Possible association between breast thyroid carcinoma: analysis of risk factors.

BACKGROUND: Breast cancer (BC) is the most common tumor in women, 523.000 cases were estimated in Europe in 2018 and it remains the third cause of cancer related deaths after lung and colorectal cancer. The incidence of thyroid cancer (TC) in females is higher than in males. METHODS: We have retrospectively collected all female patients undergone to surgery for breast or thyroid cancer in 2010The aim of the study was to value the incidence of BC in patients with a personal history of differentiated thyroid cancer (DTC) and conversely, the incidence of DTC in patients with previous BC within 5 years from the diagnosis of the first tumor in 2010. RESULTS: Among 76 BC patients, 11 were death and 22 didn't answer the phone call or refused to re-submit to thyroid ultrasound so they were excluded from the study and only 43 BC were further considered. Thyroid ultrasound was performed in 2010 and in 2016 and it described nodules in 13 (30%) patients in 2010 and in 21 (49%) patients in 2016. In 2010 no FNA was needed while in 2016 6 (14%) patients underwent to FNA with a benign response (Thyr 2). Among 61 DTC patients, 11 didn't answer the phone or the questions so 50 patients were included in the study. Breast cancer family history was reported in 14 (28%) patients and thyroid cancer family history in 8 (16%) patients. No relapse was reported during follow up.All patients underwent to mammography in 2015 or in 2016 within screening programs and no breast cancer were diagnosed. CONCLUSION: The female predominance of diseases of the thyroid and breast makes difficult the separation of an expected association with a casual linkageThe relationship between the co-occurrence of breast and thyroid cancer remains controversial and inconclusive. KEY WORDS: Breast cancer, Breast surgery, Hormone therapy, Thyroid cancer, Thyroidectomy.

One-Step Prepectoral Breast Reconstruction With Dermal Matrix-Covered Implant Compared to Submuscular Implantation: Functional and Cost Evaluation.

BACKGROUND: The breast reconstructive subpectoral technique commonly leads to functional consequences. Recently, a new conservative prepectoral breast reconstruction (PPBR) technique was proposed and its surgical safety and aesthetic effectiveness proved. The aim of this prospective nonrandomized study was to compare the functional and economical outcomes of the PPBR procedure versus the subpectoral one. PATIENTS AND METHODS: From February 2015 to September 2016, 86 patients underwent mastectomy with immediate implant-based reconstruction. Thirty-nine patients were assigned to group 1 and received prepectoral acellular dermal matrix-wrapped implant reconstruction. The remaining 45 patients were assigned to group 2 and received a subpectoral implant or tissue expander. We recorded the operating time, length of hospital stay, analgesic consumption, postoperative pain, upper limb function, esthetic satisfaction, and quality of life. Additional surgical procedures for reconstruction completion or contralateral operation for symmetrization were also recorded. RESULTS: Compared to group 2 patients, group 1 patients showed less postoperative pain and faster upper limb functional recovery. Patients in group 1 also recorded a lower analgesic consumption and an earlier return to usual work. Moreover, the muscle-sparing technique improved aesthetic outcomes and largely reduced the need for symmetrization. CONCLUSION: Immediate breast reconstruction by using prepectoral muscle-sparing acellular dermal matrix-wrapped implant resulted in lower pain intensity and significant upper limb functional advantages compared to submuscular implant placement. Furthermore, when considering a series of ascertained benefits, PPBR is also economically advantageous, although future studies should better define its cost-effectiveness.

Evaluation of surgery risk factor associated to antithrombotic therapy in patients who underwent colorectal surgery.

BACKGROUND: Use of antiplatelet therapy in western people is common. The risk of bleeding related to surgical procedure or invasive procedure is higher.We want to analyse the correlation between colorectal surgery, antiplatelet therapy and postoperative surgical complications. METHODS: We categorized: 176 cases treated for colorectal cancer and we recorded the following data: type of surgery, body max index (BMI), haemoglobin value (Hb); preoperative prothrombin time (PT) and blood transfusions pre and postoperative and during surgery. The analysis focused on two groups: patients who received antiplatelet therapy (AT - antiplatelet therapy) and patients who didn't receive this therapy (NAT - not antiplatelet therapy). RESULTS: In the group of patients who underwent right emicolectomy, haemoglobin values were lower in patients who received antithrombotic therapy than in patients who didn't receive this therapy with a statistical significance (p < 0,05); the same datum resulted in patients who underwent left emicolectomy. Normal weight patients that received antiplatelet therapy had lower values of haemoglobin without statistical significance (p value not significant). Overweight patients who underwent therapy with antiplatelet agents had lesser Hb value than group that didn't performed this therapy (p < 0,05). Patients who received AT showed a bigger percentage of blood transfusions regardless of type of surgery than the second group with statistical significance Normal weight patients showed a different incidence of blood transfusions between patients who underwent antiplatelet therapy (50%) and patients who didn't receive this therapy (29%) with statistic significance (p < 0,05). Overweight patients didn't present this significant difference. We analyzed the incidence of post-operative complications in normal weight patients and overweight patients and we showed that the incidence of complications, both minor and major, was higher in patients who underwent antiplatelet therapy than in the second group regardless of weight CONCLUSIONS: Antiplatelet therapy in patients who underwent invasive surgery changes the incidence of some risk factors, such as bleeding, and of post-operative complications. This result underlines the importance of careful handling and preparation in patients receiving antithrombotic agents that have to undergo invasive surgery. KEY WORDS: Antithrombotic therapy, Bleeding, Colorectal Surgery, Risk factor.

