Tiroidectomia in urgenza per linfoma primitivo della tiroide: report di un caso ed indicazioni diagnostico-terapeutiche

Fournier's gangrene: case report and review of recent literature

Neck node dissection in thyroid cancer. A review.

INTRODUCTION: thyroid cancer recurs most commonly in one or more cervical lymph nodes. Surgical treatment for differentiated or medullary thyroid carcinoma consists of total thyroidectomy (TT). The aim is to elucidate the potential benefits and drawbacks of neck dissection TT related. MATERIALS AND METHODS: differences between therapeutic and prophylactic neck dissection were analysed to prevent post-operative morbidity, neck recurrences and improve survival. DISCUSSION: there is considerable controversy regarding the treatment of patients with cervical node metastases specially in differentiated thyroid cancer. Considering that a neck dissection might help to reduce local recurrence, espec…

La preparazione intestinale alla colonscopia. Esperienza personale e breve review della letteraura

Il posizionamento di protesi biliare per stenosi biliare post-operatorie. Nostra esperienza.

OBJECTIVE: To describe the management and outcome after endoscopic treatment of 23 patients with post-operative benign bile duct stricture (BBDS) managed in Authors' Department from 1991 to 2000. BACKGROUND DATA: The management of the postoperative bile duct strictures remains a challenge for even the most skilled biliary tract surgeon and endoscopist. The 1990s saw a dramatic increase in the incidence of bile duct strictures from the introduction and widespread use of laparoscopic cholecystectomy. The management of these injuries, short-term outcome and follow-up have been reported. METHODS: Data were collected retrospectively on 23 patients treated in the Service of Diagnostic and Operati…

Endoscopic treatment of pancreatic pseudocysts

Prevenzione dell’occlusione delle protesi biliari mediante somministrazione di levofloxacina e acido ursodesossicolico.

One of the main advances in biliopancreatic endoscopic therapy has been the ability to palliate patients with biliary obstruction by placement of a stent during ERCP, but this is often complicated by clogging of the stent with subsequent jaundice and/or cholangitis. Stent clogging may be caused by microbiological adhesion and biliary stasis. Therefore, the use of antibiotics and choleretic agents such as levofloxacin and ursodeoxycholic acid has been investigated to see whether they prolong stent patency. Ninety patients with strictures of the biliary tract and untreatable macrolithiasis with endoscopically inserted stents were randomized into two groups: 49 subjects in group 1 (levofloxaci…

La tecnica del rendez-vous nel trattamento palliativo degli itteri neoplastici: nostra esperienza

Introduction: "Rendez-vous" technique (RV) assume contemporaneous percutaneous transhepatic choledochal drainage (PTCD) and endoscopic (ERCP) approach to make easier biliary cannulation when it fails for anatomic, neoplastic or iatrogenic causes, in subject unresectable at presentation ("not fit for surgery"). Matherials and methods: Over a 3 years period 618 ERCP were performed in the Service of Digestive Endoscopy in Section of General and Thoracic Surgery, 59 of whom (9%) failed for non-visualization of ampulla of Vater (25%), intradiverticular ampulla (54%) or anatomic defects (21%). Were attempted 44 pre-cut: 14 failed (close biliary stricture), and we proceed to RV. Results: 11/14 (79…

Non recurrent laryngeal nerve. Personal experience

Anastomosi meccaniche versus anastomosi manuali nella chirurgia del retto. Esperienza personale.

Videolaparoscopic cholecystectomy: personal experience

Aim: Laparoscopic cholecystecomy (l.G) is now the gold standard for the treatment of gallstones, In this report were analyzed 153 IX ' performed by it single surgical team and, according to results, elaborated any technical recommendation. Mai i riai s and mi thuds: 153 IX. has been performed in Section of General and Thoracic Surgery of University' of Palermo, Sicily, by a single surgical team, since 2000. Indications for LC were all forms of calculous cholecystitis (biliary colic in 73.2%, acute cholecystitis in 4.5%, gallbladder polyps in 5.8%) or colecystocoledochal Hthiasis (9.8%). The mean age of patients was I9.-/6 years (range 18-78) and 6 2.7%) were female. The patients were studie…

