1988: Diploma di maturità (Liceo scientifico A.Pacinotti, La Spezia, Italia) 1996: laurea in Medicina e Chirurgia, Università di Parma. 2002: Specializzazione in chirurgia generale presso Università degli Studi di Parma
ESPERIENZA DIDATTICA E DI RICERCA 1996-2002 Scuola di Specializzazione in Chirurgia Generale 1997-1998 Ufficiale medico Marina Militare 2001 Periodo di studio presso Ospedale Italiano di Buenos Aires sez. Chirurgia vie biliari e fegato, Prof. E.Sivori 2002- oggi Ricercatore Universitario presso l’Università di Parma, Chirurgia Generale E’ docente presso la Scuola di Specializzazione in Chirurgia Generale, Chirurgia Vascolare, Anestesia e Rianimazione, Urologia, Ginecologia. E’ autore di 106 articoli a stampa in chirurgia generale ed endocrinochirurgia , 3 capitoli di libro sulla chirurgia mammaria.
Paolo Del Rio EDUCATION: 1988:Secondary school certificate (Liceo Scientifico A.PAcinotti, La Spezia, Italia) 1996: medical degree(M.D.) , Medical Faculty , University of Parma., Italy 2002: doctor in General Surgery , University of Parma
TEACHING AND RESEARCH EXPERIENCE
1996-2002 School of General Surgery in University of Parma 1997-1998 Medical in Italian Navy 2001 Fellow in Italian Hospital , Buenos Aires,Liver surgery,Prof.E.Sivori 2002-today Assistant Professor of General Surgery, Medical Faculty,University of Parma Assistant Professor in General Surgery in residency program in General Surgery, Vascular Surgery, Anesthesia, Urology, Gynecology. He is author of 106 articles on general surgery and endocrinesurgery, 3 chapters on breast surgery and surgical complications after endoscopy.
Abstract: The development of sentinel lymph node biopsy in breast cancer disease and the increasing of using adjuvant systemic therapy provide a rational reduction of axillary dissection in patients with Sentinel Lymph Nodes free from breast cancer cells. The aim of our study was to assess the state of the perisentinel lymph nodes removed and how these nodes can provide further information about the status of the axillary lymph nodes.
Abstract: A number of surgical approaches have been reported for thymectomy, including transsternal, transcervical, a combination of complete transsternal and transcervical, and various video-assisted thoracoscopic surgery techniques. A modified video-assisted transcervical approach to thymectomy is here described.
Abstract: Pre-operative cytology in thyroid disease remains the most appropriate diagnostic test for defining the nature of a thyroid nodule before surgical excision.
Abstract: Right laparoscopic colectomy was introduced to colorectal surgery later than the left colon procedure. Three-trocar laparoscopy has already been used successfully in the treatment of gynecological cancers. In the present study, we aimed to analyze the feasibility of performing an associated gynecological procedure following abdominal laparoscopic exploration and to evaluate the suitability of laparoscopic right colectomy for treating elderly patients.
Abstract: The intraoperative hemorrage determines an higher risk of parathyroid glands lesions, and laryngeal nerve injuries. We have examined if the use of oxidized and regenerated cellulose could be a cause of postoperative hypocalcemia because of the compression on the parathyroid glands or for tissue adhesions
Abstract: Surgery can be a curative treatment for ulcerative colitis. The correct surgical procedure is a total proctocolectomy and ileo anal J pouch anastomosis (IPAA). This procedure is feasible also in laparoscopic approach after a correct learning curve. Pouchitis, pouch complications, intestinal occlusion, infertility are the most common long term complications. We present a case of a 37-year-old man treated with laparoscopic proctocolectomy and followed at 18 months.
Abstract: There are no common guidelines to identify the population at risk to develop hypocalcemia preoperatively or early in the postoperative course in thyroidectomized patients, therefore the authors suggest to examine the PTH value preoperatively.
Abstract: The aim of the study was to critically review the experience of our unit to identify all the risk factors that can predict the intra-operative and post-operative complications, early and late, that are related to the procedure.
Abstract: INTRODUCTION: The depth of the tumor invasion and nodal involvement are the two main prognostic factors in gastric cancer. Staging systems differ among countries and new tools are needed to interpret and compare results and to reduce stage migration. The node ratio (NR) has been proposed as a new prognostic factor. MATERIALS AND METHODS: We retrospectively reviewed 282 patients who underwent curative resection for gastric cancer at Parma University Hospital between 2000 and 2007. TNM stage, NR, overall survival, survival according to nodal status, and survival according to the total number of nodes retrieved were calculated. RESULTS: At univariate analysis, the TNM stage, number of metastatic nodes, NR, and depth of tumor invasion, but not the number of nodes retrieved, were significant prognosis factors. Patients with more than 15 nodes retrieved in the specimen survived significantly longer (p < 0.04). This was confirmed for all N or NR classes within N groups. There was a correlation between the number of nodes retrieved and N but not with the NR category. NR was an independent prognostic factor at Cox regression. CONCLUSION: NR is a reliable and sensitive tool to differentiate patients with similar characteristics, probably more so than the TNM system. NR is not strictly related to the number of nodes retrieved and this may potentially decrease the stage migration phenomenon. More trials are needed to validate this factor.
Abstract: Mininvasive surgical techniques have been proposed to treat the patients affected by parathyroid adenoma starting by endoscopically-assisted parathyroidectomy up to video-assisted and radio-guided approaches.
Abstract: BACKGROUND: The evolution of video-assisted or laparoscopic surgical techniques in the last several years has changed the surgical treatment approach to many diseases, also in endocrine surgery. MATERIALS AND METHODS: From July 2005 to March 2009, we treated 211 patients with minimally invasive video-assisted thyroidectomy (MIVAT). The procedure was performed in accordance with Miccoli's technique using an Ultracision CS 14 (Ethicon Endosurgery) and/or Single Use Automatic Clip Applier S-90 (Autosuture). In all cases, we recorded the incidence of postoperative hypocalcaemia as a serum calcium value lower than 8 mg/dl with or without hypocalcaemic symptoms, postoperative haemorrhage or nerve palsy, mean operative time. All patients were also assessed for postoperative pain and given a visual analogue score from 0 to 10 at 1 and 24 h after surgery. We matched these results with a group of 587 patients treated during the same period with traditional thyroidectomy. RESULTS: The female/male ratio was 4:1; the mean age of the patients was 50.6 years. In the MIVAT group, the mean time of surgical procedure decreased by 52.4 min. We observed 16 hypocalcaemic cases with clinical symptoms (7.58%) (six of these cases were published in a previous article and were among the first 100 cases treated) and 59 cases of serologic hypocalcaemia (27.9%) (serum calcium lower than 8 mg/dl); the mean value of calcium concentration was 7.5 +/- 0.27 mg/dl. We observed six cases of monolateral nerve palsy, and after 6 months, a definitive palsy in two cases (0.9%); these two cases were in the first 25 cases treated. Comparisons with traditional thyroidectomy group showed statistically significant differences in postoperative serologic hypocalcaemia (p < 0.001), no difference in mean calcium value (p = 0.41) and no statistical difference in the incidences of nerve palsy and haemorrhage. CONCLUSIONS: Patients treated with MIVAT showed an improvement in incidence of postoperative hypocalcaemia, postoperative pain, postoperative stay, psychophysical recovery and cosmetic result.
Abstract: Hypocalcaemia is the most frequent complication after total thyroidectomy. The incidence of postoperative hypocalcaemia is reported with different percentages in literature.
