Pycnogenol® Supplementation Prevents Recurrent Urinary Tract Infections/Inflammation and Interstitial Cystitis.

This open pilot registry study aimed to evaluate and compare the prophylactic effects of Pycnogenol® or cranberry extract in subjects with previous, recurrent urinary tract infections (UTI) or interstitial cystitis (IC). Methods. Inclusion criteria were recurrent UTI or IC. One subject group was supplemented with 150 mg/day Pycnogenol®, another with 400 mg/day cranberry extract, and a group served as a control in a 2-month open follow-up. Results. 64 subjects with recurrent UTI/IC completed the study. The 3 groups of subjects were comparable at baseline. All subjects had significant symptoms (minor pain, stranguria, repeated need for urination, and lower, anterior abdominal pain) at inclusion. In the course of the study, the subjects reported no tolerability problems or side effects. The incidence of UTI symptoms, in comparison with the period before inclusion in the standard management (SM) group, decreased significantly; there was a more pronounced decrease in the rate of recurrent infections in the Pycnogenol® group (p < 0.05). The improvement in patients supplemented with Pycnogenol® was significantly superior to the effects of cranberry. At the end of the study, all subjects in the Pycnogenol® group were infection-free (p < 0.05vs. cranberry). Significantly, more subjects were completely symptom-free after 2 months of management with Pycnogenol® (20/22) than with SM (18/22) and cranberry (16/20). Conclusions. This pilot registry suggests that 60 days of Pycnogenol® supplementation possibly decrease the occurrence of UTIs and IC without side effects and with an efficacy superior to cranberry.

Interaction study between antiplatelet agents, anticoagulants, thyroid replacement therapy and a bioavailable formulation of curcumin (Meriva®).

OBJECTIVE: The objective of this clinical study is to evaluate possible interactions between antiplatelet agents, anticoagulants, thyroid hormone replacement therapy and a formulation of curcumin (Meriva®) that resulted effective for the complementary treatment of osteoarthritis. PATIENTS AND METHODS: Interaction between antiplatelet agents and Meriva® was evaluated by measuring anti-platelet activity with the in-vivo bleeding-time (BT) in patients assuming acetylsalicylic acid or ticlopidine or clopidogrel from at least 2 years. The BT was evaluated before and after 10 days of supplementation with Meriva®. The interaction between anticoagulants and Meriva® was evaluated in patients using warfarin or dabigatran for previous venous thrombosis. The INR level was evaluated before and after 10 days of supplementation with the curcumin formulation. Thyroid function tests in hypothyroid patients using LT4 replacement therapy (Eutirox®) were evaluated before and after 15 days of supplementation with Meriva®. Similarly, levels of glycemia and glycated hemoglobin were evaluated in diabetic patients in treatment with metformin, before and after 10 days of supplementation with the studied product. RESULTS: After 10 days of supplementation with Meriva® the average BT value was not significantly different for patients assuming acetylsalicylic acid, ticlopidine or clopidogrel at standard dosages. Similarly, after 10 days of Meriva® treatment, the INR level in the two groups of patients assuming warfarin or dabigatran was not statistically different from that observed at baseline. In the analyzed patients assuming LT4 or metformin, no interactions between the therapy and Meriva® were observed. CONCLUSIONS: Results from this non-interaction clinical study suggest that Meriva® does not interfere with the antiplatelet activity of the most common antiplatelet agents nor alters the INR values in stable patients assuming warfarin or dabigatran. Similarly, dosages of LT4 or metformin do not need to be adjusted in case of complementary treatment with Meriva®.

A natural pharma standard supplement formulation to control treatment-related toxicity and oxidative stress in genitourinary cancer: a preliminary study.

