RESUMEN
The authors present a case of giant papillary adenoma of the breast and discuss their therapeutic strategy. The patient subsequently returned due to a local recurrence, which was treated with oncoplastic surgery, with satisfactory aesthetic results. The authors conclude by stressing the considerable rarity of this disease and the need for effective cooperation between surgeons and pathologists.
Asunto(s)
Adenoma/patología , Neoplasias de la Mama/patología , Mastectomía Subcutánea , Recurrencia Local de Neoplasia/patología , Adenoma/cirugía , Adulto , Neoplasias de la Mama/cirugía , Femenino , Estudios de Seguimiento , Humanos , Mastectomía Subcutánea/métodos , Recurrencia Local de Neoplasia/cirugía , Enfermedades Raras , Reoperación , Resultado del TratamientoRESUMEN
The adrenal incidentaloma is a disease that, thanks to the progress of the modern diagnostic, means for the longer and more high quality of life, has given a progressive increase in its impact, which has become more apparent in the elderly population. The authors after a review of literature on the impact and diagnostic, troubleshooting data endocrinology and imaging, these adrenal gland silent tumor clinically poses, envisage a therapeutic for use in older patient protocol.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/diagnóstico , Anciano Frágil , Hallazgos Incidentales , Neoplasias de las Glándulas Suprarrenales/cirugía , Adrenalectomía , Anciano , Diagnóstico Diferencial , Humanos , Laparoscopía , Resultado del TratamientoRESUMEN
Like other auto-immune diseases, Hashimoto's thyroiditis (HT) results from the interaction of genetic with environmental factors. Only few studies have evaluated the year-to-year change in frequency of HT over a wide period of time. The endocrine division of our Hospital has reported a great increase in the annual frequency of HT between 1975 and 2005, and a progressive decrease in both age at presentation and female to male (F/M) ratio starting in the mid-1990s. Between years 1988 and 2007, we have collected 8397 adequate examinations by fine needle aspiration cytology (FNAC) on 8397 persons referred for the evaluation of a solitary or dominant thyroid nodule (total FNAC and persons=8520) with a 14-fold increase in 2007 over 1988. In this 20-year period, cases of HT, De Quervain's thyroiditis (DQT) and Riedel's thyroiditis (RT) were 490, 36 and two, respectively. HT cases were one in 1988 but 90 in 2007, with a significant upward temporal trend (r=0.919, P<0.001) and significant downward trend for age at FNAC (r=-0.466, P<0.05). In contrast, DQT cases were zero and one, respectively, with no significant temporal trend (r=0.29, P=0.21). The HT increase in frequency started in 1996 (+350% over 1995). Until 1995 there was only one man, but there were 22 men in 2005-2007. These FNAC data provide independent confirmation to the data from the endocrine division of the same hospital, further supporting the conclusion that only environmental modifications can explain these marked changes that have occurred in such a relatively short period of time.
Asunto(s)
Enfermedad de Hashimoto/epidemiología , Adulto , Factores de Edad , Anciano , Biopsia con Aguja Fina , Femenino , Enfermedad de Hashimoto/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Sicilia/epidemiología , Enfermedades de la Tiroides/epidemiología , Nódulo Tiroideo/diagnóstico , Nódulo Tiroideo/epidemiología , Tiroiditis Subaguda/epidemiologíaRESUMEN
Single or multiple thyroid metastases from extra-thyroid primary tumors are reported to be rare. Malignancies that metastasize to the thyroid include cancers originating from lung, breast and kidney. We report our experience with a case of thyroid metastases, which were detected 18 years after curative kidney surgery for renal cell carcinoma. After 18 years, the patients noted the sudden appearance of a lump in the neck. Ultrasonography showed the presence of a multinodular goiter, all nodules being "cold" at scintiscan. Total thyroidectomy was performed; histology of all nodules revealed a metastatic thyroid cancer from renal cell carcinoma. The patient was still alive and in good health 16 months after thyroidectomy. History of patients with thyroid nodules should include inquiring about extra-thyroid malignancies, especially renal cell carcinoma, that may have been diagnosed even many years earlier. As a corollary, follow-up of such patients should include periodic thyroid exploration or at least a physical examination.
