Search

While the frequency of papillary thyroid carcinoma (PTC) has increased in recent decades, both due to improvements in diagnostic procedures and a real, effective percentage increase in cases, the frequency of medullary thyroid carcinoma (MTC), however, has remained almost unchanged, representing 3–5% of thyroid cancer cases. Our experience relates to the observation of cases with the synchronous presence of PTC and MTC, also in chronic autoimmune thyroiditis, and this led us to carry out a brief review of the literature on the subject, with the aim above all of identifying the most correct postoperative therapeutic process. [ABSTRACT FROM AUTHOR]

Purpose: Acute appendicitis (AA) is the leading cause of acute abdomen worldwide, with an incidence of 90–100 cases per 100,000 individuals annually and a lifetime risk of 7–12%. Despite its prevalence, historical accounts of AA are limited, particularly when compared to conditions like haemorrhoids, likely due to the appendix's internal location. This article traces the historical evolution of AA treatment from ancient times to the present, highlighting key contributions. Methods: A review of common research databases and relevant literature on AA was conducted. Results: Evidence from ancient Egypt suggests early recognition of the appendix, referring to it as the "worm of the bowel." However, detailed anatomical descriptions and treatment approaches for AA did not emerge until the Renaissance, particularly with contributions from Leonardo da Vinci and Berengario da Carpi. The article traces the progression of AA management, including the first autopsies and surgeries, the development of surgical techniques predating anaesthesia and antisepsis, and advancements achieved from the nineteenth to the twenty-first century. The shift from conservative to surgical approaches is discussed, alongside innovations such as laparoscopic appendicectomy, single-incision laparoscopic surgery (SILS), natural orifice transluminal endoscopic surgery (NOTES), and endoscopic retrograde appendicitis therapy (ERAT). The impact of the COVID-19 pandemic on AA treatment, including adaptations in medical practices, is also explored. Conclusions: This review highlights the significant historical developments in AA treatment and its pivotal role in advancing abdominal surgery. [ABSTRACT FROM AUTHOR]

The authors report their experience on the use of Endo-Vascular Laser Treatment modified type 2 CHIVA (Conservatrice et Hémodynamique de l'Insuffisance Veineuse en Ambulatoire) in patients with Chronic Venous insufficiency with a type 3 Shunts in patients with severe obesity (BMI>40). The authors affirm that Laser type 2 CHIVA in type 3 shunts still offers several advantages, for the echo guided localization of the vein in bariatric patients, resulting a time saving procedure with better compliance and lower rate of mayor complications. Since January 2021 to December 2022, we have treated 30 patients, all of them with a confirmed echography diagnosis of Chronic Venous Insufficiency-type 3 shunt, m.a. 45.2 years old, with a medium BMI of 42.3 with a medium follow up of 52.2 months. We selected patients with pathological obesity and chronic venous insufficiency who presented a type 3 SHUNT on the hemodynamic examination with echo-color-Doppler. It has been observed varicose vein recurrence only in 5 patients after six months 16.6% and in 9 patients two years later 30%. Bruises was the prevalent side effect observed in 14 patients 46.6%, we didn't observe any limb infections, no superficial vein thrombosis and of course no nerve damages. The procedure was less invasive than surgical preparation in bariatric patients. 18 patients received a laparoscopic sleeve gastrectomy in the 2 years from our treatment and in none of them we have observed any complication related to chronic venous insufficiency. It's well known the advantages of CHIVA vs. Traditional Stripping in term of recurrence, side effects like bruises and especially nerve damages; the Endo-Vascular Laser Treatment in this kind of modified type 2 CHIVA seems to improve limb infections incidence, especially in bariatric patients, reducing for this complication the gap versus stripping and of course improving the traditional EVLT (Endovenous Laser Ablation Therapy) with the Hemodynamic principles of CHIVA treatment. We suggest this type of technique especially in patients with severe obesity, where the clinical and metabolic condition added to local more complicated conditions, and due especially to the enormous fat panicle, make difficult any surgical approach. [ABSTRACT FROM AUTHOR]

