Clinical outcomes of primary arterial embolization in severe hepatic trauma: A systematic review.

PURPOSE: This purpose of this systematic review was to determine the safety and efficacy of arterial embolization as the primary treatment for grade III-V liver trauma, excluding the postoperative use of arterial embolization. MATERIAL AND METHODS: A total of 24 studies published between January 2000 and June 2018 qualified for inclusion in this study. Four of them were prospective studies and 20 were retrospective. A total of 3855 patients (mean age, 33.5 years; range: 22-52.5 years) were treated non-operatively and 659 patients (659/3855; 17.09%) with hepatic hemorrhage underwent primary arterial embolization from 2000 to 2017. Indication for arterial embolization was a contrast blush visible on computed tomography in hemodynamically stable patient in all studies. RESULTS: The arterial embolization success rate ranged from 80% to 97%. The most commonly reported complication was bile leak, with an incidence of 5.7%. Nineteen bilomas (2.8%) were reported in five studies with a range between 4% and 45%. Hepatic ischemia was reported in eight studies, with a mean incidence of 8.6%. CONCLUSION: Primary arterial embolization has a high success rate in patients with hepatic trauma. Complications, including biloma and hepatic ischemia, have acceptable rates in the context of a minimally-invasive procedure that allows stabilization of life-threatening, complex liver injuries.

[Differentiated microcarcinoma of the thyroid gland]. / Il microcarcinoma differenziato della tiroide.

BACKGROUND: The thyroid microcarcinoma is a tumor with maximum diameter of 10 mm (WHO). For the most part is not clinically palpable and not evident by imaging investigations. The papillary microcarcinoma is the most common form of thyroid cancer, followed by follicular microcarcinoma. The aim of our study is to assess the frequency of microcarcinoma, the association of benign thyroid disease himself and the controversial surgery. PATIENTS AND METHODS: We analyzed 391 patients (321 F and 70 M) who underwent total thyroidectomy from 2004 to 2009 at a Unit of General Surgery, Uremic and Organ Transplant, Hospital of Palermo. RESULTS: 42 carcinomas were detected, of which 24 PTMC and 1 follicular microcarcinoma. The PTMC was associated with cancer in only 2 cases (papillary carcinoma and parathyroid carcinoma) in the remaining thyroid tissue was suffering from benign disease (20 goiters, 3 Hashimoto thyroiditis, a trabecular adenoma). TALK: Controversial is still the type of surgery to be performed in case of differentiated thyroid microcarcinomas, as well as the indication is still debated to lymphadenectomy. CONCLUSIONS: Papillary microcarcinoma of the thyroid in our series, represents 57% of all thyroid cancers. Microcarcinoma and benign thyroid disease association (76.92% of cases) was high. The therapeutic attitude adopted by us was total thyroidectomy associated with conservative lymphadenectomy in the presence of palpable lymph nodes, instead to abstaining in the absence of clinical evidence of nodal metastases.

[Association between thyroid and parathyroid diseases]. / Associazione tra patologia tiroidea e paratiroidea.

The association between thyroid and parathyroid diseases is well known in the context of MEN, but we find also in nonsyndromic scenarios. In our study, were considered the latter. Between 2003 and 2008 in our Division of General Surgery 61 patients underwent operation for hyperparathyroidism, 13 for primary, 41 secondary and 7 tertiary. Twenty-six of these patients underwent also total thyroidectomy. 31% of our patients with primary hyperparathyroidism had concomitant thyroid disease. In the literature, in this regard, there is a correspondence between the data of various authors (Keus, Masatsugu). The association between IPT and primary thyroid carcinoma is discussed. Of our 41 patients with secondary IPT, 32% had associated thyroid disease (77% for goitre). The literature shows considerable variability in this direction, depending on geographical areas and methods of diagnosis. The thyroid disease associated with tertiary IPT was in all of our cases benign. The association of thyroid and parathyroid disease is therefore relatively common. It follows therefore the importance of careful preoperative evaluation in patients with hyperparathyroidism, in order to avoid a reoperation on the neck, because of higher complication rate.