Gestione dell’ittero ostruttivo da neoplasia bilio-pancreatica

ackground: Neoplasms of the bilio-pancreatic tract are often disgnosed in an advanced stage. Palliation of these patients is focused on resolution of biliary obstruction. Methods: From 1 January 2003 to 31 January 2009 we managed 39 patients with a palliative procedure, 8 of them were treated by a surgical by-pass, the endoscopic procedures were 21, while the transepatic percutaneous drainages were 12. Discussion: Surgical palliation is reserved for patients with a good performance status and expected survival of over 6 mounths, it is also indicated for whom, affected by pancreatic carcinoma, developed duodenal obstruction associated to jaundice. If the biliary obstruction is near the papillary region the treatment of choice is endoscopic drainage, if the obstruction is distal these region the way of choice is the transepatic one. Metallic stents have a greater initial cost but a less risk of obstruction than the plastic stents, these are indicated in patients with a short survival expectance. Conclusions: Endoscopic drainage is the gold standard of treatment for obstructive jaundice, percutaneous biliary decompressione is the treatment of choice for palliation of distal bile obstruction

Post-thyroidectomy chronic asthenia: self-deception or disease?

There is clinical evidence that post-total thyroidectomy (TT) patients can present persistent asthenia. The aim of this study was to evaluate the prevalence of asthenia symptoms in such patients, assess whether a chronic asthenia syndrome could be caused by TT or become evident after it. An observational study was carried out comparing two groups of 100 patients each, all with homogeneous characteristics. Group A was treated with total lobectomy (TL), Group B with TT. All patients presented normal thyroid hormone levels. The patients were interviewed in order to identify the ones affected by post-operative asthenia persisting for at least six months, with reduced ability to perform physical and mental work, not showing improvement with rest. The severity of the symptoms has been measured by means of the brief fatigue inventory (BFI). Statistical analysis was performed to evaluate statistically significative differences between groups and prognostic factors in TT group. The incidence of post-operative asthenia was 0 % after TL and 25 % after TT, with the operation being the only significant variable. Asthenia is well known as symptom of post-thyroidectomy, but it has not been adequately investigated as consequence of surgery. We demonstrated that the complete removal of the thyroid gland could determine chronic post-thyroidectomy asthenia, although with intensity limited to low/moderate. Post-thyroidectomy asthenia is a relevant sequela interfering with quality of life of at least 25 % of patients operated, suggesting the need to identify its real causes and limit the indication to TT only when strictly required