Immagine corporea dopo tiroidectomia robotica VS tiroidectomia convenzionale: studio prospettico

RIASSUNTO INTRODUZIONE In chirurgia tiroidea, oltre alla tecnica convenzionale sono state messe a punto nel corso degli anni e da vari autori, molte tecniche chirurgiche diverse con l’ intento di ridurre al minimo le complicanze della tiroidectomia e di migliorare l’outcome estetico in considerazione che la cicatrice della cervicotomia risulta essere visibile in una zona esposta durante la vita di relazione, quale la cute del collo e che essendo l’incidenza della patologia tiroidea maggiore nella popolazione femminile, sempre più giovane grazie alla diagnosi precoce, questo non risulta essere affatto trascurabile. In realtà, l’impatto estetico della chirurgia tiroidea non risulta studiato in maniera sistematica in letteratura. Lo scopo di questo studio è quello di valutare se vi siano differenze nella percezione della propria immagine corporea nelle pazienti sottoposte a tiroidectomia open convenzionale (OT) e a tiroidectomia trans ascellare robot-assistita (RATT). MATERIALI E METODI Lo studio disegnato per questa tesi è di tipo prospettico: da agosto 2012 a marzo 2016, sono state selezionate 160 pazienti sottoposte a tiroidectomia totale presso la U.O. di Endocrinochirurgia dell’Università di Pisa. Le pazienti sono state divise in due gruppi: le pazienti nel gruppo RATT sono state sottoposte a tiroidectomia tramite tecnica RATT; le pazienti nel gruppo OT sono state sottoposte a tiroidectomia convenzionale open. A tutte le pazienti è stato somministrato un questionario di valutazione dell’immagine corporea (BIQ) a distanza di 3 mesi dall’intervento. La differenza è risultata statisticamente significativa (p = 0.039) con notevole vantaggio nella percezione dell’immagine corporea a favore della RATT. CONCLUSIONI In letteratura esistono ancora pochi studi che valutino in maniera sistematica il reale vantaggio nella cosmesi dei pazienti sottoposti a tiroidectomia RATT e OT. Nella nostra esperienza il BIQ ha dimostrato vantaggi significativi nella percezione dell’immagine corporea della popolazione femminile sottoposta a RATT rispetto a OT

Carcinoma Tiroideo Incidentale: risultati di un follow-up a 5 anni

L’incidenza del Carcinoma Differenziato della tiroide dagli anni ‘70 ad oggi è in significativo aumento: questo dato non ha una spiegazione univoca. La grande maggioranza degli Autori ritiene che la enorme diffusione dell’ecografia, associata alla conseguente possibilità di eseguire facilmente un esame citologico tramite agoaspirato (FNAC), abbia giocato un ruolo preminente nella diagnosi di neoplasia in forme sempre più precoci. Molte di queste neoplasie, probabilmente, non sarebbero divenute clinicamente apprezzabili nel corso della vita del paziente. La maggior parte dei carcinomi tiroidei responsabili dell’incremento di incidenza è rappresentata dal carcinoma papillare, generalmente considerato una neoplasia indolente ed a bassa mortalità. Gli studi epidemiologici riportati in letteratura non hanno mai messo in evidenza una mortalità legata al tumore che vada di pari passo con l’aumento delle diagnosi; al contrario, la mortalità legata al carcinoma papillare tiroideo è significativamente diminuita, a fronte dell’enorme aumento nelle diagnosi. Questo dato potrebbe essere di per sé stesso dimostrativo della succitata teoria, secondo la quale la maggior parte di questi carcinomi non avrebbe alcun risvolto clinico o prognostico nell’arco della vita del paziente, e l’elevata incidenza autoptica di carcinomi tiroidei in pazienti deceduti per altre cause, ampiamente riportata in letteratura, ne rappresenterebbe un ulteriore conferma. Un Carcinoma Tiroideo Incidentale (CTI) viene spesso diagnosticato dall’anatomopatologo nell’ambito di tiroidi asportate per patologia benigna (gozzo multinodulare, tossico od eutiroideo, morbo di Basedow ecc.). Il CTI è più spesso rappresentato da un “Microcarcinoma” papillare: il Carcinoma Papillare che ha un diametro massimo tumorale al di sotto di 1 cm, tuttavia l’incidenza di carcinomi incidentali al di sopra del centimetro non è rara, seguendo i dati riportati in letteratura. L’incidenza del CTI di qualsiasi diametro è variabile dal 3,5 al 15,2%, a seconda delle diverse casistiche esaminate, ed è dunque non trascurabile. In base allo stadio tumorale, questi pazienti, possono addirittura necessitare di un trattamento ablativo con I-131 , e necessitano comunque di un follow-up più stretto di coloro sottoposti alla tiroidectomia per la sola malattia benigna. Lo scopo di questa tesi è di verificare se il Carcinoma Tiroideo Incidentale, inteso come categoria di pazienti in cui il tumore non si è reso clinicamente evidente, abbia caratteristiche tumorali tali da poter essere monitorato tramite un follow-up meno aggressivo rispetto ai pazienti sottoposti a tiroidectomia per un CTD clinicamente manifesto.

