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Cytopathology, in addition to its role in cervical cancer screening programs, is also an important tool for controlling the efficacy of treatment in women with cervical cancer by monitoring and early detecting residual, recurrent neoplasms or benign reactive changes. In this study, we report eight cases of cytopathologic follow-up of women with cervical cancer post-radiotherapy, assisted by a Center of Oncology in Pernambuco. The main cytological findings post-treatment were described,as well as the histopathological characteristics at diagnosis and the treatments performed. RESUMO A citopatologia, além de seu papel nos programas de rastreio do câncer cervical, é uma importante ferramenta para o controle da eficácia do tratamento em mulheres com câncer de colo do útero, monitorando e detectando precocemente neoplasias residuais, recorrentes ou alterações reacionais benignas. Neste trabalho, relatamos oito casos de citopatologia de seguimento em mulheres com câncer de colo do útero após tratamento radioterápico, assistidas por um centro de oncologia pernambucano. Os principais achados citológicos pós-tratamento foram descritos, assim como as características histopatológicas ao diagnóstico e os tratamentos realizados.

AIM: Postoperative ileus has been considered an inevitable consequence of abdominal surgery. The aim of the study was to investigate the efficacy of same treatments in resolving postoperative ileus in various surgical approaches. METHODS: A total of 360 patients underwent abdominal surgery, and was divided into four groups: videolaparoscopic cholecystectomy, laparotomic colo-rectal surgery, laparotomic Hartmann procedure, laparotomic gastric surgery. In each group, patients received different postoperative treatments: chewing gum, olive oil, both, and water. Each group was compared with a control group. RESULTS: In patients who underwent videolaparoscopic cholecystectomy, median postoperative first passage of flatus and stool in the water group was 10 and 34 hours, respectively (P=0.006, P=0.021) and significantly earlier than in the control group (median postoperative 24 and 72 hours). Postoperative stay for the water group was lower (median day 1, 3rd interquartile 2.5) compared with control (median day 3; 3rd interquartile 7.0, P=0.01). In patients who underwent gastric surgery, median postoperative first passage of stool in the olive oil and chewing gum group was 48 hours, significantly earlier than in the control (median postoperative hour 120, P=0.04). Median time to first passage of flatus and stool was also earlier in the other groups compared with the control group, though this difference was not significant. CONCLUSION: Chewing gum, olive oil or both do not induce a relevant reduction of ileus after surgery. Water may be a safe and inexpensive option in reducing ileus. (United States National Institutes of Health, www.clinicaltrial.gov, number NCT01869231).

Minimally invasive video-assisted thyroidectomy (MIVAT) is a surgical technique that has showed increasingly good results, particularly in endocrine surgery centers. The aim of this prospective, non-randomized study was to evaluate feasibility, advantages and critical aspects of MIVAT in a general surgery unit.Two hundred twenty-four patients underwent total thyroidectomy for benign thyroid disease from May, 2008 to April, 2011. They were divided into two groups: one underwent conventional thyroidectomy (CT), and the other underwent MIVAT. The inclusion criteria were thyroid volume ≤35 mL and main nodule size ≤35 mm. For each patient, socio-demographic variables, hospitalization data and outcome measures (complication rate, operating time, post-operative pain, observer and patient scar assessment scale [OSAS and PSAS, respectively]) were collected. Multivariate regression analyses were done to assess the principal covariates affecting these outcome measures.There were 125 MIVATs and 99 CTs performed. The two groups were characterized by difference in age (38.4 vs. 50.9 years) and thyroid volume (18.6 vs. 23.3 mL). OSAS/PSAS scores were statistically significant in the MIVAT group (P0.001 and P0.001, respectively) even after adjusting for age and thyroid volume. Complication rate was similar in the two groups.MIVAT significantly decreased postoperative pain and improved cosmetic results. It can be performed in younger patients and in all cases in which there is a clear indication for the procedure. Its advantages were confirmed in a general surgery unit where correct indications were followed.