Abstract: Gastric metastases of breast cancer represent a not so rare event in patients affected. In fact, it occurs in 0.3% of cases. Although the introduction of new adjuvant therapies has given rise to an increase in disease free survival and overall survival rates, it has also led to more frequent occurrences of breast cancer metastatic lesions localized in bone, lung/pleura and liver, but above all in the stomach. The authors present three cases of patients suffering from breast cancer with secondary gastric neoplastic lesions from lobular and infiltrating ductal breast cancer. Lobular breast cancer is the histological type mostly involved in disseminated disease, with an incidence of 85% of cases. A review of the literature reveals that authors address the clinical and diagnostic problems of differentiating between a breast cancer metastasis to the stomach and a primary gastric cancer using recent diagnostic strategies to make an early diagnosis. Today practitioners have specific tests to detect early gastric cancer metastases of breast cancer such as endoscopic ultrasound, which provides a better endoscopic definition of the lesions, and immunohistochemical markers, able to distinguish the primary lobular histological type from ductal cancer. Besides, an early diagnosis associated with the latest adjuvant systemic therapies and hormonal treatment, alone or in combination, may grant affected patients a remission with a survival rate of 10-28 months, and a reasonable quality of life. At present the surgical approach should be reserved for selected cases and/or complications.
Abstract: The main objective is to prospectively evaluate the therapeutic efficacy of minilaparocholecystectomy combined with videolaparoscopic view in cases of complicated gallstones where VLC was risky.
Abstract: Acute, acute recurrent, and chronic pancreatitis are inflammatory diseases with multifactorial pathogenic mechanisms. Genetic mutations and polymorphisms have been correlated with pancreatitis. The aim of this study was to investigate the association of cystic fibrosis transmembrane conductance regulator (CFTR) and serine protease inhibitor Kazal type 1 (SPINK-1) gene mutations and monocyte chemoattractant protein 1 (MCP-1) -2518A/G polymorphism with acute pancreatitis (AP), acute recurrent pancreatitis (ARP), and chronic pancreatitis (CP), and to associate genetic backgrounds with clinical phenotype in these three conditions.
Abstract: BACKGROUND: The thyroid disease can appear in 0.16-3.3% of cases as mediastinal goiter. The treatment is difficult and requires a mediastinal approach. MATERIALS AND METHODS: We have analyzed our experience from September 1995 to September 2007 among 2,439 thyroidectomies conducted for thyroid disease; 16 cases required a sternotomy, in seven patients conducted as hemiclamshell approach (median sternotomy associated to a fourth intercostals space incision). Preoperative evaluation included otorhinolaryngology evaluation and computed tomography. All the cases were followed up to 12 months. RESULTS: For seven cases treated trough hemiclamshell, the mean age was 57.8 years; hospital stay is 5.2 days. All the patients were discharged after respiratory evaluation; two patients required a pneumological admittance to physio-kinesi-respiratory. There were no cases of hemorrhage, nerve injury, permanent hypocalcemia, and chylothorax. There was no mortality at 30 days. CONCLUSIONS: The hemiclamshell is a safe procedure to treat mediastinal goiter and permit a good exposure of subclavian vessels and mediastinal nodes.
Abstract: Intestinal intussusception is rare in adults, but common in children. The ileocolic or appendiceal types are more frequent compared to the colo-colic one. We report successful laparoscopic left hemicolectomy in a patient with intussusception caused by a sigmoid tumor. Abdominal CT demonstrated a colo-colic intussusception at the level of the tumoral lesion with dilation of the proximal colon. The patient underwent urgent laparoscopic oncologically radical left hemicolectomy. A 10 cm Pfannenstiel incision allowed the removal of the resected segment. The laparoscopic approach was feasible because the dilation was moderate; however, if intussusception is due to cancer, laparoscopy can be safely performed if a correct and prompt diagnosis is achieved following oncologic criteria.
Abstract: Total thyroidectomy is the treatment of choice for thyroid cancer and for selected benign thyroid conditions. The aging of the general population and the improvements in surgical technique induced an extension of the surgical indications to major thyroid surgery to older patients also on a short stay basis.
Abstract: Versione italiana Riassunto: Cisti branchiale: case report. M. Negri, P. Del Rio, M. Sianesi Gli Autori presentano il caso clinico di un paziente di 41 anni, giunto alla loro attenzione per la comparsa da circa due anni di una tumefazione latero-cervicale destra, aumentata di volume progressivamente negli ultimi mesi, la quale all'esame obiettivo appariva di consistenza teso-elastica, indipendente dai piani sottostanti. Gli esami diagnostici preoperatori ponevano il sospetto di cisti del II arco branchiale. Con l'intervento chirurgico si asportava una formazione cistica che l' esame istopatologico dimopstrava a rivestimento pavimentoso pluristratificato, circondata da tessuto linfoide organizzato in centri germinativi, compatibile con la struttura di una cisti branchiale English version Summary: Brachial cyst: a case report. M. Negri, P. Del Rio, M. Sianesi The Authors present the clinical case of a 41 years old patient, presenting since two years a right cervical swelling, progressively grown up in the last two months with tight-elastic thickness. Pre-operative diagnostic tests suggested the suspect of II branchial arch cyst. By surgery we removed a cystic formation that appeared, at histopathologic exam with a multistratified coating, surrounded by lymphoid tissue, organized in germinative centres, compstible with branchial cyst structure.
Abstract: Merkel cell carcinoma is a rare tumor of dermal origin generally found in sun exposed skin. We report the case of a woman of 76 years old presenting a large vascularized Merkel cell carcinoma (MCC) of the left arm lateral to the elbow joint, infiltrating the muscolo-fascial plane who was treated with surgical therapy and post operative radiotherapy.
Abstract: The lymph node sentinel method is today used for staging the axillary lymph node stations. Ultrasonography is widely available and inexpensive method to study axillary status.
Abstract: AIM: The postoperative hypocalcaemia has the higher incidence as complications related to thyroidectomy. METHODS: From 1 June 2006 to 30 June 2008, we examined 492 patients operated on consecutively in our unit with a total thyroidectomy for thyroid disease. We evaluated the values of ionized calcium in all the cases, matching these with the preoperative and postoperative values of serum calcium. The pre- and postoperative (24 hours after treatment) data for ionized calcium and serum calcium were examined statistically with the Student's t-test; results with a P-value <0.05 were considered to be statistically significant. RESULTS: Two-hundred-and-twenty-three of the 492 patients (45.2%) treated with total thyroidectomy had preoperative values of ionized calcium lower than 1.13 mmol/L (normal values 1.13-1.32 mmol/L), while the ionized calcium values were lower than 1.10 mmol/L in 154 of the 223 patients. The mean value of ionized calcium in all 223 cases was 1.04+/-0.07 mmol/L. The mean serum calcium value in these patients was 9.13+/-0.291 mg/dL (normal values 8.3-10.5 mg/dL). In the other 259 cases, the values of ionized calcium and serum calcium were 1.21+/-0.03 mmol/L and 9.1+/-0.29 mg/dL, respectively. In 75 cases on 223 with symptomatic hypocalcemia, the mean value of ionized calcium was 0.88+/-0.05 mmol/L, while, in the remaining 148 cases, the mean value was equal to 0.97+/-0.08 mmol/L (P<0.001). We compared this, in both groups, with the values of postoperative serum calcium; in the 75 cases with clinical hypocalcemia, the value of serum calcium was 7.32+/-0.35 mg/dL, while the value was equal to 8.4+/-0.34 mg/dL in the other cases (P<0.001). CONCLUSIONS: The values of ionized calcium must not be used as marker of hypocalcemia but must be seen as a diagnostic aid linked to others laboratory values, such as serum calcium.
Abstract: There are few reports on the use of minimally invasive video assisted thyroidectomy (MIVAT) technique in the treatment of differentiated thyroid carcinoma.
Abstract: Background: MIVAT (minimally invasive video-assisted thyroidectomy) is a recent technique that requires a learning curve. Materials and Methods: From July 2005 to December 2006, we treated 100 from a total of 467 thyroidectomy patients with MIVAT. We divided the patients into 3 groups. The first 2 groups consisted of 25 patients each: group A (cases 1-25) and group B (26-50). We also divided patients into 2 groups based on our surgical experience: group A + B (cases 1-50) and group C (cases 51-100). Results: The operative times for groups A and B were 101.7 and 84.6 min, respectively (p < 0.03); those for groups A + B and C were 91.07 and 63.06 min, respectively (p < 0.004). Complications of hypocalcemia were observed in 6 cases (4 in the first 50 cases and 2 in the second 50), and complications of nerve palsy were observed in 2 cases from group A. Conclusions: After 25 cases, we observed that the MIVAT procedure allows for a lower mean operative time and a reduction of complications.
