Immunoreactions for P53 isoforms are associated with ultrastructural proliferative profiles in benign thyroid nodules.

BACKGROUND: P53 isoforms originate from the alternative initiation of P53 gene translation through usage of an internal promoter located in intron 4. All P53 isoforms are spliced in intron 9 and may modulate cell proliferation and cell fate outcome in response to DNA damage. AIM: To examine immunoexpression of P53 isoforms in benign proliferative lesions occurring in multinodular thyroids and to assess the ultrastructural phenotype of P53 distribution in the thyrocytes of those lesions by electron microscopy. MATERIALS AND METHODS: By immunohistochemistry and transmission electron microscopy (TEM), we evaluated 38 multinodular thyroids containing a total of 102 benign lesions: 38 nodular goiters (NG; colloid=20, parenchymatous=18), 52 follicular adenomas (FA) and 12 Hashimoto's thyroditis (HT). FA were classified into 10 normo-follicular, 9 macro-follicular, 28 micro-follicular and 5 solid variants. RESULTS: Immunoreaction for P53 isoforms was observed in approximately 50% of all lesions, except macrofollicular variant FA (33%). At TEM analysis, immunoreactive NG, FA and TH lesions showed signs of proliferation by simultaneous appearance of dispersed chromatin, increased amounts of cytoplasmic organelles and dilation of the rough endoplasmic reticulum. TEM signs of apoptosis and proliferation were also detected in FA, but with different rates compared to NG. CONCLUSION: The immunohistochemical expression of P53 isoforms in NG, FA and HT suggests their role in the development of these lesions. Ultrastructural findings support the hypothesis that P53 immunoexpression correlates with reactive proliferative changes in thyrocytes.

Outcome of iatrogenic injuries to the abdominal and pelvic veins.

PURPOSE: To analyze the management and outcome of iatrogenic injuries to the abdominal and pelvic veins. METHODS: We reviewed a series of patients who sustained iatrogenic vein injuries between 1989 and 2004. RESULTS: Thirty patients (21 men and 9 women ranging in age from 38 to 82 years; mean age, 53.6 years) sustained major vein injuries during general (46%), gynecological (20%), orthopedic (13%), colorectal (10%), or urologic (10%) operations. The following veins were injured: inferior vena cava (n=10), portal vein (n=4), iliac vein (n=15), and renal vein (n=1). The following types of repair were carried out: venorrhaphy (56%), end-to-end anastomosis (10%), and an interposition graft (33%). Seven patients (23%) died of injury-related causes and 18 (60%) suffered major injury-related complications, including bleeding requiring repeat exploration (n=7), disseminated vascular coagulopathy (DIC; n=5), venous thrombosis (n=4), and lower limb arterial ischemia (n=2). There were two cases of late venous thrombosis. CONCLUSION: Iatrogenic vein injuries can occur during radical surgery for cancer and are associated with high morbidity and mortality as a result of massive bleeding. Rapid vascular control and venous repair improve early and late outcome.

[The thyroid pyramidal lobe: frequency, morphological features and related diseases]. / Il lobo piramidale della tiroide: frequenza, caratteri morfologici e patologia.

The Authors examine the features of thyroid pyramidal lobe in 1405 operated patients over the period from January 1992 to January 2006. Pyramidal lobe morphology and diseases are reported. The pyramidal lobe was detectable in 25.5% of cases, mostly in women, the primary disease invariably arising from the main gland. The Authors conclude that the pyramidal lobe is an embryological remnant which may be involved in diseases arising from the main gland.

[Day-surgery as a factor in reducing hospital stay]. / La day-surgery come fattore di riduzione della durata della degenza.

The authors analyse the factors that have conditioned the early development of day-surgery in Italy and enumerate its fields of application. They outline the history of day-surgery and report the results of studies, citing laws, documents, rules and guidelines governing its application in Italy today. They also analyse the reasons why a more widespread use of day-surgery is proving difficult in Italy. They consider the surgeon's liability and briefly report the results of day-surgery activity at the "G. Martino" Polyclinic Endocrine General Surgery Unit in Messina, consisting in over 3000 operations since 1987. In conclusion, they consider the undoubted advantages of day-surgery for selected operations and stress that it is an effective alternative in comparison with the traditional hospital stay, according to the new philosophy inspiring modern medical care, namely, that of "operating better, in the patient's interest, at lower cost, and quickly".

