniques with the objective of avoiding or markedly reducing the incidence of lesions to the superior laryngeal nerve is discussed in detail by the authors.

[Complications of surgery of Dupuytren disease. Comparison of total and partial aponeurectomy]. / Le complicanze nella chirurgia della malattia di Dupuytren. Confronto tra aponeurectomia totale e parziale.

Total and partial aponeurectomy are the most usual operations performed for the treatment of Dupuytren's disease. Eighteen patients, for a sum of 23 treated hands, were submitted to total aponeurectomy in 20 cases and to partial aponeurectomy in 3 cases. Recurrence was present in 4 cases. Postoperative morbidity was 50% (10/20 cases) following total aponeurectomy and 0% (0/3 cases) following partial aponeurectomy. In patient with recurrence disease postoperative complications were present in 3/4 cases (75%) while in patients, operated for the first time, morbidity rate was 36.8% (7/19 cases). Postoperative complications following total aponeurectomy are extremely frequent, especially if recurrence is present. Partial aponeurectomy allows to achieve functional result as good as total aponeurectomy with significative reduction of postoperative morbidity.

[The surgical treatment of thyroglossal duct cysts and fistulae]. / Il trattamento chirurgico delle cisti e fistole del dotto tireoglosso.

The authors report the results of treatment in 20 patients with thyroglossal duct cysts and/or fistula. Three patients underwent the standard Sistrunk's operation (excision of the cyst with resection of the duct above the hyoid bone with the portion of the muscle surrounding to the foramen caecum), 13 patients were submitted to a modified Sistrunk's operation (removal of the cyst and/or fistula and resection of the middle portion of the hyoid bone with dissection above it only with macroscopic evidence of duct epithelium) and 4 patients underwent less radical procedures. There were no recurrence in those patients operated upon with the standard or modified Sistrunk's operation. On the contrary two recurrence were observed in patients operated in elsewhere by simple excising the cyst without hyoid bone resection. In conclusion the authors strongly support the modified Sistrunk's operation as treatment of choice in patients with thyroglossal duct cysts and fistula; This operative procedure can avoid long-term recurrence even though many authors suggest that only the standard Sistrunk's operation can guarantee the lowest rate of failures.

[The use of laser through thoracoscopy in the treatment of spontaneous pneumothorax. Presentation of a clinical case]. / L'impiego del laser per via toracoscopica nel trattamento del pneumatorace spontaneo. Presentazione di un caso clinico.

The authors present the case of a patient with right plurirecidive pneumothorax. During the 12 months before the operation the patient suffered from 3 episodes of pneumothorax, treated with the insertion of an intrapleural drainage. Preoperative exams showed the presence of multiple emphysematous blebs with diameter ranging from 0.5 cm to 3 cm. The patient was treated with Nd:YAG laser photocoagulation of the blebs and mechanical abrasion of the parietal pleura through thoracoscopy. The laser photocoagulation of the blebs was performed using the contact technique and a 25 Watt power. After operation a TX of the thorax, using the high resolution technique, showed the presence of residual blebs involving the apex and the mediastinal surface of the inferior lobe of the right lung. After a 12 month follow-up no recidive pneumothorax occurred and the general conditions of the patient were good. The authors state that the laser treatment of spontaneous pneumothorax secondary to bullous emphysema is effective and safe and it is also successful in patients with multiple blebs. As it is often difficult to find and treat all the blebs, it may be useful to perform thoracography during thoracoscopy.

[Electrohydraulic intracorporeal lithotripsy in the treatment of "difficult" calculi of the common bile duct. Report of a caseload]. / La litotrissia intracorporea elettroidraulica nel trattamento della calcolosi "difficile" della via biliare principale. Presentazione della casistica.

The Authors report their experience in 38 cases (January 1990-Septembre 1994) of "difficult" gallstone disease of the main bile duct treated with electrohydraulic intracorporeal lithotripsy. Nineteen patients were affected with giant stones of the biliary tree, 6 with multiple stones of the main bile duct, 13 with stones of one or both hepatic ducts. The approach to the biliary tree was peroral transpapillary in 16 patients and transhepatic in the remaining 22. Twenty-five patients were previously submitted to surgery of the biliary tree (13 hepaticojejunostomy, 8 choledochoduodenostony, 4 papillostomy), while 5 had required a cholecystectomy, and 6 a gastroresection according to Billroth II. In 80% of the cases two lithotripsy sessions were enough to achieve the complete clearing of the bile duct. There was no mortality and morbidity was 5.3%. Total clearing was obtained in 97.4% of the cases. 6-48 months after treatment 37 patients still do not show clinical, laboratory or echographic signs of gallstone stasis or disease relapse.

[Recurrent leiomyoma of the rectum treated by endoscopic transanal microsurgery]. / Leiomioma recidivo del retto trattato mediante microchirurgia endoscopica transanale.

