Search

Hypothesis: Occurrence of adverse effects and advantages of the LigaSure diathermy system (or LigaSure vessel sealing system) in total thyroidectomy have not been tested in prospective randomized studies comparing its use with that of the time-saving clamp-and-tie technique to ligate and divide thyroid vessels. The effectiveness of LigaSure in achieving vessel division and hemostasis remains dependent on vessel diameter, and the risk of damage to adjacent structures cannot be completely excluded. We tested the hypothesis that use of LigaSure compared with the clamp-and-tie technique can significantly and conveniently reduce operative timewithout increasing postoperative complications in patients undergoing total thyroidectomy for benign multinodular goiter. Design: Prospective randomized study. Setting: Regional hospital. Patients: Two hundred consecutive patients with benign multinodular goiter undergoing total thyroidectomy performed by 1 of 3 surgeons. Interventions: According to a randomized sequence, total thyroidectomy was performed in 100 patients using LigaSure and in 100 patients using the clamp-andtie technique. Main Outcome Measures: End points of the study included the comparative evaluation of postoperative complications, need for parathyroid gland autotransplantation, operative time, and time to hospital discharge. Preoperative, postoperative (24 hours), and 6-week follow-up serum Ca++ levels are also reported and compared. Results: The postoperative complication rate was 35% overall, including all transient postoperative disturbances. The incidence of cervical hematomas was 2%, but 3 patients (1.5%), 1 in the LigaSure group and 2 in the clamp-and-tie group, required repeat operations because of respiratory tract obstruction. The incidence of permanent complications was 2.5% overall, including 3 patients (1.5%) with permanent hypocalcemia and 2 patients (1%) with permanent recurrent nerve lesions. No statistical difference in the incidence of complications was found between the 2 study groups. Similarly, no difference was found in mean hospitalization time and need for parathyroid gland autotransplantation. Preoperative, postoperative, and 6-week follow-up mean serum Ca++ levels were not statistically different in the 2 study groups and in the subset of patients undergoing parathyroid gland autotransplantation. Mean operative time was significantly shorter in the LigaSure group, although the mean difference between the 2 study groups was minimal (7.4 minutes). Concomitantly, there was an additional cost of 45€ (US $57.40) per operation using LigaSure. Conclusion: The use of LigaSure is equally as safe and effective at vessel division and homeostasis as the clampand- tie technique, with a statistically significant (although minimal) decrease in mean operative time. Because of this minimal decrease in operative time, use of LigaSure would allow more patients to undergo total thyroidectomy each year, which would eventually help to offset its higher cost. [ABSTRACT FROM AUTHOR]

The gastro-intestinal neuroectodermal tumor (GNET) is a rare sarcoma of the digestive tract, which was recently recognised. The knowledge of the morphological, immunohistochemical and molecular diagnostic criteria is necessary to not mistake it for the metastasis of a melanoma or for another sarcoma of the digestive tract as the gastro-intestinal clear cells sarcoma or the malignant peripheral nervous system tumor (MPNST). We report the case of a 41-year-old patient with a GNET of the small intestine with hepatic metastasis. The histological examination showed a diffuse proliferation of epithelioid cells, which only express PS100. The presence EWSR1-ATF1 gene fusions with any melanocytic differentiation leads to the diagnosis of GNET., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Gastrointestinal stromal tumours are rare mesenchymal neoplasms, accounting less than 3% of all the gastrointestinal tumours, that may arise in all portions of the gastrointestinal tract but more frequently they involve stomach and small bowel. Generally are asymptomatic or slight symptomatic, although they may also cause acute clinical conditions. Histologically are characterised by a meshwork of spindle-like cells mixed with fibro-hyaline stroma. The immunohistochemical assessment, marked for a strong immunopositivity for CD117 antibodies, allows the differential diagnosis with others muscular, nervous and fibroblastic tumours. Tumour size and mitotic rate are the most important prognostic indicators. Surgery represents the treatment for patients with primary non-metastatic disease, however a prolonged oncologic follow-up is always recommended. Minimally invasive technique is increasingly adopted and preferred for its low morbidity and shorter in-hospital stay, and more and more reports confirm its safety, efficacy and feasibility. We report a case series of three pauci-sympomatic patients, all hospitalised for severe anaemia related to a chronic gastrointestinal bleeding, successfully treated by laparoscopic approach for the removal of gastrointestinal stromal tumours, two located in the stomach and one in the jejunum.

Unlabelled: Retroperitoneal leiomyomata are infrequent, and their prevalence among primary retroperitoneal tumours has been estimated as 0.5-1.2%. The authors report a case of symptomatic retroperitoneal leiomyoma with a favourable prognosis. A 53-year-old woman presented for abdominal pain associated to an inflammatory syndrome. A contrast-enhanced computed tomography revealed a large abdominopelvic mass and patient underwent open surgical excision. Definitive diagnosis was done after immunohistochemical assessment. Immunoreactivity was strong for smooth muscular actin. Presence of oestrogen and progesterone receptor proteins was also detected. Prognosis of these well-differentiated smooth muscle tumours is generally favourable but a postoperative surveillance is always recommended., Key Words: Leiomyoma, Retroperitoneal space, Surgery.

We report our prospective experience of short-stay hospitalisation for benign thyroid surgery. Post-operative outcome, complication rate and duration of hospitalisation were evaluated for 200 similar patients with bilateral multi-nodular goitres treated surgically by total thyroidectomy. All subjects gave written informed consent. A short-stay regimen, with discharge within 24 h of admission, was possible in 92.5 %. Fourteen (7 %) were discharged on the second post-operative day and one on the fourth post-operative day. Causes of the 15 delayed discharges beyond 24 h were 11 hypocalcaemia (5.5 %), 3 haematoma (1.5 %) and 1 dysphonia (0.5 %). All compressive haematoma were treated by urgent reoperation. No mortality occurred. None required tracheostomies. Transient complications were diagnosed in 36 cases: 25 with hypocalcaemia and 11 with recurrent laryngeal nerve injuries. Permanent complications were observed in three patients: two with hypoparathyroidism and one with nerve damage. All patients were carefully counselled about potential thyroid surgery complications and a 24-h emergency-contact number was provided. Short-stay hospitalisation represents safe and cost-saving surgical management for benign thyroid surgery.