89 results on '"Erdas, Enrico"'
Search Results
52. Observations on a Giant Sigmoid Volvulus with Unusual Clinical Presentation and Challenging Postoperative Course: Case Report
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Pisano, Giuseppe, primary, Calò, Pietro Giorgio, additional, Piras, Stefano, additional, and Erdas, Enrico, additional
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- 2015
- Full Text
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53. Long-Term Results of Fixation-Free Incisional Hernia Repair Using a Tentacle-Shaped Implant.
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AMATO, GIUSEPPE, ROMANO, GIORGIO, GOETZE, THORSTEN, GORDINI, LUCA, ERDAS, ENRICO, MEDAS, FABIO, and CALÒ, PIERGIORGIO
- Published
- 2017
54. Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option?
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Calò, Pietro Giorgio, primary, Medas, Fabio, additional, Santa Cruz, Rosa, additional, Podda, Francesco, additional, Erdas, Enrico, additional, Pisano, Giuseppe, additional, and Nicolosi, Angelo, additional
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- 2014
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55. Total thyroidectomy without prophylactic central neck dissection in clinically node-negative papillary thyroid cancer: is it an adequate treatment?
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Calò, Pietro, primary, Pisano, Giuseppe, additional, Medas, Fabio, additional, Marcialis, Jacopo, additional, Gordini, Luca, additional, Erdas, Enrico, additional, and Nicolosi, Angelo, additional
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- 2014
- Full Text
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56. Diagnosis and treatment of symptomatic right paraduodenal hernia: report of a case
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Erdas, Enrico, primary, Pitzalis, Antonella, additional, Scano, Daniela, additional, Licheri, Sergio, additional, Pomata, Mariano, additional, and Farina, Giampaolo, additional
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- 2013
- Full Text
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57. Late Bleeding after Total Thyroidectomy: Report of Two Cases occurring 13 Days after Operation
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Calò, Pietro Giorgio, primary, Erdas, Enrico, additional, Medas, Fabio, additional, Pisano, Giuseppe, additional, Barbarossa, Michela, additional, Pomata, Mariano, additional, and Nicolosi, Angelo, additional
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- 2013
- Full Text
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58. Molecular characterization of a t(16;17)(p13.3;q21.3) translocation in a deep fibrous histiocytoma
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Frau, Daniela V., primary, Caria, Paola, additional, Erdas, Enrico, additional, Ambu, Rossano, additional, Dettori, Tinuccia, additional, Faa, Gavino, additional, and Vanni, Roberta, additional
- Published
- 2010
- Full Text
- View/download PDF
59. Correction to: Appendectomy versus conservative treatment with antibiotics for patients with uncomplicated acute appendicitis: a propensity score–matched analysis of patient-centered outcomes (the ACTUAA prospective multicenter trial).
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Podda, Mauro, Poillucci, Gaetano, Pacella, Daniela, Mortola, Lorenzo, Canfora, Alfonso, Aresu, Simona, Pisano, Marcello, Erdas, Enrico, Pisanu, Adolfo, Cillara, Nicola, Serventi, Fernando, Marini, Stefano, Sirigu, Danilo, Piga, Michela, Coppola, Massimiliano, Balestra, Francesco, De Nisco, Carlo, Pazzona, Marco, Anania, Marco, and Pulighe, Fabio
- Abstract
A Correction to this paper has been published: https://doi.org/10.1007/s00384-021-03862-5 [ABSTRACT FROM AUTHOR]
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- 2021
- Full Text
- View/download PDF
60. Tall Cell Variant versus Conventional Papillary Thyroid Carcinoma: A Retrospective Analysis in 351 Consecutive Patients.
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Longheu, Alessandro, Canu, Gian Luigi, Cappellacci, Federico, Erdas, Enrico, Medas, Fabio, and Calò, Pietro Giorgio
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PAPILLARY carcinoma ,LYMPHATIC metastasis ,THYROID cancer ,LYMPHADENECTOMY ,RETROSPECTIVE studies ,MEDICAL records - Abstract
Background: The aim of this retrospective study was to investigate clinical and pathological characteristics of the tall cell variant of papillary thyroid carcinoma compared to conventional variants. Methods: The clinical records of patients who underwent surgical treatment between 2009 and 2015 were analyzed. The patients were divided into two groups: those with a histopathological diagnosis of tall cell papillary carcinoma were included in Group A, and those with a diagnosis of conventional variants in Group B. Results: A total of 35 patients were included in Group A and 316 in Group B. All patients underwent total thyroidectomy. Central compartment and lateral cervical lymph node dissection were performed more frequently in Group A (42.8% vs. 18%, p = 0.001, and 17.1% vs. 6.9%, p = 0.04). Angiolymphatic invasion, parenchymal invasion, extrathyroidal extension, and lymph node metastases were more frequent in Group A, and the data reached statistical significance. Local recurrence was more frequent in Group A (17.1% vs. 6.3%, p = 0.02), with two patients (5.7%) in Group A showing visceral metastases, whereas no patient in Group B developed metastatic cancer (p = 0.009). Conclusions: Tall cell papillary carcinoma is the most frequent aggressive variant of papillary thyroid cancer. Tall cell histology represents an independent poor prognostic factor compared to conventional variants. [ABSTRACT FROM AUTHOR]
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- 2021
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- View/download PDF
61. Predictive Factors of Recurrence in Patients with Differentiated Thyroid Carcinoma: A Retrospective Analysis on 579 Patients.
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Medas, Fabio, Canu, Gian Luigi, Boi, Francesco, Lai, Maria Letizia, Erdas, Enrico, and Calò, Pietro Giorgio
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CANCER relapse ,CANCER patients ,LYMPH nodes ,METASTASIS ,MULTIVARIATE analysis ,RISK assessment ,STATISTICS ,THYROID gland tumors ,THYROIDECTOMY ,RETROSPECTIVE studies ,ODDS ratio ,CANCER risk factors - Abstract
Differentiated thyroid carcinoma (DTC) is usually associated with a favorable prognosis. Nevertheless, up to 30% of patients present a local or distant recurrence. The aim of this study was to assess the incidence of recurrence after surgery for DTC and to identify predictive factors of recurrence. We included in this retrospective study 579 consecutive patients who underwent thyroidectomy for DTC from 2011 to 2016 at our institution. We observed biochemical or structural recurrent disease in 36 (6.2%) patients; five-year disease-free survival was 94.1%. On univariate analysis, male sex, histotype, lymph node yield, lymph node metastasis, extrathyroidal invasion and multicentricity were associated with significantly higher risk of recurrence, while microcarcinoma was correlated with significantly lower risk of recurrence. On multivariate analysis, only lymph node metastases (OR 4.724, p = 0.012) and microcarcinoma (OR 0.328, p = 0.034) were detected as independent predictive factors of recurrence. Postoperative management should be individualized and commensurate with the risk of recurrence: Patients with high-risk carcinoma should undergo strict follow-up and aggressive treatment. Furthermore, assessment of the risk should be repeated over time, considering individual response to therapy. [ABSTRACT FROM AUTHOR]
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- 2019
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62. Benign Multicystic Peritoneal Mesothelioma in a Male Patient with Previous Wilms’ Tumor: A Case Report and Review of the Literature
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Luigi Canu, Gian, Medas, Fabio, Columbano, Giulio, Gordini, Luca, Saba, Luca, Erdas, Enrico, and Giorgio Calò, Pietro
- Abstract
Benign multicystic peritoneal mesothelioma (BMPM) is a rare condition, more common in females of reproductive age, which arises from the peritoneal mesothelium. A 33-year-old male presented to our unit with abdominal pain and constipation. His past medical history included a previous unilateral nephrectomy for Wilms’ tumor and the previous incidental finding of some intra-abdominal cystic formations at the level of the mesentery. After performing a CT scan, an exploratory laparotomy was done and a voluminous cystic mesenteric mass, composed of 3 confluent formations, was observed. Some other similar but significantly smaller lesions were found. An en bloc resection of the mesenteric mass together with the corresponding intestinal loops, an appendicectomy, and some peritoneal biopsies were performed. The postoperative period was complicated by a peritonitis due to dehiscence of the intestinal anastomosis, which required another operation, and a delayed return of normal bowel function, which was resolved through prokinetic therapy. Through histological examination, a BMPM was diagnosed. At 8 months of follow-up, the patient is free of symptoms. BMPM exact etiopathogenesis still remains uncertain. Given his high recurrence rate, a long-term follow-up is recommended.
