Search

Introduction Neoplasms of the thymus gland are the most common tumors in the anterior mediastinum, and differentiation between benign and malignant forms is rather difficult. Extrathoracic invasions or metastases are extremely rare, and only a few cases have been reported previously. Case presentation We report herein the case of a patient in whom a thymoma type A recurred at skeletal muscle 2-years after surgery. The metastases were completely resected. Adjuvant treatment was started. Actually, no signs of recurrence were seen. Conclusion Our case shows that also thymoma type A, generally defined as a low malignancy, may recur. Thus, a strict follow-up is required. If metastases are present, surgical resection with curative intent associated with adjuvant therapy should be attended.

Introduction To study the impact on adult’s fertility of serum inhibin B levels in adolescent patients with idiopathic varicocele after minimally invasive surgical correction and to compare fluctuation of pituitary-testis hormonal values and testicular volumes. Materials and Methods: A case-control study was carried out on a group adolescent patients (n=60) affected by idiopathic left varicocele (group V) and compared with control adolescents (n=40) in the Paediatric Surgery Section of Siena (from June 1993 till September 2013). Inhibin B levels and testicular volume before (T0) and after at 6 and 12 months from surgery (T1 and T2) were evaluated. Results: A positive correlation between testicular growth at T1 and T2 (P

Aim The anastomosis technique used following right-sided colonic resection is widely variable and may affect patient outcome. This study aimed to assess the association between leak and anastomosis technique (stapled vs handsewn). Method This was a prospective, multicentre, international audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a 2-month period in early 2015. The primary outcome measure was the presence of anastomotic leak within 30 days of surgery, determined using a prespecified definition. Mixed effects logistic regression models were used to assess the association between leak and anastomosis method, adjusting for patient, disease and operative cofactors, with centre included as a random-effect variable. Results This study included 3208 patients, of whom 78.4% (n = 2515) underwent surgery for malignancy and 11.7% (n = 375) underwent surgery for Crohn's disease. An anastomosis was performed in 94.8% (n = 3041) of patients, which was handsewn in 38.9% (n = 1183) and stapled in 61.1% (n = 1858). Patients undergoing hand-sewn anastomosis were more likely to be emergency admissions (20.5% handsewn vs 12.9% stapled) and to undergo open surgery (54.7% handsewn vs 36.6% stapled). The overall anastomotic leak rate was 8.1% (245/3041), which was similar following handsewn (7.4%) and stapled (8.5%) techniques (P = 0.3). After adjustment for cofactors, the odds of a leak were higher for stapled anastomosis (adjusted OR = 1.43; 95% CI: 1.04-1.95; P = 0.03). Conclusion Despite being used in lower-risk patients, stapled anastomosis was associated with an increased anastomotic leak rate in this observational study. Further research is needed to define patient groups in whom a stapled anastomosis is safe.

Since the use of robotic surgery (RS) revolutionized some adult surgery procedures such as radical prostatectomy, it has been progressively and increasingly introduced in pediatric surgery. The aim of this study is to evaluate how the Da VinciWe prospectively included patients older than 6 months of age undergoing RS or conventional minimal access surgery (MAS): Study period ranges between February 2015 and April 2016. Surgical indications were defined after a detailed disease-specific diagnostic work-up. We analyzed surgical outcomes and the most relevant economic aspects. The 30-day postoperative complications were evaluated and retrospectively collected in an electronic database.From February 2015 to April 2016, we performed 77 procedures with RS and 84 with conventional MAS in patients with a median age of 77 and 98 months at surgery and a median weight of 20 and 23 kg, respectively. Median operative times were 130 and 109 minutes, respectively. We observed 9.1% of complications in the RS group and 6% in the MAS group and the difference was not statistically significant. Of note, 8 out of 77 RS procedures would have been performed with open classic surgery in case of conversion or failure of RS.This initial experience confirms that RS is as safe and effective as conventional MAS. A number of selected procedures performed with RS would only benefit from this approach, as it is not suitable for conventional MAS. Although economically demanding, in particular for a pediatric hospital, we firmly believe that centralization of care would allow pediatric surgeons adopting RS to perform complex reconstructive surgical procedures with great advantages for the patients and a minimal increase in overall costs for the health system.

The recent changes in the work environment have highlighted the need for a new approach in the management of physical, economic and social security in the workplace. The Italian legislation responded with the law n. 81/2008 which arises from the realization that security can not be conceived only as normative and technical concept, but that disciplines such as sociology and business organization provide a vital contribution.

