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Several studies report a higher rate of papillary thyroid carcinomas (PTC) in patients with Hashimoto thyroiditis (HT), indicating a possible correlation between the two diseases. We studied a group of 89 subjects undergoing surgery for thyroid carcinomas compared with a control group of 89 subjects operated on for normofunctioning goiter, and a second group of 47 patients undergoing total thyroidectomy for HT. Association with HT was found in 19 of the 71 PTC subjects (26.7%) and in 8 goiter patients (8.9%), which was a significant difference ( P < 0.02). Thirteen of the HT patients, mostly with the nodular form, showed coexistent PTC (27.6%). HT and PTC coexisted in several morphological, immunohistochemical, and biomolecular aspects; increased incidence of PTC in HT patients might therefore indicate that HT is a precursor of thyroid cancer. Further studies are required, however, in order to confirm this hypothesis; until then, HT patients should undergo careful clinical and technical follow-up.

BACKGROUND: Although Ki-ras and TP53 mutations have probably been the genetic abnormalities most exhaustively implicated and studied in colorectal cancer (CRC) progression, their significance in terms of disease relapse and overall survival has not yet clearly been established. PATIENTS AND METHODS: A prospective study was carried out on paired tumor and normal colon tissue samples from a consecutive series of 160 previously-untreated patients, undergoing resective surgery for primary operable sporadic CRC. Mutations within the TP53 (exons 5-8) and Ki-ras (exon 2) genes were detected by PCR-SSCP analyses following sequencing. RESULTS: Mutation analyses of exons 5 to 8 of the TP53 gene showed mutations in 43% (68/160) of the cases, while mutation analyses of exon 2 of the Ki-ras gene showed mutations in 46% (74/160) of the cases. Multivariate analyses showed that clinical outcome were strongly associated with the presence of specific TP53 mutations in L3 domain alone (only in DFS) or in combination with specific Ki-ras mutations at codon 13. CONCLUSION: Specific TP53 mutations in L3 domain alone (only in DFS) or in combination with specific Ki-ras mutations at codon 13 are associated with a worse prognosis in sporadic CRC.

La via linfatica è una delle principali vie di diffusione metastatica di molte neoplasie. I linfonodi sono gli "snodi" di questo intricato sistema e in alcuni distretti assumono il ruolo di veri e propri check point, meglio ancora di "sentinella", in quanto il loro mancato coinvolgimento nella diffusione metastatica sembrerebbe poter escludere l'interessamento di quelli posti a monte. L'applicazione della tecnica di ricerca e identificazione del linfonodo sentinella, comunemente impiegata nei casi di melanoma e cancro della mammella, anche al carcinoma del colon-retto ha suscitato molto interesse ma, nonostante i molti studi compiuti al riguardo, non sono stati ancora ottenuti risultati tali da consentirne una standardizzazione anche nei casi di pazienti con neoplasie maligne coliche e rettali. Attraverso questa monografia ci si propone di fare il punto sull'argomento, suggerendo una possibile metodica attuativa con la quale potere superare alcune delle problematiche ad esse relative.

PURPOSE: Anastomotic strictures occur in 3-30% of colorectal anastomosis and one of the main causes may be a reaction to the presence of the metal staples used for suturing. The aim of this study was to evaluate the efficacy of a compression anastomosis ring using the memory shaped device in initial, i.e. nickel-titanium alloy (NiTi) for the prevention of colorectal anastomotic strictures. PATIENTS AND METHODS: A compression anastomosis ring device (NiTi CAR 27) was used to perform compression anastomosis in 20 patients underwent left hemicolectomy and anterior resection of the rectum for carcinoma. An endoscopic check of the anastomosis was carried out at one month and at six months after surgery. RESULTS: In 2 patients (10%) a dehiscence of the anastomosis occurred on the fifth and the eighth postoperative day. No anastomotic strictures were observed in any of the other 18 patients at six months follow-up after surgery. CONCLUSION: Our preliminary results suggest that the use of a compression anastomosis ring might well be a valid method of preventing anastomotic strictures in colorectal surgery. Further studies involving a larger number of patients are needed in order to confirm these preliminary results.

Background Knowledge of the etiology of pyogenic liver and pancreatic abscesses is an important factor in determining the success of combined surgical and antibiotic treatment. Literature shows geographical variations in the prevalence and distribution of causative organisms, and the spread of Klebsiella pneumoniae carbapenemase-producing bacteria is an emerging cause of abdominal infections. Case presentation We herein describe two cases of intra-abdominal abscesses due to monomicrobial infection by Klebsiella pneumoniae Sequence Type 258 producing K. pneumoniae carbapenemase 3 (KPC-Kp). In case 1, a 50-year-old HIV-negative Italian woman with chronic pancreatitis showed infection of a pancreatic pseudocystic lesion caused by KPC-Kp. In case 2, a 64-year-old HIV- negative Italian woman with pancreatic neoplasm and liver metastases developed a liver abscess due to KPC after surgery. Both women were admitted to our hospital but to different surgical units. The clonal relationship between the two isolates was investigated by pulsed-field gel electrophoresis (PFGE). In case 2, the patient was already colonized at admission and inter-hospital transmission of the pathogen was presumed. A long-term combination regimen of colistin with tigecycline and percutaneous drainage resulted in full recovery and clearance of the multidrug-resistant (MDR) pathogen. Conclusions Timely microbiological diagnosis, the combined use of new and old antibiotics and radiological intervention appeared to be valuable in managing these serious conditions. The emergence and dissemination of MDR organisms is posing an increasing challenge for physicians to develop new therapeutic strategies and control and prevention frameworks.