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- 2018
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63. Appendectomy versus conservative treatment with antibiotics for patients with uncomplicated acute appendicitis: a propensity score-matched analysis of patient-centered outcomes (the ACTUAA prospective multicenter trial)
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Gaetano Poillucci, Nicola Cillara, Enrico Erdas, M. Pisano, Mauro Podda, S Aresu, Daniela Pacella, Lorenzo Mortola, Alfonso Canfora, Adolfo Pisanu, Podda, Mauro, Poillucci, Gaetano, Pacella, Daniela, Mortola, Lorenzo, Canfora, Alfonso, Aresu, Simona, Pisano, Marcello, Erdas, Enrico, Pisanu, Adolfo, and Cillara, Nicola
- Subjects
medicine.medical_specialty ,03 medical and health sciences ,0302 clinical medicine ,Multicenter trial ,Internal medicine ,medicine ,Appendectomy ,Prospective cohort study ,Adverse effect ,Uncomplicated appendicitis ,business.industry ,Clinical outcome ,Patient-centered outcomes ,Gold standard ,Gastroenterology ,Hepatology ,medicine.disease ,Antibiotic treatment ,Appendicitis ,Multicenter study ,Surgery ,030220 oncology & carcinogenesis ,Propensity score matching ,030211 gastroenterology & hepatology ,business ,Conservative treatment - Abstract
Purpose: The aim of this prospective multicenter study was to compare antibiotic therapy and appendectomy as treatment for patients with uncomplicated appendicitis confirmed by ultrasound and/or computed tomography. Methods: The study was conducted from January 2017 to January 2018. Data regarding all patients discharged from the participating centers with a diagnosis of uncomplicated appendicitis were collected prospectively. Results: Of the 318 patients enrolled in the study, 27.4% underwent antibiotic-first therapy, and 72.6% underwent appendectomy. The matched group was composed of 87 patients in both study arms. Of the 87 patients available of 1-year follow-up in the antibiotic-first group, 64 (73.6%) did not require appendectomy. The complication-free treatment success in the antibiotic-first group was 64.4%. A statistically significant higher complication-free treatment success was found in the appendectomy group: 81.8% in the pre-matching sample and 83.9% in the post-matching sample. Patients in the antibiotic-first group reported lower VAS scores compared to those treated with an appendectomy, both at discharge (2.0 ± 1.7 vs 3.6 ± 2.3) and at 30-day follow-up (0.3 ± 0.6 vs 2.1 ± 1.7). The mean of the days of absence from work was higher in the appendectomy group (β 0.63; 95% CI 0.08-1.18). Conclusion: Although laparoscopic appendectomy remains the gold standard of treatment for uncomplicated appendicitis, conservative treatment with antibiotics is a safe option in most cases. Approximately 65% of patients treated with antibiotics are symptom-free at 1 year, without increased risk of adverse events should symptoms recur, and better outcomes in terms of less pain and shorter period of absence from work compared to patients undergoing an appendectomy. Trial registration: Clinicaltrials.gov identifier (NCT number): NCT03080103.
- Published
- 2021
64. Prophylactic Central Neck Dissection in Clinically Node-Negative Differentiated Thyroid Carcinoma: An Overview
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Gian Luigi Canu, Fabio Medas, Francesco Boi, Giovanni Conzo, Francesco Podda, Enrico Erdas, Pietro Giorgio Calò, Luigi Canu, Gian, Medas, Fabio, Boi, Francesco, Conzo, Giovanni, Podda, Francesco, Erdas, Enrico, and Giorgio Calò, Pietro
- Abstract
Although therapeutic central neck dissection is recommended for patients with differentiated thyroid cancer with cervical lymph node metastasis, the effectiveness of prophylactic central neck dissection following total thyroidectomy in patients with clinical node-negative differentiated thyroid cancer remains controversial. There are many arguments in favor and many against the execution of prophylactic central neck dissection. The authors review the most recent literature and illustrate the latest published guidelines, focusing on the currently hottest and most debated points. Authors conclude that there is still no consensus on the role of prophylactic central neck dissection in clinically node-negative differentiated thyroid carcinoma. Prophylactic central neck dissection is associated with higher rates of hypoparathyroidism and recurrent laryngeal nerve injury with uncertain benefits. So, in the absence of involved lymph nodes, prophylactic central neck dissection should be avoided, reserving it to high-risk patients with advanced primary tumors; prophylactic central neck dissection should be performed by high-volume surgeons to avoid definitive complications.
- Published
- 2019
65. Intraoperative Neuromonitoring in Thyroid Surgery
- Author
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Medas, Fabio, Canu, Gian Luigi, Erdas, Enrico, and Calò, Pietro Giorgio
- Subjects
Medical - Abstract
Recurrent laryngeal nerve (RLN) injury is the most feared complication in thyroid surgery, resulting in a worse patients’ quality of life, and is the most common cause of medical claim. Visualization of RLN before proceeding with dissection of the gland is considered the gold standard. In the last decade, intraoperative neuromonitoring (IONM) of RLN has progressively gained acceptance; nowadays, this method is widely spread, being routinely used in large workflow centers. IONM is helpful in the identification of RLN and allows to asses nerve functionality during and at the end of surgical procedure. In this chapter, IONM features, its advantages and limits, and its usefulness will be discussed.
