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We describe a patient affected by adrenal insufficiency due to metastases of breast cancer. Adrenal involvement became clinically evident 20 years after radical mastectomy and it was the only secondary localization of the tumor. There is still no evidence of other metastases after a two year follow-up. This case suggests that adrenal function evaluation should be included in periodical follow-ups of patients who underwent radical mastectomy for breast cancer.

The authors report their experience in haemorrhage after thyroid surgery. Haemorrhagic complications occurred in 5 cases in a series of 1803 sequential thyroidectomies (incidence: 0.27%). In particular, incidence was 1.9% after interventions for thyroid neoplasias (adenoma and carcinoma) and 0.18% after interventions for non-neoplastic thyroid pathology. Haemorrhage occurred always after "total" operations, even if monolateral. Causative and contributing factors, precautions and measures helpful in reducing the incidence and the potential dangerousness of haemorrhagic complications are discussed.

Thyrotropin (TSH) suppression therapy using thyroid hormone plays an important role in the management of patients thyroidectomized for differentiated thyroid cancer. The rationale for TSH suppression is that differentiated thyroid cancer cells have TSH receptors and show increased adenylate cyclase activity following TSH exposure. L-thyroxine is used for long-term therapy. L-triiodothyronine is preferred when suppressive therapy must be discontinued for radioiodine scan, since its shorter half-life allows more rapid increases of TSH levels. The assessment of TSH suppression is still uncertain. The development of second and third TSH assay generations with progressive improvement in sensitivity has made the TRH test unnecessary and has raised the issue of the TSH level indicative of TSH suppression. In clinical practice TSH values below 0.1 mU/L are considered compatible with appropriate TSH suppression. Serum thyroglobulin is a reliable marker of metastatic disease after total surgical and radioiodine ablation of the thyroid gland and it is useful in the surveillance of patients with differentiated thyroid cancer.

We have analysed the nuclear DNA content in a series of 33 thyroid tumours (18 carcinomas and 15 adenomas) and, for comparison, in 189 nodular strumas and 17 tissue samples of normal thyroids, calculating cell cycle parameters and presence of aneuploid DNA. Cell suspensions were prepared for each of three tissue fragments taken for different areas of the surgical specimens. Cell subpopulations with aneuploid DNA content were present in 39% of carcinomas, 27% of adenomas, 20% of strumas, but were absent in the samples from normal thyroids. The presence of hyperdiploid DNA was much more frequent than that of hypodiploid DNA in all pathologic tissues. The mean proliferation index was 14.1 in the carcinomas, 6.6 in the adenomas, 7.1 in the strumas and 6.1 in normal thyroid tissues. The percent of histograms with a coefficient of variation of the G0-G1 peak greater than 5 was highest in the carcinomas (26%). The significance and implications of the reported data are discussed for the interpretation of thyroid neoplastic pathologies.

The purpose of this study was to measure the nuclear DNA content of cells in three different areas of multinodular goiter from 15 patients. Diploid DNA was found in the cell samples from 12 patients; the biopsies from one patient contained a clear ipodiploid peak (61%, D.I. 0.75) and those from the remaining 2 had dubious ploidy. The calculation of the mitotic index, including cells in S + G2M phases, evidentiated a large variability between different samples from the same goiter, thus correlating with the cellular heterogeneous composition of the thyroid.

This present review of the literature deals with the possible autoimmune genesis of the multinodular goiter. Some investigators have identified an immunoglobulin stimulating specifically the growth of the thyroid gland (TGI) in the sera of patients affected with sporadic goiter, quite different from TSI, involved in Graves' disease. Other authors report divergent results; however there are many methological differences in these studies that give rise to controversies about the evaluation of the data. At present, these studies have failed to demonstrate consistently an autoimmune genesis of multinodular goiter.

In the light of their experience, the Authors examine the validity of synchronous abdomino-perineal resection. Their study population consists of 224 such operations. On the basis of the results achieved, the conclusion is reached that there is still no realistic alternative today to synchronous abdomino-perineal resection for the treatment of malignancies whose lower borders lie at a distance of less than 6.5 cm from the anal margin.

Hepatic arterial vascularisation, as described by Michels in 1954, is outlined; the importance of selective angiography in preparation of the hepatic de-arterialisation operation is then stressed, and its theoretical foundations and the surgical technique are illustrated; other procedures which can usefully be combined are also indicated. Lastly an evaluation of the limits and results of this therapy is given.