The aim of this prospective cohort study was to identify the patient factors that predict postoperative deviation from each item of a fast-track colorectal surgery protocol (FT) and these factors' influences on postoperative outcomes. A total of 606 patients with colorectal pathology from 2005 to 2011 were analyzed to assess the relationships between patient factors, the outcome variables, and the items of the FT program. The median length of stay was 5 days, and readmission rate was 2.3%. The morbidity rate was 26.7%. Independent predictors of prolonged length of stay were older than 75 years of age, ASA grade 3 and 4, and the presence of an ileostomy. Independent predictors of morbidity were age above 75 years old and ASA grade, whereas age was confirmed as an independent predictor of mortality. Male sex, age above 75 years old, and ASA 3 and 4 were identified as independent predictors of negative compliance to most of the postoperative FT items.

Congenital cystic lung lesions are a rare but clinically significant group of anomalies, including congenital cystic adenomatoid malformation (CCAM), pulmonary sequestration, congenital lobar emphysema (CLE) and bronchogenic cysts. Despite the knowledge of these lesions increasing in the last years, some aspects are still debated and controversial. The diagnosis is certainly one aspect which underwent many changes in the last 15 years due to the improvement of antenatal scan and the introduction of 3-D reconstruction techniques. As it is known, a prompt diagnosis has an essential role in the management of these children. The new imaging studies as 3D Volume rendering system are the focus of this paper. We describe our preliminary experience in a case of hybrid lung lesion, which we approached by thoracoscopy after a preoperative study with 3D VR reconstruction. Our final balance is absolutely positive.

This single-center prospective cohort study, conducted outside of a clinical trial, tried to identify the importance of each fast-track surgery procedure and protocol adherence level on clinical outcomes after colorectal surgery. From a prospectively maintained database, 606 patients who underwent elective laparoscopic or open colorectal resection within a well established fast-track surgery (FT) protocol, between 2005 and 2011, were identified. Univariate and multivariate analysis were performed to assess the relationship between each FT procedure with an adherence rate

The authors present a case of a female patient 45 years old with chronic abdominal pain and a retroperitoneal tumor mass which showed the diagnosis of endometriosis by fine needle biopsy. Bilateral oophorectomy was performed. The patient remained symptomatic,the next four years, with pain and weight loss and new diagnostic images revealed tumor mass growth. Radical surgical treatment was impracticable due to tumor adhesions to major vascular structures. Post operatory was troublesome with septic complications evolving to death. The autopsy results showed the diagnosis of endometrioid adenocarcinoma.

Background: Anaplastic thyroid cancer (ATC) is a rare, lethal disease associated with a median survival of 6 months despite the best multidisciplinary care. Surgical resection is not curative in ATC patients, being often a palliative procedure. Multidisciplinary care may include surgery, loco-regional radiotherapy, and systemic therapy. Besides conventional chemotherapy, multi kinase-targeted inhibitors are emerging as novel therapeutic tools. The numerous molecular alteration detected in ATC are targets for these inhibitors. The aim of this review is to determine the prevalence of the major genetic alterations occurring in ATC and place the results in the context of the emerging kinase-targeted therapies. Methods: The study is based on published PubMed studies addressing the prevalence of BRAF, RAS, PTEN, PI3KCA and TP53 mutations and RET rearrangements in ATC. Results: 21 articles dealing with 652 genetic analyses of the selected genes were used. The overall prevalence determined were the following: RET/PTC, 4%; BRAF, 23%; RAS, 60%; PTEN, 16%; PI3KCA, 24%; TP53, 48%. Genetic alterations are sometimes overlapping. Conclusions: Mutations of BRAF, PTEN and PI3KCA genes are common in ATC, with RAS and TP53 being the most frequent. Given ATC genetic complexity, effective therapies may benefit from individualized therapeutic regimens in a multidisciplinary approach.

