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P Berti

Publications and source records attributed to P Berti.

At least 37 records · Page 2Linked to original sources
PubMed2002

Evaluation of telomerase mRNA (hTERT) in colon cancer.

Telomerase activation, a cardinal requirement for immortalization, is a crucial step in the development of malignancy and requires the induction of the catalytic component, human telomerase reverse transcriptase (hTERT), encoded by the hTERT gene. By reverse transcription-PCR, using primers within the reverse transcriptase domain of hTERT, we investigated telomerase messenger in 8 adenomatous and 9 dysplastic polyps, and in 32 paired cancer-normal mucosa specimens, one liver and one spleen metastasis from patients resected for sporadic colorectal cancer. Telomerase messenger was absent or very low in normal mucosa and in adenomatous polyps. Dysplastic polyps and adenocarcinoma samples showed hTERT mRNA, with higher levels in cancer tissues compared to dysplastic lesions. A high telomerase messenger level was shown to be associated with late-staged cancers and with metastasis; thus, detection of telomerase messenger may be useful in the early diagnosis of colon cancer, and telomerase may be a new target for therapeutic intervention.

Adenoma↗
PubMed2002

Evaluation of telomerase in the development and progression of colon cancer.

Telomerase activity, a cardinal requirement for immortalization, is a crucial step in the development of cancer and has been studied in many kinds of malignant tumours for clinical diagnostic and/or prognostic utilities. Using a PCR-based TRAP assay, we investigated telomerase activity in 8 adenomatous polyps, 9 dysplastic polyps, and in 36 paired cancer-normal mucosa specimens, one liver and one spleen metastasis from patients resected for sporadic colorectal cancer. Telomerase was absent or very low in normal mucosa and in adenomatous polyps. Dysplastic polyps and adenocarcinoma samples showed telomerase activity, with higher levels in cancer tissues compared to dysplastic lesions. A high telomerase activity was shown to be associated with late-staged cancers and metastasis, providing arguments supporting the role of telomerase not only in the development but also in the progression of colorectal carcinoma. Moreover, telomerase evaluation may help to confirm the malignant transformation in polypoid colorectal lesions with different levels of dysplastic alterations.

Adenocarcinoma↗
PubMed2001

Impact of harmonic scalpel on operative time during video-assisted thyroidectomy.

BACKGROUND: Minimally invasive video-assisted thyroidectomy (MIVAT) has been practiced in our department since 1998. It has some advantages over conventional surgery in terms of postoperative pain and cosmetic result. The aim of this study was to evaluate the use of the Harmonic scalpel (HS) on the performance of this procedure. METHODS: Between October 1998 and January 2001, 116 patients underwent MIVAT. The HS was used for the last 26 operations. We compared this group of patients (HS-G) with a control group (C-G) of 26 patients who had undergone MIVAT before the introduction of the HS. The following parameters were considered: age, gender, preoperative diagnosis, size of the lesion, type of operation (lobectomy or total thyroidectomy), operative time, complication rate, and postoperative hospital stay. RESULTS: The two groups were well matched for age, gender, preoperative diagnosis, lesion size, and type of operation. The mean operative time was significantly reduced in the HS-G for both lobectomy (37.3 +/- 8.4 vs 49.4 +/- 18.0 min) and total thyroidectomy (53.8 +/- 16.3 vs 90.6 +/- 22.1 min). No differences were found for postoperative stay. One patient in the C-G experienced a transient recurrent nerve palsy. There were no other complications. CONCLUSIONS: This study showed that the utilization of the HS for MIVAT is safe and associated with a shorter operative time. A reduction of the rates for such complications such as hypoparathyroidism and recurrent nerve injuries was not possible to demonstrate in the present study. Much larger series are needed for further evaluation of this instrument.

Adolescent↗
PubMed2001

Minimally invasive video-assisted thyroidectomy.

BACKGROUND: In this paper we describe the results of our personal technique for minimally invasive video-assisted thyroidectomy (MIVAT). METHODS: Sixty-seven patients were selected for MIVAT. Selection criteria were nodule size less than 30 mm, thyroid volume less than 20 mL, no thyroiditis, no previous neck surgery or irradiation. The procedure, totally gasless, is carried out through a 15-mm central incision above the sternal notch. Dissection is performed under endoscopic vision, using conventional and endoscopic instruments. RESULTS: We performed 51 lobectomies and 15 total thyroidectomies. Mean operative time was 73.6 minutes for lobectomy and 109.6 minutes for total thyroidectomy. Conversion to open procedure was required twice (3%). We observed 2 cases of transient postoperative hypocalcemia and 1 case of transient recurrent laryngeal nerve palsy. The cosmetic result was considered excellent by most patients. CONCLUSIONS: MIVAT is safe and feasible. The indications are limited at present, but the results are encouraging, and we are optimistic about the future expansion of its applicability.

