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Biomedical subjects

P Miccoli

Publications and source records attributed to P Miccoli.

At least 127 records · Page 7Linked to original sources
PubMed1995

Symptomatic adrenal myelolipoma: therapeutic considerations.

Four cases of symptomatic myelolipoma of the adrenal gland are presented. Three were treated at laparotomy and one with a laparoscopic approach. On the basis of these four cases we discuss the aetiology, pathogenesis, clinical manifestations, diagnosis and treatment of this rare disease. We also report the follow-up of a patient with bilateral myelolipoma, who underwent monolateral excision. We conclude that myelolipoma, if correctly diagnosed, can be treated conservatively with careful follow-up, limiting surgery to symptomatic cases.

Adrenal Gland Neoplasms↗
PubMed1995

Laparoscopic adrenalectomy.

Laparoscopic adrenalectomy has already been described by various authors. The present series consists of 25 consecutive, nonselected cases operated on in the Department of Surgery, University of Pisa. All operations were carried out using a minimal access technique, and there were no conversions to open surgery. The mean operative time was 109 min. The median postoperative stay was 3 days (range 2-5). There were no complications, and none of the patients required blood transfusion. This technique proved to be as safe as open surgery and caused less distress and allowed more rapid return to normal activity. Increased experience and the development of new laparoscopic equipment are expected to further reduce operative time.

Adrenal Gland Neoplasms↗
PubMed1995

Role of neck ultrasonography in the follow-up of patients operated on for thyroid cancer.

The aim of the study was to evaluate the role of neck ultrasonography in follow-up of patients with differentiated thyroid cancer. Sixty-three patients had total thyroidectomy and 131I ablation for differentiated thyroid cancer and had a negative whole body scan during follow-up. They were admitted for a high resolution neck ultrasound examination. Sixteen of 63 patients presented images suspicious for lymph node metastasis and/or for local recurrences (4 cases). Fine needle aspiration confirmed the suspicion of malignancy in 12 patients: only lymph node metastasis in 8 cases, local recurrence and lymph node metastasis in 3 cases, and in one case only local recurrence. Fine needle aspiration was suspicious for lymphadenitis in 4 cases. Thyroglobulin levels were very high in all patients with local recurrence and/or lymph node metastasis but undetectable in 2 cases presenting node metastasis and in 4 cases with lymphadenitis. All but one patient were admitted for surgery and the cytological diagnosis was confirmed. Early identification of a pathologic mass in the neck is a desirable goal; high resolution echography can play an important role in the follow-up of these patients and can detect local recurrences even when there is a negative whole body scan or undetectable thyroglobulin level.

Adenocarcinoma, Follicular↗
PubMed1995

[Preoperative imaging in the detection of parathyroid tumefaction in patients with primary hyperparathyroidism. The authors' own experience].

The authors report their 3-year experience with the diagnosis of parathyroid lesions in primary hyperparathyroidism patients in a geographic area where the occurrence of endemic goiter is medium. Our study was aimed at prospectively assessing preoperative imaging results in these patients. The following imaging methods were used: high-definition and color-Doppler ultrasonography (US), double-tracer 201Thallium-99mTechnetium (T1/Tc) subtraction scintigraphy, Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and US-guided fine-needle aspiration of the suspected parathyroid lesions. Preoperative US and scintigraphy were performed in 50 patients with primary hyperparathyroidism; in addition, color-Doppler US studies were performed in 33 patients for vascular characterization of the lesions. In 19 patients, the suspected lesions were punctured under US guidance to measure parathormone (PTHa) and thyroglobulin (TGa) levels in the aspirated material. CT and MRI were performed in 9 patients, to identify a possible ectopic parathyroid gland. Surgery demonstrated 48 solitary parathyroid lesions and one double parathyroid adenoma. In one patient no abnormal parathyroid gland was found. Overall sensitivity rates of US and scintigraphy were 85.7% and 61.2%, respectively. In multinodular goiter patients, the sensitivity rates of US and scintigraphy were 71.4% and 47.6%, respectively. At color-Doppler US the presence of parenchymal vascularization was specific of parathyroid nodules and the method helped differentiate parathyroid lesions from thyroid nodules in 14 multinodular goiter patients. Overall PTHa sensitivity was 72.2% and its specificity 100%. Overall TGa sensitivity was 100% and specificity 94.7%. CT and MRI allowed the detection of 8 ectopic parathyroid lesions. In conclusion, in our personal experience, US should be preferred to double-tracer T1/Tc subtraction scintigraphy in the early examination of primary hyperparathyroidism patients. When US detects a suspected parathyroid lesion, color-Doppler US and PTH and TG sampling can make useful diagnostic tools for reducing false-positive results, especially when thyroid disease is associated.

