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.

[Current trends in the treatment of voluminous eventrations]. / Moderni orientamenti nella terapia delle voluminose eventrazioni.

The authors speak about their experience on the giant incisional hernias. The surgical treatment of these lesions in not always easy, especially when exist some conditions such as the loss of parietal substance and the loss of residence right. In these cases the use of prosthetic meshes and the Goni Moreno's pneumoperitoneum are very helpful. The Authors point out how important is, for a successful treatment, as well as a correct surgical procedure and opportune pre and post operative management.

[Polyps of the gallbladder. Considerations on their real clinical significance]. / I "polipi" della colecisti. Considerazioni sul loro reale significato clinico.

The authors review all the cases of polyps of the gallbladder observed during the period 1964 to 1992 at the Institutes of Pathology and General Surgery at the University of Florence. On the basis of their experience, the authors affirm that these phenomena always cause more or less evident, even if not specific clinical symptoms; moreover, since they are considered high-risk lesions for the onset of malignant tumours, the authors emphasize the need for cholecystectomy in all cases.

[Anatomic and surgical considerations regarding the recurrent laryngeal nerve in thyroidectomy]. / Considerazioni anatomo-chirurgiche sul nervo laringeo ricorrente in corso di tiroidectomia.

The majority of surgeons view the preliminary identification of the recurrent laryngeal nerve (RLN) as an essential stage in thyroidectomy in order to preserve thyroid integrity. This conviction is based on the fact that the anatomical relations of the recurrent nerve during the cervical tract with adjacent structures are highly variable. The preparation of the RLN in a series of 42 thyroidectomies performed by the 1st Department of Pathological Surgery of the University of Florence confirmed this variability above all with regard to relations with the trachea, Berry's ligament and the branches of the lower thyroid artery. As a result, it is justified to consider the identification and preliminary preparation of the RLN on both sides as a fundamental and unavoidable stage in thyroidectomy.

[Progressive pneumoperitoneum in the surgical treatment of conspicuous ventral hernias. Importance of the procedure to restore a good respiratory function]. / Il pneumoperitoneo progressivo nella chirurgia delle ernie ventrali di ragguardevoli dimensioni. Importanza del procedimento per ristabilire una buona funzionalità respiratoria.

A recent clinical report regarding a patient with a voluminous laparocele treated using progressive pneumoperitoneum justifies this short paper on the use of this method as a preparatory act to reparative surgery. The paper emphasises the undoubted advantages deriving from the use of this technique, especially in the case of those subjects with a particularly poor respiratory function secondary to hernia.

[Therapeutic approach in ventral hernia]. / La tattica nella terapia dei laparoceli.

Laparoceles are diseases of the abdominal wall and their repair does not usually involve technical problems which are difficult to resolve. The use of classic surgical methods, such as direct suture and plastic surgery, enables the parietal defect to be easily repaired in most case. However, cases do occur in which the surgeon is faced with considerable technical and tactical difficulties largely due to anatomopathological causes: the "loss of the right of domicile" of herniated viscera and the loss of musculo-aponeurotic substance. In the former case it is necessary to prepare the peritoneal cavity using pneumoperitoneum. In the event of the extensive destruction of the muscular component, or when the parietal breech is located next to bone or cartilagenous structures, it is essential to use a prosthesis. The paper goes on to describe the indications for the use of various techniques and their respective methods of use under different anatomo-clinical conditions.

[Pneumoperitoneum in preparation for surgery of large ventral hernia]. / Il pneumo-peritoneo nella preparazione agli interventi dei grandi laparoceli.

Reparative surgery of ventral hernia may be relatively simple or, on the other hand, the surgeon may be confronted with a number of tactical and technical problems. Many of these are caused by the "loss of the right of domicile". In order to avoid this particular condition it is useful to resort to preoperative pneumoperitoneum. This method entails the gradual and progressive introduction of air into the peritoneal cavity. In this way abdominal capacity is increased and it is therefore possible to re-insert all the viscera into their natural cavities avoiding all the harmful consequences for respiratory and cardio-circulatory organs following forced replacement. Preoperative pneumo-peritoneum is a relatively well consolidated surgical technique in large scale eventration. The methods is simple to perform and has a low incidence of complications.

[Progressive pneumoperitoneum in the preparation for surgical intervention for voluminous ventral hernias]. / Il pneumoperitoneo progressivo nella preparazione all'intervento chirurgico per voluminose ernie ventrali.

The paper report three patients suffering from voluminous ventral hernias who were treated using progressive pneumoperitoneum as a preparative method prior to reparative surgery. On the basis of the results obtained, the authors sustain the rationality, safety and efficacy of the procedure, in particular given its ability to reestablish good respiratory and circulatory function in those cases where the latter were severely affected by hernia. Since this method needs a longer application time and therefore involves a greater economic burden, pneumoperitoneum should probably be reserved for selected cases, and alternative techniques should be used in patients where hernia is more easily resolved.

[Malignant tumors of the small intestine. Comments concerning 21 observed cases]. / I tumori maligni del tenue. Considerazioni su 21 casi osservati.

Patients affected by malignant tumors of the small intestine observed by the Department of Clinical and Pathological Surgery at the University of Florence were studied from 1964 to 1989. The most important aspects of the disease were studied, on the one hand emphasising its low incidence and on the other the poor prognosis which accompanies it. Greater attention should be focused on these lesions in order to enable an early diagnosis to be made since this currently represents the sole possibility for carrying out an efficacious therapy.

[Endometriosis]. / Considerazioni in tema di endometriosi.

On the basis of two recently treated cases of endometriosis, the main aspects of this unusual pathology are examined; in particular its aetiopathogenesis, clinical picture and treatment still provide reasons of uncertainty. On the basis of an albeit limited experience, stress is laid on the importance of radical surgery, the only way to resolve the situation. Medical or conservative surgical measures are left to the early stages of the disease.

[Frequency and clinical significance of ectopic pancreas]. / Frequenza e significato clinico dei pancreas aberranti.

Ten cases of ectopic pancreas are presented. The literature on the subject is reviewed and the more controversial aspects of the disorder are discussed, in particular the clinical and anatomic-pathological significance, its diagnostic recognition, and the necessary treatment.

Retrovesical echinococcal cyst causing acute urinary retention.

A case report of a fifty-six-year-old man with acute urinary retention due to a retrovesical echinococcal cyst is presented. He had a history of surgery for hepatic hydatidosis; diagnosis was made preoperatively with the help of conventional x-ray studies, pelvic sonography, and CT scanning. Treatment consisted of removal of the cyst.