Role of reoperation in recurrence of adrenal cortical carcinoma: results from 188 cases collected in the Italian National Registry for Adrenal Cortical Carcinoma.

BACKGROUND: Recurrence of adrenal cortical carcinoma (ACC) after radical surgery is a common finding. Although successful reoperations have been reported with encouraging results, most published experiences are anecdotal and based on few cases. We report the results of surgical treatment for recurrent ACC in a multiinstitutional series. METHODS: One hundred eighty-eight cases of ACC were collected in a national registry. A complete follow-up was obtained in 179 cases. At initial diagnosis 92 patients had local disease (stage I or II). One hundred seventy patients underwent surgical treatment, considered radical in 140; in this group, recurrent disease was observed in 52 cases (37%) after a mean disease-free interval of 21.7 months. RESULTS: Adjuvant chemotherapy was ineffective in ameliorating the prognosis. The mean survival in 20 patients who underwent reoperation was significantly higher (15.85 +/- 14.9 months) than in nonreoperated cases (3.2 +/- 2.9 months). Five-year actuarial survival in reoperated patients is significantly better than in nonreoperated patients (49.7% versus 8.3%, respectively). CONCLUSIONS: Although the prognosis of this tumor is still poor, surgery is the only effective therapy; reoperation allows survival comparable to that observed in patients without recurrent disease. An aggressive strategy for recurrent ACC is advisable until prospective studies demonstrate a real effectiveness for chemotherapy.

Antigen detection for the diagnosis of pneumonia.

Streptococcus pneumoniae and Haemophilus influenzae type b are the main agents of bacterial community-acquired pneumonia in developing countries, although a definite etiologic diagnosis cannot be established in most cases. This study was carried out to assess the performance of a latex particle agglutination test (LPAT) from a commercial kit (Slidex Méningite Kit trade mark, BioMérieux, France) in diagnosing pneumococcal and H. influenzae type b pneumonia. One hundred and seven children (45 ill subjects and 62 healthy controls) were enrolled. All 45 cases had a presumptive diagnosis of bacterial pneumonia based on clinical (WHO criteria), laboratory (white blood cell count > or = 15.000/mm3, polymorphonuclear leukocytes > or = 70%, bands > or = 500/mm3, and C-reactive protein > or = 40 mg/l), and radiological findings, i.e., two or more positive points in the scoring system described by Khamapirad and Glezen (Semin Respir Infect 1987;2:130-144). Clinical, laboratory, and radiological assessments were performed in a blinded manner. LPAT was performed in urine samples after concentration through an ethanol-acetone solution. Sensitivity, specificity, and positive and negative predictive values were 77.3% (95% CI, 61.8-88.0%), 90.3% (95% CI, 79.5-96.0%), 85.0% (95% CI, 69.5-93.8%), and 84.8% (95% CI, 73.4-92.1%), respectively. Results suggest that LPAT is a useful diagnostic tool for the etiologic diagnosis of S. pneumoniae and H. influenzae type b pneumonia, especially in the developing world.

[Paraganglioma of the posterior mediastinum (author's transl)]. / Il paraganglioma del mediastino posteriore.

The authors describe one case of paraganglioma of the posterior mediastinum successfully removed after being discovered accidentally in a young male patient who showed no symptoms attributable to the tumor. The latter was a round mass, about 6 cm in diameter, richly vascular, located in the right costomediastinal gutter. Histologically it was a functionally silent paraganglioma originating from the intrathoracic aortosympathetic paraganglia, these being part of the very numerous groups of the paragangliar system distributed segmentally into metamers, particularly in the adrenal medulla. According to the more recent views, chemodectoma or paraganglioma (chromaffine or non-chromaffine, functionally active or silent) and pheochromocytoma (functionally active or silent, adrenal or extra-adrenal) constitute a group of tumors sharing the same tissue matrix, namely paragangliar cells.

[Percutaneous transhepatic biliary drainage]. / Il drenaggio biliare transepatico-percutaneo.

