1
|
Del Rio P, Polistena A, Chiofalo MG, De Pasquale L, Dionigi G, Docimo G, Graceffa G, Iacobone M, Medas F, Pezzolla A, Sorrenti S, Spiezia S, Calò PG. Management of surgical diseases of thyroid gland indications of the United Italian Society of Endocrine Surgery (SIUEC). Updates Surg 2023; 75:1393-1417. [PMID: 37198359 PMCID: PMC10435599 DOI: 10.1007/s13304-023-01522-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/23/2023] [Indexed: 05/19/2023]
Abstract
A task force of the United Italian society of Endocrine Surgery (SIUEC) was commissioned to review the position statement on diagnostic, therapeutic and health‑care management protocol in thyroid surgery published in 2016, at the light of new technologies, recent oncological concepts, and tailored approaches. The objective of this publication was to support surgeons with modern rational protocols of treatment that can be shared by health-care professionals, taking into account important clinical, healthcare and therapeutic aspects, as well as potential sequelae and complications. The task force consists of 13 members of the SIUEC highly trained and experienced in thyroid surgery. The main topics concern clinical evaluation and preoperative workup, patient preparation for surgery, surgical treatment, non-surgical options, postoperative management, prevention and management of major complications, outpatient care and follow-up.
Collapse
Affiliation(s)
- P Del Rio
- Unit of General Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - A Polistena
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
| | - M G Chiofalo
- Department Head and Neck, Thyroid Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - L De Pasquale
- Thyroid and Parathyroid Service, Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - G Dionigi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Division of Surgery, Istituto Auxologico Italiano Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - G Docimo
- Division of Thyroid Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - G Graceffa
- Department of Surgical Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - M Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - A Pezzolla
- Division of Videolaparoscopic Surgery, Department of Emergency and Organ Transplanatation, University of Bari "A. Moro", Bari, Italy
| | - S Sorrenti
- Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - S Spiezia
- Department of Endocrine and Ultrasound-guided Surgery, Ospedale del Mare, Naples, Italy
| | - P G Calò
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| |
Collapse
|
2
|
Dobrinja C, Samardzic N, Giudici F, Raffaelli M, De Crea C, Sessa L, Docimo G, Ansaldo GL, Minuto M, Varaldo E, Dionigi G, Spiezia S, Boniardi M, Pauna I, De Pasquale L, Testini M, Gurrado A, Pasculli A, Pezzolla A, Lattarulo S, Calò PG, Graceffa G, Massara A, Docimo L, Ruggiero R, Parmeggiani D, Iacobone M, Innaro N, Lombardi CP, de Manzini N. Hemithyroidectomy versus total thyroidectomy in the intermediate-risk differentiated thyroid cancer: the Italian Societies of Endocrine Surgeons and Surgical Oncology Multicentric Study. Updates Surg 2021; 73:1909-1921. [PMID: 34435312 DOI: 10.1007/s13304-021-01140-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/26/2021] [Indexed: 11/27/2022]
Abstract
The surgical treatment of the intermediate-risk DTC (1-4 cm) remains still controversial. We analyzed the current practice in Italy regarding the surgical management of intermediate-risk unilateral DTC to evaluate risk factors for recurrence and to identify a group of patients to whom propose a total thyroidectomy (TT) vs. hemithyroidectomy (HT). Among 1896 patients operated for thyroid cancer between January 2017 and December 2019, we evaluated 564 (29.7%) patients with unilateral intermediate-risk DTC (1-4 cm) without contralateral nodular lesions on the preoperative exams, chronic autoimmune thyroiditis, familiarity or radiance exposure. Data were collected retrospectively from the clinical register from 16 referral centers. The patients were followed for at least 14 months (median time 29.21 months). In our cohort 499 patients (88.4%) underwent total thyroidectomy whereas 65 patients (11.6%) underwent hemithyroidectomy. 151 (26.8%) patients had a multifocal DTC of whom 57 (10.1%) were bilateral. 21/66 (32.3%) patients were reoperated within 2 months from the first intervention (completion thyroidectomy). Three patients (3/564) developed regional lymph node recurrence 2 years after surgery and required a lymph nodal neck dissection. The single factor related to the risk of reoperation was the histological diameter (HR = 1.05 (1.00-1-09), p = 0.026). Risk stratification is the key to differentiating treatment options and achieving better outcomes. According to the present study, tumor diameter is a strong predictive risk factor to proper choose initial surgical management for intermediate-risk DTC.
