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A Bastagli

Publications and source records attributed to A Bastagli.

33 records · Page 2Linked to original sources
PubMedDate not supplied

Post-thyroidectomy hypocalcemia and feasibility of short-stay thyroid surgery.

AIM: To study the feasibility of thyroid surgery in a short-stay hospitalization regimen, with particular reference to postoperative hypocalcemia. METHODS: The clinical files of 696 patients operated on from January 1977 to January 2000 for thyroid diseases were analyzed. They were divided into groups on the basis of extent of operation and type of disease. Hypocalcemia incidence was compared between the different groups of patients. Data were analyzed statistically using the chi-square and Fisher's exact tests. RESULTS: There were 74 temporary (10.6%) and 12 (1.7%) persistent hypocalcemia cases. None of these occurred in patients undergoing lobectomy. The incidence of hypocalcemia was higher in two-lobe vs. single-lobe operations (p < 0.05), in total thyroidectomy with lymphadenectomy vs. total thyroidectomy (p < 0.05) and in hyperthyroidism vs. patients with normal serum hormone levels (p < 0.05). 84.9% of hypocalcemia cases developed on postoperative day 1, with only one tetanic crisis. CONCLUSIONS: Thyroid surgery in the short-stay hospitalization regimen is feasible for all patients undergoing lobectomy. Patients undergoing subtotal or total thyroidectomy may be treated in a short-stay regimen, only if they are affected with non-hyperfunctioning benign diseases and if they have normal serum calcium levels on postoperative day 1.

Adolescent↗
PubMedDate not supplied

[Follicular neoplasm of the thyroid: usefulness of extemporaneous histologic study of frozen sections].

PURPOSE: The role of frozen section (FS) in determining thyroidectomy extent in patients with follicular neoplasms is debated. The Authors consider FS usefulness through experience retrospective review. MATERIAL AND METHODS: From January 1980 to June 1999, 1252 Fine Needle Aspirations (FNA) were performed in patients with thyroid nodules. Out of these, 155 (12.4%) resulted follicular neoplasms. All these patients were operated on: 54 had total thyroidectomy because of both lobes disease and 101 had emithyroidectomy with FS. FS results were compared to definitive histological examination. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of frozen section have been estimated. RESULTS: Out of 155 follicular neoplasms, 15 resulted malignant at definitive histological examination: 6 were diagnosed by FS. All 6 patients had a total thyroidectomy during the same operation. Of the rimanenti 9, 6 had a second operation for radicalization within 2-3 days. FS sensitivity was 42.9%, specificity 100%, accuracy 92.0%, PPV 100% and NPV 8.5%. DISCUSSION: Some Authors consider FS useful because it allows to radicalize the operation immediately, in case of positivity for malignancy. Even if only few patients, the possibility to solve the problem in a one-step procedure is a great advantage. Other Authors consider FS useless because to diagnose a poor number malignant neoplasms, a lot of intra-operative examination have to be done. Costs are higher than benefits. CONCLUSIONS: The Authors believe that both attitudes are correct and the decision of using or not FS cannot be standardized.

Adenocarcinoma, Follicular↗
PubMedDate not supplied

New trends in the diagnosis and therapy of acute cholangitis.

For a long time, acute cholangitis has been a difficult therapeutic problem, mostly due to the limited information about the jaundiced patient available from diagnostic investigations. The diagnostic precision of percutaneous transhepatic cholangiography in association with the great therapeutic possibilities of percutaneous transhepatic biliary drainage has solved this problem. The successful results obtained in 37 patients with acute cholangitis prove the value of this approach.

Cholangiography↗
PubMedDate not supplied

Recurrence of goitre after operation in euthyroid patients.

OBJECTIVE: To try and resolve some of the problems associated with the treatment of goitre in euthyroid patients. DESIGN: Retrospective open study SETTING: University hospital SUBJECTS: 106 out of a total of 161 euthyroid patients operated on for goitre from 1974-1988. Those who underwent total thyroidectomy (n = 14), in whom the histological diagnosis was thyroiditis (n = 10), or who were lost to follow up (n = 31) were excluded from the study. MAIN OUTCOME MEASURES: Recurrence of goitre, and correlation with type of operation, age, and histological type. RESULTS: 62 Patients underwent unilateral, and 44 bilateral resections. There were 24 recurrences (23%), 13 of which were subclinical; 19 occurred after unilateral, and 5 after bilateral, resections (p = 0.02). There were no significant associations between recurrence and age or histological type. CONCLUSION: Subtotal thyroidectomy is the treatment of choice for goitre in euthyroid patients.

Adenoma↗
PubMedDate not supplied

[Pneumocystosis of splenic localization in the course of HIV infection: a new indication for splenectomy. Description of a case].

Pneumocystis carinii is a common cause of interstitial pneumonitis in AIDS patients: it affects 85% of patients with cell-mediated immunodeficiencies. Extrapulmonary infection is much more infrequent and it is observed only in these patients who receive aerosolized pentamidine prophylaxis because of minimal systemic distribution of the drug. No case of extrapulmonary disease was observed in patients receiving systemic prophylaxis for Pneumocystis carinii with cotrimoxazole. The pathogenesis of extrapulmonary infection is not clear: it is probably connected with hematogenous or lymphatic dissemination from the lung. In a small number of case is due to reactivation of extrapulmonary foci or to a new infection. The management of disseminated infection of Pneumocystis carinii is medical: only recently a combination of medical and surgical approach was proposed for a patient with extrapulmonary infection. We report a case of 29 years old patient with AIDS with a demonstrated pulmonary and splenic localisation of pneumocystis carinii submitted to surgical splenectomy. The surgical decision was taken for several reasons: no response to medical therapy, the relative good general condition of the patient despite the immunological status, the presence of thrombocytopenia and abdominal pain in the left upper quadrant, and the risk of rupture of spleen. The post-operative course was eventful. We support splenectomy for splenic infection of Pneumocystis carinii in very small selected cases and only with palliative intent.

Adult↗