Biomedical subjects

P Bernante

Publications and source records attributed to P Bernante.

31 records · Page 2Linked to original sources

PubMed1996

[Which thyroidectomy in Basedow disease?].

One hundred and seventy patients with Graves' disease underwent thyroidectomy between 1987 and 1994 (10.5% of all thyroidectomies performed in the same period). Female/male ratio was 9/1; mean age 55.2 years and average period between diagnosis and surgical treatment 5.3 years. The average thyroid weight was 230 g (range 90-950 g). Thyroidectomy was subtotal in 110 and total in 60 patients, 5 of which had been previously treated elsewhere from 5 to 33 years before. Malignancy was incidentally found in 2.35% of patients. The complication rate resulted higher in total thyroidectomies than in subtotal procedures (bleeding 0.9% vs 5.4%, transient hypoparathyroidism 4.5% vs 12.7%, recurrent nerve lesion 0.45% vs 2.72%) however the differences were not statistically significant; this probably because both the procedures were carried out with the same technique for parathyroid gland and recurrent nerve safety. The need of repeated surgery increased the risk. In opposition to total thyroidectomy, subtotal thyroidectomy does not doom to complete and permanent replacement therapy (96.4% of hypothyroidism at 2 months, 72.6% at 4 years), but in this series it failed to achieve remission in 2 patients who maintained a mild hyperthyroidism and in one more patient who developed a relapse 4 years later. Serum TSI meaning is not clear, but preoperative positivity suggests a wider resection and postoperative persistence a closer follow-up by functional assessment. In conclusion surgical procedures for Graves' disease range from subtotal to total thyroidectomy but for a safe outcome the choice depends more on the intraoperative troubles of each single case than on theoretic advantages.

Adolescent↗

PubMed1995

[Post-thyroidectomy hypocalcemia and ligation of the inferior thyroid artery trunk].

The effect of bilateral truncal ligation of the inferior thyroid artery on parathyroid function is prospectively analyzed in two homogeneous groups of 10 patients treated by total thyroidectomy, with (G1) and without (G2) truncal ligation, comparing immediately postoperative and late serum calcium levels. A significant decrease in mean calcemic levels (minimal ones 2.1, with n.v. 2.1-2.6 mmol/l) was observed in both groups no longer than in the first postoperative days. There was no significant difference in global (clinical + laboratory) hypocalcemia rate (G1 = 0-30% vs G2 = 10-40% respectively); nevertheless hypocalcemia was noted paradoxically to occur more frequently in G-2 patients, out of which one developed a permanent hypoparathyroidism.

Adult↗

PubMed1994

The extent of surgery for thyroid medullary cancer.

AIMS: Evaluation of the impact of the extent of primary surgery and reintervention on the outcome of patients with medullary thyroid carcinoma. METHODS: Seventy-two patients with medullary thyroid carcinoma (MTC) were surgically treated between 1967 and 1992. RESULTS: Fifty-five cases were sporadic, 5 patients had MEN 2A, 4 MEN 2B syndrome and 8 familial non-MEN MTC; 1 patient had stage I disease, 30 patients stage II, 36 stage III and 5 stage IV. Sixty-four had their initial treatment at our center, and 8 came for subsequent treatment. At first treatment, 8 patients were subjected to partial thyroidectomy, 10 to total thyroidectomy, 53 to total thyroidectomy with neck dissection, and 1 to only radical neck dissection; postoperative serum calcitonin (Ct) levels returned to normal in 3, 6 and 27 patients, respectively. In the patient with only radical neck dissection, Ct levels remained elevated. No patient with Ct normalization after surgery became responsive to pentagastrin in the follow-up. Thirteen patients had a reoperation due to nodal relapse. At a mean follow-up of 5.7 years (6-252 months), the 10-year survival rate was 84.5% with a significant difference between patients under and over 40 years of age (96.4 vs 57%), between stage I-II (100%) and stage III, IV (83.8%, 0% respectively). At the last follow-up, 36 (50%) patients were alive and disease free and 26 were alive with disease (15 with distant metastases). Of the 10 deaths, 7 were due to tumor recurrence, 3 to 120 months after surgery. CONCLUSIONS: Data suggest that an earlier diagnosis rather than more extensive surgery could improve survival and reduce recurrences. However, the least treatment required is total thyroidectomy plus central neck and upper mediastinum clearance and in addition, according to the extent of nodal involvement, mono- or bilateral neck dissection. To avoid ineffective reoperation due to distant (mainly liver) micrometastases, persistent residual microscopic disease requires a more aggressive restaging.