Pubblicazione realizzata nell'ambito del progetto "Elaborazione di un modello di gestione integrata delle risorse e della fascia costiera del Comune di Mazara del Vallo" - P.O.R. Sicilia 2000-2006 - Azioni a sostegno della pesca e dell'acquacoltura Misura 4.17b.

Aim: To assess the efficacy of two widely used topical haemostatic agents: oxidised regenerated cellulose gauze and Collagen-Fibrinogen-Thrombin Patch in patients undergoing total thyroidectomy. Material of study: This was a prospective, comparative, non-randomised study in which consecutive patients undergoing total thyroidectomy for benign disease received standard treatment with no haemostatic agent, cellulose gauze, or CFTP. Main outcome measures were drainage volume 24 hours after surgical procedure and the occurrence of post-operative complications (haematoma, seroma, surgical-site infection). Results: Two hundred seventy-one (271) patients undergoing total thyroidectomy for benign disease: 65 received standard treatment, 60 received cellulose gauze and 146 received CFTP. Seroma was significantly reduced in the CFTP group compared with both the cellulose gauze group (p=0.006) and the standard treatment group (p=0.017). A significant reduction in drainage volume was also observed with CFTP compared with the other two groups (both p

BACKGROUND: Patients undergoing thyroidectomy often complain aerodigestive disorders. In a previous study we showed the associations between voice impairment and proximal acid reflux, swallowing impairment and Upper Esophageal Sphyncter (UES) incoordination and the decrease in UES pressure in thirty-six patients observed before and soon afterwards uncomplicated thyroidectomy. This study investigated the state of post-thyroidectomy esophageal motility changes and its associations with these disorders after 18-24 months. PATIENTS AND METHODS: The thirty-six patients prospectively recruited according to selection criteria (thyroid volume ≤60 ml, benign disease, age 18-65 years, previous neck surgery, thyroiditis, pre- or postoperative vocal cord palsy) underwent voice (VIS) and swallowing (SIS) impairment scores, esophageal manometry and pH monitoring once again. RESULTS: After 18-24 months, both VIS and SIS recovered (respectively: p=0,022; p=0,0001); UES pressure increased (p=0,0001) nearing the preoperative values. The persistence of swallowing complaints were associated with the persistence of esophageal incoordination (p=0,03); the association between voice impairment and proximal acid reflux was confirmed (p

Objective Swallowing and voice impairment are common after thyroidectomy. We evaluated short-term functional changes in esophageal motility in a series of patients who had undergone total thyroidectomy. Several studies have investigated these symptoms by means of interviews or questionnaires. Study Design Prospective study. Setting Academic research. Materials and Methods Thirty-six consenting patients were prospectively recruited. Eligibility criteria were thyroid volume ≤60 mL, benign disease, and age between 18 and 65 years. Exclusion criteria were previous neck surgery, severe thyroiditis, hyperthyroidism, and pre- or postoperative vocal cord palsy. Voice impairment score, swallowing impairment score, lower esophageal sphincter pressure, esophageal motility, upper esophageal pressure, and coordination were evaluated preoperatively and 30 to 45 days after surgery. Results Postoperative swallowing impairment (appearance or worsening of dysphagia) was found in 20% of patients and voice impairment in more than 30%. Both preoperative and postoperative esophageal motility were similar. All patients showed an average decrease of 25% in upper esophageal pressure, although the pressure was within normal range. Swallowing alterations were associated with upper esophageal incoordination (P < .03), and proximal acid reflux was significantly associated with voice impairment (P < .02). Conclusion After uncomplicated thyroidectomy, decreased upper esophageal pressure may explain both pharyngeal (dysphagia) and laryngeal (vocal impairment) exposure to acid. In the future, proton pump inhibitor therapy protocols should be evaluated.

