[Drainage in thyroid surgery]. / Il drenaggio nella chirurgia della tiroide.

Bleeding represents a rare complication of thyroid surgery but when it occurs it may be life-threatening. To prevent this complication drainage is widely used. However no study has demonstrated the drains' value and recent reports have questioned its benefits. Therefore we have analyzed our experience of a 10 year-period in which 1.217 thyroidectomies were performed by the same surgical team and prophylactic routine drainage was always adopted. In 13 patients (1.06%) a benign hematoma occurred with spontaneous remission. In 6 patients the bleeding was severe and compressive hematoma occurred; it required surgical re-exploration. Such a complication is unusual in the neck surgery (0.49% in the authors' series) performed by experienced surgeons and when life-threatening hematomas do occur they depend on various uncontrolled factors and drainage is often not helpful. Otherwise a meticulous haemostatic technique is necessary and patients should be observed very closely during the few first hours following surgery on the thyroid gland. Therefore on the basis of the analysis of their series, although it is not always possible to prove the benefit of the drainage, the authors suggest its indication in the neck surgery, as in other fields with dead space, to remove blood and secretions reducing postoperative complications. They have never observed wound infections and patients were discharged within 72 hours.

Effects of early postnatal exposure to low concentrations of carbon monoxide on cognitive functions in rats.

Male Wistar rats were exposed to 75 and 150 ppm of carbon monoxide (CO) from day 1 after birth until postnatal day 10 and their cognitive functions were evaluated at 3 and 18 months of age. The results show that early postnatal exposure to CO does not affect the acquisition and reacquisition of an active avoidance task in both adult and aged rats. Conversely, our previous findings indicate that prenatal exposure to CO (75 and 150 ppm), resulting in maternal blood carboxyhaemoglobin concentrations equivalent to those found in human cigarette smokers, induces long-lasting learning and memory deficits. These findings suggest that neurofunctional sequelae of prenatal CO exposure are notably different from those occurring in response to early postnatal exposure and that the vulnerability of the developing brain to prolonged, relatively mild, decrease in oxygen availability induced by CO critically depends on the particular period of developmental exposure.

[Hyperthyroidism and carcinoma of the thyroid gland]. / Ipertiroidismo e carcinoma della tiroide.

The incidence of thyroid carcinoma in hyperthyroidism varies considerably from as low as 0.3% to as high as 16.6% with a higher rate in toxic nodular goiters. Occult thyroid carcinoma (< 1.5 cm or microscopic foci) is the rule and only a few tumors are suspected preoperatively with ultrasonography or fine needle aspiration or 131 I scan. In 408 patients who underwent surgery for hyperthyroidism in our Surgery Department from January 1967 through December 1994 the incidence of thyroid carcinoma was 5.6% (23 cases). In detail, a neoplasm occurred in 5 cases of Graves' disease (specific incidence: 3.8%), in 13 cases of toxic nodular goiter (12.5%) and in 5 cases of hyperfunctioning adenomas (2.8%). 19 cancers were papillary (12 in toxic nodular goiter, 3 in Graves' disease, 4 in hyperfunctioning adenomas), three were follicular (1 in Graves' disease, 1 in toxic nodular goiter, 1 in hyperfunctioning adenomas) and 1 medullary in Graves' disease. A papillary carcinoma was diagnosed preoperatively on fine needle aspiration with ultrasonography in only two patients with Graves' disease and confirmed by postoperative histological examination on permanent section. We do not believe in the frozen-section examination intraoperatively because it's not diagnostical for follicular lesions and evaluates rarely capsular invasion. Twenty patients received total thyroidectomy and four of them also lymphoadenectomy. Three patients received emithyroidectomy: in two cases for occult papillary carcinoma and in the last case for local cancer invasion (T4N0M0). Twenty patients are alive and with no evidence of cancer recurrence. Mean follow-up is 59.6 months. Our retrospective study shows a progressive increase of the incidence of coexisting thyroid malignancy and hyperthyroidism especially in toxic nodular goiter, probably related to extended surgical indications. Our findings do confirm that, even in the presence of hyperthyroidism, all thyroid nodules require careful diagnostics for exclusion of malignancy.

Role of reoperation in recurrence of adrenal cortical carcinoma: results from 188 cases collected in the Italian National Registry for Adrenal Cortical Carcinoma.