- Published
- 2019
66. Neomyogenesis in 3D Dynamic Responsive Prosthesis for Inguinal Hernia Repair
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Giuseppe, Amato, Giorgio, Romano, Roberto, Puleio, Antonino, Agrusa, Thorsten, Goetze, Eliana, Gulotta, Luca, Gordini, Enrico, Erdas, Piergiorgio, Calò, Amato, Giuseppe, Romano, Giorgio, Puleio, Roberto, Agrusa, Antonino, Goetze, Thorsten, Gulotta, Eliana, Gordini, Luca, Erdas, Enrico, and Calò, Piergiorgio
- Subjects
Male ,Muscle Cells ,Inguinal hernia ,Biomedical Engineering ,Tissue scaffold ,Muscle Cell ,Medicine (miscellaneous) ,Hernia, Inguinal ,Bioengineering ,Middle Aged ,Muscle Development ,Biomaterial ,Follow-Up Studie ,Prosthesis Implantation ,Prosthese ,Tissue regeneration ,Humans ,Muscular tissue ,Herniorrhaphy ,Follow-Up Studies ,Aged ,Human - Abstract
Despite undisputed improvements, prosthetics hernia repair continues to be affected by unacceptable rates of complications. Postoperative adverse events such as discomfort and chronic pain represent a subject of increasing concern among the surgical community. Poor quality biologic response, stiff scar plates, and mesh shrinkage, a typical effect of conventional static meshes and plugs, are all indicated as the main reasons for many of the complications related to inguinal hernia repair. Even the conventional concept of treatment based upon a supposed reinforcement of the groin consequent to the fibrotic incorporation of meshes, would appear to be inadequate in the light of the latest scientific evidence concerning the degenerative genesis of inguinal hernia. Following these recent studies, a newly conceived 3D dynamically responsive implant has been developed. It concerns a multilamellar shaped prosthesis, intended to be placed fixation-free to obliterate the hernia defect. This 3D structure has already demonstrated to induce a probiotic biological response with development of viable tissue, instead of the fibrotic plaque typical of conventional meshes. Newly formed elastic fibers, neo-angiogenesis, and neo-nerve genesis in a surrounding of well perfused connective tissue are the typical elements of the biologic response in the newly conceived implant. In addition to these elements, muscle fibers have also been detected in the implant structure. The aim of this research was to determine the ingrowth of muscle fibers in the implant by assessing the quantity and quality of muscle development in the short, medium, and long term post-implantation. Histological examination of biopsy samples excised from patients who underwent dynamic hernia repair with the 3D dynamic implant showed the presence of muscular elements that in the short term could be described as multiple spots of myocytes in the early stage of development. Over the mid- to long-term, muscle fibers increased in number and level of maturation, assuming the typical aspect of standard muscle bundles in the final phase. Effectively, long term, myocytes histologically evidenced the distinctive arrangement of the muscle structure, with nuclei and striated elements being similar to normal muscle elements. The development of this highly specialized connective tissue in the 3D dynamic responsive implant seems to document the finalization of an enhanced biologic response leading to the ingrowth of typical tissue components of the groin. Reverting degenerative pathogenesis into effective regeneration recognized in the newly conceived 3D prosthesis would appear to represent a significant concept change in the repair of inguinal hernias.
- Published
- 2018
67. Intraoperative neuromonitoring in thyroid surgery: Is the two-staged thyroidectomy justified?
- Author
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Francesco Podda, Gian Luigi Canu, Giovanni Conzo, Claudio Gambardella, Giuseppe Pisano, Fabio Medas, Pietro Giorgio Calò, Angelo Nicolosi, Enrico Erdas, Calã², Pietro Giorgio, Medas, Fabio, Conzo, Giovanni, Podda, Francesco, Canu, Gian Luigi, Gambardella, Claudio, Pisano, Giuseppe, Erdas, Enrico, and Nicolosi, Angelo
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Intraoperative Neurophysiological Monitoring ,medicine.medical_treatment ,Clinical Decision-Making ,Thyroid Gland ,030230 surgery ,Neuromonitoring ,Sensitivity and Specificity ,Group B ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Postoperative Complications ,Tracheostomy ,Recurrent laryngeal nerve ,Predictive Value of Tests ,medicine ,Paralysis ,Humans ,Therapeutic strategy ,Intraoperative neuromonitoring ,Aged ,Aged, 80 and over ,Surgical team ,Palsy ,business.industry ,Thyroid ,Thyroidectomy ,Signal Processing, Computer-Assisted ,General Medicine ,Middle Aged ,Recurrent laryngeal nerve monitoring ,Thyroid surgery ,Surgery ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Anesthesia ,Recurrent Laryngeal Nerve Injuries ,Female ,medicine.symptom ,business ,Vocal Cord Paralysis - Abstract
Background: The aim of this study was to evaluate the diagnostic accuracy of intraoperative neuro-monitoring (IONM) in predicting postoperative nerve function during thyroid surgery and its consequent ability to assist the surgeon in intraoperative decision making.Materials and methods: A total of 2365 consecutive patients were submitted to thyroidectomy by the same surgical team. Group A included 1356 patients (2712 nerves at risk) in whom IONM was utilized, and Group B included 1009 patients (2018 nerves at risk) in whom IONM was not utilized.Results: In Group A, loss of signal (LOS) was observed in 37 patients; there were 29 true positive, 1317 true negative, 8 false positive, and 2 false negative cases. Accuracy was 99.3%, positive predictive value was 78.4%, negative predictive value was 99.8%, sensitivity was 93.6%, and specificity was 99.4%. A total of 29 (2.1%) cases of unilateral paralysis were observed, 23 (1.7%) of which were transient and 6 (0.4%) of which were permanent. Bilateral palsy was observed in two (0.1%) cases requiring a tracheostomy. In Group A, 31 (2.3%) injuries were observed, 25 (1.8%) of which were transient and 6 (0.4%) of which were permanent. In Group B, 26 (2.6%) unilateral paralysis cases were observed, 20 (2%) of which were transient and 6 (0.6%) of which were permanent; bilateral palsy was observed in 2 (0.2%) cases. In Group B, 28 (2.8%) injuries were observed, 21 (2.1%) of which were transient and 7 (0.7%) of which were permanent. Differences between the two groups were not statistically significant.Conclusions: Our results show that IONM has a very high sensitivity and negative predictive value, but also good specificity and positive predictive value. For these reasons, in selected patients with LOS, the surgical strategy should be reconsidered. However, patients need to be informed preoperatively about potential strategy changes during the planned bilateral surgery. Future larger and multicenter studies are needed to confirm the benefits of this therapeutic strategy. (C) 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.
- Published
- 2016
68. Risk of malignancy in thyroid nodules classified as TIR-3A: What therapy?
- Author
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Pietro Giorgio Calò, Angelo Nicolosi, Fabio Medas, Claudio Gambardella, Giuseppe Pisano, Luca Gordini, Gian Luigi Canu, Giovanni Conzo, Enrico Erdas, Medas, Fabio, Erdas, Enrico, Gordini, Luca, Conzo, Giovanni, Gambardella, Claudio, Canu, Gian Luigi, Pisano, Giuseppe, Nicolosi, Angelo, and Calã², Pietro Giorgio
- Subjects
Thyroid nodules ,Adult ,Male ,medicine.medical_specialty ,Biopsy, Fine-Needle ,030209 endocrinology & metabolism ,Malignancy ,Thyroid cancer ,Papillary thyroid cancer ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Adenocarcinoma, Follicular ,medicine ,Humans ,Thyroid Neoplasms ,Thyroid Nodule ,Atypia of undetermined significance ,Follicular thyroid cancer ,Aged ,Retrospective Studies ,Ultrasonography ,Fine-needle aspiration ,Thyroid ,medicine.diagnostic_test ,business.industry ,Cancer ,General Medicine ,Middle Aged ,medicine.disease ,Fine needle cytology ,Carcinoma, Papillary ,medicine.anatomical_structure ,Thyroid Cancer, Papillary ,030220 oncology & carcinogenesis ,Axilla ,Surgery ,Female ,Radiology ,Lymph Nodes ,Cytology ,business - Abstract
Background: The aim of the present study was to assess the clinical applicability of the TIR3A category in managing thyroid nodules, to examine the malignancy rates of TIR 3A and TIR 3B nodules, and to suggest management guidelines for these nodules.Materials and methods: Thyroid cytologies performed in patients referred to our Department between January 2014 and August 2016 were classified according to the guidelines published by the SIAPEC. 102 cases were included in this retrospective study and were divided into two groups: 19 TIR3A were included in group A and 83 TIR3B in group B.Results: In group A, malignancy was diagnosed in 4 (21.1%) cases, papillary thyroid cancer was found in 3 patients and follicular thyroid cancer in 1; one case was classified as microcarcinoma, in two cancer was multicentric and bilateral and in one central node metastases were observed. In Group B malignancy was diagnosed in 48 (57.8%) patients, papillary thyroid cancer was found in 36 patients and follicular cancer in 12; microcarcinoma was observed in 25 cases, 12 were unilateral multicentric and 7 bilateral multicentric; in 3 cases central node metastases were present.Conclusion: Thyroid nodules with TIR3A cytology have a lower risk of malignancy than TIR3B cases, for which the new SIAPEC classification has proved accurate and effective. Malignancy rates in nodules with TIR3A cytology are higher than expected, although the real and accurate definition of the risk is extremely difficult. The recommendation to perform an accurate follow-up and repeat the fine-needle aspiration still appears the best option. For better management of patients with TIR3A cytology a careful assessment of risk factors and ultrasound characteristics is always needed. Further multicenter studies with longer follow-up are needed to better define the efficacy of this classification, the actual cancer risk, and the best management of these lesions. (C) 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.
