Laparoscopic treatment of sigmoid colon intussusception by large malignant tumor. Case report

L’intussuscezione intestinale è un’evenienza rara negli adulti, più comune in età pediatrica. Le sedi ileale e ileo-ciecale sono più frequenti rispetto alla sede colica. Riportiamo il caso di un paziente affetto da intussuscezione da carcinoma del sigma. La TC addominale pre-operatoria dimostrava la presenza di intussuscezione colo-colica a livello della lesione tumorale con dilatazione del colon a monte. Il paziente è stato sottoposto in urgenza a emicolectomia sinistra laparoscopica. Si è proceduto a estrazione del pezzo operatorio tramite incisione di Pfannenstiel di 10 cm. Il trattamento laparoscopico è risultato sicuro poiché la dilatazione a monte era di grado moderato. Nel caso di intussuscezione colica da carcinoma l’approccio laparoscopico può essere condotto in sicurezza secondo criteri oncologici se è stata posta preoperatoriamente una corretta diagnosi

Grave ostruzione delle alte vie respiratorie da gozzo cervico-mediastinico inveterato in paziente cardiopneumopatica

La sintomatologia da gozzo retrosternale è correlabile alla compressione di organi e strutture mediastinici. Riportiamo il caso di una paziente anziana, affetta da broncopneumopatia cronica ostruttiva e fibrillazione atriale, in cui un gozzo presente da anni si era sviluppato notevolmente in mediastino determinando un quadro di compressione delle vie respiratorie e un improvviso aggravamento della funzionalità respiratoria. L’intervento di tiroidectomia totale, seppur gravato dal rischio di una possibile tracheomalacia, ha determinato un netto miglioramento della performance respiratoria della paziente

THE UTILITY OF SERUM PTH ASSESSMENT 24 HOUR AFTER TOTAL THYROIDECTOMY

BACKGROUND: Hypocalcemia is the most frequent complication following total thyroidectomy. This prospective study examines the predictive value of parathyroid hormone (PTH) levels measured 24 hours after surgery. MATERIAL AND METHODS: A total of 1006 consecutive patients (mean age, 54.8 years; female/male ratio, 4/1) underwent total thyroidectomy for benign or malignant thyroid from January 1995 to November 2003. Serum calcium, phosphorus, and PTH were measured preoperatively and at 24 hours after surgery. All patients underwent preoperative examination to assess cord motility. RESULTS: A total of 253 (25.1%) patients presented with hypocalcemia demonstrated by clinical and laboratory findings. In 101 cases the hypocalcemic syndrome manifested after 24 to 36 hours whereas in 5 of 101 cases, symptom onset was between 48 and 72 hours. Serum calcium levels lower than 7.5 mg/dL were recorded in all the 101 cases. In 239 of 253 cases serum calcium returned to normal values within 7 days following surgery. PTH at 24 hours was below normal levels in 49 of the 101 patients but was within normal limits in 52 cases. The incidence of hypocalcemia was higher in patients undergoing surgery for malignant thyroid ( P < 0.05). CONCLUSIONS: We do not consider PTH levels at 24 hours postoperatively as predictive of hypocalcemia

Comparison of immediate and short‐term outcomes of cricoarytenoid and thyroarytenoid lateralization in dogs with idiopathic laryngeal paralysis

Objective: To compare the immediate and short-term outcomes of thyroarytenoid lateralization (TAL) and cricoarytenoid lateralization (CAL) for the treatment of canine laryngeal paralysis in dogs. Study design: A prospective, clinical trial. Animals: Fourteen client-owned dogs referred to our hospital because of bilateral laryngeal paralysis. Methods: Dogs with confirmed laryngeal paralysis were randomly assigned to the CAL or TAL group. Video images of the rima glottidis obtained preoperatively, immediately postoperatively (t0), and 15 days postoperatively (t1) were digitized. The rima glottidis area was measured using image-analysis software. An increase in the rima glottidis area was expressed as a percentage of the preoperative area. Results: The rima glottidis area increased by a mean of 152% at t0 and 127% at t1 for the TAL group and 205% at t0 and 199% at t1 for the CAL group compared with preoperative values. The increase in the rima glottidis area differed (P .05) in the CAL group but there was a large difference (P < .05) in the TAL group. Conclusion: Cricoarytenoid lateralization and TAL were both effective for surgical abduction of the arytenoid cartilage. Although a reduction (P < .05) in the rima glottidis area occurred in the TAL group at t1, we observed no associated clinical signs. Clinical significance: Cricoarytenoid lateralization and TAL result in good short-term outcomes in dogs with laryngeal paralysis