[Parathyroidectomy: bilateral exploration of the neck vs minimally invasive radioguided treatment]. / Paratiroidectomia: esplorazione bilaterale del collo versus trattamento radio-guidato mini-invasivo.

AIM: In the therapy of primary hyperparathyroidism, the first surgical intervention, if efficacious, can remarkably reduce the incidence of persistence and relapses which are approximately about 5%. At present, the surgical approach of choice should involve the bilateral exploration of the neck. METHODS: In the light of the high sensibility (91%) and specificity (98.8%) in the localization of parathyroid adenomas obtained by the parathyroid 99mTc-MIBI scintigraphy, we submitted, prospective and at random, between January 2001 and July 2004, 69 patients with primary hyperparathyroidism, to a conventional surgical treatment (bilateral exploration of the neck: 35 patients) or minimally-invasive approach (minimally invasive radioguided parathyroidectomy: 34 patients). This method consists of the injection of 50 mCi of 99mTc Sestamibi 2 h before the operation and the execution of parathyroid scintigraphy. When the adenoma is evident, we perform an incision of about 4 cm in the neck, 2 cm over the jugulum and the surgical dissection is guided by a probe showing the emission of gamma rays. RESULTS: The parameters considered in order to compare the 2 groups, i.e. operating time, hospital stay and time of recovery were reduced in a significant way in the group submitted to the minimally invasive radioguided parathyroidectomy (MIRP). There were no complications in the 2 groups. In the follow-up we did not observe cases of persistence or relapses. CONCLUSIONS: Therefore, we can confirm that the minimally invasive radioguided parathyroidectomy is a safe and efficacious method as well as the bilateral exploration of the neck. Moreover, cost reduction may convince many surgeons to consider MIRP the <> in the management of primary hyperparathyroidism.

[Post-mastectomy breast reconstruction: esthetic-psychological rebalance]. / Ricostruzione mammaria postmastectomia riequilibrio estetico-psicologico.

Patient motivation and desire are the main indications for restoring the breast. Breast reconstruction can alleviate the sense of deformity that may develop after mastectomy or conservative treatment.

A comparison of serum interleukin-6 concentrations in patients treated by cholecystectomy via laparotomy or laparoscopy.

BACKGROUND/AIMS: Interleukin-6 (IL-6), a multifunctional cytokine, is expressed by various cells after many stimuli. This cytokine release is related, among other things, to the extent of the surgically-induced trauma. Laparoscopic cholecystectomy (LC) is a so-called "mini-invasive" surgical procedure and, on the basis of this consideration, the aim of the present prospective non-randomized study, is to examine (a) whether the IL-6 is modified and how, in patients after LC compared to patients undergoing open cholecystectomy (OC), (b) whether these findings are indicative of an increased risk to develop infectious complications and whether they are therefore clinically significant. METHODOLOGY: Circulating IL-6 level was measured using a random access chemiluminescense-immunoassay system in 71 patients before the operation (time 0) and 1, 2, 3, 6, 24 and 48 hours after the beginning of the operation. Thirty-five patients underwent OC and 36 LC. RESULTS: The increase in the serum IL-6 during LC was found to be significantly smaller than that during OC and resulted in a smaller extent of postoperative elevations for C-reactive protein. We recorded three cases (8.5%) of postoperative infections in the "open" group and IL-6 concentration normalized only 6 days after surgery. CONCLUSIONS: An increase in the serum IL-6 level during LC is lower in comparison to OC and results in lower postoperative elevation in C-reactive protein. Laparoscopic surgery, associated with a small skin incision and the avoidance of open laparotomy, can thus minimize surgical stress, and provide more favorable postoperative conditions for patients. Indeed excessive and prolonged post-injury elevations are associated with increased morbidity.

Changes in the blood coagulation, fibrinolysis, and cytokine profile during laparoscopic and open cholecystectomy.

