Primary Cavernous hemangioma of the Thyroid Gland. A series of 4 cases and review of literature.

Cavernous hemangiomas can arise nearly anywhere in the body where there are blood vessels. The primary hemangioma of the thyroid gland is extremely rare, and only a few cases have been previously reported. The true incidence of cavernous hemangiomas is difficult to estimate because they are frequently misdiagnosed as other venous malformations. We will present 4 cases from the age of 38 to 72 years old, diagnosed with cavernous hemangiomas. All 4 cases are women and the diagnosis was established after total thyroidectomy by histopathological examination. They clinically present as asymptomatic cervical tumors, are occasionally fast-growing, especially if intratumoral bleeding is present. KEY WORDS: Cavernous Hemangioma, Thyroid, Pathology, Histology.

Case report: SARS-CoV-2-induced urticaria or just a concomitance?

The association between urticaria and different virus infections has been reported in many studies. Different virus infections have been reported to be comorbidities of spontaneous urticaria. In this paper, we report the case of a male patient with acute urticaria 7 days after he left the hospital where he was treated for coronavirus disease 2019 (COVID-19). This infection may act as a causative or a facilitating factor for the initiation of acute urticaria and additional cofactors such as stress may contribute for the urticaria phenotype to be expressed. Additional facts for severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) virus in future will clarify if urticarial rash is one of the COVID's multiple faces.

Laparoscopic cholecystectomy: which predicting factors of conversion? Two Italian center's studies.

BACKGROUND: Laparoscopic cholecystectomy represents the gold standard technique for the treatment of lithiasic gallbladder disease. Although it has many advantages, laparoscopic cholecystectomy is not risk-free and in special situations there is a need for conversion into an open procedure, in order to minimize postoperative complications and to complete the procedure safely. The aim of this study was to identify factors that can predict the conversion to open cholecystectomy. METHODS: We analyzed 1323 patients undergoing laparoscopic cholecystectomy over the last five years at St. Orsola University Hospital-Bologna and Umberto I University Hospital-Rome. Among these, 116 patients (8.7%) were converted into laparotomic cholecystectomy. Clinical, demographic, surgical and pathological data from these patients were included in a prospective database. A univariate analysis was performed followed by a multivariate logistic regression. RESULTS: On univariate analysis, the factors significantly correlated with conversion to open were the ASA score higher than 3 and the comorbidity, specifically cardiovascular disease, diabetes and chronic renal failure (P<0.001). Patients with a higher mean age had a higher risk of conversion to open (61.9±17.1 vs. 54.1±15.2, P<0.001). Previous abdominal surgery and previous episodes of cholecystitis and/or pancreatitis were not statistically significant factors for conversion. There were four deaths in the group of converted patients and two in the laparoscopic group (P<0.001). Operative morbility was higher in the conversion group (22% versus 8%, P<0.001). Multivariate analysis showed that the factors significantly correlated to conversion were: age <65 years old (P=0.031 OR: 1.6), ASA score 3-4 (P=0.013, OR:1.8), history of ERCP (P=0.16 OR:1.7), emergency procedure (P=0.011, OR:1.7); CRP higher than 0,5 (P<0.001, OR:3.3), acute cholecystitis (P<0.001, OR:1.4). Further multivariate analysis of morbidity, postoperative mortality and home discharge showed that conversion had a significant influence on overall post-operative complications (P=0.011, OR:2.01), while mortality (P=0.143) and discharge at home were less statistically influenced. CONCLUSIONS: Our results show that most of the independent risk factors for conversion cannot be modified by delaying surgery. Many factors reported in the literature did not significantly impact conversion rates in our results.

Parathyroid adenolipoma. A case report and review of the literature.

The primary hyperparathyroidism is a pathological condition that needs frequent surgical treatment. Usually it is encountered due to a parathyroid adenoma, but in rare cases it is configured as structured parathyroid tissue in a rich environment with a bulk of adipose cells. This pathology initially described as Hamartoma of the parathyroid gland and then as parathyroid adenolipoma is rarely encountered and it requires special care from medical staff because of the difficulty in its early diagnosis and also its treatment. We are presenting a case treated by our team and a review of the literature on this topic. KEY WORDS: Hyperparathyroidism, Parathyroid surgery, Parathyroid adenolipoma, Parathyroid hamartoma.

