Metastases to the thyroid gland: review of incidence, clinical presentation, diagnostic problems and surgery, our experience.

PURPOSE: Metastases to the thyroid gland are uncommon and they represent 1-3% of all thyroid malignancy. The aim of this study is to analyze the diagnostic problems and the role of surgery in metastatic lesions to the thyroid. METHODS: We retrospectively analyzed all patients who had undergone thyroidectomy at our Center. Out of more than 5000 thyroidectomies performed, only 9 cases had metastases to the thyroid gland. RESULTS: The most common primary tumor arises from kidney and lung. Non-thyroid malignancies diagnosis was obtained with US, FNAC and PET-CT. Surgery was performed in all our series (except for one case) and the expectancy of life after surgery is related to the primary tumor and comorbidities of patients. CONCLUSION: The thyroid gland can be a rare site of metastases for many tumors, especially in an abnormal thyroid gland. Surgery is associated with an improved survival and the extension of surgery depends on the extension of the neoplastic lesion.

Laparoscopic total mesorectal excision for rectal cancer: experience of a single center with a series of 174 patients.

BACKGROUND: Laparoscopic total mesorectal excision for low rectal cancer is not considered a gold standard treatment due to the high conversion rate and the long operation time. METHODS: A retrospective review examined a surgical series of 174 laparoscopic low rectal resections involving total mesorectal excision (1995-2006), with particular reference to technical points as well as surgical and oncologic outcomes. Miles operations and partial mesorectal excisions were excluded. RESULTS: The cancer affected the low rectum in 110 cases and the medium rectum in 64 cases. A total of 68 patients were subjected to neoadjuvant radiochemotherapy. The anastomosis was mechanical for 83.3% of the cases and intersphinteric through the perineum for 16.6% of the cases. Protective ileostomy was performed in 112 cases. The conversion rate was 4.6%. The mesorectum remained intact in 91.6% of the cases and was partially interrupted in 15 of the cases. In no case was it totally discontinued. The postoperative morbidity rate was 16.7%, and the mortality rate was 0.57%. The incidence of anastomotic fistulas was 14.4%. The percentage was higher for males (18.6 vs 8.3%) and correlated with the low distance of the tumor from the anal verge (18.2 vs 7.8%) and the absence of a protection ileostomy (20.9 vs 10.7%). After an average follow-up period of 48.6 months (range, 24-149 months), six patients (3.44%) experienced a pelvic recurrence. The 5-year overall survival rate was 75.4%, and the disease-free survival rate was 61.9%. CONCLUSION: Laparoscopic total mesorectal excision for low rectal cancer is safe and effective, allowing surgical and oncologic outcomes similar to those reported for open surgery.

[The standardization of a technic for laparoscopic left hemicolectomy with radical lymphadenectomy]. / Standardizzazione della tecnica dell'emicolectomia sinistra laparoscopica con linfoadenectomia radicale.

A standardized technique of left laparoscopic hemicolectomy is explained based upon the experience of the authors through the study of 166 cases and other cases described in literature. In the above study all of the single steps and the material needed for this technique, which is one of the most complex in laparoscopic surgery, are explained.

Laparoscopic cholecystectomy. Analysis of results of first 322 cases.

From April 1994 to June 1995 322 laparoscopic cholecystectomies were performed in S. Camillo hospital Treviso, 294 in election and 28 in urgency. The technique and results of this experience are reported. No mortality was observed and morbility was 1.8%. Utility of gallstones in main biliary duct screening is discussed to select patients to subject to preoperative ERCP and the role of intraoperative cholangiography. Laparoscopic cholecystectomy is considered the choice option in cholelitiasis. In case of evidence of choledocholithiasis with anamnesis or preoperative tests, the tactics of choice in authors opinion is the sequential one, providing preoperative ERCP and laparoscopic cholecystectomy.

[Isolated rupture of the right hemidiaphragm with complete herniation of the liver into the thorax. Considerations of diagnosis and therapy]. / Rottura isolata dell'emidiaframma destro con erniazione completa del fegato in torace. Considerazioni sulla diagnosi e sul trattamento.

The Authors report a case of right diaphragmatic hernia due to road-traffic accident. They discuss the problems of early diagnosis because it is delayed for multiple associated lesions or a low index of suspicion. The ratio of laceration of the left side to that of the right is twenty to one. The clinical and diagnostic data best able to lead to a rapid preoperative diagnosis are considered. The Authors recommended early operative treatment and the thoracic approach; thoracoabdominal incisions are more suitable whenever abdominal lesions are coexisting. The Authors stress the use of safety belts with three point fastener which have significantly decreases cranial and abdominal lesions, particularly if associated with two rolls up.