Collapse
Affiliation(s)
- C Dobrinja
- UOC Clinica Chirurgica di Trieste, Dipartimento Universitario Clinico di Scienze Mediche Chirurgiche e della Salute, Trieste, Italy
| | - N Samardzic
- UOC Clinica Chirurgica di Trieste, Dipartimento Universitario Clinico di Scienze Mediche Chirurgiche e della Salute, Trieste, Italy. .,Division of General Surgery, Department of Medical and Surgical Sciences, Cattinara Hospital, Università degli Studi di Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
| | - F Giudici
- UOC Clinica Chirurgica di Trieste, Dipartimento Universitario Clinico di Scienze Mediche Chirurgiche e della Salute, Trieste, Italy
| | - M Raffaelli
- UNITÀ OPERATIVA COMPLESSA Chirurgia Endocrina e Metabolica, Dipartimento Scienze mediche e chirurgiche, Policlinico Gemelli, Roma, Italy
| | - C De Crea
- UNITÀ OPERATIVA COMPLESSA Chirurgia Endocrina e Metabolica, Dipartimento Scienze mediche e chirurgiche, Policlinico Gemelli, Roma, Italy
| | - L Sessa
- UNITÀ OPERATIVA COMPLESSA Chirurgia Endocrina e Metabolica, Dipartimento Scienze mediche e chirurgiche, Policlinico Gemelli, Roma, Italy
| | - G Docimo
- UOSD Chirurgia Tiroidea Università della Campania "Luigi Vanvitelli", Caserta, Italy
| | - G L Ansaldo
- U.O.S. di Chirurgia Endocrina, IRCCS Ospedale Policlinico San Martino di Genova, Genoa, Italy
| | - M Minuto
- U.O.S. di Chirurgia Endocrina, IRCCS Ospedale Policlinico San Martino di Genova, Genoa, Italy
| | - E Varaldo
- U.O.S. di Chirurgia Endocrina, IRCCS Ospedale Policlinico San Martino di Genova, Genoa, Italy
| | - G Dionigi
- UOSD di Chirurgia Endocrina e Mininvasiva, Policlinico Gaetano Martino MESSINA Azienda Ospedaliera Universitaria, Messina, Italy
| | | | - M Boniardi
- Chirurgia Endocrina-Chirurgia Oncologica e Mininvasiva, Ospedale Niguarda di Milano, Milan, Italy
| | - I Pauna
- Chirurgia Endocrina-Chirurgia Oncologica e Mininvasiva, Ospedale Niguarda di Milano, Milan, Italy
| | - L De Pasquale
- Servizio di Chirurgia di Tiroide e Paratiroidi, U.O. ORL Asst Santi Paolo e Carlo, Ospedale Polo Universitario San Paolo, Via A. di Rudinì, 8, 20142, Milano, Italy
| | - M Testini
- U.O.C. di Chirurgia Generale Universitaria "V. Bonomo", Azienda Ospedaliero Universitaria Policlinico di Bari. Dipartimento di Scienze Biomediche ed Oncologia Umana, Università degli Studi "A. Moro" di Bari, Bari, Italy
| | - A Gurrado
- U.O.C. di Chirurgia Generale Universitaria "V. Bonomo", Azienda Ospedaliero Universitaria Policlinico di Bari. Dipartimento di Scienze Biomediche ed Oncologia Umana, Università degli Studi "A. Moro" di Bari, Bari, Italy
| | - A Pasculli
- U.O.C. di Chirurgia Generale Universitaria "V. Bonomo", Azienda Ospedaliero Universitaria Policlinico di Bari. Dipartimento di Scienze Biomediche ed Oncologia Umana, Università degli Studi "A. Moro" di Bari, Bari, Italy
| | - A Pezzolla
- Policlinico di Bari, UOS Videolaparoscopica, Bari, Italy
| | - S Lattarulo
- Policlinico di Bari, UOS Videolaparoscopica, Bari, Italy
| | - P G Calò
- Chirurgia Generale Polispecialistica, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - G Graceffa
- UO CH ONCOLOGICA, Policlinico P. Giaccone di Palermo, Università degli Studi di Palermo, Palermo, Italy
| | - A Massara
- UO CH ONCOLOGICA, Policlinico P. Giaccone di Palermo, Università degli Studi di Palermo, Palermo, Italy
| | - L Docimo
- XI Chirurgia Generale, Universita' della Campania Luigi Vanvitelli, Via Pansini 5, Naples, Italy
| | - R Ruggiero
- XI Chirurgia Generale, Universita' della Campania Luigi Vanvitelli, Via Pansini 5, Naples, Italy
| | - D Parmeggiani
- XI Chirurgia Generale, Universita' della Campania Luigi Vanvitelli, Via Pansini 5, Naples, Italy
| | - M Iacobone
- Endocrinochirurgia- Azienda Ospedaliera di Padova, Padua, Italy
| | - N Innaro
- Unità Operativa di Endocrinochirurgia, Azienda Ospedaliero-Universitaria Mater Domini, Catanzaro, Italy
| | - C P Lombardi
- Unità Operativa Complessa Chirurgia Endocrina, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - N de Manzini
- UOC Clinica Chirurgica di Trieste, Dipartimento Universitario Clinico di Scienze Mediche Chirurgiche e della Salute, Trieste, Italy
| |
Collapse
|
3
|