Abstract: BACKGROUND: Substantial modifications in surgical treatment of thyroid disease have changed the postoperative management of thyroidectomized patients. The reduction of postoperative pain permit a short-stay surgery. MATERIALS AND METHODS: We have analyzed the patients treated in our Unit from July 2006 to December 2006, with minimally invasive cervicotomy and mini-invasive video-assisted thyroidectomy. We have registered the postoperative pain applying an evaluation protocol numeric scale. The results were analyzed by t test. RESULTS: One hundred thirteen patients were divided in two groups: group A, minimally invasive cervicotomy (15 male and 46 female patients); group B, mini-invasive video-assisted thyroidectomy (9 male and 43 female patients). Upon returning to the ward, the pain scale group A vs B was 2.77 +/- 1.16 vs 2.5 +/- 0.762 (p = 0.22) .At 24 h after surgery, the pain scale in group A was 1.82 +/- 1.258 vs 1.031 +/- 0.8608 (p < 0.005). CONCLUSIONS: Both methods are safe, but mini-invasive video-assisted thyroidectomy gives not only a better cosmetic result but a reduction of postoperative pain especially at 24 h.
Abstract: Glutamate neurotoxicity is exacerbated when energy metabolism is impaired. In vitro studies show that neuronal death in these conditions is related to mitochondrial dysfunction, ATP depletion, and the loss of calcium homeostasis. We have recently observed that, in vivo, enhancement of glutamate toxicity elicited by previous mitochondrial inhibition does not involve severe ATP depletion, suggesting the involvement of other processes. Factors such as the activation of different proteases may determine the extent and type of cell death. Protease activation might be triggered by internal or external factors, such as mitochondrial damage or the activation of a particular glutamate receptor subtype. In the present study we aimed to investigate whether moderate inhibition of mitochondrial metabolism facilitates glutamate toxicity through caspase-3 or calpain activation, as well as the contribution of NMDA and non-NMDA glutamate ionotropic receptors to this activation. Rats were pre-treated with a subtoxic dose of 3-NP and 4 h later intrastriatally injected with glutamate. Results show that neither of these treatments alone (3-NP or Glu) or in combination (3-NP+Glu) activated caspase-3. Conversely, calpain activity is induced after glutamate injection both in intact and 3-NP pre-treated rats. Inhibition of calpain activity by MDL-28170 significantly prevented striatal damage. NMDA and non-NMDA receptors contributed equally to calpain activation and to the induction of neuronal death. Results suggest that enhancement of glutamate toxicity due to inhibition of mitochondrial metabolism in vivo, does not recruit caspase-dependent apoptosis but favors calpain activation through the stimulation of both subtypes of glutamate ionotropic receptors.
Abstract: BACKGROUND: Primary hyperparathyroidism (PHPT) is characterised by pathological hyperfunctioning of one or more of the parathyroid glands leading to excessive parathyroid hormone (PTH) secretion. The aim of this study was to assess the diagnostic capacity of scintigraphy with MIBI, considering the surgical findings and the level of agreement with the result of cervical ultrasonography. PATIENTS AND METHODS: In the period January 1996 to January 2006, 84 cases with PHPT were included in the study, in which scintigraphy with MIBI was used in addition to cervical ultrasonography. All were hospitalised as "short stay surgery" patients and then seen as outpatients at follow-up visits (at 7, 14 and 30 days), during which calcium, phosphorus and PTH values were measured. RESULTS: In 55 cases (65.5%), the site of the pathology was suspected on the basis of the cervical ultrasonography. Scintigraphy with MIBI was positive in 76 cases (90.4%) and negative in the other eight (9.6%). In six of these eight cases the site had been detected by the cervical ultrasonography. In the remaining two cases (2.4%), neither of these examinations gave positive diagnostic findings. In 58 patients we proceeded with the removal of a single adenoma, in 19 cases with the removal of two out of the four glands, and in seven cases with the removal of three out of the four glands, the single formations removed not showing clearly-defined macroscopic characteristics; in two of the seven patients in whom three of the four glands were removed, the preoperative diagnostic examinations had not shown any evidence of gland pathology. CONCLUSIONS: We regard scintigraphy with MIBI as a preoperative diagnostic examination that has modified the surgical approach to PHPT, inclining surgeons towards a mini-invasive surgical procedures. We consider CT, MRI and SPECT techniques to be indicated only in cases of relapse of PHPT, possibly associated with ectopic localisation of the parathyroid gland not identified in the course of previous surgical procedures.
Abstract: AIM: The association between papillary thyroid carcinoma (PTC) and chronic lymphocytic thyroiditis (CLT) has been reported in literature. The aim of this study was to examine this association evaluating the lesser or greater neoplastic aggressiveness. METHODS: One hundred and eighty-nine patients were examined from June 2004 to June 2007; they were divided into two groups: Group A included all the patients affected by PTC without CLT and Group B all the patients affected by PTC with CLT association. The surgical treatment was in all the patients the total thyroidectomy (TT). For the study age, sex, tumour features (dimensions, angioinvasion, capsular infiltration, multifocality and lymphnode metastases) were taken into consideration. The analysis was carried on with Student t test and chi squared analysis (statistically significant P<0.05). RESULTS: Group A included 117 patients; Group B 72 patients. No statistical difference in sex (P=0.989), age (P=0.480); tumour dimension (P=0.832). The capsular infiltration was present in 23 cases in Group A and 19 in Group B (P=0.368). The difference in average diameter was found to be 1.161+/-0.5812 and 1.485+/-1.082 cm in Group A and in Group B (P=0.290), respectively. The angioinvasion was found in 9 cases of Group A and in 3 cases in Group B (P=0.510). Multifocality was found in 35 patients in Group A and in 26 in Group B (P=0.469). CONCLUSION: The CLT may have only a minimum impact in the development of the tumour. In this study the association does not modify the aggressiveness.
Abstract: A multicenter, open labelled, randomized study was carried out to compare the prophylactic efficacy of Cefepime and Ceftriaxone in patients undergoing biliary tract surgery. Two hundred and nine patients were included in the study and randomized to receive preoperative infusion of 2 g Cefepime (n=107) or 2 g Ceftriaxone (n=102) both in a single i.v. administration. Antimicrobial prophylaxis was successful in preventing infections in 98.9% of patients in the Cefepime group and 97.7% in the Ceftriaxone group (p=0.3871). Both regimens were well tolerated without any adverse drug-related reactions. A single dose of Cefepime seems to be a very useful alternative to other regimens for antibiotic prophylaxis of postoperative infectious complications in the elective surgical treatment of cholelithiasis.
Abstract: The symptoms of the retrosternal goitre are due to the compression especially on airway, by thyroid growth in mediastinum. We present a case of an old woman affected by chronic obstructive broncopneumopathy, atrial fibrillation and mediastinal goitre. The previous growth in mediastinum was the cause of compression on airway with unexpected worsening of respiratory function. The risk of total thyroidectomy was related to the possible tracheomalacia. The surgery improved respiratory performance.
Abstract: The incidence of phylloides breast tumors is less than 1% in the population affected by breast cancers. The age at higher risk is between 35 and 45 years. These neoplasms are characterized by a proliferation of mesenchimal and epithelial cells. We present a rare case of giant malignant phylloides tumor (28 x 21 x 15 cm) with a complet substitution of the gland. The clinical presentation of phylloides tumors is heterogenous; the surgical treatment is a conservative one of the gland if the neoplastic lesion size is less than 5 cm with a free margin of 1 cm and a mastectomy if the diameter of lesion is more than 5 cm. Complementary therapies still remain controversial.