BACKGROUND: Primary thyroid lymphomas (PTLs) account for 5% of thyroid malignant tumors and often develop in patients with Hashimoto Thyroiditis (HT). Fine-needle cytology (FNC) is widely used in the diagnosis of thyroid nodules, including those arising in HT. Two PTL cases in HT elderly patients are here described and discussed. METHODS: FNC was performed in rapidly enlarged thyroid nodules of 2 elderly patients under ultrasound (US) control. FNC was used to prepare conventional cytologic smears, immunocytochemistry (ICC) and flow cytometry (FC) assessment of cell populations. RESULTS: The above cases were diagnosed as well differentiated, small B-cell and diffuse large B-cell thyroid lymphomas, respectively, by means of FNC. The histological diagnoses were mucosa-associated non Hodgkin lymphoma (MALT) and diffuse large B-cell lymphoma (DLBCL), confirming FNC diagnoses, and patients were treated accordingly. CONCLUSIONS: FNC diagnosis of PTL is reliable and accurate; it may be conveniently used in the clinical practice since it provides indications for appropriate therapeutic procedures or diagnostic surgery, and avoids to treat benign nodules.

Background Long standing Hashimoto Thyroiditis (HT) causes shrinking and atrophy of the thyroid, but may also lead to diffuse enlargement of the gland and/or formation of nodules. These nodules should be differentiated from papillary thyroid carcinoma (PTC) and primary thyroidal non-Hodgkin lymphoma (PTL), which are possible complications of HT, and require pre-surgical diagnoses and different treatments. This study focuses on the role of fine-needle cytology (FNC) in the clinical surveillance and pre-surgical diagnosis of HT with diffuse and nodular enlargement of the gland in elderly patients. Methods Thirty-four elderly patients (≥ 65 yrs) with HT and diffuse or nodular enlargement of the thyroid underwent ultrasound (US)-guided FNC. Smears were routinely stained and evaluated; additional passes were used for flow cytometry (FC) assessment of lymphoid infiltrate in 6 cases. Results The cytological diagnosis was HT in 12 cases with prevalence of Hurtle cells in 2 cases, PTC in 1 case and PTL in 2 cases. FC assessed the reactive, non-lymphomatous nature of the lymphoid infiltrate in 5 cases and demonstrated light chain restriction, hence the lymphomatous nature of the lymphoid infiltrate in 2 cases of PTL. Conclusions FNC plays a key role in the clinical surveillance and pre-surgical diagnosis of diffuse enlargement and nodular presentation of HT in elderly patients. FNC can correctly diagnose HT, PTC and PTL indicating the need for surgery and its extension in suspicious or neoplastic cases, leaving other cases to the medical treatment and clinical surveillance.

Pulmonary sequestration is an uncommon disease, accounting for only approximately 1.5% of all congenital pulmonary malformations. In most cases, the diagnosis is a result of accidental radiological findings; it is rarely accompanied by clinical symptoms, and is more commonly associated with other congenital malformations. Herein, we reported a case of pulmonary sequestration presented as massive left hemothorax and associated with primary lung sarcoma. A pneumonectomy via thoracotomy was attended with complete resection of sequestration and of sarcoma. The postoperative course was unremarkable, and the patient was discharged on postoperative day 11.

The mechanical stapler is routinely used in thoracic surgery practice to attend resection of bronchus and vessels. Herein, we reported a very rare complication as the migration of a titanium surgical clip through a right lobectomy stump. One year after the procedure, the patient complained of persistent cough. A misdiagnosis of asthma was made and she treated for 6 months with bronchodilators, corticosteroid and antihistaminic without success. Thus, patient re-referred of our unit. No clinical signs of infection as fewer, productive cough, dyspnea were present. The laboratory exams were within normal value including white cells. CT scan revealed no abnormalities. Bronchoscopy demonstrated a healed upper bronchus stump without evidence of an actual, open bronchopleural fistula but with clips apparently working their way into the airway, with approximately half of the clip visible within the lumen. The side of the clips that would be open before closure by the surgeon formed the leading edge of the clips visible in the lumen. The clips were successfully removed during flexible bronchoscopy with a forceps usually used for biopsy. After the procedure, the cough disappeared. The endoscopy check after 3 months showed a normal bronchial stump without evidence of fistula.