Breve comentario sobre obligaciones determinadas o de resultado y obligaciones generales de prudencia y diligencia o de medios en la legislación y doctrina francesas

The aim of this chronicle is to analyze on the basis ofthe legislation and opinion of the authors exclusively in his Frenchoriginal language, a classification of the obligations, the only one thatthe editor of the Chilean Civil Code, Andrés Bello, not transferredfrom the principal source of our civil codification, the French CivilLaw and its Napoleonic Code. In the first ones the obligation is strictlycertain: the debtor is obliged to a precise result, as the transporterwho must make come the load to destination; in the second ones,the debtor is not forced but to using the best possible means, actingwith the maximum of prudence and diligence to obtain the result butwithout guaranteeing it, as the doctor who does everything possibleto cure his patient. A classification, that having express consecrationwould come in solving explicit and unquestionably numerous juridicalcontroversies of full current importance.El objetivo de esta crónica es analizar en base a la legislación y opinión de los autores exclusivamente en su idioma francés original, una clasificación de las obligaciones de origen doctrinario, la única que el redactor del Código Civil Chileno, don Andrés Bello, no transfirió desde la principal fuente de nuestra codificación civil, el Derecho Civil Francés y su Código Napoleónico. En las primeras, la obligación está estrictamente determinada: el deudor es obligado a un resultado preciso, como el transportista que debe hacer llegar la carga a destino; en las segundas, el deudor no está obligado sino a emplear los mejores medios posibles, actuar con el máximo de prudencia y diligencia para obtener el resultado pero sin garantizarlo, como el médico que hace todo lo posible para sanar a su paciente. Una clasificación que de tener consagración expresa vendría en solucionar explícita e incuestionablemente numerosas controversias jurídicas de plena actualidad

Minimally invasive video-assisted thyroidectomy (MIVAT)

Minimally invasive video-assisted thyroidectomy (MIVAT) was first described in 1999 and it has become a widespread technique performed worldwide. Although initially limited to benign thyroid nodules, MIVAT was progressively adopted for all types of thyroid diseases, while remaining within the selection criteria. It is reported that, in selected cases, MIVAT is comparable to standard open thyroidectomy (SOT) in terms of oncologic radicality, time, costs and complications rate, with the advantage of a better cosmetic result and a lower post-operative pain

NPM1 Deletion Is Associated with Gross Chromosomal Rearrangements in Leukemia

BACKGROUND: NPM1 gene at chromosome 5q35 is involved in recurrent translocations in leukemia and lymphoma. It also undergoes mutations in 60% of adult acute myeloid leukemia (AML) cases with normal karyotype. The incidence and significance of NPM1 deletion in human leukemia have not been elucidated. METHODOLOGY AND PRINCIPAL FINDINGS: Bone marrow samples from 145 patients with myelodysplastic syndromes (MDS) and AML were included in this study. Cytogenetically 43 cases had isolated 5q-, 84 cases had 5q- plus other changes and 18 cases had complex karyotype without 5q deletion. FISH and direct sequencing investigated the NPM1 gene. NPM1 deletion was an uncommon event in the "5q- syndrome" but occurred in over 40% of cases with high risk MDS/AML with complex karyotypes and 5q loss. It originated from large 5q chromosome deletions. Simultaneous exon 12 mutations were never found. NPM1 gene status was related to the pattern of complex cytogenetic aberrations. NPM1 haploinsufficiency was significantly associated with monosomies (p<0.001) and gross chromosomal rearrangements, i.e., markers, rings, and double minutes (p<0.001), while NPM1 disomy was associated with structural changes (p=0.013). Interestingly, in complex karyotypes with 5q- TP53 deletion and/or mutations are not specifically associated with NPM1 deletion. CONCLUSIONS AND SIGNIFICANCE: NPM1/5q35 deletion is a consistent event in MDS/AML with a 5q-/-5 in complex karyotypes. NPM1 deletion and NPM1 exon 12 mutations appear to be mutually exclusive and are associated with two distinct cytogenetic subsets of MDS and AML

Two arms prospective study to compare surgical completeness in patients operated on conventional total thyroidectomy (OT) and trans-axillary robot-assisted total thyroidectomy (RATT) by a single axillary approach.