As with any other sector, the healthcare industry is also prone to cyber threats. Though the nature of threats is similar to any other industries, it does need to address sector-specifics risks along with security risks in its operating environments. Every day the Hospitals need to ensure that the information is adequately secured. Currently Chief Information Officer (CIOs) and Chief Information Security Officer (CISOs) are trying to protect their hospital Information Systems (IS) departments from security threats. It's imperative to take necessary measures to ensure risk management and business continuity. The paper addresses some of the challenges faced by healthcare organizations in the selection of a cyber-security framework by reviewing some of the common standards and frameworks that are used by healthcare organizations. The also paper highlights the advantages and disadvantages of each of the standards as: international organization for standardization (ISO)/IEC 27799, Health Insurance Portability and Accountability Act (HIPAA), HITRUST, Nation Institute of Standards and Technology (NIST) has developed the Cyber Security Framework (CSF) and General Data Protection Regulation (GDPR) and compare and the additional directives provided by this standards. [ABSTRACT FROM AUTHOR]

Postoperative hypocalcemia incidence range after thyroid surgery from 1-2% to 61.9%. Such a wide oscillation of values in literature cannot fail to raise doubts about the method of detection and the composition of the different experiences. We here refer to the personal experience gained over the course of 3 years from January 2020 to December 2022; 320 consecutive thyroid surgeries: 79 M, 241 F, mean 49.11 Amino Acid (AA), 59 near total thyroidectomies, 213 total thyroidectomies, 48 recurrence interventions of which 18 for neoplastic pathology with central or later-cervical emptying performed in 258 cases for benign pathology and in 62 cases for cancer. In a smaller group of 50 cases of low parathyroid vascularization after dissection, we selected 12 cases of absolutely no color signal of parathyroid vascularization at early and late acquisition and in those cases, we proceeded to a homolateral sternocleidomastoid muscle implant. The entire sample of 320 patients can therefore be subdivided, according to the extent of the demolition, to the method of opotherapy substitution with L-Thyroxine and to Parathyroid ICGA (Indo-Cyanine Green Angiography) in 4 groups: I group 59 patients near total thyroidectomy; II group 155 total thyroidectomies with L-Thyroxine from 15th-30th Parathyroidectomy (PO) day; III group 94 patients total thyroidectomy with L-Thyroxine from the first PO day and finally IV group 12 patients total thyroidectomy with a muscle parathyroid implant. In the first group the incidence of early hypocalcemia was 5 cases, equal to 8.47%, the incidence of protracted hypocalcemia was 0 cases, equal to 0%. In the second group the incidence of early hypocalcemia was 33 cases, equal to 21.29%, the incidence of protracted hypocalcemia was 7 cases, equal to 4.51%. In the third group (94 cases) the overall incidence of hypocalcemia was practically nil, with only 2 cases of early hypocalcemia, equal to 2.12% and no case of protracted hypocalcemia. In the fourth group the incidence of hypocalcemia is 1 case of early hypocalcemia 12.0% and no case of protracted hypocalcemia. We suggest that Parathyroidectomy (PO) hypoparathyroidism doesn't look to be influenced by total or near total thyroidectomy and that an early thyroid hormonal replacement therapy should be started, whenever possible, post total thyroidectomy. The surgical muscle implant of a completely devascularized parathyroid gland approach is certainly an interesting method, not without limits and criticisms, in an attempt to limit the iatrogenic impact in the determinism of post-thyroidectomy hypocalcemia. [ABSTRACT FROM AUTHOR]

Abstract Hepatocellular carcinoma (HCC) is a complex and heterogeneous tumor with multiple genetic aberrations. Several molecular pathways involved in the regulation of proliferation and cell death are implicated in the hepatocarcinogenesis. The major etiological factors for HCC are both hepatitis B virus (HBV) and hepatitis C virus infection (HCV). Continuous oxidative stress, which results from the generation of reactive oxygen species (ROS) by environmental factors or cellular mitochondrial dysfunction, has recently been associated with hepatocarcinogenesis. On the other hand, a distinctive pathological hallmark of HCC is a dramatic down-regulation of oxido-reductive enzymes that constitute the most important free radical scavenger systems represented by catalase, superoxide dismutase and glutathione peroxidase. The multikinase inhibitor sorafenib represents the most promising target agent that has undergone extensive investigation up to phase III clinical trials in patients with advanced HCC. The combination with other target-based agents could potentiate the clinical benefits obtained by sorafenib alone. In fact, a phase II multicenter study has demonstrated that the combination between sorafenib and octreotide LAR (So.LAR protocol) was active and well tolerated in advanced HCC patients. The detection of molecular factors predictive of response to anti-cancer agents such as sorafenib and the identification of mechanisms of resistance to anti-cancer agents may probably represent the direction to improve the treatment of HCC.