Adolescent↗
PubMed2001

[Video-assisted parathyroidectomy: learning curve].

STUDY AIM: Minimally invasive video-assisted parathyroidectomy (MIVAP) was introduced in 1997 for the treatment of sporadic primary hyperparathyroidism (sPHPT). The study aim was to review the entire series of patients operated on in order to analyse the learning curve of this procedure. PATIENTS AND METHODS: Between February 1997 to January 2001, 185 patients underwent MIVAP. All these patients were divided into three groups: group A (GA) included 63 patients operated on between February 1997 and September 1998; group B (GB) 64 patients operated on between October 1998 and January 2000; Group C (GC) 64 patients operated on between January 2000 and January 2001. Mean operative time, complications and conversions rates of the three groups were compared. RESULTS: The three groups were well matched for age and gender. Mean operative time was significantly shorter in patients of GC (28.3 +/- 13.6 min) when compared with GA (62.3 +/- 24.6 min) and GB (48.4 +/- 18.1 min). Conversion was required in 3 cases of GA (4.8%), in 8 cases of GB (12.8%) and in 4 cases of GC (6.5%). One transient postoperative recurrent nerve palsy and 4 cases of transient postoperative hypocalcemia were observed among patients of GA. No complications were registered in the other groups. CONCLUSIONS: This study shows that with increasing experience, the operative time of MIVAP was dramatically reduced, as well as postoperative complications rate. The higher percentage of conversion in groups B and C may be explained by the fact that, with increasing experience, more difficult and ambiguous cases were operated with this technique.

Adult↗
PubMed2001

Minimally invasive parathyroid surgery.

Several minimally invasive procedures have been described over the past 3 years for the treatment of sporadic primary hyperparathyroidism (PHPT). These techniques (totally endoscopic, video assisted and radio guided) have been demonstrated to be feasible and safe, but the surgeon should be well trained to obtain the best results with these approaches. Not all patients are eligible for minimally invasive procedures. The results are comparable to those of conventional surgery with advantages in terms of cosmetic result and reduced post-operative pain. These procedures should be considered to be a valid option by surgeons dealing with patients with primary hyperparathyroidism.

Endoscopy↗
PubMed2001

Comparison between minimally invasive video-assisted thyroidectomy and conventional thyroidectomy: a prospective randomized study.

BACKGROUND: Endoscopic procedures for thyroid surgery have been introduced since 1998, but their diffusion has remained limited because their advantages were never demonstrated. METHODS: Forty-nine patients undergoing surgery for either a thyroid nodule or a small papillary carcinoma were allotted to 1 of these procedures, minimally invasive video-assisted thyroidectomy (MIVAT) or conventional thyroidectomy (CT). Exclusion criteria were nodules greater than 35 mm, presence of thyroiditis, and thyroid volume greater than 20 mL. Preoperative diagnosis, operative time, postoperative pain, complications, and cosmetic result were evaluated. RESULTS: MIVAT group included 25 patients and the CT group 24 patients. Operative time was 66 +/- 24 minutes for MIVAT and 45 +/- 15 minutes for CT (P = .001). Postoperative course was significantly less painful in the patients who underwent MIVAT (P = .003). Cosmetic result evaluated by verbal response scale and numeric scale was in favor of MIVAT (P = .003 and P = .01, respectively). One recurrent nerve palsy and 1 transient hypoparathyroidism were present in CT patients; MIVAT patients experienced 2 transient palsies. CONCLUSIONS: Despite some MIVAT advantages in terms of postoperative pain and cosmesis, CT still offers an advantage in terms of operative time and its safety should not differ. Larger series of patients are needed before deciding whether endoscopic thyroidectomy can offer important advantages.

Adolescent↗
PubMed2001

Minimally invasive approach to the cervical spine: a proposal.

BACKGROUND AND PURPOSE: During the last 3 years, a minimally invasive video-assisted approach for parathyroidectomy and thyroidectomy has been developed. Because of the good exposure of the cervical spine during these procedures, the authors decided to perform an anatomic-radiologic study in order to evaluate which cervical vertebrae could be reached by this minimally invasive approach. PATIENTS AND METHODS: Three consenting patients, two undergoing minimally invasive parathyroidectomy and one a conventional operation for C4-C5 disc herniation, were selected for this study. The procedure was carried out through a single 1.5-cm central skin incision above the sternal notch. After opening of the cervical linea alba, dissection was performed under endoscopic vision, without using any CO2 insufflation or trocar. After exposure of the prevertebral fascia, an operative tube was introduced through the cervical incision in order to maintain the operative space without using conventional retractors. RESULTS: Through this operative tube, it was possible to introduce both a 5-mm (or 3-mm) endoscope and the surgical instruments. In our patients, we inserted a 1-mm metal probe to exactly localize during fluoroscopy the vertebrae reached by the dissection (C2-C7). CONCLUSIONS: This study shows the feasibility of an anterior minimally invasive approach to the cervical spine. Although the exact indications have to be verified, a video-assisted approach could add some advantages to the well-known benefits coming from the anterior approaches to the cervical spine, especially in terms of cosmetic results and postoperative course and recovery.

