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1.
Surg Endosc ; 32(5): 2340-2344, 2018 05.
Article in English | MEDLINE | ID: mdl-29101555

ABSTRACT

BACKGROUND: Minimally invasive video-assisted thyroidectomy (MIVAT) has been introduced into clinical practice by Miccoli in the late 1990s (Miccoli et al., Am J Surg 181(6):567-570, 2001) and it has become a widespread technique used and welcomed worldwide. In this paper, we present our experience of the last 2 years; we also describe tips and techniques derived from over 460 cases performed in the last 10 years by the same surgical team with the same single operator. METHODS: In the last 10 years, we did about 460 MIVAT procedures. In the last 2 years, we performed MIVAT on 156 consecutive patients at Sant'Andrea University Hospital of Rome "Sapienza" University. of 156 cases performed, we were able to monitor the follow-up in 110 patients. RESULTS: On 110 cases, the mean surgical time was 74 ± 7.2 min. In our data, we reported: transitory hypoparathyroidism 11 (10%), definitive hypoparathyroidism 4 (3.60%) (this value is inclusive of patients treated with central neck dissection. The value referred only to MIVAT is 1.05%), 2 (1.81%) transitory monolateral nerve palsy, 16 (14.50%) transitory, and 1 (0.9%) definitive nerve palsy. 4 (3.60%) cases of transitory dysphagia and 0 (0%) cases of definitive dysphagia (Table 4). We also had 1 (0.9%) case of surgical scar infection, 0 (0%) postoperative bleeding, and 2 (1.81%) cases of subcutaneous surgical adhesion. Cosmetic results were: 0 (0%) insufficient, 0 (0%) sufficient, 6 (6.30%) passable, 17 (15.50%) good. and 86 (78.20%) excellent. Conversion rate 0 (0%). CONCLUSION: MIVAT is a good and safe technique, with similar short-term outcomes and similar costs compared to traditional total thyroidectomy. We hope that the tips and techniques reported in this paper as well as the advices in the use of instruments in MIVAT and open surgery will be useful to improve the skills of young surgeons and make thyroid surgery less invasive.


Subject(s)
Thyroid Diseases/surgery , Thyroidectomy/methods , Video-Assisted Surgery/methods , Adult , Female , Follow-Up Studies , Hospitals, University , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , Retrospective Studies , Thyroid Neoplasms/surgery , Treatment Outcome
2.
Trastor. ánimo ; 7(1): 25-34, ene.-jun. 2011. tab
Article in Spanish | LILACS | ID: lil-618814

ABSTRACT

Mood disorders are highly prevalent. It has been suggested that cortisol dysregulation may play a role in depression pathophysiology. Alterations in the Hypothalamic-Pituitary-Adrenal (HPA) axis and cortisol circadian rhythm resembles the alterations of Cushing´s syndrome. This functional hypercortisolism may produce consequences in central nervous system, such as cognitive impairment and reduced hippocampal volume. Systemic effects, such as the association of mood disorders with central obesity, hypertension and diabetes could be partly mediated by cortisol.


Los Trastornos del Ánimo (TA) son una patología de alta prevalencia. Dentro de su fisiopatología se ha planteado que el cortisol podría jugar un rol fundamental. Recientemente, se ha descrito una desregulación en el eje Hipotálamo Hipófisis Suprarrenal (HHS) y en el ritmo circadiano del cortisol en la depresión que se asemeja a las alteraciones del Síndrome de Cushing. Este hipercortisolismo funcional provocaría consecuencias a nivel del sistema nervioso central, como alteraciones cognitivas y disminución del volumen del hipocampo. Además, se describen efectos sistémicos, como asociación de los TA con obesidad central, hipertensión y diabetes que podrían ser en parte mediadas por cortisol.


Subject(s)
Humans , Affect , Hydrocortisone , Depressive Disorder, Major , Diabetes Mellitus , Hypertension , Obesity , Cushing Syndrome
3.
Infection ; 38(1): 58-61, 2010 Feb.
Article in English | MEDLINE | ID: mdl-19904491

