Axillary Treatment Management in Breast Cancer during COVID-19 Pandemic (Association between ACOSOG Z0011 Criteria and OSNA Test).

The outbreak of the SARS-COVID-2 pandemic (COVID-19) had a significant effect on the organisation of healthcare systems. Surgical units saw a significant reduction in the volume of surgical procedures performed, with lengthening waiting lists as a consequence. We assessed the surgical activity in relation to breast cancer that took place at the University Hospital of Cagliari, Italy, from February 2018 to March 2022. Two phases were identified based on the epidemiological circumstances: Phase 1-February 2018 to February 2020; Phase 2-March 2020 to March 2022. The surgery performed in the two phases was then compared. All the patients in our sample underwent a breast surgical procedure involving a lymph node biopsy using OSNA associated with the ACOSOG Z0011 criteria. In the study period overall at our facility, there were 4214 procedures, 417 of which involved breast surgery. In Phase 2, 91 procedures were performed using the OSNA method and ACOSOG Z0011 criteria, enabling the intraoperative staging of axillary nodes. Axillary treatment in breast cancer using this approach resulted in a significant reduction in the number of reoperations for the radicalisation of metastatic sentinel lymph nodes.

Adult idiopathic intussusception: a case report and review of the literature.

Adult intussusception is a rare condition. Most of the cases are due to an organic lesion and unlike the incidence in children idiopathic forms are really exceptional, occurring at a rate of 5% of all cases. Whereas in children a main cause is seldom found, adult intussusception is usually characterised by the presence of a leading intraluminal benign or malignant lesion. The authors report their experience with a clinical case of ileocolic intussusception occurring in an 28-year-old white male. In spite of the patient's age, the clinical presentation was very typical with the classic triad of abdominal pain, blood per rectum and a palpable mass. Diagnostic tools, namely US and TC scan, together with colonoscopy confirmed the physical examination, so that surgery was initiated with a definite diagnosis of intussusception. A large polyp or a lymphoma were considered the possible leading causes. After right hemicolectomy, pathology revealed that there was no organic lesion and the bulging mass was caused only by oedema and haemorrhagic infiltration of the invaginated loop. The patient had been on antipsychotic drugs for several months and the possible explanation of the pathology was linked to altered peristalsis induced by the pharmacological agents he was taking. The authors compare their experience with the data reported in the literature, evaluating in particular the incidence, pathology, clinical presentation, diagnosis and treatment of adult intussusception.

Surgical gastrostomy when percutaneous endoscopic gastrostomy is not feasible: indications, results and comparison between the two procedures.

Percutaneous endoscopic gastrostomy (PEG) is the procedure of choice in patients unable to eat owing to neoplastic or neurological diseases. In a few cases, however, PEG is not feasible and on such occasions a surgical gastrostomy (SG) proves mandatory to prevent starvation. The aim of the present study was to evaluate the cases submitted to SG when PEG could not be performed and to compare the results of the two procedures. We reviewed the medical records of 52 patients who required clinical nutrition in the years 2000-May 2007: 41 cases underwent PEG and 11 SG. Surgery was adopted when PEG failed or was deemed not to be feasible Analysis of the two series included sex, age, indications, associated diseases, mortality, complications, hospital stay and survival. Head and neck malignancies were the main indication to SG (81.1%), while PEG was adopted mainly for neurological diseases. In two cases, SG was required after failure of PEG due to lack of transillumination. A tracheostomy was present in 54.4% of the SG group and in 17% of the PEG group. Thirty-day mortality was nil in SG and 12% in PEG; morbidity was 9 and 7.3%, respectively. Hospital stay was 7 days in SG and 3 days in the PEG group. Survival at 24 months was poor in both series: 10% in SG and 25% in PEG. In case of PEG failure or contraindication, SG is more than satisfactory in terms of effectiveness, mortality and morbidity.

[Length of hospital stay and complications in thyroid surgery. Our experience]. / Durata della degenza e complicanze in chirurgia tiroidea. Nostra esperienza.

Length of hospital stays for thyroid surgery has decreased significantly over the last years. Hypoparathyroidism is one of the main obstacles to short-stay hospitalization. The aim of this study was to evaluate length of hospital stay in our experience, its relationship with complications observed and feasibility of short-stay hospitalization regimen. Between September 2002 and December 2005, 932 patients underwent total thyroidectomy in our institution. Serum calcium and phosphorus values were obtained at 6 hours after operation and on postoperative day 1 and 2. Discharge was possible on the morning of the first postoperative day in 2 patients (0.2%), the second day in 687 (73.7%), third day in 167 (17.9%), fourth in 44 (4.7%), fifth in 22 (2.4%), after the fifth in 10 (1.1%). Complications observed were hypoparathyroidism in 393 patients (42.1%), neck hematoma in 12 (1.3%), bilateral recurrent nerve palsy in 5 (0.5%), unilateral recurrent nerve palsy in 4 (0.4%), glottic hemorrhagic edema in 1 (0.1%) and foreign body granuloma and/or fistula in 5 (0.5%). Hypocalcemia was observed on post-operative day 1 in 338 patients (86%), on day 2 in 50 (12.72%) and on day 3 in 5 (1.27%). Serum calcium and phosphorus determination 6 hours after operation and on postoperative day 1 permits an early treatment of hypocalcemia and to shorten length of hospital stay. A normal serum calcium level on postoperative day 1 lets suppose an easy discharge on the second. Earlier discharge is to be reserved to selected patients and not always meets their favour.

