Hemithyroidectomy versus total thyroidectomy in the intermediate-risk differentiated thyroid cancer: the Italian Societies of Endocrine Surgeons and Surgical Oncology Multicentric Study.

The surgical treatment of the intermediate-risk DTC (1-4 cm) remains still controversial. We analyzed the current practice in Italy regarding the surgical management of intermediate-risk unilateral DTC to evaluate risk factors for recurrence and to identify a group of patients to whom propose a total thyroidectomy (TT) vs. hemithyroidectomy (HT). Among 1896 patients operated for thyroid cancer between January 2017 and December 2019, we evaluated 564 (29.7%) patients with unilateral intermediate-risk DTC (1-4 cm) without contralateral nodular lesions on the preoperative exams, chronic autoimmune thyroiditis, familiarity or radiance exposure. Data were collected retrospectively from the clinical register from 16 referral centers. The patients were followed for at least 14 months (median time 29.21 months). In our cohort 499 patients (88.4%) underwent total thyroidectomy whereas 65 patients (11.6%) underwent hemithyroidectomy. 151 (26.8%) patients had a multifocal DTC of whom 57 (10.1%) were bilateral. 21/66 (32.3%) patients were reoperated within 2 months from the first intervention (completion thyroidectomy). Three patients (3/564) developed regional lymph node recurrence 2 years after surgery and required a lymph nodal neck dissection. The single factor related to the risk of reoperation was the histological diameter (HR = 1.05 (1.00-1-09), p = 0.026). Risk stratification is the key to differentiating treatment options and achieving better outcomes. According to the present study, tumor diameter is a strong predictive risk factor to proper choose initial surgical management for intermediate-risk DTC.

Study of the role of telomerase in colorectal cancer: preliminary report and literature review.

AIM: The aim of our study is to focus on hTERT (human Telomerase Reverse Transcriptase) expression to identify tumoral tissue after a comparison to TP53 and KRAS. More than 85% of cancer cells contain genetic aberrations and also overexpression of hTERT, and, in fact, the promoter of hTERT characterizes all malignant cells. PATIENTS AND METHODS: Our sample is composed of 18 patients, including 10 with CRC that underwent surgical procedure and 8 patients without CRC, which represent the control group. The hTERT gene expression, KRAS and p53 were evaluated by methodical Real Time - PCR on RNA extracted from tumor tissues, peritumoral tissue and control cases. RESULTS: Within the CRC group the evaluation of the tumor tissue showed an increase of hTERT expression with a statistical significance (> 0.1) in 5 of these, also associated with substantial increase of KRAS (> 0.2). The peritumoral tissue assessment showed important increase in KRAS in 4 patients (> 0.2), while hTERT is not found to be particularly increased. The value of p53 did not show any particular significance (<0.1). DISCUSSION: The analysis of our data leads us to consider that the increase of hTERT is evident in patients suffering from CRC and that some of them will become significant in relation to the increase of KRAS and independent of p53. In peritumoral tissues, however, KRAS increases considerably, instead hTERT maintains a low concentration and this is compatible with the cellular evolution of the neoplastic tissue adjacent to the tumor. CONCLUSIONS: hTERT could be used for diagnosis and prognosis in the future, to be able to identify the risk of tumor progression and to set up an adequate therapy.

[Management of a symptomatic acute severe hyponatremia recovered by its neurological sequelae. A case report]. / Management in un caso di iponatriemia acuta severa recuperata dalle sue sequele neurologiche.