ABSTRACT

INTRODUCTION: Hepatitis B virus (HBV) reactivation is a major cause of morbidity and mortality in patients with hematological malignancies who receive cytotoxic chemotherapy. We have therefore carried out a prospective observational study out to assess the incidence, prevalence, and clinical course ina cohort of these patients. METHODS: HBV and HCV markers and liver function indices were monitored prospectively in 318 consecutive patients(171 males, 147 females; mean age 57 years) with hematological malignancies, who had been referred to the Hematology Division, Perugia University, between October 2005 and March 2007 and followed up for at least 6 months. RESULTS: At diagnosis, 32 patients (10%) had received HBV vaccination; 30 were responders. At least one HBV marker was positive in 70/318 patients (22%): 14 (20%) were HBsAg-positive(HBV surface antigen-positive), 13 (19%) were only anti-HBc positive (antibodies to HB core antigen), and 43(61%)were anti-HBc and anti-HBs positive. Twelve HBsAg+ patients received nucleoside/nucleotide analogs (adefovir [six patients],lamivudine [four], and combined adefovir/lamivudine[two non-responders to lamivudine]). After 6 months of therapy, HBV-DNA was negative and transaminases were normal in nine of these 12 patients (adefovir [six], lamivudina[two], adefovir + lamivudina [one]). Seroreversion was achieved in 3/13 patients (23%) who were only anti-HBc positive;all were on rituximab therapy and received adefovir. Seroreversion was not observed in any of the 43 patients who were anti-HBc- and anti-HBs positive. CONCLUSIONS: Essential to the management of patients with hematological malignancies undergoing chemotherapy are surveillance and prophylaxis of HBV infection together with prompt administration of nucleoside/nucleotide analogs in cases of reactivation and/or seroreversion.


Subject(s)
Antineoplastic Agents/therapeutic use , Drug-Related Side Effects and Adverse Reactions , Hematologic Neoplasms/complications , Hematologic Neoplasms/drug therapy , Hepatitis B virus/isolation & purification , Hepatitis B/diagnosis , Hepatitis B/drug therapy , Adolescent , Adult , Aged , Antiviral Agents/therapeutic use , Female , Hepacivirus/isolation & purification , Humans , Immunocompromised Host , Italy , Liver Function Tests , Male , Middle Aged , Prospective Studies , Virus Activation , Young Adult
4.
G Chir ; 27(4): 179-82, 2006 Apr.
Article in Italian | MEDLINE | ID: mdl-16768876

ABSTRACT

Surgery is the only curative treatment for primary hyperparathyroidism (pHPT). Surgical exploration is recommended for all patients with biochemically documented pHPT and signs or symptoms of the disease. Some patients are asymptomatic, others have subtle symptoms that disappear after parathyroid surgery. Felix Mandl successfully performed the first parathyroidectomy in 1925, using a bilateral neck exploration (BNE) with examination of all four glands and this remained the procedure of choice for pHPT into the 1990s. As over 80% of pHPT cases are due to a single parathyroid adenoma, many authors have questioned the need of BNE and have proposed directed unilateral approaches, termed "mini-invasive parathyroidectomies". The aim of this report is to define which is the actual role of the conventional surgical approach to pHPT.


Subject(s)
Hyperparathyroidism, Primary/diagnosis , Hyperparathyroidism, Primary/surgery , Diagnostic Techniques, Surgical , Humans , Neck
5.
G Chir ; 27(3): 85-9, 2006 Mar.
Article in Italian | MEDLINE | ID: mdl-16681866

ABSTRACT

Through the analysis of our preliminary experience on 36 consecutive cases of thyroid surgery, we assessed the feasibility of the rapid intraoperative assay of the intact parathyroid hormone (iPTH) as predictive risk factor of hypocalcemia versus seric calcium level on the first post-operative day to select the patients eligible to an early discharge. Furthermore, we managed to determine if iPTH level during thyroid surgery could point out the cases in which parathyroid autotransplantation is necessary, as the macroscopic evaluation of the parathyroid gland's viability is inadequate.


Subject(s)
Parathyroid Hormone/blood , Thyroidectomy , Adult , Aged , Calcium/blood , Feasibility Studies , Female , Humans , Immunoassay , Intraoperative Period , Male , Middle Aged , Predictive Value of Tests , Retrospective Studies , Thyroidectomy/adverse effects
6.
G Chir ; 26(11-12): 411-4, 2005.
Article in Italian | MEDLINE | ID: mdl-16472417

ABSTRACT

The aim of this paper is to describe a typical clinical case of tuberous sclerosis complex (Bourneville disease) and discuss controversial issues about the management of this rare condition, with a short revision of the literature. Particularly, we define which is the role of the surgeon in the treatment of this very rare condition, that should be primary approached conservatively.