Adolescent↗
PubMed1994

Disappearance rate of serum calcitonin after total thyroidectomy for medullary thyroid carcinoma.

We studied the half-life of serum calcitonin (CT) in patients subjected to total thyroidectomy for medullary thyroid carcinoma (MTC). One patient showed a rapid serum CT component with a half-life of 3 hours and a slow component with a half-life of 30 hours; in another case only the 30-hour component was found. By chromatography of tumor extracts, we found that all the immunoreactive CT had a molecular weight of 3,600. After surgery, normalization of serum CT was achieved within 15 days in 4 patients, at 3 months and at 6 months in 2 other patients, while 1 patient never normalized. Normalization of serum CT after surgery is not an index of definitive cure in MTC, as demonstrated by one patient who relapsed 3 months after normalization of serum CT. However, as a general rule, patients who reach undetectable serum CT levels soon after surgery, are those having the best prognosis.

Adult↗
PubMed1994

Routine measurement of serum calcitonin in nodular thyroid diseases allows the preoperative diagnosis of unsuspected sporadic medullary thyroid carcinoma.

To assess whether routine measurement of serum calcitonin (CT) could improve the preoperative diagnosis of sporadic medullary thyroid carcinoma (MTC), 1385 consecutive patients presenting for nodular thyroid disease during the year 1991 were submitted to serum CT determination and fine needle aspiration cytology (FNAC). The clinical diagnosis was nontoxic nodular goiter in 1197 (86.4%) patients, toxic multinodular goiter in 65 (4.7%), autonomously functioning thyroid nodule (AFTN) in 64 (4.6%), and autoimmune thyroid disease (Graves' disease or Hashimoto's thyroiditis) with nodule(s) in 59 (4.3%). As controls, 177 patients with nonnodular thyroid disease and 32 normal subjects were also studied. Patients with FNAC suspicious of any kind of thyroid carcinoma and patients with elevated basal and pentagastrin-stimulated serum CT, regardless of the results of FNAC, were submitted to surgery. Eight (0.57%) patients (7 with nontoxic nodular goiter and 1 with AFTN) had elevated basal serum CT levels, ranging between 55-10,000 pg/mL. The pentagastrin test was abnormal in all of them. FNAC was suggestive of MTC in 2, thyroid carcinoma in 1, benign nodule in 3, and inadequate in 2. By histology, immunohistochemistry, and Northern blot analysis of total tumor RNAs, MTC was confirmed in all patients, including the 1 with AFTN, who had the association of microfollicular adenoma and a small MTC in the same lobe. After surgery, serum CT decreased to undetectable levels in 7 patients and remained undetectable in 6 of them during a mean follow-up of 22 months, although 1 of them had a positive response to pentagastrin. Forty-four patients in the group with normal serum CT levels had FNAC suspicious for differentiated thyroid carcinoma and were treated by surgery. Differentiated thyroid carcinoma, mostly papillary, was confirmed at histology in 43 subjects (3.1% of all thyroid nodules). In conclusion, the results of our study indicate that serum CT measurement is useful for the screening of sporadic MTC in patients with thyroid nodule(s). The prevalence of MTC, diagnosed by serum CT measurement in a 12-month period, among an unselected series of 1385 patients with nodular thyroid disease was surprisingly high: 0.57% of all thyroid nodules and 15.7% of all thyroid carcinomas. Serum CT measurement was superior to FNAC in suggesting the diagnosis of MTC and was devoid of falsely positive results. Increasing the diagnostic accuracy helped the surgeon to perform more radical treatment of MTC, thus achieving frequent normalization of postoperative serum CT levels. Whether this result indicates definitive cure remains to be established on the basis of longer follow-up.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1994

[The postoperative hemorrhagic complication in thyroid surgery].

