Primary breast lymphomas: a multicentric experience

Background: The Primary Breast Lymphomas (PBL) represent 0,38-0,70% of all non-Hodgkin lymphomas (NHL), 1,7-2,2% of all extranodal NHL and only 0,04-0,5% of all breast cancer. Most frequent PBLs are the diffuse large B cell lymphomas; in any case-reports MALT lymphomas lack or are a rare occurrence. Their incidence is growing. From 1880 (first breast resection for "lymphadenoid sarcoma" carried out by Gross) to the recent past the gold standard treatment for such diseases was surgery. At present such role has lost some of its importance, and it is matter of debate. Methods: Twenty-three women affected by PBL underwent surgery. Average age was 63 years (range: 39-83). Seven suffered of hypothyroidism secondary to autoimmune thyroiditis. Fourteen patients underwent mastectomy, nine patients received quadrantectomy (average neoplasm diameter: 1,85 cm, range: 1,1-2,6 cm). In 10 cases axillary dissection was carried out. Pathologic examination revealed 16 diffuse large B cell lymphomas and 7 MALT lymphomas. Results: Seven patients in the mastectomy group had a recurrence (50%), and all of them with diffuse large B cell lymphomas at stage II. Two of these had not received chemotherapy. No patient undergoing quadrantectomy had recurrence. In the mastectomy group disease free survival (DFS) at 5 and 10 years was 57 and 50%. Overall survival (OS) at 5 and 10 years was 71.4% and 57.1% respectively. All recurrences were systemic. DFS and OS at 5 and 10 years was 100% in the quadrantectomy group. In the patients with recurrence mortality was 85.7%. For stage IE DFS and OS at 5 and 10 years were 100%. For stage II DFS at 10 years was 62.5% and 56.2% respectively; OS at 5 and 10 years was 75% and 62.5% respectively. For MALT lymphomas DFS and OS at 5 and 10 years were 100%. For diffuse large B cell lymphomas DFS at 5 and 10 years was 62.5% and 56.2% respectively; OS at 5 and 10 years was 75% and 62,5% respectively. Conclusions: The role of surgery in this disease should be limited to get a definitive diagnosis while for the staging and the treatment CT scan and chemio/radioterapy are repectively mandatory. MALT PBLs have a definitely better prognosis compared to large B cell lymphomas. The surgical treatment must always be oncologically radical (R0); mastectomy must not be carried out as a rule, but only when tissue sparing procedures are not feasible. Axillary dissection must always be performed for staging purposes, so avoiding the risk of under-staging II o IE, due to the possibility of clinically silent axillary node involvement

High-resolution aeromagnetic survey of Calabria (Southern Italy)

We present a 1:350,000 high-resolution magnetic anomaly map of Calabria (Southern Italy), obtained by merging the results from two low-altitude aeromagnetic surveys performed in southern and northern Calabria. Magnetic anomalies of Calabria are of low intensity, and mostly range from 11 to –9 nT. Northern Calabria is characterized by positive anomalies in the Tyrrhenian margin (Coastal Chain) that turn into negative values moving eastward in the Sila Massif. Southern Calabria is characterized by slightly positive anomaly values, interrupted by a null magnetic anomaly corridor roughly corresponding to the eastern margin of the Gioia Tauro basin. Finally, anomaly values turn systematically negative in the Messina Straits. Due to the unprecedented resolution (low flying height, spatial sampling along the flight line of ∼5 m and 1–2 km flight line spacing), the new map highlights, in detail, the geometry and setting of the upper crustal features. As Calabria is one of the most seismically active regions in Italy, hit by several high-magnitude earthquakes in recent centuries, the interpretation of this new map will hopefully contribute to new insights into the crustal geological setting, location and dimension of the main seismogenic sources.Published116-1231A. Geomagnetismo e Paleomagnetismo3SR. AMBIENTE - Servizi e ricerca per la SocietàJCR Journa

Antibiotic prophylaxis in thyroid surgery: a preliminary multicentric italian experience

Post-operatory wound infections are a very uncommon finding after thyroidectomy. For these reasons international guidelines do not routinely recommend systemic antibiotic prophylaxis

Meta-analysis of thyroidectomy with ultrasonic dissector versus conventional clamp and tie