Construction and employment of a low cost laparoscopic simulator. Test on General Surgery residents.

INTRODUCTION: Based on studies that confirm the usefulness of simulators in laparoscopic surgical training, we designed and tested a cost-effective solution to improve the skills of surgeons training in the operating room. The goal was to exercise the basic gestures of laparoscopic surgery. MATERIALS AND METHODS: The initial budget of € 500 was sufficient for this project. We spent only € 360 on the majority of the components, which included buying a laptop. The project was performed with material that was readily available online, and the assembly did not require special tools. The goal was to make the product easily replicable. The test was performed using a simulator on 9 doctors in specialist training in general surgery at the University Hospital of Parma distributed, who were equally distributed among the six years of school in general surgery. RESULTS: The first exercise, which was the simplest, had as its objective the acquisition of familiarity with the vision monocular feature of VL and coordination between the two hands. We observed statistically significant improvement between the first and second (2.52 to 2.17 min, p = 0.006) tests and between the first and third (from 2.52 to 1.57 min, p = 0.001) tests with a non-significant correlation between the time of year and the achieved specialty. In the second exercise, there was a statistically significant improvement due to the excessive excursion of the confidence intervals (remarkable variability with overlap of the same features). This exercise, which consisted of two parts, explored the ability to use two hands independently. The third and final exercise involved the packaging of a laparoscopic ligation and was the most complex because it required skill in the use of instruments with both hands as well as considerable coordination. The t-test for paired data showed a significant improvement in all tests with p = 0.0008 between the average time for the first and second tests, p = 0.001 between the second and third tests, and p = 0.01 between the first and third tests (from 10.09 min to 3.52 min). CONCLUSIONS: The simulator that we constructed will never replace the experience gained in the operating room, and it was not our intention to replace the normal process of learning for young surgeons. Instead, we aimed to provide an inexpensive tool for refining the basic skills of laparoscopic surgery, such as the use of instruments in monocular vision, coordination between two hands and ambidexterity.

Are we changing our inclusion criteria for the minimally invasive videoassisted thyroidectomy?

AIM: The first cases treated with Minimally Invasive videoassisted thyroidectomy (MIVAT) were characterized by inclusion and exclusion criteria that are changing with the experience. MATERIALS AND METHODS: We have analyzed the patients treated from july 2005 to december 2010 with MIVAT All these cases were treated in accord with Miccoli's technique with a minicervicotomy of 1.5-2 cm above the sternal notch. We have divided the cases on the surgical period highlighting changing in the inclusion criteria and the adverse events (0-211 cases; 212-300 cases). All the cases treated were followed up at days 7 (ambulatory visit) and days 30-12 months (ambulatory visit or telephone contatct). The patients classified in the II° period were chracterized by the exclusion of the clinical thyroiditis. We have related these cases with the cases treated with conventional thyroidectomy(CT). RESULTS: No differences in postoperative pain,nerve palsy and hypocalcemia in MIVAT group and CT group. We have registered a postoperative pain at 24 hours lower in MIVAT group. The percentage of transitory nerve palsy in the MIVAT group in the first period was 2,84 % versus 1,12 % in the second period. CONCLUSION: MIVAT technique is safe and reproducible, with an excellent cosmetic results. In our experience MIVAT remains the better surgical options for the patients that meet the inclusion criteria.These cases are 15% of patients treated with thyroidectomy in our Endocrine surgery Unit.

Unintentional parathyroidectomy and postoperative hypocalcaemia. Conventional thyroidectomy versus miniinvasive thyroidectomy.

