Thyroid Cancer and Nodules in Graves' Disease: A Single Center Experience.

BACKGROUND: The existence of a link between Graves' Disease (GD) and Thyroid Cancer (TC) has long been investigated, however a clear pathogenic correlation is yet to be found. OBJECTIVE: We verified the presence of TC in patients submitted to surgery for GD, both with and without thyroid nodules (TN). METHODS: In this study we analyzed retrospectively a cohort of 151 patients treated at our clinic with total thyroidectomy between 2013 and 2018. All the patients were symptomatic at the time of surgery, preoperatively ultrasonographic (US) study was performed to evaluate the presence of nodules and their distribution. All patients reached euthyroid state before surgery. RESULTS: Nodules were detected in 53% of cases, above 60 years of age, at least one nodule was found; however, younger patients were mostly nodules free. Bilateral diffusion of nodules appeared with increasing age. Cancer was found in 19 of 151 subjects (12.5%), all were papillary carcinomas, and among them 93% were microcarcinomas. Among cancer-proven patients, 14 had thyroid nodules while 5 were nodule-free. During the follow up period, no cancer recurrence was recorded. The most common complication after surgery was transient hypocalcemia (36%). CONCLUSIONS: Graves' patients are burdened by major incidence of TC in the context of their TN. Pre-operative assessment in GD patients should consider the risk of cancer, US scan can help in rapid evaluation of nodules and new rising frontiers in molecular biomarkers analysis may help defining pathogenic basis of Graves' neoplastic development.

An approach to complicated diverticular disease. A retrospective study in an Acute Care Surgery service recently established.

AIM: Acute diverticulitis is a frequent disease in the Western Countries. The increase number of patients admitted in the Surgery Departments led the necessity of new Scores and Classifications in order to clarify, in absence of clear guidelines, the best treatments to offer in the different situations. METHODS: A retrospective study of ninety-nine patients treated in our Department from June 2010 and March 2015. RESULTS: In our study 41 patients were treated conservatively, the remaining 58 were operated, 56 laparotomic and 2 laparoscopic. 5 patients submitted US guided drainage of abscess which failed in 2 cases. 25 submitted Hartmann's Procedure (HP), 29 Primary Resection and Anastomosis (PRA), 3 Contemporary Closure of Perforated Diverticula (CC) and just 2 Laparoscopic Peritoneal Lavage and Drainage (LPL). We related different Hinchey groups and up-groups with the treatments approached, identifying patients risk factors, ASA score and complications. DISCUSSION: The treatment of perforated diverticulitis is debated. CT scan is becoming an useful instrument to make a correct diagnosis. Hinchey I and II patients are preferentially treated conservatively except in cases of complicated presentations. Hinchey III and IV are necessarily treated with surgical approach. We analyze the different types of intervention currently approached. CONCLUSION: We believe in PRA in Hinchey III and IV selected patients, HP is the gold standard in higher ASA scores patients but the low number of stoma reversal remains an open problem. Many studies are ongoing concerning LPL and now there are insufficient data to think of a widespread use of this technique. Key words: CT scan, Diverticular Disease, Hartmann's Procedure, Intr-abdominal abscess, Laparoscopic Peritoneal Lavage and Drainage (LPL), Peritonitis, Primary Resection and Anastomosis (PRAHinchey Classification, US and CT guided drainage.