Asunto(s)
Carcinoma de Células Renales/secundario , Neoplasias Renales/patología , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/secundario , Anciano , Carcinoma de Células Renales/cirugía , Humanos , Neoplasias Renales/cirugía , Masculino , Nefrectomía , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Resultado del TratamientoRESUMEN
Chemodectomas are uncommon neoplasms, born by glomic cell of extra-adrenegic system. Usually, these neoplasms are benign and non functioning, but when they are more than 4 cm can induce a neuro-vascular compressive syndrome. In this study the Authors propose the guidelines for diagnostic, clinical and therapeutic management, of these tumors according to their experience.
Asunto(s)
Tumor del Cuerpo Carotídeo/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Paraganglioma Extraadrenal/diagnóstico , Anciano , Angiografía , Tumor del Cuerpo Carotídeo/clasificación , Tumor del Cuerpo Carotídeo/diagnóstico por imagen , Tumor del Cuerpo Carotídeo/cirugía , Femenino , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Paraganglioma Extraadrenal/diagnóstico por imagen , Paraganglioma Extraadrenal/cirugía , Guías de Práctica Clínica como Asunto , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ultrasonografía DopplerRESUMEN
The Authors, after a review of the topic of thyroid cancer, focus on the epidemiology, aetiology and diagnosis of well-differentiated thyroid cancers. They then describe their own case series and their many years' experience in treating the patients affected by this pathology, which is generally regarded as having low malignancy. Nowadays the Authors consider the treatment of choice the total thyroidectomy with central compartment lymphectomy, eventually associated with metabolic radiotherapy.
Asunto(s)
Adenocarcinoma Folicular/epidemiología , Carcinoma Papilar/epidemiología , Neoplasias de la Tiroides/epidemiología , Adenocarcinoma Folicular/radioterapia , Adenocarcinoma Folicular/secundario , Adenocarcinoma Folicular/cirugía , Adenoma Oxifílico/epidemiología , Adenoma Oxifílico/radioterapia , Adenoma Oxifílico/secundario , Adenoma Oxifílico/cirugía , Carcinoma Papilar/radioterapia , Carcinoma Papilar/secundario , Carcinoma Papilar/cirugía , Diferenciación Celular , Terapia Combinada , Estudios de Seguimiento , Humanos , Radioisótopos de Yodo/uso terapéutico , Italia/epidemiología , Escisión del Ganglio Linfático , Metástasis Linfática , Pronóstico , Estudios Retrospectivos , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/radioterapia , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Tiroxina/uso terapéuticoRESUMEN
The Authors, after a careful review of literature about the instrumental diagnostic techniques (with particular attention to the nuclear-medical ones) and the surgical therapy of parathyroid diseases, report their experience on the use of the radio-guided mininvasive surgery with MIBI and gamma-probe for intraoperative localization of pathological glands. Once exposed their experience, the Authors conclude asserting that this technique is fast, slightly invasive and expensive, and certainly useful for the detection of pathological or ectopic glands. It can be widely employed because, in comparison to its numerous advantages, such as the reduction of the operating time and of the hospital-stay, the greater radicality and the possibility to use mininvasive techniques, it does not present significant technical limitations and/or radio-protectionistic problems.
Asunto(s)
Glándulas Paratiroides/diagnóstico por imagen , Paratiroidectomía/métodos , Radiología Intervencionista/métodos , Adenoma/diagnóstico por imagen , Adenoma/cirugía , Adulto , Anciano , Carcinoma/diagnóstico por imagen , Carcinoma/cirugía , Coristoma/diagnóstico por imagen , Coristoma/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Glándulas Paratiroides/cirugía , Neoplasias de las Paratiroides/diagnóstico por imagen , Neoplasias de las Paratiroides/cirugía , Cintigrafía , Radiofármacos/farmacocinética , Estudios Retrospectivos , Tecnecio Tc 99m Sestamibi/farmacocinéticaRESUMEN
The authors, after reviewing parathyroid gland diseases, their location, and the modern strategies that can be used for their pre-operative detection, describe a case of primary hyperparathyroidism which recently came to their attention. The use of a combination of instrumental techniques (US, scintigraphy and SPEcT) enabled them to establish, prior to surgery, the mediastinal ectopic site of the parathyroid adenoma. Mini-invasive surgery proved to be the optimal technique to performing a targeted surgical excision that reduced the operative time and the hospitalisation.
