[Association between thyroid and parathyroid diseases]. / Associazione tra patologia tiroidea e paratiroidea.

The association between thyroid and parathyroid diseases is well known in the context of MEN, but we find also in nonsyndromic scenarios. In our study, were considered the latter. Between 2003 and 2008 in our Division of General Surgery 61 patients underwent operation for hyperparathyroidism, 13 for primary, 41 secondary and 7 tertiary. Twenty-six of these patients underwent also total thyroidectomy. 31% of our patients with primary hyperparathyroidism had concomitant thyroid disease. In the literature, in this regard, there is a correspondence between the data of various authors (Keus, Masatsugu). The association between IPT and primary thyroid carcinoma is discussed. Of our 41 patients with secondary IPT, 32% had associated thyroid disease (77% for goitre). The literature shows considerable variability in this direction, depending on geographical areas and methods of diagnosis. The thyroid disease associated with tertiary IPT was in all of our cases benign. The association of thyroid and parathyroid disease is therefore relatively common. It follows therefore the importance of careful preoperative evaluation in patients with hyperparathyroidism, in order to avoid a reoperation on the neck, because of higher complication rate.

Role and clinical importance of Helicobacter pylori infection in hemodialysis patients.

Dyspepsia is an extrarenal symptom frequently found in hemodialysed patients; it is due to chronic renal failure, and uremic gastritis is a specific associated condition in chronic renal failure (CRF). On the other hand, in the general population, Helicobacter pylori infection is an important dyspepsia-related risk factor; its close connections with gastro-duodenal pathology are already known, above all the peptic disease in a really exclusive way. By observation of a dyalitic group of patients, opportunely matched with a no CRF group, we evaluated CRF-associated uremia and Helicobacter pylori infection which could eventually interact causing symptoms and lesions. A statistical analysis of obtained data allowed us to conclude that, although there is not, from an epidemiological view-point, a larger diffusion of Helicobacter pylori among dyalitic patients compared to general population, moreover the infection is uremia-synergic in causing gastro-duodenal symptoms and lesions. These findings, therefore, suggest systematically investigation a possible Helicobacter pylori infection in CRF patients and its relation to gastritis grading, and searching for probable active peptic lesions.

[Laparoscopic adrenalectomy: our preliminary experience]. / Videolaparosurrenectomia: nostra esperienza preliminare.

INTRODUCTION: In 1992, Gagner described the first laparoscopic adrenalectomy. Since then this technique has been more and more widely employed and several studies confirmed its advantages, comparing to the traditional approach, in terms of reduction of mean hospital stay and therefore of the health expense. PATIENTS AND METHODS: The Authors' preliminary experience spreads from March to November 2003 when 4 patients were studied and thus underwent a transperitoneal laparoscopic adrenalectomy: 2 of them were affected by Cushing syndrome, 1 by pheochromocytoma in MEN and 1 by an incidentaloma. The transabdominal access in lateral decubitus with 4 trocars was performed. RESULTS: No complication was reported with a minimal need of analgesic drugs. The mean hospital stay was 4 days and all patients were discharged 48 hours after surgery. The mean diameter of nodules was 40 +/- 30 mm. The definitive histological examination showed 2 cortical adenomas, 1 diffuse cortical hyperplasia and 1 pheochromocytoma. CONCLUSIONS: This preliminary report confirms the optimal results of other experienced authors. Further interventions will be necessary for improvements and technical requirements.

[The surgical treatment of nodular thyroid lesions: our experience. Analysis of 462 cases]. / Il trattamento chirurgico delle lesioni nodulari tiroidee: nostra esperienza. Analisi di 462 casi.

Nodular thyroid lesions are the most frequent endocrine diseases in the general population. The surgical procedure is indicated for nodular thyroid tissue degeneration, or when the suppressive pharmacologic therapy is less efficient, even if sometimes both factors are associated. In Authors' study 462 patients were observed who underwent surgical procedures for thyroid diseases between January 1997-April 2003. In the thyroid pathology, either uninodular or multinodular, the surgical therapy adopted is total thyroidectomy, according to other Authors. The aim of total thyroidectomy is to avoid recurrence and simplify long term pharmacologic treatment. Although the question about the surgical approach (total thyroidectomy vs lobectomy) is still open in the case of single monolateral lesions, on the basis of their experience the Authors believe that the first is the best procedure. For diffused or malignant nodular thyroid pathology, on the contrary, total thyroidectomy is widely adopted.