Hyponatremia is a common condition in hospitalized patients, with an incidence rate of about 30%. Acute severe hyponatremia is frequently acquired in hospital, due to surgery or an injudicious use of fluid infusions, or the use of nephrotoxic drugs or those stimulating excessive natruresis. A 59 year old male was hospitalized under emergency conditions in General Surgery for abdominal pain. The patient's anamnesis included: hypertension, diabetes, suspected Crohn's disease all in pharmacological treatment. During the recovery rehydration and antibiotic therapy (imipenem+cilastatin and metronidazole) was made and beclomethasone was suspended. On the seventh day from the recovery, the patient had a symptomatic acute severe hyponatremia with neurological severe symptoms (loss of consciousness, seizures). After the immediate diagnosis of the severe sodium loss, the patient underwent to an aggressive intravenous therapy for the electrolytic disorder during the first 24 hours, followed by a target-guided therapy until the level of serum sodium was in the normal values range. The patient, despite the neurological symptoms due to hyponatremia and the rapid and aggressive electrolytic therapy, had no neurological damage with a complete "restitutio ad integrum" of his neurological activity.

Rectosigmoid endometriosis: comparison between CT water enema and video laparoscopy.

AIM: To evaluate the accuracy of water enema computed tomography (CT) for predicting the location of endometriosis in patients with contraindications to magnetic resonance imaging (MRI), focusing on rectosigmoid lesions and having laparoscopic and histological data as the reference standard. MATERIALS AND METHODS: Thirty-three women (mean age 33.4 ± 3.1 years) suspected of having deep pelvic endometriosis underwent 64-row CT and video laparoscopy within 4 weeks. Two radiologists blinded to the clinical data evaluated the CT images obtained after colonic retrograde distension using water as the contrast medium, and a comparison with laparoscopic and histological findings was performed. CT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. The radiation dose to patients was estimated. Cohen's weighted kappa (κ) test was used to evaluate the interobserver agreement. RESULTS: In 23 out of 33 patients (69%) intestinal implants were found at surgery and pathological examinations. CT confirmed the diagnosis of rectosigmoid endometriosis in 20 out of 23 implants. Three nodules located on the proximal sigmoid colon (two serosal lesions and one infiltrating the muscularis layer) with a diameter of less than 1 cm were not diagnosed. CT sensitivity, specificity, PPV, NPV, and accuracy values were 87, 100, 100, 77, and 91%, respectively. The mean effective dose estimate was 6.30 ± 1.7 mSv. Almost perfect agreement between the two readers was found (k = 0.84). CONCLUSION: Water enema CT can play a role in the diagnosis of bowel endometriosis and represents another accurate potential tool for video laparoscopic approaches, especially in patients for whom MRI is contraindicated.

Colonic lipomas. Three surgical techniques for three different clinical cases.

Colonic lipomas larger than 2 cm in diameter are likely to be symptomatic. In some cases a complication is the first clinical sign. Massive lower intestinal bleeding or obstruction, acute bleeding, prolapse or perforation or, rarely, acute intussusception with intestinal obstruction require urgent surgery. Diagnosis is often made following colonoscopy, which can also have a therapeutic role. Imaging procedures such as CT has a secondary role. Patients with small asymptomatic colonic lipomas need regular follow up. For larger (diameter > 2 cm) and/or symptomatic lipomas, resection should be considered, although the choice between endoscopic or surgical resection remains controversial. We believe that even lipomas > 2 cm can safely be removed by endoscopic resection. If surgery is indicated, we consider laparoscopy to be the ideal approach in all patients for whom minimally invasive surgery is not contraindicated.

Air sampling methods to evaluate microbial contamination in operating theatres: results of a comparative study in an orthopaedics department.

AIM: To evaluate the level of microbial contamination of air in operating theatres using active [i.e. surface air system (SAS)] and passive [i.e. index of microbial air contamination (IMA) and nitrocellulose membranes positioned near the wound] sampling systems. METHODS: Sampling was performed between January 2010 and January 2011 in the operating theatre of the orthopaedics department in a university hospital in Southern Italy. FINDINGS: During surgery, the mean bacterial loads recorded were 2232.9 colony-forming units (cfu)/m(2)/h with the IMA method, 123.2 cfu/m(3) with the SAS method and 2768.2 cfu/m(2)/h with the nitrocellulose membranes. Correlation was found between the results of the three methods. Staphylococcus aureus was detected in 12 of 60 operations (20%) with the membranes, five (8.3%) operations with the SAS method, and three operations (5%) with the IMA method. CONCLUSION: Use of nitrocellulose membranes placed near a wound is a valid method for measuring the microbial contamination of air. This method was more sensitive than the IMA method and was not subject to any calibration bias, unlike active air monitoring systems.