Backgrounds Nowadays trans-axillary robot-assisted total thyroidectomy (RATT) is worldwide accepted as a safe and effective procedure for the treatment of benign and some malignant thyroid diseases, but surgical completeness about RATT is still debated. Materials and Methods This prospective study aims to demonstrate that total thyroidectomy can be performed by single trans-axillary robot-assisted procedure, with same results in surgical completeness compared to conventional open thyroidectomy. Patients inclusion criteria for the present study were: non toxic multinodular goiter with biggest nodule < 6 cm in the major diameter, indeterminate thyroid nodule < 6 cm, well differentiated thyroid cancer less than 5 cm without local and/or distant metastasis. Each patient was evaluated by means of three blood specimens: TSH, AbTg, hs-Tg and a neck ultrasound performed preoperatively and three months postoperatively. Results From January 2017 to September 2019 we enrolled 100 patients: 50 consecutive female patients underwent robot assisted trans-axillary total thyroidectomy and 50 matched female patients who underwent conventional open thyroidectomy. The type of surgical procedure was chosen according to patient’s preference. We divided patients in subgroups based on the final histology: benign and malignant subgroup. There were no significant differences in terms of postoperatively values of hs-Tg levels in patients operated on with robotic thyroidectomy and open thyroidectomy either for benign and malignant subgroup (benign: 1,22+-1,254 ng/ml vs 0,654+-0,672 ng/ml, p=0,207; malignant: 2,116+-4,677 ng/ml vs 0,921+-1,819, p=0,256), despite the RATT group of benign patients had a significantly higher preoperative hs-Tg level (320,58+-709,197 ng/ml vs 222,781+-215,529 ng/ml, p=0,014). The postoperative thyroid remnant volume estimated by means of neck ultrasonography was not significantly different between the two groups, both for benign and for malignant subgroups (benign: 0,167+-0,250 ml vs 0,194+-0,111 ml, p= 0,717 and malignant: 0,202+-0,260 ml vs 0,154+-0,160 ml, p=0,366). We also analyzed the difference between the remnant volume of thyroid tissue ipsilateral to the axillary access VS the remnant on the contralateral side, the result was not significantly different for benign subgroup (p=0,302) neither for malignant subgroup (p=0,127). Moreover in the RATT group the thyroid remnant tissue of both side were equivalent if compared with an equivalency test either for both benign (inf.limit p=0,001, sup.limit p<0,0001) and malignant subgroups (inf.limit p=0,006, sup.limit p<0,0001). Conclusions Despite the small number of patients enrolled and the short-term follow-up, RATT confirm to be a safe technique for treatment of both, benign thyroid diseases and well differentiated thyroid cancer. In addition, it demonstrates to offer a comparable surgical completeness with open conventional procedure and it seems of not affecting the outcome. We performed RATT by a single trans-axillary access, therefor we would like to share our experience with other professionals who performed bilateral axillary approach or use an extra chest or peri-areolar incision to perform robot-assisted total thyroidectomy. We look forward for a long term follow up of these patients to evaluate oncological outcome

Breve comentario sobre obligaciones determinadas o de resultado y obligaciones generales de prudencia y diligencia o de medios en la legislación y doctrina francesas