OBJECTIVE: Oncological treatments are associated with toxicities that may decrease compliance to treatment in most genitourinary cancer patients. Supplementation with pharmaceutical-standardized supplement may be a supplementary method to control the side effects after chemo- and radiotherapy and the increased oxidative stress associated to treatments. This registry study evaluated a natural combination of supplements containing curcumin, cordyceps, and astaxanthin (Oncotris™) used as supplementary management in genitourinary cancer patients who had undergone oncological therapy. PATIENTS AND METHODS: Patients with genitourinary cancers (prostate or bladder malignancies) who had undergone and completed cancer treatments (radiotherapy, chemotherapy or intravesical immunotherapy with increased oxidative stress and residual symptoms) were recruited in this registry, supplement study. Registry subjects (n = 61) freely decided to follow either a standard management (SM) (control group = 35) or SM plus oral daily supplementation (supplement group = 26). Evaluation of severity of treatment-related residual side effects, blood count test, prostate-specific antigen (PSA) test and plasma free radicals (oxidative stress) were performed at inclusion and at the end of the observational period (6 weeks). RESULTS: Two patients dropped out during the registry. Therefore, the analysis included 59 participants: 26 individuals in the supplementation group and 33 in the control group. In the supplement group, the intensity of signs and symptoms (treatment-related) and residual side effects significantly decreased at 6 weeks: minimal changes were observed in controls. Supplementation with Oncotris™ was associated with a significant improvement in blood cell count and with a decreased level of plasmatic PSA and oxidative stress. CONCLUSIONS: Naturally-derived supplements, specifically Oncotris™ (patent pending), could support the body to overcome the treatment-related toxicities - and the relative oxidative stress in cancer patients.

Management of Varicose Veins and Chronic Venous Insufficiency in a Comparative Registry with Nine Venoactive Products in Comparison with Stockings.

The aim of this registry study was to compare products used to control symptoms of CVI. Endpoints of the study were microcirculation, effects on volume changes, and symptoms (analogue scale). Pycnogenol, venoruton, troxerutin, the complex diosmin-hesperidin, Antistax, Mirtoselect (bilberry), escin, and the combination Venoruton-Pycnogenol (VE-PY) were compared with compressions. No safety or tolerability problems were observed. At inclusion, measurements in the groups were comparable: 1,051 patients completed the registry. Best performers : Venoruton, Pycnogenol, and the combination VE-PY produced the best effects on skin flux. These products and the combination VE-PY better improved PO 2 and PCO 2 . The edema score was decreased more effectively with the combination and with Pycnogenol. Venoruton; Antistax also had good results. Considering volumetry, the best performers were the combination PY-VE and the two single products Venoruton and Pycnogenol. Antistax results for edema were also good. The best improvement in symptoms score were obtained with Pycnogenol and compression. A larger decrease in oxidative stress was observed with Pycnogenol, Venoruton, and with the VE-PY combination. Good effects of Antistax were also observed. Parestesias were lower with Pycnogenol and with Antistax. Considering the need for interventions, the best performers were Pycnogenol, VE-PY, and compression. The efficacy of Pycnogenol and the combination are competitive with stockings that do not have the same tolerability in warmer climates. A larger and more prolonged evaluation is suggested to evaluate cost-efficacy (and non-interference with drugs) of these products in the management of CVI. The registry is in progress; other products are in evaluation.

Movardol® (N-acetylglucosamine, Boswellia serrata, ginger) supplementation in the management of knee osteoarthritis: preliminary results from a 6-month registry study.