Picciariello A, Lobascio P, Spazzafumo L, Rinaldi M, Dibra R, Trigiante G, Laforgia R, Pezzolla A, Altomare DF. The REALISE score: a new statistically validated scoring system to assess the severity of anal fissures. Tech Coloproctol 2021; 25:935-940. [PMID: 33987779 PMCID: PMC8289784 DOI: 10.1007/s10151-021-02459-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/04/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Anal fissure (AF) is a common, painful disease that strongly affects patients' quality of life, however, no scoring system to assess the severity of AF is available in the literature. The aim of this study was to set up and validate a reliable scoring system to quantify the severity of AF, to be used in prospective trials comparing the efficacy and the outcomes of surgical or medical treatments. METHODS The study was conducted on patients with acute or chronic AF and a control group in a tertiary centre for coloproctology in June 2020-September 2020. Two researchers independently carried out a structured interviewer-led questionnaire at two different time points (T1/T2). The questionnaire consisted of five items selected according to the most commonly reported symptoms for AF: the item pain, was scored from 0 to 10 using a visual analogue scale, and quality of life, duration of pain, use of painkillers, and bleeding were scored from 1 to 5 using Likert-scale questions. The scoRing systEm for AnaL fIsSurE (REALISE) score was the sum of the points. Patients with AF and a control group of patients with haemorrhoids, anal fistula, or obstructed defecation syndrome entered the study. Main outcome measures were reliability, inter-/intraobserver agreement, and repeatability. RESULTS One hundred and fifty well-matched patients (75 with AF and 75 controls) were enrolled. A significant difference was found between the mean REALISE score for patients with AF and controls (p < 0.001). The two REALISE scores were highly correlated (r = 0.99). The coefficient of repeatability was 1.45 in T1 and 1.18 in T2. CONCLUSIONS The REALISE score may have an important role in the assessment and management of AF, in grading the severity of AF and comparing results of different treatments.
Collapse
Affiliation(s)
- A Picciariello
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy. .,Unit of Laparoscopic Surgery, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.
| | - P Lobascio
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - L Spazzafumo
- Agenzia Regionale Sanitaria (The Regional Agency for Health), Marche Region, Ancona, Italy
| | - M Rinaldi
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - R Dibra
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - G Trigiante
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - R Laforgia
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - A Pezzolla
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - D F Altomare
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| |
Collapse
|
4
|
Medas F, Ansaldo GL, Avenia N, Basili G, Bononi M, Bove A, Carcoforo P, Casaril A, Cavallaro G, Conzo G, De Pasquale L, Del Rio P, Dionigi G, Dobrinja C, Docimo G, Graceffa G, Iacobone M, Innaro N, Lombardi CP, Novelli G, Palestini N, Pedicini F, Perigli G, Pezzolla A, Pezzullo L, Scerrino G, Spiezia S, Testini M, Calò PG. Impact of the COVID-19 pandemic on surgery for thyroid cancer in Italy: nationwide retrospective study. Br J Surg 2021; 108:e166-e167. [PMID: 33659983 PMCID: PMC7989577 DOI: 10.1093/bjs/znab012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/19/2020] [Accepted: 01/06/2021] [Indexed: 12/25/2022]
Affiliation(s)
- F Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - G L Ansaldo
- Endocrine Surgery Unit, Ospedale Policlinico San Martino, Genoa, Italy
| | - N Avenia
- General Surgery and Surgical Specialties Unit, Santa Maria University Hospital Terni and University of Perugia, Medical School, Terni, Italy
| | - G Basili
- General Surgery Department, Endocrine Surgery Unit, Azienda USL Toscana Nord-Ovest, Pontedera, Italy
| | - M Bononi
- Department of Surgery, Pietro Valdoni, Sapienza University of Rome, Rome, Italy
| | - A Bove
- Department of Medicine, Dentistry and Biotechnology, University 'G. D'Annunzio', Chieti, Italy
| | - P Carcoforo
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy
| | - A Casaril
- Endocrine Surgery Unit, Pederzoli Hospital, Peschiera del Garda, Italy
| | - G Cavallaro
- Department of Surgery, Pietro Valdoni, Sapienza University of Rome, Rome, Italy
| | - G Conzo
- Division of General and Oncological Surgery, Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - L De Pasquale
- Endocrine Surgery, ASST Santi Paolo e Carlo University of Milan, Milan, Italy
| | - P Del Rio
- General Surgery Unit, Parma University Hospital, Parma, Italy
| | - G Dionigi
- Division for Minimally Invasive and Endocrine Surgery, University of Messina, Messina, Italy
| | - C Dobrinja
- Department of Medicine, Surgery and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - G Docimo
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - G Graceffa
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - M Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - N Innaro
- Unit of Endocrine Surgery, AOU Mater Domini, Catanzaro, Italy
| | - C P Lombardi
- Division of Endocrine Surgery, Department of Gastroenterological, Endocrine-Metabolic and Nephro-Urologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - G Novelli
- Endocrine Surgery Unit, Department of Oncological-Mininvasive Surgery, Niguarda Hospital, Milan, Italy