- Published
- 2016
69. Is prophylactic central neck dissection justified in patients with cn0 differentiated thyroid carcinoma? An overview of the most recent literature and latest guidelines
- Author
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Canu, G. L., Medas, F., Conzo, G., FRANCESCO BOI, Amato, G., Erdas, E., Calò, P. G., Canu, Gian Luigi, Medas, Fabio, Conzo, Giovanni, Boi, Francesco, Amato, Giuseppe, Erdas, Enrico, and Calò, Pietro Giorgio
- Subjects
Lymphatic Metastasis ,Practice Guidelines as Topic ,Thyroidectomy ,Humans ,Neck Dissection ,Lymph Nodes ,Thyroid Neoplasms ,Neoplasm Recurrence, Local - Abstract
To date, in patients with differentiated thyroid cancer, central neck dissection is recommended in the presence of central compartment lymph node metastases. Differently, the efficacy of prophylactic central neck dissection in case of clinically node-negative differentiated thyroid carcinoma remains still uncertain. There are many arguments in favor and many against the execution of this surgical procedure. The most recent literature and latest guidelines have been reviewed and illustrated, paying particular attention to currently hottest and most discussed points. Prophylactic central neck dissection is associated with higher rates of postoperative complications, such as recurrent laryngeal nerve injury and hypoparathyroidism, with unclear oncological benefits. Thus, in the absence of lymph node involvement, this procedure should be avoided, reserving it for high-risk patients with advanced primary tumors. Moreover, to avoid serious complications, prophylactic central neck dissection should be performed by high-volume surgeons. KEY WORDS: Clinically node-negative differentiated thyroid cancer, Differentiated thyroid carcinoma, Prophylactic central neck dissection.Attualmente, nei pazienti con carcinoma tiroideo differenziato, la linfectomia del comparto centrale del collo è raccomandata in presenza di metastasi linfonodali in tale sede. L’efficacia della linfectomia profilattica del comparto centrale nel carcinoma tiroideo differenziato con linfonodi clinicamente negativi rimane invece ancora controversa. Esistono diversi argomenti a favore e diversi contro l’esecuzione di questa procedura chirurgica. Sono state revisionate ed illustrate la letteratura più recente e le ultime linee guida, prestando particolare attenzione ai punti più caldi e discussi. La linfectomia profilattica del comparto centrale è associata a tassi più elevati di complicanze postoperatorie, come lesioni del nervo laringeo ricorrente ed ipoparatiroidismo, con benefici oncologici poco chiari. Pertanto, in assenza di coinvolgimento linfonodale, tale procedura dovrebbe essere evitata, riservandola a pazienti ad alto rischio con tumori primari avanzati. Inoltre, per evitare gravi complicanze postoperatorie, questa la linfectomia profilattica del comparto centrale dovrebbe essere eseguita da chirurghi ad alto volume.
70. Risk factors of permanent hypoparathyroidism after total thyroidectomy Retrospective analysis of 285 consecutive patients.
- Author
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Canu GL, Medas F, Cappellacci F, Noordzij JP, Marcialis J, Erdas E, and Calò PG
- Subjects
- Humans, Parathyroid Glands, Parathyroid Hormone, Postoperative Complications epidemiology, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Hypoparathyroidism epidemiology, Hypoparathyroidism etiology, Thyroidectomy adverse effects
- Abstract
Aim: Permanent hypoparathyroidism is the most common long-term complication after total thyroidectomy. The aim of the present study was to investigate the risk factors of this complication., Material and Methods: Patients undergoing thyroidectomy in our Unit between January 2017 and February 2018 were retrospectively analysed. They were divided into 2 groups: those with normal parathyroid function in the long term were included in Group A, those who developed permanent hypoparathyroidism in Group B., Results: Two hundred and eighty-five patients were included in this study: 271 in Group A and 14 in Group B. No statistically significant difference was found in terms of sex, age, extent of surgery, rate of retrosternal goiter, postoperative stay and histopathological findings between the 2 groups. On the contrary, mean operative time, rate of patients with PTH values < 6.3 pg/mL on postoperative day 1 and mean thyroid weight were significantly greater in Group B than in Group A (P = 0.049, P < 0.001, P = 0.014; respectively)., Conclusions: Long operative times, PTH levels < 6.3 pg/mL on postoperative day 1 and high thyroid weight have proved to be strong risk factors of permanent hypoparathyroidism after total thyroidectomy. Thus, in these cases a careful follow-up is highly recommended., Key Words: Permanent hypoparathyroidism, Risk factors, Total thyroidectomy.
- Published
- 2021
71. Is extensive surgery really necessary in patients with parathyroid carcinoma? Single-centre experience and a brief review of the literature.
- Author
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Canu GL, Medas F, Cappellacci F, Piras S, Sorrenti S, Erdas E, and Calò PG
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- Calcium blood, Humans, Neoplasm Recurrence, Local prevention & control, Parathyroid Diseases blood, Parathyroid Diseases complications, Parathyroid Diseases surgery, Parathyroid Hormone blood, Reoperation, Retrospective Studies, Hyperparathyroidism, Primary blood, Hyperparathyroidism, Primary etiology, Hyperparathyroidism, Primary surgery, Parathyroid Neoplasms blood, Parathyroid Neoplasms complications, Parathyroid Neoplasms surgery, Parathyroidectomy methods
- Abstract
Aim: Parathyroid carcinoma (PC) represents a rare cause of primary hyperparathyroidism (PHPT). In this paper, among patients who underwent surgery for PHPT, we compared those with benign parathyroid disease with those affected by PC in terms of demographic and preoperative biochemical features. Moreover, we singularly described all 10 cases of PC treated at our Institution (including a case that occurred in a patient with tertiary hyperparathyroidism) and a brief review of the literature., Material and Methods: Patients undergoing surgery for PHPT in our Unit between 2003 and 2018 were retrospectively analysed. They were divided into two groups: Group A (benign parathyroid disease), Group B (PC). The case of PC that occurred in the patient with tertiary hyperparathyroidism was not included into the two groups., Results: Three hundred and eight patients were included: 299 in Group A and 9 in Group B. The mean preoperative serum PTH value and mean preoperative serum calcium level were significantly higher in Group B than in Group A (P = 0.018, P = 0.027; respectively). Including the case of PC that occurred in the patient with tertiary hyperparathyroidism, 10 patients with PC were treated at our Institution. Among these, 3 underwent a re-exploration. Disease recurrence occurred in 1 (10%) patient, who developed a local recurrence and distant metastases., Conclusions: In the presence of PHPT characterized by particularly high preoperative levels of serum PTH and calcium this malignancy should be suspected. On the basis of our experience, we believe that extensive surgery is not always necessary., Key Words: Hyperparathyroidism, Parathyroid carcinoma, Parathyroid surgery.
- Published
- 2021
72. Is prophylactic central neck dissection justified in patients with cN0 differentiated thyroid carcinoma? An overview of the most recent literature and latest guidelines.