OBJECTIVE: Knee Osteoarthritis (OA) is a chronic disease caused by the deterioration of cartilage in joints, which results in activation of the inflammatory response, pain, and impaired movement. Complementary therapies, particularly supplementation, in the management of moderate/severe knee OA have been gaining attention. This registry study aimed at evaluating the synergistic effect of Movardol®, a supplementation containing active ingredients with recognized anti-inflammatory activities on symptoms and levels of circulating biomarkers of knee OA. PATIENTS AND METHODS: 54 subjects with symptomatic, moderate knee OA freely decided to follow either a standard management (SM) (n = 26) or SM plus oral supplementation with Movardol® (n = 28). Movardol® supplementation containing N-acetyl-D-glucosamine, ginger, and Boswellia Serrata extract was taken at the following dosage: 3 tablets/day for one week and then 2 tablets/day. Several parameters were assessed at inclusion and after 1, 3 and 6 months: functional impairment by the Karnofsky Performance Scale Index; pain, stiffness, physical, social and emotional functions by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); total and pain-free walking distance; circulating biomarkers of inflammation and oxidative stress. RESULTS: Significant improvements in the functional outcomes and pain-free walking distance were observed after 1, 3 and 6 months in OA patients supplemented with Movardol®. Moreover, all the signs/symptoms of disease assessed by the WOMAC tended to regress over a 6-month period in patients following SM+supplementation. Inflammatory markers and plasmatic content of reactive oxygen species decreased over 6 months, in supplemented patients. Movardol® supplementation resulted to be safe and well tolerated, also showing the beneficial effect in term of a decrease in pharmacological and non-pharmacological treatments and, consequently, reduction in management costs. CONCLUSIONS: These preliminary results indicate the efficacy and safety of Movardol® supplementation in the management of moderate knee OA.

Management of functional, hepatic damage after chemotherapy with Liverubin (pharma-standard silymarin).

Mild, temporary hepatic failure (MTHF) after chemotherapy is a common clinical problem; in case of repeated episodes MTHF may cause chronic impairment. This registry has evaluated post- chemotherapy (PC)-MTHF in subjects using Liverubin (standardized Silymarin) for 8 weeks (3 capsules/day). METHODS: PC-MTHF was evaluated in a registry study. Hepatitis markers were negative at inclusion and at end-registry. In the final registry there were results concerning 18 Liverubin-supplemented patients and 19 controls completing the 8-week period. Signs/symptoms. The distribution of the most common symptoms and signs with ultrasound scans were comparable. Symptoms were mostly minimal or subclinical. Most symptoms observed at inclusion were completely disappeared or greatly attenuated after 8 weeks. The improvement produced by Liverubin induced a better and faster disappearance of symptoms. The results of the blood tests (at inclusion and at 8 weeks showed the increase in albumin, significantly (P<0.05) faster with the final values higher in the supplement group. Total bilirubin was reduced with the supplement better than in controls (P<0.05). Direct bilirubin values improved more in the supplement (P<0.05) group. The decrease in SGPT and AST-ASAT was more evident with the supplement (P<0.05). Improvement in controls was more limited. Alkaline phosphatase was significantly lower (than in controls) with Liverubin at 8 weeks (p<0.05). Gamma GT also decreased more and faster with the supplement. The ESR (erythrocytes sedimentation rate) was decreased in both groups, more in the Liverubin group (P<0.05). There was a more limited decrease in controls with persisting higher values at 8 weeks. The white cell count was also better at 3 months (with a larger decrease with the supplement; P<0.05). Oxidative stress. Plasma free radicals (PFR) were elevated in both groups at inclusion. A more significant decrease in the supplement group was observed at 8 weeks. Persisting elevation in values was seen in controls (P<0.05). Platelets values improved better with Liverubin (P<0.05). Safety and tolerability were optimal (no side effect was registered). In conclusion, results from this pilot registry indicate a significant activity of Liverubin associated with a very good safety profile, in patients with post-chemotherapy hepatic failure. The recovery of hepatic function is faster and more effective with Liverubin in comparison with the best "standard" management.

Supplementary management of functional, hepatic damage with Liverubin (pharma-standard Silymarin). A 3-month registry.

