The eligibility of MIVA approach in thyroid surgery

Introduction Thyroid size, by preoperative ultrasound evaluation, is a very important criterion of minimally invasive video-assisted thyroidectomy (MIVAT) exclusion because the working space provided by the technique is limited. The aim of this work is to verify the suitability of MIVAT and its applicability in clinical practice in patients with a thyroid volume up to 50 ml. Methods From January 2003 to February 2006, 33 patients were selected for MIVAT. A completely gas-less procedure was carried out through a central skin incision performed “high” between the cricoid and jugular notch. Results The skin incision performed was from 20 to 35 mm (mean 24.88 mm ± 2.74) for different thyroid sizes. We obtained in all cases excellent results about patients cure rate and comfort, few cases of postoperative pain, and attractive cosmetic results. Conclusion In this study, we demonstrated that the MIVAT, for thyroids up to 50 ml in volume, is feasible and safe. This procedure allows more patients, who would have been excluded before, to take advantage of this minimally invasive approach with good cosmetic results, highly regarded by young female patients, and reduced paresthetic consequences. Presented at the 2nd Biannual Congress of European Society of Endocrine Surgeons, 18–20 May 2006, Krakow, Poland.     

Recurrent obstructive hydrocephalus in a 4-month-old infant

Introduction  

Transient, recurrent or permanent causes of hydrocephalus in children are usually due to tumours, cerebral bleeding or colloid cysts and complications of infectious meningitis or secondary to poisoning. Recurrent, obstructive hydrocephalus is very rare.     

The Role of Surgery and Adjuvants to Survival in Pagetic Osteosarcoma

Background  

Osteosarcoma is a rare complication of Paget’s disease with a very poor prognosis. Treatment is controversial: the older age of the patients affected by Paget’s disease may limit the use of chemotherapy and axial involvement may limit the practicality of surgery.     

Determinants of COVID-19-related lethality in multiple sclerosis: a meta-regression of observational studies

Journal of Neurology - To identify risk factors for an increased lethality of COVID-19 in patients with multiple sclerosis (MS). We searched scientific databases to identify cohort studies with the...     

Complications of spine surgery for metastasis

The spinal column represents the third most common site for metastases after the lungs and the liver, and the most common site for metastatic bone disease. With life-extending advances in the systemic treatment of cancer patients, the surgical procedures performed for spinal metastases will increase, and their related complications will increase unavoidably. Furthermore, considering the high complication rates reported in the spinal literature regarding spine surgery overall, it becomes clear that a better understanding of complications that the cancer patients with spinal metastases may experience is necessary. This article aims to summarize and critically examine the current evidence for complications after spine surgery for metastatic spinal disease, in both the perioperative and postoperative period. This paper would be useful for the treating physicians of these patients in their clinical practice.

     

Both early and committed haemopoietic progenitors are more frequent in peripheral blood than in bone marrow during mobilization induced by high-dose chemotherapy + G-CSF

Summary. Haemopoietic growth factor administration following high-dose chemotherapy markedly amplifies progenitor cell pool in the peripheral blood (PB). Collection and reinfusion of these cells enable rapid haemopoietic recon-stitution following autograft. Less is known on engraftment potentiality of bone marrow (BM) cells taken under analogous conditions. To investigate this tissue, PB and BM were evaluated simultaneously during maximal mobilization in a series of 14 patients undergoing the HDS chemotherapy programme. A significantly higher growth of committed progenitors was found from PB rather than from BM (663 ± 123 v 267±40CFU-GM/10⁵ MNC, respectively). Also, significantly more CFU-GM could be collected by a median of three leukaphereses, compared to those harvested from BM (158 ± 31 v 16 ± 4 ± 10⁴ CFU-GM/kg, respectively). Most mobilized CFU-GM were phenotypically immature (CD15⁻); in addition, circulating cells included primitive progenitors, as assessed by LTC-IC assay, or by evaluation of non-proliferating pre-CFU-GM, selected by an anti-CD71 immunotoxin. The amount of pre-CFU-GM determined by both techniques was consistently higher in PB than in BM. Moreover, a direct correlation could be established between circulating CFU-GM and primitive precursors. Thus, during optimally induced mobilization, PB contains many more haemopoietic progenitors, of both committed and primitive stages, than does BM. Under such conditions, PB is probably the best source of material for graft purposes.     