Surgical therapy of medullary thyroid carcinoma.

This study describes the findings of a retrospective study of 57 medullary thyroid cancer patients observed at the main Sicilian centres for endocrine surgery. Six of these patients were observed locally in order to add a further dimension to the discussion of surgical therapies for medullary thyroid carcinoma. A review of the literature on sporadic forms of medullary thyroid carcinoma and hereditary neoplastic syndromes is followed by presentation of the authors' series. Diagnostic protocols, surgical therapies and pathological observations are discussed. Particular attention is paid to patterns of metastases of medullary thyroid carcinoma and to the differing opinions regarding the extent of lymph-node dissection required and the treatment of recurrent disease. Total extracapsular thyroidectomy with lymph-node dissection is identified as the gold standard of surgical therapies for this form of cancer.

[Hemostatic problems in surgery]. / Problematiche emostatic, in chirurgia.

In this study the authors analyse hemostatic problems in surgery, with particular reference to the perioperative management of the patient. They examine the numerous factors giving rise to hemorrhagic and thrombotic complications, namely, the hemostatic technique adopted, the use of drainages, patient risk factors, pharmacological prophylaxis, etc. Prevention of bleeding, however, depends essentially on adequate preparation of the patient at surgery and on the surgeon's skill and experience.

[Ileal leiomyosarcoma presenting with an episode of acute massive intestinal bleeding]. / Leiomiosarcoma ileale manifestatosi con episodio di enterorragia acuta massiva.

The aim of this article was to present a case of gastrointestinal stromal tumour (GIST) presenting with acute intestinal bleeding. The Authors outline the histogenetic, clinical, diagnostic and prognostic profile of this pathology. Technical progress in immuno-histochemical and ultrastructural diagnostics has made possible to go beyond the old definition of gastrointestinal stromal tumours and identify several subgroups of such tumours on the basis of nervous and/or muscular phenotypic differentiation. The histopathological and structural variety of GIST accounts for their different clinical manifestations and variable and unpredictable biological behaviour. Histological criteria are by no means of absolute value: tumours considered benign on the basis of histology may present a malignant behaviour in the course of time, with the development of metastases and recurrences. In this regard, a number of predictive malignancy indices have been identified such as the patient's age, tumour size, presence of haemorrhage and necrotic areas, high mitotic index (> 5 mitoses/50 HFP), and kit-gene mutations. The Authors stress the diagnostic importance of 99m Tc-RBC scintigraphy in the case reported and agree with the literature as to the appropriate therapy, consisting in intestinal resection. The therapy of active GIST is essentially surgical and consists in resection of the intestinal tract affected by the tumour: lymphadenectomy must be performed only in case of need, because GIST metastasis preferably via the blood stream. As far as therapy is concerned, the demonstration of kit-gene mutation, expressed by the more aggressive forms, has made it possible to produce an inhibitor of protein tyrosine kinase Ber-Abl, which causes selective inhibition of cellular proliferation both in vitro and in vivo and induces apoptosis of Ber-Abl positive cell lines.

[Haemorrhagic complications in thyroid surgery. Control of bleeding from retroneural vessels using collagen and thrombin gelatine granules]. / Complicanze emorragiche in ch irurgila tiroldea. Impiego di granuli di gelatina di collageno e trombina.

They conclude that numerous factors contribute towards causing haemorragic complications, such as the technique used for haemostasis, the drainage, and the haemorragic risk factors presented by the individual patient. Prevention of bleeding, however, will depend essentially on the surgeon's experience and the precautions he takes. Of particular interest is the use of FloSeal (collagen and thrombin gelatine) to treat bleeding from retroneural arterial vessels, wich has often been seen to pose a serious problem for the surgeon. The results obtained in the case series described confirm the validity of this haemostatic sealant (arrest of bleeding in 100% of treated patients).

[Complications of open prosthetic surgery for large incisional hernias]. / Le complicanze della chirurgia protesica "open" dei grandi laparoceli.