BACKGROUND: Hypocalcemia and unintentional parathyroidectomy would be associated as cause of post-thyroidectomy hypocalcemia. MATERIALS AND METHODS: We analysed the cases treated with total thyroidectomy by two experienced endocrine surgeons from January 2010 to December 2011 at the Unit of General Surgery and Organ Transplantation of the University Hospital of Parma. These cases were divided in two groups: "Group A" included patients for whom a histological report was made that was negative for a parathyroid avulsion, and "Group B" included patients for whom an inadvertent avulsion of the intracapsular parathyroid glands had occurred. RESULTS: In total, 538 patients were treated with a total thyroidectomy from January 2010 to December 2011. In 26 cases, the histological report highlighted the presence of an intracapsular parathyroid gland. The values of pre-operative calcaemia in group A and group B were 9.204 ± 0.2703 mg/dl versus 9.283 ± 0.401 mg/dl, respectively (p=0.32). The values of post-operative calcaemia were 8.039 ± 0.596 mg/dl for group A versus 7.569 ± 0.618 mg/dl for group B (p=0.0002) In Group A, 91/512 patients were treated with the minimally invasive video-assisted thyroidectomy (MIVAT) technique (17,7%), while 1/26 patients in group B was treated with a MIVAT (3,8%). DISCUSSION: Unintentional parathyroidectomies can occur with experienced surgeons, but this complication is not related to a substantial difference in the incidence of hypocalcemia. MIVAT can helps the endocrine surgeon in the detection of the parathyroids glands, but when the parathyroid is intracapsular, is difficult to preserve it, during surgical dissection.

Diabetic mastopathy: case report.

UNLABELLED: Diabetic mastopathy is a rare fibro-inflammatory breast disease, which occurs in premenopausal women affected by longstanding type I insulin-dependent diabetes. It is a benign disease and it is often misunderstood for its clinical and radiological features that may mimic a breast cancer. The diagnosis of diabetic mastopathy is based on histological examination and it is characterized by lymphocytic lobulitis with glandular atrophy and perivascular lymphocytic infiltration. The patients do not need to undergo surgery but it is necessary to plan an adequate clinical and radiological monitoring program. KEY WORDS: Diabetic mastopathy, Diagnostic and therapeutic features.

Can we define a role for perisentinel lymph-nodes on breast cancer disease?

BACKGROUND: 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. MATERIALS AND METHODS: We have analysed data about 319 patients undergoing surgery for benign and malignant breast disease from January 2007 to July 2010; 134 cases were subjected to the sentinel lymph node biopsy; 29 cases of these patients had the presence of perisentinel lymph nodes at histological examination. Before the intervention, we have used colloidal albumin marked with 99mtc to select the sentinel lymph node; during the intervention, we identified by probe the ipercaptant lymph node, consequently we removed and sent it to histological extemporaneous definitive examination. RESULTS: In 134 Sentinel Lymph Nodes examined, 15 resulted positive for breast cancer cells at extemporaneous examination. In these cases, we decided to proceed with an axillary dissection in the same operative session, with the discovery of axillary lymph nodes metastases in 3 cases on 15 (20%). The positive predictive value of sentinel lymph node in case of positivity was 0.2. 8 cases (6,7% of the lymph nodes sentinel biopsy made) were negative to extemporaneous examination and positive to definitive histological examination for presence of micrometastasis. In 8 axillary dissection, 3 patients were positive for the presence of metastasis. We have analysed with the test "t-student" these data divided on age and the value of Ki-67. Then we calculated the predictive positive and negative value (patients with negative sentinel lymph node: Mean age (+/- sd) =61.93 +/- 13.8 years, ki-67=10.87 +/- 5.78; patients with positive sentinel lymph node: Age mean (+/- sd) = 64 +/- 12 36 years, ki-67=14.08 +/- 8.005). The study showed no statistically significant differences between the positive and negative sentinel lymphnodes about the age (p=0.58) and the Ki-67 (p=0.184). In the 29 cases in which the sentinel lymph node was negative at extemporaneous histological examination and in which were removed the perisentinel lymph nodes, resulted negative at definitive histological examination, the negative predictive value was equal to 1. CONCLUSIONS: The method of sentinel lymph node has demonstrated to be a reproducible, reliable and safe technique. The positivity of sentinel lymph node at final examination (micrometastasis, cells isolated) in case of extemporaneous examination negative for breast cancer cells, determines specifical considerations on surgical indication to axillary dissection. We think that in selected cases (age, biological characteristic of cancer) in which perisentinel lymph nodes were removed and free from breast cancer cells, may not be indicated in case of sentinel node positivity the axillary dissection.

Choledocholithiasis and endo-laparoscopic rendezvous. Analysis of 59 consecutive cases.

