Scintigraphy with 99mTc-MIBI and echography in the study of primitive hyperparathyroidism.

BACKGROUND: The authors analyse the value of the exams preoperative for the identification of the pathological parathyroid glands. METHODS: The authors examined 58 patients affected by primitive hyperparathyroidism (HPTp) who had undergone surgical treatment for primary hyperparathyroidism at the Third Surgical Department of University "La Sapienza" of Rome, in 175 patients affected by primitive hyperparathyroidism observed between January 1970 and June 2000; all patients had undergone echotomography of the neck and 99mTc-MIBI scintigraphy in the diagnostic phase. The histological valuation confirmed the diagnosis by I.P. RESULTS: 99mTc-MIBI scintigraphy demonstrated the pathological glands in 56 cases (96.6%), the echography in 57 cases (98.2%). The comparison of the two exams demonstrated the pathological glands in 100% of the cases. In 45 cases the scintigraphy localized the side (77.6%), and the echography in 41 cases (70.7%). In one case demonstrated I.P. persistent (1.7%) and never one case demonstrated relapsed. CONCLUSIONS: The authors think that the scintigraphy together with the echography show high sensibility to identification the pathological glands. Neck surgical exploration can still give the side good when the diameter of the parathyroids is inferior to 5 mm.

[Correlation between surgical intervention, adjuvant therapy, and long-term survival in patients operated on for breast neoplasia]. / Correlazione tra intervento chirurgico, terapie adiuvanti e sopravvivenza a distanza in pazienti operate per neoplasia mammaria.

INTRODUCTION: Breast cancer is the most frequent cancer among female sex, above all in rich countries where it occurs ten times more than the others. The most incidence of breast cancer is in female over 45 yrs and over 70 yrs with a plateau during menopause. So it is really very uncommon before 30 yrs. It is well known that breast cancer is related to several risk factors: these have always to be well evaluated before any treatment, especially in surgery. In the last years we can see an improvement of techniques to make diagnosis of breast cancer. Also surgery has improved in that way, so it can ensure better results to patients than before, also from the esthetical point of view. There are lot of discussions on which is the best surgical treatment to do, if lymphoadenectomy of the armpit is always required and if it has to be considered only as a prognostic element or also a therapeutical one. It is also important to plan radio, chemio and hormonal therapy, well chosen on the base of histological exams, and of the grading made either before either during surgery. Last studies moreover evaluate the specificity, the importance and the prognostic value of searching the so called "sentinel lymph node" who is always the first one to be interested in a metastatic process. STUDY AND DISCUSSION: Through a random and retrospective study among all our female patients (Department of Surgical Science in Rome University "La Sapienza") who had surgery for breast cancer in the last ten years (approving all the hystological exams) we have related the kind of surgical treatments to overall survival, to the therapies, and to any possible local recurrence of disease. We analyzed 270 female patients (age between 19 and 83). We considered all surgical treatments used in breast cancer: from the "simple" quadrantectomy up to radical mastectomy with the association of lymphoadenectomy of the armpit (both armpits in case of recurrence to disease). All these patients had then their own therapy (radio, chemo or hormonal one, it depended on each case) and follow up of the length of at least five years. The overall survival was of 82.2%. From these study we made important considerations about all the factors involved in breast cancer. The first step is to consider always all of these to have a well surgical approach, and to get the best compliance and performance from patients in order to have at distance the best results.

Thyroid cancer: surgical experience with 322 cases.

From November 1970 to July 1983, a total of 322 thyroid cancers were treated surgically in our clinic. Total thyroidectomy was the treatment of choice. In 131 patients, modified neck dissection (unilaterally in 23 and bilaterally in 108) was added. Of the latter patients, 33 also required upper mediastinal lymph node dissection. There were no operative deaths. No recurrent laryngeal nerve iatrogenic palsy was observed. Permanent parathyroid insufficiency developed in only about 4% of patients. The low morbidity and good long-term results justify the use of this procedure in all patients with thyroid malignancies. Despite conservative arguments in the controversial issue of lobectomy versus total thyroidectomy, skilled surgeons should be able to perform total thyroidectomy safely. It is recommended as the treatment of choice because of the well-documented multicentricity of thyroid cancers and the good prognosis of differentiated cancers associated with a near-normal life expectancy, to permit radioactive iodine therapy of possibly functioning metastases and the easier control of hypothyroidism with thyroid supplement medication.