- Author
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Canu GL, Medas F, Conzo G, Boi F, Amato G, Erdas E, and Calò PG
- Subjects
- Humans, Lymph Nodes, Lymphatic Metastasis, Neoplasm Recurrence, Local, Practice Guidelines as Topic, Thyroidectomy, Neck Dissection, Thyroid Neoplasms surgery
- Abstract
To date, in patients with differentiated thyroid cancer, central neck dissection is recommended in the presence of central compartment lymph node metastases. Differently, the efficacy of prophylactic central neck dissection in case of clinically node-negative differentiated thyroid carcinoma remains still uncertain. There are many arguments in favor and many against the execution of this surgical procedure. The most recent literature and latest guidelines have been reviewed and illustrated, paying particular attention to currently hottest and most discussed points. Prophylactic central neck dissection is associated with higher rates of postoperative complications, such as recurrent laryngeal nerve injury and hypoparathyroidism, with unclear oncological benefits. Thus, in the absence of lymph node involvement, this procedure should be avoided, reserving it for high-risk patients with advanced primary tumors. Moreover, to avoid serious complications, prophylactic central neck dissection should be performed by high-volume surgeons. KEY WORDS: Clinically node-negative differentiated thyroid cancer, Differentiated thyroid carcinoma, Prophylactic central neck dissection.
- Published
- 2020
73. Monitored transoral endoscopic thyroidectomy.
- Author
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Calò PG, Medas F, Canu GL, and Erdas E
- Abstract
Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.
- Published
- 2019
- Full Text
- View/download PDF
74. Small bowel transanal evisceration mimicking a rectal prolapse. A case report and review of literature.
- Author
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Pisano G, Erdas E, Medas F, Pisano U, and Calò PG
- Subjects
- Aged, Anal Canal, Emergencies, Female, Humans, Rectal Diseases surgery, Rupture, Spontaneous, Diagnostic Errors, Jejunum, Rectal Diseases diagnosis, Rectal Prolapse diagnosis
- Abstract
Transanal intestinal evisceration is a very uncommon and dramatic occurrence, linked most frequently to rectal prolapse rupture or, very rarely, to traumatic pathology. The Authors describe a case of a 74-year-old female patient who required urgent hospital admission because of a seemingly strangulated rectal prolapse. During surgical preparation the protruding mass was recognized as small bowel loops herniating from the anus. Evisceration was due to spontaneous rectal wall rupture, most likely caused by increased abdominal pressure and consequent breach through the weakened rectum. Surgical treatment consisted in small bowel resection combined with an Hartmann's procedure. Spontaneous rectal rupture without a pre-existing rectal prolapse is a rather infrequent and challenging condition; its mechanism is still incompletely explained. The management is surgical and may range from primary repair up to extensive intestinal resection to include a defunctioning colostomy., Key Words: Rectal prolapse, Spontaneous rectal rupture, Transanal evisceration.
- Published
- 2017
75. Adrenal incidentalomas and subclinical Cushing syndrome: indications to surgery and results in a series of 26 laparoscopic adrenalectomies.
- Author
-
Pisano G, Calò PG, Erdas E, Pigliaru F, Piras S, Sanna S, Manca A, Dazzi C, and Nicolosi A
- Subjects
- Adenoma diagnosis, Adenoma surgery, Adrenal Cortex Neoplasms complications, Adrenal Cortex Neoplasms diagnosis, Adrenal Cortex Neoplasms surgery, Adrenal Gland Neoplasms diagnosis, Adrenal Gland Neoplasms secondary, Adrenal Gland Neoplasms surgery, Adrenocortical Adenoma complications, Adrenocortical Adenoma diagnosis, Adrenocortical Adenoma surgery, Adult, Aged, Carcinoma secondary, Diabetes Mellitus, Type 2 complications, Humans, Hyperplasia, Hypertension etiology, Incidental Findings, Middle Aged, Obesity complications, Thyroid Neoplasms pathology, Adenoma complications, Adrenal Gland Neoplasms complications, Adrenalectomy, Cushing Syndrome etiology, Laparoscopy
- Abstract
Background: Casual detection of an adrenal mass, the so called incidentaloma (AI) requires an in-depth analysis of imaging phenotype together with hormonal investigation, in order to evaluate both its potential malignancy and the occurrence of a preclinical condition of hypercortisolism (Subclinical Cushing Syndrome, SCS). Aim of the present work is to evaluate surgical indications and results of surgery in patients harbouring an AI with inapparent hypercortisolism., Methods: The study has been carried on in a series of 26 Laparoscopic Adrenalectomies (LA) performed from January 2009 and January 2015. Indications to surgery included AI (11 cases), Cushing's syndrome (7 cases), suspected metastases (5 cases) and Conn's disease (3 cases). Six patients with AI had a SCS associated with variable forms of a metabolic syndrome: they were evaluated in detail analysing cortisol secretion and values of Arterial Hypertension, Diabetes Mellitus and BMI before and after surgery., Results: As far as SCS is concerned, LA was completed in 5 patients (one case converted). Pathology revealed 5 adenomas and one nodular hyperplasia. Four cases required oral cortisone administration at the discharge. At a mean follow- up of 33 months cortisol secretion returned to normal range in all patients; an improvement of metabolic condition was observed in 60, 25, and 50 per cent of hypertensive, diabetic and obese patients respectively., Conclusion: Indications to LA in case of AI and SCS is strongly supported by the presence of an associated metabolic syndrome. In spite of a limited number, our experience confirms the favourable results of surgery in such patients., Key Words: Adrenal incidentaloma, Laparoscopic adrenalectomies, Subclinical Cushing syndrome.
- Published
- 2015
76. [Anastomotic leak following colorectal surgery: incidence, risk factors and treatment].
- Author
-
Erdas E, Zedda A, Pitzalis A, Scano D, Barbarossa M, Aresu S, Licheri S, Pomata M, and Farina G
- Subjects
- Adult, Aged, Aged, 80 and over, Anastomosis, Surgical adverse effects, Female, Humans, Incidence, Male, Middle Aged, Risk Factors, Colonic Neoplasms surgery, Postoperative Complications epidemiology, Postoperative Complications surgery, Rectal Neoplasms surgery
- Abstract
The aim of this study was to assess the incidence and identify the risk factors associated with colorectal anastomotic leakage. A further objective was to investigate the therapeutic choices. We reviewed the clinical files of 124 patients who underwent mechanical end-to-end anastomosis after colorectal resection during the period 2000-2007. The mean age was 66.9 years and the male:female ratio was 1.2:1. Indications for surgery were malignant neoplasms in 109 cases (87.9%) and benign disease in 15 cases (12.1%). The anastomosis was always performed in an elective setting in the framework of a procedure of one or more stages (87.9% and 7.3% respectively). A pelvic drain was positioned in a routine manner and no protective ileostomies were constructed. Among the various risk factors, co-morbidities, ASA risk and low anastomotic level were the most important we examined. Student's t-test, the Chi-square test and Fisher's test were used for comparative univariate analysis, with significant results for p < or = 0.05. The incidence of anastomotic leak was 10.5% (13/124), but only 4.8% (6/124) required a second operation or failed to heal with simple conservative therapy. The pelvic drain was always effective in allowing the early diagnosis of leakages and limiting the spread of peritoneal inflammation. Mortality was 1.6% (2/124) overall, but, if leakages alone were considered, it increased to 15.4%. Among the risk factors examined, only low anastomotic level was confirmed by statistical analysis. In conclusion, the study confirms low anastomotic level as a negative prognostic factor for the healing of colorectal anastomosis. The pelvic drain proved to be effective in allowing early diagnosis and conservative management of leakages.
- Published
- 2009
77. [Fournier's gangrene in an HIV-positive patient. Therapeutic options].