El objetivo de esta crónica es analizar en base a la legislación y opinión de los autores exclusivamente en su idioma francés original, una clasificación de las obligaciones de origen doctrinario, la única que el redactor del Código Civil Chileno, don Andrés Bello, no transfirió desde la principal fuente de nuestra codificación civil, el Derecho Civil Francés y su Código Napoleónico. En las primeras, la obligación está estrictamente determinada: el deudor es obligado a un resultado preciso, como el transportista que debe hacer llegar la carga a destino; en las segundas, el deudor no está obligado sino a emplear los mejores medios posibles, actuar con el máximo de prudencia y diligencia para obtener el resultado pero sin garantizarlo, como el médico que hace todo lo posible para sanar a su paciente. Una clasificación que de tener consagración expresa vendría en solucionar explícita e incuestionablemente numerosas controversias jurídicas de plena actualidad.The aim of this chronicle is to analyze on the basis of the legislation and opinion of the authors exclusively in his French original language, a classification of the obligations, the only one that the editor of the Chilean Civil Code, Andrés Bello, not transferred from the principal source of our civil codification, the French Civil Law and its Napoleonic Code. In the first ones the obligation is strictly certain: the debtor is obliged to a precise result, as the transporter who must make come the load to destination; in the second ones, the debtor is not forced but to using the best possible means, acting with the maximum of prudence and diligence to obtain the result but without guaranteeing it, as the doctor who does everything possible to cure his patient. A classification, that having express consecration would come in solving explicit and unquestionably numerous juridical controversies of full current importance

Microbiological and biochemical aspects of inland Pecorino Abruzzese cheese

Little is known on physicochemical and biochemical characteristics of “Pecorino” Abruzzese cheese in L’Aquila province, an artisanal cheese produced from ewe raw full-cream milk.Three batches of inland “Pecorino” Abruzzese cheese were examined for microbiological, compositional, biochemical and sensory characteristics at the aim of isolating and storing in a bacterial collection, indigenous strain to preserve the microbial biodiversity present in this cheese, to a possible definition of a PDO. Cheese samples from three dairies, at different stages of production were collected and 148 colonies were characterized. Physicochemical assays, species-specific PCR and 16S rRNA gene sequencing revealed that the majority of the lactic acid bacteria (LAB) isolates were Enterococcus faecium and En. faecalis. They were highly prevalent, accounting for 48% of the isolates. The lactic microflora consisted of lactobacilli and lactococci from the species Lactobacillus plantarum (12.2%), Lactobacillus brevis (10.1%), Lactococcus lactis subsp. cremoris (11.5%), respectively.Urea-PAGE electrophoresis showed extensive degradation of αS1-casein (CN) and moderate hydrolysis of β-CN. Formation of γ-CNs from β-CN were highlighted. RP-HPLC profiles of the ethanol-soluble and ethanol-insoluble fractions of the pH 4.6-soluble nitrogen showed only minor differences between the three farms: lower proteolysis in the soluble fraction than the insoluble.Leucine, glutamic acid, lysine, valine were the free amino acids present at the highest levels in all the cheeses. Flavour and texture profile were characterized through a sensory analysis

Increased costs of perioperative risk assessment for thyroid surgery in elderly people (over 80 years) presenting with benign disease

Background/objectives: Evaluate how surgical treatment of benign thyroid disease in elderly people is prone to induce an increase of costs in the next future due to the aging process of the population. Methods: A retrospective analysis has been performed on a total of 116 patients operated between January 2007 and September 2011, divided in a group of 58 patients aged over 80 years (Group A) and 58 patients younger than 80 years (Group B). The analyzed data included age, preoperative diagnosis, severe co-morbidities, procedures other than standard needed to evaluate anaesthesiological risk, postoperative hospital stay, complications, duration of postoperative intensive care monitoring, pathologic characteristics, and costs of anaesthesiological risk assessment. Results: Statistical analysis of collected data showed that the costs related to perioperative risk assessment (p value < 0.001) and the duration of hospital stay (p value < 0.001) were higher in Group A than in Group B. Instead, surgery-related complications were not statistically different. Conclusions: Despite feasibility and safety of modern surgical techniques, indications for surgery in elderly patients affected by benign thyroid disease should be reserved mainly for those patients with severe medical necessity. © 2013 Springer-Verlag Berlin Heidelberg

In vitro phosphorylation of lamin B by protein kinase C in friend erythroleukemia. Effect of chemically induced differentiation

Nuclear matrix isolated from murine erythroleukemia cells (Friend cells) has been phosphorylated with gamma 32P-ATP and purified protein kinase C in order to identify specific nuclear substrates for the enzyme. HMBA has been employed to induce the cell to differentiate and to compare the changes of phosphorylation profile after erythroid differentiation. Lamin B has been found to be hyperphosphorylated by rat brain PK-C in nuclear matrix purified from uninduced cells. This difference characterizes the cells from 14 to 72 hrs of HMBA treatment and indicates that the ability of lamin B to be phosphorylated by PK-C is linked to the differentiated state. The involvement of PK-C in lamin phosphorylation might represent an early step of the signalling pathway utilized by erythroid differentiating agents to target the cell nucleus. © 1991