The Authors report a case of recurrent leiomyoma of the rectum treated by Transanal Endoscopic Microsurgery (T.E.M.). Leiomyoma of the rectum is a rare entity (0.1-0.3%) (the incidence of smooth muscle tumours being 7% in the digestive tract). Benign leiomyomas are usually asymptomatic; discomfort or pain, related or not to defecation, sensation of foreign body, change in bowel habits, rectal bleeding are rarely reported. The distinction between a benign leiomyoma and a leiomyosarcoma is often difficult and requires an accurate microscopic study. In most cases rectal leiomyoma is detected incidentally in the course of a rectal examination. Endoscopic examination of the rectum with biopsies and endorectal ultrasonography are useful for the diagnosis, while rarely a plain radiologic examination is sufficient. Leiomyoma of the rectum also presents a high tendency to local recurrence (31%). Therefore the choice of an adequate treatment is often difficult. The Authors believe that the treatment of rectal leiomyoma by T.E.M. may substitute conventional methodics (transanal excision, proctectomy with or without amputation of the sphincter and coloanal anastomosis, endoscopic electroexcision of the neoplasm). T.E.M. allows short-term hospitalization and implies minimal surgical trauma.

[Etiopathogenetic and histopathologic aspects of acute necrotico-hemorrhagic pancreatitis in experimental animals]. / Aspetti etiopatogenetici ed istopatologici della pancreatite acuta necrotico-emorragica nell'animale da esperimento.

In this study, the Authors have provoked experimentally acute pancreatitis in the rat by different methods, in order to find out morphological modifications of the pancreas in the initial stage of the disease. In case of biliary and pancreatic duct obstruction with pure pancreatic reflux, both oedema and inflammatory infiltrations were evident, whereas, in the presence of biliary reflux too, more serious histological features were detected. In conclusion, the first sign of alteration in acute pancreatitis could be represented by the association of intraductal hypertension and pure pancreatic reflux.

Characteristic cholescintigraphic images in space-occupying lesions.

Patients with space-occupying lesions (SOL) were studied using cholescintigraphy and varying results found. In 24 cases of SOL of 40 patients studied, we observed: (1) the presence of focal defects; (2) displacement of the intrahepatic biliary tree; (3) blocking of the passage (stop) of radioactivity to the intrahepatic biliary tree. The first indication, the presence of focal defects, had a sensitivity of 0.81 and a specificity of 0.78. The displacement and radioactivity stop was less frequent, but more specific. This is due to the fact that cholescintigraphy permits the specific study of the biliary tree and its pathological alterations. In our patients, the diagnostic errors were due to extreme hepatic damage, which produced an unclear image of the liver parenchyma and the biliary tree. This is observed in complete obstruction and in some cases of cirrhosis. When signs of displacement and stop were closely associated with focal defects, the diagnosis of SOL was highly specific.

Host defense and survival in patients with lung carcinoma.

BACKGROUND: Numerous studies have investigated locoregional immune responses and long term survival in patients with various types of cancer; few have focused on patients with lung carcinoma. The current study was designed to assess the prognostic value of immunomorphologic changes in locoregional lymph nodes and lymphocytic infiltration of primary tumor (LI) in patients who undergo resection for bronchogenic carcinoma. METHODS: In a retrospective analysis, immune responses in locoregional lymph nodes and at primary tumor sites were studied histologically in 172 selected patients. Lymph node morphology was studied according to the system of Cottier et al. Sinus histiocytosis and paracortical lymphoid cell hyperplasia were considered to be cellular immune responses, and follicular hyperplasia of the cortical area was considered to be a humoral reaction. LI was classified with Black's method. The survival rate was estimated by using the Kaplan-Meier product-limit method. The log rank test and the Cox proportional-hazards model were used to determine statistical significance in univariate and multivariate survival analyses. RESULTS: Among the 172 patients, 35.5% had no evident response in regional lymph nodes, 19.8% had a marked cellular response, 11% had a marked humoral response, and 33.7% had a mixed cellular and humoral response. LI was intense in 36.6% of patients and was absent or scarcely evident in 63.4%. A lymph node cellular response and marked LI improved long term survival rates even in patients with regional lymph node metastases. Multivariate analysis identified two independent variables that had high prognostic value: lymph node immunoreactivity and LI. CONCLUSIONS: Lymph node immunoreactivity and LI significantly influence long term survival after curative surgery for patients with carcinoma of the lung and may be useful in stratifying patients for prospective trials of adjuvant treatment, including immunotherapy.

Technetium-99m sestamibi: an indicator of breast cancer invasiveness.

As recently shown, angiogenesis is the most reliable marker of breast cancer invasiveness. Unfortunately it must be assessed by immunohistochemistry on tissue specimens. We have used technetium-99m sestamibi, a marker of regional blood flow in other organs that often but not always images breast cancer, to assess the invasiveness of this tumour. Nineteen patients, ten with nodal metastases and nine without any metastases, were studied with 99mTc-sestamibi scintigraphy before operation. Angiogenesis was quantitatively assessed by immunohistochemical staining of endothelia for factor VIII. All the node-positive (N+) patients at surgical revision showed a positive 99mTc-sestamibi scan of the primary tumour and all the N-patients were negative. Nine out of ten N+ and sestamibi-positive tumours showed more than 135 microvessels/mm2 and one showed 99 microvessels/mm2; by contrast there were 71.6 +/- 12.1 microvessels/mm2 in the nine N- and sestamibi-negative tumours. Our study suggests that 99mTc-sestamibi is a marker of breast cancer invasiveness: its uptake is related to angiogenesis and, possibly, to oxidative metabolism of the tumour.