Purpose: to evaluate the role of contrast-enhanced ultrasound (CEUS) in the characterization of focal liver lesions (FLLs) for surgical patients selection. Materials and Methods: 135 consecutive patients (71 women, 64 men) with 165 FLLs (mean size: 3.1 cm) - 89 benign (10 simple cysts, 26 hemangiomas, 29 focal nodular hyperplasia (FNH), 2 hepatocellular adenomas, 11 focal fatty sparing, 3 focal fatty areas, 5 regenerative nodules, 2 hydatid cysts, 1 abscess) and 76 malignant - 47 metastases, 26 hepatocellular carcinomas and 3 peripheral cholangiocarcinomas - underwent CEUS after the administration of SonoVue®. Two readers reviewed in consensus baseline US and CEUS scans obtained 25-30 s (arterial phase), 55-80 s (portal-venous phase), and 235-260 s (late phase) after the beginning of SonoVue® injection respectively. The readers classified each lesion as malignant or benign by means of definite diagnostic criteria. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated. Results: CEUS correctly ha characterized 156/165 (94,5%) FLLs, 85 benign and 71 malignant. 5/165 (3%) FLLs, 3 hemangiomas e 2 HCCs, remained undetermined after CEUS and 4/165 (2,4%) FLLs, 3 HCCs and 1 abscess were misdiagnosed. CEUS showed sensitivity, specificity, and diagnostic accuracy values of 93,4%, 95,5% e 94,7% respectively. positive predictive value and negative predictive values were 94,7% e 94,4%.

Il controllo delle perdite ematiche intra e post-operatorie caratterizza da sempre la chirurgia resettiva epatica. Nel corso degli ultimi anni notevoli progressi sono stati compiuti in tale ambito, grazie all'adozione di materiali e strumentari sempre più specifici ed efficaci che consento l'esecuzione di interventi resettivi con minime perdite ematiche ed una significativa riduzione dell'incidenza di complicanze emorragiche post-operatorie. Vengono presentati 2 casi di resezione epatica realizzata utilizzando un manipolo a radiofrequenza senza eseguire il clampaggio del peduncolo epatico e senza l'utilizzo di clips o legature per le piccole perdite dalla trancia di sezione. Un buon controllo dell'emostasi sulla trancia di sezione è stato ottenuto intraoperatoriamente mediante l'utilizzo di spugne medicate (fibrinogeno umano + trombina umana), la cui indicazione è stata estesa anche a pazienti che non presentavano significative perdite ematiche intraoperatorie allo scopo di ridurre il rischio di sanguinamenti nel postoperatorio (in considerazione del tipo di emostasi realizzata, basata quasi esclusivamente sulla necrosi coagulativa indotta sulla trancia epatica mediante radiofrequenza).

Objective: To evaluate BRAFV600E mutation on consecutive fine-needle aspiration biopsy (FNAB) specimens in order to assess FNAB’s usefulness in preoperative papillary thyroid carcinoma (PTC) diagnosis with the contemporaneous analysis of RET=PTC1 and RET=PTC3 rearrangements obtained from ex vivo thyroid nodules. Design: Thyroid FNABs from 156 subjects with nodules and 49 corresponding surgical samples were examined for the presence of BRAF mutation by real-time allele-specific polymerase chain reaction, confirmed with the use of a laser pressure catapulting system. Samples were also examined for RET=PTC rearrangements. The results were compared with the cytological diagnosis and histopathology. Main outcomes: 13=156 cytological examinations were diagnostic for PTC and 19=156 showed suspicious=indeterminate FNAB (12.2%). FNAB-BRAFV600E mutation was detected in 11=16 (69%) cases with histological confirmation of PTC. In our series, RET=PTC rearrangement was detected in only one case of PTC, whereas it was not present in any case of adenoma, goiter, or Hashimoto’s thyroiditis. No PTC case was found positive at the same time for BRAF mutation and RET=PTC rearrangements. Conclusion: BRAFV600E mutation detected on FNAB specimens, more than RET=PTC rearrangerangements, is highly specific for PTC and its routine research might well be an adjunctive and integrative diagnostic tool for the preoperative diagnostic iter.