Abstract: Celiac artery compression syndrome (CACS) and superior mesenteric artery syndrome (SMAS) are 2 rare diseases, widely described in literature. Their association has not been specifically investigated; in fact, few cases have been reported. For this reason we reviewed our experience from January 1974 to June 2004. We report 59 patients affected by CACS and 28 by SMAS. Coexistence of both syndromes in 8 patients was observed. These 8 patients were successfully treated with duodenojejunal bypass and decompression of the celiac trunk. In this paper, we analyze the pathogenesis, clinical presentation, diagnosis, and treatment of these syndromes, emphasizing their common aspects. The misdiagnosis of this association may justify in some cases the controversial results reported regarding the surgical treatment of these syndrome.
Abstract: BACKGROUND: Mirizzi syndrome is one possible complication of the gallstones. The incidence in patients treated with cholecystectomy is 0.7-1.1%. MATERIALS AND METHODS: We have analyzed on 4123 colecistectomie conduct in Unit of General Surgery and Organ Transplantation of the University of Parma from January 1992 to October 2006, 46 cases of syndrome of Mirizzi (1.1%) with age comprised between 29-82 years (medium 67.8 years) were 28 women (60.9%) and 18 men (39.1%). We have considered the symptomatology, the diagnostic and therapeutic way, the comorbidity. RESULTS: In 19 cases (41.3%) there were the signs of acute cholecystitis; in 28 cases (60.9%) the clinical picture was characterized from repeated biliary pain. The jaundice was present in 29 cases (63%) with hyperpyrexia (>38 degrees) in 27 cases (58.7%). In 14 cases (30.4%) was a Mirizzi type I, in 32 cases (69.6%) a Mirizzi of type II. CONCLUSIONS: The Mirizzi syndrome is a diagnosis frequently conduct intraoperatively. The surgical therapy is characterized by the acknowledgment of the biliary structures, the complete removal of the stones, the surgical therapy of the leaks.
Abstract: The incidence of haemangiosarcoma in the literature is variable especially in the Alpine region and in Austria, ranging from 2 to 10% of all thyroid neoplastic lesions. This thyroid disease is characterised by positive endothelial markers (CD 31, CD 34 and FVIII), and co-positive markers for cytokeratins, epithelial membrane antigen and a loss of thyroglobulin can sometimes be found. Immunochemistry does not help the physician to classify the neoplasia as a variant of anaplastic carcinoma or sarcoma of endothelial origin. We present a case of epithelioid haemangiosarcoma in an elderly woman from outside the Alpine region with a contralateral papillary cancer treated by total thyroidectomy. The prognosis is poor and case reports are rare.
Abstract: BACKGROUND AND OBJECTIVES: Angiogenesis is a complex multistep process that involves extracellular matrix remodeling, migration and proliferation of endothelial cells, and morphogenesis of microvessels. CD105 (endoglin), a co-receptor of the TGF-beta superfamily, was proposed as a marker of neovascularization in solid malignancies. The aim of this study was to evaluate retrospectively the effect of CD105-assessed angiogenesis on the risk of developing metastatic disease in colorectal cancer (CRC). METHODS: One hundred and twenty-five paraffin-embedded samples were analyzed by immunohistochemical methods using a CD105 monoclonal antibody. The median follow-up was 70.8 months. Survivals were calculated from actuarial estimates, and logistic regression predicted the risk of developing metastatic disease. RESULTS: The CD105-vessel count was strongly correlated with the occurrence of metastatic disease. The median CD105-positive vessels in patients with and without metastatic disease were 24.7 and 13.2 vessels/mm(2), respectively (P < 0.001). For each one microvessel increase in the vessels count per 400x field, there was a 1.42-fold increase in the risk of metastatic disease (P < 0.001). CONCLUSIONS: The assessment of tumor angiogenesis with anti-CD105 was not sufficient for its use as a surrogate end point for survival because of the amount of survival variability explained was only 8% in absence of metastatic disease. In contrast, multivariate logistic regression analysis revealed that CD105-vessels count can identify patients at high risk of metastatic disease.
Abstract: BACKGROUND: We report our initial experience in the treatment of thyroid disease with Minimally Invasive Videoassisted Technique (MIVAT) introduced by Miccoli. METHODS: We have treated from July to September 2005, 5 patients, with MIVAT. The procedure is carried out through an incision of 15-20 mm 2 cm on sternal notch and the thyroidectomy is performed by dedicated instruments. RESULTS: We have surgically treated 3 follicular hyperplasias, one Hurthle adenoma and one papillary carcinoma. The mean time of thyroidectomy was 98 +/- 14 minutes; four cases were discharged after 24 hours and one case after 48 hours for a postoperative hypertension. No hypocalcemia, no nerve palsy. Cosmetic result and postoperative pain were excellent. CONCLUSION: MIVAT is a safe, reproducible technique with an indication in a minority of patients candidates to thyroidectomy and is characterized by a better postoperative discomfort.
Abstract: BACKGROUND: Hypocalcemia is a possible sequela of thyroidectomy; the causes are not fully understood. METHODS: We analyzed 804 patients (594 total thyroidectomy, 209 emithyroidectomy) treated in our Institute from January 1995 to December 2000. Serum calcium, ionized calcium, parathyroid hormone (PTH), fosforemia were screened pre- and postoperatively. RESULTS: Hypocalcemia, defined by a serum calcium less than 7.5 mg/dL, occurred in 126 patients (21.2%). In 90.6% of these patients the serum calcium was normal at seven days after thyroidectomy. In two patients we have registered at 180 days after thyroidectomy a permanent hypoparathyroidism. CONCLUSIONS: Several factors are important in the incidence of postthyroidectomy hypocalcemia but the inadvertent excision of parathyroid gland, ischemia and injury are the major causes of lowering of serum calcium concentration.
Abstract: We examined a series of 176 consecutive patients scheduled for videolaparoscopic cholecystectomy for acute cholecystitis to identify the independent parameters most likely to lead to conversion to laparotomy. This prospective study was conducted from June 2001 to December 2003 on 176 consecutive patients who were scheduled for videolaparoscopic cholecystectomy for acute cholecystitis. Of the 176 patients, 119 (group A) underwent videolaparoscopic chlecystectomy, and 57 (32.3%) were converted to laparotomy (group B). Patients were assessed for gender, age, time between onset of symptoms and surgery, previous surgery, ASA (American Society of Anesthesia) risk, leukocytosis, echotomographic findings, average operating time, intra- and post-operative complications, and conversion rate. Our study found that the parameters of age, ASA risk, duration of symptoms, leukocytosis, and operative time are independent conversion risk factors.
Abstract: AIM: Percutaneous endoscopic gastrostomy (PEG) is a practical and safe option to place an alimentary gastrostomy. We observed that a relevant rate of complications are related to management of PEG. PATIENTS AND METHODS: We registered the patients treated in our Unit from September 1994 to December 2005. We placed 293 PEG (243 pts). Preferably using a tube 16 Fr, in 7 cases 18 Fr, in 21 cases 20 Fr and only in 3 cases 9 Fr. The median age was 69.8 years; ratio female:male 3:1. In 67 cases the treatment was carried out in not hospitalized patients. RESULTS: The incidence of late and early complications is statistically higher in hospitalized patients than at home. CONCLUSION: We think that a correct management of PEG (nurses correct information) and the experience of endoscopist and a dietician can significantly reduce the rate of complications.
Abstract: AIM: We analysed our experience of laparoscopic surgical treatment vs traditional surgery of right colon cancer. METHODS: A series of 27 patients was treated from January 2001 to December 2005 out of a total of 927 surgical colorectal operations in the same period (147 with the laparoscopic approach). Inclusion and exclusion criteria are reported. We compared this group with 25 patients treated by the same surgical group with open surgery. The mean operative time, the distance from the distal margin of resection, the number of lymphnodes, the mean period of canalization and the mean hospital stay are reported. RESULTS: In the laparoscopic group, the mean operative time was 124.8+/-36.3 min vs open surgery group of 94+/-23.6 min; the distance from the distal margin was 6.7+/-3.1 cm vs 6.4+/-2.1 cm; number of lymphnodes was 15.2+/-4.3 vs 18.7+/-2.9 nodes; and canalization 1.7+/-0.9 vs 2.7+/-0.7 days. The hospital stay was 6.8+/-1.7 vs 7.2+/-0.8 days. CONCLUSIONS: We consider laparoscopic right colon resection a safe procedure but it needs good laparoscopic practice and the observance of inclusion criteria.