Background Amyloidosis is a systemic disease characterized by the extracellular deposition of amyloid fibrils in different organs and tissues. The thyroid gland may be affected by diffuse or nodular amyloid deposits, along with multiple myeloma (MM) (Amyloid Light-Chain Amyloidosis, AL amyloidosis) or chronic inflammatory diseases (Amyloid A Amyloidosis, AA amyloidosis), but thyroid gland involvement rarely appears as the first clinical manifestation in both conditions. The present study reports a case of primary thyroidal nodular amyloid goiter diagnosed by fine-needle cytology (FNC) in an elderly patient. Case report A 66-year-old female patient presented with dysphagia and hoarseness; the patient suffered from rheumatoid arthritis but did not have kidney failure or altered thyroid function. Ultrasound examination (US) showed a 30 mm irregular, hypoechoic area in the left thyroid lobe. FNC showed abundant, dense and amorphous material similar to the one stained in purple at Diff-Quik stain and pinkish at the Papanicolaou. Spindle cells with thin, bland and bent nuclei were scattered in this material; few thyroid follicular cells were also present. An alcohol-fixed smear was stained with Congo red: the amyloid material appeared cherry red and it also showed apple-green birefringence when observed with a polarizing microscope. A differential diagnosis between different thyroid pathologies was considered and the cytological diagnosis of nodular amyloid goiter was pointed out. The patient underwent thyroid lobectomy and the subsequent histological examination confirmed the cytological diagnosis. Conclusions FNC is a safe and effective procedure for the diagnosis of thyroid amyloidosis. Congo red-stained smears can be used to demonstrate the presence of amyloid material, showing the typical green birefringence under polarized light. An early and accurate cytological diagnosis may suggest an hematological screening and the appropriate treatment for the thyroid nodule.

Vascular lesions of the maxillofacial area are even more challenging than in other different body district, because of the high aesthetic and functional relevance of this area for the sense organs presence like eye, brain, tongue, ear and nose. For these reasons, we propose an accurate classification based on hemodynamic and histologic aspects usefulthat is for diagnostic and therapeutic planning. A female, 60 years old patient came to our observation showing a vascular lesion of the lower left lip, and complaining for aesthetical and functional impairment. To confirm the diagnosis of vascular malformation and to detect lesion flow rate or other possible localization, a Tc red blood cell scintigraphy was carried out. Result was a venous low flow lesion; hence, sclerotherapy by a 3% Polidocanol solution (Atossisclerol) followed by surgery was planned. The aim of this work was to propose a diagnostic and therapeutic scheme with an integration of ISSVA and a flow rate classifications for a three-step planning based on 1) the biological findings in an early age at the lesion discover with a pharmacological treatment; 2) Hemodynamic study of the lesions at growing age followed by sclerotherapy or embolization; 3) Imaging study of these lesions for patients candidate to surgery when after step 1 and step 2 diagnostic and therapeutic planning results were incompletely successful.

Since 1988, when Rogers first described a boy with anophthalmia associated with esophageal atresia, eight similar cases have been reported. These patients lend support to the hypothesis that this association of congenital anomalies constitutes a discrete entity, although the etiology is still unknown. We report a patient with this combination of malformations as well as a marked hypoplasia of the entire left half of the body.

At birth, newborn babies tend to respond to any stressful event with elective blood shunting towards the main organ systems, such as the brain and heart. Consequently, the bowel may suffer from a severe flow reduction with a high risk of hypoperfusion. The distal ileum is relatively less vascularized than other parts of intestine, due to a lack of collateral arteriolar circulation. It is therefore at higher risk of hypoxia, tissue necrosis and perforation in situations of minimal hypoperfusion or spasm. A rare case of covered perforation of the last loop of the ileum in a severely preterm baby is reported. The perforation manifested atypically as inflammatory stenosis of the loop and the ileo-cecal valve. To avoid misdiagnoses and to manage these cases correctly, the caregiver has to consider this rare eventuality in the differential diagnosis of intestinal occlusion/subocclusion in the first days of life.

BACKGROUND: Some technical aspects of laparoscopic spleen surgery still are debated, although efforts have been made to standardize them. The position of the patient, the approach to the spleen, vessel identification and division, and spleen extraction can vary from center to center. METHODS: This retrospective muticentric study led by the Società Italiana di Videochirurgia Infantile (SIVI) examined indications, surgical details, and complications of laparoscopic spleen surgery in the pediatric population during a 5-year period. RESULTS: The study period from January 1999 to December 2003 (5 years) involved nine centers and included 85 patients with a mean age of 10 years (range, 2-17 years). Hypersplenism or severe hemolysis in cases of hematologic disorders represented the most important indications. More than 90% of the patients underwent total laparoscopic splenectomy. Specific technical details from each center were collected. Intraoperative complications occurred in 19% of the patients (hemorrhage in 8% and technical problems in 14%), and 6% of the patients required conversion to the open approach. No deaths occurred, and no reoperations were required. Postoperative complications were experienced by 2% of the patients. CONCLUSION: Laparoscopic spleen surgery is safe, reliable, and effective in the pediatric population. On the basis of the results, some technical details for laparoscopic spleen surgery can be suggested. The patient is preferably kept supine or lateral, approaching the spleen anteriorly. Moreover, the ilar vessels should be identified selectively and individually, with initial artery division performed to achieve spleen shrinking. Any hemostatic device proved to be effective in experienced hands. Once freed, the spleen is preferably extracted via a suprapubic cosmetic transverse incision (faster, easier, and safer), although a bag can be used. Finally, the size of the spleen does not represent a contraindication for a trained and experienced surgeon. Nevertheless, this parameter must be considered when laparoscopic spleen surgery is planned.