The authors describe their experience in 23 cases of biliary tract drainage by the transhepatic-percutaneous approach in the course of obstructive jaundice of diversified origin. This can be done for essentially three reasons, namely to alleviate jaundice preoperatively, to provide permanent bile drainage in patients not amenable to surgery, and to relieve excess pressure in surgical anastomoses of the biliary passages. On the basis of biological considerations (relationship between severity and duration of cholestasis on the one hand and postoperative mortality and morbidity on the other), and in light of their own results, the authors argue in favor of this procedure, explaining that it is only mildly traumatic to the patient, easy to perform, attended by a low quota of complications, and above all effective as a drainage; also, it does not unduly prolong the preoperative period for patients scheduled for further and major surgery. Also in view of the current role of PTC in the diagnosis of obstructive jaundice, they submit that transhepatic-percutaneous drainage should be done right next to recognition of dilatation of the intrahepatic bile passages by CAT or echotomography.

[Incidence of recurrent nerve paralysis in personal cases of thyroid surgery]. / Incidenza della paralisi ricorrenziale nella nostra casistica di chirurgia tiroidea.

The authors review their series of thyroid operations, totaling 383 cases in the last seven years. In that series the incidence of recurrent nerve lesions leading to permanent sequels was 1.07% (all treated without surgical preparation of the nerve); an additional 0.53% of the patients developed transient paralysis of the recurrent nerve--of which the authors discuss the possible etiology. The authors conclude by stating the need for careful recognition of the recurrent nerve in all surgical procedures involving the thyroid gland, except some enucleo-resections; they confirm the importance of branches of the inferior thyroid artery and the inferior horn of the thyroid cartilage as reference points.

[Behavior of calcemia in breast malignancy. Note I (author's transl)]. / Sul comportamento della calcemia nelle neoplasie della mammella. (Nota 1).

The authors report a statistical investigation conducted in 95 patients with mammary carcinoma, designed to show the behavior of calcemia in the course of this malignancy. The data were analyzed statistically by the binomial test, the scatter of values (F test of Snedecor), and the t test of Student. The authors confirmed the existence of a statistically significant alteration of calcemia only in the group of patients with metastasis to bone versus control subjects; conversely there was no significant difference of distribution in the various groups in regard to values beyond those given as normal.

[Complications of thyroidectomy: hemorrhage]. / Complicanze della tiroidectomia: l'emorragia.

The authors report their experience in haemorrhage after thyroid surgery. Haemorrhagic complications occurred in 5 cases in a series of 1803 sequential thyroidectomies (incidence: 0.27%). In particular, incidence was 1.9% after interventions for thyroid neoplasias (adenoma and carcinoma) and 0.18% after interventions for non-neoplastic thyroid pathology. Haemorrhage occurred always after "total" operations, even if monolateral. Causative and contributing factors, precautions and measures helpful in reducing the incidence and the potential dangerousness of haemorrhagic complications are discussed.

[The relationship between thyroid surgical operations and blood calcium]. / Sul rapporto tra interventi chirurgici tiroidei e calcemia.

The behaviour of calcemia was studied in a group of patients subjected to surgical operation of varying extent on the thyroid (enucleoresection, hemithyroidectomy, subtotal and total thyroidectomy). Average calcaemia was found to be diminished in all groups of operated cases, in relation to the extent of the operation. Surgery interferes by significantly modifying the variability of calcaemia in the different groups. The frequency of cases with pre-operative calcaemia higher than the average and retaining a postoperative level higher than the minimum of the controls is roughly inversely proportional to the extent of the surgery. A comparison between calcaemia after subtotal thyroidectomy for nodular struma and for Graves' disease did not evidence any statistically significant differences.

[The isolated thyroid nodule: notes on our personal experience]. / Il nodo tiroideo isolato: appunti sulla nostra esperienza.