| | - N Palestini
- Head and Neck Oncological Surgery, Candiolo Cancer Institute, Candiolo, Italy
| | - F Pedicini
- Thyroid Endocrine Surgery, Sant'Eugenio Hospital, Rome, Italy
| | - G Perigli
- Endocrine Surgery Unit, University of Florence, Florence, Italy
| | - A Pezzolla
- Division of Videolaparoscopic Surgery, Department of Emergency and Organ Transplantation, University of Bari 'A. Moro', Bari, Italy
| | - L Pezzullo
- Thyroid Surgery Unit, INT IRCSS Fondazione Pascale, Naples, Italy
| | - G Scerrino
- Department of Surgical Oncology and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - S Spiezia
- Endocine and Ultrasound-Guided Surgery Operative Unit, Ospedale del Mare, Naples, Italy
| | - M Testini
- Unit of Academic General Surgery 'V. Bonomo', Department of Biomedical Sciences and Human Oncology, University of Bari 'A. Moro', Bari, Italy
| | - P G Calò
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | | |
Collapse
|
5
|
Panebianco A, Laforgia R, Volpi A, Punzo C, Vacca G, Minafra M, Di Salvo M, Pezzolla A. Preoperative fasting - "nihil per os" a difficult myth to break down: a randomized controlled study. G Chir 2020; 41:84-93. [PMID: 32038017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION For several years the scientific anaesthesia societies declared a preoperative fast of 6 hours for solid foods and 2 hours for clear liquids before elective surgical interventions to be sufficient. The aim of this study is to identify the extent of the gap that exists between the preoperative fasting time required and that actually encountered in operating rooms. PATIENTS AND METHODS The safety and clinical applicability of a reduction of the preoperative fasting time was investigated through the use of oral solutions enriched with maltodextrin and their effects on the pre- and postoperative well-being that this may have on patients who are candidates for elective abdominal surgery. The study was conducted in two successive phases (I and II) and patients divided into two groups (A and B). DISCUSSION Clinical practice is slow to change, in fact, in our study the duration of fasting was an average of 19 hours for solids and 13 hours for liquids. The duration of the fasting did not show differences in the various surgical departments, demonstrating that it is a transversal practice and is not only limited to abdominal surgery in which the utility of fasting would theoretically be greater. Among Group patients A, the fasting time for liquids was about 9 hours. This shows that the time is certainly shorter but not much different when compared to the fasting time for liquids in group B which was on average 14 hours. It is important how difficult it is to achieve good compliance from patients when trying to reduce the time of preoperative fasting based on scientific evidence that is now well established. CONCLUSION The use of carbohydrate-enriched drinks up to 2 hours after induction of anaesthesia appears to be a safe procedure. The use of these solutions reduces the catabolic response to surgery and contributes to maintaining a pre-operative state of well-being by reducing feelings of hunger and thirst and the state of preoperative anxiety.
Collapse
|
6
|
Pezzolla A, Lattarulo S, Mancusi Materi G, Labellarte C, Madaro A, Spinelli S, Corciulo R. [Management of a symptomatic acute severe hyponatremia recovered by its neurological sequelae. A case report]. Clin Ter 2014; 165:e216-8. [PMID: 24999577 DOI: 10.7417/ct.2014.1722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hyponatremia is a common condition in hospitalized patients, with an incidence rate of about 30%. Acute severe hyponatremia is frequently acquired in hospital, due to surgery or an injudicious use of fluid infusions, or the use of nephrotoxic drugs or those stimulating excessive natruresis. A 59 year old male was hospitalized under emergency conditions in General Surgery for abdominal pain. The patient's anamnesis included: hypertension, diabetes, suspected Crohn's disease all in pharmacological treatment. During the recovery rehydration and antibiotic therapy (imipenem+cilastatin and metronidazole) was made and beclomethasone was suspended. On the seventh day from the recovery, the patient had a symptomatic acute severe hyponatremia with neurological severe symptoms (loss of consciousness, seizures). After the immediate diagnosis of the severe sodium loss, the patient underwent to an aggressive intravenous therapy for the electrolytic disorder during the first 24 hours, followed by a target-guided therapy until the level of serum sodium was in the normal values range. The patient, despite the neurological symptoms due to hyponatremia and the rapid and aggressive electrolytic therapy, had no neurological damage with a complete "restitutio ad integrum" of his neurological activity.