Hemorrhage is a complication of thyroid surgery less important than recurrent laryngeal nerve injury or hypoparathyroidism, but extremely dangerous. Hemorrhage may be early or delayed. Early hemorrhage occurs generally in the operating theatre and is made easier by vomiting and coughing after removal of the tracheal tube. For this reason it is indispensable for the surgeon to remain until the patient is awake and carefully control the drainages. Delayed hemorrhage generally occurs some hours after the surgical operation with a swelling of the neck associated with difficulties in the breathing, due to tracheal compression. In our institution, from 1988 to 1992, we performed 1800 surgical operations for thyroid diseases and we observed 9 early hemorrhages and 10 delayed hemorrhages. In all cases we performed reoperation in general anaesthesia. In our series the hemorrhage was due to the vessels of the pre-thyroidal muscles and of the inferior pole, rarely of the superior pole. We had no complications after the reoperation. To prevent this complication, we have to respect some technical aspects: accuracy in the ligature of the blood vessels of the superior and inferior pole; partial section of the pre-thyroidal muscles; to bring the remaining thyroid (in case of subtotal thyroidectomy) near to the trachea with some stitches.

Female↗
PubMed1994

[Carcinoma of the parathyroids. Surgical experience in 3 cases].

Parathyroid carcinoma is a rare cause of hyperparathyroidism (rate of occurrence of 0.5% of all parathyroid neoplasms). In this report we describe three cases of parathyroid carcinoma seen in our Institution and we analyse the clinical, diagnostic, therapeutic and pathological findings of this disease. The three patients were 14, 22 and 45 year old respectively. Familial history was negative for endocrine diseases. The laboratory and instrumental findings of thyroid and adrenal glands were negative. Predominant symptoms were in all cases weakness, lethargy, bone and muscular pain, nausea, vomiting. The two young patients presented fractures of the inferior limb and of the forearm respectively, five years and one year before the diagnosis. X-ray examination and MNR easily demonstrated the "brown tumors". In two cases a symptomatic nephrolithiasis was present. The 14 year old child presented polyuria and polydipsia. In all cases a mass was palpable in the neck (two in the right side and one in the left one). The elevated serum calcium concentration (15, 18, and 20.2 mg/dl respectively) and the elevated serum PTH (480, 651, and 680 pg/ml respectively) allowed the diagnosis of hyperparathyroidism. Ultrasound scan and thallium-technetium scanning identified in all cases a mass adjacent the thyroid. A radical resection of the malignant parathyroid gland and the ipsilateral thyroid lobe was performed in two cases, while only a resection of the involved parathyroid gland in one case. The diagnosis of parathyroid cancer was established using pathologic criteria.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Follicular carcinoma and Hürthle cell tumor of the thyroid].

In this paper we present the current therapeutical strategies for follicular carcinoma (10-15% of all thyroid tumours) which is more common in areas of endemic goitre, and is classified according to histology into encapsulated and angioinvasive (more aggressive). The treatment of choice is total thyroidectomy, eventually associated with functional latero-cervical lymphadenectomy. Distant metastases can be treated by surgery if single and resectable, or by radiometabolic therapy in the other cases. Hürthle cell (oxyphilic) tumour, also called oncocytoma, has an unpredictable biological behaviour, even after histological examination. During the eighties the preferred treatment was total thyroidectomy, but currently many authors favour a less aggressive approach, especially with lesions considered "benign" according to the common histological parameters. We too apply an individualised strategy of treatment; follow-up must be very thorough in order to detect early any recurrence.

Adenocarcinoma, Follicular↗
PubMed1994

[Transient hypocalcemia after thyroidectomy].

