Minimally-invasive treatments for benign thyroid nodules: recommendations for information to patients and referring physicians by the Italian Minimally-Invasive Treatments of the Thyroid group

Purpose: In this paper, the members of the Italian Working Group on Minimally-Invasive Treatments of the Thyroid (MITT group) aim to summarize the most relevant information that could be of help to referring physicians and that should be provided to patients when considering the use of MITT for the treatment of benign thyroid nodules. Methods: An interdisciplinary board of physicians with specific expertise in the management of thyroid nodules was appointed by the Italian MITT Group. A systematic literature search was performed, and an evidence-based approach was used, including also the knowledge and the practical experience of the panelists to develop the paper. Results: The paper provides a list of questions that are frequently asked by patients to operators performing MITT, each with a brief and detailed answer and more relevant literature references to be consulted. Conclusions: This paper summarizes the most relevant information to be provided to patients and general practitioners/referring physicians about the use of MITT for the treatment of benign thyroid nodules

Towards the european strategy for particle physics: The briefing book

This document was prepared as part of the briefing material for the Workshop of the CERN Council Strategy Group, held in DESY Zeuthen from 2nd to 6th May 2006. It gives an overview of the physics issues and of the technological challenges that will shape the future of the field, and incorporates material presented and discussed during the Symposium on the European Strategy for Particle Physics, held in Orsay from 30th January to 2nd February 2006, reflecting the various opinions of the European community as recorded in written submissions to the Strategy Group and in the discussions at the Symposium

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Cardiovascular and sympathetic responses reflexly elicited through the excitation with bradykinin of sympathetic and vagal cardiac sensory endings in the cat

The intracoronary administration of bradykinin (30 ng.kg-1) was used to study the reflex responses to the excitation of sympathetic and vagal cardiac sensory endings in anaesthetised cats. The left main coronary artery was perfused with a constant flow pump to administer the drug without concomitant manipulations of the heart. The reflex effects were assessed by recording simultaneously target haemodynamic functions and the impulse activity of sympathetic preganglionic fibres, isolated from an outflow largely directed to the heart. In eight out of 13 cats with intact cardiovascular innervation the intracoronary injection of bradykinin produced a consistent and significant increase in systemic mean arterial pressure (MAP), left ventricular pressure (LVP) and LVdP/dt(max) along with a significant increase in the sympathetic efferent impulse activity. In the remaining five animals, bradykinin caused a significant haemodynamic depressor response concomitant with a slight increase in sympathetic impulse activity. In eight additional cats with sinoaortic denervation, excitatory or inhibitory haemodynamic reflex responses were also observed, the types of response being consistent in each individual animal. However, in the case of inhibitory responses the sympathetic impulse activity was simultaneously decreased. After vagotomy, bradykinin induced a significant increase in MAP, LVP, LVdP/dt(max) and in cardiac sympathetic efferent activity in all 21 cats. These excitatory responses were abolished after the interruption of a large part of the cardiac sympathetic afferents. Thus the intracoronary administration of bradykinin induced haemodynamic and sympathetic reflex responses that were dependent upon the interaction of opposite influences mediated by the simultaneous activation of cardiac vagal and sympathetic afferents