Collapse
Affiliation(s)
- A Pezzolla
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Università "Aldo Moro", Bari, Italia
| | - S Lattarulo
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Università "Aldo Moro", Bari, Italia
| | - G Mancusi Materi
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Università "Aldo Moro", Bari, Italia
| | - C Labellarte
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Università "Aldo Moro", Bari, Italia
| | - A Madaro
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Università "Aldo Moro", Bari, Italia
| | - S Spinelli
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Università "Aldo Moro", Bari, Italia
| | - R Corciulo
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Università "Aldo Moro", Bari, Italia
| |
Collapse
|
7
|
D'Elia G, Fabiano G, Lattarulo S, Specchia G, Pezzolla A, Punzo C, Mestice A, Tromba A, Palasciano N, Pannarale O. Cellular and humoral inflammatory response after laparoscopic and conventional colorectal surgery. Eur J Surg Oncol 2013. [DOI: 10.1016/j.ejso.2013.07.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
8
|
Pezzolla A, Lattarulo S, Caputi O, Ugenti I, Fabiano G, Piscitelli D. Colonic lipomas. Three surgical techniques for three different clinical cases. G Chir 2012; 33:420-422. [PMID: 23140930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Colonic lipomas larger than 2 cm in diameter are likely to be symptomatic. In some cases a complication is the first clinical sign. Massive lower intestinal bleeding or obstruction, acute bleeding, prolapse or perforation or, rarely, acute intussusception with intestinal obstruction require urgent surgery. Diagnosis is often made following colonoscopy, which can also have a therapeutic role. Imaging procedures such as CT has a secondary role. Patients with small asymptomatic colonic lipomas need regular follow up. For larger (diameter > 2 cm) and/or symptomatic lipomas, resection should be considered, although the choice between endoscopic or surgical resection remains controversial. We believe that even lipomas > 2 cm can safely be removed by endoscopic resection. If surgery is indicated, we consider laparoscopy to be the ideal approach in all patients for whom minimally invasive surgery is not contraindicated.
Collapse
Affiliation(s)
- A Pezzolla
- Department of Emergency and Organ Transplantation, Aldo Moro University of Bari, Bari, Italy
| | | | | | | | | | | |
Collapse
|
9
|
Ciampolillo A, Bellacicco M, Natalicchio A, Pezzolla A, Trerotoli P, Grammatica L, Achille G, Giorgino F. Clinical aggressiveness of incidental and non-incidental thyroid cancer. J Endocrinol Invest 2011; 34:599-603. [PMID: 20820129 DOI: 10.3275/7254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND With the increasing use of thyroid ultrasound, the recognition of thyroid nodules in a large proportion of apparently healthy subjects has become common. Because also the papillary thyroid microcarcinomas (PTMC) are being increasingly discovered, it is important to ascertain whether PTMC may exhibit heterogenous clinical features, associated with different aggressiveness. AIM We retrospectively examined 122 subjects [98 female (80.3%), and 24 male (19.7%)] with thyroid cancer to find potential clinical and pathological findings that could be predictive of clinically aggressive behavior. RESULTS Twenty of the 31 patients with true incidental cancer (64.5%) in comparison to 20 of the 91 patients with non-incidental cancer (21.9%) had a diameter <10 mm, and this difference was statistically significant (p<0.0001). There was a statistically significant association between size and invasiveness because 19.3% of invasive cancers were <10 mm whereas 44.6% of non-invasive cancers were <10 mm (p=0.005). The relationship between incidental discovery and invasiveness was also evaluated, but the proportion of incidental invasive cancer (19.3%) was not significantly different from that of incidental non-invasive cancer (30.8%). In the multivariate analysis, only size <10 mm (odds ratio=0.35, p=0.013) and papillary vs other histotypes (odds ratio=0.35, p=0.04) were statistically significant protective factors against invasiveness. CONCLUSIONS a) Incidentally discovered thyroid cancers are more frequently microcarcinomas; b) there appears to be no difference in terms of invasive behavior between incidental and non-incidental thyroid cancer; c) smaller tumor size emerges as a protective factor.
Collapse
Affiliation(s)
- A Ciampolillo
- Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Disease, Aldo Moro University of Bari, Bari, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Sanguinetti A, Docimo G, Ragusa M, Calzolari F, D'Ajello F, Ruggiero R, Parmeggiani D, Pezzolla A, Procaccini E, Avenia N. Ultrasound scissors versus electrocautery in axillary dissection: our experience. G Chir 2010; 31:151-153. [PMID: 20444331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The ultrasound scissors are recently emerging as an alternative surgical tool for dissection and haemostasis and have been extensively used in the field of minimally invasive surgery. We studied the utility and advantages of this instrument compared with electrocautery to perform axillary dissection. The operative and morbidity details of thirty-five breast cancer patients who underwent axillary dissection using the ultrasound scissors were compared with 35 matched controls operated with electrocautery by the same surgical team. There was no significant difference in the operating time between the ultrasound scissors and electrocautery group (36 and 30 mins, p>0.05). The blood loss (60 +/- 35 ml and 294 +/- 155 ml, p<0.001) and drainage volume (200 +/- 130 ml and 450 +/- 230 ml, p<0.001) were significantly lower in the ultrasound scissors group. There was a significant reduction of draining days in ultrasound scissors group (mean one and four days, respectively p<0.05). There was significant difference in the seroma rate between the two groups (10% and 30%, respectively). Axillary dissection using harmonic scalpel is feasible and the learning curve is short. Ultrasound scissor significantly reduces the blood loss and duration of drainage as compared to electrocautery.