Prevenzione delle complicanze in chirurgia tiroidea: la lesione del nervo laringeo ricorrente. Esperienza personale su 313 casi

Introduction: Thyroidectomy poses many challenges for the surgeon who undertakes endocrine surgery and iatrogenic injury of inferior laryngeal nerve (ILN) is one of the most serious (0-20%). We report our personal experience of a series of 313 thyroidectomy with intraoperative identification of ILN. Methods: 313 patients (253 females, 60 males, whose age was between 17 and 86 years, mean 41 years) had undergone thyroidectomy in our Operative Unit from January 2000 to January 2004. Among them, 259 patients underwent total extracapsular thyroidectomy, 38 subtotal thyroidectomy, 5 istmo-lobectomy and 11 were completions of thyroidectomy in patients who had previously undergone a first thyroid …

An uncommon complication of liver biopsy: obstructive jaundice from blood clots

Introduction: The AA. report on a case of one young woman who developed obstructive jaundice induced by hemo- bilia after percutaneous liver biopsy, successfully treated with endoscopic retrograde cholangiopancreatography (ERCP) Methods: An endoscopic sphincterotomy was performed with extraction of the clots Observations: Four weeks after ERCP the patient was healthy and asymptomatic, valuated as outpatient Conclusions: The role of ERCP in managing biliary sequelae of hemobilia is well established: biliary decompression is required if and intrabiliary lot causes obstructive jaundice and/or biliary colic. ERCP is feasible and leads to relief of symptoms in most cases, without the need of sur…

REATMENT OF GASTROINTESTINAL STROMAL TUMOR (GIST). REVIEW OF THE LITERATURE AND A CASE REPORT

Acute pancreatitis during liver hydatidosis: treatment with ERCP and endoscopic sphincterotomy

Severe rectal bleeding after transrectal US-guided prostate biopsy. Case report

CASE: The Authors report their experience about a case of severe rectal bleeding after transrectal ultrasound-guided prostate biopsy. INTERVENTION: After correct and sure diagnosis, the patient was submitted to resolutive endoscopic haemostatic treatment (failure of haemostatic mechanical manoeuvres, emergency colonscopy, haemostasis with sclerotherapy, heat bipolar probe and Argon Plasma Coagulation). RESULTS: Complete recovery (immediate stop bleeding). Follow-up (1 year) negative. CONCLUSIONS: Rectal bleeding after prostate biopsy is a important but rare complication of prostate cancer screening, potentially lethal. Best knowledge of causes and risk factors may improve the diagnosis and …

Trattamento chirurgico del carcinoma midollare della tiroide. Esperienza personale

Introduction: Medullary Thyroid Carcinoma (MTC) is a rare malignancy of the parafollicular C cells of the thyroid gland. Aim of our study is reporting retrospective analysis of our experience about the surgical treatment of MTC, especially pointing on limphadenectomy. Patients and methods: from January 2000 to March 2006, were performed 546 thyroidectomy, 6 of them for MTC (1.09%): 5 sporadic and 1 familiar. All the patients were operated with standard technique (total thyroidectomy) and submitted to endocrinologic and instrumental follow-up. Results: in our experience, we do not registered early or late complications as bleeding, laryngeal nerves lesions and parathyroid lesions or intra-po…

Common bile duct stones in cholecystectomized patients (chapt. 28) in Biliary lithiasis Basic science, current diagnostic and therapeutic approaches di C. Cordiano e G. Borzellino

The incidence of retained or primary stones is approximately 2-5% after LC and 5-15% after common bile duct exploration: in principle, these patients are in need of further intervention. Residual common bile stones are called secondary when they originate in gallbladder and later pass down through the cystic duct into the common bile duct.

