Specific features of differentiated thyroid carcinoma in patients over 70 years of age.

BACKGROUND AND OBJECTIVES: Among the geriatric population, there is a lower incidence of thyroid carcinoma (TC), but it accounts for 30% of all thyroid disorders compared to 6-8% in younger subjects. Prognosis, moreover, is worse in the elderly, as demonstrated by the fact that 81% of deaths related to these tumors occur in patients over 55. The aim of this retrospective study was to identify the characteristics of differentiated thyroid carcinoma (DTC) peculiar to the elderly. METHODS: Of 638 patients who underwent surgery for DTC over a period of 30 years, 46 were more than 70 years old. All the elderly patients had undergone radioioidine and TSH-suppression therapy following surgical resection. RESULTS AND CONCLUSIONS: Despite these measures, the rate of recurrence was 26.5% at 5 years and 63.6% at 10 years. The 5- and 10-year disease-specific survival rates were 87.8% and 63.6%, respectively. On an average, survival was 55.1 months when death was disease-related, and with regard to histological type, it was longer in papillary carcinoma than in the follicular variant, and longest of all in occult sclerosing carcinoma. Survival was greatest in patients with tumors less than 2 cm in diameter, characterized by the absence of extraglandular spread and by lymph node metastasis.

[Proposal for update of Bassini's procedure in the treatment of inguinal hernia under local anesthesia]. / Proposta di un aggiornamento della tecnica di bassini per la riparazione dell'ernia inguinale in anestesia locale. Nota preliminare.

Inconvenience due to tension along the suture, a relative high recurrence rate, the availability of optimal prosthetic materials and the tendency to reduce hospital stay are the motivations which induced many surgeons to adopt alternative techniques instead of the traditional ones for inguinal hernia repair. Among these latter it is worthwhile to add a personal update of the Bassini's technique: the plasty tailored upon the polypropylene mesh performed in local anesthesia. Thanks to the use of the prosthetic mesh, the plasty is performed using only four stitches tied loosely without much high tension on the conjoined tendon. Such technical expedients reduced postoperative pain and give better warrant for the plasty and allow hernia repair in local anesthesia and on a daily basis.

The exocrine pancreas of patients with WDHA syndrome. A light and electron microscopical study.

The exocrine pancreas of two patients with WDHA syndrome was studied by light and electron microscopy and by morphometrical methods. Compared to the controls, centroacinar and ductular cells were increased in number and richer in organelles, and acinar cells were markedly degranulated with well-developed ergastoplasm and Golgi apparatus. These findings suggest enhanced secretion of bicarbonate and enzymes in patients with WDHA syndrome. These results are discussed in the light of the complex metabolic and endocrine conditions occurring in this syndrome.

The effects of chronic hypergastrinemia on human pancreas.

The pancreas of four patients with chronic hypergastrinemia and recurrent peptic ulcer--without pancreatic tumors--were studied by light and electron microscopy. Centroacinar and ductular cells were increased in number, enlarged and richer in organelles, microfilaments and apical microvilli compared to the controls. The hyperplasia of these cells was significantly correlated with the peak values of gastrinemia stimulated either by secretin or by calcium. Zymogenic cells were degranulated to various degrees and always had well-developed ergastoplasm and Golgi apparatus. The degree of degranulation was significantly correlated with the peak values of stimulated gastrinemia. Cells with features intermediate between ductular and islet cells were found near some islets and typical islet cells (mostly A and B cells) were observed in the walls of some ductules and acini. These results suggest enhanced secretion of both bicarbonate and enzymes and neogenesis of islet cells from ductular cells during chronic hypergastrinemia.

Factitious hypoglycemia: an unusual clinical picture within Von Münchausen's syndrome.

Two cases of hyperinsulinism from insulin self-administration are described, both patients being admitted to hospital with a diagnosis of insulinoma. In the first case, the diagnosis was clarified after a left pancreatectomy elsewhere, thanks to the discovery of a bottle of insulin. In the second case, the diagnosis was confirmed by the measurement of C-peptide during a hypoglycemic attack. The simultaneous sharp decrease in glucose levels, an exceptional increase in insulinaemia and a reduction or disappearance of serum C-peptide is indicative of this particular type of hyperinsulinism. The two cases described here were remarkably similar. Apart from the most common features, both reported a severe hypoglycemic syndrome of recent onset; negative tolbutamide and calcium tests; a frequent relapse shortly after glucose administration.