Mild, temporary hepatic failure (MTHF) is a common clinical problem; in case of repeated episodes MTHF may cause chronic liver impairment. This registry has evaluated MTHF in subjects using Liverubin (standardized Silymarin) for 8 weeks. METHODS: MTHF was evaluated in a registry study. In all subjects viral hepatitis markers were negative at inclusion. Different possible causes of MTHF had been considered. In these subjects alcohol was not a main factor. The registry included MTHF patients with decreased albumin levels, increased total bilirubin, altered hepatic function enzymes, increased oxidative stress. Two management groups were created: a standard management (SM) group and a SM+Liverubin group; 32 Liverubin patients and 33 SM subjects completed the registry. Liverubin was used at the dosage of two tablets (each equivalent to 140 mg) daily. RESULTS: Distribution of symptoms, blood test values and ultrasound results were comparable. Symptoms observed at inclusion disappeared at 3 months in both groups. The increase in albumin levels was significantly (P<0.05 at 4 weeks) faster and the final blood tests improved more with Liverubin. Total bilirubin was reduced with the supplement (better than in controls; P<0.05). Direct bilirubin values improved more in the supplement group at 3 months (P<0.05). The decrease of SGPT and AST- ASAT was more evident in the supplement group (P<0.05). Alkaline phosphatase value was normalized at in Liverubin patients; values decreased less in controls (P<0.05). Gamma GT decreased more with Liverubin. ESR was decreased in both groups (significantly more with Liverubin: P<0.05). There was a less important decrease in controls at 3 months. The white cell count was also better with the supplement group; P<0.05). Plasma free radicals - significantly elevated in both groups at inclusion - decreased more with the supplement at 3 months. All other blood tests (including hematocrit, renal function tests) were within the normal range at inclusion and at 3 months in both groups. Hepatitis markers were negative at inclusion and at end-registry. Safety and tolerability were optimal (no side effect was registered). CONCLUSION: In conclusion, data from this pilot, registry study indicate a significant activity of Liverubin associated with a very good safety profile, in patients with temporary hepatic failure. The recovery of hepatic function is faster and more effective with Liverubin compared to the best "standard" management.

Thyroid cysts treatment with the sclerosing agent Atossiclerol. Long-term (5 to 15 years) follow-up.

AIM: The aim of this study was to evaluate the long-term efficacy of the sclerosing agent Atossisclerol in the treatment of benign, ecolucent, thyroid cysts. METHODS: Two groups of cysts, one between 1 and 3 cm and a group smaller than 0.99 mm in maximum diameter (range 0.6-0.99) were considered in the inclusion plan. The localization of the cysts was at lobar level. A limited quantity of Atossisclerol (0.5 to 2%) was injected. RESULTS: No side effects were noted. After 5 years in the group treated with the sclerosing agent 93% of the cysts were completely disappeared (vs 60% in controls). However the initial target cyst at 5 and years was completely cured in most patients (>80%) treated with the sclerosing agent; at 10 years more than 90% of the original, sclerosed target cysts were not visible. Another control of most of these patients (53/68) at 15 years indicated that sclerosis of the cyst is safe and allow a better occlusion/obliteration (in almost all patients) of the cyst in comparison with aspiration only (slow recurrence in some 25% of the cysts). CONCLUSION: The sclerosing agent can be re-injected in the same patients without significant reaction or clinical problems or immunological reactions.

Cyanidin reduces preadipocyte differentiation and relative ChREBP expression.

Adipogenesis is a continuous process even in adult adipose tissue for the presence of preadipocytes that, when subjected to appropriate stimuli can proliferate and differentiate. ChREBP, the essential transcription factor for lipogenesis, is expressed in all tissues, but mainly in lipogenic organs. In this study, we focused on ChREBP expression during preadipocytes differentiation. Since it was found that cyanidin-3 reduces body weight in mice even in the presence of a high-fat diet, by decreasing levels of blood glucose and by improving insulin sensitivity, we studied the effect of this substance on adipogenic differentiation. For this purpose we used preadipocytes obtained from subcutaneous and visceral human adipose explant tissue, characterized and stimulated to differentiate in selective media. On cytofluorimetric analysis these cells showed mesenchymal markers (CD29, CD90, CD44), whereas they were negative for hematopoietic markers (CD45, CD10, CD117,CD31). ChREBP expression levels were quantified by immunoelectron-microscopy and western blotting analysis. In this report we show that ChREBP is expressed in preadipocytes (both nuclear and cytoplasmic compartments); the cytoplasmic level of ChREBP increased by 50 percent on day seven of differentiation into mature adipocytes. Cyanidin reduced differentiation by 20 percent (as evaluated by red oil O staining) and the expression of ChREBP. In addition, cyanidin-treated cells showed abnormal morphology, a square shape with irregular size, probably due to the fact that cyanidin may interfere with the extracellular matrix. These findings suggest that dietary cyanidin, may have inhibitory effects on adipogenesis.

