7-T MRI of explanted liver and ex-vivo pancreatic specimens: prospective study protocol of radiological-pathological correlation feasibility (the EXLIPSE project).

The study focuses on radiological-pathological correlation between imaging of ex vivo samples obtained by a 7-T scanner and histological examination. The specimens will be derived from native explanted cirrhotic livers, liver grafts excluded from donation because of severe steatosis, and primary pancreatic tumours. Magnetic resonance imaging (MRI) examinations will be performed within 24 h from liver or pancreatic lesion surgical removal. The MRI protocol will include morphological sequences, quantitative T1, T2, and fat-, water-fraction maps with Cartesian k-space acquisition, and multiparametric methods based on a transient-state "MRI fingerprinting". Finally, the specimen will be fixed by formalin. Qualitative imaging analysis will be performed by two independent blinded radiologists to assess image consistency score. Quantitative analysis will be performed by drawing regions of interest on different tissue zones to measure T1 and T2 relaxation times as well as fat- and water-fraction. The same tissue areas will be analysed by the pathologists. This study will provide the possibility to improve our knowledge about qualitative and quantitative abdominal imaging assessment at 7 T, by correlating imaging characteristics and the corresponding histological composition of ex vivo specimens, in order to identify imaging biomarkers. Trial registration: ClinicalTrials.gov : 13646. Registered 9 July 2019-retrospectively registered.

Facial nerve function after parotidectomy for neoplasms with deep localization.

PURPOSE: To determine whether the deep location of a parotid gland neoplasm is specific risk factor for facial nerve paralysis after parotidectomy. METHODS: We retrospectively reviewed 88 patients, including 59 with a benign superficial neoplasm of the parotid treated by superficial parotidectomy (group 1); 5 with a benign deep neoplasm treated by total parotidectomy (group 2); 20 with a malignant superficial neoplasm treated by total parotidectomy (group 3); and 4 with a malignant deep neoplasm treated by total parotidectomy (group 4). RESULTS: Temporary facial nerve paralysis developed in 10.3%, 20%, 10%, and 50% of groups, 1, 2, 3, and 4, respectively. Permanent facial nerve paralysis developed in 0%, 0%, 10% and 50% of groups 1, 2, 3, and 4, respectively. CONCLUSION: The risk factor associated with nerve damage resulting from surgery for parotid neoplasms were malignancy and deep localization. However, the deep location of a benign tumor was not a major risk factor for permanent paralysis.

Randomized study on oral administration of calcitriol to prevent symptomatic hypocalcemia after total thyroidectomy.

BACKGROUND: Symptomatic hypocalcemia remains the main postoperative complication after total thyroidectomy. The aim of the present study was to evaluate the role of oral supplementation of calcitriol and calcium salts in preventing severe postoperative hypocalcemia after total thyroidectomy. METHODS: A consecutive series of patients undergoing total thyroidectomy followed by administration of 500 mg of calcium salts 3 times per day were randomized to 3 different postoperative medical treatments: in group A, .5 microg of calcitriol twice per day was administered to 104 patients; in group B, 1 mmicrog of calcitriol twice per day was administered to 111 patients; and in group C, 202 patients did not receive calcitriol. RESULTS: The rate of postoperative tetany in group A was 2.9%, in group B was 0%, and in group C was 7.4% (P=.03) and the rate of paresthesias was 28.8%, 17.1%, and 22.3%, respectively (P=.19). At discontinuation of calcitriol/calcium salts treatment, intact parathyroid hormone levels did not significantly differ from the preoperative levels. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve for serum concentration of calcium in predicting postoperative tetany was .749, .858 and .862 on the first, second, and third postoperative day, respectively. The best cut-off value of calcemia for prediction tetany was 7.5 mg/dL, and the rate of severe hypocalcemia on the third postoperative day was 23.1% in group A, 9.9% in group B, and 27.2% in group C (P=.001). CONCLUSIONS: Oral administration of 1 microg of calcitriol twice per day and 500 mg of calcium salts 3 times per day after total thyroidectomy significantly decreases the risk of severe postoperative hypocalcemia.

