Parathyroid carcinoma as a challenging diagnosis: report of three cases.

Parathyroid carcinoma (PC) is a rare malignancy with an indolent but progressive course. This rare tumour is often difficult to diagnose preoperatively, thus limiting the efficacy of surgery. As long-term survival is largely dependent on the extent of the primary surgical resection, it is of great importance to consider PC in the differential diagnosis of hyperparathyroidism.

A rare case of giant papillary adenoma of the breast.

The authors present a case of giant papillary adenoma of the breast and discuss their therapeutic strategy. The patient subsequently returned due to a local recurrence, which was treated with oncoplastic surgery, with satisfactory aesthetic results. The authors conclude by stressing the considerable rarity of this disease and the need for effective cooperation between surgeons and pathologists.

Parathyroid carcinoma presenting as normocalcemic hyperparathyroidism.

Parathyroid carcinoma (PC) is a rare malignancy, with an indolent but progressive course. Long-term survival is largely dependent on the extent of the primary surgical resection. Hence, pre- or intraoperative suspicion of malignancy is of great importance.

[Adrenal incidentaloma in elderly patients].

The adrenal incidentaloma is a disease that, thanks to the progress of the modern diagnostic, means for the longer and more high quality of life, has given a progressive increase in its impact, which has become more apparent in the elderly population. The authors after a review of literature on the impact and diagnostic, troubleshooting data endocrinology and imaging, these adrenal gland silent tumor clinically poses, envisage a therapeutic for use in older patient protocol.

Increased annual frequency of Hashimoto's thyroiditis between years 1988 and 2007 at a cytological unit of Sicily.

Like other auto-immune diseases, Hashimoto's thyroiditis (HT) results from the interaction of genetic with environmental factors. Only few studies have evaluated the year-to-year change in frequency of HT over a wide period of time. The endocrine division of our Hospital has reported a great increase in the annual frequency of HT between 1975 and 2005, and a progressive decrease in both age at presentation and female to male (F/M) ratio starting in the mid-1990s.

Thyroid metastases from renal cell carcinoma: review of the literature.

The thyroid gland is a rare site of clinically detectable tumor metastasis and kidneys are frequently the site of the parent malignancy. In the present review on thyroid metastases from renal cell carcinoma, cases were searched on PubMed by entering the strings: "renal carcinoma [or "hypernephroma"] AND thyroid metastasis/metastases". Thus, we retrieved a total of 111 cases that were published between 1964 and 2007, a total that became 113 by adding two patients observed by us.

Thyroid metastases from clear cell renal carcinoma 18 years after nephrectomy.

Single or multiple thyroid metastases from extra-thyroid primary tumors are reported to be rare. Malignancies that metastasize to the thyroid include cancers originating from lung, breast and kidney. We report our experience with a case of thyroid metastases, which were detected 18 years after curative kidney surgery for renal cell carcinoma.

[Radio-guided parathyroidectomy].

The Authors, after a careful review of literature about the instrumental diagnostic techniques (with particular attention to the nuclear-medical ones) and the surgical therapy of parathyroid diseases, report their experience on the use of the radio-guided mininvasive surgery with MIBI and gamma-probe for intraoperative localization of pathological glands. Once exposed their experience, the Authors conclude asserting that this technique is fast, slightly invasive and expensive, and certainly useful for the detection of pathological or ectopic glands. It can be widely employed because, in comparison to its numerous advantages, such as the reduction of the operating time and of the hospital-stay, the greater radicality and the possibility to use mininvasive techniques, it does not present significant technical limitations and/or radio-protectionistic problems.

[Carotid body tumor. An often misdiagnosed disease].

Chemodectomas are uncommon neoplasms, born by glomic cell of extra-adrenegic system. Usually, these neoplasms are benign and non functioning, but when they are more than 4 cm can induce a neuro-vascular compressive syndrome. In this study the Authors propose the guidelines for diagnostic, clinical and therapeutic management, of these tumors according to their experience.

Increase in voice level and speaker comfort in lecture rooms.

Teachers often suffer from health problems related to their voice. These problems are related to their working environment, including the acoustics of the lecture rooms. However, there is a lack of studies linking the room acoustic parameters to the voice produced by the speaker.

[Differentiated thyroid cancers].

The Authors, after a review of the topic of thyroid cancer, focus on the epidemiology, aetiology and diagnosis of well-differentiated thyroid cancers. They then describe their own case series and their many years' experience in treating the patients affected by this pathology, which is generally regarded as having low malignancy. Nowadays the Authors consider the treatment of choice the total thyroidectomy with central compartment lymphectomy, eventually associated with metabolic radiotherapy.

[Case report of a cervical thoracic duct cyst].

After a number of anatomical considerations regarding the thoracic duct and the diseases that may affect it, the authors report that, in the literature, such cystic lesions of an iatrogenic nature are extremely rare in the cervical area. After discussing the diagnostic methods for a correct preoperative diagnosis, they address the surgical technique they used for removal of the lesion.

[Hyperparathyroidism from mediastinal parathyroid adenoma. Case report].

