Differentiated thyroid tumors: surgical indications.

Thyroid gland tumors represent 1% of malignant tumors. In Italy their incidence is in constant growth. The aggressiveness depends on the histological type.

The administration of anesthetic in the thyroid pericapsular region increases the possibility of side effects during percutaneous laser photocoagulation of thyroid nodules.

Background And Objective: Nodular thyroid disease is very frequent in iodine-deficient areas affecting at least 50% of the population. Percutaneous laser ablation (LA) represents an effective method and an alternative to conventional surgery. Since the first description of the LA methodology for thyroid nodules, various studies have suggested some modifications to increase the percentage of volume reduction of the nodules.

Do Italian surgeons use antibiotic prophylaxis in thyroid surgery? Results from a national study (UEC--Italian Endocrine Surgery Units Association).

Thyroid surgery is a clean procedure and therefore antibiotic prophylaxis is not routinely recommended by most international guidelines. However, antibiotics are often used in clinical practice. We enrolled 2926 patients who performed a thyroid surgical operation between the years 2009 and 2011 in the 38 centers of endocrine surgery that joined the UEC--Italian Endocrine Surgery Units Association.

Persistent hypercalcitoninemia in patients with medullary thyroid cancer.

Medullary thyroid carcinoma is a highly malignant and progressive disease. Surgery is the only effective treatment. Calcitonin is a significant marker for medullary thyroid carcinoma, and due to its sensitivity it represents a useful tool for the follow-up.

A useful ultrasound score to select thyroid nodules requiring fine needle aspiration in an iodine-deficient area.

Background: The high prevalence of thyroid nodules in iodine-deficient areas is a practical problem because of the large number of patients requiring fine needle aspiration (FNA) to detect malignant nodules.

Aim: To obtain an ultrasound (US) score for predicting malignant nodules and reduce the number of unnecessary and expensive FNA.

Subject And Method: All nodules observed from September 2001 to March 2006 were evaluated by US: echostructure, echogenicity, halo, microcalcifications and ratio between antero-posterior and transversal diameters (AP/TR).

Surgical treatment of sporadic medullary thyroid carcinoma: strategy and outcome.

Background: Medullary Thyroid Carcinoma (MTC) originates from the thyroid C cells and accounts for approximately 5-9% of all thyroid cancers. Aim of this study was to retrospectively evaluate the outcomes of 41 patients with MTC who underwent treatment at our institution. PATIENTS AND METHODS.

Surgical treatment of intrathyroid metastases: preliminary results of a multicentric study.

Background: Intrathyroid metastases (ITM) are rare and usually have a dismal prognosis. The aim of this study was to detect which neoplasms metastasize most often to the thyroid gland, their clinical features and treatment options.

Materials And Methods: Retrospective analysis of clinical files of 17,122 patients submitted to surgery for thyroid disease between 1995 and 2005.

[Non-recurrent inferior laryngeal nerves and sympathetic-inferior laryngeal anastomotic branches: 6 years' personal experience].

The incidence and possible association of inferior laryngeal nerve and sympathetic anastomotic branch anomalies were evaluated in this study. Non-recurrent inferior laryngeal nerves stem from vascular anomalies involving the right subclavian artery and aortic arches during embryological development. These anomalies usually have no functional consequences (except for occasional dysphagia), but are potentially dangerous during thyroid surgery, occurring in about 1% of cases.

[Molecular medicine in thyroid surgery].

Cancer originates from a single cell which, through the acquisition of mutations in genes for key growth and survival factors, undergoes clonal expansion. Study of the genome allowed the detection of genes whose mutation is involved in tumour formation. In detail, in most thyroid neoplasms we are now able to identify the genes which cause cancer initiation.

Fine needle aspiration cytology of thyroid nodules: conventional vs thin layer technique.

Objective: Liquid-based cytology using the thin layer technique has recently been introduced in thyroid fine needle aspiration cytology together with or in substitution of direct smears, but its usefulness is still controversial and relatively few studies have been published in this field. The aim of the present study was to compare the results obtained from conventional smears with those from thin layer smears.

Design: In 3875 thyroid nodules, a double cytologic sampling was taken in randomized order, to prepare conventional or thin layer smears.

[Intraoperative ultrasonography in the surgery of recurrence of well differentiated thyroid cancer].

Surgical resection is the only curative treatment option for local recurrence of well differentiated thyroid cancer. In our experience, we found that intraoperative ultrasonography can be of significant help in facilitating the localisation and complete resection of lesions. From 2005 to 2006, 12 patients with well differentiated thyroid tumour recurrences underwent intraoperative ultrasonography.

[Granulomatous mastitis: diagnostic and therapeutic problems. Case report and review of the literature].

The granulomatous mastitis is uncommon inflammatory disease of the breast of unknown etiology. The diagnosis is obtained only through hystopathology. We report a case of woman, 41 years old, showing lesions of the breast, that caused strong pain with ulcerations sero-haematic secretion and axillary omolateral lymphadenopathy.

A randomized controlled trial to evaluate the efficacy of ultrasound-guided laser photocoagulation for treatment of benign thyroid nodules.