Il ruolo della ERCP nell’era della colecistectomia videolaparoscopica. Nostra esperienza

Il trattamento chirurgico dell’idatidosi epatica: nostra esperienza e considerazioni diagnostico-terapeutiche

A rare complication of ERCP: Mallory-Weiss syndrome

OBJECTIVE: To describe the management and outcome after endoscopic treatment of hematemesis by Mallory-Weiss Syndrome (MWS) occurred after CPRE (suspected choledocolithiasis). Background data: Although cough and retching is common during EGD or CPRE, MWS resulting from endoscopy seems to be uncommon (0.0001-0.04%) and always self-limiting. Case report: The patient was submitted to CPRE with the suspicion of choledocholithiasis. Eight hours after CPRE the patient presented with hematemesis amd hypotension. With emergency EGD, the AA identified a small bleeding mucosal tear (visible vessel with spurting) just proximal to the esophagogastric junction. The patient was safely treated with endosc…

Il carcinoide bronchiale: revisione della letteratura recente

Objective: Yo evaluate methods of diagnosis and treatment, and the long term survival of patients treated for bronchial carcinoid tumor by the review of recent literature. Methods: The Authors conducted a retrospective study on internet-based-evidence of patients treated for bronchial car-cinoid tumor since 1993 to 2004. Symptoms, diagnosis, operative approach and survival were assessed. Conclusions: On the basis of the review of the international literature, the Authors affirm that the 5 and 10-year probability of survival are closely linked to the histological type of carcinoid, to the presence of nodal and distant metastasis. Owing to the potential malignancy of these tumours, preference…

Corpi estranei gastrici: i bezoari. A proposito di due casi

Objective: The authors report their experience about the treat merit of two cases of gastric bczoar, treated in curative mode, the first endoscopically and the second with surgical intervention. Setting: Operative Unit of General and Thoracic Surgery, Department of General and Emergency Surgery, Organ Transplantation. Policlinico, University of Palermo. Imerventaiion: The patients were submitted to curative treatment, one with endoscopic treatment (mechanical frag- mentation of phytobezoar and fragments extraction via-over- tube), the second with surgical gastrotomy {stamp trichobezoar). There were no procedure- related complications. Results: the two patients were curative and radically tr…

Surgical treatment of liver hydatidosis: our experience with diagnostic and therapeutic consideration

Objective: The Authors report on their experience in diagnosis and treatment of liver hydatidosis (LH). Materials and methods: From January 2000 to December 2003, we observed 24 patients (10 male = 42% and 14 female = 58%, male/female ratio 1:1.4, range of age 23 - 80 years, mean age 45.25 years). The most frequent initial symptom was hepigastric and hypocondriac pain (82.6%), meanwhile acute abdominal pain was only in 26.1%. In one half of cases performed radical surgery (total pericistectomy), in 35% of cases the AA subtotal pericistectomy and only in 17% the AA partial pericistectomy. Only one left hepatectomy during total pericistectomy we performed. Major complications were registered,…

Trattamento chirurgico di megacolon tossico da pancolite granulomatosa di Crohn. Caso clinico

Colecistectomia videolaparoscopica. Nostra esperienza

La tiroidectomia totale di principio nel microcarcinoma papillare

Regression of primary low-grade gastric mucosa-associated lymphoma by eradication of Helicobacter pylori infection: case report

Objective: the Authors report their experience in diagnosis and treatment of one case of primary low-grade gastric lymphoma of mucosa associated lymphoid tissue (MALT); recent international literature review. Experimental Design: complete clinical report. Diagnostic, clinical and prognostic indication, evaluation of effectiveness of eradication therapy and short follow-up. Setting: Operative Unit of General and Thoracic Surgery. University "Paolo Giaccotie" of Palermo. Intervention: treatment of H. Pylori infection (lansoprazole, amoxicillin and metronidazole twice a day for 14 days; after that, lansoprazole for another 4 weeks), according to international guide-lines. Results: H. Pylori wa…

Pancreas aberrante: una causa rara di epigastralgia

Objective: The Authors report their experience about a case of aberrant pancreas that lead epigastralgia. Design: Report of 1 case and endoscopic treatment (upper endoscopy + EUS + endoscopic polipectomy + endoscopic biopsy of the base. Surgical effectiveness evaluation. Setting: Section of General and Thoracic Surgery. Department of General Surgery; Emergency and Organ Transplantation. Policlinico "Paolo GiacconePalermo. Intervention: After correct and sure diagnosis, the patient was submitted to endoscopic polipectomy with radical and curative intention. Results: Complete recovery. Hematochemical and endoscopic follow-up (1 months) negative. Conclusions: Diagnosis of aberrant pancreas is …

Toracentesi e pleurodesi nel trattamento dei versamenti pleurici. Esperienza personale