Carcinoma, Medullary↗

PubMed1994

Prognostic value of early postoperative calcitonin level in medullary thyroid carcinoma.

AIMS: Serum calcitonin (CT) assay is commonly used in the diagnosis and follow-up of medullary thyroid carcinoma (MTC). The aim of this study was to ascertain whether serum CT levels, measured in the first few days after surgery, could be used to evaluate the efficacy of treatment. METHODS: A group of 33 patients was studied. In all patients the follow-up was more than 20 months. RESULTS: Preoperatively basal CT serum levels were high in all patients. Twenty-four hours after surgery CT serum levels dropped to within the normal range in 8 patients and 72 hours after operation in 7 others. In this group 1 patient was at stage I, 11 at stage II and 3 at stage III. Basal and pentagastrin stimulated CT levels continued to be in the normal range in these 15 patients 6 and 12 months after surgery and at the subsequent year by follow-up visits. No clinical or radiological evidence of disease was found during the follow-up in this group. In the other 18 patients CT was reduced but still high 72 hours after surgery; 6 months later basal serum CT levels continued to be elevated or responsive to pentagastrin stimulation. In this group restaging showed tumor relapse in the thyroid bed in 2 patients, cervical lymphadenopathy in 11, and distant metastases (bone, liver) in 3. CONCLUSIONS: Immediate postoperative CT serum levels seem to be the most useful index to evaluate the efficacy of surgical treatment and the presence of residual neoplastic tissue.

Adolescent↗

PubMed1994

[Epidemiology and risk factors in thyroid carcinoma].

Thyroid carcinoma represents less than 2% cancers although there is an increasing incidence, mainly of the papillary variety, due in part to improved diagnostic procedures. In contrast there is a remarkably higher prevalence of occult foci in detailed autopsy studies (up to 34%) suggesting the possibility of a spontaneous regression for most of them. Only 1-2% of latent tumours grow larger and become clinically important through environmental, genetic and cellular factors (two-mutational event model by Knudson). Each single histological subgroup has different influencing factors: X ray exposure, iodide diet intake, coexisting (autoimmune and non) thyroid disease such as thyroiditis, Graves' disease, goitre, dyshormonogenesis, heredity and altered cellular oncogenes have been considered. Of a series of 715 thyroid cancers operated on between 1967 and 1992 we analyze sex ratio, mean age, radiation exposure, coexisting thyroid disease, familial occurrence.

Adenocarcinoma, Follicular↗

PubMed1994

[Reoperation in differentiated carcinoma of the thyroid gland].

A series of 112 patients reoperated on for differentiated thyroid cancer is analyzed; 60 patients (38 with papillary and 22 with follicular cancer) underwent ex-principio to completion of a non total thyroidectomy and 52 (37 with papillary and 15 with follicular cancer) to repeat surgery for local relapse. At a mean follow-up of 8.7 years, all the 38 patients with papillary cancer reoperated on for completion are alive and disease-free, while of those with follicular cancer 4 are dead, 2 are alive with carcinoma and 16 (72.7%) are disease free. A reoperation for relapse was performed on the thyroid in 11, on the thyroid and nodes in 23 patients (all had initially received partial thyroidectomy), and on nodes alone in 28 patients. At a mean follow-up of 10.2 years, 20 patients (54%) with papillary and 7 (46.6%) with follicular cancer are alive and disease-free, 8 patients with papillary and 1 with follicular cancer are alive with disease and the remainder are dead due to the tumour. Although there is no sure evidence that total thyroidectomy provides higher survival and fewer recurrences, since many factors, predominantly age influence the prognosis, total thyroidectomy is recommended as a minimal procedure to avoid less safe and less radical subsequent reoperation.