Subject(s)
Angiomyolipoma , Kidney Neoplasms , Tuberous Sclerosis , Adult , Angiomyolipoma/diagnosis , Angiomyolipoma/diagnostic imaging , Female , Follow-Up Studies , Humans , Kidney Neoplasms/diagnosis , Kidney Neoplasms/diagnostic imaging , Radiography, Abdominal , Time Factors , Tomography, X-Ray Computed , Tuberous Sclerosis/complications , Tuberous Sclerosis/diagnosis
7.
G Chir ; 24(5): 177-82, 2003 May.
Article in Italian | MEDLINE | ID: mdl-12945168

ABSTRACT

During the surgical treatment of two patients with benign anastomotic colorectal stenosis, the Authors registered the presence of concomitant tenacious adherence of the anastomotic line to the sacral bone. Such event, according to the Authors, could represent one of the causes of failure and greater risk of perforation during the treatment with the different endoscopic therapies that, nevertheless, ought to be considered the gold standard in the therapy of benign structures. The Authors developed their hypothesis physiopathologic on the basis of personal experience and of the search a diagnostic procedure able to highlight the presence of a tenacious adherence with solid structures during the operative evaluation. If further studies focused on this subject will bring to satisfactory results, this would represent a further aid for the evaluation of the best therapeutic approach of the benign post anastomotic stenosis.


Subject(s)
Cicatrix/etiology , Colon/surgery , Intestinal Obstruction/etiology , Rectum/surgery , Tissue Adhesions/etiology , Aged , Anastomosis, Surgical/adverse effects , Constriction, Pathologic , Female , Humans , Male , Middle Aged
8.
G Chir ; 24(4): 119-21, 2003 Apr.
Article in Italian | MEDLINE | ID: mdl-12886749

ABSTRACT

A cecal mass of uncertain etiology encountered during surgery for presumed appendicitis is a dilemma for the surgeon. The differential diagnosis of an unsuspected ileocecal mass must include neoplasm, diverticular disease, inflammatory bowel disease and severe appendicitis involving the ileocecal region. Right hemicolectomy is the gold standard for the treatment of the unsuspected ileocecal mass. The Authors report a case of inflammatory tumour of caecum secondary to appendicitis in a young adult.


Subject(s)
Cecal Diseases/surgery , Granuloma, Plasma Cell/surgery , Acute Disease , Appendicitis/complications , Cecal Diseases/diagnosis , Cecal Diseases/diagnostic imaging , Cecal Diseases/etiology , Colectomy , Diagnosis, Differential , Emergencies , Follow-Up Studies , Granuloma, Plasma Cell/diagnosis , Granuloma, Plasma Cell/diagnostic imaging , Granuloma, Plasma Cell/etiology , Humans , Male , Middle Aged , Radiography, Abdominal , Time Factors , Tomography, X-Ray Computed , Ultrasonography
9.
Phys Rev Lett ; 89(18): 183201, 2002 Oct 28.
Article in English | MEDLINE | ID: mdl-12398596

ABSTRACT

We report the stopping power of molecular hydrogen for antiprotons of kinetic energy above the maximum (approximately 100 keV) with the purpose of comparing with the proton one. Our result is consistent with a positive difference in antiproton-proton stopping powers above approximately 250 keV and with a maximum difference between the stopping powers of 21%+/-3% at around 600 keV.

10.
G Chir ; 23(4): 157-61, 2002 Apr.
Article in Italian | MEDLINE | ID: mdl-12164006

ABSTRACT

Although the vestigial retrorectal cysts are still rare, the number of the observed ones is destined to increase, as methods by imaging become routinely used in the clinical practice. Once diagnosed, the removal of retrorectal lesions should be mandatory. Therefore, by reporting three clinical cases, the Authors propose notes of technique above the abdominal approach used for the surgical treatment of these retrorectal congenital neoformations. In their experience, the anterior route had no postoperative complications, short stay, no neurological consequences and good long-term results.


Subject(s)
Cysts/surgery , Rectal Neoplasms/surgery , Sacrococcygeal Region , Teratoma/surgery , Abdomen , Adolescent , Adult , Cysts/diagnosis , Cysts/diagnostic imaging , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging , Rectal Neoplasms/diagnosis , Rectal Neoplasms/diagnostic imaging , Teratoma/diagnosis , Teratoma/diagnostic imaging , Tomography, X-Ray Computed
11.
G Chir ; 23(4): 163-8, 2002 Apr.
Article in Italian | MEDLINE | ID: mdl-12164007

ABSTRACT

General surgeons are more and more frequently requested to prepare an operative exposure of the spine, in order to perform anterior maneuvers of removal and stabilization of the vertebral bodies. Since 1989 to date, in collaboration with the neurosurgical équipe of Prof. G. Cantore, Neurological Sciences Department, La Sapienza University of Rome, the Authors have collected 116 cases of vertebral diseases: among them, 48 involved the thoraco-lumbar junction of the spine (D12-L2). In this paper, Authors' aim is to state precisely the surgical technique of the anterior access to the thoraco-lumbar junction: attention has been focused on this tract of the column stating its anatomical complexity and the high invasivity of the procedures requested for its exposure. Therefore, such notes of technique have been elaborated to make safer the neurosurgical demolitive and reconstructive procedures and, most of all, to reduce the surgical trauma whenever it is possible.


