Hyperfunctioning Parathyroid Giant Adenoma

Purpose: The objective of this paper is to report the management and treatment of a 47-year-old patient admitted with multiple problems including asthenia, nausea and bradycardia, and was diagnosed with a giant parathyroid adenoma. Case report: A 47-year-old man was admitted to the Department of General Surgery for acute and worsening asthenia, nausea and bradycardia. Blood tests showed hypercalcemia, hypophosporemia, very high serum parathormone level, so that he was diagnosed with primary hyperparathyroidism. Cervical ultrasonography and scintigraphy with technetium 99 mTc Methoxyisobutylisonitrile (99 mTc-MIBI) showed the presence of positive nodule at the isthmus of the thyroid gland. The patient underwent neck exploration. Intra-operative iPTH essay was measured. A giant parathyroid adenoma was identified and excised, with no macroscopic signs of malignancy. Discussion and conclusion: Hyper functioning parathyroid giant adenoma can present with typical symptoms of hypercalcemic crisis: ECG alterations, kidney failure, emotional lability, confusion, delirium, psychosis, asthenia, epilepsy. Elective treatment is the excission. The surgical technique contemplates neck exploration and to ensure the finding of the adenoma, previously identified with imaging tests. It is necessary to measure intra-operative iPTH assay

Two Case Reports of Biliary Tract Injuries during Laparoscopic Cholecystectomy

Background and Study Aims. Biliary tract injuries (BTI) represent the most serious and potentially life-threatening complication of cholecystectomy occurring also during laparoscopic approaches. Patients and Methods. We describe and discuss two different cases of BTI occurring during laparoscopic cholecystectomy (LC). Results. Two patients developed BTI during LC and one evidenced the complication during the LC itself and was treated during the same LC in real time. The other patient evidenced BTI only after the primary intervention and was successfully reoperated in laparotomy after 10 days from the LC. Conclusions. The factors that predispose to the occurrence of BTI during cholecystectomy and the cautions to be used to prevent BTI are discussed

Post-thyroidectomy respiratory failure in patients with bilateral paralysis of the laringeal nerve after the use of an oxidised regenerated cellulose: Two case reports

Recurrent laryngeal nerve palsy represents the most serious complication in thyroid surgery. This complication is generally unilateral and transient, but occasionally it can be bilateral and permanent and it may be either deliberate or accidental. Bilateral recurrent laryngeal nerve injury is much more serious, because both vocal cords may assume a median or paramedian position and cause airway obstruction and tracheotomy may be required. We report two subjects underwent total suturless thyroidectomy by the same surgeon, presenting with postoperative bilateral transitory recurrent laryngeal nerve palsy. Case1: a 60-year-old caucasian woman with diagnosis of follicular tumor. Case 2: a 49 year-old Caucasian woman with diagnosis of hurtle tumor. We used in both patient the oxidised regenerated cellulose for haemostasis during thyroidectomy, especially in the region of the cricothryoid joint/recurrent laryngeal nerve. In a 60-year-old woman was required a temporary tracheotomy. Damage to the recurrent laryngeal nerve remains the most feared complication with very serious functional sequelae for the patient. Most of the underlying lesions are iatrogenic, however, a variety of different reasons can lead to such a condition. We have examined that the use of the hemostatic agent (oxidised regenareted cellulose) could be a cause of postoperative paralysis for the compression on the laryngeal nerve or for chemical damage. Surgical medicaments are often placed in close proximity to peripheral nerves and may be responsible for some postoperative disturbances

Trattamento Multimodale di HCC plurifocale su cirrosi in paziente geriatrico

Abstract La chirurgia epatica maggiore nei pazienti con epatocarcinoma su cirrosi è condizionata da alcuni importanti fattori tra cui: - Stadio della malattia cirrotica - Mono o pluri focalità delle lesioni neoplastiche - Ampiezza delle resezione - Rischio ASA - Emorragie intra o post operatorie - Durata dell’intervento Viene presentato il caso relativo ad un paziente di 86 anni affetto da epatocarcinoma su cirrosi HCV correlata, stadio Child A, a localizzazioni epatiche multiple, iperteso, diabete mellito, sindrome ansioso-depressiva

The role of Laparoscopy in pancreatic surgery

Direct laparoscopic visualization can be combined with intraoperative laparoscopic ultrasonography (LUS), which has shown a positive predictive value of resectability of 91%. Laparoscopic pancreatoduodenectomy (LPD) shows a high rate of complications and should be performed by very well-trained surgeons. Laparoscopic distal pancreatectomy (LDP) with an "en bloc" splenectomy and spleen preservation should be performed

Breast Surgery and sentinel node biopsy:Our Experience

Massive campaigns of screening of breast pathologies improved early diagnosis of breast cancers. Most of these cancers are small-sized (T1) and seldom show intraoperative nodal involvement. Sentinel node biopsy is the elective choice in the above mentioned cases because, if negative, it avoids axillary dissection. International literature reports rates of false negative sentinel node biopsy ranging among 4.5 and 12%; results in our experience account for almost 6%. As a consequence, there is the definite risk of potentially positive axilla that will not be dissected with subsequent risk of axillary recurrence within 24 months. The reason of that could be related to the fact that in Referral Centers this technique is performed in strictly selected patients, so as to gain a diagnostic accuracy of 98%. The rate of axillary recurrences does not justify the routine axillary dissection, since this is just a staging, not a therapeutic procedure. In case of doubt, it can be recommended a close and careful follow-up of the axilla