Abstract: BACKGROUND: The surgical management of diverticulitis in emergency is controversial: The primary reconstructive surgery or Hartmann's procedure? METHODS: The Authors have analyzed our experience on 409 cases of diverticulitis from January 1975 to December 2004; 101/409 were treated in emergency and divided in two groups before and after December 1994. The patients were divided on Hinchey's classification, type of surgical procedure, ASA status and complications. The Authors have analyzed all cases by t-Student and chi2 analysis. RESULTS: No difference between two groups on age, sex, concomitant diseases are observed. The hospital stay in patients treated in emergency was 10.2 days to 7.1 days in patients operated after 24 hours (p<0.05). The incidence of primary anastomosis in the second group is higher (p<0.03). The incidence of leaks in two groups was respectively 27.2% and 10.3% (p<0.005). The deaths were 12/101 (11.8%); 9 of these in III-IV stages of Hinchey's classification. DISCUSSION: In the lasts ten years the surgical approach to diverticulitis in emergency is changed. The individual risks factors, the Hinchey's stage, play an important role in decision making. The Authors have registered a major indications to primary anastomosis in emergency.
Abstract: The authors analyzed their experience from January 2001 to February 2005 on 117 patients treated with Longo hemorrhoidopexy (46 cases) and Milligan-Morgan hemorroidectomy (71 cases). All the patients were observed after a week and one month after surgical procedure; at 6 months the Authors controlled 70 patients treated with Milligan-Morgan and 33 treated with Longo technique. The pain after 24 hours was the same in two groups but after a week a significative difference between two groups (p<0.05) was registered with a better quality of life for hemorrhoidopexy group. At 6 months pain during defecation was present in two cases of Longo group and in 6 cases of Milligan-Morgan group. In author's experience the Longo technique is a safe treatment with lower postsurgical pain and lower complications.
Abstract: So far, the use of fibrin glue has been limited to the treatment of anal, recto-vaginal and enterocutaneous fistulae. Between 1991 and 2003 we performed the treatment of anastomotic leaks of the upper and lower gastro-intestinal tract with fibrin glue in 13 selected patients. In our experience the treatment with fibrin glue has been proved to be effective in the selected cases. If the fistulae clinically occured 7 days after surgery a higher number of endoscopic sessions were necessary than in patients with earlier appearance of anastomotic leakage.The utilization of fibrin glue for the endoscopic management of anastomotic leakages after surgery can be successful and safe if applied in selected patients.
Abstract: BACKGROUND: Hypocalcemia is the most frequent complication following total thyroidectomy. This prospective study examines the predictive value of parathyroid hormone (PTH) levels measured 24 hours after surgery. MATERIAL AND METHODS: A total of 1006 consecutive patients (mean age, 54.8 years; female/male ratio, 4/1) underwent total thyroidectomy for benign or malignant thyroid from January 1995 to November 2003. Serum calcium, phosphorus, and PTH were measured preoperatively and at 24 hours after surgery. All patients underwent preoperative examination to assess cord motility. RESULTS: A total of 253 (25.1%) patients presented with hypocalcemia demonstrated by clinical and laboratory findings. In 101 cases the hypocalcemic syndrome manifested after 24 to 36 hours whereas in 5 of 101 cases, symptom onset was between 48 and 72 hours. Serum calcium levels lower than 7.5 mg/dL were recorded in all the 101 cases. In 239 of 253 cases serum calcium returned to normal values within 7 days following surgery. PTH at 24 hours was below normal levels in 49 of the 101 patients but was within normal limits in 52 cases. The incidence of hypocalcemia was higher in patients undergoing surgery for malignant thyroid ( P < 0.05). CONCLUSIONS: We do not consider PTH levels at 24 hours postoperatively as predictive of hypocalcemia.
Abstract: PURPOSE: To evaluate the pitfalls occurring during the virtual colonoscopy examination performed with a protocol designed for screening purposes. MATERIALS AND METHODS: 40 patients underwent a spiral CT for virtual colonoscopic evaluation with the following parameters: collimation 3 mm, feed 6 mm.rot(-1), pitch 2 and increment 1 mm in supine position. Virtual colonography examination was carried out using a dedicated workstation equipped with a software which allows to generate 3D images and virtual endoscopic views. Colon distension, fluid and fecal material were assessed on a 3 point scale. RESULTS: Distension score was 0.50. Left colon and cecum score was 0.32 while in the sigmoid and rectum the score was worse with 0.86. Fluid and fecal residues scores were 0.31 and 0.19 respectively. On almost half of the patients additional scans would be necessary. The main cause of additional scans is suboptimal intestinal preparation and colon distension. CONCLUSION: The use of virtual colonoscopy for screening purposes will be possible through the further technical development and with the optimisation of the protocols, particularly by the improvement of colon cleansing and distension.
Abstract: BACKGROUND: Authors generally agree that Giant Pancreatic Pseudocysts (> 10 cm) have a lower spontaneous resolution and are more difficult to treat than smaller pancreatic pseudocysts. This study was carried out on two groups of patients with larger and smaller pancreatic pseudocysts (pancreatic pseudocysts > 10 cm versus pancreatic pseudocysts < 10 cm), and aims to establish whether the size of pancreatic pseudocysts is a factor influencing treatment outcomes. PATIENTS AND METHODS: In a retrospective study, we examined 71 patients with pancreatic pseudocysts following an episode of acute pancreatitis, which were treated in our hospital from 1980 to 2000. Forty-one (57.5%) patients had a large pancreatic pseudocyst. Most patients underwent invasive treatments: 9 (12.6%) had percutaneous drainage, 37 (52.1%) open surgery and 13 (18.3%) endoscopic cyst gastrostomy. 12 patients (16.9%) of the 71 were cured with medical therapy alone. RESULTS: As far as the aetiology of the pancreatitis, location and number of the cysts were concerned, no major differences emerged between the two groups, although large pancreatic pseudocysts followed more severe pancreatitis (P = 0.0005). All giant pancreatic pseudocysts required invasive treatments; 40% of the pancreatic pseudocysts < 10 cm were successfully treated with medical therapy alone. No statistical differences were found regarding hospital mortality, morbidity, recurrence rate and hospital stay among the patients treated invasively. CONCLUSIONS: Giant pancreatic pseudocysts more often require invasive therapy due to persistent symptoms or complications. Treatment outcomes do not seem to be influenced by the size of the pancreatic pseudocysts.
Abstract: Hypocalcaemia is a possible sequela of thyroidectomy, the causes of which are not fully understood. Today, correct surgical technique is the most important factor in decreasing the incidence of hypocalcaemia. We analysed 1223 patients (930 total thyroidectomies, 293 hemi-thyroidectomies) treated in our institute from January 1995 to July 2003. Serum calcium, ionized calcium, parathyroid hormone and phosphoraemia were screened pre- and postoperatively. Hypocalcaemia, as defined by a serum calcium concentration below 8.5 mg/dL, occurred in 241 patients (25.1%). In 90.9% of these patients, serum calcium was normal 7 days after thyroidectomy. In three patients we registered permanent hypoparathyroidism 180 days after thyroidectomy. We found a statistically significant difference in the incidence of hypocalcaemia between patients treated for benign disease and those treated for malignant disease with a greater incidence in the latter group (P < 0.05). Several factors are important in determining the incidence of post-thyroidectomy hypocalcaemia but the inadvertent excision of the parathyroid gland, ischaemia and injury are the main causes of the lowering of serum calcium concentrations.