Asunto(s)
Adenoma/complicaciones , Coristoma/complicaciones , Hiperparatiroidismo Primario/etiología , Neoplasias del Mediastino/complicaciones , Neoplasias de las Paratiroides/complicaciones , Adenoma/diagnóstico , Adenoma/diagnóstico por imagen , Adenoma/cirugía , Adulto , Coristoma/diagnóstico , Coristoma/diagnóstico por imagen , Coristoma/cirugía , Femenino , Humanos , Hiperparatiroidismo Primario/diagnóstico , Hiperparatiroidismo Primario/diagnóstico por imagen , Hiperparatiroidismo Primario/cirugía , Neoplasias del Mediastino/diagnóstico , Neoplasias del Mediastino/diagnóstico por imagen , Neoplasias del Mediastino/cirugía , Glándulas Paratiroides/diagnóstico por imagen , Neoplasias de las Paratiroides/diagnóstico , Neoplasias de las Paratiroides/diagnóstico por imagen , Neoplasias de las Paratiroides/cirugía , Paratiroidectomía , Tomografía Computarizada de Emisión de Fotón Único , Resultado del TratamientoRESUMEN
The Authors report their surgical experience in patients with uninodular goitre, and stress the trends in management benign and malignant lesions. The total thyroidecromy is the first choice. In some well selecrioned cases it is possible a videoassisted approach.
Asunto(s)
Bocio Nodular/cirugía , Tiroidectomía , HumanosRESUMEN
The Riedel's thyroiditis, also called "wood's thyroiditis", is a rare chronic "inflammatory" disease of unknown etiology, relatively frequent in female >45-50 years, characterized by a fibrotic process that pervades thyroid and neighbouring structures (vessels, muscles, oesophagus, trachea upper- mediastinum). The authors discuss about three cases of Riedel's thyroiditis and report the outcome after total thyroidectomy in two cases and sub-total resection in the other one.
Asunto(s)
Tiroiditis , Anciano , Femenino , Fibrosis , Humanos , Persona de Mediana Edad , Tiroiditis/patología , Tiroiditis/cirugíaRESUMEN
Authors, considering the increasing of the middle duration of life and the increasing of geriatric population, examine various surgical problems in the elderly. They took in consideration not only the age, but all the other markers of surgical risk related to the surgical illness, to the associate illness and to the type of operation. After reporting their experience in the treatment of geriatric patients, they conclude that a scrupulous surgical preparation, a correct indication to the operation and an accurate overseeing after surgery are necessary to do that the elderly patient faces surgical intervention with the same capability of success of the young.
Asunto(s)
Anciano , Procedimientos Quirúrgicos Operativos , Factores de Edad , Anciano de 80 o más Años , Urgencias Médicas , Humanos , Factores de RiesgoRESUMEN
After several remarks on the etiopathogenesis of primary hyperparathyroidism the Authors emphasise the importance of follow-up in operated patients. The evaluation begins right after removal of the lesion in the intraoperative phase, in order to evaluate the validity of the intervention and continues with evaluation of mineral homeostasis, disease itself and function of target structures. In addition to possible hypocalcemic crises, special attention should be placed on possible disease recurrence, and the study of all involved parts such as bones, kidneys, pancreas, digestive apparatus as well as the psychological aspects. These are often involved in a significant manner and condition the quality and duration of the patient's life.