Introduzione La chirurgia mininvasiva, laparo- e retroperitoneosco- pica, rappresenta oggi la tecnica di scelta nella realizza- zione della nefrectomia in ogni epoca dell’età pediatrica. Consente il rispetto della muscolatura addominale ed una più rapida guarigione del paziente. Riportiamo l’esperienza di un gruppo di chirurghi della SIVI relativa a 90 procedure retro e videolaparoscopiche. Materiali e metodi Sono stati trattati con tecnica mininvasiva 90 pazienti di età compresa tra 2 mesi e 18 anni (età media: 9 anni). In 86 di essi è stata eseguita una nefrectomia, in 4 una eminefrectomia. L’approccio laparoscopico è stato eseguito in 9 pa- zienti: 7 con un rene multicistico normotopico, 2 con rene ectopico pelvico (1 rene multicistico, 1 rene displasico). Nei restanti 81 pazienti è stato preferito l’approccio retro- peritoneoscopico (77 nefrectomie e 4 eminefrectomie) po- sizionando il paziente in decubito laterale ed utilizzando tre trocars operativi; si trattava di: 43 casi di rene multici- stico, 6 casi di sindrome del giunto pielo-ureterale, 11 casi di displasia renale (4 ipoplasia, 2 ureterocele, 1 uretero- cele in uretere retroiliaco, 3 ureteri ectopici, 1 ureterocele in rene ectopico), 16 casi di rene grinzo, 1 caso di calco- losi renale. Le 4 eminefrectomie polari superiori, 2 destre e 2 sinistre, si riferiscono a 4 casi di displasia in duplicità pielo-ureterale. Risultati La durata media delle procedure è stata di 120’ (range compreso tra 65’ e 180’). Le complicanze intra-operatorie si sono limitate a: 6 casi di pneumoperitoneo (2 desuffla- zioni con ago di Verres e 4 conversioni), 2 conversioni per problemi tecnici ed 1 conversione in un caso di litiasi re- nale complessa. In totale si sono rese necessarie 7/81 con- versioni (8.6%) nella serie retroperitoneoscopica. Non si è manifestato nessun caso di sanguinamento intra- o post- operatorio e la degenza media è stata di circa tre giorni. Conclusioni La nefrectomia mininvasiva è realizzabile con sicurezza ed efficacia nelle diverse epoche di vita, anche in periodo neonatale. Le indicazioni ed il timing permangono co- munque i medesimi della chirurgia tradizionale. La se- quenza dei tempi chirurgici riproduce più o meno fedel- mente quelli della chirurgia open ed i tempi di realizza- zione in mani esperte sono pressocché sovrapponibili. La tecnica retroperitoneoscopica offre il vantaggio di evitare la contaminazione della cavità peritoneale, la mo- bilizzazione del colon ed il rischio di lesioni accidentali o di raccolte endoperitoneali. L’approccio ai vasi dell’ilo è più diretto, con un ottimo controllo vascolare. I limiti sono rappresentati dalla camera di lavoro piccola e dal ri- schio di pneumoperitoneo. Rimangono come indicazioni controverse i traumi, la chirurgia precedente, le coagulopatie, la sepsi o la pielone- frite xantogranulomatosa, mentre crediamo debba essere accolta la realizzazione di nefrectomie parziali o totali nella pratica oncologica, soprattutto nei pazienti sottopo- sti a chemioterapia che presentano una riduzione della massa neoplastica. La tecnica videolaparoscopica può es- sere allo stesso modo realizzata in sicurezza dal chirurgo più confidente con questa pratica e trova elettiva indica- zione in condizioni specifiche: rene ectopico pelvico, pre- lievo per donazione da vivente, nella chirurgia oncologica e nella robotica. L’analisi dei costi rispetto alla nefrectomia tradizionale non mostra un aggravio di costi, bensì un risparmio grazie alla riduzione delle giornate di degenza.