Cervical Vertebrae↗
PubMed2000

Cutaneous spreading of parathyroid carcinoma after fine needle aspiration cytology.

BACKGROUND: Ultrasound-guided fine needle aspiration cytology (FNAC) of suspect parathyroid adenomas is sometimes used for the diagnosis of primary hyperparathyroidism (PHPT). FNAC complications are rare or mild. We describe the first case in literature of cutaneous spread of parathyroid carcinoma after FNAC. CASE: A woman underwent a neck ultrasound which revealed a solid hypoechogenic nodule of 1.5 cm at the level of the inferior pole of the right thyroid. In the same time a FNAC of the nodule was performed. Cytology showed no atypical cells. Successively PHPT was diagnosed and a few weeks later the patient had a subcutaneous lump in the same area of FNAC. The patient underwent surgery and histology of the specimen showed a differentiated parathyroid carcinoma. The postoperative course was regular and calcium and parathormone resulted normal. CONCLUSION: The use of FNAC should be carefully assessed in the presence of suspect parathyroid carcinoma, because this could cause a possible diffusion of a parathyroid carcinoma along the needle tract.

Adult↗
PubMed2000

Minimally invasive video-assisted surgery of the thyroid: a preliminary report.

BACKGROUND: Endoscopic thyroidectomy has not yet met the favor of most endocrine surgeons. We evaluated the technical feasibility of a video-assisted approach to thyroid surgery. PATIENTS AND METHODS: The study group comprised 22 females and 5 males, all with a single thyroid nodule. The nodule was "hot" in 4 patients, microfollicular in 17 and with Hürthle cell cytology in 6. A 15-mm skin incision was made above the sternal notch. The midline was opened and a 12-mm trocar inserted into the thyro-tracheal groove. It was inflated with CO2 for 3 min. The trocar was then removed and the procedure performed using external retractors and needlescopic instruments. The upper pedicle was dissected. Identification of recurrent nerve and parathyroid glands was facilitated by endoscopic magnification. The upper gland portion was then retracted out of the operative cavity; inferior veins were ligated and the lobe entirely extracted and dissected. Frozen section was obtained for "cold" nodules. RESULTS: Video-assisted hemithyroidectomy was accomplished in 24 patients; 1 underwent video-assisted total thyroidectomy (positive frozen section). Cervicotomy was required once to achieve hemostasis and once to perform total thyroidectomy (positive frozen section). Mean operative time was 82 min (range 60-120 min). No complications were registered. The cosmetic result was excellent. CONCLUSIONS: Video-assisted thyroid surgery is feasible and may improve cosmetic outcome; total thyroidectomy can be accomplished through the same access point.

Adenocarcinoma↗
PubMed2000

Minimally invasive video-assisted parathyroidectomy: lesson learned from 137 cases.

BACKGROUND: Since February 1997, a technique of minimally invasive video-assisted parathyroidectomy (MIVAP) was developed at our institution for the treatment of sporadic primary hyperparathyroidism (sPHPT). In this study we analyzed the entire series of patients who underwent MIVAP during the last 3 years. STUDY DESIGN: One hundred thirty-seven patients with sPHPT were selected for MIVAP. Selection criteria were: diagnosis of single adenoma based on preoperative localization studies (ultrasonography, sestamibi scintigraphy, or both), and no previous neck surgery or concomitant large multinodular goiter. The procedure, already described, is performed by a gasless video-assisted technique through a single 1.5-cm central skin incision above the sternal notch. Quick, intraoperative parathyroid hormone assay was used in 134 cases (97.8%) to confirm the complete removal of all hyperfunctioning parathyroid tissue. RESULTS: Mean operative time was 54.3 +/- 22.6 minutes. The conversion rate was 8.8%. One laryngeal nerve palsy was registered (0.7%), as was one case of persistent hyperparathyroidism. In six patients (4.4%) a transient symptomatic postoperative hypocalcemia was observed. Two thyroid lobectomies were associated using the same minimally invasive access. At a mean followup of 15.4 +/- 10.6 months, all but two patients were normocalcemic. The cosmetic result was considered excellent by most of the patients (92.8%). CONCLUSIONS: Although not all patients with sPHPT are eligible for MIVAP, this approach can now be proposed in a bigger proportion (67% of patients). As already demonstrated in a previous study, also in a large series of patients, after greater experience has been achieved, the results and the operative time are the same as in traditional surgery, with better cosmetic result and a less painful course.