BACKGROUND: Recurrence of adrenal cortical carcinoma (ACC) after radical surgery is a common finding. Although successful reoperations have been reported with encouraging results, most published experiences are anecdotal and based on few cases. We report the results of surgical treatment for recurrent ACC in a multiinstitutional series. METHODS: One hundred eighty-eight cases of ACC were collected in a national registry. A complete follow-up was obtained in 179 cases. At initial diagnosis 92 patients had local disease (stage I or II). One hundred seventy patients underwent surgical treatment, considered radical in 140; in this group, recurrent disease was observed in 52 cases (37%) after a mean disease-free interval of 21.7 months. RESULTS: Adjuvant chemotherapy was ineffective in ameliorating the prognosis. The mean survival in 20 patients who underwent reoperation was significantly higher (15.85 +/- 14.9 months) than in nonreoperated cases (3.2 +/- 2.9 months). Five-year actuarial survival in reoperated patients is significantly better than in nonreoperated patients (49.7% versus 8.3%, respectively). CONCLUSIONS: Although the prognosis of this tumor is still poor, surgery is the only effective therapy; reoperation allows survival comparable to that observed in patients without recurrent disease. An aggressive strategy for recurrent ACC is advisable until prospective studies demonstrate a real effectiveness for chemotherapy.

Irreversible impairment of active avoidance behavior in rats prenatally exposed to mild concentrations of carbon monoxide.

Wistar female rats were exposed to relatively mild concentrations of carbon monoxide (75 and 150 ppm) from day 0 to day 20 of pregnancy. The results show that prenatal exposure to CO (150 ppm) significantly impairs the acquisition of a two-way active avoidance task in 3-month-old male rats as well as the acquisition and reacquisition of this schedule in 18-month-old animals subjected to six daily 20-trial sessions. These deficits do not seem to be attributable to alterations of a non-associative nature, as the intertrial activity and the escape response latencies in CO exposed animals were not significantly affected with respect to controls. These findings, showing that gestational exposure to CO induces in rat offspring permanent learning and memory impairment, confirm that the offspring of smoking mothers may be at considerably greater risk than current epidemiological studies on birthweight and neonatal mortality suggest.

Alterations in the ontogeny of rat pup ultrasonic vocalization produced by prenatal exposure to nitrogen dioxide.

Wistar female rats were exposed to low concentrations of nitrogen dioxide, NO2 (1.5 and 3 ppm) from day 0 to day 20 of pregnancy. The results show that prenatal exposure to this oxidant gas produced significant changes in the duration pattern of ultrasonic vocalizations emitted by male pups removed from their nest. In particular, a significant decrease in the length of ultrasonic calls was found in both 10- and 15-day-old rats exposed to NO2 (3 ppm) during gestation. These alterations were found at dose levels which did not significantly affect reproduction parameters, body weight gain and motor activity development. These findings suggest that gestational exposure to NO2, at concentrations below those associated with overt signs of toxicity, induces in rat offspring subtle behavioral changes characterized by altered ontogeny of ultrasonic emission.

Neurobehavioral changes produced in rats by prenatal exposure to carbon monoxide.

Wistar female rats were exposed to relatively mild concentrations of carbon monoxide (75 and 150 ppm) from day 0 to day 20 of pregnancy. The results show that prenatal exposure to CO (150 ppm) produced a significant reduction in the minimum frequency of ultrasonic calls emitted by rat pups removed from their nest. Moreover, a significant decrease in the responsiveness (rate of calling) to a challenge dose of diazepam (0.25 mg/kg) was found in male pups exposed to CO (150 ppm) during gestation. Prenatal CO (75 and 150 ppm) did not significantly affect locomotor activity or D-amphetamine-induced hyperactivity in both 14- and 21-day-old animals. Furthermore, adult male rats exposed to this chemical (150 ppm) during gestation exhibited significant alterations in the acquisition of an active avoidance task. CO-induced learning disruption does not seem to be linked to changes in the emotionality of animals. These findings suggest that gestational exposure to CO induces in rat offspring both short- and long-term behavioral changes characterized by altered ontogeny of emotional responsiveness to environmental challenges and by learning impairment.

[The prognostic significance of the vascular invasion of colorectal tumors]. / Significato prognostico della invasione vascolare nei tumori colo-rettali.