Il trattamento dei tumori stromali gastrici (GIST). Revisione della letteratura e descrizione di un caso

background: Gastrointestinal stromal tumors (GIST) are rare mesenchimal tumors that are characterized by constitutive overexpression of the tyrosin-kinase receptor KIT (CD 117). The authors analyse the basis of the treatment of gastric GIS, starting form the study of a recent observed case. Experimental design: Report of one case treated with endoscopic resection. Evaluation of treatment and 2-years follow- results: The treatment of gastric GIS I must be modulated on prognostic, genetic and molecular factors. These factors are the basis of the formation and growth of GIST. conclusions: Complete surgical extirpation without rupture remains the only curative treatment of localized favourable …

Il trattamento endoscopico delle pseudocisti pancreatiche.

Aim: the Authors report their experience about the endoscopic treatment of pancreatic pseudocysts (PP). Patients and methods: report of 10 cases; evaluation of effectiveness, morbidity and mortality of treatment. Setting: Section of General and Thoracic Surgery, AOUP “Paolo Giaccone”, University of Palermo. Procedure: endoscopic drainage was performed in all 10 patients, with 2 cysto-gastrostomy, 5 cysto-duodenostomy and 3 trans-papillary cystic drainage. Results: 100% successful; one case of bleeding post-procedure (10%), one case of sepsis (10%) and one case of stricture of fistula between PP and duodenum. Conclusion: endoscopic drainage of PP is a safe and simple treatment, with high rat…

Sorveglianza endoscopica del colon-retto. Ruolo del Narrow Band Imaging (NBI)

La gastrectomia percutanea endoscopica (PEG) metodo pull: nostra esperienza

Una rara complicanza precoce delle anastomosi digestive meccaniche:l’emorragia.

Introduction: Bleeding from mechanical digestive anastomosis is an uncommon complication (0.9-3.2%) often self- limiting but potentially lethal if not evidenced intraoperatively or in the immediate postoperative. Material and methods: The Authors retrospectively report incidence of anastomotic bleeding after stapled anastomosis (11/163 = 6.7%) and analyse probable causes. In 6 of 11 patients (54%) intraoperative bleeding was stopped after manual reinforce of anastomosis (3/6) or stopped spontaneously (3/6). In 5 patients (45%), 1 with gastro-jejunal anastomosis, 2 with ileo-colonic anastomosis and 2 with colo-rectal anastomosis, they used endoscopy and endoscopic treatment in emergency. Res…

The importance of pyramidal lobe in thyroid surgery

Pyramidal lobe (PL) is an embryological remnant of the thyro-glossal duct; its incidence varies from 15% to 75% but data concerning its size are lacking and limited to autoptic and radiologic evidences. Aim of our study is to elucidate the intraoperative frequency, location and surgical management of the PL.604 total thyroidectomy were performed between 1999 and 2007 in Unit of General and Thoracic Surgery of the University Policlinico of Palermo. The intraoperative incidence of PL was 12% (57% male, 43% female, mean age 42.5 years), but only about 50% were identified preoperatively with ultrasonography (US) (4% false positive) or with Tc-99m pertechnetate scintigraphy (8% false positive).I…

Malattia di Fournier: caso clinico e revisione della letteratura

OBJECTIVE: The authors report their experience in diagnosis and treatment of one case of Fournier's gangrene; recent international literature review. EXPERIMENTAL DESIGN: Complete clinical report. Diagnostic, clinical and prognostic indication, evaluation of effectiveness of surgical treatment (debridement and necrosectomy) and follow-up; comparison between indications and multidisciplinary approach proposed by international literature. SETTING: Operative Unit of General and Thoracic Surgery. University "Paolo Giaccone" of Palermo. INTERVENTION: Repeated surgical treatment previous multimodal approach, according to international guide-lines. RESULTS: Complete recovery with "restitutio ad in…

Juxtapapillary duodenal diverticular bezor as an exceptional cause of biliary stent obstruction. Case report.