Adenoma↗
PubMed1999

Minimally invasive surgery for thyroid small nodules: preliminary report.

Cytological assessment of cold thyroid nodules cannot exclude malignancy in case of follicular tumors. Many follicular nodules undergo surgery although most of them later on prove to be benign. We report a new minimally invasive video-assisted approach (MIVA) for the treatment of thyroid lesions with a diameter minor than 3 cm. Ten females and 2 males (mean age: 37 yr) with a cold thyroid nodule and a cytological diagnosis of microfollicular tumor were selected for MIVA hemythyroidectomy. The procedure was carried out through a 15 mm incision with needlescopic instruments and a 30 infinity 5-mm endoscope. Mean operative time was 87 min (range 60-120). No complications were registered. Cosmetical result was excellent in all patients. MIVA hemythyroidectomy is safe and effective; indications and limits of this new procedure require further studies.

Adult↗
PubMed1999

[Video-assisted parathyroidectomy: a series of 85 cases].

AIM OF THE STUDY: To verify the feasibility of video-assisted parathyroidectomy, set up the indications and report the results in a series of 85 patients. MATERIAL AND METHODS: From 1997 to 1999, 85 patients affected by primary hyperparathyroidism due to single gland disease, with an adenoma smaller than 35 mm as demonstrated by preoperative imaging, were referred for video-assisted parathyroidectomy. There were 62 females and 23 males. Mean age was 53 years, (range 23-82). Video-assisted parathyroidectomy was associated with intra-operative PTH quick-assay. Calcium testing was controlled before leaving the hospital, 1 month and 3 months later, and postoperative laryngoscopy was performed in all patients. RESULTS: There were five conversions to open cervicotomy: three due to a contra-lateral second adenoma, two because of an intrathyroidal adenoma. The mean operative time for video-assisted procedure was 59 minutes (range: 25-180). Circulating PTH levels 10 minutes after the removal of the affected gland(s) always dropped significantly, and pathological report confirmed the parathyroid nature of the specimens (mean diameter 13 mm, range 7-35). Morbidity consisted of five cases of transient hypocalcemia and one permanent laryngeal nerve paralysis. We registered no persistent or recurrent disease (mean follow-up 12.8 months, range 1-28). CONCLUSIONS: Video-assisted parathyroidectomy is feasible, and its results are similar to those of traditional procedure, while it seems superior as regards postoperative course and aesthetic results. It also allows different strategical decisions even during operation (i.e. bilateral exploration or thyroid lobectomy) by the same approach.

Adenoma↗
PubMed1999

Video-assisted versus conventional parathyroidectomy in primary hyperparathyroidism: a prospective randomized study.

BACKGROUND: Several studies demonstrated the feasibility of minimally invasive parathyroidectomy as a treatment for primary hyperparathyroidism. We compared its results with those of traditional surgery in a prospective randomized study. METHODS: From March to November 1998, 38 patients eligible for video-assisted parathyroidectomy (VAP) were referred to us. They were randomly divided into 2 groups: patients of group A underwent a conventional cervicotomy with bilateral exploration and frozen section of the removed adenoma; patients of group B underwent VAP with intraoperative measurement of parathyroid hormone. Operative time, postoperative pain, fever and hypocalcemia, cosmetic result, and costs were compared. Two cases of VAP were performed with locoregional anesthesia. RESULTS: Groups A (18 patients) and B (20 patients) were statistically balanced. Operative time was significantly shorter in group B (57 vs 70 minutes). Cosmetic result was significantly better in group B, which also experienced less postoperative pain (P < .05). No cases of persistent primary hyperparathyroidism were present in either group, but recurrent laryngeal nerve palsy occurred in 1 patient in group B. CONCLUSIONS: Compared with conventional surgery, VAP is associated with a shorter operative time, a better cosmetic result, and a less painful postoperative course.

Adult↗
PubMed1999

[Superficial cervical plexus block in association with laryngeal mask in parathyroid surgery].

Superficial cervical plexus block in association with laryngeal mask for the airways control has improved the postoperative outcome, in comparison with a previous group in general anaesthesia, performed by the same equipment. The local anaesthetic infiltration as a preemptive analgesia give us good evidences in pain control. The laryngeal mask contributes to a good surgical field and avoid the neck hypertension.

Cervical Plexus↗