[Anaplastic carcinoma of the thyroid: long-term survival]. / Il carcinoma anaplastico della tiroide: sopravvivenza a distanza.

Anaplastic carcinoma of the thyroid is a highly aggressive neoplasm with quickly total course. It is characterized by an average survival of 4-12 months. It infiltrates precociously into the windpipe, oesophagus, vessels of the neck and gives distant metastases in 10-48% of cases. In 30.8 to 80% of cases, this carcinoma originates in an old multinodular goiter. The hypothesis has been also advanced that this neoplasm could derive from a pre-existent well-differentiated carcinoma. The improvement in diagnostic techniques (especially immunohistochemistry) allows a more correct definition of this neoplasm, permitting a differential diagnosis with other tumours (lymphoma, medullary carcinoma, hemangioblastoma) with which in the past it has been erroneously identified. The results reported in the literature are controversial as regards long-term survival, but usually it is less than one year. Longer survival must lead to the suspicion of wrong diagnosis. A relatively better prognosis is observable in intraglandular forms, "minimi" neoplastic focus and young patients. The presence of regional metastatic lymph nodes doesn't seem to modify the prognosis. Instead, a factor which can condition the prognosis is the type of therapy. Now a days the most efficacious curative treatment is the multinodal one (surgery, radio- and chemotherapy). The best results about survival and quality of life have been obtained using chemo-radiotherapy before operation and chemotherapy after it.

[Short-stay in patients surgically treated for thyroid disease]. / Sull'invio precoce a domicilio del paziente operato per tireopatia.

The improvement in anesthesiology and greater experience of medical staff have permitted short-stay surgery. The authors in this pages report their knowledge of thyroid short-stay surgery. Their series numbers twenty-two lobectomies for uninodular the thyroid disease and one enucleoresection for a nodule of pyramidal lobe. Short-stay surgery has been proposed to euthyroid patients, selected according to age, residence and health (lack of associated pathologies such as cardiopathy, bronchopathy, hepatopathy, nephropathy, allergy, calcemic disorders and dysphony) and confirmed in the presence of histological extemporary diagnosis of "adenoma" (21 cases). The histological extemporary diagnosis of "carcinoma" has lengthened hospital stay. Among the lobectomies, 21 were executed in general anaesthesia and 1 in acupuncture. The enucleoresection was executed in local anaesthesia. Only in eighteen cases was a "Penrose" deainage used, removed after 24 hours. The choice of thyroid short-stay surgery, particularly in day-hospital, must arise from a careful selection of patients. Besides, this surgery requires an administrative and sanitary structure which permits a constant patient's check at hare too.

[The superior laryngeal nerve: an anatomical structure at risk during thyroid surgery]. / Il nervo laringeo superiore (NLS): una struttura anatomica a rischio nella chirurgia tiroidea.

The effects of injury to the external branch of the superior laryngeal nerve (ESLN) during thyroid surgery are well known, while the frequency and consequences of ESLN lesions aren't today well known. The Authors report their own experience of the incidence of ESLN injuries in thyroid surgery.

[Hypocalcemia after total thyroidectomy. Therapeutic considerations]. / La ipocalcemia post-tiroidectomia totale. Considerazioni terapeutiche.

One of the post-operative complications of total thyroidectomy is the onset of a transitory or permanent hypocalcemic syndrome. Hypocalcemia is caused by different physiopathological mechanisms that operate either individually or in association (parathyroidal deficit, deficiency of bone calcium subsequent to parathyroid osteodystrophy, acute emission of calcitonin into the circulation). Calcemia levels were studied p.o. in a selected group of 25 patients who had undergone total extracapsular thyroidectomy with the apparent preservation of the parathyroid glands. Totals thyroidectomy has been performed in 15 patients with euthyroid goitre, in 4 with papillary carcinoma, in 3 with diffuse toxic goitre and in 3 with multinodular toxic goitre. Eight patients received drug and diet therapy since calcemia levels were lower than 7.5 mg/ml. Fifteen days after the operation, calcemia levels in 21 patients were subliminal and dihydrotachysterol therapy was commenced. Hypocalcemia was permanent in only one case.