BACKGROUND: Choledocholithiasis is a real problem of major clinical importance. The incidence of cholelithiasis is 10-20%. MATERIALS: We have examined 2907 patients treated with videolaparoscopic cholecystectomy (VLC) between January 2001 and September 2009. 214 cases (7.4%) were affected by choledocolithiasis; among these, 59 consecutive cases were treated by rendezvous, 151 cases by sequential treatment (ERCP-ES before VLC), 3 cases by extraction with Dormia's basket, and 1 case by ERCP-ES after VLC. RESULTS: The complications were one biliary fistula and three hemorrhages (one from the cystic artery, one from the hepatic area and one from trocar's site). The mean hospital stay was 1.38 +/- 0.83 days for the rendezvous group vs 4 53 +/- 0.74 days in the sequential treatment group (p<0.004). The satisfaction scores were 6.6 +/- 1.39 versus 5.7 +/- 0.96 (p<0.004). CONCLUSIONS: The rendezvous procedure reduces hospital stay and has a greater compliance (only one treatment). We can use this option in the management of cases where preoperative ERCP-ES has failed.

Laparoscopic proctocolectomy: analysis of long term complications. Case report.

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.

Gastric metastasis from breast carcinoma. Report of three cases, diagnostic-therapeutic critical close examination and literature review.

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.

Minimally invasive video-assisted thyroidectomy (MIVAT): what is the real advantage?

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.

Use of axillary ultrasonography in breast cancer: a useful tool to reduce sentinel node procedures.

AIM OF THE STUDY: 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. METHODS: One hundred fourteen patients were studied consecutively using axillary ultrasonography and ultrasound guided fine needle aspiration of the lymph node. We used ATL Ultramark 9 with 5-7.5 MHz multiple frequency linear probe or Aloka SSDD-1400 with 7.5 MHz linear probe. RESULTS: One hundred fourteen patients were examined; six were excluded because of definitive histological diagnosis of non-infiltrating carcinoma. 106 had monofocal carcinomas, 2 had bifocal carcinoma in 104/108 ultrasonography was carried out successfully. The axillary cytological examination was positive in 18 cases (17.3%) who were subjected to axillary examination. 86 patients were subjected to sentinel lymph node biopsy: positive 13 cases (6 micrometastases). 31 cases/104 (29.8%) showed positive axilla. Sensitivity of ultrasonography was 58%, 100%specificity. Predictive positive value 100%, Negative value 84.9% for an accuracy of 87.5%. DISCUSSION: Ultrasonography is useful in all cases eligible to sentinel lymph node examination; the minimum cost of the procedure and of the human resources is amply rewarded by the direct indication for surgical axillary dissection in case of a positive result (17.3% in our experience).

Minimally invasive video-assisted thyroidectomy in differentiated thyroid cancer: a 1-year follow-up.

BACKGROUND: There are few reports on the use of minimally invasive video assisted thyroidectomy (MIVAT) technique in the treatment of differentiated thyroid carcinoma. MATERIALS AND METHODS: From January 2007 to September 2007, we treated 227 patients for benign or malignant diseases with a total thyroidectomy. We have selected 68 cases consecutively treated for thyroid carcinoma with a total thyroidectomy. The inclusion criteria considered the patients treated with conventional thyroidectomy and the patients treated with the MIVAT. Our follow-up examination was conducted in agreement with the guidelines of the European Consensus Conference. RESULTS: We have identified a first group of cases; group A, which stored the cases treated with the MIVAT technique. This group contained 9 males and 27 females; the median age was 49.69+/-9.26 years. Group B contained 6 males and 26 females treated with the conventional thyroidectomy; the median age was 44.15+/-11.73 years. The postoperative pain at 24 hours after the surgical procedure in A group was 1.033+/-0.87, whereas in B group it was 1.915+/-1.24 (P<0.05).The neoplastic node diameter was 13.31+/-6.31 mm in group A and 16.36+/-8.15 mm in group B (P=ns). All of the patients were treated with radioiodine. The value of thyroglobulin after 12 months in group A was 0.648+/-0.2 ng/mL whereas the value was 0.705+/-0.2 ng/mL in group B (P=ns). DISCUSSION: We think that MIVAT for the right cases is a safe and valid surgical procedure for differentiated thyroid cancer. This technique has a challenging learning curve, and the surgeons must be experts in conventional thyroid surgery.

Thyroidectomy for differentiated carcinoma in older patients on a short stay basis.