Adenocarcinoma, Follicular↗

PubMed1993

[Medullary thyroid carcinoma: prognostic factors].

Fifty-one patients treated by total thyroidectomy plus nodal neck dissection of necessity for medullary thyroid carcinoma (MTC) with a minimum follow-up of 10 years (mean 14.5, max 22 years) were divided into three groups according to the outcome (alive disease-free; alive with disease; dead) and were compared in order to analyze the prognostic factors of MTC. Twenty years actuarial survival rate for age at diagnosis less than 50 years versus age over 50 (90% vs 45%) as well as for stage II versus stage III (85% vs 55%) was statistically different (p < 0.005 and p < 0.05 respectively). About 60% of recurrences were observed within 5 years after surgical treatment. Recurrence rate for stage III (70%) versus stage II (20%) was statistically different, but it was not for the age. Survival rate for patients with bony metastases (50% at 1 and 30% at 3 years) versus patients with other than bony metastases (100% at 10 years) was statistically different.

Actuarial Analysis↗

PubMed1992

[Somatostatin in the treatment of lymphorrhea after lateral neck dissection].

A new pharmacological effect of somatostatin has been verified in the treatment of lymphorrea due to a thoracic duct injury, produced during left lateral neck dissection. The drug (stilamin 3 mcg/kg/h in continuous venous infusion) allowed in 3 case a strongly decrease of the lymphatic loss within 24 hours and the complete depletion within 6 days. Further studies are required to clarify the dynamic effects of the drug in this complication.

Adolescent↗

PubMed1991

[Efficacy of immunomodulating treatment in patients with different degrees of immunosuppression].

Immunodepression is a common condition in patients undergoing elective operations and it constitutes a high risk for the onset of postoperative infective complications. The use of immunomodulatory drugs has proved useful in the prophylaxis of these complications, although the precise indications for each drug have not yet been clearly codified. The present study aimed to assess the effects of thymostimulin in patients with different degrees of immunodepression, by evaluating both the incidence of postoperative infections and the changes induced in various immunological parameters. The results obtained indicated that those subjects with the highest degree of immunodepression (hypo-anergic) benefited most from drug therapy in comparison to those with a lesser degree of immunodepression (relatively hypo-ergic). The advantages were evident in hypo-anergic subjects both with regard to the frequency of early postoperative infections, and with regard to immunological parameters. On the other hand, in relatively hypo-ergic subjects, benefits were limited to the improvement of some immunological parameters. In our opinion, the use of thymostimulin is of particular use only in those subjects with marked immunodepression since the incidence of post-operative sepsis is highest in this group.

Adjuvants, Immunologic↗

PubMedDate not supplied

Frequency of thyroid carcinoma in a recent series of 539 consecutive thyroidectomies for multinodular goiter.

AIMS AND BACKGROUND: The aim of the study was to analyze the frequency of thyroid carcinoma in a consecutive series of 539 thyroidectomies for multinodular goiter (MNG) and to assess the influence of sex and age as cancer risk factors. METHODS: In a 2-year period, 539 patients underwent subtotal or total thyroidectomy for MNG at the institute of General Surgery, University of Padova, Padova, Italy: 455 were females and 84 males (F/M = 5.5/1); mean age was 46 years (min. 17, max 78). Only 17 patients (3.1%) (16 females and 1 male) were aged 21 years or less. RESULTS: A malignancy was found in 41 patients: 38 females and 3 males; 39 older and 2 younger than 21 years. The frequency of cancer in MNG was 7.6%: 8.3% in females and 3.6% in males; 7.5% in patients older than 21 and 11.7% under 21 years. CONCLUSIONS: The combination of MNG and carcinoma should always be carefully considered but not overemphasized, and the policy of surgically treating all patients with MNG is not justified. Sex and age cannot be considered as factors of a higher risk of cancer.