Meticulous dissection and accurate hemostasis are required in thyroid surgery. The authors recently performed a number of thyroidectomies using a new device that combines heat and pressure for sealing and cutting tissue. A prospective randomized trial was conducted on 98 patients subjected to total thyroidectomy for benign disease: 49 patients (group A) with the Starion tissue welding system and 49 (group B) with the clamp-and-tie technique. The 2 groups were comparable in mean age, gender, thyroidal volume (20-60 mL), incision length ( 2 test or Fisher’s exact test, as appropriate, was used. The mean operative time was 53.8 ± 6.1 minutes in group A and 63.2 ± 8 minutes in group B ( P < .0001). The difference in terms of postoperative calcemia was significant (group A: 8.35 ± 0.39 mg/dL; group B: 8.08 ± 0.39 mg/dL; P < .001). The duration of postoperative treatment with calcium and vitamin D was significantly different (group A: 4 days; group B: 5 days; P < .039). No significant difference in terms of postoperative complications was found. The new system reduced operative time and the duration of postoperative hypocalcemia, and there was minimal tissue necrosis and thermal spread. The reduction in duration of postoperative calcium and vitamin D treatment is also an indication of improvement in quality of the treatment.

Background/Aims: Nutcracker esophagus and non-specific motility disorders are the main causes of non-cardiac chest pain (NCCP), with gastroesophageal reflux in 60% of cases. Achalasia and diffuse esophageal spasm are the most frequent anomalies described in patients with dysphagia. The goal of this study was to evaluate the occurrence of esophageal body and lower esophageal sphincter motor abnormalities in patients with dysphagia, NCCP, or both. Materials and Methods: This study is a retrospective analysis of 716 patients with NCCP and/or dysphagia tested between January 1994 and December 2010. 1023 functional studies were performed, 707 of which were esophageal manometries, 225 esophageal pH-meters, and 44 bilimetries. We divided the patients into three groups: group 1 was composed of patients affected with dysphagia, group 2 with NCCP and group 3 with NCCP and dysphagia. Results: Manometric anomalies were detected in 84.4% of cases (p

OBJECTIVES: Patients with chronic constipation due to food hypersensitivity (FH) had an elevated anal sphincter resting pressure. No studies have investigated a possible role of FH in anal fissures (AFs). We aimed to evaluate (1) the effectiveness of diet in curing AFs and to evaluate (2) the clinical effects of a double-blind placebo-controlled (DBPC) challenge, using cow's milk protein or wheat. METHODS: One hundred and sixty-one patients with AFs were randomized to receive a "true-elimination diet" or a "sham-elimination diet" for 8 weeks; both groups also received topical nifedipine and lidocaine. Sixty patients who were cured with the "true-elimination diet" underwent DBPC challenge in which cow's milk and wheat were used. RESULTS: At the end of the study, 69% of the "true-diet group" and 45% of the "sham-diet group" showed complete healing of AFs (P

PURPOSE: Graves' disease can induce alterations of the psychosocial well-being that negatively influence the overall well-being of patients. Among the current treatments, surgery has limited indications, and its impact on the health-related quality of life has not been well clarified. The aim of this study was to assess the impact of surgery on the quality of life. METHODS: Fifty-seven patients who underwent total thyroidectomy for Graves' disease in our surgical unit between April 2002 and December 2009 were administered a questionnaire concerning four issues: organic alterations and clinical manifestations, neurovegetative system disturbances, impairment of daily activities, psychosocial problems. Patients were retrospectively questioned after thyroidectomy about the presence of these symptoms in both the pre and postoperative periods. RESULTS: There was a significant improvement after surgery in all four areas. Organic manifestations and psychosocial problems had higher average improvements, as did some aspects of the neurovegetative system and difficulties in undertaking daily activities. There were no reports of a worsening of symptoms. CONCLUSIONS: Surgery resolved the hyperthyroidism in 100 % of cases, and was associated with a quality of life improvement of about 70 % in the patients. Surgery can therefore provide an immediate and effective resolution of Graves' disease, with benefits in health-related quality of life.