The Authors report a case of thyroid squamous cell carcinoma associated to a counterlateral lobe follicular carcinoma, they had the opportunity to observe. The histogenetic hypotheses and problems of differential diagnosis are discussed.

A hepatic localised antiblastic chemotherapic technique combining limited discomfort for patients with appreciable palliative results is illustrated; a short description of the surgical procedure of intubation of the hepatic artery itself and of some auxiliary procedures is given. Lastly the possible complications and the results are illustrated.

The authors discuss some legal aspects and protection problems relative to surgical procedures involving radioactive patients, also in the light of recent European guidelines. They analyse in particular the radiation risk associated with the more common cases concerning radioactive substances that are administered for diagnostic purposes. This study affords a preliminary evaluation of the risk inherent in such surgery, in the light of experimental measurements.

In the light of their experience, the authors review the data reported in the literature regarding Arbuthnot Lane Disease. The therapeutic indications are examined, and the results of the various types of surgery proposed are compared.

The Authors, considering 141 cases of patient women under 40, suffering from breast cancer, analyse the prognostic factors in relation to the different therapeutical approach, histologic type, dimensions of T, and presence or absence of metastases at the axillary lymph nodes. They, moreover, appraise the actuarial global survival with no disease (NED) of this group of patients as compared with the survival of women in more advanced age.

The author consider the problem of hypothyroidism after thyroid surgery for Basedow's disease and multinodular, toxic and nontoxic, goitre. In the behavior of such surgical complication, in addition to thyroid remnant size and technique employed many others biological factors, whose nature up to today is not well defined, are the cause. This multifactorials genesis makes very unforeseeable, in each case, the long term result of surgery in the form of hypothyroidism. However, the hypothyroidism after surgery may be the consequence of a phase of functional adjustment, and then to start substitution therapy immediately after surgery may have opposite effect.

The authors, starding from their own clinical casuistry, critically review the literature, and suggest a new classification of appendicular mucocele based upon the anatomo-pathological aspects. They, moreover, analyse the clinical-therapeutical aspects, and hope the histologic testing of appendix becomes a routine practise.

The behaviour of calcemia was studied in a group of patients subjected to surgical operation of varying extent on the thyroid (enucleoresection, hemithyroidectomy, subtotal and total thyroidectomy). Average calcaemia was found to be diminished in all groups of operated cases, in relation to the extent of the operation. Surgery interferes by significantly modifying the variability of calcaemia in the different groups. The frequency of cases with pre-operative calcaemia higher than the average and retaining a postoperative level higher than the minimum of the controls is roughly inversely proportional to the extent of the surgery. A comparison between calcaemia after subtotal thyroidectomy for nodular struma and for Graves' disease did not evidence any statistically significant differences.

The authors consider the behaviour of TBII (TSH receptor binding inhibitory immunoglobulins) in multinodular goiter, in relation to the functional status of the thyroid classified on the basis of T3, FT4, TSH IRMA. The samples were collected from 53 patients with normal T3, FT4 and TSH; 14 patients with T3 and FT4 in normal range and TSH less than 0.15 milli U/l; 8 patients with T3 and/or FT4 above the superior limits of normal range and TSH less than 0.15 milli U/l and from a control group of 10 patients with Grave's disease. TBII was measured by radioreceptor assay and the index resulted less than 15% in all the patients with eufunctioning or hyperfunctioning multinodular goiter. Mean value in biochemically hyperthyroid patients was 6.25% and in euthyroid patients was 5.69%. The difference was statistically not significant. Moreover, significantly elevated levels of TBII were found in 60% of patients with Grave's disease.

The authors report the behaviour of serum concentration of thyroglobulin (TG) after fine needle aspiration biopsy of the thyroid. Compared with the basal level, serum concentration of thyroglobulin increase of 70% three minutes and of 341% sixty minutes after this maneuver. The authors agree with those who believe an interval of 10-15 days between fine needle aspiration biopsy of the thyroid and determination of serum concentration of thyroglobulin is necessary.

The Authors face the diagnostic and therapeutical problems involved in the tardy recognition of diaphragmatic breakages. On the basis of two clinical cases observed, they emphasize the relative frequency of this lesion, the variability of the clinical pictures, the limits of the clinical and radiological diagnostics, the utmost seriousness of the complications. They face the problem of the choice of the surgical way of approach and the techniques for repairing the diaphragmatic lacerations.

