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1.
G Chir ; 36(1): 26-8, 2015.
Article in English | MEDLINE | ID: mdl-25827666

ABSTRACT

INTRODUCTION: Tracheal varices are a rare condition but they can be an important source of massive or recurrent haemoptysis. Usually they are related to increased pressure in the pulmonary veins. Mediastinal goiter is often associated to compressive effects on the surrounding structures, including mediastinal vessels with potential superior vena cava syndrome. CASE REPORT: We describe a case, not previously reported in literature, of mediastinal goiter with hemoptysis as first clinical manifestation. Bleeding was attributed to a superior vena cava syndrome associated to a tracheal fragile mucosa with an easily bleeding intramural nodule which was diagnosed as tracheal varices after total thyroidectomy. The nodule in fact disappeared together with the venous hypertensive signs after venous decompression of the mediastinum. CONCLUSIONS: Compressive symptoms including tracheal varices, related to mediastinal goiter, can be treated surgically by total thyroidectomy via cervicotomy and when required with associated median sternotomy.


Subject(s)
Goiter, Substernal/surgery , Thyroidectomy , Trachea/blood supply , Varicose Veins/etiology , Goiter, Substernal/complications , Hemoptysis/etiology , Humans , Male , Middle Aged , Sternum/surgery , Thyroidectomy/methods , Treatment Outcome , Varicose Veins/complications
2.
G Chir ; 34(11-12): 307-10, 2013.
Article in English | MEDLINE | ID: mdl-24342156

ABSTRACT

The last decade has witnessed the affirmation of the paradigm Health Technology Assessment (HTA) as a tool for government innovation technology in health care. As is known, this is an approach of evaluation oriented policy making that, in addition to provide for the disclosure of its results, it is proposed to consider simultaneously the clinical, economic, organizational, ethical and social issues arising from the introduction or disposal of a health technology, understood in the broadest sense of the term. In order to reconstruct a realistic picture of its level of implementation we have reproduced a micro HTA which served to assess the Harmonic Focus® device usefulness in breast surgery.


Subject(s)
Biomedical Technology/standards , Breast Neoplasms/surgery , Mastectomy/economics , Technology Assessment, Biomedical , Biomedical Technology/methods , Clinical Governance , Female , Hospital Units , Hospitals , Humans , Italy
3.
G Chir ; 34(7-8): 198-201, 2013.
Article in English | MEDLINE | ID: mdl-24091174

ABSTRACT

The growth of technological innovation, the request for assistance, the rising patient's expectations and the interest of the industry have led to a rise in the cost of health care systems. In this context the role of the National Health System is not to delay the development or adoption of new technologies, but rather to drive the development selecting priorities and promoting its use. Health Technology Assessment (HTA) is a multidisciplinary and multidimensional approach for analyzing the medical-clinical, social, organizational, economic, ethical and legal implications of a technology (devices, drugs, procedures) through the assessment of multiple parameters such as effectiveness, safety, costs of the social and organizational impact. A health technology assessment is a comprehensive, systematic evaluation of the prerequisites for estimating the consequences of using health technology. Main characteristic of HTA is that the problem is tackled using an approach focused on four main elements: - technology; - patient; - organization; - economy. The authors have applied the HTA method for the analysis of the ultrasonic focus dissector on thyroid surgery. They compared the cost of the surgical procedure using the ultrasonic dissector and without it in a case study of 440 patients who underwent thyroidectomy.


Subject(s)
Technology Assessment, Biomedical , Thyroidectomy/standards , Costs and Cost Analysis , Humans , Surveys and Questionnaires , Technology Assessment, Biomedical/economics , Thyroidectomy/economics
4.
G Chir ; 34(5-6): 153-7, 2013.
Article in English | MEDLINE | ID: mdl-23837952

ABSTRACT

Thyroid gland tumors represent 1% of malignant tumors. In Italy their incidence is in constant growth. The aggressiveness depends on the histological type. The relative non-aggressive grade of different forms of tumors is the basis for discussing the treatment of choice: total thyroidectomy vs lobectomy with or without lymphadenectomy of the sixth level in the absence of metastasis. Authors report about their experience, and they advocate, given the high percentage of multicentric forms, total thyroidectomy as treatment of choice.