<p>Abstract</p> <p>Background</p> <p>We conducted a systematic review to evaluate the role of Ultrasonic dissector (UAS) versus conventional clamp and tie in thyroidectomy.</p> <p>Materials and methods</p> <p>We searched for all published RCT in into electronic databases. To be included in the analysis, the studies had to compare thyroidectomy with UAS versus conventional vessel ligation and tight (conventional technique = CT). The following outcomes were used to compare the total thyroidectomy group with UAS versus CT group: operative duration, operative blood loss, overall drainage volume during the first 24 hours, transiet laryngeal nerve palsy, permanent laryngeal nerve palsy, transiet hypocalcaemia and permanent hypocalcaemia.</p> <p>Results</p> <p>There are currently 7 RCT on this issue to compare thyroidectomy with UAS versus CT. From the analysis of these studies it was possible to confront 608 cases: 303 undergoing to thyroidectomy with UAS versus 305 that were treated with CT. Actually, it was shown a relevant advantage of cost-effectiveness in patients treated with UAS; there is a statistically significant reduction of the operative duration (weighted mean difference [WMD], -18.74 minutes; 95% confidence interval [CI], (-26.97 to -10.52 minutes) (P = 0.00001), intraoperative blood loss (WMD, -60.10 mL; 95% CI, -117.04 to 3.16 mL) (P = 0.04) and overall drainage volume (WMD, -35.30 mL; 95% CI, -49.24 to 21.36 mL) (P = 0.00001) in the patients underwent thyroidectomy with UAS. Although the analysis showed that the patients who were treated with USA presented more favourable results in incidence of post-operative complications (transient laryngeal nerve palsy: P = 0.11; permanent laryngeal nerve palsy: not estimable; transient hypocalcaemia: P = 0.24; permanent hypocalcaemia: P = 0.45), these data didn't present statistical relevance.</p> <p>Conclusion</p> <p>This meta-analysis shown a relevant advantage only in terms of cost-effectiveness in patients treated with UAS; it is subsequent to statistically significant reduction of operation duration, intraoperative blood loss and of overall drainage volume during the first 24 hours. Although the analysis showed that the patients who were treated with UAS presented more favourable results in incidence of post-operative complications (transiet laryngeal nerve palsy; transiet hypocalcaemia and permanent hypocalcaemia), these data didn't present statistical relevance.</p

Surgical treatment of sporadic medullary thyroid carcinoma: strategy and outcome

Background. Medullary Thyroid Carcinoma (MTC) originates from the thyroid C cells and accounts for approximately 5-9% of all thyroid cancers. Aim of this study was to retrospectively evaluate the outcomes of 41 patients with MTC who underwent treatment at our institution. Patients and methods. We reviewed the records of 41 patients who underwent surgery between 1995 and 2004. The patients were divided into two groups: A) patients (n 30) without any previous surgery; B) patients (n 11) previously thyroidectomized and high calcitonin levels with or without radiological evidence of local regional or distant metastases. We performed total thyroidectomy with central compartment lymphoadenectomy and ipsilateral modified radical neck dissection in group A patients. Group B patients underwent re-excision of the central neck compartment and bilateral modified radical neck dissection if it had not been previously performed. Results. Most patients had major reduction in postoperative calcitonin levels. Compartmental dissection of the cervical node significantly improved the results of primary surgery and calcitonin returned to normal levels in approximately 60% of the patients in group A, but only the 30% of the patients in group B. Conclusions. The extent of the primary surgical resection and the evidence of local or distant metastases significantly influence the outcome of MTC patients. An extensive lymphadenectomy performed early in the treatment and re-operative cervical lymphadenectomy in patients with persistently high calcitonin levels after thyroidectomy significantly improved the outcome, although re-operation rarely results in normalized calcitonin levels and is associated with a higher incidence of complication

Thyroidectomy with ultrasonic dissector: a multicentric experience

Obiettivo. Abbiamo condotto uno studio clinico controllato (Clinical Control Trial - CCT) su 2.736 pazienti (pz) sottoposti a tiroidectomia per gozzo o carcinoma della tiroide. Obiettivo dello studio era valutare i benefici del dissettore ad ultrasuoni rispetto alla sola tecnica chirurgica convenzionale (legatura e sezione del vaso). Pazienti e metodi. Tra gennaio 2007 e dicembre 2009 2.736 pz sono stati arruolati in questo CCT e suddivisi in due gruppi: 1.021 pz (203 M e 818 F) sottoposti a tiroidectomia con dissettore ad ultrasuoni (UAS) e 1.715 (369 M e 1,346 F) sottoposti a tiroidectomia con tecnica convenzionale (CT). Risultati. La durata dell’intervento chirurgico (UAS 80 min in media, da 50 a 120 min, vs CT 120 min, da 70 a 180 min) è minore nel gruppo sottoposto a tiroidectomia con UAS. L'incidenza di paralisi transitoria del nervo laringeo ricorrente (UAS 17/1.021, 1,6%, vs CT 16/1.715 , 0.9%) è risultata maggiore nel gruppo sottoposto a tiroidectomia con UAS; l'incidenza di paralisi permanente del nervo laringeo ricorrente è stata simile nei due gruppi (UAS 9/1.021, 0,9%, vs CT 18/1.715, 1%). L'ipocalcemia transitoria (UAS 98/1.021, 9,5%, vs CT 132/1.715, 7,7%) è risultata maggiore nel gruppo sottoposto a tiroidectomia con UAS; non vi sono differenze significative per l’ipocalcemia permanente (UAS 26/1.021, 2,5%, vs 35/1.715, 2%). La degenza media post-operatoria è stata simile (2 giorni). Conclusioni. Questo CCT ha dimostrato un significativo vantaggio in termini di diminuzione dei costi per i pazienti trattati con UAS; ciò è conseguente alla riduzione dei tempi dell’intervento chirurgico. L’UAS non ha presentato vantaggi in termini di complicanze post-operatorie transitorie: ipocalcemia (UAS 9,5% vs CT 7,7%) e paralisi del nervo laringeo ricorrente (UAS 1,6% vs CT 0.9%). Non ci sono neppure differenze nell’incidenza di paralisi permanente del nervo laringeo ricorrente (UAS 0,9% vs CT 1%) e di ipocalcemia permanente (UAS 2,5% vs CT 2%). L'esperienza del chirurgo è l'unico fattore significativo nella comparsa di complicanze. L'utilizzo del dissettore ad ultrasuoni può agevolare l'atto chirurgico, ma non si può sostituire all'esperienza dell'operatore. È necessario eseguire nuovi e più ampi RCT con il nuovo dissettore ad ultrasuoni Focus