Laparoscopic colectomy in colon cancer. A single-center clinical experience.

INTRODUCTION: Aim of our study was to compare the results of the laparoscopic technique to those obtained by traditional open approach in patients with colon cancer. The advantages, disadvantages, and the contraindications (real and presumptive) of this mini-invasive approach are described, by comparing the data obtained from the international literature with our clinical experience. PATIENTS AND METHODS: From February 2000 to May 2006, we performed 73 laparoscopic colectomies for cancer in the Operative Unit of General and Laparoscopic Surgery, Department of Surgical Sciences of the University of Chieti, Italy. The data of these patients were compared with the data obtained from 141 other patients who underwent open procedure for the same pathology in the same period and in the same Unit. Factors such as obesity, previous major abdominal surgery, T4 cancers, perforation and obstruction of the colon, tumor located in the transverse colon or in the left flexure of the colon were considered contraindications to laparoscopic approach. RESULTS: The length of surgical specimens and the number of lymph nodes removed did not show significant differences in the two groups. Two patients in the open procedure group died in the postoperative period. No postoperative death was noted in the group of patients operated by laparoscopic method. Postoperative complications requiring re-operation were observed in 9 patients in the open group and in 3 patients of laparoscopic group. Postoperative complications not requiring re-operation were observed in 16 patients in the open group and in 4 patients in laparoscopic group. Hospital stay was shorter for laparoscopic right or left colectomy compared to corresponding open procedures. At the follow-up (a mean 30 months), the overall survival was 78% for open colectomies and 82.1% for laparoscopic colectomies. Disease-free survival, excluding patients with stage IV tumor and patients died in the postoperative period, was 77.6% for open colectomies and 82.5% for laparoscopic colectomies. In the group of laparoscopic patients, we observed 1 case of port-site recurrence. CONCLUSIONS: Our clinical experience, even if limited by the number of patients and by the duration of follow-up period, contributes in confirming the reliability of laparoscopic procedures in the treatment of tumours of the colon and the safety of oncological results.

[Neoadjuvant radiochemotherapy of rectal cancer: our experience]. / Radiochemioterapia neoadiuvante nel cancro del retto nostra esperienza.

Postoperative chemoradiotherapy is the recommended standard therapy for patients with locally advanced rectal cancer. In recent years, encouraging results with preoperative radiotherapy have been reported. From 2000 at January 2005 we treated 11 patient and our results suggest that preoperative radiotherapy combined with chemotherapy increases the chances of tumor downstaging and downsizing and facilitates sphincter-sparing surgical procedures.

[Thyroid microcarcinoma: our experience]. / Microcarcinoma tiroideo: nostra esperienza.

The thyroid microcarcinoma is definited differentiated carcinoma of max 1 cm in diameter. We have reviewed clinical and histopathological results of 54 consecutive patients with papillary and follicular thyroid microcarcinoma and operated in the our clinic in the period 1985 to 2004. Several variables, such as older age, multifocality, bilateral disease, and extrathyroidal spread at initial assessment, may have some adverse prognostic significance. We recommend total thyroidectomy accompanied by modified neck dissection if enlarged nodes are diagnosed.

[Isolated cystic cervical lymphatic metastasis from occult papillary carcinoma of the thyroid: unusual and rather difficult diagnosis]. / La metastasi cistica linfonodale cervicale isolata da carcinoma papillare occulto della tiroide: una diagnosi rara e talvolta difficile.