- Author
-
Licheri S, Erdas E, Pisano G, Garau A, Barbarossa M, Tusconi A, and Pomata M
- Subjects
- Adult, Humans, Male, Fournier Gangrene etiology, Fournier Gangrene surgery, Genital Diseases, Male etiology, Genital Diseases, Male surgery, HIV Seropositivity complications, Perineum, Scrotum
- Abstract
Fournier's gangrene is a life-threatening necrotising infection of the perineal and genital regions. The case presented here refers to an HIV-positive 42-year-old man, admitted in emergency to our department with clinical signs and symptoms of sepsis related to gangrene of the perineum and scrotum. An early wide surgical necrosectomy was performed under epidural anaesthesia. Treatment was completed by intensive care, broad-spectrum antibiotics and hyperbaric oxygen therapy. The wound was managed with advanced dressing (AQUACEL Hydrofiber) until complete healing was obtained, and the scrotum was reconstructed with skin flaps. The disease did not involve the testes, spermatic cord or anorectal canal. The satisfactory aesthetic and functional outcome prompts the authors to stress a number of features of the therapeutic approach adopted: (i) the advantages of epidural anaesthesia with an indwelling catheter that allows further necrosectomy and wound dressing to be performed totally painlessly; (ii) the possibility of avoiding faecal diversion by means of synthetic opioid drugs which are useful to reduce the frequency of defecation; and (iii) the positive impact of advanced dressing on the wound healing process in relation to patient satisfaction and cost management.
- Published
- 2008
78. Surgical gastrostomy when percutaneous endoscopic gastrostomy is not feasible: indications, results and comparison between the two procedures.
- Author
-
Pisano G, Calò PG, Tatti A, Farris S, Erdas E, Licheri S, Dazzi C, and Daniele GM
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Gastroscopy, Gastrostomy methods
- Abstract
Percutaneous endoscopic gastrostomy (PEG) is the procedure of choice in patients unable to eat owing to neoplastic or neurological diseases. In a few cases, however, PEG is not feasible and on such occasions a surgical gastrostomy (SG) proves mandatory to prevent starvation. The aim of the present study was to evaluate the cases submitted to SG when PEG could not be performed and to compare the results of the two procedures. We reviewed the medical records of 52 patients who required clinical nutrition in the years 2000-May 2007: 41 cases underwent PEG and 11 SG. Surgery was adopted when PEG failed or was deemed not to be feasible Analysis of the two series included sex, age, indications, associated diseases, mortality, complications, hospital stay and survival. Head and neck malignancies were the main indication to SG (81.1%), while PEG was adopted mainly for neurological diseases. In two cases, SG was required after failure of PEG due to lack of transillumination. A tracheostomy was present in 54.4% of the SG group and in 17% of the PEG group. Thirty-day mortality was nil in SG and 12% in PEG; morbidity was 9 and 7.3%, respectively. Hospital stay was 7 days in SG and 3 days in the PEG group. Survival at 24 months was poor in both series: 10% in SG and 25% in PEG. In case of PEG failure or contraindication, SG is more than satisfactory in terms of effectiveness, mortality and morbidity.
- Published
- 2008
79. Uncommon pathologies discovered during exploratory laparoscopy for malignant diseases.
- Author
-
Pisano G, Erdas E, Licheri S, Dazzi C, Pomata M, and Daniele GM
- Subjects
- Adult, Aged, Biopsy, Diagnosis, Differential, Female, Humans, Laparotomy, Lymphoma diagnosis, Male, Middle Aged, Pancreas pathology, Pancreatitis, Acute Necrotizing diagnostic imaging, Pancreatitis, Acute Necrotizing mortality, Pancreatitis, Acute Necrotizing pathology, Peritoneal Neoplasms diagnosis, Peritoneum pathology, Peritonitis, Tuberculous pathology, Recurrence, Tomography, X-Ray Computed, Laparoscopy, Pancreatitis, Acute Necrotizing diagnosis, Peritonitis, Tuberculous diagnosis
- Abstract
In spite of the most sophisticated diagnostic tools, the final diagnosis in malignant diseases may require an exploratory laparoscopy for confirmation. The aim of this study was to report our experience with exploratory laparoscopy and to describe two unexpected cases of uncommon pathologies discovered during this procedure. From January 2003 to December 2005, 7 exploratory laparoscopies were performed to confirm and stage carcinoma with peritoneal involvement (4 cases) and to obtain histological evidence of lymphoma (3 cases). Uncommon pathologies were detected in two cases (28%): the first was a black man presenting with multiple tubercular lesions mimicking neoplastic spread, and the second an elderly Caucasian woman with a pre-pancreatic mass suspected of being a lymphoma, which was due to previous subclinical pancreatitis. The effectiveness of laparoscopy was confirmed in the present experience. A tissue specimen is mandatory when the differential diagnosis is hard to achieve.
- Published
- 2007
80. [Inflammatory complications of colon diverticular disease: current therapeutic challenges].
- Author
-
Erdas E, Licheri S, Garau A, Pisano G, Pomata M, and Daniele GM
- Subjects
- Acute Disease, Adult, Age Factors, Aged, Aged, 80 and over, Colostomy, Diverticulitis, Colonic drug therapy, Diverticulitis, Colonic etiology, Diverticulitis, Colonic surgery, Diverticulosis, Colonic mortality, Drainage, Emergencies, Female, Humans, Male, Middle Aged, Peritonitis etiology, Prognosis, Quality of Life, Risk Factors, Diverticulitis, Colonic therapy, Diverticulosis, Colonic complications, Intestinal Perforation etiology, Intestinal Perforation surgery, Peritonitis surgery
- Abstract
Inflammatory complications of diverticular disease are still responsible for high mortality rates. The aim of the present study was to analyse the factors that primarily influence the type of treatment and prognosis of such pathologies. From 1996 to 2006, 88 patients were admitted to our department for inflammatory complications secondary to diverticular disease. The majority of the patients were emergency room referrals, and nearly half of them were elderly (over 65 years of age). The most frequently observed complications were acute diverticulitis (45.5%), which was almost always resolved with medical therapy, and diverticular perforations (43.2%), for which surgical therapy was always necessary. The main treatment for localised peritonitis was one-stage colorectal resection, whereas for generalized peritonitis a two-stage resection was the procedure of choice. The highest degrees of peritonitis were observed in elderly patients. Restoration of bowel continuity was performed in nearly all patients below 65 years of age, but was not possible in 44.4% of those aged above 65. Postoperative mortality occurred in two cases, both with diffuse peritonitis, advanced age, and elevated anaesthetic risk. The present series seems to confirm the findings of other Authors, namely that the prognosis of diverticular perforation is influenced more by patient-related factors (older age, sepsis, comorbidity) than by the type of surgical procedure. Thus, it is probable that a decrease in the mortality rate and improvements in the quality of life can be achieved through more aggressive diagnostic protocols and new preventive strategies.
- Published
- 2007
81. [Sclerotherapy and hydrocelectomy for the management of hydrocele in outpatient and day-surgery setting].