In a patient submitted to thyroidectomy a transitory hypocalcemia can develop, the frequency of which is very variable in reference with on international literature. Several hypotheses have been enunciated to explain the phenomenon. This study would contribute to suggest its etiology and to quantify its entity. For this purpose we selected a series of patients among those operated from September, 1989 to May, 1991. 6 of them were affected by non toxic multinodular goiter (group 1), while 12 were affected by Graves' disease (group 2). We evaluated their serum levels of calcium, parathormone (iPTH), calcitonin (CT), osteocalcin and total proteins. In both groups we registered a temporary hypocalcemia that resulted statistically significant. In group 1 the hypocalcemia was associated with a decrease in iPTH levels, so that the cause of hypocalcemia in patients submitted to thyroidectomy for nontoxic multinodular goiter seems to be a transient parathyroid failure, while in group 2 the hypocalcemia was associated with a decrease in total protein levels, showing a different pathogenetic mechanism. We conclude that the transitory hypocalcemia post-thyroidectomy relies on a different etiology in the two thyropathies.

Adult↗
PubMed1993

[Cardiac echinococcosis. Case report and review of the literature].

Cardiac echinococcosis is a rare disease. We report the case of a patient affected by cardiac echinococcosis who underwent surgical treatment successfully. A forty year old woman was hospitalized referring palpitation and dyspnea. The patient had undergone surgical pericystectomy of the right lobe of the liver for echinococcosis 6 month before. Chest X-ray film showed a round opacity well delineated on the left side of the heart, Ghedini reaction was negative, ECG was normal. After a review of literature we analyze anatomo-clinic and therapeutic aspects of the disease.

Adult↗
PubMed1993

Prospective, randomized, double-blind study about effectiveness of levothyroxine suppressive therapy in prevention of recurrence after operation: result at the third year of follow-up.

BACKGROUND: Levothyroxine has often been given to patients operated on for nodular goiter to prevent recurrence. The rationale is that suppression of thyroid-stimulating hormone (TSH), considered to be the main growth factor in this disease, can be obtained by administration of levothyroxine. METHODS: Sixty patients undergoing operation for nontoxic nodular goiter were randomized in two groups: (1) thirty-two were administered levothyroxine at substitutive dosage (100 micrograms) or placebo and (2) twenty-eight were given levothyroxine at suppressive dosage (2.2 to 3 micrograms/kg/day). Levels of thyroid hormones and TSH were evaluated every 6 months. Recurrences detected by echography were then considered. RESULTS: After a 3-year follow-up we observed 25 of 32 recurrences in group 1 and 6 of 28 in group 2 (p < 0.005). Subjects with endemic goiter problems responded better to therapy. Patients with a multinodular goiter responded better than patients with a uninodular goiter. No difference was found regarding the type of surgical treatment (subtotal thyroidectomy vs lobectomy). CONCLUSIONS: The results confirmed suppressive therapy as actually being effective in preventing recurrences at least in iodine-deficient regions like Italy. Thus for these patients it may be suggested as a prophylactic treatment after operation.

Aged↗
PubMed1993

[Treatment of hyperfunctioning thyroid adenoma: current trends].

Thyroid adenoma is commonly associated with surgery and radiometabolic treatment; recently, according to previous successful reports, percutaneous ethanol injection therapy under sonographic guidance, has been introduced as an alternative. This technique has already been favourably used in the treatment of focal lesions, such as liver cancer and hyperparathyroidism. In our experience, we have treated with such therapy 69 patients affected by thyroid adenoma (55 females, 14 males; 28 pretoxic, 41 toxic). Ethanol (0.5-2.8 mL/mL nodular tissue) was injected, under sonographic guidance, in 4-9 sessions (1 weekly). Thyroid hormone profile was assessed during treatment and at 3 and 6 months follow-up. Apart from local transient pain in 21% sessions, two cases of pyrexia (38.5 degrees-1 day) and 3 cases of transient dysphonia, no relevant adverse effects were observed. A slight thyroid hormone increase was seen in both groups immediately following treatment. Six months after therapy a biochemical and clinical remission of hyperthyroidism was observed in 33 out of 41 toxic patients (80%); a significant increase of TSH levels was seen in both groups (p < 0.001). With follow-up, significant volume shrinkage (70-80% volume reduction--p < 0.0001) as well as structural alterations of the nodule, were consistently recorded at sonography, in both groups; a linear relationship (p < 0.0001) between pretreatment volume and volume reduction was found. At scintiscan functional activity of extranodular parenchyma was found in 75% of patients affected by pretoxic adenoma and in 63.1% of patients with toxic adenoma. These data confirm that percutaneous ethanol injection therapy is effective in obtaining functional ablation and in inducing remission of hyperthyroidism, when present; so it represents a valid and safe alternative to standard therapeutic tools of thyroid adenoma.

