How to Manage Advanced Differentiated Thyroid Cancer: Step-by-Step Analysis from Two Italian Tertiary Referral Centers.

BACKGROUND: Differentiated thyroid carcinoma (DTC) has an excellent prognosis; however, advanced disease is associated with a worse prognosis and is relatively common. Surgery followed by RAI treatment remains the mainstream treatment for a large majority of patients with high- and intermediate-risk DTC, but its benefits should be carefully weighed against the potential for harm. The aim of this paper is to critically review the experience in treating advanced DTC at two tertiary referral centers in Italy. METHODS: Retrospective analysis of 300 patients who underwent surgery for ADTC over 30 years. RESULTS: The complication rate was 50.33%. A total of 135 patients (45%) remained at regular follow-up, 118 (87.4%) were alive, while 17 (12.6%) were deceased. The mean overall survival at 12 years was 84.8% with a mean of 238 months. Eleven patients (8.1%) experienced a relapse after a median of 13 months. CONCLUSIONS: ADTC patients adequately treated can achieve prolonged survival even in the case of metastasis or disease relapse. Patients with ADTC should be referred to high-volume centers with the availability of an extended multidisciplinary team to receive tailored treatment.

Maturation Selection Biases and Relative Age Effect in Italian Soccer Players of Different Levels.

Soccer is a sport practiced all over the world, in which players are expected to show specific physical and technical skills. Soccer academies look for young talented individuals to develop promising players. Although several parameters could affect the players' performance, the relative age effect (RAE) and the maturity status appeared debated. Therefore, this study compared the differences in RAE and biological maturity among the players of two Italian soccer teams of different levels and to understand their interaction effects with the competition level on youth players' physical characteristics and abilities. One hundred and sixty-two young soccer players from the U12 to U15 age categories of the elite (n = 98) and non-elite (n = 64) teams were recruited. The prevalence of maturity status and RAE was observed. Many anthropometric parameters, BIA vectors, and motor tests (CMJ, Sprint, RSA) were carried out. The maturity status had a greater effect on several anthropometric characteristics and on 15 m sprint, while it affected the CMJ only in U12 (F = 6.187, p ≤ 0.01). Differently, the RAE seemed to priorly affect the U13 and U15 categories in body composition, whereas its effect appeared on the 15-m sprint (F(3, 45) = 4.147, p ≤ 0.01) and the RSA (F(3, 45) = 3.179, p ≤ 0.05) in the U14 category. In addition, early matured players or those who were born in the first six months presented cellular characteristics similar to adult elite players. Soccer professionals should be encouraged to monitor the maturity status to better interpret changes in the physical performance of young soccer players to guide adequate training plans.

Assessment of Body Composition and Physical Performance of Young Soccer Players: Differences According to the Competitive Level.

Soccer is a multifactorial sport, in which players are expected to possess well developed physical, psychological, technical, and tactical skills. Thus, the anthropometric and fitness measures play a determinant role and could vary according to the competitive level. Therefore, the present study aimed to verify differences in body composition and physical performance between two soccer team. 162 young soccer players (from the Under 12 to Under 15 age categories; age: 13.01 ± 1.15 years) of different competitive levels (elite­n = 98 and non-elite­n = 64) were recruited. Anthropometric characteristics (height, weight, lengths, widths, circumferences, and skinfold thicknesses (SK)), bioelectrical impedance, physical performance test as countermovement jump (CMJ), 15 m straight-line sprints, Yo-Yo Intermittent Recovery Test Level 1 (Yo-Yo), and 20 + 20 m repeated-sprint ability (RSA)) were carried out. In addition, Body mass index (BMI), body composition parameters (percentage of fat mass (%F), Fat mass (FM, kg), and Fat-free mass (FFM, kg)) and the areas of the upper arm, calf and thigh were calculated, and the Bioelectric Impedance Vector Analysis (BIVA) procedures were applied. In addition, a linear discriminant analysis was assessed to determine which factors better discriminate between an elite and non-elite football team. Many differences were observed in body composition between and within each football team's category, especially in triceps SK (p < 0.05), %F (p < 0.05), and all performance tests (p < 0.01). The canonical correlation was 0.717 (F(7,128) = 19.37, p < 0.0001), and the coefficients that better discriminated between two teams were 15 m sprint (−2.39), RSA (1−26), suprailiac SK (−0.5) and CMJ (−0.45). Elite soccer team players present a better body composition and greater physical efficiency. In addition, BIVA outcome could be a relevant selection criterion to scout among younger soccer players.