- Author
-
Erdas E, Pisano G, Pomata M, Pinna G, Secci L, Licheri S, and Daniele GM
- Subjects
- Adolescent, Adult, Aged, Humans, Male, Middle Aged, Retrospective Studies, Scrotum surgery, Testicular Hydrocele surgery, Treatment Outcome, Ambulatory Surgical Procedures, Sclerotherapy methods, Testicular Hydrocele therapy, Urologic Surgical Procedures, Male methods
- Abstract
The purpose of this report was to compare two different procedures in the treatment of idiopathic hydrocele, namely, hydrocelectomy and percutaneous sclerotherapy, both of which performed in the outpatient or day surgery setting. A detailed description of the technical local anaesthesia steps is reported together with the sclerotherapy method. The study was conducted in 71 patients with a total of 77 hydroceles treated from 1993 to 2004. Surgery was carried out in 53 cases and sclerotherapy in 24. The latter was more frequently opted for elderly subjects as well as in those patients who requested it. Local or locoregional anaesthesia was reserved to patients treated surgically. The two treatments were compared on the basis of the following parameters: age, operative time, length of hospital stay, success rate and complications. The efficacy of the two procedures was comparable (sclerotherapy 95.8% vs surgery 100%), but sclerotherapy proved more favourable in terms of simplicity, rapidity of execution, shortness of hospital stay and risk of complications. However, 41.7% of patients required more than one treatment to obtain a radical cure, whereas surgery was effective in all cases in just one step. Hospital stay and morbidity were almost the same when surgery was performed under local anaesthesia. Sclerotherapy is an efficient alternative to the classic hydrocelectomy. The choice between the two treatment modalities should be made, taking into account above all the patient's individual preference.
- Published
- 2006
82. [Small bowel obstruction caused by postoperative adhesions: personal experience and review of the literature].
- Author
-
Pomata M, Erdas E, Casu B, Pinna G, Licheri S, Pisano G, and Daniele GM
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Intestinal Obstruction mortality, Intestinal Obstruction therapy, Male, Middle Aged, Retrospective Studies, Survival Analysis, Tissue Adhesions complications, Abdomen surgery, Intestinal Obstruction etiology, Intestine, Small, Postoperative Complications
- Abstract
Small bowel obstruction due to postoperative adhesions still remains an important matter in terms of frequency, diagnostic and therapeutic commitment and costs. The Authors report on a series observed over 14 years consisting of 63 patients (71 cumulative hospital admissions). Surgery was required in 42 cases (59.2%), 23 cases were treated in emergency and 19 cases after failure of conservative treatment. In 29 cases (69%) the surgical procedure was limited to adhesiolysis, whereas in 13 cases (31%) an intestinal resection was performed. During operation the mechanisms responsible for obstruction were: strangulation by an adhesive band (39.4%), angulation (34%), bowel loops and volvulus glued together (13.2% in each case). The operative mortality was 4.7% (2 cases). In 29 cases (40.8%), after medical treatment, the obstruction was completely resolved within a mean period of 4.15 days (range: 2-8). The results lead to the conclusion that diagnostic accuracy in cases of obstruction due to postoperative adhesions is still uncertain. The main aspects of treatment and surgical timing are left to the surgeon's personal experience. Medical treatment, however, should be the first therapeutic option and, in case of doubt, further diagnostic investigations are necessary (mainly CT) to identify those cases amenable to surgical treatment.
- Published
- 2006
83. [Peutz-Jeghers syndrome: an account of 3 cases in the same family and a review of the literature].
- Author
-
Erdas E, Licheri S, Pisano G, Pomata M, and Daniele GM
- Subjects
- Adult, Aged, Female, Humans, Intestinal Polyposis surgery, Male, Pedigree, Peutz-Jeghers Syndrome diagnosis, Peutz-Jeghers Syndrome surgery, Treatment Outcome, Peutz-Jeghers Syndrome genetics
- Abstract
Peutz-Jeghers syndrome is a rare autosomal dominant polyposis characterized by mucocutaneous pigmentation, intestinal hamartomas and an increased risk mainly for gastrointestinal and gynaecological cancer. Our interest in this syndrome is due to the observation of three cases in the same family, two of whom presented the classic Peutz-Jeghers syndrome, while the other had perioral pigmentation only. Therefore, the main clinical elements emerge in the two first cases presenting with recurrent abdominal pain and sub-occlusion. The condition was managed by a combination of radiological, endoscopic and surgical procedures which enabled us to map and remove several gastrointestinal polyps. On histopathological examination the polyps were mainly hamartomas, though some presented both hamartomatous and adenomatous features, while others, removed endoscopically during the follow-up, were identified as true adenomas with initial carcinomatous changes. Furthermore, in one case follow-up examination allowed the early diagnosis and treatment of a cervical carcinoma. In agreement with the literature, our experience suggests that simple polypectomy, via an endoscopic and/or surgical approach, is the treatment of choice in Peutz-Jeghers syndrome. However, if gangrene due to invagination or neoplastic change occurs, an intestinal resection is mandatory. Cancer surveillance must be the first aim of follow-up.
- Published
- 2005
84. Femoral hernia repair with Bard Mesh Dart Plug.
- Author
-
Licheri S, Erdas E, Pomata M, Pisano G, and Daniele GM
- Subjects
- Adult, Aged, Aged, 80 and over, Equipment Design, Female, Follow-Up Studies, Humans, Male, Middle Aged, Time Factors, Hernia, Femoral surgery, Surgical Mesh
- Abstract
Several tension-free femoral hernia repair techniques are currently available with different approaches and prosthetic devices, all of which, however, largely yielding excellent results. The aim of this report was to describe the technical aspects of femoral hernia repair via an infrainguinal approach using the Bard Mesh Dart Plug, and to evaluate the short- and medium-term results in our experience. From May 2000 to December 2003, 25 patients (F/M ratio 2.1:1; mean age 66.4 years) underwent femoral hernia repair with the Bard Mesh Dart Plug. Fourteen patients (56%) were operated on as emergency cases for irreducible hernias and in 3 cases a bowel resection under general anaesthesia was necessary. The other 11 patients underwent surgery on an outpatient day surgery basis under local or spinal anaesthesia. Topical antibiotic prophylaxis was administered in all cases, while short-term prophylaxis with ceftazidime was limited to emergency patients. The main phases of the operation are described. The mean operative time was 40 minutes and the patients were mostly discharged within 2 hours of surgical treatment. No general or local intraoperative complications were registered. Postoperative mortality occurred in a single case (a 98-year-old woman, ASA IV, affected by strangulated hernia). Postoperative morbidity included 4 seromas and 1 haematoma. No recurrences were observed over a mean follow-up period of 24 months (range: 5-46 months). The femoral hernia repair with the Bard Mesh Dart Plug is a simple, safe, fast and effective procedure which can often be carried out in the day surgery setting. It can therefore be regarded as a valid alternative to other tension-free techniques.
- Published
- 2004
85. [Basedow's disease associated with benign and malignant nodular disease of the thyroid: diagnosis and treatment].
- Author
-
Erdas E, Licheri S, Pisano G, Pomata M, and Daniele GM
- Subjects
- Adult, Female, Humans, Incidence, Male, Middle Aged, Retrospective Studies, Thyroid Diseases diagnosis, Thyroid Diseases epidemiology, Thyroid Diseases therapy, Thyroid Neoplasms diagnosis, Thyroid Neoplasms epidemiology, Thyroid Neoplasms therapy, Graves Disease complications, Thyroid Diseases complications, Thyroid Neoplasms complications
- Abstract
Nowadays the prevalence of thyroid nodules in Graves' disease (GD) is estimated as ranging from 15 to 33% and several studies support a high risk of thyroid cancer in this condition. The present study presents a retrospective analysis of 41 cases of GD submitted to total thyroidectomy from 1995 to 2003, aimed at discovering the most useful elements for an optimal diagnostic and therapeutic strategy. We identified 23 patients with coexisting nodular goitre (nodular variants of GD) and among these we carried out a comparative study of 12 cases with only benign nodules and 7 with thyroid carcinoma detected prior to the operation. Four cases were not considered because of incidental microcarcinomas. We found no significant differences in the number, average size and radionuclide imaging of nodules in the two groups. In contrast, analysis of ultrasonographic findings showed that hypoechogenicity correlated closely with malignancy, particularly if associated with ill-defined margins, microcalcifications and intranodular vascular patterns, whereas hyperechogenicity was a typical appearance of benign lesions. Our study suggests that routine thyroid US scans should be considered for complete evaluation of GD, since this pathology frequently implies the development of thyroid nodules which are not always detectable at clinical or radionuclide examination. Surgery is mandatory when nodules with suspicious ultrasonographic features are found and if malignancy cannot be excluded at fine needle aspiration cytology.