[Early postoperative enteral nutrition and total parenteral nutrition. Technics compared in patients undergoing radical surgery for carcinoma of the large intestine. Preliminary report]. / Nutrizione enterale precoce postoperatoria (NEPPO) e nutrizione parenterale totale (NPT). Tecniche a confronto in pazienti sottoposti a chirurgia demolitiva per carcinoma del grosso intestino. Nota preliminare.

A preliminary study has been carried out on 10 patients suffering from cancer of the colon and rectum, all subjected to radical surgery. The clinical effectiveness of two alternative techniques of postoperative artificial nutrition, EPEN and TPN, are compared. The results confirm that enteral nutrition is technically applicable and well tolerated in the immediate post-operative period in these patients; it also presents a lower cost, it is more manageable and present a lower incidence of complications compared to TPN while offering similar metabolic and nutritional results.

[Direct post-mastectomy reconstruction with skin expansion. Technical notes]. / Ricostruzione diretta post-mastectomia con espansore cutaneo. Note di tecnica.

The demolition-reconstruction sequence in patients suffering from breast cancer may, in selected cases, be reduced to two surgical steps alone without compromising the radical nature of the surgery or the aesthetic result. The technical details of a protocol realisable in a short time that proposes on the one hand classical radical mastectomy (according to Patey or Madden) and on the other reconstruction by tissue expansion are described.

[Perforated duodenal ulcer. Personal experience]. / Ulcera duodenale perforata. Nostra esperienza.

Reference is made to personal experience in affirming that the treatment of perforated duodenal ulcer should set out to resolve both the perforation and the ulcer at the same time. Troncular vagotomy combined with pyroloplasty is put forward as an effective way of achieving this, and long-term results on a par with those obtained electively are described.

Treatment of "locally advanced" well-differentiated thyroid carcinomas.

PURPOSE: To analyse thyroid carcinomas having an extrathyroid extension in order to identify the principal prognostic factors and outline an effective therapeutic strategy. METHODS: We selected a sample of 160 patients suffering from locally advanced "well differentiated thyroid carcinoma (T4) who had undergone surgery at the Department of Surgery of University of Rome "La Sapienza". The sample was subdivided into three groups: T4, limited type I, and extensive type II, T4 microcarcinomas. RESULTS: We obtained excellent results with the T4 microcarcinomas, above all in patients under the age of 45, with a 94.5% survival rate, compared with 88% in patients aged over 45. In the extensive type II T4 carcinoma we obtained a survival rate of 29.4% in patients aged over 45 years. CONCLUSIONS: Age, combined with an aggressive histological variant (Sclerosing and tall-cell papillary carcinoma), is an important factor in prognosis. The radicality of surgical excision is considered an important prognostic factor, although the results reported in the literature are contradictory. Aggressive surgery can free from the disease a high percentage of patients over the age of 50 even with T4. We deem it fundamental to perform total thyroidectomy in all advanced cases of thyroid neoplasm and to extend neoplasm excision to the adjacent tissues, even involving justified surgical demolition.

[PTFEe in the treatment of facial wrinkles]. / II PTFEe nel trattamento delle rughe facciali.

The first signs of skin aging appear quite early, around 30 years of age, and show as glabella and facial wrinkles particularly pronounced around the eye, lips and nasolabial area. None of these imperfections can be expressively modified through a cervicofacial rhytidectomy (facelift). The use of PTFEe in reconstructive surgery has been established by years of positive experience; therefore, the well known characteristics of such material suggested the idea of extending its use to aesthetic surgery. The corrections performed with this material are carried out mostly as day hospital surgery in local anaesthesia, requiring, however, technical skill to obtain satisfying results.

[Artificial nutrition in acute pancreatitis]. / La nutrizione artificiale nella pancreatite acuta.

Nutritional support for acute pancreatitis is a matter of debate, clear guidelines based on objective data do not exist. We report our experience in patients with severe disease. Parenteral nutrition appears to be a safe initial therapy, but the enteral route has many practical and theoretical advantages and should be started as soon as possible.

[Suppurative cyst or purulent collection in the diaphragm? A difficult, almost impossible diagnosis. Description of a clinical case]. / Cisti suppurata o raccolta purulenta del diaframma? Una diagnosi difficile, quasi impossibile. Descrizione di un caso clinico.

The Authors report a case of diaphragmatic cyst. They remark the difficulty of clinical diagnosis and briefly discuss the hypothesis on its origin.