Subject(s)
Thyroid Neoplasms/surgery , Thyroidectomy , Adult , Female , Humans , Male , Middle Aged , Thyroid Neoplasms/pathology
6.
G Chir ; 31(10): 447-50, 2010 Oct.
Article in Italian | MEDLINE | ID: mdl-20939953

ABSTRACT

Thoracic duct injury is uncommon in surgery of the neck: relatively more common after laryngeal and esophageal surgery, rare in thyroid surgery. From January 1986 to June 2009 were treated 14 patients with lesions of the cervical thoracic duct undergo surgery for thyroid disease: 4 goitre cervico-mediastinal and 10 total thyroidectomy for cancer, 9 of which have laterocervical left lymphadenectomy. In 2 cases, the intraoperative detection has allowed immediate ligature. In 12 patients a cervical chylous fistula without chilothorax was found: 5 low-flow fistulas and 7 high-flow fistulas. Of the 5 cases of low-flow fistula, 4 were recovered after 1 month of conservative treatment, only 1 patient required surgical correction. The 7 patients with high-flow fistula were undergoing surgery: 4 in the first week post-operative and 3 after a period of more than 30 days of medical therapy. In patients with high-flow fistula prolonged medical treatment does not provide benefit and increase the risk of complications during and after surgery.


Subject(s)
Thoracic Duct/injuries , Thyroidectomy/adverse effects , Adult , Aged , Female , Humans , Male , Middle Aged , Neck
7.
Ann Ital Chir ; 73(2): 211-7; discussion 217-8, 2002.
Article in Italian | MEDLINE | ID: mdl-12197295

ABSTRACT

Satisfactory palliation of the lesions involving the carinal region is difficult to achieve because the stenting is conducted in an unsuitable anatomy, in highly symptomatic patients. During the period 1987-2000 we performed 785 operative rigid bronchoscopies in 524 patients, 184 of whom received a respiratory stent. The stenting of the carinal region was carried out in 27 patients with the use of the Frietag Dynamic stent. In this group of patients indication for stenting was as follows:--advanced lung cancer (22);--esophageal cancer invading the lower trachea (1);--severe tracheobronchomalacia (2);--postintubation stenosis of the lower trachea (2). No perioperative mortality was observed. All patients experienced symptomatic improvement. Follow-up ranged from 1 to 60 months: all neoplastic patients died for advanced disease without significant respiratory problems with a median survival of 5.6 months; three patients treated for benign diseases are still alive at 2, 31 and 65 months from stent deployment. No major complications were observed: in two patients the stent was removed after few days due to mucous retention; furthermore we observed symptomatic respiratory infections caused by a residual space between the tracheal wall and the prosthesis in other two patients with severe COPD. Dynamic stent is to be considered the stent of choice for palliation of the carinal region because it is effective and well tolerated with a low complications rate. The main limitations of such prosthesis are the shortness of the right bronchial branch and the size, sometimes inadequate.


Subject(s)
Stents , Tracheal Stenosis/therapy , Adult , Aged , Aged, 80 and over , Bronchoscopy , Female , Follow-Up Studies , Humans , Lung Neoplasms/complications , Male , Middle Aged , Palliative Care , Stents/adverse effects , Time Factors , Tracheal Diseases/complications , Tracheal Neoplasms/complications , Tracheal Stenosis/etiology
8.
Minerva Endocrinol ; 26(4): 247-53, 2001 Dec.
Article in Italian | MEDLINE | ID: mdl-11782710

ABSTRACT

Small cell lung cancer (SCLC) is a biologically aggressive tumor with a low long-term survival rate. SCLC is highly responsive to chemotherapy and surgery has a very limited role in its treatment because the disease is usually widely disseminated at the diagnosis. Good results from surgery have been reported in the small subgroup of T1-2 N0 M0 patients. In N1 peripheral SCLC, surgery in combination with other treatments, can obtain fair results. Surgical treatment does not influence the prognosis in SCLC as stage III and IV.