Collapse
|
11
|
Fabiano G, Pezzolla A, Maiorino R, Ferrarese F. [Peritoneal adhesions: pathophysiology]. G Chir 2008; 29:115-125. [PMID: 18366893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Peritoneal adhesions will form as a consequence of all types of trauma of the peritoneal serosa, be they mechanical, thermal, chemical, infective, or ischemic. Any stimulation induces deposition on the serosa of a fibrin-rich exudate that results in a weaker or stronger adhesion of the viscera to other viscera or to the wall parietal peritoneum. These adhesions are mostly temporary and are eliminated by the action of the fibrinolytic agents present in the peritoneum. In optimal conditions, repair of the injured peritoneum occurs thanks to early mesothelial proliferation over the entire damaged surface, with little production of permanent fibrous adhesions. Some traumatic events are more prone than others to inhibit fibrinolysis through the production of cytokines, that trigger the production of plasminogen inhibitors, thus determining a greater number of more tenacious adhesions. Some stimuli producing postoperative adhesions are iatrogenic in nature and can be individuated and corrected to reduce the production of such adhesions and avoid the onset of adhesion syndromes.
Collapse
Affiliation(s)
- G Fabiano
- Universita' degli Studi di Bari, Dipartimento di Ginecologia, Ostetricia e Neonatologia
| | | | | | | |
Collapse
|
12
|
Fabiano G, Pezzolla A, Filograna MA, Ferrarese F. [Traumatic shock--physiopathologic aspects]. G Chir 2008; 29:51-57. [PMID: 18252151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Traumatic shock is a complex phenomenon that represents the culminating element of a series of events. It is, in fact, the outcome of an imbalance-decompensation of the organism's defence mechanisms, in which the oxygen supply to the mitochondria is hampered by a macro and/or microcirculation failure. Basically, it is a form of hypovolemic shock in which further factors have a role, including the activation of inflammation mediators. It should also be stressed that part of the cellular damage is caused by tissue reperfusion. Good hemodynamic compensation is maintained with loss of up to 30% of the circulation mass but, beyond this amount, a fall of the cardiac index, peripheral pO2, and an increase of blood lactates will ensue. Hypoxia causes capillary injury and increased permeability, resulting in the formation of edema and finally in loss of the self-regulating power of the microcirculation. Moreover, it strongly stimulates pro-inflammatory activation of the macrophages and the release of vasoactive substances, such as prostaglandins and thromboxanes. The inflammatory response is triggered by cascade systems (such as the complement, coagulation, kinins, fibrinolysis), cell elements (endothelium, leukocytes, macrophages, monocytes, mast cells) and the release of mediators (cytokines, proteolytic enzymes, histamine, etc.) and others interacting factors. In severe trauma, the inflammatory process extends beyond the local limits, maintaining and aggravating the state of shock and causing a Systemic Inflammatory Response Syndrome (SIRS), with involvement and injury of healthy organs and tissues even at a distance from the site of trauma, raising a risk of onset of ARDS (Acute Respiratory Distress Syndrome), sepsis, MODS (Multiple Organ Dysfunction Syndrome). Tissue reperfusion (reoxygenation) also induces the production of toxic metabolites, such as hydroxylated anions, superoxide, hydrogen peroxide: peroxidation of the phospholipid cell membranes alters the barrier functions, permitting entry of substances such as calcium, which interfere with the intracellular enzymatic systems.
Collapse
Affiliation(s)
- G Fabiano
- Università degli Studi di Bari, Dipartimento Di Scienze Chirurgiche Generali e Specialistiche, Italy
| | | | | | | |
Collapse
|
13
|
Portincasa P, Moschetta A, Petruzzelli M, Palasciano G, Di Ciaula A, Pezzolla A. Gallstone disease: Symptoms and diagnosis of gallbladder stones. Best Pract Res Clin Gastroenterol 2006; 20:1017-29. [PMID: 17127185 DOI: 10.1016/j.bpg.2006.05.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The clinical aspects and the diagnostic features of gallstone disease are described. The natural history of silent gallstones is overviewed, and the risk of developing symptoms and complications is also discussed. The importance of colicky pain as a specific gallstone symptom is highlighted, and the role of both laboratory tests and diagnostic investigations for differential diagnosis is discussed. Finally, we describe the diagnostic features of gallbladder stone disease, including indications, sensitivity, specificity, and limitations of different test investigations under special circumstances.