[Surgical repair of laparocele with expanded PTFE: technicalities]. / Correzione chirurgica dei laparoceli con PTFEe: particolari di tecnica.

Surgical repair of ventral hernias may often be quite difficult; however, the use of prosthesis, now generally accepted by many surgeons, has improved the results of such type of surgery. The Authors experience confirm the safety of the expanded PTFE and its versatility of employment, obtaining good functional and aesthetic results.

[Report on surgical strategy in reoperation of esophageal achalasia]. / Cenni di strategia operatoria nei reinterventi per acalasia esofagea.

Surgical therapy for achalasia of the esophagus gives good results in only 80-90% of cases. Several reasons could be responsible for this 10-20% failure; the most frequent causes are inadequate cardiomyotomy and reflux esophagitis. We report our experience and our procedure in the management of recurrent achalasia. The most important controversies are also discussed.

[Low-malignancy duodenal leiomyosarcoma]. / Il leiomiosarcoma duodenale a bassa malignità.

The authors report a case of duodenal leiomyosarcoma presenting a low degree of histological malignancy. The main anatomoclinical features of the neoplasm are summarized. The authors conclude indicating not aggressive surgical therapy as adequate in such cases. However, a prolonged post-operative follow-up is always necessary, in order to detect recurrences as early as possible.

[Liposuction treatment for lipodystrophy of the pelvis and the legs]. / Trattamento con liposuzione delle lipodistrofie del bacino e degli arti inferiori.

In a series of 20 lipolysis procedures, there have been no serious major and few minor complications. Selection of patients is important and the best results can be acquired in the patients under 35 years of age. The postoperative circulation and diuresis control are very important particularly during the first 24 hours.

[Cavernous hemangioma of the small intestine]. / Emangioma cavernoso del tenue.

The Authors report an uncommon cavernous hemangioma of the small bowel. Pathological and clinical features are compared with those of the literature. Considering the difficulty of diagnosis, they remark the importance of histological exam as the only reliable diagnostic tool and surgery as the only therapy.

[Benign cystic neoplasm of the pancreas: considerations on 2 surgically treated cases]. / Le formazioni cistiche neoplastiche benigne del pancreas: considerazioni su due casi operati.

Two cases of pancreatic cystoadenoma are reported. The value of ultrasound as the first choice imaging technique approach is stressed.

[Malignant fibrous histiocytoma of the pancreas]. / Istiocitoma fibroso maligno del pancreas.

The authors report a case of pancreatic malignant fibrous histiocytoma (approximately 22 cm). Clinical and instrumental approach for preoperative diagnosis is discussed and the anatomopathological features of the lesion, which is rarely localized in the pancreatic gland, are stressed. Surgical treatment is outlined as well.

[Gastrointestinal carcinoids and carcinoid syndrome: classification, diagnosis and therapy]. / I carcinoidi gastrointestinali e la sindrome da carcinoide: inquadramento, diagnosi e terapia.

Historically, carcinoids have long been known as a morphologically distinct class of rare intestinal tumors which behave less aggressively than the more common intestinal adenocarcinomas. In recent decades refined methods in pathology improved our knowledge on the diffuse neuroendocrine system, leading to some confusion in classification and nomenclature of carcinoids. The World Health Organization (WHO) classification of endocrine tumors has cleared the definition of carcinoids. The Authors report on 7 cases of midgut carcinoid tumors and 1 case of carcinoid syndrome focusing on the newer approaches to the diagnosis, localization, and role of surgery and peptide therapy.

[Symptomatologic and surgical definition of functioning parathyroid carcinoma]. / Contributo alla definizione sintomatologica e chirurgica del carcinoma paratiroideo funzionante.

Hyperparathyroidism due to parathyroid carcinoma is rare. The natural history of this neoplastic disease is poorly understood for the extremely small number of cases reported in literature. The Authors observed three cases and discuss the clinical features illustrating how to recognize and treat this neoplasia.

[Mastectomy operation with expected reconstruction of the breast: anatomo-surgical notes]. / L'intervento di mastectomia in previsione di una ricostruzione mammaria: note anatomo-chirurgiche.

The Authors, on the basis of their experience, underline the importance general surgeon has in carrying out a radical surgery for breast cancer without compromising a subsequent reconstruction. The latter, in fact, is nowadays considered a second step in the surgical management of breast cancer.