This randomized controlled study was designed to test the efficacy and safety of percutaneous ultrasound (US)-guided laser photocoagulation (PLP) for treatment of subjects with compressive symptoms due to benign thyroid nodules and/or at high surgical risk. Twenty six subjects were randomized to the intervention (no. 13, age 68+/-3 yr, mean+/-SEM) or observation (no.

[Lymphectomy in differentiated thyroid cancers: our experience].

Introduction: At present we are still debating on which is the most adequate therapeutic strategy concerning the size of the thyroidectomy and the extension of the lymphectomy in differentiated thyroid tumors.

Patients And Methods: From January 2000 to December 2005, 334 operations for thyroid neoplasms have been performed; 304 (91%) for differentiated tumors. In 124 cases (37%) the latero-cervical and/or the central compartment lymphectomy have been associated with thyroidectomy: 79 monolateral and central compartment lymphectomies (ML and CCL) (64%), 11 bilateral and central compartment lymphectomies (BL and CCL) (8%), and 34 central compartment lymphectomies (CCL) (28%) have been performed.

[Male breast cancer. Five years experience and literature review].

Male breast cancer is an uncommon disease and its aetiology, clinical behaviour and treatment is not well-known . Retrospective studies show that age and stage-matched breast cancer in men and women are compared. Nevertheless, the poor mammary tissue in man allow a rapid local infiltration, late diagnosis and poor survival rate.

[Diagnostic-therapeutic pathways as instruments of clinical management: experience at the S. Maria Hospital in Terni].

Diagnostic-therapeutic itineraries and treatment profiles are instruments of clinical management. The authors report on their experience with the experimental creation of such itineraries in thyroid nodular pathology. These are the fruit of collaboration between the management team, endocrinological surgeons, and the hospital computer staff.

[Role of minimally invasive surgery in the treatment of primary hyperparathyroidism].

The minimally invasive approach to parathyroid surgery is considered an efficient alternative to traditional cervicotomy when the pre-operative diagnostic work-up indicates a single parathyroid adenoma. Imaging techniques (ultrasound, SPECT), on the one hand, and intraoperative diagnostic techniques (radio-guided surgery, intraoperative parathyroid hormone assay), on the other, contribute to the success and development of specialized centres which prefer to use this type of surgery. The postoperative pain control and aesthetic results achieved with these techniques are today the main subjects of interest in the minimally invasive approach.

[Quality sharing between the national health service and citizens: a diagnostic and therapeutic planning experience at the "S. Maria" Hospital in Terni].

The Diagnostic and Therapeutic Programs are instruments of clinical management. The authors report on their experience with the construction of a Diagnostic and Therapeutic Program in the field of breast cancer. This is the result of collaboration between the Breast Unit, an administrative team and a computer team at the "S.

[Thyroid microcarcinoma: our experience].

Differentiated thyroid cancer had an excellent prognosis; the diagnosis of sub-centimetric differentiated cancer (microcarcinoma) is more and more frequently. Clinical evolution of microcarcinoma could be various: microcarcinoma can represent an autoptic finding or can evolve with locoregional lymph node involvement or metastasis. Various clinical and genetic factors have been considered to predict the aggressiveness of this neoplasm.

Breast surgery and sentinel node biopsy. Our experience.

Massive campaigns of screening of breast pathologies improved early diagnosis of breast cancers. Most of these cancers are small-sized (T1) and seldom show intraoperative nodal involvement. Sentinel node biopsy is the elective choice in the above mentioned cases because, if negative, it avoids axillary dissection.

Major complications in thyroid surgery: utility of bipolar vessel sealing (Ligasure Precise).

In the present study the Authors tried and assess the advantages of the standard sutureless thyroidectomy performed by the Ligasure Vessel Sealing System, thanks to the use of the dedicated Precise handle. The Authors compared the efficacy of haemostasis and the economical impact of the device, in terms of drug administration and costs. The Authors comparatively analyzed 120 total extracapsular thyroidectomies (TET) performed by the standard operative technique (Group A, control) and 70 TET achieved by the "sutureless technique" (Group B, case).

Which therapy to prevent post-thyroidectomy hypocalcemia?

Hypocalcemia is one of the most frequent complications after total extracapsular thyroidectomy (TET). In most of cases it is a transient phenomenon. The aim of this study is to evaluate if and how the oral administration of calcium or calcium combined with D-vitamin could effectively prevent post-thyroidectomy hypocalcemia.

[Bile leakage after laparoscopic cholecystectomy: report of three cases in our experience].

Laparoscopic cholecystectomy (LC) is associated with an higher incidence of bile duct injury than open cholecystectomy. There has been concern and the reason why bile leakages are more frequent with LC is yet unclear. Bile collections can occurr because of major about (75%) or minor (about 25%) injuries.

[Interstitial laser photocoagulation in liver tumours: our experience].

Interstitial lasertherapy (ILT) is one of the percutaneous thermal procedures allowing the ablation of primary or secondary hepatic lesions. This technique can be performed without general anaesthesia, since the patient is completely painless, in spite of the high temperatures reached, because there are no sensitive fibers around the lesion. This study includes patients with small hepatocarcinomas (< 2 cm) non peripherically sited, far from the gallbladder and the hepatic hilum.