Ruolo della timectomia nel trattamento della miastenia gravis: considerazioni e casistica personale

L’effetto terapeutico della timectomia sul decorso clinico della miastemia gravis è ancora quanto mai controverso. Infatti, mentre la chirurgia è ormai universalmente accettata per i timomi, il suo ruolo è ancora discutibile in pazienti con miastenia gravis. La via chirurgica di elezione per la timectomia totale è rappre - sentata dalla sternotomia mediana. Altre metodologie chirurgiche includono l’accesso cervicale e la sternotomia parziale. Queste tecni - che, seppure con alterne fortune, hanno mostrato risultati eccellenti nella exeresi del timo. Più recentemente la timectomia toracoscopica video-assistita è stata proposta come una tecnica meno invasiva e parimenti efficace per l’asportazione di quest’organo ed il trattamento della miastenia gravis. Scopo del presente lavoro è quello di riferire l’esperienza degli Autori in tema di timectomia, analizzando i dati riportati dalla lette - ratura internazionale sulla mortalità operatoria, le eventuali compli - canze e i risultati estetici delle diverse tipologie di accesso chirurgico

Analgesia post-operatoria in chirurgia toracica: aspetti fisiopatologici, basi terapeutiche e metodi

Il dolore che compare dopo un intervento chirurgico è un importante fattore di inabilità per il paziente in quanto ne limita e riduce la capacità al movimento spontaneo, alla tosse, ai respiri profondi, facilitando la comparsa di complicanzeed inficiandone le capacità di recupero. In chirurgia toracica la necessità di redigere ed utilizzare linee guida per il controllo del dolore post-chirurgico ha rappresentato una reale esigenza in questi ultimi anni. I protocolli attualmente disponibili includono diverse opzioni di trattamento, continuamente oggetto di pubblicazioni scientifiche; essi svolgono un ruolo importante perché rappresentano la base sulla quale intervenire con modifiche e variazioni che tengano conto delle situazioni contingenti, riferite sia al paziente che alla chirurgia, sia all'aspetto organizzativo che strutturale dell'ambiente operativo. Scopo del presente lavoro è una dettagliata analisi dei trattamenti analgesici post-operatori per la chirurgia toracica, presentando quelli più efficaci, attualmente disponibili, per vie e modalità di somministrazione, nonché gli eventuali effetti collaterali o complicanze

Misunderstood cardiac involvement with heart impairment in traumatic sternal fracture: an enzimatic-guided evaluation

Background. Isolated sternal fractures occur more and more frequently in traffic road accidents in particular after the introduction of the seat-belt law. This study sets out to assess by laboratory parameters the incidence and consequences of pericardial and myocardial involvement in sternal injury. Patients and methods: Between June 1997 and March 2007, 50 consecutive patients were admitted to our Thoracic Surgical Unit with acute traumatic sternal fractures. X-ray, CT scan, standard 12-lead electrocardiogram (ECG) and echocardiographic evaluation were obtained in all patients. (28 males, 22 females), with displaced and undisplaced fractures. The patients were hospitalised for cardiorespiratory monitoring, pain control and physiotherapy. Oxygen implementation was performed to obtain an arterial saturation above 96%. Supplementary investigations or therapeutic interventions were assessed if clinically indicated.Results. Our data, according to literature, show that sternal trauma must be careful evaluated by monitoring of vital parameters. In our collection we have no mortality with complex comorbidity. The interparametric relation between laboratory values and cardiac involvement was not significant anyway . The prolonged CK-MB peak level in a large number of patients is related with cardiac impairment. Conclusions. Our results suggest that in traumatic sternal fratures enzymatic activity of CK-MB, echocardiographic investigation and careful monitorizing for the first 96 hours are necessary. The cardiac compliance is inadequate in politraumatic patients and can lead to cardiac impairmen

Supra-Acetabular Brown Tumor due to Primary Hyperparathyroidism Associated with Chronic Renal Failure

A 63-year-old woman presented to the Orthopedic Unit of our hospital complaining of right hip pain of 6 months'duration associated with a worsening limp. Her past medical history included chronic renal insufficiency. Physical examination revealed deep pain in the iliac region and severe restriction of the right hip's articular function in the maximum degrees of range of motion. X-rays and CT scan detected an osteolytic and expansive lesion of the right supra-acetabular region with structural reabsorption of the right iliac wing. 99mTc-MDP whole-body bone scan showed an abnormal uptake in the right iliac region. Bone biopsy revealed an osteolytic lesion with multinucleated giant cells, indicating a brown tumor. Serum intact PTH was elevated (1020 pg/ml; normal values, 12 62 pg/ml), but her serum calcium was normal (total = 9.4 mg/dl, nv 8.5–10.5; ionized = 5.0 mg/dl, nv 4.2–5.4) due to the coexistence of chronic renal failure. 99mTc-MIBI scintigraphy revealed a single focus of sestamibi accumulation in the left retrosternal location, which turned out to be an intrathoracic parathyroid adenoma at surgical exploration. After surgical removal of the parathyroid adenoma, PTH levels decreased to 212 pg/ml. Three months after parathyroidectomy, the imaging studies showed complete recovery of the osteolytic lesion, thus avoiding any orthopedic surgery. This case is noteworthy because (1) primary hyperparathyroidism was not suspected due to the normocalcemia, likely attributable to the coexistence of chronic renal failure; and (2) it was associated with a brown tumor of unusual location (right supra-acetabular region)

Current hospital policies on breastfeeding: a survey from Italy

Abstract Background The availability of an appropriate newborn feeding policy is an essential component of the promotion of breastfeeding in health facilities. The Italian Society of Neonatology (SIN) and the Italian Society of Paediatrics (SIP) have run an online survey among Maternity Hospitals to explore the existing breastfeeding policies and their characteristics. Methods Between February and April 2023, an online survey was carried out among 110 Italian maternity hospitals with a Neonatal Intensive Care Unit (NICU). Results Forty-nine Maternity Hospitals completed the online questionnaire. Twenty out of 49 (40.8%) reported to have a breastfeeding policy. When a policy is available, its quality appears to be suboptimal because of lack of inclusion of a family representative in the policy working group, limited options for translating breastfeeding policy into minority languages, lack of periodic assessment of their implementation. Conclusion Currently, only a limited number of Italian Maternity Hospitals have developed a breastfeeding policy. Additional efforts are needed for their improvement as well as implementation