Constraining age and volume of lava flow invasions of the Alcantara valley, Etna volcano (Italy). New insights from paleomagnetic dating and 3D magnetic modeling

The Alcantara Rivermarks the northern border of Etna volcano, and along its NE sector, it forms a narrowNW-SE elongated valley that is carved in the Mts. Peloritani sedimentary sequences. The valley has been invaded by several lava flows during the growth of the main bulk of the stratovolcano edifice in the past 60 ky (Ellittico and Mongibello volcanoes). In this paper, we have constrained the age of the main lava flows forming the valley floor and reconstructed the length and volume of the main lava flow that impacted this area through a multidisciplinary approach integrating stratigraphic and aeromagnetic data analysis together with new paleomagnetic and 14C dating. The new age determinations showed that the evolution of the present-day geological and hydrographic setting of the valleywasmainly conditioned by a fewflank eruptions that occurred in the lowerNflank of Etna during the activity of theMongibello volcano. In particular, between 13.9 and 9.7 ka BP the valley floor was filled by the so-called Alcantara lava flow for its entire length up to the river mouth, reaching amaximumlength of about 24 km. Later, two other flank eruptions – producing the so-calledMt. Dolce and Solicchiata lava flows – occurred at 9.1–7.2 and 7.3–7.2 ka BP (respectively), covering the eruptive fissure and the proximal portion of the Alcantara lava field and generated themost recent northward shift of the riverbed. Finally, 3Dmagneticmodeling allowed us to calculate the total on- and off-shore volume of the Alcantara lava flow as 1 km3, a value comparable to those of the long-lasting historical eruptions of Etna. Conversely, the 24 kmlength reached by this lava flow is anomalously high when compared to lava flows of the past 15 ky, likely because its emplacement occurred within the valley floor, preventing any possibility of lateral expansion.Published13-251V. Storia eruttivaJCR Journa

Ultrasound scissors versus electrocautery in axillary dissection: our experience

The ultrasound scissors are recently emerging as an alternative surgical tool for dissection and haemostasis and have been extensively used in the field of minimally invasive surgery. We studied the utility and advantages of this instrument compared with electrocautery to perform axillary dissection. The operative and morbidity details of thirty-five breast cancer patients who underwent axillary dissection using the ultrasound scissors were compared with 35 matched controls operated with electrocautery by the same surgical team. There was no significant difference in the operating time between the ultrasound scissors and electrocautery group (36 and 30 mins, p>0.05). The blood loss (60 ± 35 ml and 294 ± 155 ml, p<0.001) and drainage volume (200 ± 130 ml and 450 ± 230 ml, p<0.001) were significantly lower in the ultrasound scissors group. There was a significant reduction of draining days in ultrasound scissors group (mean one and four days, respectively p<0.05). There was significant difference in the seroma rate between the two groups (10% and 30%, respectively). Axillary dissection using harmonic scalpel is feasible and the learning curve is short. Ultrasound scissor significantly reduces the blood loss and duration of drainage as compared to electrocautery

Unravelling Mount Etna’s early eruptive history by three-dimensional magnetic modeling

Evidence of Mount Etna’s early volcanism is hidden by the products of its continuously intense volcanic activity. Etna’s volcanism has buried most of the onshore geological record, and the poorly known offshore extent of these volcanic deposits further limits understanding the volcano’s history. We obtained and analyzed new high-resolution offshore aeromagnetic data along the Ionian continental margin of Mount Etna and combined these with recent paleomagnetic data and available geological information. Specifically, we calculated a three-dimensional (3-D) magnetic inversion model of the thickness variations of the offshore Etnean volcanic system. The inversion model highlights E-W and N-S tabular lava flows associated with the Basal Tholeiitic (ca. 500 ka) and Timpe (ca. 220–110 ka) volcanic phases. These early Etna products, considering the onshore and offshore sectors, achieved total volumes of ~26 km3 and 77 km3, respectively. Moreover, the magnetic anomalies reveal several gravitational collapses that may be indicative of the submarine instabilities of Etna’s eastern flank. The findings shed new light on the history of Mount Etna and its early offshore phases. The observed geometry of these early products links the magma distribution to a recently discovered system of faults that can be associated with the presence of a lateral slab-tearing mechanism during the Ionian subduction.Published1664-16742TR. Ricostruzione e modellazione della struttura crostaleJCR Journa