The aim of this research is the application of the Method of Organizational Congruencies before and after the substitution of organic solvents with vegetable agents for the cleaning of an offset printing machine in order to assess the organizational changes. A solvent-free process is the goal of the Subsprint Project (Technology Transfer Program of the European Community). This, study shows how human and environmental health is improved by using vegetable agents, though this change may lead to some other organizational constraints such as an increase of tbe time needed, monotony, and repetitiveness of the technical actions involved. The authors underline that the knowledge of the impact of the new technology on health helps a better understanding of the resistance to the change and its further amelioration.

Actuellement la chirurgie laparoscopique se developpe largement en chirurgie pediatrique. Les chirurgiens pediatres sont maintenant susceptibles d'etudier les applications possibles en chirurgie pediatrique de cette technique nouvelle et fascinante. Il est cependant indispensable d'avoir une equipe experimentee en laparoscopie pour realiser une intervention importante. Seulement quelques cas de fundoplication selon la technique de Nissen ont ete rapportes a la periode pediatrique. Nous rapportons une etude experimentale dans laquelle nous avons ajoute une modification technique par l'utilisation de la colle de fibrine qui permet de se contenter de deux sutures aux deux extremites de la grande courbe mobilisee devant l'estomac. Les resultats ont ete interessants et nous pensons que c'est un excellent point de depart pour une application ulterieure de cette nouvelle technique.

We evaluate the results and complications of laparoscopic urological procedures in children.In a 3-year period 4,350 laparoscopic procedures were performed at 8 Italian centers of pediatric surgery. We analyzed only the data of urological procedures for a total of 701 laparoscopic operations on patients 1 month to 14 years old. The indications for surgery were cryptorchidism in 414 cases, varicoceles in 159, ambiguous genitalia in 37, total nephrectomy in 34, partial nephrectomy in 4, adrenalectomy in 3 and other diagnostic procedures in 50. We adopted a retroperitoneoscopic approach in 72 cases (10.3%) and a laparoscopic approach in 629 (89.7%). Patient records were analyzed to search for any complication that may have occurred during the laparoscopic procedure and assess how they were managed.We recorded 19 complications (2.7%) in our series, of which 6 required conversion to open surgery and 13 did not. There was no mortality. At a maximum followup of 4 years all children were alive and had no problems related to the laparoscopic complications.Our study shows that pediatric laparoscopic urological surgery has an acceptable rate of complications with no mortality. We believe that routine use of open laparoscopy in pediatric patients is a key factor to help avoid complications. Most complications can be avoided with surgeon and team experience, together with proper compliance with the indications for surgery.

Introduction: the aim of this study is to presents the results of our preliminary series of 8 partial nephroureterectomy performed by retroperitoneoscopy using harmonic scalpel with a preoperative 3D virtual reconstruction of bidimensional magnetic resonance images in children affected by duplication of the renal system. Materials and methods: We perform a retrospective study in our Pediatric Surgery Unit from January 2007 to January 2012 of all children affected by duplication of the renal system treated by retroperitoneal laparoscopic approach. Images collected were reconstructed using IRCAD VR render software. Data include: sex, age at surgery, clinical and radiological features, surgical procedure, follow-up and complications. Results: retroperitoneal laparoscopic partial nephroureterectomy was performed in 8 children (6 males and 2 females). All patients had a non-functioning moiety of a duplex kidney and in addition recurrent urinary tract infections. Two cases were associated with ureterocele; of them in one case we performed a previous endoscopic incision of the obstructing ureterocele. All patients underwent radiological evaluation prior to surgery, by ultrasound, voididng cystourethrography, renal scintigraphy and contrast-enhanced MRI evaluations. Images collected were reconstructed using IRCAD VR render software. Patients were treated by a 3-4 trocars technique and parenchymal section was performed using harmonic scalpel. The mean operative time was 180 minutes; no cases required open conversion. The mean hospital stay was 5 days. The mean follow-up was 38 months. No cases of secondary atrophy of the lower pole were observed. Discussion: Volume rendering gives high anatomical resolution and it can be useful to guide the surgical procedure. Laparoscopic retroperitoneal partial nephrectomy is a safe and feasible procedure in children for experienced pediatric laparoscopic surgeons.