Adult↗

PubMedDate not supplied

[Prevention and treatment of intra- and post-operative complications in thyroid surgery].

Frequency of complications in thyroid surgery is evaluated in a series of patients treated during a recent period lasting one year (1997). The records of 455 patients consecutively operated on were analyzed: 396 patients were affected by benign disorders and 59 by thyroid carcinoma. Total thyroidectomy was performed in 158 cases, near subtotal thyroidectomy in 94, thyroid totalization for recurrent disease in 21 and lobectomy in 182 ones. Post-operative haemorrhage, such to require surgical re-exploration of the thyroid bed, occurred in 2 patients (0.4%), both after total thyroidectomy for hyperfunctioning goiter. Recurrent laryngeal lesion has been observed in 2 patients (0.4% of all patients), both after total thyroidectomy for cervico-mediastinal goiter. Transient hypoparathyroidism occurred in 48 patients (10.5%), while definitive one in 9 (1.9%), of which 5 after total thyroidectomy, 2 after subtotal thyroidectomy and 2 after reoperation. Haemorrhage nearly always occurs in the first postoperative hours and gravity is conditioned by tracheal compression exercised by the haematoma. An aspirative drainage located in thyroid bed and a not hermetic closure of the middle line help a precocious diagnosis and sometimes avoid a surgical re-exploration. Some technical surgical devices permit to reduce the risk of inferior laryngeal nerve palsy. Hypoparathyroidism, often transient, is a complication of bilateral thyroid surgery, but unavoidable when more extensive thyroid surgery is required.

Adolescent↗

PubMedDate not supplied

[Cancer in multinodular goiter].

Multinodular goitre is a very common, and commonly benign, thyroid disorder; however variable and sometimes surprisingly high occurrence of malignancy has been reported in surgical series. In this connection we retrospectively analyzed a large consecutive series of 539 thyroidectomies performed for M.N.G. over a short period of time of 3 years: there were 455 female and 84 male patients, of whom 522 over and 17 under 21 years of age. It was found an overall incidence of carcinoma of 7.5% (90.2% of papillary type), with prevalence in female (8.3%) vs male sex (3.6%) and in patients under (11.7%) vs over (7.5%) the age of 21 years; differences for sex and age were not significant. We remark that present revision left out of consideration other known factors predisposing to cancer, and included occult papillary carcinomas that are a frequent autoptic finding and do not affect life expectancy. Surgical selection, in addition to these circumstances, concurred to distort, making higher than true, the incidence of cancer in M.N.G. We conclude that M.N.G. cannot be considered as a condition predisposing to cancer but it may harbour a cancer; since that selective surgical approach is recommenced. Selection criteria for surgery and treatment are mentioned.

Adolescent↗

PubMedDate not supplied

[A case of forgotten giant goiter].

The forgotten goiter is most often the consequence of the incomplete removal of a "plunging" goiter, but it can sometimes be attributed to a concomitant, unrecognised mediastinal goiter which is not connected to the thyroid. Differential diagnosis must be made with other mediastinal masses and with plunging relapses of a previously operated struma. Radiological analysis of persisting mediastinal involvement before and immediately after surgery is the only decisive means of diagnosis, but this is not always available in practice. In this paper the authors report a case of considerable size observed in a series of 346 mediastinal goiters operated between 1967 and 1994. They examine the pathogenetic aspects and the nosological, diagnostic and therapeutic problems related to forgotten goiter, and lastly they list the recommendations that several surgeons have made in an attempt to reduce the incidence. In conclusion, the systematic use of CAT or NMR in the diagnosis of mediastinal opacity may help to reduce the risk of forgetting glandular residue in the mediastinum.

Diagnosis, Differential↗