Asunto(s)
Hiperparatiroidismo/cirugía , Estudios de Seguimiento , HumanosRESUMEN
The Authors confirm how the advent of mechanical suture has directed the management of rectal carcinoma to an increasingly conservative attitude. In reporting their experience--which consists of about twenty years (222 patients) they specify how not only an increased incidence of recurrence has not appeared, but they have also observed a reduction of theirs (-5.2%). They then attempt to outline basic moments which have characterized the history of rectal carcinoma surgery and they state how today, 80 years since it was conceived, Miles' intervention maintains its validity, even if with more restrictive indications.
Asunto(s)
Neoplasias del Recto/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Femenino , Humanos , MasculinoRESUMEN
The authors report their experience on synthetic prosthesis used in 36 patients with abdominal hernias. Thirty six cases of incisional hernias have been analyzed by Institute of General Surgery of Messina University from 1992 to 1998. Among the 33 cases with median parietal defect, in 7 cases concerning great incisional hernias group a PTEF-e prosthesis, which was positioned in an intraperitoneal site, was employed. In 21 cases of medium size incisional hernias they used a polypropylene prosthesis, which was positioned in an intraparietal or preperitoneal site. In 5 cases of small size incisional hernias, polypropylene prosthesis was placed in a superfascial site. In the 3 cases of medium size lateral laparocele++, polypropylene prosthesis was positioned in a intraparietal site. There was no operative mortality. Among postoperative complications, 4 seromas, 1 parietal and 1 subcutaneous haematoma and 2 haematomas in retroperitoneal site appeared. Clinical-instrumental controls, which have continued until two or three years after the operation were performed which pointed out a recurrence in just one case where the prosthesis was positioned in a superfascial site. To conclude, we consider that nowadays the use of synthetic prosthesis lets us face and solve problems concerning surgical treatment of incisional hernias with confidence.
Asunto(s)
Hernia Ventral/cirugía , Mallas Quirúrgicas , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polipropilenos , Politetrafluoroetileno , Prótesis e ImplantesRESUMEN
Aortoesophageal fistula is a rare but fatal cause of upper gastrointestinal bleeding. AEF develop progressively from the esophageal perforation caused by foreign body. Clinically, there is a medial chest pain, followed by hematemesis and finally terminal exsanguination. Diagnosis must be achieved during the free intervals in this triad of often rapidly succeeding signs.
Asunto(s)
Enfermedades de la Aorta/etiología , Fístula Esofágica/etiología , Cuerpos Extraños/complicaciones , Fístula Vascular/etiología , Aorta Torácica , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Primary hyperparathyroidism is a hormonal disease that is more and more frequent and is often manifested exclusively by an increase in calcium levels in the serum. After examining the main anatomopathological and clinical characteristics of the disease, the authors present their experience in its diagnosis and surgical treatment. They suggest that cervical exploration with removal of the adenomas and hyperplastic glands in both asymptomatic and highly symptomatic patients is strongly advised. Since it is already possible to obtain an early diagnosis of the disease thanks to multicanal hematochemical equipment, the Authors conclude that in the near future, studies on cellular receptors for calcium will allow new therapeutic treatments to be applied.
Asunto(s)
Hiperparatiroidismo/diagnóstico , Adolescente , Adulto , Anciano , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Hiperparatiroidismo/cirugía , Masculino , Persona de Mediana Edad , Paratiroidectomía , Complicaciones Posoperatorias/epidemiología , Cuidados PreoperatoriosRESUMEN
Neuroendocrine tumours are rare and often include insulinoma, gastrinoma and other low frequency tumours that secrete gastrointestinal hormones. Their preoperative localization, despite continuous medical advances, is extremely difficult but helpful in guiding the surgeon towards a proper form of treatment. After presenting their cases, the authors conclude that the treatment of choice for these tumours is surgery due to their anatomopathological features (benign, scarcely malign or invasive, slow growth). On the other hand, medical therapy plays an important role in either preparing the surgical intervention or alleviating symptoms when the patient is inoperable.