Imaging techniques, such as ultrasound imaging, computed tomography, positron emission tomography or magnetic resonance imaging, are highly accurate procedures for the detection of lymph node enlargement, but none of them has the same sensitivity in the biological definition and in the cause of enlargement. Therefore, a direct evaluation of corresponding lymph nodes is necessary in most cases and fine needle cytology (FNC) is one of the most frequently used techniques for this purpose. The same imaging procedures are often used to perform targeted biopsies including FNC. This study discusses procedures, indications, advantages and limitations of imaging techniques as a support to FNC.

Sub-acute thyroiditis or De Quervain's thyroiditis is a viral, inflammatory disease which causes the serum release of thyroidal hormones and hyperthyroidism. The pathogenesis of thyroid follicle damage is unclear because the exclusive viral action or a concomitant autoimmune component, determined by the lymphoid infiltrate remain to be assessed. We describe the case of a patient under immunosuppressive treatment, who developed sub-acute thyroiditis with hormone release and hyperthyroidism. The patient, while was under immunosuppressive treatment for kidney transplant, exhibited a clinical picture and hormonal profile of hyperthyroidism. Thyroid scintiscan exhibited an extremely low uptake. Fine-needle cytologic diagnosis was granulomatous sub-acute thyroiditis (De Quervain's thyroiditis). This case suggests the primary or even exclusive role of the viral infection in hormone release and hyperthyroidism in sub-acute thyroiditis, excluding an autoimmune component.

The aim of this systematic review was to compare intracorporeal (IA) versus extracorporeal anastomosis (EA) after laparoscopic right hemicolectomy for cancer. The meta-analysis was conducted following all aspects of the Cochrane Handbook for systematic reviews and Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Studies published from 2009 to 2012 that compare IA and EA after laparoscopic right hemicolectomy were identified. The included non-randomized studies were assessed for their methodological quality using the revised and modified grading system of the Scottish Intercollegiate Guidelines Network. Intraoperative, early postoperative, and postoperative recovery outcomes were compared using weighted mean differences and odds ratios. Five non-randomized controlled trials published between 2009 and 2011, comprising 425 patients, were included in this analysis. IA was associated with significant faster bowel movement, faster first flatus, shorter time to solid diet, decreased use of analgesics, and shorter duration of the hospital stay. No differences were observed for nasogastric tube reintroduction rate, operative time, incision length, number of nodes harvested, intraoperative complications, mortality, non-surgical site complications, surgical site complications (anastomotic leakage, anastomotic bleeding, wound infection, ileus), reintervention, and readmission rate. Even when the limitations are taken into account due to the observational nature of the included studies, the results suggest that the IA after laparoscopic right hemicolectomy for cancer results in better postoperative recovery outcomes, such as shorter hospital stay, faster bowel movement recovery, faster first flatus, faster time to solid diet, and lesser analgesic usage.

The aim of this study is to present a preliminary series of six children affected by an anterior mediastinal mass, resulting in a thymoma. We treated this pediatric population by a video-assisted thoracoscopic thymectomy.We performed a retrospective study from January 2000 to January 2012 of all children affected by an anterior mediastinal mass, resulting in a thymoma. Data included sex, age at surgery, clinical and radiological features, surgical procedure, follow-up, and complications.Video-assisted thoracoscopic thymectomy was performed in six children (five boys and one girl). Four patients presented with dyspnea and/or thoracic pain treated with analgesic and corticosteroid therapy without any benefits. Two patients were asymptomatic. Preoperatively, exams included radiological imaging, blood, and immunological test. All 6 patients were treated with a thoracoscopic approach; of these patients, 5 were treated with a thoracoscopic right-side thymectomy and 1 with a left-side approach. Patients were treated by a three-trocar technique, and thymectomy was performed using Valleylab (now Covidien) (Boulder, CO) LigaSure™. The mean operative time was 120 minutes. The mean hospital stay was 5 days. In all cases histological findings revealed no malignancy. The mean follow-up was 38 months.Thoracoscopic thymectomy facilitated the goal of early thymectomy. The right-side approach is preferred because it gains a good visualization of the venous anatomy for dissection. The left side allows a good extended resection of both the thymus and perithymic fat. Thoracoscopic thymectomy should be consider a valid, less invasive alternative to the most radical open approach.