- Published
- 2004
86. The treatment of Spigelian hernia with the Prolene Hernia System: notes on techniques.
- Author
-
Licheri S, Pisano G, Pintus M, Erdas E, Martinasco L, Pomata M, and Daniele GM
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Surgical Procedures, Operative methods, Hernia, Ventral surgery, Polypropylenes
- Abstract
Spigelian hernia repair techniques use prostheses both in the traditional and the videolaparoscopic approach; only in selected cases direct suturing of the parietal defect is performed. The aim of this study is to describe a technique that uses a device proposed specifically for inguinal hernias, but which has not yet been described in the literature, namely the Prolene Hernia System (P.H.S.). Our personal experience consists of 7 cases (5 females and 2 males; mean age: 58 years) operated on from January 2002 to May 2003. Four patients were operated on in the ordinary hospitalisation regime with selective spinal anaesthesia and three patients were treated in the day surgery setting with local anaesthesia. With this technique, the underlay patch is positioned in an adequately prepared preperitoneal space and the onlay patch above the internal oblique muscle, while the connector acts as a plug positioned in the parietal defect. The method has proved simple, safe, and fast. It causes minimal discomfort to the patient in terms of postoperative pain and allows rapid rehabilitation. Moreover, it can also be performed in the day surgery setting. The authors conclude that the P.H.S. Spigelian hernia repair technique is a valid alternative to any of the other methods used to date.
- Published
- 2004
87. [Treatment of inguinal hernia with the Prolene Hernia System (P.H.S.)].
- Author
-
Licheri S, Erdas E, Martinasco L, Pisano G, Pomata M, and Daniele GM
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Surgical Procedures, Operative methods, Hernia, Inguinal surgery, Polypropylenes, Surgical Mesh
- Abstract
Among the several techniques available for the treatment of inguinal hernia, the Prolene Hernia System (P.H.S.) has gained widespread acceptance over the past few years. This is an original prosthetic device that combines, in a single step, what other techniques offer separately, namely an underlay patch (preperitoneal placement), an onlay patch (subfascial placement) and a connector that joins them together and works as a plug. The aims of this study were to specify the indications and the technique of this method and to evaluate its efficacy in our experience. From January 1999 to July 2003 we performed 156 inguinal herniorraphies with the P.H.S. in 152 patients (143 male, 9 female; mean age 62.4 years). One hundred and thirty-six cases were primary hermias (mainly types III, IV and VI according to the Rutkow and Robbins classification) and 18 were recurrences (mainly type R3 according to the Campanelli classification). In 56.5% of cases the operations were performed in the day surgery setting, 37.5% as ordinary admissions and 6% as emergency procedures. Locoregional (62.5%) or local (34.2%) anaesthesia were mainly given. Early postoperative complications (7%) were 7 haematomas and 4 seromas. In 125 patients with a follow-up of at least 6 months, the late postoperative complications included 4 cases of persistent inguinocrural pain among the primary hernias (3.7%) and a new recurrence among the recurring hernias. The Authors believe that hernia repair with the P.H.S. is a valid choice comparable to the other common techniques but they suggest its use particularly in primary hernias with major relaxation of the posterior inguinal wall of the inguinal canal or of the entire myopectineal orifice.
- Published
- 2004
88. [Cervico-mediastinal hematoma secondary to extracapsular hemorrhage of parathyroid carcinoma. Clinical case and review of the literature].
- Author
-
Erdas E, Licheri S, Lai ML, Pisano G, Pomata M, and Daniele GM
- Subjects
- Humans, Male, Middle Aged, Carcinoma, Papillary complications, Hematoma etiology, Mediastinal Diseases etiology, Neck, Parathyroid Neoplasms complications
- Abstract
Extracapsular parathyroid haemorrhage is a rare but ominous occurrence, which may cause cervico-mediastinal haematoma and a severe calcaemia imbalance. We identified only 23 cases reported in the literature and these were always secondary to adenoma, hyperplasia or cysts, and never to carcinoma. We describe a case of a 56-year-old man who was admitted to our Institute because of the sudden development of an anterior neck swelling, together with dysphagia, dyspnoea and hoarseness. Physical examination revealed a large ecchymosis extending from the anterior neck to the upper chest, while the early symptoms had disappeared. Laboratory studies, ultrasonography and 99mtTC-Sestamibi scintiscan demonstrated the presence of primary parathyroidism due to a right inferior parathyroid neoplasm. At operation, the parathyroid was excised en bloc with the right thyroid lobe because they were joined together by an extensive fibrous reaction. Histological examination showed a well-differentiated parathyroid carcinoma with evidence of recent haemorrhage. To the best of our knowledge this is the first case of extracapsular haemorrhage due to a parathyroid carcinoma. In summary, although parathyroid haemorrhage is a rare condition, it should always be suspected when a painful mass or diffuse swelling suddenly occurs in the anterior neck, with or without ecchymosis, especially when serum calcium and phosphorus are abnormal.
- Published
- 2003
89. [Adenomyomatosis of the gallbladder. Personal experience and analysis of the literature].
- Author
-
Erdas E, Licheri S, Pulix N, Lai ML, Pisano G, Pomata M, and Daniele GM
- Subjects
- Adult, Aged, Cholecystectomy, Cholecystitis complications, Cholelithiasis complications, Diagnosis, Differential, Female, Follow-Up Studies, Humans, Male, Middle Aged, Time Factors, Ultrasonography, Adenomyoma complications, Adenomyoma diagnosis, Adenomyoma diagnostic imaging, Adenomyoma surgery, Gallbladder Neoplasms complications, Gallbladder Neoplasms diagnosis, Gallbladder Neoplasms diagnostic imaging, Gallbladder Neoplasms surgery
- Abstract
Gallbladder adenomyomatosis is a pathological condition due to parietal thickening and intramural diverticulosis. Though it has always been considered a hyperplastic benign disease, the possibility of malignant transformation is currently admitted. Through an analysis of their personal experience and of the relevant literature, the authors draw attention to anatomical and clinical features, diagnostic interpretations and up-to-date trends in the therapy of this condition. Over the period from 1990 to 2001, 13 patients with adenomyomatosis of the gallbladder were observed, amounting to 4% of all cholecystectomies performed over the same period. According to the extent of the disease three forms have been identified: diffuse (26%), segmental (26%) and localized (48%). The clinical presentation appears to be mainly conditioned by the frequent association with gallstones (84%), and for this reason ultrasonographic features were commonly interpreted as being signs of chronic inflammation or suspected neoplasia, though retrospective ultrasound evaluation revealed pathognomonic signs of gallbladder adenomyomatosis. Indications to surgery were therefore mainly based upon the presence of stones and chronic inflammation. Cholecystectomy is currently also indicated in symptomatic cases of non-lithiasic gallbladder adenomyomatosis, whereas there appears to be no such clear-cut rule for the treatment of asymptomatic cases. Nevertheless, prophylactic laparoscopic cholecystectomy may be justified considering the evolution, the uncertain nature of the disease and the difficult differential diagnosis versus malignant lesions.
- Published
- 2002
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