Assessment of cyclin D1 overexpression as a prognostic factor in soft tissue sarcomas: role of laparoscopy and core needle biopsy.

BACKGROUND: This study was designed to test cyclin D1 as a prognostic marker in patients with soft tissue sarcomas (STS), and to evaluate the usefulness of laparoscopy for determining cyclin D1 overexpression. METHODS: The records of 62 patients with STS were collected: 28 with retroperitoneal STS (RSTS) and 34 with extremity STS (ESTS). A total of 51 patients underwent surgical resection, whereas 11 did not undergo surgery because of advanced tumor stage. Preoperative-intraoperative laparoscopic staging was performed for patients judged to be resectable at preoperative imaging. RESULTS: Cyclin D1 was overexpressed in 30 (58.8%) of 51 resected patients and in 10 (90.9%) of 11 nonresected patients. Laparoscopy avoided unnecessary laparotomy in 9 (32.1%) of 28 RSTS patients. CONCLUSIONS: High tumor grade, positive surgical margins, local recurrence, distant metastases, and cyclin D1 overexpression were related to poor survival. Multivariate analysis demonstrated cyclin D1 to be the only independent factor. Laparoscopy was shown to be useful for avoiding useless laparotomies.

[Video-assisted surgery of the thyroid: outlines of the technique and analysis of the results]. / La chirurgia video-assistita della tiroide: note di tecnica e analisi dei risultati.

INTRODUCTION: The authors described the technique of the video-assisted approach to thyroid surgery (MIVAT: minimally invasive video-assisted thyroidectomy), selection criteria of the patients and evaluated the technical feasibility of this method. MATERIALS AND METHODS: Patients selection is based on many parameters. Exclusion criteria are: nodules greater than 35 mm, presence of thyroiditis, thyroid volume greater than 20 mL, previous neck surgery and irradiation. The surgical procedures are conducted through a minimal substernal skin incision (1-3 cm); the procedure performed using external retractors and needlescopic instruments. RESULTS: MIVAT was accomplished in 20 patients (15 female and 5 men). One cervicotomy was required to perform total thyroidectomy (positive frozen section). Mean operative time was 70 min. Two patients have reported transient hypoparathyroidism; one patient has reported transient recurrent nerve palsy. DISCUSSION: MIVAT has not yet met the favor of most endocrine surgeons; nevertheless we think that this technique is safe and feasible for benign thyroid diseases in selected cases, with the advantage of satisfactory cosmetic results Conversion to conventional surgery is required generally for local bleeding and to perform total thyroidectomy for positive frozen section. CONCLUSIONS: MIVAT is feasible and may improve cosmetic outcome. The indications are limited at present, but the results are encouraging for the future.

Magnetic resonance imaging and abdominal wall hernias in aortic surgery.

BACKGROUND: The aim of this study was to evaluate the incidence of abdominal wall hernias (AWH) in patients operated on for abdominal aortic aneurysm (AAA) compared with patients treated for aortoiliac occlusive disease. The efficacy of MRI in early diagnosis of AWH also was studied. STUDY DESIGN: One hundred fourteen patients operated for either AAA (51 patients, group A) or aortoiliac occlusive disease (63 patients, group B) constitute the study. The presence of AWH onset was evaluated by clinical observation followed by ultrasonography. Data acquired by ultrasonography were compared with those obtained by MRI to determine the efficacy of this diagnostic tool in all 114 patients. The prevalence of inguinal hernias in both groups also was determined. RESULTS: A significant difference was found in the incidence of AWH. AWH developed in 31.7% (16 of 51) of group A patients and 17.4% (11 of 63) of group B patients (p < 0.03). A significant prevalence ofinguinal hernias was detected in group A (p < 0.01). The Cox hazard regression analysis revealed as independent predictors of postoperative AWH only the presence of AAA and a history of laparotomy. CONCLUSIONS: Ours and other studies recall collagen synthesis disorders to explain the statistical association observed among AAA, inguinal hernias, and AWH. MRI, especially in patients at risk, appears to be an effective diagnostic approach to early detection of AWH.

Our experience in the management of pancreatic pseudocysts.

The authors discuss the problems in the diagnosis and treatment of pancreatic pseudocysts; they emphasize the risk of complication. The authors discuss their personal experience in the treatment of 31 pancreatic pseudocysts using the different techniques, and the very good results they observed in their own series.

[Ischemic phlebitis and venous gangrene]. / Flebiti ischemizzanti e gangrene venose

Seventeen cases of ischaemising phlebitis and 5 of venous gangrene are reported. Attention is given to the aetiopathogenetic factors that lead to massive thrombosis and dramatic progression of the disease: depression of vascular heparin, polyglobulia, serious dysproteinaemia, marked involvement of the arterial district, etc. Treatment may be medical or surgical, based on large doses of anticoagulants, low-weight dextrane and thrombolytic drugs, though the results expected are not always obtained. At present, early venous disobstruction with a Fogarty catheter, coupled with prolonged anticoagulant management is the best course. Prognosis is certainly better in ischaemia. When gangrene sets in, prognosis is particularly poor, even as far as survival is concerned, due to serious concomitant shock.