The authors, after reviewing parathyroid gland diseases, their location, and the modern strategies that can be used for their pre-operative detection, describe a case of primary hyperparathyroidism which recently came to their attention. The use of a combination of instrumental techniques (US, scintigraphy and SPEcT) enabled them to establish, prior to surgery, the mediastinal ectopic site of the parathyroid adenoma. Mini-invasive surgery proved to be the optimal technique to performing a targeted surgical excision that reduced the operative time and the hospitalisation.

[Surgical treatment of uninodular gotter. Personal experience].

The Authors report their surgical experience in patients with uninodular goitre, and stress the trends in management benign and malignant lesions. The total thyroidecromy is the first choice. In some well selecrioned cases it is possible a videoassisted approach.

[Riedel's thyroiditis. Personal experience].

The Riedel's thyroiditis, also called "wood's thyroiditis", is a rare chronic "inflammatory" disease of unknown etiology, relatively frequent in female >45-50 years, characterized by a fibrotic process that pervades thyroid and neighbouring structures (vessels, muscles, oesophagus, trachea upper- mediastinum). The authors discuss about three cases of Riedel's thyroiditis and report the outcome after total thyroidectomy in two cases and sub-total resection in the other one.

[Aorto-esophageal fistula caused by foreign body].

Aortoesophageal fistula is a rare but fatal cause of upper gastrointestinal bleeding. AEF develop progressively from the esophageal perforation caused by foreign body. Clinically, there is a medial chest pain, followed by hematemesis and finally terminal exsanguination.

[The use of synthetic prosthesis in the treatment of hernia].

The authors report their experience on synthetic prosthesis used in 36 patients with abdominal hernias. Thirty six cases of incisional hernias have been analyzed by Institute of General Surgery of Messina University from 1992 to 1998. Among the 33 cases with median parietal defect, in 7 cases concerning great incisional hernias group a PTEF-e prosthesis, which was positioned in an intraperitoneal site, was employed.

[Miles operation in rectal carcinoma: history and current status].

The Authors confirm how the advent of mechanical suture has directed the management of rectal carcinoma to an increasingly conservative attitude. In reporting their experience--which consists of about twenty years (222 patients) they specify how not only an increased incidence of recurrence has not appeared, but they have also observed a reduction of theirs (-5.2%).

[Primary hyperparathyroidism: follow-up of the surgically treated patient].

After several remarks on the etiopathogenesis of primary hyperparathyroidism the Authors emphasise the importance of follow-up in operated patients. The evaluation begins right after removal of the lesion in the intraoperative phase, in order to evaluate the validity of the intervention and continues with evaluation of mineral homeostasis, disease itself and function of target structures. In addition to possible hypocalcemic crises, special attention should be placed on possible disease recurrence, and the study of all involved parts such as bones, kidneys, pancreas, digestive apparatus as well as the psychological aspects.

[Neuroendocrine tumors of the pancreas].

Neuroendocrine tumours are rare and often include insulinoma, gastrinoma and other low frequency tumours that secrete gastrointestinal hormones. Their preoperative localization, despite continuous medical advances, is extremely difficult but helpful in guiding the surgeon towards a proper form of treatment. After presenting their cases, the authors conclude that the treatment of choice for these tumours is surgery due to their anatomopathological features (benign, scarcely malign or invasive, slow growth).

[Primary hyperparathyroidism].

Primary hyperparathyroidism is a hormonal disease that is more and more frequent and is often manifested exclusively by an increase in calcium levels in the serum. After examining the main anatomopathological and clinical characteristics of the disease, the authors present their experience in its diagnosis and surgical treatment. They suggest that cervical exploration with removal of the adenomas and hyperplastic glands in both asymptomatic and highly symptomatic patients is strongly advised.

[Surgical problems in the aged patients].

Authors, considering the increasing of the middle duration of life and the increasing of geriatric population, examine various surgical problems in the elderly. They took in consideration not only the age, but all the other markers of surgical risk related to the surgical illness, to the associate illness and to the type of operation. After reporting their experience in the treatment of geriatric patients, they conclude that a scrupulous surgical preparation, a correct indication to the operation and an accurate overseeing after surgery are necessary to do that the elderly patient faces surgical intervention with the same capability of success of the young.

[Surgical management of hereditary medullary carcinoma of the thyroid in patients with "RET" proto-oncogene mutation].

The authors report their results in 64 individuals belonging to 11 families with MEN 2 and familial medullary carcinoma of thyroid (CMT) syndromes. They show amplification and restriction techniques, type, site and incidence of genetic alteration in the observed cases; besides they illustrate the adopted surgical management related to the mutation. They stress the concept that genetic test allows to detect the population with altered gene before laboratory or clinical evidence, with the great advantage to indicate an early surgical approach.

[Day-surgery treatment of pilonidal sinus].

Authors discuss ethiopathogenus of pilonidal disease after a historical background and support acquired-congenital theory. Open and closed treatment are reported on the acute and chronic phases, highlighting economical advantages of closed method. Carbon-dioxide laser on Authors experience was very useful to prevent complications and to shorten healing time in open method.

[Surgery of the thyroid in short-stay hospitalization].

New trends and improvements in health care system allow to choose short hospital stay even on major surgical operations. Authors report their experience on 200 moderate or good operative risk patients who underwent operation for thyroid disease from 1993 to 1998. Short hospital stay program was achieved after 48-72 hours under observation in 193 patients (96%) who underwent subtotal, total and total with lymphadenectomy, thyroidectomy.