Subject(s)
Lumbar Vertebrae , Spinal Diseases/surgery , Spinal Fractures/surgery , Thoracic Vertebrae , Adolescent , Adult , Aged , Chordoma/surgery , Female , Follow-Up Studies , Humans , Intervertebral Disc Displacement/surgery , Male , Middle Aged , Neurilemmoma/surgery , Spinal Neoplasms/surgery , Time Factors
13.
15.
Med Biol Eng Comput ; 28(1): 54-9, 1990 Jan.
Article in English | MEDLINE | ID: mdl-2182949

ABSTRACT

In assessing the level of stenosis in extracranial Doppler analysis, spectral analysis has until now been used qualitatively, for the most part. Owing to the many variables affecting the measurements (mainly noise level and instrument setting made subjectively by the operator), the reliability of the inferences on the degree of stenosis is not clearly definable. Under such conditions the need arises for algorithms and systems that can estimate spectral parameters with a higher degree of accuracy, to verify whether reliable inferences can indeed by made or if this technique is only a qualitative one. In the paper a real-time spectral analysis system is described. The system relies on a new spectral estimation algorithm which gives estimates with good robustness with respect to noise. Moreover, a clear measurement procedure which eliminates the many subjective factors affecting the estimates has also been proposed and used. The system has been evaluated with simulated signals and in clinical trials and has shown better performance than the commonly used commercial analysers.


Subject(s)
Arterial Occlusive Diseases/diagnosis , Ultrasonography , Adult , Algorithms , Clinical Trials as Topic , Humans , Models, Biological
18.
Nouv Presse Med ; 5(13): 847-50, 1976 Mar 27.
Article in French | MEDLINE | ID: mdl-1264625

ABSTRACT

A study concerning changes in anti-tetanus antibody (ATA) levels in 50 patients with tetanus following the injection of antitetanic serum of equine origin and of toxoid, the first dose of the latter being given 24 hours after the administration of serum and the others at intervals of 5 to 7, 15 and 30 days. Repeated estimation of ATA demonstrated, regardless of the toxoid dose protocol adopted, that levels did not reach 0.1 IU/ml on the 30th day and that they only rose late. By contrast, after a booster, the increase was the same as that seen in subjects who had not acquired tetanus. The various factors which may underly defective active immunisation during the acute phase of tetanus are discussed. Heterologue serum therapy, which has been held responsible, cannot be considered to be a responsible factor since patients who did not receive serum behaved in exactly the same way as those who had. By virtue of this "gap" in the acquisition of immunity, the use of heterologue serum is recommended to neutralise any remaining circulating toxin as rapidly as possible.


Subject(s)
Antibodies, Bacterial , Tetanus Antitoxin/therapeutic use , Tetanus Toxoid/therapeutic use , Tetanus/therapy , Age Factors , Antibodies, Bacterial/analysis , Humans , Immunization, Secondary , Tetanus/immunology , Time Factors
19.
Bull Soc Pathol Exot Filiales ; 68(2): 133-41, 1975.
Article in French | MEDLINE | ID: mdl-53109

ABSTRACT

The antigenic relationship between some rickettsiae of arthropods, which do not transmit germs pathogenic to vertebrates was investigated by agglutination and immunofluorescence techniques. The comparison of R. melolonthae, R. tipulae, R. cetonidarum, R. grylli and of the rickettsiae of the scorpion Buthus occitanus shows that the Wolbachiae are divided into three serological groups. The insect crystallogen rickettsiae belong to the first group, R. grylli and the scorpion Rickettsia are antigenically distinct (tables I and II). No antigenic relationship was found between these arthropod microorganisms and the following agents of vertebrate rickettsioses and chlamydioses : historical typhus, murine typhus, pustulous fever, Q-fever, epizootic absortion of sheep and psittacosis (tables III and IV). Bacteria of OX2 and OX19 strain of P. vulgaris when mixed with anti-Wolbachiae serums of I, II, III groups, give a negative Weil a Felix reaction. The OXK Proteus are however agglutinated by 4 out of 6 rabbit anti-Rickettsiella serums of the group. This fact calls for a further investigation regarding the comparison of these Rickettsiella with various strains of R. tsutsugamushi.


Subject(s)
Antigens, Bacterial/analysis , Rickettsiaceae/immunology , Antibodies, Bacterial/analysis , Arthropods/microbiology , Epitopes , Rickettsia/immunology
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