[Anatomical thyroid abnormalities. Quadrilobate thyroid gland: a case report and review of the literature]. / Anomalie anatomiche della tiroide. Su un caso di tiroide quadrilobata e revisione della letteratura.

Abnormalities of the thyroid gland and of some adjacent structures arouse interest because of their surgical implications. One need only think of a non-recurrent laryngeal nerve, of thyroid hemiagenesis or of a quadrilobate thyroid gland, as in the case described here. To the best of the authors' knowledge, no similar reports of such a case are present in the medical literature. The patient was a 37-year-old woman suffering from Graves' disease. The abnormality was detected only during surgical examination and consisted in two lobes divided by a cleft on each side and joined by an isthmus. After a number of considerations regarding the anatomical details of this case and a review of the literature, the authors attempt to give an embryological interpretation and formulate the hypothesis that the second lateral lobe could be a development of the widely studied and controversial embryological anlage, the so-called "lateral thyroid".

[Our experience with pharyngo-esophageal Zenker's diverticulum]. / Considerazioni sulla nostra esperienza in tema di diverticolo faringo-esofageo di Zenker.

Zenker's diverticulum is the single most common diverticular event arising in the esophagus. Its physiopathology is universally recognized. Lack of coordination between the propulsive pharyngeal contractions and the release of the upper esophageal sphincter creates abnormally high pressure in the pharyngeal chamber, resulting in the collapse of the posterior wall of the hypopharynx, i.e., the Laimer-Killian triangle (or Killian's dehiscence). The mucosal hernia that develops constitutes the diverticulum, which grows in volume and above all in length and is compressed between two rigid structures, namely, the spine posteriorly and the trachea anteriorly. Swallowing progressively fills the diverticulum, which in turn leads to compression of the esophagus and hence to the characteristic symptom of "delayed dysphagia" or "dysphagia of the 3rd bite". These physiopathological considerations underpin the rationale for surgical treatment, namely upper esophageal sphincter myotomy and diverticulectomy, which is the standard approach used in the 44 cases presented here. A diverticulopexy was performed only once due to the patient's advanced age. Myotomy alone was performed in only one case, given the small size of the diverticulum. In two patients the standard procedure was carried out following emergency therapy for iatrogenic perforation of the diverticulum. The patient with cancer underwent chemo-radiotherapy after futile surgical attempts. Complications included transitory salivary leakage (1 case), and a transitory laryngeal nerve deficit (1 case). Gastroesophageal reflux disease was present in two-thirds of the patients. A Nissen-Rossetti fundoplication was performed one year after treatment of the diverticulum in 5 patients. The following important aspects emerged: i) the incidence of neoplasia on the diverticulum; ii) the association and possible pathogenetic relationship with gastro-esophageal reflux disease iii) the validity of myotomy plus diverticulectomy as a treatment option in view of the negligible complications and the absence of relapse and/or persistence of dysphagia.

[Treatment of inguinal hernia: a prospective study comparing Bassini's procedure, the inguinal pre-peritoneal prosthesis and the Lichtenstein technique]. / Trattamento dell'ernia inguinale. Studio prospettico: Bassini vs protesi peritoneale per via inguinale vs Lichtenstein.

Inguinal hernia surgery has aroused considerable interest in recent years, with numerous advances being proposed to treat these disorders. Bassini's procedure, based on the importance of the transversalis fascia as a fundamental containment mechanism, was for many years the treatment of choice for inguinal hernia. In our study, covering eight years of activity, we focused our attention on this principle, comparing repair procedures such as Bassini's and those with a preperitoneal mesh, in which the repair involves the transversalis fascia, with procedures based on Lichtenstein's technique in which the fascia is left intact. The investigation protocol was thus based on the performance of the three techniques in parallel by the same surgical team. The parameters of immediate complications, lasting pain and recurrence were used to evaluate the results. The first two occurred infrequently in all groups (a greater incidence was seen with mesh procedures). Recurrence rates after preperitoneal mesh techniques were extremely low, confirming the paramount functional importance of the transversalis fascia. The results of our analysis substantiate the advantage of employing the preperitoneal mesh technique, which opens up new horizons for the treatment of recurrent hernia.