Familial clustering of scleroderma spectrum disease

This is the second case report of familial scleroderma (systemic sclerosis) in South Carolina. The family includes two cases of scleroderma meeting American Rheumatism Association criteria, one of systemic sclerosis sine scleroderma, and two other cases of undifferentiated connective tissue disease with features of scleroderma spectrum disorders; there are also two cases of Raynaud's phenomenon (one associated with rheumatoid arthritis), for a total of seven affected relatives. Evidence of scleroderma spectrum disorders was sought in six siblings of the two co-index cases and in 23 of the 35 offspring. Laboratory studies included antinuclear antibody determinations and typing for the following genetic markers: HLA (A, B, C, DR), complotypes, Gm and Km allotypes, and alpha-1 antitrypsin phenotypes. No common genetic markers restricted to affected members of this family were found, and no environmental exposures were detected that could explain this familial clustering of cases. This report should, however, add to the slowly accumulating information on the genetic characteristics of families at unusually high risk for scleroderma spectrum disorders. Positive antinuclear antibody tests at a titer of 1/40 or higher were present in 57 percent of the first-degree relatives of the affected cases.     

Inferior mesocaval shunt for bleeding anorectal varices and portal vein thrombosis

Intractable bleeding from anorectal varices is a serious and often misdiagnosed complication of portal hypertension and no agreement has been reached on which could be the optimal diagnostic and therapeutic strategy. Indeed, fatal outcome has been often reported resulting from delayed diagnosis and improper treatment. The case of a 67-year-old gentleman with life-threatening bleeding from anorectal varices who successfully underwent inferior mesocaval shunt is reported, and surgical technique for establishing a shunt between the inferior mesenteric vein and inferior vena cava is described. A review of other therapeutic options is presented and results are discussed and compared to those obtained with this novel form of treatment. In our experience, immediate control of recurrent bleeding from anorectal varices was obtained with inferior mesocaval shunt. Technical ease, promptness of action and effectiveness, low procedure-related morbidity are the main features of the shunt. With the introduction of new promising second-line treatment modalities to primary and metastatic liver tumors, like percutaneous radiofrequency thermal ablation, and improvement in outcome of portal vein thrombosis, the inferior mesocaval shunt may represent a sound alternative for patients who are ineligible for transjugular intrahepatic portosystemic shunt or presenting with clotted shunt.     

Abnormal distribution of AQP4 in minor salivary glands of primary Sjögren’s syndrome patients

A decreased saliva production occurs in primary Sjögren’s syndrome (pSS), an autoimmune disease characterized by oral and ocular dryness due to dysfunction of the lacrimal and salivary glands (SGs). Since water movement is involved in saliva secretion, the expression, localization, and function of the water channels aquaporins (AQPs) have been extensively studied in SGs. To date, the presence of AQP4 remains controversial and ambiguous in human SGs. We investigated by immunohistochemistry, high-resolution confocal microscopy and quantitative image analysis, Western blot and real-time RT-PCR, the presence of the AQP4 gene, and the distribution of AQP4 protein in healthy controls and pSS SG biopsies. Through the immunohistochemical analysis, we demonstrated that AQP4 presence is confined to the basal region of acini, to the lateral and apical membrane of intercalated and striated ducts in both control and pSS glands. The most striking observation was the discovery of AQP4 localization in myoepithelial cells (MECs) that surround acini lobules and intercalated ducts, and the demonstration of AQP4-downregulated immunoreactivity in pSS MECs. Our studies suggest that the capacity for water flow across the membrane of MECs may be altered in pSS, identifying AQP4 as a promising new therapeutic agent to treat xerostomia.