An analysis of 255 patients operated for isolated thyroid nodes is made. Of these, 81% were cold nodes and 19% hot. Carcinomas were present in 21 cases. One carcinoma appeared as a scintigraphically hot node. The frequency of carcinomas, in relation to the nodules observed, was roughly the same in the two sexes. There is parallelism in behaviour of the rate in the two sexes as regards cold nodes, while this is not true for hot nodes. The importance of some recent diagnostic techniques is briefly discussed.

[The problems of surgical tactics in the treatment of pancreatic pseudocysts and related complications]. / Problemi di tattica chirurgica nel trattamento delle pseudocisti pancreatiche e delle relative complicanze.

On the basis of 45 cases of operated pseudocyst, the Authors tackle the problem of surgical tactis in treatment of these lesions and any complications. The paper outline the contribution that recent diagnostic methods--such as endoscopic retrograde cholangiopancreatography, computed tomography and ultrasonography--have made to solution of the problem and establishes the criteria for emergency or elective operation. In the first condition, consisting in cases of complications (haemorrhagic, suppurative, perforative etc.), abnormal development of pseudocysts and serious impairment of the patient's general conditions, the treatment of the pseudocyst generally takes the form of external drainage. The second condition, obtainable after a sufficient period of "ripening", usually consists in a cysto-digestive shunt or cysto-parenchymal demolition in view of the high morbidity arising from external drainage. Surgical treatment of the pseudocyst is completed by therapy of any basic chronic pancreatitis and by correction of probable associated lesions affecting the bile and digestive tracts and the splanchnic venous circulation. In the reported cases, 28 patients were treated by cysto-digestive shunt, 8 by cysto-parenchymal demolition and 9 by external drainage. There were 37 combined operations.

[Behavior of creatine kinase-isoenzyme BB in the nodular pathology of the thyroid (preliminary note)]. / Comportamento della creatinakinasi-isoenzima BB nella patologia nodulare della tiroide (nota preliminare).

The literature indicates the presence of the BB isoenzyme of creatinakinase in the thyroid tissue. The CKBB, therefore, was dosed with radioimmunologic method in a group of 79 patients bearing nodular pathology of thyroid (12 carcinomata, 42 nodular strumata, 25 adenomata), to check whether such parameter could be used as marker in the thyroid neoplasms. The CKBB, however, did not show a statistically different behaviour in the three classes of pathology considered.

[Behavior of antithyroglobulin and antimicrosomal antibodies in thyroid pathology]. / Sul comportamento degli anticorpi antitireoglobulina e antimicrosomiali in patologia tiroidea.

The Authors report the behaviour of antithyroid and antimicrosomial antibodies in a group of 394 patients suffering from nodular struma, thyroid adenoma and carcinoma, Hashimoto's thyroiditis, other thyroidites and Basedow's disease. The autoimmune pathology (Hashimoto's thyroiditis and Basedow's disease) is joined to a higher frequency of positive titles for both antibodies. In such pathology we also meet the highest titles. In the non-autoimmune pathology the antimicrosomial antibodies are more frequently positive than the antithyroid ones. If one considers the behaviour of both antibodies, the specificness about the diagnosis of thyroiditis increases.

[Unusual association of squamous and follicular carcinoma of the thyroid]. / Sulla singolare associazione del carcinoma squamoso e follicolare della tiroide.

The Authors report a case of thyroid squamous cell carcinoma associated to a counterlateral lobe follicular carcinoma, they had the opportunity to observe. The histogenetic hypotheses and problems of differential diagnosis are discussed.

[Clinical and pathological staging of 85 patients with Hodgkin's disease: a clinical contribution (author's transl)]. / Stadiazione clinica e patologica in 85 casi di morbo di Hodgkin: contributo casistico.

This is a retrospective study of 85 patients with Hodgkin's disease undergoing studies of clinical staging. Of these, 28 were investigated by laparotomic splenectomy, which revealed evidence of disease progress not otherwise detectable in 10 cases (36%). The authors also note that cases with an unfavorable histotype are associated with a higher incidence of spleen involvement and a more advanced stage of disease.