Thyroid papillary carcinoma, exceptionally, can appear with cervico-lateral metastases in absence of thyroid evident disease. In that case we can have an infected branchial cyst, therefore is very important a correct preoperative diagnosis with FNAB. In literature were described 30 cases of cervico-lateral cystic masses that the histology revealed as occult papillary carcinoma metastases. Our experience is about 80 cases of papillary carcinoma, in only 2 cases the cancer was evident as a tight-elastic tumour in cervico-lateral region, hypoechogenic to the US scan with irregular and thick wall: one of the patient had multinodular goiter; the other one didn't have clinical of US scan character of thyroid disease. FNAB on lymph nodes shows doubtful cells evidence. Both patient had a total thyroidectomy with functional cervico-lateral and MAS lymphadenectomy. In one patient histology showed a papillary carcinoma of 4 mm in the right lobe, in the other patient the cancer was unknown. FNAB, in all doubtful cases, is the most important diagnosis test.

[The surgical treatment of primary hyperparathyroidism: clinical experience]. / Il trattamento chirurgico dell'iperparatiroidismo primitivo: esperienza clinica.

The primitive hyperparathyroidism (PHPT) constitutes still cause of discussion both from the diagnostic point of view and from the therapeutic one although surgical successes are generally reported. Between the most important problems there is the increase of the HPT asymptomatic or oligosymptomatic patients with the decisional difficulties in the timing of the surgical treatment and the difficult framing of the HLP disease associated with MEA and the relating surgical failures. Besides some authors support an unilateral dissection of the neck in patients with adenoma diseases diagnosed before the intervention against the traditional address of a bilateral exploration. Our experience is based on 31 patients subjected to intervention of parathyroidectomy for primitive HPT: 26 carriers of adenomas, of which 1 double, and 5 of diffused hyperplasia. We have effected 25 simple parathyroidectomy for adenoma, 1 resection of three parathyroid glands for double adenoma, 2 subtotal parathyroidectomy (7/8) for diffused hyperplasia. 2 patients had new surgical treatment for persistent hypercalcemia, and they were respectively carriers: 1 of a second ectopic adenoma and 1 of asymmetrical hyperplasia; 2 patients finally, operated in other hospitals had a second exploration and they were affected from MLP. In 26 patients we had very good results, in 2 persistence of hypercalcemia (patients who had a second look) and 3 hypocalcemia.

[Personal experience in the treatment of carcinoma of the head of the pancreas]. / Esperienza personale nel trattamento del carcinoma della testa del pancreas.

The Authors report 195 cases of carcinoma of the head of the pancreas observed in the period 1983-1995. Only 94 (48%) of these patients were operated: in 32 cases an exploratory laparotomy was performed, while in 36 a bilio-digestive bypass, associated in 2 patients with a gastro-jejunal bypass was assured. In 26 patients a resection was performed: in 12 a Whipple procedure, in 6 a total duodenopancreatectomy, in 8 a pylorus preserving procedure (Traverso-Longmire). The mean survival was 2 months after laparotomy, 6 months after bilio-digestive bypass, 20 months after Whipple procedure, 20 months after total duodenopancreatectomy, 23 months after a pylorus preserving procedure (Traverso-Longmire). The Authors believe that the Whipple procedure is the treatment of choice for the carcinoma of the head of the pancreas. Only in cases of suspected multifocality or when there is a severe nodal involvement it is advisable to perform a total duodenopancreatectomy.

[Clinical considerations of cases of biliary ileus]. / Considerazioni cliniche su alcuni casi di ileo biliare.

The authors report 6 cases of gallstone ileus due to cholecystoduodenal fistula. In 4 patients a simple enterolithotomy was performed, while in one case the enterolithotomy was associated to cholecystectomy and duodenal suture; in the last patient it was associated to cholecystectomy and gastric resection. Only one death was registered among the cases treated with enterolithotomy. The authors believe that the severity of the pathology, generally combined with other important diseases, needs an eclectic treatment depending on the patient status.