The Authors remark the clear infections are rare in thyroid surgery, whereas rather frequent are the light phlogistic forms, appearing through thermal movement, slight oedema and reddening of the cutaneous wound, drainage emergency point and upper cutaneous edge, which may make the postoperative course unideal. They report the observations done on 25 patients who underwent operation of thyroidectomy after preparation of skin, the evening before operation, with detergent and antiseptic solution containing cetrimide and chlorexidin, followed by dressing with alcoholic solution of quaternary ammonium salts. The patients were immediately treated before and after 8 and 16 hours from operation with amoxicillin. The results obtained confirm the validness of proximate antibacterial chemoprophylaxis in this surgery too.

This is a retrospective study of 85 patients with Hodgkin's disease undergoing studies of clinical staging. Of these, 28 were investigated by laparotomic splenectomy, which revealed evidence of disease progress not otherwise detectable in 10 cases (36%). The authors also note that cases with an unfavorable histotype are associated with a higher incidence of spleen involvement and a more advanced stage of disease.

The authors report a statistical investigation conducted in 95 patients with mammary carcinoma, designed to show the behavior of calcemia in the course of this malignancy. The data were analyzed statistically by the binomial test, the scatter of values (F test of Snedecor), and the t test of Student. The authors confirmed the existence of a statistically significant alteration of calcemia only in the group of patients with metastasis to bone versus control subjects; conversely there was no significant difference of distribution in the various groups in regard to values beyond those given as normal.

The Authors report the behaviour of antithyroid and antimicrosomial antibodies in a group of 394 patients suffering from nodular struma, thyroid adenoma and carcinoma, Hashimoto's thyroiditis, other thyroidites and Basedow's disease. The autoimmune pathology (Hashimoto's thyroiditis and Basedow's disease) is joined to a higher frequency of positive titles for both antibodies. In such pathology we also meet the highest titles. In the non-autoimmune pathology the antimicrosomial antibodies are more frequently positive than the antithyroid ones. If one considers the behaviour of both antibodies, the specificness about the diagnosis of thyroiditis increases.

The authors, in the light of the data of the literature, study the problem of the surgical treatment of Basedow disease. Besides those who suggest the total thyroidectomy as an ultimately curative intervention, most of surgeons prefer the subtotal thyroidectomy. However, the result of such operation is doubtful as to postoperative hypo- and hyperthyroidism, due to the operativeness of factors of not only biological, but also technical nature. In order to make the therapeutical result as satisfactory as possible, the literature suggests some particular surgical solutions, such as ligature of thyroid artery, limited subtotal thyroidectomy and modified subtotal thyroidectomy, which seem to obtain satisfactory results from the clinical standpoint.

The authors review their series of thyroid operations, totaling 383 cases in the last seven years. In that series the incidence of recurrent nerve lesions leading to permanent sequels was 1.07% (all treated without surgical preparation of the nerve); an additional 0.53% of the patients developed transient paralysis of the recurrent nerve--of which the authors discuss the possible etiology. The authors conclude by stating the need for careful recognition of the recurrent nerve in all surgical procedures involving the thyroid gland, except some enucleo-resections; they confirm the importance of branches of the inferior thyroid artery and the inferior horn of the thyroid cartilage as reference points.

An analysis of 255 patients operated for isolated thyroid nodes is made. Of these, 81% were cold nodes and 19% hot. Carcinomas were present in 21 cases. One carcinoma appeared as a scintigraphically hot node. The frequency of carcinomas, in relation to the nodules observed, was roughly the same in the two sexes. There is parallelism in behaviour of the rate in the two sexes as regards cold nodes, while this is not true for hot nodes. The importance of some recent diagnostic techniques is briefly discussed.

The surgery of the last ileal ansa in case of non-neoplastic pathology bears some problems of technical nature, bound to the remarkable anatomic variabilities in the arterial blood supply to terminal ileum. The authors report the observation of three cases of non-neoplastic pathology of the last ileal ansa, treated with different technique in relation to the type of arterial blood supply remarked. In a case an ileum resection with termino-terminal anastomosis was performed, and in the other two cases a resection of the last ileal ansa, followed by an ileo-caecal reimplantation, was effected.

The authors report a case, they had the opportunity to observe, of pyloric stenosis, secondary to the migration of two big gall-stones into stomach through a cholecysto-gastric fistula. As the event is extremely rare, they discuss some clinical, diagnostical and therapeutical aspects of same.

The authors, starting from the recent observation of a case of gall-bladder hypoplasia, point out the extreme rareness of the disease, the aspecificity of the symptomatology and the frequent impossibility to reach a preoperative diagnosis.