Acute gastric anisakiasis: an Italian experience.

Anisakidosis is a parasitic disease of the human gastrointestinal tract caused by ingestion of larvae of marine nematodes such as Anisakis spp. or, rarely, Pseudoterranova spp., present in raw or undercooked fish. We report the first series of gastric Anisakis infection (anisakiasis) from a single centre in Italy. In our department, we observed 3 cases, all in women who were urgently hospitalized following intense epigastric pain and vomiting, developed after the ingestion of raw fish. The patients underwent urgent gastroscopy within a few hours. In each, a worm was extracted from the gastric mucosa by means of biopsy forceps. This was followed by prompt clinical improvement. The worm was identified by its macroscopic and microscopic characteristics as an Anisakis spp. larva (L3). In 2 cases, laboratory tests revealed marked leukocytosis and eosinophilia in the peripheral blood 3-4 days after ingestion of the raw fish. The diagnosis of anisakiasis can be made by endoscopy, radiology and abdominal ultrasound, but is often made only at surgery. In the gastric form of the disease, urgent gastroscopy has both a diagnostic and a therapeutic role, because the worm can be removed by means of biopsy forceps.

[Monitoring of postmenopausal women treated with tamoxifen for breast carcinoma]. / Il monitoraggio di donne in post-menopausa in trattamento con tamoxifene per carcinoma mammario.

The aim of this study was to evaluate the usefulness of different diagnostic tools in the screening for endometrial neoplasms in women receiving tamoxifen as adjuvant treatment after surgery for breast cancer. The Authors' experience, while confirming the importance of a very strict and careful follow-up, stresses the higher sensitivity and specificity of diagnostic hysteroscopy.

[Schwannomas of the digestive tract. Observations on a case localizing in the ileum]. / Schwannomi deli tubo digerente. Osservazioni su di un caso a localizzazione ileale.

The schwannomas are rare tumors taking origin from Schwann's cells; even rarer is their location at a peripheral level. Even if they show the macroscopic and microscopic characteristics of a benign tumor, it is possible that they engage malignant course, with possibility of recurrency and of distant metastasis. In the alimentary tract the schwannomas reveal with repeated episodes of digestive hemorrhage which could engage, according to the location, the characters of enterorrhagia or melena. Arteriography has the higher diagnostic sensibility, in course of bleeding. The CT could demonstrate a submucosal neoplasia. The diagnosis of schwannomas is based on the immunohistochemical search of the protein S100, that allows to differentiate them from the tumors of muscular origin, having such tumors common histological and cytological aspects. The schwannomas are today set in the widest chapter of the so-called "stromal tumors of the gastrointestinal tract" (GISTs) with an indefinite malignancy which need surgical excision and an attentive follow-up. The authors report a case of schwannoma located at the first jejunal loop, having had repeated episodes of digestive hemorrhage. The diagnosis was based on the selective arteriography of the upper mesenteric artery and the immunohistochemical search of the protein S100. The surgical treatment consisted of the resection of the jejunal loop, after having sought for eventual multiple locations of the neoplasia.

[Intestinal occlusion caused by cecal carcinoid]. / Occlusione intestinale da carcinoide del cieco.

It is possible that carcinoids present themselves by a surgical emergency, without a <>. For these reasons, whenever a rational treatment is requested, an intraoperative diagnosis should be performed. In fact these neoplasms--owing to a less intense aggressiveness--present more indications to undergo surgery. In fact the authors report a case of caecum carcinoid characterized by the lack of typical symptoms of the homonymous syndrome. Urgent surgery was performed because of intestinal occlusion; the ileocaecal valve involvement caused the necessity of a large ileocolic resection with a L-L ileo-transverse anastomosis. The diagnosis of carcinoid was revealed only by the definitive histopathological examination.