[Thoracentesis and pleurodesis in the treatment of pleural effusion. Personal experience]. / Toracentesi e pleurodesi nel trattamento dei versamenti pleurici. Esperienza personale.

AIM: The pleural effusion is a sign of pulmonary, pleural or extrapulmonary, benign or malignant pathology. Our aim is to bring our experience on the treatment of the malignant pleural effusion through thoracentesis and successive pleurodesis. PATIENTS AND METHODS: From January 2000 to January 2007 we performed 217 thoracentesis of which 123 (57%) in subjects with malignant pleural effusion. In 92 of 123 subjects (75%) we performed a drainage with small size thoracic tube to realize directly the pleurodesis with sterile des-asbestos talc. RESULTS: None complication was registered during and after thoracentesis and pleurodesis and no mortality was recorded. We usually used talc slurry technique. Relapse rate after first treatment was of 12.2%. CONCLUSIONS: The pleural effusion is a pathological condition that usually needs repeated operative procedures with serious danger for the patient, however without definitive results. On the basis of our experience and considering the characteristics of sclerosing agents, we conclude that the sure, effective and economic agent for the pleurodesis is the des-asbestos talc.

[Surgical management of medullary thyroid carcinoma. Personal experience]. / Trattamento chirurgico del carcinoma midollare della tiroide. Esperienza personale.

INTRODUCTION: Medullary Thyroid Carcinoma (MTC) is a rare malignancy of the parafollicular C cells of the thyroid gland. Aim of our study is reporting retrospective analysis of our experience about the surgical treatment of MTC, especially pointing on lymphadenectomy. PATIENTS AND METHODS: from January 2000 to March 2006, were performed 546 thyroidectomy, 6 of them for MTC (1.09%): 5 sporadic and 1 familiar. All the patients were operated with standard technique (total thyroidectomy) and submitted to endocrinologic and instrumental follow-up. RESULTS: in our experience, we do not registered early or late complications as bleeding, laryngeal nerves lesions and parathyroid lesions or intra-postoperative deaths. DISCUSSION: MTC occurs sporadically or as part of the multiple endocrine neoplasia type 2 (MEN 2 a/b) syndromes in patients who have inherited a mutation in the RET proto-oncogene. The diagnosis is made by fine needle aspiration biopsy (FNAB) and by measuring calcitonin levels in the blood. Primary treatment consists of surgical resection including a total thyroidectomy, central neck nodal dissection and functional lateral neck nodal dissections. Most patients with a palpable primary tumour have nodal disease at the time of operation, and nodal involvement is often bilateral. CONCLUSIONS: adequate resection of the primary tumour and cervical lymph nodes is important to optimize outcome and minimize the risk of recurrent disease. Following primary surgical resection, more than 50% of the patients will have recurrent disease with persistent elevation of calcitonin levels. Currently, there is no adequate systemic therapy for recurrent disease. Surgical reoperation or conservative observation are the best available options.

Unusual acute onset of pedunculated extragastric leiomyosarcoma. Case report.

INTRODUCTION: A case report of 25 yrs-old man with pedunculated exogastric leiomyosarcoma (with acute onset) surgically treated is presented. CASE REPORT: The patient was operated after clinical, instrumental and blood sample tests. We performed a 5 cm wedge resection of the stomach in continuity with the omentum. Careful inspection revealed neither adenopathy nor metastases. RESULTS: Actual complete remission of pathology. Negative 1 year follow up by endoscopy and CT. DISCUSSION: Information on gastric leiomyosarcoma (LM), such as prognostic factors, patterns of disease recurrence, and optimal methods of treatment, are derived from limited clinical experience. Although about 25% of the gastric mesenchymal tumors present an exogastric growth, pedunculated exogastric leiomyosarcomas are extremely rare. Lymphatic spread of gastric LM is uncommon, therefore a formal lymph node dissection is not standard surgical management. At present, there is no evidence of intraperitoneal seeding from exogastric leiomyosarcomas. Consequently, a local resection with an adequate margin is sufficient when no invasion to the adjacent structures is observed. Neither the addition of lymphadenectomy nor the wider tumor-free margins of a radical gastrectomy seemed superior to the more conservative local excision. CONCLUSIONS: Further studies are called for to elucidate if exogastric tumours lead to peritoneal seeding and, thereby, affect tumour survival.