BACKGROUND: It has long been known that a hypercoagulability state develops after surgery. A surge in circulating cytokine levels is also commonly found in the postoperative period. These cytokines have all been shown to be capable of inducing a hypercoagulability state. Recently laparoscopic cholecystectomy (LC) has been introduced, and its advantages over the open procedure seem related to the reduced surgical trauma. LC is associated with a diminished acute-phase response compared with the open procedure. Our present knowledge on the influence of laparoscopic upon coagulation and fibrinolysis is incomplete and based on a few studies. METHODS: The aim of this prospective, nonrandomized study was to investigate hemostatic system alterations in patients who undergo open and laparoscopic cholecystectomy. In addition we also measured the plasma cytokine profile to explore any relationship between changes in plasma cytokine levels and postoperative coagulation profile. Between September 1999 and April 2002, 71 patients were nonrandomly assigned to open (group 1) or laparoscopic cholecystectomy (group 2). All patients from group 1 were operated by a surgical team different from ours, who prefers the OC procedure. The patients with acute cholecystitis were excluded. Prothrombin fragment 1.2 (F1.2), thrombin-antithrombin (TAT), fibrinogen, soluble fibrin, antithrombin III (AT), protein C, plasminogen, and D-dimer levels were measured at baseline and at 1, 24, 48, and 72 h postoperatively. Serial serum levels of IL-1beta and IL-6 were measured by colorimetric enzyme-linked immunosorbent assay (ELISA). RESULTS: Plasma levels of F1.2, TAT, fibrinogen, soluble fibrin, and D-dimer increased significantly in group 1. Plasma levels of AT, protein C, and plasminogen decreased in both groups. In the OC group, the serum IL-3 and IL-6 levels began to significantly increased as early as 1 h from the beginning of the operation, revealing a peak at the sixth hour. When IL-6 and IL-1 levels were markedly elevated also, F1.2, fibrinogen, and soluble fibrin levels were increased. CONCLUSIONS: Only mild hypercoagulability was observed in patients who had undergone laparoscopic cholecystectomy. The cytokine surge was correlated with hypercoagulability. There was in fact a positive correlation between IL-6 level and hypercoagulability. The correlation between cytokine levels and coagulation activation may be related to the type of surgery performed. Further studies are required to investigate these issues.

[Madelung's disease. Clinical case and review of the literature]. / Malattia di Madelung. Caso clinico e revisione della letteratura.

Symmetrical benign lipomatosis (Madelung's disease) is extremely rare. Approximately 200 cases have been reported in the literature. SLB is a syndrome characterized by the occurrence of symmetric lipomas of the neck. No clear etiology has been recognized while a frequent association with systemic metabolic abnormalities has been described. The only effective therapy is the palliative surgical removal of the fatty tissue by lipectomy or liposuction. Experience with surgically treated patients shows the tendency of this disease to recur.

[Hydatid cysts of the right lobe of the liver treated with total pericystectomy using a transparenchymal approach]. / Cisti idatidee del lobo destro del fegato trattate con pericistectomie totali per via transparenchimale.

The Authors report on 2 cases of hydatid cyst of the right hepatic lobe. A transparenchymal approach with total pericystectomy was the treatment of choice.

[Laparoscopic adrenalectomy: technical knowledge in lateral position]. / Adrenectomia laparoscopica: note di tecnica con posizione laterale.

Laparoscopic approach to adrenal glands present to the patient the advantages of a lower invasivity respect to anterior or posterior thoracoabdominal access. Thanks to the minor pain occurring after the operation, the rapid gain and canalization, the brief hospitalization and the better aesthetic result. This method is to prefer to the others.

[Splenic localization of an echinococcal cyst]. / Localizzazione splenica della cisti da echinococco.

The finding of echinococcal cyst in the spleen is an extremely uncommon event occurring in Literature in 4% of the cases, setting, for frequency, after the liver and the lungs. The symptomatology is not very evident, being characterized by fever, left upper quadrant fullness or discomfort due to splenomegaly, which is demonstrable with physical examination and US. Splenectomy is the best surgical choice in the treatment of echinococcal cyst while conservative surgery should be reserved as an alternative in very selected cases.

[Primary cysts of the spleen: a case report]. / Cisti primarie della milza: descrizione di un caso clinico.

The cystic pathology of the spleen is comparatively infrequent and the origin is parasitic, hydatid. The parasitic cysts are the 65% of the total and the cysts secondary at trauma are the 28%. The real or primary cysts of the spleen are only the 75 of the case record. Analyze, in this work, the etiology and the clinic of these formations and show the personal experience about a clinical case arrived at our observation with negative anamnesis for trauma and with aspecific symptomatology like dyspepsia. We think that this notification is useful because the cystic primary formations of the spleen are very rare.

Carpal tunnel syndrome: the role of tridimensional computerized tomography.

The authors evaluated the possibility of obtaining tridimensional images of the fibrotendinous structures of the carpal tunnel and interpreting their diagnostic meaning starting from high resolution axial images of computerized tomography. In all of the cases proposed 3D-CT allowed for a representation of the tendons of the flexor muscles and the transverse ligament of the carpus (when present) in a complete and totally original manner. Of particular importance is the choice of a correct threshold value in order to obtain diagnostic imaging.

[Compression arthrodesis in tuberculous coxitis]. / L'artrodesi a compressione nella coxite Tbc.

Based on their experience, the authors emphasise the possible recurrence of inveterate centres of Tbc coxitis. It is their opinion that in cases healed with painful stiffness, where prosthetization does not guarantee good results, surgical revision of the joint, filling of the residual cavity with autoplastic or homoplastic intra-articular bone transplants, treatment with anti-Tbc drugs, and extra-articular stabilisation by compression, such as that provided by a Schneider cobra plate, are indicated.