BACKGROUND: 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. METHODS: From January 2004 to December 2006, 152 patients affected by thyroid carcinoma underwent total thyroidectomy on a short stay basis. We divided our series in 2 groups of patients according to the age (> or < of 65 yrs) and considered the outcome analysing several factors including: ASA score, mean operative time, mean hospital stay, tumour size, and post-operative complications. RESULTS: The groups consisted of: 115 pts with a mean age of 46.81 +/- 11.63 years and 37 pts with a mean age of 74.53 +/- 3.71 years for the younger and older group respectively. The differences in ASA score and hospital stay were statistically significant between the groups (P < 0.007 and P < 0.004); neither postoperative haemorrage nor permanent hypocalcemia was observed. One permanent paralysis of the recurrent laryngeal nerve was noted at 12 months follow up; transient hypocalcemia, which resolved in all cases within 30 days from surgery, was reported in 23 and in 7 patients in the younger and older group respectively. CONCLUSIONS: Although a longer length of stay was noted in the older group and possibly related to a higher ASA score and a worse preoperative airways condition, total thyroidectomy for differentiated thyroid carcinoma may be safely carried out in older patients on a short stay basis if performed by an expert staff and in the setting of a multidisciplinary and exhaustive preoperative assessment.

Defunctioning stoma in high-risk rectal anastomosis.

BACKGROUND: Ileostomy in rectal surgery is not always indicated for protecting the anastomosis. METHODS: We examined patients who underwent low rectal resection surgery for carcinoma between June 2005 and December 2007. We categorized the patient's characteristics according to the American Society of Anesthesiologists (ASA). We estimated hospital stay, and postoperative Dukes stage. RESULTS: 68 patients, 47 males and 21 females (mean age 67.8 years, range 40-85 years) treated with low rectal resection for carcinoma. An ileostomy was performed in 29 out of 68 patients (42.6%). Six postoperative ileostomy cases led to the appearance of peritonitis from anastomotic fistula. Among the patients with ileostomy 19 pts. (65.5%) belonged to ASA II and 10 pts.(34.5%) to ASA III; among those patients without ileostomy, 32 (82.05%) ASA II and 7 (17.95%) ASA III (p = n.s.). Of patients who underwent the first protective surgical procedure, 4 belonged to ASA II (66.6%) and 2 to ASA III (33.3%). The mean hospital stay for the non ileostomy group was 7.64 +/- 0.7 days, while it was 7.36 +/- 0.49 (p = n.s.) for the ileostomy group. The mean stay of postoperative ileostomy for leakage was 10.83 +/- 1.16 days. CONCLUSIONS: Ileostomy cannot completely prevent the onset of leakage, but may reduce overall hospitalization time.

Association between primary hyperparathyroidism and thyroid disease. Role of preoperative PTH.

BACKGROUND: The association between patients with surgically treatable thyroid disease and patients affected by PHPT is not just accidental. MATERIALS: We report 591 patients who underwent total thyroidectomy in our center. Data, collected during the preoperative period according to our protocol for candidates to total thyroidectomy, included: type of thyroid disease, sex, age, type of surgical procedure, preoperative PTH and plasmatic calcium level. Calcium plasmatic level has been monitored at 24 hours after surgery on day 6 and monthly for 6 months. RESULTS: On 591 cases, PTH above the normal range were present in 19.1% (113 patients), all asymptomatic for PHPT 30 were males (26.6%) and 83 females (73.4%), with a mean age of 62.97 +/- 12.51 years and 57.38 +/- 15.09 years ( p = 0.19). The mean preoperative PTH and calcium plasmatic level were 104.4 +/- 21.96 pg/ml and 119.7 +/- 37.93 pg/ml (p = 0.39) and 9.21 +/- 0.59 mg/dL e 9.37 +/- 0.87 mg/dl (p = 0.45) respectively. Intraoperative exploration proved a pathological parathyroid gland in 12 on 113 cases. In 9 of the 12 patients with parathyroid adenoma, hypocalcaemia developed. It resolved in 7 days for 4 patients and within 30 days for the others. No hypocalcaemia has been recorded at a 6 months follow up for the 97 considered (4 were lost at follow up). CONCLUSION: Preoperative PTH measurement for all patients undergoing total thyroidectomy may offer a concrete tool to screen and identify the above-described category of patients, with no additional cost for further radiological investigations, because this class of patients will be submitted to bilateral cervical exploration associated with a total thyroidectomy.

Dunbar's syndrome and superior mesenteric artery's syndrome: a rare association.

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.

[The Mirizzi syndrome. Analysis of an unknown complication of the gallstones]. / La sindrome di Mirizzi. Analisi di una patologia spesso preoperatoriamente misconosciuta.

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.

[Hypocalcemia after thyroidectomy: analysis on 804 treated patients]. / L'ipocalcemia post-tiroidectomia Analisi prospettica su 803 pazienti operati.

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.