Adenoma↗
PubMed1992

Detection of thyroglobulin in fine needle aspirates of nonthyroidal neck masses: a clue to the diagnosis of metastatic differentiated thyroid cancer.

We studied the feasibility of employing the measurement of thyroglobulin (Tg) in the washout of the needle used to perform the fine needle aspiration cytology (FNA-Tg) for the differential diagnosis of nonthyroidal neck masses of unknown etiology. We studied 35 patients presenting for 1 or more neck lumps outside the thyroid gland. A previous history of treated differentiated thyroid cancer (DTC) was given by 23 patients and of nonthyroidal malignancy by 3 patients. FNA-Tg was measured in the Tg-free serum used to wash out the needle employed for the cytology. Finally, all patients were treated by surgery. FNA-Tg was always detectable in 14 patients with thyroid cancer metastases demonstrated by histology, with a mean (+/- SD) of 27,087 +/- 37,622 ng/FNA (P less than 0.002) compared to patients without thyroid cancer metastases (mean +/- SD, 12.1 +/- 4.8 ng/FNA in 7 cases; undetectable in 14 cases). Assuming 21.7 ng/FNA (the mean +/- 2 SD of the negative patients) as the cut-off value, all patients with metastases from DTC were detected by FNA-Tg. FNA-Tg had better negative predictive value than cytology, since this last technique gave 10 inconclusive results, comprising 2 false negative results in patients with metastases from DTC. Our results indicate that elevated concentrations of FNA-Tg in nonthyroidal neck nodes strongly suggest the diagnosis of metastases from DTC.

Adolescent↗
PubMed1992

Percutaneous intranodular ethanol injection for treatment of autonomously functioning thyroid nodules.

BACKGROUND: The aim of the study is the assessment of percutaneous intranodular ethanol injection (PNEI) as an alternative therapeutic procedure to classic surgery and radioiodine administration in autonomously functioning thyroid nodule treatment. METHODS: Thirty-seven patients with hot nodules (18 pretoxic and 19 toxic) have been treated by means of PNEI under ultrasonographic guide. Ninety-five percent ethanol in a mean dose of 25 ml has been used. RESULTS: Nearly 80% of the patients showed normalization of thyroid-stimulating hormone levels and a complete recovery of extranodular tissue at scintiscan. All nodules decreased strikingly in size, many becoming undetectable. Mild and transient side effects were seen in 9% of the patients. CONCLUSIONS: PNEI seems to be a feasible procedure on outpatients. It is safe when performed by a well-trained staff using ultrasonographic control. It may be carried out at any age and in patients at risk for surgery. PNEI can be considered a useful alternative to surgery and radioiodine administration in all autonomously functioning thyroid nodules and particularly in pretoxic nodules.

Administration, Cutaneous↗
PubMed1992

Retroperitoneal seminoma secondary to 'burned out' testicular tumor in an acromegalic patient.

We report a case of an acromegalic patient with a retroperitoneal seminoma secondary to a testicular tumor which had completely disappeared. Testicular ultrasonography did not show any pathological mass and histological examination indicated that the normal testis had been totally replaced by fibrous tissue, without neoplastic cells. Our patient had high levels of growth hormone (GH) and prolactin (PRL), both hormones with high immunostimulating effect, and an increase of interleukin-2 receptor-positive lymphocytes, a finding supporting enhanced immunological activity. Thus, we cannot exclude that the immunological pattern of this acromegalic patient may have played some role in the tumoral destruction.

Acromegaly↗