Abstract: Reports of the relationship between the putative metastasis suppressor NM23 and metastasis and/or survival in colorectal cancer patients are conflicting. This study aimed to investigate whether nm23 immunostaining is correlated with established prognostic variables (Dukes' stage, degree of tumour differentiation, T stage and nodal involvement) in colorectal carcinomas for the patients treated with radical intent using Kruskal chi(2) analysis. The rates of survival at five years were estimated with the use of the Kaplan-Meier product-limit method with 95% confidence intervals derived by Greenwood's formula and the curves were compared with the use of the log-rank test. Cox proportional-hazard regression model was used to identify multivariate predictors and the corresponding outcome. The staining was performed on 112 paraffin-embedded surgical specimens collected between 1989-1992 using a monoclonal anti-nm23 antibody. Follow-up of patients was until time of death or for at least 5 years. There was not a significant correlation between tumour staging, degree of tumour differentiation, nodal involvement and nm23 status. Furthermore, there was no significant association with overall 5-year survival, disease recurrence, tumour site, age or sex. Although nm23 may be involved in suppressing tumour metastasis, nm23 immunohistochemistry has no prognostic value in colorectal cancer. For these reasons nm23 does not contribute further to the prognostic information provided by established prognostic variables.
Abstract: The risk of dislodgment of endoclips placed during laparoscopic cholecystectomy in enlarged cystic duct is higher with minor bile leak. From January 2000 to April 2004, we performed 1013 procedures; in 12 patients we have showed a enlarged duct ligated with 4 laparoscopic cholecystectomy endoclips after a 180 degrees rotation of the gallbladder during a retrograde cholecystectomy. We haven't registered complications and all the cases were discharged the first postoperative day. The method is safe and economically sound.
Abstract: CONTEXT: The natural history of pancreatic pseudocysts has become well known in recent years, but the choice of a proper treatment still remains controversial. OBJECTIVE: This study aims at establishing whether predictive factors influencing therapeutic outcomes exist. SETTING: Patients with pancreatic pseudocysts following an episode of acute pancreatitis treated from January 1980 to December 2001 at the Department of General Surgery and Organ Transplantation of the University of Parma, Italy. PATIENTS: Seventy-four patients were studied: 12 had a spontaneous resolution, 37 patients were treated surgically, 15 were treated endoscopically and in 10, percutaneous drainage was used. MAIN OUTCOME MEASURES: Epidemiological, clinical and pathological characteristics of patients with pancreatic pseudocysts were related to morbidity, recurrence rates and hospital stay. RESULTS: At univariate logistic regression, our data reveal a significant increase in morbidity related to age (P=0.013), etiology (alcoholic vs. biliary, P=0.024), Ranson score of previous pancreatitis (P=0.006), nutritional assessment (P=0.001), residual necrosis (P<0.001) and modality of treatment (P=0.009), whereas none of these parameters has been shown to be significantly correlated to recurrence. At multivariate logistic regression, only residual necrosis was significantly related to morbidity. CONCLUSIONS: Some factors, such as epidemiological (age, etiology), clinical (severity of previous pancreatitis, malnourishment), pathological (residual necrosis), and therapeutical factors (emergency/urgency treatment) are predictive of worse outcomes for invasive treatment of pseudocysts. In particular residual necrosis appeared to be the most important factor influencing invasive treatment outcomes, confirming that this pathological aspect deserves particular attention from surgeons. No risk factors predicting pancreatic pseudocyst recurrence emerged.
Abstract: The Authors report their experience on laparoscopic colectomy in 38 patients treated between June 2001-September 2003 in General Surgery and Organ Transplantation Department of University of Parma, Italy. The patients were 23 male and 15 female, with average age 58.4 years. All patients were studied with TC and colonoscopy performed by the surgeon. The conversion rate was 15.8% and the average hospital stay 6.9 days (range 6-15 days). The patient's general clinical conditions and the results showed that the laparoscopic colectomy is a safe surgical option.
Abstract: Videolaparoendoscopic treatment of choledocholithiasis in a single stage is an important option for this disease. We currently adopt this approach to choledocholithiasis in our department. We report here the case of a woman with stones in the biliary tract and gallbladder. After videolaparoscopic cholecystectomy we performed a transcystic cholangiography. A guidewire was used to show Vater's papilla during endoscopic papillosphinterotomy, because this was in a duodenal diverticulum that made it impossible to cannulate the papilla. We propose this method in all those cases in which, for anatomical reasons, the papilla cannot be easily cannulated.
Abstract: BACKGROUND: The pathological association between thyroid and parathyroid gland disease is here discussed. The multiphase analyzer has revealed a new type of subclinical primary hyperparathyroidism (HPP) and the role of surgery in these cases is not clear. METHODS: This is a prospective study of all cases of thyroid disease in association with parathyroid disease treated surgically in our Institute from July 1999 to June 2001. RESULTS: Of the 221 thyroidectomies carried out, 29 patients had an elevated preoperative serum level of parathyroid hormone (PTH). An ultrasonography examination was performed on all patients and a preoperative scanning with 99Tc-MIBI on 11 of 29 patients. We examined intraoperatively 19 cases of HPP (14 parathyroid adenoma, 5 hyperplasia). In 10 cases we observed a normal size of the parathyroid gland and we did not perform a parathyroidectomy. CONCLUSIONS: All patients with elevated serum parathyroid hormone and serum calcium levels before thyroidectomy should be considered candidates also for surgery to the parathyroid glands. The pathological association between thyroid and parathyroid gland diseases is not rare. We must conduct an accurate neck exploration in all these cases.
Abstract: Various tumor node metastasis (TNM) classifications have been proposed for staging of gastric carcinoma, including the fourth edition of the TNM classification and the Japanese Research Society for Gastric Cancer (JRSGC) system. In 1997 the fifth edition of TNM classification introduced the concept of the number of metastatic lymph nodes. We review our experience with staging gastric cancer in light of both the fourth and fifth editions of the TNM classification system. From January 1986 to December 1997, we performed subtotal resection in 193 patients with carcinoma of the gastric antrum. A total of 147 patients presented with criteria from the fifth TNM edition. We compared data from these patients with data from the fourth TNM edition. We analyzed 84 females and 63 males whose average age was 68.9 years. The average number of lymph nodes removed was 16.7. We used the Kaplan-Meier method to analyze survival. In accordance with the fourth TNM edition, we recorded 82 patients who were pN0, 36 who were pN1, and 29 who were pN2; according to the fifth edition, 82 patients were pN0, 33 were pN1, 17 were pN2, and 15 were pN3. Average follow-up was 26.7 months, and average survival was 56.9 months for N0 patients, 38.7 months for N1 patients, and 24.5 months for N2 patients staged according to the fourth edition. According to the fifth edition, survival was 39.3 months for N1 patients, 33.6 months for N2 patients, and 10.3 months for N3 patients. The survival curve was statistically different (P<0.001) between N0 and N1 patients according to the fourth edition; there was no significant difference between N1 and N2 patients. According to the fifth edition, the difference in survival probability was P<0.001 between N0 and N1 patients and N2 and N3 patients. The fifth TNM edition presents a greater ease of stratification in bringing together and mediating diverse cultural experiences between West and East. This staging lays the basis for a more accurate comparison between the groups.
Abstract: Parathyroid carcinoma is a rare entity with an 0,5-1% of incidence on primary hyperparathyroidism (HPP) in literature. The very high values of calcium and parathormone (PTH) and the clinical aspects of hypercalcemia are the characteristics findings in these patients. We present our experience on 6 pts on 153 cases with HPP treated (3,9%). The clinical and diagnostic suspects are frequently intraoperative findings and the decision making for the surgeon is not always easy (parathyroidectomy with or without hemithyroidectomy, lymphadenectomy, surgical resection of other tissues). The mortality rate is high and we have registered three deaths at 8,14 and 64 months.
Abstract: We present a case of a 67-year-old woman, in which a clip in the common bile duct (CBD) was the nidus of stone formation. The ultrasonographic examination reported a CBD with an abnormally large diameter and an endoscopic retrograde sphincterotomy showed a stone in the ampulla. The stone was extracted through the Vater's Papilla and the patient was discharged after 24 hours.