Asunto(s)
Tumor Carcinoide/diagnóstico , Gastrinoma/diagnóstico , Insulinoma/diagnóstico , Tumores Neuroendocrinos/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Adulto , Anciano , Tumor Carcinoide/tratamiento farmacológico , Tumor Carcinoide/cirugía , Quimioterapia Adyuvante , Femenino , Gastrinoma/tratamiento farmacológico , Gastrinoma/cirugía , Humanos , Insulinoma/tratamiento farmacológico , Insulinoma/cirugía , Masculino , Persona de Mediana Edad , Tumores Neuroendocrinos/tratamiento farmacológico , Tumores Neuroendocrinos/cirugía , Pancreatectomía , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/cirugíaRESUMEN
The authors report their results in 64 individuals belonging to 11 families with MEN 2 and familial medullary carcinoma of thyroid (CMT) syndromes. They show amplification and restriction techniques, type, site and incidence of genetic alteration in the observed cases; besides they illustrate the adopted surgical management related to the mutation. They stress the concept that genetic test allows to detect the population with altered gene before laboratory or clinical evidence, with the great advantage to indicate an early surgical approach. If it is shown a multi-organ disease, as in one patient with CMT associated with bilateral pheocromocytoma, the two diseases must be treated during the same operative time.
Asunto(s)
Carcinoma Medular/genética , Carcinoma Medular/cirugía , Mutación , Proto-Oncogenes/genética , Neoplasias de la Tiroides/genética , Neoplasias de la Tiroides/cirugía , Adolescente , Adulto , Niño , Femenino , Pruebas Genéticas , Humanos , Masculino , Neoplasia Endocrina Múltiple Tipo 1/genética , Neoplasia Endocrina Múltiple Tipo 2a/genética , Proto-Oncogenes MasRESUMEN
From 1990 to 1996, a total of 223 patients, with breast cancer, were treated. Out of these patients, 7 (3.04%) developed a second primary carcinoma in the controlateral breast. Two (28.5%) had a synchronous manifestation while the remaining 5 (71.5%) had a metachronous manifestation. The seven patients were followed up for periods between 4-8 years: 80% of the metachronous tumours occur within 5 years of follow-up. The 7-year actuarial survival was 100% in the two synchronous tumours and 60% in the five metachronous tumours (two patients died on account of intervening diseases). The prognosis does not depend on the length of the interval between the development of the two carcinomas but it is in relation with the anatomo-clinical state, to the adequate treatment of each primary tumour and to the rigorous clinical-instrumental follow-up, in which the mammography plays a fundamental role.
Asunto(s)
Neoplasias de la Mama , Carcinoma Ductal de Mama , Carcinoma Lobular , Neoplasias Primarias Múltiples , Neoplasias Primarias Secundarias , Análisis Actuarial , Adulto , Factores de Edad , Anciano , Mama/patología , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/diagnóstico por imagen , Carcinoma Ductal de Mama/mortalidad , Carcinoma Ductal de Mama/patología , Carcinoma Lobular/diagnóstico por imagen , Carcinoma Lobular/mortalidad , Carcinoma Lobular/patología , Femenino , Estudios de Seguimiento , Humanos , Mamografía , Persona de Mediana Edad , Neoplasias Primarias Múltiples/diagnóstico por imagen , Neoplasias Primarias Múltiples/mortalidad , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Secundarias/diagnóstico por imagen , Neoplasias Primarias Secundarias/mortalidad , Neoplasias Primarias Secundarias/patología , Pronóstico , Factores de TiempoRESUMEN
Thyroid carcinoma in childhood is very rare. The Authors report the features of this neoplasm versus other period of the life. There were no undifferentiated type of neoplasm in 69 cases. Almost all the tumors were well differentiated epithelial types especially papillary and only few cases were non epithelial differentiated tumors. Prognosis, that is better on childhood than other ages, depends, besides surgical indications (total thyroidectomy with lymphadenectomy for epithelial types of neoplasm to metabolic radiotherapy even if metastatized. Medullary carcinoma that as after associated to other endocrinopaties has the worst prognosis; total thyroidectomy with bilateral lymphadenectomy as not enough to avoid recurrence that does not responds to complementary treatment. Thyroid surgery in the child exposes to a major risk of iatrogenic lesions than the adult because of anatomical characteristics.