In situ preservation of the partathyroid glands in total thyroidectomy: a propensity score matched analysis.

AIM: Severe hypocalcemia due to parathyroid gland damage may be a serious complication after thyroidectomy. In order to save parathyroid integrity we developed a no-touch parathyroid (NTP) thyroidectomy technique. METHODS: We performed a total extracapsular thyroidectomy with NTP technique in consecutive 50 cases of benign goiter between July 2014 and June 2015. Parathyroid glands were firstly indentified, then they were separated from the thyroid avoiding manipulation or trauma and preserving their vascularization. Traditional scissors were preferentially used for dissection around the glands. Patients operated with NTP technique were matched by a propensity score to a control group. RESULTS: NTP was feasible in all foreseen patients except one. Propensity score selected a group of 23 patients/group for matching. No mortality has been observed in either group. Operative time were comparable between groups. Blood loss were significantly less abundant in the NTP group. No laryngeal permanent paralysis was experienced. Hospital stay was shorter yet not significantly in NTP group. Neither hypocalcemic crisis nor permanent hypoparathyroidism were described in either group. Serum calcium levels (NTP Vs control) were significantly higher in NTP group at day 1 (p=0.03) and day 2 (p=0.002), respectively. Similarly, intact parathormone dosages were significantly higher at day 1 (p=0.004) and day 7 (p=0.001), respectively. CONCLUSIONS: We conclude that NTP thyroidectomy is a feasible in the majority of the patientsand, allows a significant reduction of blood loss without prolonging the operative time. After the procedureboth values of calcemia and intact parathormonewere stable and no hypocalcemic crisis was experienced. KEY WORDS: Parathyroid, Hypoparathyroidism, Hypocalcemia, Total thyroidectomy.

Intraoperative continuous intestinal loop warming technique A prospective randomised trial.

AIM: The aim of this study is to evaluate if the Intraoperative Continuous Intestinal Loop Warming (ICLW) is a valid trick to decrease the postoperative paralytic ileus. METHODS: The subjects were patients who underwent emergency open abdominal surgery for either benign or malignant diseases. Patients were divided into two groups; group A patients who was secluded for ICLW, and a control group B who was not secluded for ICLW. The primary outcomes were the time of recovery of bowel movement, 30 days postoperative mortality and morbidity, morbidity was graded by the Clavien-Dindo classification of surgical complications. Secondary outcomes were operative time, and length of hospital stay. RESULTS: A total numbers of 100 patients were randomly assigned in this prospective study. The mean time of bowel function recovery in the group A was 41.52 hours, whereas for group B was 67.20 hours, these differences were statistically significant with a P value < 0.05. In group B the bowel function recovery for 64% of the patients took between 72-96 hours furthermore, the longest time for peristaltic recovery was 96 hours which was only observed in patients of group B. There were no intra-operative complication in both groups. There is no difference in the two groups in term of 30 day postoperative morbidity. CONCLUSIONS: Intra-operative continuous intestinal loop warming technique is a simple, safe and low cost technique. It seems that intra-operative continuous intestinal loop warming technique maintain tissues hydration and conserve the body temperature limiting the stress response and help in decreasing the incidence of postoperative paralytic ileus. KEY WORDS: Paralytic Ileus, Postoperative Care, Warming.

Transitional challenges of Medicine and Surgery in Albania.

Data on the State of Art of Medicine and Surgery in Albania, are given in this short survey. From recent epidemiological data, conditioned by high rate of migration and territory problems, to problems arising from lack of technological supports and important changes in medical education. An analysis that we could do from the observatory of our Medical School, and international one, based on a strict collaboration among an international professor staff, mostly coming from Italian Universities, particularly the University of Rome, "Tor Vergata", co-founder of the "Catholic University Our Lady of Good Counsel" (UCNSBC). The integration between academics in UCNSBC and health personnel in health care offers some interesting opportunities in research. The recognized limited technological supports create the possibilities to adjust and ameliorate health care services, with the aim of a more convenient distribution of the available resources. KEY WORDS: Academic education, Albania, Epidemiology, Health education.