Validity and Reliability of a New Device to Measure Type of Actions in Indoor Sports.

The purpose of this study was to analyze the validity and the reliability of the intensity ranges, number of actions and changes of direction measured by a commercial inertial measurement unit. Eleven elite youth futsal players performed a circuit with different type of displacements as sprinting, running at low-medium intensity, standing up and changes of direction. Data recorded by the Overtraq system were compared with video-analyzer during the six trials of each player. Standard error mean, Intraclass Correlation Coeficient and Coefficient of variation, were calculated to analyze the reliability of the device, as well as the Root Mean Square Error and Confidence Interval with correlation of Pearson for its validity. The results reported good validity for three intensity ranges (R2>0.7) with high reliability (Intraclass Correlation Coeficient: 0.8-0.9), especially for high intensity actions (Intraclass Correlation Coeficient: 0.95, Coefficient of Variation: 3.06%). Furthermore, the validity for the number of different actions was almost perfect (96.3-100%), with only small differences regarding changes of activity (mean error: 2.0%). The Overtraq system can be considered as a valid and reliable technology for measuring and monitoring actions at different intensities and changes of direction in futsal, likewise common actions for other indoor sports.

Acute inflammatory response in the subcutaneous versus periprosthethic space after incisional hernia repair: an original article.

BACKGROUND: The acute inflammatory response following mesh implantation has been often evaluated in vitro and in animal models. The aim of this study was to evaluate the acute inflammatory response near the prosthesis in human by analysing some inflammatory indicators. METHODS: We used a cohort of twelve male patients affected by midline incisional hernia, who were admitted for surgical mesh repair. A suction drain was placed between the mesh and rectal muscles whereas, the other one was placed between the subcutaneous tissue and the oblique external sheath. The acute inflammatory response was analyzed by measuring the production of interleukin [IL]-1, IL-10, IL-1ra, C-Reactive Protein (CRP), total proteins, albumin and pH in the drain fluids. RESULTS: The dynamics of CRP and ILs production resulted similar in both drainages. Comparing drain over mesh and subcutaneous drain at all times, IL-1 and CRP values always resulted significantly higher in the first one, whereas IL-1ra and IL-10 values were significantly higher in the last one. Total protein and albumin were similar in both drains at all time; only in the drain over mesh fluid, pH values resulted significantly reduced in the fourth post-operative day. CONCLUSIONS: Our data showed that an acute inflammatory reaction is present in both sites examined. However, it was significantly higher in the space after mesh implantation.

Concomitant small cell neuroendocrine carcinoma of gallbladder and breast cancer.

The neuroendocrine carcinoma is defined as a high-grade malignant neuroendocrine neoplasm arising from enterochromaffin cells, usually disposed in the mucosa of gastric and respiratory tracts. The localization in the gallbladder is rare. Knowledge of these gallbladder tumors is limited and based on isolated case reports. We describe a case of an incidental finding of small cell neuroendocrine carcinoma of the gallbladder, observed after cholecystectomy for cholelithiasis, in a 55-year-old female, who already underwent quadrantectomy and sentinel lymph-node biopsy for breast cancer. The patient underwent radiotherapy for breast cancer and six cycles of chemotherapy with cisplatin and etoposide. Eighteen months after surgery, the patient was free from disease. Small cell neuroendocrine carcinoma of the gallbladder has poor prognosis. Because of the rarity of the reported cases, specific prognostic factors have not been identified. The coexistence of small cell neuroendocrine carcinoma of the gallbladder with another malignancy has been reported only once. The contemporary presence of the two neoplasms could reflect that bioactive agents secreted by carcinoid can promote phenotypic changes in susceptible cells and induce neoplastic transformation.

The improvement of quality of life a indication for elective surgery in elderly patients with minimally symptomatic inguinal hernia.