[Lymphectomy for well differentiated or "aggressive" thyroid malignancies. Indications, complications and results of our experience]. / La linfectomia per neoplasie maligne ben differenziate o "aggressive" della tiroide. Indicazioni, complicanze e risultati nella nostra esperienza.

The aim of this retrospective study was to assess the role of lymphectomy in the treatment of well differentiated and aggressive carcinomas of the thyroid gland. From 1987 to 2002, 231 patients were operated on in our Division; 97 were male (42%) and 134 female (58%), with a mean age of 48 years (range 17-45). One hundred and ninety-four patients had well differentiated thyroid carcinomas, and 37 aggressive thyroid cancer. We performed a follow-up on 171/231 patients (74%) who underwent surgery from 1997 to 1998. Among the 143 patients with well differentiated neoplasms, 93 were treated with total thyroidectomy (65%), and 50 with total thyroidectomy with simultaneous or subsequent lymphectomy (35%); 92 patients underwent postsurgical radiomethabolic therapy (64%). Two patients developed non-functional metastases and died because of disease progression. Of the 28 patients affected by aggressive tumours, 8 underwent total thyroidectomy (29%) and 20 total thyroidectomy with simultaneous or subsequent central lymphectomy (71 %). All 28 patients with aggressive malignancies underwent postsurgical radiomethabolic therapy (100%). Three patients developed diffuse non-functional metastases and died because of disease progression.

[Pancreaticojejunostomy by simple introduction after pancreaticoduodenectomy]. / Pancreatodigiunostomia per introduzione semplice dopo duodenocefalopancreatectomia.

The method which most surgeons still prefer in the treatment of the pancreatic stump after pancreaticoduodenectomy is pancreaticojejunostomy. In this article, we describe our preliminary experience with a fast, effective method, consisting in an end-to-end pancreaticojejunostomy by simple introduction, in 11 cases operated on without morbidity or mortality. From 1998 to 2002, 11 patients with pancreatic head or distal bile duct neoplasms underwent pancreaticoduodenectomy. After removal of the specimen, the residual pancreatic stump was prepared towards the left for about two centimetres, mobilizing the posterior surface from the porto-meseraic axis. A single layer of interrupted suture, consisting only in two posterior stitches, was enough in all cases; each stitch was done taking the stump full-thickness at about one centimetre from the transection margin (so as to introduce a corresponding portion of parenchyma into the jejunal lumen), and from the superior and inferior margin, respectively, of the pancreas. On the intestinal side, the stitches were passed full-thickness from the inner surface to the outside, 6 to 7 millimetres from the transection margin. After introducing the stump completely into the intestinal lumen, three anterior stitches were always done and knotted between the pancreatic capsule and the jejunum. All the anastomoses proved to be perfectly sealed.

Complications in total thyroidectomy: our experience and a number of considerations.

The authors review 1,636 cases of total thyroidectomy with reference to specific complications, classifying them under the headings: major-minor, early-late, transitory-definitive. They report 19 cases of postsurgical haemorrhage, all within 12 hours of the operation, 31 transitory and 15 definitive cases of recurrent laryngeal nerve paralysis, and 14 cases of definitive hypoparathyroidism. As far as the minor complications were concerned, there was a greater incidence of seroma following the use of the harmonic scalpel. The risk factors and physiopathological mechanisms associated with each type of complication are analysed here, above all those responsible for the major and definitive complications. The need for routine preparation of the recurrent nerve, in order to prevent occurrence of postsurgical paralysis is stressed, as is the efficacy of vitamin D in preventing symptomatic postsurgical hypocalcaemia.

[Ultrasonic scalpel in thyroid surgery]. / Il dissettore ad ultrasuoni in chirurgia tiroidea.

In order to evaluate the harmonic scalpel during "open" thyroid surgery, a prospective randomized study was performed using the device versus the traditional procedure. One hundred and forty-two multinodular goiter patients were selected for total thyroidectomy and subdivided into two gender- and age-matched groups. In the first group of 72 patients, the surgical procedure was performed with the US scalpel without using any electrical device or vascular ligatures; in the second group of 70 patients, the traditional technique was employed. No statistically significant differences were recorded with regard to permanent inferior laryngeal nerve palsy or hypoparathyroidism rates. Use of the harmonic scalpel was associated with a higher incidence of transient nerve injury (P < or = 0.005, 9.7% vs 1.4%), but this difference disappeared with increasing experience with the harmonic scalpel. Using the US device significantly improves surgical duration (87.5% < 1 h) and blood loss (P < or = 0.005).