Abstract: The incidence of diagnosis of gastric polyps is now higher than in past years owing to the introduction of endoscopy in the diagnosis and treatment of upper digestive tract disease. One hundred and sixty-four polyps removed from January 1984 to August 2000 were analyzed. The median age of the patients was 61.4 years (range: 16-84 yrs). Polypoid lesions were more frequent in males (M:F = 1.5:1). Seventy-nine patients were asymptomatic (48.2%). Sixty-four percent of the polyps were located in the antrum. We diagnosed 73 hyperplastic polyps, 27 adenomatous lesions, 8 inflammatory polyps and 56 pseudopolyps. Malignant lesions were detected in 9 adenomatous polyps (4 type I and 5 type II early gastric cancers). Endoscopy is the examination of choice in the diagnosis and treatment of gastric polyps. We confirm that there is a relationship between histological type, neoplastic change and the size of the polyps.
Abstract: Pancreatic pseudocysts are the most common lesions of the pancreas. Endoscopic and US-endoscopic techniques are today the best minimally invasive diagnostic and therapeutic procedures available for this pathology. From January 1980 to December 2001 we observed a total of 74 patients with pancreatic pseudocysts secondary to acute pancreatitis. Twelve patients were treated by medical therapy, 37 with a surgical approach, 15 by endoscopic drainage and 10 by CT-guided drainage. The mean size of the pseudocysts was 12.9 cm (range: 3.4 to 24 cm) and 69.4% were larger than 10 cm. CT-guided drainage had a 50% complication rate (P = 0.00814), a 20% mortality rate (P = 0.00463) and a 10% relapse rate. The surgical approach was associated with a complication rate of 18.9% and a 5.4% relapse rate. The endoscopic approach presented a 13% morbidity rate and a 6.6% relapse rate. CT-guided drainage is the therapeutic approach we use in emergency cases, but endoscopic therapeutic technique is the best procedure and is a valid alternative to surgical and CT-guided drainage. The shortest mean hospital stay (4.8 days) was observed with the endoscopic approach.
Abstract: The Authors we report the case of a 50 year old woman with accessory breast cancer in the thoracic region. The examination revealed a mass of 1 cm diameter and a tumorectomy showed a ectopic breast with an intraductal carcinoma. Nodal dissection, chemo-, radio- and hormonal therapy there performed. The follow up didn't show a relapse of breast carcinoma after 5 years.
Abstract: Percutaneous endoscopic gastrostomy (PEG) is a valid alternative to surgical gastrostomy to provide nutritional support in patients unable to ingest food. Previous Billroth II gastroresection is no longer a controindication. We describe our experience with 5 cases of PEG placement in patients who had previously undergone Billroth II gastroresection.
Abstract: We present our experience in the treatment of 18 patients affected by gastrointestinal stromal tumours (GIST) from January 1988 to march 2002. The ratio M.F was of 2:1 and the median age of 68.6 years. In 13 patients the tumours were located in the stomach while in 5 patients in the jejunum ileum area. In 7 patients the neoplasms were malignant. All the patients were operated and in 11 patients a partial gastric resection was carried out. 2 patients had a total gastrectomy and 5 had a small bowel resection. The diagnostic and therapeutic options and the uncertain prognosis of these neoplasms are discussed.
Abstract: The complications in thyroid surgery reported in literature are variables. The Authors describe the experience on 803 thyroidectomy from 1 January 1995 to 31 December 2000. The knowledge of the embryologic origin of the parathyroids glands, of the causes of haemorrhage and the improvement of the surgical technique has permitted a lower incidence of complications.
Abstract: Pseudocyst is a complication of acute and chronic pancreatitis. Today endoscopic drainage is reported as being the treatment of choice for these complications. Endoscopic drainage was performed in 15 patients with a pseudocyst bulging into stomach or duodenal lumen as detected by CT and endoscopic examination. All 15 cases treated from January 1991 to December 2001 (11 men, 4 women; median age: 55.7 years [range: 33-81] were successfully drained. The mean hospital stay was 4.8 days. No mortality or major complications were observed and the compliance was very good. The procedure is safe and we believe that endoscopic drainage should be the procedure of choice for pseudocysts which bulge into the gastrointestinal lumen.
Abstract: The Authors present their experience from 1980 to 2001 in the treatment of 5 cases of endometriosis. The median age is 26.5 years, the symptomatology was the presence of abdominal pain feces mixed with blood in two patients and in three cases a colorectal localization as well as a pelvic endometriosis. In a case the Authors have treated the patient with a surgical approach and in the others with a medical therapy with LH-RH analogs. Pathogenesis, symptomatology, diagnostics, medical and surgical therapy of this disease are also analyzed.
Abstract: Acute bleeding of the lower gastrointestinal tract causes complex diagnostic problems. Colonoscopy is subject to discussion as the first method of diagnosing lower digestive tract bleeding. From June 1998 to September 2001 we observed 80 patients with acute bleeding (45 males and 35 females; mean age: 65.5 years). All patients underwent an emergency colonoscopy. In 15 cases we carried out an angiography and in 9 a scintigraphy (always after colonoscopy). Colonoscopy detected the cause of the bleeding in 69 patients (86.2%) during the first examination. Angiography and scintigraphy revealed the haemorrhage in 8 (53%) and 7 (77.7%) cases, respectively. Ten cases were treated during colonoscopy; 31 underwent surgery. We consider an emergency colonoscopy as the first method for diagnosing the causes of bleeding. If this examination fails we consider arteriography and scintigraphy as second-line approaches for obtaining a diagnosis.
Abstract: We analyzed 824 patients treated by thyroidectomy in our Institute from January 1995 to December 2000. We observed the presence of cervicomediastinal goiter in 117 patients (14.9%), 92.7% of whom presented euthyroidism. Sternotomies were performed in 15 patients (10 midline and 5 hemi-clamshell). On the basis of our own experience and the reports in the literature, we analyse the diagnostic and surgical approach to the therapy of cervicomediastinal goiter.
Abstract: Over the past three decades important progress has been made in the diagnosis and treatment of non-variceal upper gastrointestinal bleeding. We discuss the endoscopic techniques available today in combination therapies. The data in the literature regarding endoscopic techniques are discordant and no single technique has proved statistically superior in the management of bleeding. We believe that the initial injection approach is still the procedure of choice, particularly when performed by less expert endoscopists.
Abstract: Percutaneous endoscopic gastrostomy (PEG) is a valid alternative to surgical gastrostomy to provide nutritional support in patients unable to ingest food. Previous Billroth II gastroresection is no longer a contraindication. We describe our experience with 5 cases of PEG placement in patients who had previously undergone Billroth II gastroresection.
Abstract: Breast cancer in pregnancy involves a psychosocial, religious, multidisciplinary medical decision. From 1991 the Authors have surgically treated six patients affected by breast cancer in pregnancy. The Authors, in this papers, review analysing current therapeutic approach for this disease.
Abstract: The gastric polyps are lesions found in 2-3% of endoscopic procedures. We point out the hystologic nature of these lesions to a correct therapeutic evaluation. The endoscopic polypectomy is today safe; we report our experience in an endoscopic polypectomy with use of endoloop for a giant gastric polyp.
Abstract: Colonic perforations associated with colonoscopy are uncommon. We determined the incidence, clinical presentation, and medical and surgical treatments of iatrogenic colon perforations. We present the medical records of 8 patients with iatrogenic colorectal perforations seen over a period of 17 years. The median age 68.3 years. Emergency laparotomy was performed in 7 patients. One case was treated with a medical approach. One postoperative death occurred. In the absence of significant contamination primary repair is the best treatment. Non-operative management is indicated in patients without peritoneal irritation.
Abstract: The use of mammography for early detection of breast cancer showed an increased detection of non-palpable breast-lesions (NPBL). The authors evaluate the radiologic findings, the biological factors and the surgical approach, trough the personal experience and the literature, for a correct treatment of these lesions.