[Medullary carcinoma of the thyroid]. / II carcinoma midollare della tiroide.

Medullary thyroid carcinoma represents 4-8% of thyroid malignancies; regional nodal involvement is commonly found, even at the time of first surgical approach. In these patients after surgical resection, other therapeutic choices are really limited. The Authors evaluated their experience in the period 1981-1994, concerning 14 patients, 9 females and 5 males, all affected with sporadic MTC. Diagnosis was preoperative in 10 patients and intraoperative in 4; as for the staging: in 8 patients the tumor resulted confined to the thyroid, while in the remaining 6 patients it was extra-thyroidal. In 5 patients a total thyroidectomy with regional lymphadenectomy was performed, with in 6 patients a total thyroidectomy with cervico-mediastinic total lymphadenectomy was achieved. Survival was evaluated with a short, follow-up (3 months) and calculated using the K-Mayer method. Average survival was: 5 years in patients undergoing only total thyroidectomy; 3 years and 1 month in patients undergoing total thyroidectomy and lymphadenectomy; 6 months in patients undergoing no treatment at all. Among the factors negatively affecting patients survival, the Authors pointed out: metastasis occurrence; incomplete resection and mediastinal metastasis. In conclusion surgical resection (total thyroidectomy) associated with radical lymphadenectomy resulted to be a good approach. However, prognostic factors require further investigation.

[Resection therapy in the treatment of intrahepatic biliary lithiasis]. / La terapia resettiva nel trattamento della litiasi biliare intraepatica.

The authors report a case of intrahepatic lithiasis in a patient already operated of cholecystectomy and without lithiasis of the common bile duct. The lithiasis was present in the left lateral bile duct, was multiple and trapped behind a very narrow stricture. The stones were associated with a marked dilatation of the involved biliary ducts, cholangitis, fibrosis and atrophy of surrounding hepatic parenchyma. It was performed a resection of the II and III hepatic segments and the patient recovered completely and is well and disease free after one year. The authors believe, also on the base of the data reported by others, that in the intrahepatic lithiasis with strictures of the bile intrahepatic ducts the hepatic resection is the treatment of choice, especially when the lithiasis is present in a sectorial or segmental bile duct, preventing any stone recurrence.

[Surgical treatment of hyperthyroidism]. / Trattamento chirurgico dell'ipertiroidismo.

The most important problems of hyperthyroidism surgery are: the correct indication of operation, the choice of the best moment for operation and at last the extension of the resection. The authors experience include 365 patients with hyperthyroidism; 201 of them had monolateral autonomous nodules, 82 had diffuse multinodular goitre and 79 had Graves disease. In the first group of patients surgical treatment was total extracapsular isthmo-lobectomy, in the second group was performed subtotal thyroidectomy and in the third group was almost performed near-total thyroidectomy. Three relapses were found: two of that regarded patients with autonomous function nodule and one in patient with Graves disease. In 201 patients with toxic monolateral hyperfunction of the node, an extracapsular isthmo-lobectomy was performed. In the greater part of the 82 multinodular goiter cases a sub-total thyroidectomy was performed, as well as in 79 patients with Graves disease. Among the 3 recidive cases of hyperthyroidism (0.8%) one was recorded in a patient with Graves disease, (after subtotal thyroidectomy) and two in patients with hyperfunction of the node, (after isthmo-lobectomy). The authors justify the low incidence of recurrence by the choice of large extension of resection without a great number of complications.

[Goiter recurrences after surgical resection]. / Le recidive del gozzo dopo resezione chirurgica.

A personal experience about 135 pz. with non-toxic goitre treated by mono o bilateral thyroidectomy and followed during 5 years (2-8) to evaluate the incidence of recurrences is reported. The recurrences were 10.5%, especially after monolateral thyroidectomy (9 pz.). Therefore the authors stress the importance of a more accurate surgical indication, a wider resection of the gland and a careful follow-up to undertake opotherapy when hypofunction appears.