The authors report their experience about the clinical significance of the invasion of veins (BVI) in 68 patients with colorectal carcinoma, submitted to potentially curative surgery in the period 1980-1988. Every patient was screened for BVI. The tumoral spreading was differentiated into endovascular and perivascular permeation. The authors also considered the incidence and kind of BVI, the recurrence rate of the tumour and five-year survival rate. BVI was present in 33 patients (48.5%). Recurrence was observed in 22 patients (22.3%): 19 patients in the group with BVI (33 patients): 3 in the group of 35 patients without BVI. BVI was related to tumour stage, but it may be considered as an independent factor in its relationship with a poorer prognosis in patients affected by tumours in stages II or III; in fact, the patients in stage II had a poorer prognosis than those in stage III without BVI. These results suggest that BVI, as a prognostic factor, is independent from tumoral stage in determining the recurrence rate and the long term prognosis.

[Colonic neoplasms: long-term survival after surgical treatment. Our experience]. / Neoplasie del colon: sopravvivenza a distanza dopo trattamento chirurgico. Nostra esperienza.

The surgery is still the only treatment for large bowel tumours. The patients who underwent a radical operation and then were treated with chemo and/or radiotherapy have not shown a longer free-disease survival. Palliative resection should be preferred to by pass operation, since the latter has shown less postoperative morbility and mortality. The authors report their experience on 139 patients with large bowel tumours operated between 1979 and 1988, and they analyze the surgical results and the five-years survival according to the stage of disease.

[Therapeutic and prognostic possibilities in primary lymphoma of the thyroid]. / Prospettive terapeutiche e prognostiche nel linfoma primitivo della tiroide.

Personal experience with small cell thyroid tumours is reviewed in the light of recent developments in diagnosis and treatment. All cases were examined by means of immunohistochemical investigation of the lymphocytic and epithelial antigens. In 7 cases in which the production of lymphocytic antigens was confirmed, a primary lymphoma of the thyroid was diagnosed. Immunohistochemical studies of the lymphocytic and epithelial antigens are essential in all small cell thyroid tumours, in order to differentiate between small cell anaplastic carcinomas and thyroid lymphomas. This differentiation is indispensable for the correct choice of treatment and an accurate prognostic assessment. In the case of lymphomas, combined surgical and radiation treatment adjusted to the clinical stage of the tumour is recommended.

[Evaluation of prognostic factors in surgery of gastric cancer]. / Valutazione dei fattori prognostici nella chirurgia del cancro gastrico.

The prognostic role of some clinical and pathologic variables in patients with carcinoma of the stomach was evaluated. While for some of these (invasion of the gastric wall, nodal status) the prognostic value is widely accepted, for the others (age, sex, size and site of tumors, histologic type, surgical procedure) the prognostic significance has not been fully defined. Using univariate analysis, the best predictors of survival after curative resection were nodal status, histologic type and serosal involvement. As related to the last three, using a multivariate analysis, the serosal involvement was the most important prognostic variable.

[Advanced age and clinical staging in the prognostic evaluation of differentiated carcinoma of the thyroid gland]. / Età avanzata e stadio clinico nella valutazione prognostica del carcinoma differenziato della tiroide.

The prognostic significance of age in differentiated thyroid tumours is assessed via the analysis of 156 cases of differentiated thyroid carcinoma surgically treated in 1967-85. A statistical analysis was performed on a sample of 120 patients under observation since their operation. The results indicate that the negative influence of old age is due more to the higher incidence of advanced tumours among the elderly than to more aggressive behaviour by the tumour.

Regional chemotherapy by a totally infusion pump preceding radiotherapy in advanced cervical carcinoma: a preliminary report.

The authors report the preliminary results of a prospective study on intra-arterial chemotherapy and radiotherapy of advanced cervix carcinoma. The drugs were delivered by a totally implanted Infusaid Model 400 pump and patients received cyclic therapy consisting of Cis-Platinum, Methotrexate and Bleomycin. The catheter tips were positioned during a laparotomy in the hypogastric arteries with sutures and the pump was implanted in a subcutaneous pouch in the abdomen. After chemotherapy all patients had radiotherapy. Five patients entered in the study. Preliminary results suggest that long-term intra-arterial infusion chemotherapy for the treatment of advanced cervix carcinoma is practical for many patients. Two of five patients, after intra-arterial chemotherapy and radiotherapy, had radical hysterectomy.