[Extracapsular lobectomy in benign monolobar thyroid diseases]

On the basis of their experience acquired in the field of thyroid surgery the authors examine the problems related to extracapsular lobectomy from a tactical and technical point of view, starting with its principal indications: benign monolobar thyroid disease in a single or multiple nodular form. The validity of extemporary histological tests is also assessed on the basis of their experience of rare false negatives and the relative successive totalization programme. Lastly, the paper underlines the fundamental identification of the recurrent nerve as the central point of the operation, before which the authors emphasize that nothing should be cut or ligated apart from the superior vascular peduncle and vena media.

[Immune evaluations in cancer patients after colorectal resection]

The authors report a protocol of immunomodulation and monitoring of the intestinal function in coloresected patients using fermented milk (yoghurt). Intestinal immunity was evaluated with respect to CD4+ cells armed with secretory intestine-derived IgA, and to CD8+ cells armed with IgG aiming to an additional effect in the host protection against Gram-negative strains, such as Salmonella typhi, whose particularly high incidence in Apulia accounts for an increased immunitary activity. Ten patients (six females, four males), age ranging from 44 to 85 years, who underwent surgery between 1989 and 1992, each of whom had been prescribed a daily ration of 500 gr skimmed yoghurt for one month, were observed. The authors suggest that yoghurt may determine a higher release of gamma-IFN with activation of CD4+ and CD8+ cells. The Lactobacillus stimulation of the B lymphocytes of the Peyer plates seems to induce an increased production of secretory IgA that bind to the CD4+ surface, and of IgG (as an anamnestic response to challenge with yoghurt lactobacilli). Coloresected patients show an immunitary deficiency related to the Gram+ bacterial flora reduction and consequently a decrease in the physiological stimuli. Although these date concern a limited sample, the authors stress the importance of the restoration of bacterial flora in coloresected patients.