Hydatid cyst of trapezius muscle: an unusual localisation. Report of a case and review of the literature.

The muscular localisation of hydatid cyst is very uncommon. The authors report a recently observed case of hydatid cyst of the trapezius muscle. An 81-year-old man presented with a 9-months history of a slow-growing painless mass in his left shoulder associated with itching. US examination showed a large multiloculated cystic mass, strongly suspicious of a hydatid cyst. At operation, under local anesthesia, complete surgical resection of the cystic mass was performed. The patient tolerated surgery very well. The postoperative course was uneventful and the patient was discharged from hospital on postoperative day 2. No recurrence occurred after 11 months. Muscular hydatidosis is very rare and can cause a variety of diagnostic problems, especially in the absence of typical radiological findings. The possibility of hydatid disease should always be kept in mind in the differential diagnosis of muscular masses, especially in endemic areas.

[Emergencies in thyroid surgery. Our experience]. / Le urgenze in chirurgia tiroidea. Nostra esperienza.

The rate of complications after thyroid surgery is about 5% and among these real emergencies account for less than 1%, consisting in intraoperative and postoperative bleeding, bilateral recurrent palsy, severe hypoparathyroidism and, rarely, laryngeal oedema and tracheomalacia. Between 2000 and 2004 849 patients were submitted to total thyroidectomy for various thyroid pathologies in our institution. Complications observed were postoperative bleeding in 13 patients (1.5%), laryngeal recurrent nerve palsy in 18 (monolateral in 14 - 8 transient and 6 permanent - and bilateral in 4, 3 of which transient), transient hypoparathyroidism in 390 (45.9%), permanent hypoparathyroidism in 10 (out of 400 patients followed up for more than one year = 2.5%). Tetanic crises were observed in 33 patients (3.9%). One patient, on treatment with heparin, showed a glottic haemorrhagic oedema (probably caused by trauma after endotracheal intubation) treated by an emergency tracheotomy on postoperative day two. Thyroid surgery is today very safe and morbidity is rare. Anatomical knowledge and accuracy of surgical indications are the main factors capable of reducing the number of complications. Experience in performing thyroid surgery is essential for the best outcome with the fewest complications. Complications of total thyroidectomy can be minimised with increasing experience and refinement of surgical technique.

[Differentiated thyroid carcinoma and hyperthyroidism: a frequent association?]. / Carcinoma differenziato della tiroide e ipertiroidismo: associazione frequente?

The relationship between hyperthyroidism and thyroid carcinoma remains controversial. In hyperthyroid patients the incidence of thyroid cancer varies considerably from 0.1% to 21%. We analyzed the frequency of coexisting hyperthyroidism and thyroid malignancy in our experience. From September 2002 to June 2004, 450 patients were submitted to total thyroidectomy in our surgical department. Hyperthyroidism was observed in 71 cases and thyroid carcinoma in 110 (107 differentiated). The association of hyperthyroidism and thyroid cancer was observed in 15 patients (14% of differentiated carcinomas and 21.1% of hyperthyroid patients). All patients were submitted to total thyroidectomy and are alive and disease-free. Seven cases of transitory hypoparathyroidism were observed (46.6%). There was no other morbidity. The association of thyroid cancer and hyperthyroidism is by no means rare. Careful exami- nation of hyperthyroid patients is always necessary to exclude the presence of carcinoma. These results confirm that the operation should be total thyroidectomy when surgery is performed in patients with hyperthyroidism.

[Substernal goiter: personal experience]. / Il gozzo cervico-mediastinico: nostra esperienza.

AIM OF THE STUDY: The Authors report on their experience in the surgical treatment of substernal goiter. MATERIAL AND METHODS: Between 1972 and 2004, 222 patients with substernal goiters were observed among 2720 patients undergoing surgical treatment for various thyroid diseases (8.16%). Seventy patients underwent subtotal thyroidectomy and 152 total thyroidectomy. A cervical approach was employed in 213 cases, a sternotomy was required in 7 patients while a thoracotomy was necessary in 2 cases. Postoperative complications were definitive hypoparathyroidism in 9 cases (4%), recurrent laryngeal nerve palsy in 5 patients (2.2%) and postoperative bleeding in 4 cases (1.8%); there was no intraoperative mortality. CONCLUSIONS: In substernal goiter it is necessary to define its exact relationship to neck and mediastinal structures in order to establish the most appropriate surgical approach. In the majority of the cases total thyroidectomy is possible through a cervical approach with an acceptable morbidity rate. When dissection of the substernal goiter is difficult and recurrent laryngeal nerve is not clearly identified, partial sternotomy is required to enable a better control of the nerve and the vessels with only a minimal morbidity rate. Thoracotomy is rarely necessary.