[Diagnostic, therapeutic and healthcare management protocols in parathyroid surgery. 1st Consensus Conference]

AIM

The aim of the study was to draw up a management protocol in parathyroid surgery promoted by the Italian Association of Endocrine Surgery Units (UEC Club), based on the guidelines of the main international scientific societies and shared by the experts and applied by the operators in the sector.

METHODS AND CONSENSUS

The management protocols, already presented in 2003, on the occasion of the current review were examined by the 1st Consensus Conference called on the topic by the Italian Association of Endocrine Surgery Units (UEC). The Conference comprised two distinct sessions, the first in November 2006 within the framework of the 5th National Congress of the UEC Club in Verona, and the second in September 2007 within the framework of the 10th Multidisciplinary Scanno Prize Meeting. A selected board of endocrinologists and endocrine surgeons examined the individual chapters and submitted the consensus text for the approval of several experts.

CONCLUSIONS

The diagnostic, therapeutic and healthcare management protocols in parathyroid surgery approved by the 1st Consensus Conference are officially those proposed by the Italian Association of Endocrine Surgery Units (UEC Club) and are subject to review by October, 2009.

[Giant aneurysm of the splenic artery: case report and review of the literature]

INTRODUCTION

The authors describe an unusual case of giant aneurysm of the splenic artery. The problem of deciding between endovascular and open vascular surgery and what are the tools necessary to choose the most appropriate procedure are discussed in this report.

CASE REPORT

A man 55 years old was admitted to the hospital for an unspecified abdominal pain. Subsequent examinations (TC and angiography) showed a large aneurysm of the splenic artery without any sign of rupture. Endovascular treatment was excluded because of the extreme tortuosity of the artery; the patient underwent open surgical operation of legation of the aneurysm and splenectomy. The patient was discharged in 6th postoperative day.

DISCUSSION

Splenic artery aneurysm are usually an occasional finding but they are related with an important risk of rupture and mortality; elective treatment both surgical and endovascular is recommended. Emergency surgery is still complicated with an high rate of mortality related to the patient's comorbidities. Endovascular treatment by covered stent-graft or selective embolization may represent the best option but it can be proposed only after an accurate selection of the patients. Endovascular treatment also seems to be feasible even in emergency but only in very selected cases and in expert vascular-interventional units. Laparoscopic surgery has been performed only sporadically.

CONCLUSIONS

We would like to point out that nowadays the treatment of splenic artery aneurysm doesn't give a real choice and each case should be assessed singularly with the purpose to choose the best therapeutic approach either percutaneous or surgical.

Ultrasonographic contrast agent: evaluation of time-intensity curves in the characterisation of solitary thyroid nodules

PURPOSE

To evaluate whether the time-intensity curve can improve characterisation of solitary thyroid nodules.

MATERIAL AND METHODS

From June to December 2000 we studied 61 patients (16 men and 45 women, mean age 46 years) with solitary thyroid nodules that were not associated with any important hormonal alteration and that showed poor tracer uptake at scintigraphy. We evaluated the Power Doppler vascular pattern before and after a 60" intravenous injection of 2.5 g of Levovist (diluted in 7 ml). The study lasted 5 minutes from the beginning of the infusion. Finally, the time-intensity curves were processed. All the nodules underwent fine needle aspiration biopsy (FNAB) and excision biopsy.

RESULTS

Histology revealed 43 benign lesions and 18 malignant lesions. At contrast-enhanced Power Doppler 83.4% (15/18) of the malignant nodules were found to be hypervascularized, while 16.6% (3/18) were hypovascularized. Of the benign lesions, 90.7% (39/43) were hypervascularized, 9.3% (4/43) were hypovascularized. All the nodules, both hyper- and hypovascularized, displayed rapid and intense wash-in curves. By contrast, the wash-out curves were regular and monophasic in 40/43 (93%) benign lesions (36 hypervascularized and 4 hypovascularized lesions) and irregular and polyphasic in 16/18 (89%) malignant lesions (13 hypervascularized and 3 hypovascularized lesions); 3/43 (7%) benign nodules showed polyphasic wash-out and 2/18 malignant lesions (11%) showed monophasic wash-out.

DISCUSSION AND CONCLUSIONS

Time-intensity curves, and particularly wash-out curves, provide useful information for the characterisation of solitary thyroid nodules. 93% of benign nodules (with regular vascularization) showed a monophasic pattern of the wash-out curve, while 89% of malignant nodules ("anarchical" vascularization) had polyphasic wash-out curves. This behaviour was observed in both hypervascularized and hypovascularized lesions. Our method proved to have a sensitivity of 88% and a specificity of 93%. The study of time-intensity curves could therefore enable us to differentiate between benign and malignant lesions and characterise hypovascularized malignant nodules which would not be observed without contrast agent.

[The survival curves of 153 cases of thyroid cancer]

A study is presented on the stage by stage survival curves in 153 cases of thyroid carcinoma observed over 15 years in Ancona Regional Hospital's General Surgery Division. The study reveals that prognosis is good in the first stage, but that neither surgery nor medical or radiological treatments is effective in preventing the deaths of incurable patients at later stages. It is therefore concluded that early surgery is more useful than any operations conducted at later stages.