INTRODUCTION: we describe the first case in literature of biliary stent obstruction by bezoar impaction in a iuxtapapillary duodenal diverticulum. CASE REPORT: this case illustrates an juxtapapillary duodenal diverticulum and bezoar in it causing obstructive jaundice in subject with two biliary stents for cholangiocarcinoma (Klatskin's tumor) in the absence of bile duct stones. RESULT: successful treatment with endoscopic stent removal and diverticulum toilette. Obstructive jaundice was cured after endoscopic removal of the bezoar and stent substitution. DISCUSSION: the presence of a bezoar and its possible contribution to the pathogenesis of pancreatitis in the presence of periampullary ex…

Tiroidectomia in urgenza per linfoma primitivo della tiroide

Objective: A case of acute wheezing causing primitive thyroid lymphoma observed ay the Operative Unit of General and Thoracic Surgery of the University "P. Giaccone" of Palermo, Italy, is reported. Experimen tal design: Diagnostic, clinical and prognostic indication, evaluation of effectveness of radical surgical treatment and follow-up. Intervention: Emergency radical surgical treatment (debulking) and surgical tracheostomy (tracheal infiltration) Results: Complete recovery with "restitutio ad integrum". No relapse were recorded ad short follow-up. Conclusions: Total thyroidectomy in front of uncertain cytology with the suspect of Hashimoto's treatment or acute wheezing nr localized neopla…

La palliazione endoscopica dell’ittero ostruttivo da carcinoma inoperabile del pancreas. Nostra esperienza

Aim of the study: Few patients with pancreatic cancer are eligible for resection. In the remainder; estimation of prognosis is important to optimise various aspects of care, including palliation of biliary obstruction and trial of chemotherapy. The aim is to refer our personal experience about the palliation with endoscopic stenting in patients with unresectable pancreatic cancer. Methods: The Authors reviewed retrospectively 132 patients affected by unresectable pancreatic cancer who underwent palliative interventions with endoscopic stenting from 2000 to 2004. Results: Jaundice dramatically decreased in 86% of patients within 36 hours, in 12% within 48 hours and in 2% after two days. As c…

Variazione della pressione intraoculare durante le procedure diagnostiche endoscopiche

Obiettivo. Obiettivo del presente studio è stato quello di rilevare qualsiasi possibile variazione nella pressione intraoculare (PIO) in soggetti non glaucomatosi sottoposti a esami endoscopici come la gastroscopia o la colonscopia, al fine di valutare il ruolo della tensione mentale in tali cambiamenti. Metodi. La frequenza cardiaca e il tono oculare sono stati misurati prima e subito dopo le procedure endoscopiche e 30’ dopo la somministrazione di un antagonista delle benzodiazepine in 100 soggetti, 52 uomini e 48 donne, sottoposti a gastroscopia, colonscopia o entrambi gli esami nella stessa occasione. Risultati. La frequenza cardiaca è diminuita da 82,10±14,41 a 76,11±10,96 30’ dopo la …

Acute onset of esophageal duplication cyst in adult. Case report.

Esophageal duplication (ED) cyst is unusual congenital disorder of the foregut, accounting for 10% to 15% of duplications of all foregut cysts. We report a case of esophageal duplication with acute clinical presentation, treated successfully with surgical resection.46-year-old man with acute dysphagia and gastroesophageal reflux of 2 weeks duration, showed submucosal bulging mass in the posterior wall of the middle third of oesophagus, fluid-filled cystic structure, dyshomogeneous, low-attenuation mass with smooth borders compatible with an hemorrhagic esophageal duplication cyst. With the suspect of acute presentation of a complicated esophageal cyst, the patient underwent surgery by right…

Endoscopic palliation of obstructive jaundice caused by inoperable pancreatic cancer: personal experience

Endoscopic cytology in biliary strictures. Personal experience

The differential diagnosis between malignant and benign biliary strictures is the cornerstone of the management of jaundiced patients. The aim of our study is to define the role of cytology of the bile withdrawn during endoscopic retrograde cholangiopancreatography (ERCP), to reach a diagnosis of the nature of biliary stricture.This retrospective study was conducted on 67 consecutive patients affected of ingravescent obstructive jaundice who underwent ERCP+/-PTE (percutaneous transhepatic endoscopic)+bile withdrawn+stenting. We founded hilar stricture in 21 patients (31.3%), middle third the common duct stricture in 17 (25.3%), and lower third stricture in 28 patients (41.4%). In one patien…

