Nail matrixectomies using radio wave technique.

The authors present a successful method for surgically correcting ingrown toenails by using radio wave technique. A review of the literature is also presented.

[Recurrences after thyroid lobectomy for benign thyroid diseases: analysis of a clinical-instrumental follow up]. / Le recidive dopo lobectomia per tireopatia benigna: analisi di un follow up clinico-strumentale.

The authors propose to verify the therapeutical role of lobectomy in confronting monolobar nodular thyroid disease. In a period of 4 years (1990-1993), forty-four patients (30 women, 14 men) underwent thyroid lobectomy for a benign disease and follow-up treatment for 3 years on a semestral basis. All patient were studied both before the operation and during the follow-up using US and measuring the levels of T3, T4 and TSH; 34 patients (77.2%) had undergone a scintigraphy before surgery. The indication towards surgical intervention was, in 16 patients, consequent to the diagnosis of monolobar uninodular goiter and in 28 patients to monolobar plurinodular goiter. The operation involves thyroidal extracapsular lobectomy with isthmectomy. There were no temporary and/or permanent recurrential lesions, nor there were any significant hypocalcaemic alterations. The US description of the follow-up has been classified in four groups: normal, non-homogeneity (presence of simple parenchymal non-homogeneity), recurrence/non-homogeneity (presence of both pseudonodular forms and parenchymal non-homogeneity), recurrence (presence of recurrence with nodule(s) whose diameter is greater than 5 mm.). From the US follow-up examination, it was shown that 14 out of 44 patients (31.8%) presented alterations in the residual lobe wich were not identifiable in the pre-operative US examination (3 recurrences = 6.81%; recurrence/non-homogeneity = 2.27%; 10 non-homogeneity = 22.7%). Thirteen out of 14 patients are treated with substitutive ormonal therapy Out of these 30 patients whose residual lobe shows no alterations using US, 23 (70.6%) are treated with substitutive ormonal therapy. The authors have underlined a substantial percentage difference between the incidence of normality of the residual lobe during follow-up to lobectomy due to adenoma (normality 88.8%) and to lobectomy due to goiter-related lesions (normality 60%). During US follow-up examinations, abnormality percentages equal or superior to 30%--as those noticed after lobectomy due to goiter-related lesions underline the doubts wich characterize any form of partial thyroidal asportation (4 recurrence in 35 cases of monolobar uni- or plurinodular goiter = 11.4%); also, in the authors' experience, substitutive ormonal therapy has seemingly no effect on the recurrence incidence. According to the authors, the lobectomy can occupy a therapeutical role in thyroid diseases with monolobar expression, but to avoid an elevated number of recurrences, a rigorous evaluation of the real extension of the nodular disease is indispensable.

[Total thyroidectomy technique: suggestions and proposals of surgical practice]. / Tecnica della tiroidectomia totale. Suggerimenti e proposte di pratica chirurgica.

Total thyroidectomy at present depicts a diffuse surgical procedure in the management of benign and malignant disease of thyroid gland. It is followed by a low incidence of iatrogenic damages (nervous lesions or permanent hypoparathyroidism), just like subtotal thyroidectomy and lower than surgery for nodular recurrences. Authors present the surgical technique they follow to perform total thyroidectomy, used in over 400 cases of benign thyroid diseases operated since 1986. The most important points of this surgical procedures are represented by exposure and sparing of inferior laryngeal nerve and by preservation of parathyroid function. Parathyroid glands can be exposed to direct surgical trauma but, more often, they are injured by damage of their vascular supply. To avoid this complication, vascular ligations of inferior thyroid artery have to be done never on the trunk of the artery, but on its branches just near the glandular capsula. Sparing of inferior laryngeal nerves comports the exposure of this structure for all its cervical course especially in the terminal edge, when the nerve is nearest to the gland. Systematical application of illustrated procedure has produced no operative mortality, no inferior laryngeal nerve permanent palsy, transient hoarseness in 0.5%, and transient symptomatic hypocalcemia in 2.7%.

[Small cell carcinoma of the esophagus: a case report]. / Il carcinoma a piccole cellule dell' esofago: descrizione di un caso clinico.

The authors present the case of a primitive small cell esophageal carcinoma. It is a rare and biologically aggressive neoplasm which occurs mainly in the elder male. The case observed concerns a 69 year old female treated with surgical therapy consisting in esophagectomy and intrathoracic esophagealgastrictype plasty. Diagnostic problems either histological or immunohistochemical and the choice of the following treatment are discussed. The cases of patients treated in other Surgical or Oncological centers are reported. Therapeutic orientation adopted by our group is stressed. In this case we have chosen surgical therapy because a sure diagnosis come be given only on the base of the attent histological examination of the entire specimen (endoscopic biopsies are not sufficient); survival data reported are in favour of surgical treatment where secondary metastases are not evident in the respect of antiblastic therapy and/or radiotherapy. Neoplastic recurrence occurred ten months after and a metallic endoscopic esophageal prothesis was positioned. The patient died 1 year after surgery by mediastinal syndrome.