Subject(s)
Carcinoma, Small Cell/surgery , Lung Neoplasms/surgery , Aged , Antineoplastic Agents/therapeutic use , Carcinoma, Small Cell/drug therapy , Combined Modality Therapy , Female , Humans , Lung Neoplasms/drug therapy , Male , Middle Aged , Neoplasm Staging
9.
Ann Thorac Surg ; 69(4): 1030-4, 2000 Apr.
Article in English | MEDLINE | ID: mdl-10800789

ABSTRACT

BACKGROUND: A variety of respiratory stents are currently available, but the ideal airway prosthesis seems far from being recognized. The objective of this study was to verify safety and long-term effect on the bronchial wall of three different types of airway stents. METHODS: Twelve healthy adult sheep were divided in three groups, scheduled to receive: (1) bare self-expandable metallic stents (Gianturco); (2) silicone stents (Dumon); and (3) covered self-expandable synthetic stents (Polyflex). Insertions were performed through a rigid bronchoscope under general anesthesia. Chest roentgenogram was performed 1 and 6 months after surgery, and flexible bronchoscopy after 6 months. Twelve months postoperatively, the animals were killed and a postmortem examination was carried out. RESULTS: All Polyflex stents migrated during the observation period; one late migration was observed in the Dumon group. Microscopic study showed: (1) Gianturco stents: full-thickness perforation of the bronchial wall covered by a thick layer of a chronic inflammatory infiltrate. Infection by Candida at the bottom of some ulcerations; (2) Dumon stents: mild bronchial inflammation (squamous metaplasia, submucosal inflammatory infiltrates; granuloma-like infiltrates). In case of displacement, no significant changes of the previously stented bronchus occurred; and (3) Polyflex stents: no changes of the previously stented bronchi. CONCLUSIONS: Gianturco stents proved unsafe in the long term, owing to the risk of severe airway wall damage. The Polyflex stent is well tolerated but presents a high migration rate. Silicone stents show several limitations but appear to be well tolerated by the host mucosa.


Subject(s)
Bronchial Diseases/pathology , Bronchial Diseases/therapy , Stents , Animals , Bronchoscopy , Constriction, Pathologic , Prosthesis Design , Sheep , Silicones
11.
Ann Thorac Surg ; 65(1): 203-7, 1998 Jan.
Article in English | MEDLINE | ID: mdl-9456118

ABSTRACT

BACKGROUND: Endoscopic treatment of malignant central airway obstructions usually is done for palliation. The exact role of such a procedure as preparatory to operation remains controversial. METHODS: From 1987 through 1996, 24 patients at our institution underwent tracheobronchial pulmonary resection after preliminary endoscopic treatment. During the same period, 304 patients underwent 449 operative rigid bronchoscopies for airway obstructions, most involving the use of a neodymium:yttrium-aluminum-garnet laser. The indications for operation were squamous cell carcinoma in 14 patients, bronchial gland tumors in 8 patients, and papillary thyroid cancer infiltrating the trachea in 2 patients. The total resection rate was 9.5% (5% for squamous cell carcinoma, 75% for low-grade malignant bronchial tumors, and 75% for papillary thyroid cancer). The median period between operative rigid bronchoscopy and operation was 18 days. RESULTS: No complications were observed after endoscopic treatment. There were two perioperative deaths (adult respiratory distress syndrome after carinal resection and pulmonary embolism after pneumonectomy) and one major complication (poor postoperative pulmonary function after pneumonectomy). No anastomotic complications were observed in the tracheobronchoplastic procedures. Follow-up was possible in every patient but 1: 6 patients died at a median of 30.5 months after operation (range, 3 to 46 months), 2 patients are alive with disease, and the rest are alive without evidence of disease at a median of 21 months (range, 2 to 61 months). CONCLUSIONS: Most patients who require endoscopic therapy for malignant airway obstructions are not candidates for operative resection. Preliminary endoscopic relief of obstruction can increase operability and improve surgical results in a highly selected group of patients.


Subject(s)
Bronchial Neoplasms/therapy , Bronchoscopy , Carcinoma, Papillary/therapy , Carcinoma, Squamous Cell/therapy , Thyroid Neoplasms/therapy , Tracheal Neoplasms/therapy , Adult , Aged , Bronchial Neoplasms/surgery , Bronchoscopy/adverse effects , Carcinoma, Papillary/surgery , Carcinoma, Squamous Cell/surgery , Female , Humans , Laser Therapy , Male , Middle Aged , Thyroid Neoplasms/surgery , Tracheal Neoplasms/surgery , Treatment Outcome
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