Il gozzo cervicomediastinico

INTRODUCTION: Aim of the study is to discuss the diagnostic and therapeutic problems of substernal goiter (SG). MATERIALS AND METHODS: The Authors retrospectively analyzed 12 patients (3.1%) with substernal goiters among 379 patients undergoing surgical treatment for thyroid diseases from January 2000 to 2005, and evaluated the clinical data, preoperative diagnostic findings, surgical treatments, histopathological results, and postoperative complications. RESULTS: The most common symptoms were a cervical mass (100%) and dyspnea (16%), but 50% of the patients were asymptomatic. Chest radiography provided the first evidence of a substernal goiter in 100% of the patients. The AA performed tota…

Intestinal endometriosis: an obscure cause of cyclic rectal bleeding

Complicanze in chirurgia tiroidea: ipoparatiroidismo sintomatico post-operatorio.Incidenza, note di tecnica chirurgica, prevenzione e trattamento.

Introduction: Total thyroidectomy has a definite role in the management of malignant and benign thyroid disorders, with minimal complications and rare postoperative mortality. Even though thyroid surgery is quite safe, mechanical damage, devascularization or inadvertent removal of the parathyroid glands are possible. The aim of this study is to report report the personal surgical experience and to define some of the pathologic and clinical characteristics of unintentional parathyroidectomy and post-thyroidectomy hypocalcemia Materials and methods: A retrospective-observational study was carried on 313 thyroidectomies from January 2000 to January 2004 (60 males and 253 females), mean age 41 …

Heterotopic gastric mucosa in the gallbladder: case report and literature review

Complications of elective esophago-gastro-duodenoscopy (EGDS). Personal experience and literature review

Abstract INTRODUCTION: Although upper gastrointestinal (GI) endoscopy is reasonably safe, it is not perfectly so. The complication rate is about 0.1% for EGDS. Aim of this study is to schedule and evaluate all possible complications, starting from personal experience in Operative Unit of Surgical Endoscopy. PATIENTS AND METHODS: We evaluated all EGDS performed at the Operative Unit of Surgical Endoscopy of Policlinico in Palermo between January 2000 and January 2008. A single staff of endoscopists performed diagnostic and therapeutic exam. All complications were tabulated and scheduled to identify possible risk factors or indicators procedure- or patient-related. RESULTS: 5.258 patients (43…

Ruolo del palloncino intragastrico riempito ad aria (Heliosphere Bag ®) nel trattamento dell’obesità grave. Esperienza personale.

Trattamento endoscopico di un caso di “gastric outlet syndrome” dopo gastroplastica verticale sec. Mason

What to do when endoscopic retrograde cholangio-pancreatography fails? Personal experience.

Pneumotorace da frattura del terzo laterale della clavivola. Caso clinico e revisione della letteratura

INTRODUCTION: the clavicle is one of the most commonly fractured bones, accounting for up to 4-10% of all adult's fractures. These fractures are comparatively easy to manage and typically heal with routine immobilisation. CASE REPORT: a 28 year old man had direct driving trauma to the left shoulder and reported a displaced fracture of the third lateral of left clavicle and an apical pneumothorax. The pneumothorax was treated by the insertion of a chest drain under local anaesthesia. The chest drain was removed 12 days after the injury and the patient was transferred in Traumatology for specific therapy. RESULT: 6 months after the accident, the clavicular fracture had united and the chest ra…

Cisti broncogena diaframmatica associata ad ernia di Bochdalek

Linfangioma cistico mesenterico. Descrizione di un caso e revisione della letteratura.

Objective: The Authors report their experience in diagnosis and treatment of one case of mesenteric cystic lymphangioma; recent international literature review. Experimental Design: Complete clinical report. Diagnostic, clinical and prognostic indication, evaluation of effectiveness of radical surgical treatment and follow-up. Setting: Operative Unit of General and Thoracic Surgery. University "Paolo Giaccone" of Palermo. Intervention: Radical surgical treatment, according to international guide-lines. Results: Complete recovery with "restitutio ad integrum". No relapse were recorded at short follow up. Conclusions: Even when asymptomatic and discovered incidentally, LCM must be treated sur…