Nonpalpable breast lesions. Diagnostic and therapeutic considerations

The early detection of breast cancer is of primary importance, as one method which many reduce the unacceptably high mortality rate associated with this disease. In fact, it is well stated that the most concrete possibility of therapeutic success in the treatment of breast cancer is represented by early treatment, while the disease is still localized. Then a screening program is necessary in asymptomatic women, to diagnose the disease as early as possible even in case of non palpable lesion. Mammography is nowadays the most specific and sensitive investigation for clinically occult breast cancer. In this study we searched for mammographic findings with the best predictive value for cancer and we tested the most careful techniques for preoperative localization and surgical biopsy of nonpalpable breast lesions. Seventy-one asymptomatic women (age range: 31-76 years, mean: 53.6) underwent stereotaxic needle localization to perform surgical biopsy of mammographically suspicious but nonpalpable breast lesions. Mammographic findings were classified as: a) well defined and smooth bordered opacities (11.3% of cases); b) poorly defined, irregular, spiculated and stellate opacities (32.4% of cases); c) lowly suspicious microcalcifications, larger, rounder, fewer in number (19.7% of cases); d) highly suspicious microcalcifications, with irregularities on shape, density and size described as clustered and polymorphic (36.6% of cases). Cancer was found in 22 cases (31%); 12 of those (54.5%) were associated with highly suspicious microcalcifications, 10 of those (45.5%) were associated with stellate and poorly defined opacities. On the contrary, all cases of lowly suspicious microcalcifications and all cases of well defined opacities resulted histologically benign lesions; fibrocystic disease accounted for more than half of these. Other findings included fibroadenomas, cysts, ductal or lobular hyperplasia. Fourteen of the cancers (63,6%) were 1 cm or less in diameter and all the others were less than 2 cm; sixteen of the cancers (72.7%) had negative axillary lymph nodes. However the rate of detection of cancer should be significantly improved, beacuse the positive predictive value of mammography currently is not very high. With the increasing specificity of mammographic findings, more strict criteria in the selection of patients undergoing breast biopsy will found, so that surgery must be performed only in very highly suspicious mammographic lesions, decreasing the unnecessary overall biopsy cost. Then, in these cases, stereotaxic technique for hook-wire needle guided biopsy can be very useful in detecting small, early and do potentially curable breast cancer

The methyl donor S-adenosylmethionine potentiates doxorubicin effects on apoptosis of hormone-dependent breast cancer cell lines

In this work, we have investigated the antiproliferative effect of AdoMet and Doxorubicin (Doxo), alone or in combination, on different breast cancer cell lines. For the evaluation of synergism, we have calculated the combination index (CI) by the Calcusyn software and we have evaluated the effects of the combination on apoptosis occurrence at FACS analysis in hormone-dependent CG5 cell line. We have found that AdoMet and Doxo given in combination were strongly synergistic in the hormone-dependent CG5 and MCF-7 human breast cancer cell line, as a CI50\ua0<\ua00.5 was found after 72\ua0h of treatment while the effect was only additive in hormone-independent MDA-MB 231 cells. On the basis of our results, we have selected a combination of AdoMet and Doxo, that was highly synergistic and we have found that the AdoMet in combination with Doxo increased apoptosis induced by Doxo alone, suggesting that the synergism on growth inhibition was largely due to apoptosis. Notably, the AdoMet/Doxo combination induced a significant activation of caspases 3, and 8, while no effect was found on caspase 9 cleavage. In contrast, no significant changes of the expression of cleaved caspase 8 and 9 were found in cells treated with AdoMet and Doxo alone. Moreover, the combination induced a significant increase of Fas and FasL expression. These results highlight the importance of the synergistic effect of AdoMet with Doxo in the regulation of hormone-dependent breast cancer cell proliferation and emphasize the anti-tumor activity of these molecules

Open versus endoscopic adrenalectomy in the treatment of localized (stage I/II) adrenocortical carcinoma: Results of a multiinstitutional Italian survey

Background: We compared the oncologic effectiveness of open adrenalectomy and endoscopic adrenalectomy in the treatment of patients with localized adrenocortical carcinoma. Methods: One hundred fifty-six patients with localized adrenocortical carcinoma (stage I/II) who underwent R0 resection were included in an Italian multiinstitutional surgical survey. They were divided into 2 groups based on the operative approach (either conventional or endoscopic). Results: One hundred twenty-six patients underwent open adrenalectomy and 30 patients underwent endoscopic adrenalectomy. The 2 groups were well matched for age, sex, lesion size, and stage (P = NS). The mean follow-up time was similar for the 2 groups (P = NS). The local recurrence rate was 19% for open adrenalectomy and 21% for endoscopic adrenalectomy, whereas distant metastases were recorded in 31% of patients in the conventional adrenalectomy group and 17% in the endoscopic adrenalectomy group (P = NS). The mean time to recurrence was 27 ± 27 months in the conventional open adrenalectomy group and 29 ± 33 months in the endoscopic adrenalectomy group (P = NS). No significant differences were found between the 2 groups in terms of 5-year disease-free survival (38.3% vs 58.2%) and 5-year overall survival rates (48% vs 67%; P = NS). Conclusion: The operative approach does not affect the oncologic outcome of patients with localized adrenocortical carcinoma, if the principles of surgical oncology are respected. © 2012 Mosby, Inc. All rights reserved