Collapse
Affiliation(s)
- P Portincasa
- Clinica Medica A. Murri, Department of Internal and Public Medicine, University of Bari Medical School, Piazza Giulio Cesare 11-Policlinico-70124 Bari, Italy.
| | | | | | | | | | | |
Collapse
|
14
|
Fabiano G, Pezzolla A, Filograna MA, Ferrarese F. [Risk factors of surgical wound infection]. Ann Ital Chir 2004; 75:11-6. [PMID: 15283381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Surgical Site Infection (SSI) continues to be a major source of morbidity following operative procedures. The aging of the population means that not only will the number of operations likely increase, but the National Nosocomial Infections Surveillance (NNIS) Risk Index, which standardizes the risk of SSI for an aging population, will be greater. The NNIS report for 1986-1996 described an SSI rate of 2.6% for all operations at the reporting hospitals. It seems likely that overall SSI rates are likely to be greater than reported. All surgical wounds are contaminated by bacteria, but only a minority actually demonstrate clinical infection. The SSI are the biological summation of several factors: the inoculum of bacteria introduced into the wound during the procedure, the unique virulence of contaminants, the microenvironment of each wound, and the integrity of the patients host defense mechanisms. Risk factors were studied in single and multivariate analyses. Although an SSI rate of zero may not be achievable, continued progress in understanding the biology of infection at the surgical site and consistent applications of proven methods of prevention will allow us to further reduce the frequency, cost, and morbidity associated with SSI.
Collapse
Affiliation(s)
- G Fabiano
- Università degli Studi di Bari, Dipartimento di Scienze Chirurgiche Generali e Specialistiche Sezione di Chirurgia Generale.
| | | | | | | |
Collapse
|
15
|
Polignano FM, Pezzolla A, Camporeale S, Ferrarese F, Ferrarese S. Improved acceptability of laparoscopic surgery and increasing rate of cholecystectomy implications for surgeon and patients. Hepatogastroenterology 1999; 46:2796-800. [PMID: 10576347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND/AIMS The aim of our study was to evaluate the impact of introduction of laparoscopic cholecystectomy (LC) and reasons for the increase in cholecystectomy rate, by a retrospective review of all admissions for gallbladder disease before and after the introduction of laparoscopic surgery in our department. METHODOLOGY Chi-squared test was used for statistical analysis of the comparisons. RESULTS Comparing the 2 periods, cholecystectomy rate increased by 35% (p<0.01) and patients aged 25-44 years were more likely to undergo LC (p<0.001); a 35% decrease in unjustified refusal (p<0.02) was also observed. The number of both longstanding disease patients and asymptomatic ones operated upon was not different (p=1; p=0.06), while a 46% increase (p=0.02) in cholecystectomy rate was shown in patients with low-grade symptoms or at 1st colic episode. CONCLUSIONS An increase in the patient pool due to improved acceptability was responsible for the increase in cholecystectomy rate after introduction of laparoscopic surgery, rather than lowered surgical threshold, as previously suggested by other authors. Judiciousness is required to prevent the increased acceptability of LC from leading to its uncontrolled and unrestricted use, as alteration of the surgical threshold may occur without surgeon awareness, particularly when dealing with low grade symptomatic patients.
Collapse
Affiliation(s)
- F M Polignano
- 1st Department of Surgical Pathophysiology, University of Bari, Policlinico Hospital, Italy
| | | | | | | | | |
Collapse
|
16
|
Ambrosi A, Fabiano G, Sparasci V, Morelli M, Pezzolla A, Errico D, Timurian D, Bonadies E, Fersini A, Iacobone M. [Comparison of hernioplasty using the technic of Bassini and Trabucco. Comparative analysis and results]. Ann Ital Chir 1998; 69:203-6; discussion 206-7. [PMID: 9718789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We evaluated comparatively trough a randomized perspective study the hernioplasty by Bassini technique and the Trabucco repair, respectively using general and local anaesthesia, in a group of 80 patients. We studied incidence of complications and recurrences, surgery, in-patient hospitalization time, postoperative pain, costs and work resuming. Trabucco repair had better results in each considered parameter: hospitalization time, pain and costs respectively 80%, 50% and 66% lower vs Bassini technique; moreover we found no recurrence and work resuming two weeks shorter.
