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Biomedical subjects

L Revelli

Publications and source records attributed to L Revelli.

7 recordsLinked to original sources
PubMed2001

Thyroid tumors in children and adolescents: preoperative study.

Several studies indicate that in young patients (less than 21 years of age at the time of diagnosis), the prognosis of thyroid carcinoma (TC) is more favorable than in older patients. However, a more radical treatment approach is recommended in children and adolescents due to the higher prevalence of local lymph-node involvement in these cases. Since the extent of primary surgical treatment is closely related to the overall prognosis, preoperative diagnosis becomes essential in the management of thyroid neoplasms in young patients. In this retrospective study (1987-1998), we analyzed a surgical series of 50 children and adolescents with thyroid nodules in an attempt to establish the role of diagnostic studies in detecting malignant lesions prior to surgery. Our diagnostic protocol for evaluating thyroid nodules was based on clinical evaluation, measurement of thyroid-hormone and thyroglobulin (TG) levels, anti-TG and anti-TPO antibody titers, calcitonin, CEA, and TPA levels, sonography, scintigraphy, and fine-needle aspiration cytology (FNAC) of the thyroid nodules and any enlarged lymph nodes. Eleven of the 15 cases of histologically confirmed carcinoma were preoperatively identified as malignant lesions with the aid of FNAC. The authors conclude that the preoperative work-up of children and adolescents with thyroid nodules requires the collaboration of an experienced team of professionals, and recommend FNAC as the initial test.

Adolescent↗
PubMed1996

[Venous angiodysplasias with endoral manifestation. The problems of therapy].

Five oral venous angiodysplasia cases are presented by the authors. Besides subjective aesthetic and psychological factors, the treatment of these lesions depends on objective chewing problems and on haemorrhagic risk. This can be either spontaneous or in relation with dental surgery during teeth extraction or third molar pathology therapy. In two patients the lesions affected the tongue and cheek mucosa including the submandibular and masseter region. In one patient there was just one localization at the tongue apex. In another patient the lesion affected only the cheek mucosa and in another the cheek was affected in all its thickness at the left hemimandibular level. Three patients were treated surgically, another with sclerotherapy and another one didn't undergo any treatment, as the lesion didn't present any haemorrhagic risk and the symptomatology was only related to salivary lithiasis. During a three year follow up the patients surgically treated recovered completely, the patient treated with sclerotherapy showed a progressive reduction of the swellings ending in an almost complete recovery. The clinical experience and the literature review show that the correct oral venous angiodysplasia diagnosis and a right sclerotherapy or operation, preventive if necessary, nearly always allow dental surgery in the time required for the ongoing dental pathology.

Adult↗
PubMed1996

[Venous angiodysplasias of the cheek. The problems of therapy].

Four cases of cheek venous malformations observed and treated in different ways are discussed by the authors. In this region angiodysplasias may cause chewing problems or an increased haemorrhagic risk during dental surgery. The therapeutic troubles are due to the muscular connections where there are many recesses and infiltration ways close to the motor and sensitive nervous trunk. Aesthetic restrictions may oblige to a minor operation or partial excision. Particular care must be taken to the lesion access. In this experience two patients have been surgically treated with venous angioma differentiation: one of these with sclerotherapy of the residual angioma As the extent of the lesion caused reconstructing problems, one patient underwent plastic surgery. The other patient was treated with sclerotherapy. After two years the patients surgically treated recovered while the patients treated with sclerotherapy turned out to be asymptomatic. In conclusion, this experience and the literature review show that the correct diagnosis and a right sclerotherapy or surgery, preventive if necessary, allow any dental surgery in due time for dental diseases without any higher haemorrhagic risk.

Adolescent↗
PubMedDate not supplied

[Vascular cysts of the adrenals. Association with aneurysm of the abdominal aorta].

A rare case of an adrenal vascular cyst associated to an abdominal aorta aneurysm is reported. Adrenal cysts are an uncommon clinical finding, in most cases incidentally discovered for nonspecific abdominal pain, during US, TC or RM evaluation or at autopsy. Small adrenal mass are clinically silent. They may be symptomatic (lumbar tension, pain) for dimensions over 10 centimetres. Cysts of large size can cause displacement and compression of adjacent organs. They present a difficult problem of differentiation between benign and malignant lesions. Non-neoplastic adrenal cysts have been divided into four categories: parasitic (7%), epithelial (9%), endothelial (45%) and haemorrhagic or pseudocystic (39%). Vascular adrenal cysts may be a traumatic consequence of an hamartomatous vascular anomaly. The aim of this paper is to discuss, on the basis of the literature, the etiology, diagnosis and treatment of the adrenal mass. Surgical timing is discussed for the concomitant vascular lesion. The elective treatment was left adrenalectomy performed through transperitoneal approach. Surgery for abdominal aorta aneurysm was differed because the adrenal mass was suspected to be an infected neoplastic lesion and for the feasibility of endovascular procedure. The adrenal specimens contained a cystic structure with fluid blood, fibrin and calcifications. Normal adrenal cortical tissue was found in the cystic wall. This lesion (arising from vascular anomalies) require separation from haemorrhagic adrenal neoplasm. Awareness of adrenal pseudocysts and careful attention to the hystological features aids this distinction.

Adrenal Gland Diseases↗
PubMedDate not supplied

[Drainage in thyroid surgery].

Bleeding represents a rare complication of thyroid surgery but when it occurs it may be life-threatening. To prevent this complication drainage is widely used. However no study has demonstrated the drains' value and recent reports have questioned its benefits. Therefore we have analyzed our experience of a 10 year-period in which 1.217 thyroidectomies were performed by the same surgical team and prophylactic routine drainage was always adopted. In 13 patients (1.06%) a benign hematoma occurred with spontaneous remission. In 6 patients the bleeding was severe and compressive hematoma occurred; it required surgical re-exploration. Such a complication is unusual in the neck surgery (0.49% in the authors' series) performed by experienced surgeons and when life-threatening hematomas do occur they depend on various uncontrolled factors and drainage is often not helpful. Otherwise a meticulous haemostatic technique is necessary and patients should be observed very closely during the few first hours following surgery on the thyroid gland. Therefore on the basis of the analysis of their series, although it is not always possible to prove the benefit of the drainage, the authors suggest its indication in the neck surgery, as in other fields with dead space, to remove blood and secretions reducing postoperative complications. They have never observed wound infections and patients were discharged within 72 hours.

Adolescent↗
PubMedDate not supplied

Surgery of differentiated thyroid carcinoma, lymph node metastases and locoregional recurrence.

Surgery of differentiated thyroid carcinoma is burdened with risk factors that significantly impact on prognosis, as age at diagnosis and tumor stage. Problems involved concern the extent of surgical resection and the indication for regional lymphadenectomy. As for the former, the most popular approach is total thyroidectomy "on principle" with neck lymphadenectomy. Lobectomy may represent an alternative to total thyroidectomy in low risk patients with unifocal papillary carcinoma 1 cm or less in size, or minimally invasive follicular carcinoma. As for lymphadenectomy, most authors do not agree with surgery "on principle" but rather "of necessity", that is, in presence of clinically evident lymphadenopathy and neck lymphadenectomy is the preferred surgical strategy. In most cases surgery is the treatment of choice of locoregional recurrence. Careful preoperative work-up and accurate surgical procedure are mandatory.

Carcinoma↗