The authors examine the complications of open prosthetic surgery for incisional hernias and analyse them from different points of view. The case series includes, over a period of 16 years, 492 hernioplasties for incisional hernias and 160 (32.5%) for large incisional hernias. The authors stress that the best results have been achieved by the retromuscular placement of prostheses. They conclude that while, on the one hand, the successful use of prosthetic material has marked the end of the inoperability of this pathology, such procedures are closely associated with the development of complications, which were unknown in the pre-prosthetic era and are sometimes very serious and linked to the site of the prosthesis and to the kind of material used.

[Iatrogenic injuries to the colon]. / Le lesioni iatrogene del colon.

The authors examine a number of aetiological, diagnostic and therapeutic aspects of iatrogenic injuries to the colon on the basis of an analysis of their own experience and a review of the literature. They highlight the low incidence of this kind of injury, which accounts for only 0.3% of all visceral injuries. Endoscopy and laparoscopic surgery are the most important causes of iatrogenic injuries to the colon. The authors conclude that these injuries are less serious and have a better prognosis than other kinds of colon perforations, because the colon is "clean" and it is possible to obtain an early diagnosis. Exceptions are lesions that occur in the course of a barium enema since these are associated with a high mortality rate which in some series may be as high as 100% of cases owing to the high toxicity of the barium contrast medium.

Morphological changes of follicular cell basal borders and basement membranes in benign and malignant nodular lesions of the thyroid gland: an ultrastructural study.

Microfollicular nodular lesions of the thyroid gland may represent a differential diagnosis problem. Firstly, nodular areas of follicular hyperplasia have to be distinguished from follicular adenomas. On the other hand, nodular microfollicular areas exhibiting large pale nuclei, occasionally found in hyperplastic nodules and follicular adenomas, must be discriminated from latent papillary carcinomas with predominant follicular architecture. The diagnosis of follicular carcinoma still requires the detection of vascular and/or capsular microinvasion. A more refined study was planned to search for additional descriptors useful for diagnosis The authors report the results of an ultrastructural investigation carried out on 220 thyroid nodular lesions and 50 specimens of macroscopically nonnodular glands. An infolding arrangements of the thyreocyte basal border (TBB) and follicular basement membrane (FBM) was demonstrated in 50/50 nonnodular thyroid tissue specimens and 53/67 (79.1%) hyperplastic nodular lesions (p<.005). A linear arrangement of the TBB and FBM was found in 85/121 (70.2%) follicular adenomas and in 32/32 differentiated carcinomas (p<.001). In the last group, 12/32 (37.5%) cases showed focal discontinuities of FBM. In conclusion, the benign thyroid nodules show a prevalently infolding arrangements of TBBs, whereas the majority of proliferative lesions display a linear morphology. In absence of an infiltrating pattern there is no morphological evidence of discriminating potentially malignant vs. benign lesions. The linear distribution of TBBs and FBMs places the case in a group of borderline lesions that involve a more careful postsurgery investigation.

[Pancreatic echinococcosis. Report of a clinical case and review of the literature]. / Echinococcosi pancreatica. Descrizione di un caso clinico e revisione della letteratura.

We report a case of a suppurative hydatid cyst of the pancreas treated surgically (internal drainage on Roux "Y" loop). Follow-up at 6 months revealed no evidence of the cyst. We emphasise the low incidence of the disease in a pancreatic site (02-2% in the literature). This was the first case in our experience despite the fact that Sicily is an area in which the parasite is endemic. We also emphasise the preoperative diagnostic difficulties: ultrasonography and computed tomography yielded very images very similar to those of a pseudocyst or cystic carcinoma. In most cases, in fact, as in the one reported here, the condition is diagnosed during surgery.

Transclavicular access as an adjunct to standard cervical incision in the treatment of mediastinal goitre.

There are cases in which resection of cervico-mediastinal goitres requires additional thoracic access as an adjunct to standard transverse cervicotomy, and typically this takes the form of sternotomy or thoracotomy. The authors propose transclavicular access as an alternative to thoracotomy or sternotomy access for the removal of such goitres. This technical variant is performed by means of resection of the middle third of the clavicle and extraperiosteal disarticulation. They report a case of cervicomediastinal or "plunged" goitre associated with mediastinal metastasis from a follicular thyroid carcinoma in a 77-year-old woman, in whom this technical variant was used. They conclude by stressing the greater effectiveness, ease of execution and relatively limited "aggressiveness" of the technique in comparison with other ways of reaching the mediastinum. The variant proves effective in solving a number of technical, functional and aesthetic problems.