Abstract: Hypercatabolism after operations has a negative influence on nutritional status, the healing process, infective complications and hospital stay. Moreover, the immune status of the patient has been shown to be equally important for septic morbidity and mortality. It is extensively accepted that in critical situations, an adequate nutritional support (enteral or parenteral) is absolutely necessary, but subjects such as the best way of feeding, the kind of nutrients to be used and the administration time are still debatable issues. Our aim was to evaluate the effectiveness (nutritional and immunological features) and clinical outcomes (septic morbidity and mortality) of total parenteral nutrition (TPN), early enteral nutrition and early enteral immunonutrition (EEN, EEIN) in 171 patients undergoing major abdominal and urological surgery for neoplastic pathology. Our prospective, randomised study showed no significant differences among the 3 nutritional supports (TPN, EEN, EEIN) with regard to restoration of normal nitrogen balance during the acute phase of surgical stress. No correlations were found in the 3 groups with immunoglobulin percentage, lymphocyte subpopulations and their functional patterns as studied by specific immunological tests. The skin test, on the other hand, seems to be more representative of the immune condition of the patients, demonstrating a faster improvement in immunological status in the EEIN group as compared to the control group. A smaller percentage of septic morbidity and mortality was found in both enteral nutritional groups (EEN and EEIN), although there was a statistically significant difference only between the TPN and EEIN groups. The hospital stay was 3.5 days shorter in enteral feeding patients (EEN, EEIN). Finally, EEN was less expensive than the other nutritional conditions, this result depending on the cost of the different materials used (infusion sets, linear filters, prepacked diets, etc.).
Abstract: We reviewed the results of twenty-four years' experience of parathyroidectomy for secondary hyperparathyroidism. Over the period from 1976 to 2000, we performed 171 parathyroidectomies for secondary hyperparathyroidism (91 males, 80 females; median age: 57.4). Autotransplantation was performed in 45. Of the 171 patients undergoing parathyroidectomy, 14 (8.1%) were treated for relapse. Twenty-four of the 45 patients treated with autotransplantation (53.3%) were followed up for 82 +/- 37 months. Hypoparathyroidism was observed in 33.3% of these (worse after 6 months in 21% and stable in 46%). Five patients (11.1%) experienced a relapse of hyperparathyroidism. We believe that the treatment of choice for secondary hyperparathyroidism is subtotal parathyroidectomy, the indications for autotransplantation in parathyroid surgery are rare.
Abstract: Fine needle aspiration biopsy is an effective procedure for the diagnosis and biological characterization of carcinoma of the breast. The authors compared the immunocytochemical expression of oestrogen receptor and progesterone receptor, Ki67 antigen and p53 protein, evaluated in pre-surgical fine needle aspirates, with the immunohistochemical results observed in the corresponding histological sections. Fine needle aspirates and paraffin embedded sections obtained from 37 patients with primary carcinoma of the breast were studied by immunocytochemistry and immunohistochemistry, respectively. Percentage agreement between values obtained with cytology and histology was 89.6% for oestrogen receptor, 76.9% for progesterone receptor, 91.3% for Ki67 and 77.7% for p53. The data reported here suggest that the evaluation of biological parameters by fine needle aspiration biopsy may be useful to decide the best medical and surgical treatment for primary breast carcinoma.
Abstract: Radical axillary nodes dissection in breast cancer is a standard for a correct staging, unfortunately this approach can cause several unpleasant sequelae and complications. Sentinel node biopsy applied to breast tumors could be a good option for predicting axillary nodes status avoiding complete dissection. The aim of this work is to report our experience with sentinel node biopsy during a period of 18 months. One hundred and nine patients with an infiltrating breast tumor T1 had been studied. There wasn't clinical and ultrasonographic evidence of axillary infiltration. Tumors had been injected on the day before surgery with a mixture of colloidal human albumin particles marked with 99m Technetium. In 108 out of 109 patients (99%) sentinel node had been identified using a gamma probe and biopsied during surgical intervention performed under local anesthesia. Sentinel node has been examined both with conventional histology and immunohistochemistry. In 26 cases the node was positive for metastases. Radical axillary dissection in this subgroup of patients showed that in 85% of them sentinel node was the only positive. We conclude that sentinel node biopsy can be a good alternative to traditional axillary dissection but there are still important questions about the best method of analysis and, before the technique become a routine procedure in breast cancer management, we should know the results of prospective clinical trials comparing survival of patients staged by sentinel node biopsy versus traditional axillary dissection.
Abstract: We reported three cases of transpyloric prolapsed polipoid lesions. Abdominal pain, early satiety are the most common presenting features. Endoscopies and polipectomy are important for a correct diagnostic evaluation. Large polyps (> 2 cm), if prolapsed, can require a surgical excision.
Abstract: The aim of the study was to assess the significance of oesophagogastro-duodenoscopy (EGDS) before cholecystectomy. Over the period from 1988 to 1999 EGDS was performed in 384 patients before surgery out of a total of 1439 cholecystectomies. 42.8% presented no lesions, whereas pathological findings were detected in 57.2%. The lesions observed were divided into major and minor. EGDS performed prior to cholecystectomy detected major lesions in elderly patients and in patients with atypical biliary symptoms.
Abstract: We report the experience of the Institute of Surgical Pathology of the University of Parma on three patients with sporadic medullary thyroid carcinoma (MTC). MTC is a tumor of parafollicolor cells origin (C cells). The surgical excision of the thyroid tumor and cervical node metastases is potentially curative. The other therapeutic options are limited. Considerable emphasis has been placed on early diagnosis and surgery for multiple endocrine neoplasia (MEN) related MTC. Genetic screening promises earlier and accurate diagnosis (RET gene mutations are found in MEN).
Abstract: Primary hyperparathyroidism (HPP) is increasingly being recognized because of the widespread use of multiphasic screening for hypercalcemia, in patients without clinical signs. Each year develop 100,000 new cases in the United States, females/males 5:2; the peak of incidence is in V-VI degrees decade. We analyze our patients from November 1975 to July 2000. We have performed 112 parathyroidectomy for HPP, 84 females and 28 males, median age 57.5 years. We have examined the surgical options, the value of PTH, calcium, and the number of pathological glands. The Authors discuss the invasive or non-invasive procedures and the surgical treatment.
Abstract: A patient affected by Caroli's disease without congenital fibrosis, 80 y. old is reported. The Caroli's disease was asymptomatic all life long; this was a intraoperative finding and only in the last year the patient presented recurrent cholangitis. The "simple" Caroli's disease is less common than other forms. We analyze the literature and the ethiopathogenetic mechanisms hypotisized.
Abstract: The finding of Merkel cell carcinoma is a rare but important event owing to the highly aggressive nature of this neoplasm. The authors report three cases of Merkel cell carcinoma with different onsets which were representative of the possible range of clinical symptoms and the prognosis of this pathology. In two cases diagnosis was made by chance, but in the third case a preoperative biopsy was initially performed with subsequent radicalization. The authors examine the diagnostic and therapeutic protocols proposed by other authors and compare them to their personal experience to ensure early diagnosis and radical therapy. Surgery is the obligatory initial choice, followed by radiotherapy and an accurate follow-up. The authors evaluate the use of Octeotride therapy for tumours of neuroendocrine origin and hence its application to Merkel cell carcinoma.
Abstract: OBJECTIVE: To describe the use of radionuclide venography (RV) in the detection of the site(s) of blood reflux through incompetent perforating veins (IPVs) of the leg of patients with chronic venous insufficiency (CVI). EXPERIMENTAL DESIGN: Prospective study in which we evaluated our experience in the assessment and treatment of patients with moderate or severe CVI with a follow-up ranging between 6 and 48 months. SETTING: A surgical service of the Department of Surgery of the University of Rome "Tor Vergata". PATIENTS: Fifty-three patients with CVI that were referred to our service to be surgically treated. INTERVENTIONS: Physical examination, RV, and surgical procedures of ligation of IPVs. MEASURES: Based on pre- and post-operative physical examination and RV. RESULTS: The patency of deep venous system and the presence of 1 to 3 leg IPVs was confirmed preoperatively in all the limbs either with physical examination and RV. After surgery, non-ulcerated skin changes improved and all the ulcers healed within 45 days. Postoperative RV showed that the IPVs had disappeared from the affected areas in 56 limbs. Two ulcers recurred after two and six months respectively. CONCLUSIONS: RV showed to be a reliable method to exactly detect IPVs. This method is useful to guide the ligation of IPVs in patients with moderate or severe CVI.