disphagia, non-cardiac chest pain

Introduction: Most of differentiated thyroid carcinomas should be easily revealed by fine-needle aspiration cytology but sometimes preoperative diagnosis is doubtful. Galactin-3 is a carbohydrate –binding protein with affinity for beta-galactosides that plays a significant role in cell-cell and cell matrix adhesion, growth, neoplastic transformation and metastasis. Moreover, galectin-3 immunodetection is related to follicular thyroid malignancies. Our aim is to test Galectin-3 as potential preoperative marker for follicular and papillary carcinomas. Methods: Expression of galectin -3 was tested by fluorescence staining on 40 fresh cytological thyroid samples obtained preoperatively; the samples were fixed, stained using gal-3-specific monoclonal antibodies and treated with Rhodamine Red-conjugated anti-mouse. Counterstaining was performed using Hoechst 33342. After thyroidectomy, we analyzed correlation between gal-3-expression in FNAB and histology. Results : In our series, definitive diagnoses were: 17 multinodular goiter (A), 13 benign follicular lesions (B), 9 papillary carcinomas (C), 1 follicular carcinoma (D). Group A had shown at the FNAB a gal-3-positivity of cells from 0% to 15% (median: 10%); group B from 2% to 95 (median: 15%); group C from 30% to 90% (median: 46%). D had a 100% positivity. Conclusions: Galectin-3 immunodetection could be an useful method to improve conventional cytology’s performance in pre-operative identification of thyroid differentiated carcinomas: one “suspected” FNAB case showing 3% of positive cells proved to be benign at histology ; one “indefinite” FNAB case with 40% of positive cells proved to be malign. Stronger data are needed to establish a cut-off for malignancy.

Introduction: In spite of a low incidence of complications during thyroidectomy, there is a widespread tendency to extend hospitalization at least until postoperative second day. The need of a rebalancing between costs and profits had led us to revise the hospitalization’s duration. Methods: We reviewed our early experience (129 patients candidated to total thyroidectomy as ordinary hospitalization from 2001 to 2002) identifying the causes of hospitalization’s delay both preoperatively and in discharge. We excluded from our analysis re-operations, substernal goitre requiring sternotomy, carcinomas needing a systematic lymphadenectomy and some cases of internal medical interest. Between June 2003 and June 2007, 708 patients meeting the same criteria were referred to a short hospitalization (one-day surgery) after their expressed consent; during surgical operation hemostasis was improved with special remedy in 545 cases; after thyroidectomy all patients were subjected to a empirical protocol to prevent hypocalcaemia. Results: Between 2003 and 2007 the average of postoperative hospitalization was 1.08 days; the causes of extension were: severe/symptomatic hypocalcaemia (45 patients), re-operation because of hematoma (1 case), one tracheotomy for transient bilateral paralysis of recurrent nerve; 2 patients were readmitted for local sepsis. This procedure has been successful in 92.8% of cases. 701 patients properly interrogated have declared to be satisfied. Conclusions: A rational management of patients to undergo a total thyroidectomy with a careful emphasis on prevention of hypocalcaemia makes sure the short stay. The advantages in terms of economics are obvious. Additional benefits seem to come from the introduction of “mini invasive” techniques.

INTRODUCTION: myxoid liposarcoma approximately constitutes 20% of all mesenchymal malignancies preferably occurring in adults with prevalent localization in arts even if there are rare intra-abdominal locations: only 3 cases reported in the literature. We present a case of myxoid liposarcoma with colic localization outlining a diagnostic and therapeutic procedure through a literature’s review. CASE REPORT: We observed a 37 year-old man in January 2007 because of colic pain in the middle abdomen, dyspepsia and constipation. The CT with contrast agent showed a capsulated solid mass with net margins, lobules and adipose tissue component compressing and displacing small bowel. After incision we found a polypoid mass of 24 cm with extraluminal development arising from right colon. Total mass, terminal ileum and right colon were excised; an ileo-colic anastomosis was performed. According to the literature it was not practised any adjuvant treatment. After one year the patient presented a local peritoneal recurrences surgically excised. CONCLUSIONS: the diagnostic process is not yet well defined. Only surgery and histologic examination are able to clarify lesion’s nature. Also surgical treatment is not yet well established, although many authors suggest a total excision of lesion without reference to lymphadenectomy. As for the role of chemotherapy only one case was reported in the literature; myxoid liposarcoma is considered an histotype with intermediate degree of malignancy therefore it should be considered a potential malignant neoplasm and chemotherapy would be justified. Total surgical resection with or without adjuvant radio-chemiotherapy could have a strong impact on the prognosis and follow-up.