Predictors of outcome for patients with differentiated and aggressive thyroid carcinoma.

OBJECTIVE: To identify the risk factors affecting the outcome of operations for differentiated and aggressive thyroid carcinoma which may indicate the need for a more aggressive surgical treatment. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS AND INTERVENTIONS: 143 patients underwent total thyroidectomy with or without central neck lymphadenectomy or modified neck dissection. There were 85 papillary, 34 follicular, 6 widely-invasive follicular, 6 insular, five oxyphilic, five tall cell, and two diffuse sclerosing papillary carcinomas. MAIN OUTCOME MEASURE: Disease-related survival. RESULTS: At 12-years, the survival was 96%, being 98% among patients with differentiated and 83% among those with aggressive carcinoma (p = 0.0006). Insular and oxyphilic carcinomas had the worst prognosis (at 10 years, 67% and 60%, respectively, p < 0.0001). The high-risk age, metastases, and extent score (AMES) group had worse survival than the low-risk group (12 years, 84% compared with 98%, p = 0.001). Among patients with differentiated carcinoma, the low-risk AMES group had also better outcome than those in the high-risk AMES group (at 12 years, 100% compared with 86%, p < 0.0001), but there was no such difference among patients with aggressive disease. Multivariate analysis showed that women (RR 14.28, 95% confidence interval (CI) 1.13 to 180.28), patients with tumours > or = 5 cm in size (RR 9.60, 95%CI 1.01 to 91.43) and AMES high-risk patients (RR 30.17, 95% CI 1.57 to 577.48) had the worst outcome. CONCLUSION: In patients with differentiated thyroid carcinoma, total thyroidectomy and, if the AMES score indicates a high risk, central neck lymphadenectomy with or without modified neck dissection, is associated with a favourable outcome. Poorer outcome is expected if the carcinoma is aggressive, and an aggressive surgical approach is advocated as a routine.

High rate of recurrence after lobectomy for solitary thyroid nodule.

OBJECTIVE: To evaluate the long-term outcome of patients treated by lobectomy for solitary thyroid nodule. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: 83 patients admitted with a clinical diagnosis of solitary thyroid nodule. INTERVENTIONS: Preoperative ultrasonography showed a solitary nodule in 32 patients and this finding was confirmed intraoperatively in 24 cases (77%). 59 patients with multinodular goitres were treated by total thyroidectomy and 24 with solitary nodule by lobectomy. MAIN OUTCOME MEASURES: Postoperative complications and freedom from nodule recurrence and/or parenchymal irregularity. RESULTS: One patient after lobectomy and 3 after total thyroidectomy developed temporary recurrent laryngeal nerve injury. Postoperative temporary hypoparathyroidism occurred in 13 patients (22%) after total thyroidectomy and in no patient after lobectomy (p = 0.02). Neither permanent recurrent laryngeal nerve injury nor permanent hypoparathyroidism occurred after either procedure. Among patients who underwent lobectomy, 6 had an adenoma and 18 had a nodular hyperplasia. At 4-year follow-up, the freedom rate from any thyroid nodule recurrence or parenchymal irregularity was 44.7%, and the freedom rate from nodular recurrence was 74%. Men tended to have a 4-year freedom rate from nodular relapse poorer than women (48% vs. 87%. p = 0.07). Nodular recurrence occurred in one patient operated on for an adenoma, and all the other recurrences occurred in patients with nodular hyperplasia. CONCLUSIONS: The mid-term freedom rate from thyroid nodule recurrence or parenchymal irregularity after lobectomy for solitary nodule of the thyroid is unsatisfactory. This observation calls for a better evaluation of long-term results after lobectomy for this condition and identification of risk factors predictive of recurrence. This would enable a more appropriate preoperative selection of patients undergoing lobectomy, indicating total thyroidectomy for those patients with solitary nodule at high risk of recurrence.