AIM: Effectiveness of surgery on quality of life in elderly affected by minimally symptomatic inguinal hernia. MATERIAL OF STUDY: Forty male patients aging over 75 years affected by minimally symptomatic inguinal hernia were included. In the first group were allocated 15 patients who refused hernioplasty; in the second were included 25 patients who underwent early elective hernioplasty using an high density polypropylene mesh under local anesthesia. The SF-36 questionnaire was administered to all patients at the time of enrollment and 6 months after. RESULTS: All 8 domains of SF-36 and his related two comprhensive index, Mental Component Summary and Physical Component Summary scores, improved 6 months after surgery in patients of the second group. No significant differences were detected in the first group. DISCUSSION: There is no scientific evidence concerning early repair or watchful waiting strategy for elderly with minimally symptomatic inguinal hernia. in the last years, the evaluation of quality of life have a central role in the decision making of disease. CONCLUSION: Improvement of quality of life in elderly with minimally symptomatic inguinal hernia underwent to early hernia repair hernioplasty could represents a further indication for elective hernia repair.

Manometric evaluation of internal anal sphincter after fissurectomy and anoplasty for chronic anal fissure: a prospective study.

Chronic anal fissure (CAF) is a common painful clinical disease and its pathogenesis remains poorly understood. After failure of pharmacological therapy, that is the first-line treatment, surgical sphincterotomy remains the treatment of choice although it is followed by a high rate of anal incontinence resulting from the sphincter damage; therefore, the research of a sphincter-saving surgical option has become an important goal. The aim of this study was to evaluate the manometric modifications and the incidence of anal incontinence after fissurectomy and anoplasty with advancement skin flap in patients affected by CAF with hypertonia of the internal anal sphincter (IAS). Fifteen patients affected by CAF with hypertonia of IAS, unresponsive to medical therapy, were enrolled. All subjects underwent fissurectomy and anoplasty with advancement skin flap. Anorectal manometry was performed preoperatively and after 6 and 12 months from surgery. Maximum resting pressure (MRP), maximum squeeze pressure (MSP), ultraslow wave activity (USWA), fissure healing, anal continence, and postoperative complications were recorded. All patients healed within 30 days from surgery. No intra- or postoperative complications were recorded except for a case of partial donor site break. No significant modifications of MSP were detected. Six months after surgery, MRP was higher with respect to healthy subjects but significantly reduced in comparison to baseline levels. At 12 months, it was higher have versus 6-month values but significantly lower versus preoperative values. USWA was significantly represented in patients with CAF versus healthy subject. Both at 6 and 12 months, they decreased significantly with respect to preoperative values without significant differences versus healthy subjects. Both at 6 and 12 months, anal continence did not differ with respect to preoperative time. The fissurectomy with anoplasty resulted in a high healing rate without surgical sequelae or anal incontinence. Also, it was able to reduce IAS pressure in the same manner as surgical sphincterotomy or forceful dilatation.

Advancement flap in the management of chronic anal fissure: a prospective study.

Lateral internal sphincterotomy is the surgical treatment of choice of chronic anal fissure after failure of conservative measures. Several randomized trials identified an overall risk of incontinence of 10 % mostly for flatus. Fissurectomy is the most commonly used procedure to preserve the integrity of the anal sphincters. However, a possible complication is keyhole defect that may lead to faecal soiling. In this study, chronic anal fissure (CAF) was treated by fissurectomy and anal advancement flap to preserve the anatomo-functional integrity of sphincters and to reduce healing time and the risk of anal stenosis. In patients with hypertonia, surgical treatment was combined with chemical sphincterotomy by injection of botulinum toxin to enhance tissue perfusion. Forty eight patients with CAF underwent fissurectomy and anal advancement flap. In 22 subjects with hypertonia of the internal anal sphincter, intrasphincter injection of 30 UI of botulinum toxin at the completion of the surgical operation was used. All patients were followed up to 24 months. Since the first defecation, the intensity and duration of pain were significantly reduced. Two patients had urinary retention, five had infections and three had partial breakdowns. No anal stenosis, keyhole deformity or necrosis flap was recorded. At the 24 months follow-up visit, anal incontinence was similar to those detected preoperatively. Only four recurrences were detected at 18 and 20 months. After medical treatment failure, fissurectomy with advancement flap is a valid sphincter-conserving procedure for treatment of anterior or posterior CAF, regardless of hypertonia of the internal anal sphincter.