Collapse
Affiliation(s)
- A Ambrosi
- Cattedra di Endocrinochirurgia, Università degli Studi di Bari
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Morelli M, Lattarulo S, Ugenti I, Lerario C, Brindicci D, Napoli A, Pezzolla A. [Schwannomas of the digestive tract. Observations on a case localizing in the ileum]. Ann Ital Chir 1997; 68:549-52; discussion 553. [PMID: 9494187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The schwannomas are rare tumors taking origin from Schwann's cells; even rarer is their location at a peripheral level. Even if they show the macroscopic and microscopic characteristics of a benign tumor, it is possible that they engage malignant course, with possibility of recurrency and of distant metastasis. In the alimentary tract the schwannomas reveal with repeated episodes of digestive hemorrhage which could engage, according to the location, the characters of enterorrhagia or melena. Arteriography has the higher diagnostic sensibility, in course of bleeding. The CT could demonstrate a submucosal neoplasia. The diagnosis of schwannomas is based on the immunohistochemical search of the protein S100, that allows to differentiate them from the tumors of muscular origin, having such tumors common histological and cytological aspects. The schwannomas are today set in the widest chapter of the so-called "stromal tumors of the gastrointestinal tract" (GISTs) with an indefinite malignancy which need surgical excision and an attentive follow-up. The authors report a case of schwannoma located at the first jejunal loop, having had repeated episodes of digestive hemorrhage. The diagnosis was based on the selective arteriography of the upper mesenteric artery and the immunohistochemical search of the protein S100. The surgical treatment consisted of the resection of the jejunal loop, after having sought for eventual multiple locations of the neoplasia.
Collapse
Affiliation(s)
- M Morelli
- I Clinica Chirurgica, Università degli Studi di Bari
| | | | | | | | | | | | | |
Collapse
|
18
|
Ambrosi A, Pezzolla A, Barone G, Quaranta G, Errico D, Iacobone M, Ciampolillo A, Triggiani V. [Clinical study of residual function and recurrences in patients after partial thyroidectomy for non-toxic nodular goiter]. Ann Ital Chir 1994; 65:543-6; discussion 546-7. [PMID: 7733577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The different surgical chances for the treatment of non toxic nodular goiter led the Authors to study the residual function after partial thyroidectomy. A variable rate of recurrences and hormone deficiency was shown in patients who underwent sub-total thyroidectomy, lobectomy and enucleation. It depended on the amount of residual gland and the different methods they used. Recurrences occurred more in patients studied by ultrasonography. After sub-total thyroidectomy the Authors noted a more reduced number of recurrences than after lobectomy and enucleation. There was a meaningless connection between high plasmatic levels of TSH and recurrences. Subclinical hypothyroidism was higher in patients who underwent subtotal thyroidectomy than in patients treated with lobectomy and enucleation. These clinical data show that recurrences could depend on growth factors (EGF, IGF) in thyroid tissues and not only on TSH action. Therefore the surgical attitude of the authors in the treatment of nodular goiter consists in total thyroidectomy.
Collapse
Affiliation(s)
- A Ambrosi
- Cattedra di Chirurgia Generale Base, Università degli Studi di Bari
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Ambrosi A, Pezzolla A, Bandini MR, Fabiano G. [Therapeutic problems in euthyroid multinodular goiter]. Ann Ital Chir 1992; 63:593-7; discussion 597-8. [PMID: 1290363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Now therapeutic different possibilities of goitre pathology seem well defined, in front of limit of suppressive therapeutic range in initial stages, prevalently diffuse, that interest young people and arise in jodic want lands; it's possible that medic theraphy ends can't be obtained because of not responders patient, or even for possibilities of controindications. Local presence of suspicious nodules and the need of goitre volumetric reduction for aesthetical and compressory ends, with the possibility in course of time of functional changes are sure reasons to surgery. Certainly main problems exist about surgery definition of multinodular disease with bilobar involvement where there is comparing between total and subtotal thyroid exeresis. Now by literature analysis and our School experience we think that surgery choice, considered before operation, must find absolute assurance after preoperative morphotopographic careful exploration of thyroid. We think that total thyroidectomy must be done when it's certain a total gland involvement, reserving subtotal thyroidectomy in the other cases; always employing a careful surgery technique, keeping operative field interely bloodless to identify important structures and dissection plan narrowly close by capsule.
Collapse
Affiliation(s)
- A Ambrosi
- Università degli Studi di Bari, Istituto di I Patologia Speciale Chirurgica e Propedeutica Clinica
| | | | | | | |
Collapse
|
20
|
Ambrosi A, Pezzolla A, Ugenti I, Bandini MR, Biffi E, Fabiano G. [The endoscopic diagnosis of reflux esophagitis: the value of color endoscopy]. MINERVA CHIR 1992; 47:617-9. [PMID: 1375348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- A Ambrosi
- Istituto di I Patologia Speciale Chirurgica, Università degli Studi di Bari
| | | | | | | | | | | |
Collapse
|
21
|
Fiorella R, Barbara M, Morelli M, Pezzolla A. [Esophageal manometry in non-organic pharyngo-esophageal dysphagia syndromes]. Boll Soc Ital Biol Sper 1986; 62:651-7. [PMID: 3790301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|