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Alimentary Tract, DDW, Washington DC, May 2007

The aim of the study was to evaluate the efficacy of parathyroid hormone 1-hour assay for the early prediction of hypoparathyroidism after thyroidectomy. Candidates for total, subtotal, completion thyroidectomy or lobectomy were entered into the study. Pre- and postoperative calcium and parathyroid hormone (1 hour and postoperative day 1 after thyroidectomy) levels and clinical hypocalcaemia were recorded. Patients were divided into 3 groups and 2 subgroups: 1. patients who underwent lobectomy (control group); 2. patients who underwent total thyroidectomy with postoperative hypocalcaemia (2A: asymptomatic patients, 2B: symptomatic patients); 3. asymptomatic patients with normal calcium levels after total thyroidectomy. Of 119 patients, 109 underwent total thyroidectomy and 10 lobectomy. Of the 109 patients submitted to total thyroidectomy, 35 (32.11%) developed postoperative transient hypocalcaemia. Twenty-one patients (19.27%) were asymptomatic and 14 (12.84%) were symptomatic. Parathyroid hormone levels decreased after 1 hour in group 3 (32.98 pg/dl), 2A (9.84 pg/dl) and 2B (7.46 pg/dl). There was no significant difference in parathyroid hormone levels at 1 hour between group 2A and 2B (p = 0.06), but were significantly lower compared to groups 3 and 1 (p0.05). Parathyroid hormone levels at 1 hour after total thyroidectomy is a good predictor of early hypocalcaemia. It might be more useful than serum calcium monitoring for the early identification of patients requiring postoperative calcium supplementation.

Among the late complications of high-dosage pelvic radiotherapy for cervical cancer, anorectal and bladder malignancies are sporadically reported in the literature. In this study the possible relationships of previous radiotherapy with late appearance of neoplasms are analyzed and in particular post-radiotherapy interval, dosage and type or irradiation to the cervical area. The mechanisms or neoplastic transformation or irradiated tissues are also studied. Three clinical cases or women irradiated in the past because or cervical cancer and recently treated at our surgical Division for the appearance or four new pelvic malignancies in the irradiated field (three rectal and one bladder cancer are presented. In conclusion, the possible cause-effect relationships between previous radiotherapy and subsequent appearance of neoplasms are analyzed as well as the potential therapeutical consequences or considering these women high-risk subjects. The usefulness or recruiting women with history or previous radiotherapy for cervical cancer in a strict follow-up program (ultrasonography, cytology and endoscopy) is suggested in order to make an early diagnosis of the new pelvic malignancy with a better possibility or treatment.

The microarchitecture of the corpora cavernosa of the human clitoris was investigated by immunohistochemistry. The distribution pattern of the nerve network was demonstrated by S-100 and neuron specific enolase immunoreactivity. Vascular and nonvascular muscle cells were identified by desmin and/or vimentin expression, and fibroblasts and endothelial cells by vimentin immunoreactivity. The findings show that tissue organisation in the corpora cavernosa of the clitoris is essentially similar to that of the penis except for the absence of the subalbugineal layer interposed between the tunica albuginea and erectile tissue. This has functional implications, suggesting that the clitoral erection cycle differs from that of the penis.

The Authors report their series of 86 patients with gastric polyps, observed from 1986 to 1989. Basing on the literature data the lesions were divided in A) inflammatory polyps, B) hyperplastic polyps, C) adenomatous polyps and 27, 49 and 10 lesions, were respectively found for each type. Particular attention was given to the association between intestinal metaplasia and gastric dysplasia for each type of polyp. A significant prognostic value as a precancerous lesion was recognized only to dysplasia. Therapeutic trend for each single polyp, based on the histologic type, is suggested.

A six case series of "minute gastric cancer", with maximum dimension of less than 5 mm., is presented by the authors. All these cases were studied clinico pathologically by endoscopy and preoperative biopsy and were controlled by detailed pathological examination of the operative specimens, specially in order to assess the incidence of intestinal metaplasia and dysplasia of the gastric mucosa. Histogenetically the authors appreciate a relation between intestinal metaplasia of the gastric mucosa and the intestinal type of the gastric cancer, in according to the Lauren classification. This relation is not evident between intestinal metaplasia and diffuse histological type of gastric cancer. Mucosal dysplasia is the alteration most often found in the gastric mucosa of patients with gastric cancer. Dysplasia of the gastric mucosa should be considered the most important factor related to the development of the gastric cancer.

Primary malignant lymphoma of the thyroid is a very uncommon disease and represents approximately 5% of all thyroid malignant neoplasms. The Authors report a case whose clinical and histopathological features are discussed and compared with those of previously published series. Primary malignant lymphomas raise a number of issues: abrupt onset, age and sex patterns, histological typing (virtually 100% of cases are non-Hodgkin lymphomas), differential diagnosis with either Hashimoto's chronic thyroiditis (often associated with thyroid primary lymphomas) or genuine anaplastic carcinoma of the thyroid. Routine histological study can be complemented by immunohistochemistry. The treatment of choose is total thyroidectomy plus radiotherapy in cases where radical surgery is possible, or radiotherapy alone which usually carries good results.

Prostatic lithiasis is a well know phenomenon. It has little clinical significance and is not easily shown by conventional radiography, which has poor sensitivity and specificity. The authors have studied 612 patients with both suprapubic and transrectal US in order to 1) assess US sensitivity and specificity and 2) report the frequency, spatial distribution, number and features of prostatic calcifications with special emphasis on differential diagnosis between prostatic neoplasms and chronic prostatitis. The authors have also studied the relationship between morphology and symptoms and the results agree with those reported in the scanty literature. The authors conclude that the parameters studied are directly related to age, except for a younger group with clear evidence of genital inflammation. The authors emphasize the impossibility to correlate morphology of prostatic calcifications with pathologic conditions: there are no specific symptoms clearly connected with calcification even though the inflammation is often associated with calcifications.

Torino, 15-18 Giugno 2011