[Lateral cervical metastases from unknown primary]. / Le metastasi laterocervicali precessive.

The authors report their experience about cervical metastasis of unknown primitive neoplasms. Epidemiology, histological type and topography are exposed. Primaries which are responsible, in a high incidence, of the preceding cervical localizations are described. Diagnostic iter, non-invasive/low-price clinical and instrumental procedures, advanced endoscopic and radiologic procedures are discussed. 64 patients were treated. Only in one case we could diagnose the primitive site of the neoplasm with non-invasive procedures. The other cases (63 patients) underwent the excision-biopsy of the cervical nodes. In 52 cases we have been able to define the primitive site of the neoplasm. 11 patients, in which the primary was unknown, underwent the radiotherapy of the cervical nodes and the eventual primitive "foci"; we had no survival, on the average, after six months for the diffuse dissemination of the neoplastic disease.

[Surgical treatment of differentiated thyroid carcinomas: results in 440 cases operated between 1970 and 1994]. / Trattamento chirurgico dei carcinomi differenziati della tiroide: risultati su 440 casi operati dal 1970 al 1994.

The authors report their experience and surgical treatment of 440 patients with differentiated carcinoma of the thyroid (DCT) from 1970 to 1990 in the III Surgical Dept. at the University of Rome "La Sapienza". Considering 305 cases of papillary carcinoma, 103 Total Thyroidectomy (TT), 118 TT with Functional Regional Lymphadenectomy (FRL), 32 TT with Node-Picking, 51 TT with curative FRL and one TT with Radical Neck dissection were performed. In 135 cases of follicular carcinoma TT associated with Node-picking were performed on two patients, TT associated with FRL on 8 patients and TT associated with RND on 2 patients. Overall survival to 10 years was 90%; 98% for N- papillary carcinoma and 66% for N+ follicular carcinoma. There were no permanent recurrence of disease. Out of the patients who did not undergo cervical lymphadenectomy 30% developed temporary hypocalcemia; 53% (mediastinal lymphadenectomy) to 87% (FRL) of the patients submitted to lymphadenectomy developed temporary hypocalcemia with permanent hypoparathyroidism in 0.9%-23% of the cases. On the base of what has been observed by Pasieka and Grant, the Authors believe TT as the absolute solution for patients with DCT because it allows the removal of both the original tumor and the possible neoplasms in the residual gland tissue, and enables early identification of other metastases which can be treated efficaciously with I131.

[Submandibulectomy in the treatment of pathology of the submandibular gland: our experience 1970-1995]. / La sottomandibulectomia nel trattamento delle patologie della ghiandola sottomandibolare: nostra esperienza 1970-1995.

Submandibular gland excision is proposed in the treatment of neoplastic and non neoplastic diseases; this surgical procedure can be performed by transoral or transcervical approach. The aim of the study is to demonstrate that cervical approach must be preferred because it is safer and allows a wider exposition of the surgical field. From 1970 to June 1995, 54 patients (47 with chronic sialadenitis, 7 with benign tumors and 7 with malignant tumors) were submitted to excision of the submaxillary gland. Of the 54 resections performed, 2 were completed with "functional" cervical lymphadenectomy and 1 with Radical Neck Dissection in pts. with malignant neoplasms. There were no postoperative deaths; complications occurred in 1 patient (1/54 = 1.8%) as a iatrogenic permanent lesion of the maxillary branch of the facial nerve (in detail 0/47 patients with benign disease and 1/7 (14.7%) patients with malignant disease). The cervical approach for the resection of the submaxillary gland is preferred to the transoral approach for the lower risk of iatrogenic lesions of the lingual and hypoglossal nerves and the possibility of curative resections in case of malignant neoplasms. A regulated and experimented technique through the cervical approach also lowers the risk of a lesion of the maxillary branch of the facial nerve.

[Paraganglioma in the case records of the III Surgical Clinical Institute]. / I paragangliomi nella casistica dell'istituto di III Clinica Chirurgica (1970-1995).

Cervical paragangliomas are uncommon benign or malignant neoplasms, originated from the stem cells of the neural crest. Up to date it is still not easy to define properly their biological behaviour, the possible multicentric location and the association with Multiple Endocrine Neoplasias. After a wide review of recent diagnostic, pathological and clinical notions, the Authors report their experience, from 1970 to 1995, of 10 patients affected by sporadic paraganglioma and 1 by familial multicentric neoplasm localized on carotid bodies of both sides, left vagus nerve and left hypoglossus nerve. All patients but one were treated by a curative resection of the neoplasm; in one case only an explorative laparotomy was possible because of the visceral and vascular involvement.