Physicians' perceptions about the quality of primary health care services in transitional Albania.

AIM: To date, the available information regarding the quality of primary health care services in Albania is scarce. The aim of our study was to assess the quality of primary health care services in Albania based on physicians' perceptions towards the quality of the services provided to the general population. METHODS: A cross-sectional study was conducted in January-March 2013 including a representative sample of 132 physicians (59 men aged 41.3±6.9 years and 73 women aged 43.7±4.8 years; overall response rate: 132/150=88%) providing primary health care services in several polyclinics (health centers) of Tirana, the Albanian capital city. A structured self-administered and anonymous questionnaire was applied including physicians' perceptions regarding different dimensions of the quality of primary health care. Binary logistic regression was used to assess the association of self-perceived quality of health care services with baseline characteristics of physicians. RESULTS: Self-perceived adequate quality of health care services was positively related to the age of physicians, their working experience, female gender, a lower population served, and specialization in family medicine. CONCLUSION: Our findings provide useful evidence on the self-perceived quality of health services from primary health care physicians' perspective in transitional Albania. Health authorities in Albania should implement suitable instruments to measure the quality of health care services at all levels.

Acute right intrathoracic gastric volvulus. A rare surgical emergency.

The acute intrathoracic gastric volvulus is a rare condition, difficult to diagnose and treat. It consist in a abnormal organo-axial rotation over 180°, associated with gastric obstruction or strangulation. More uncommon condition is the gastric volvulus caused by a right sliding diaphragmatic hernia and dislocating the stomach, or part of it, on the right hemithorax. Gastric volvulus classic clinical presentation described by Borchardt, consist on a triad of severe epigastric pain, vomiting followed by retching without ability to vomit and difficulty or inability to pass a nasogastric tube. Imaging, beginning from a simple chest radiograph showing an elevated gastric air-fluid level in lower lung segments, can help to define diagnosis and to determine the immediate necessity to operate trying to avoid fatal complications as gastric ischemia, perforation or haemorrhage. We present the case of a 58 year-old man arrived at our Emergency Department with moderate acute epigastric pain and already vomiting from 4 hours. The patient underwent initially a chest radiograph, Computed Tomography, upper digestive endoscopy, upper digestive contrasted radiology and then was operated. Post operative situation of the patient on recovery and during the 3 months follow up didn't experience any pain or difficulty in feeding.

Synchronous bilateral renal tumour: a case report.

We report a case of synchronous bilateral renal carcinoma treated by partial nephrectomy on the right and total nephrectomy on the left. Follow-up at 42 months after surgery showed no recurrence of the disease. The increasing use of diagnostic imaging techniques such as ultrasound tomography, computerised tomography and nuclear magnetic resonance now allows even small-sized renal formations to be identified. Synchronous bilateral renal tumour has a favourable prognosis, especially when compared with single or asynchronous renal tumours. The recommended intervention is total monolateral nephrectomy combined with partial nephrectomy. The treatment of neoplasms at a more advanced stage, of such a nature as to necessitate bilateral nephrectomy or chemotherapy, results in a significant increase in mortality. Recently, biological therapy has been proposed as a more promising short-term option using interferon-alpha (IFN-alpha) and gamma.

Transduodenal excision of giant tumour of the ampulla of Vater: a case report.

Carcinoma of the papilla is a rare cancer of the digestive tract; 5% of all gastrointestinal tract malignant neoplasms are periampullary. The authors report and discuss the case of one of their patients aged 79 years suffering from a tumour of the papilla. The case was characterized by the large size of the neoplasm (5.5 cm in diameter) and by the poor clinical conditions of the patient, who was suffering from Parkinson's disease and was at high operative risk. The surgical strategy chosen involved transduodenal excision of the tumour with duodenum-bile duct anastomosis and internal duodenum-Wirsung duct anastomosis. The authors first examine the hypothesis that carcinoma of the papilla may represent the evolution of an adenomatous lesion and then go on to assess the therapeutic strategy adopted in the treatment of these neoplasms: in patients at high operative risk a transduodenal excision of the tumour with duodenum-bile duct anastomosis and internal duodenum-Wirsung duct anastomosis may be a valid alternative to the conventional Whipple procedure.