Biomedical subjects

M Biffoni

Publications and source records attributed to M Biffoni.

41 records · Page 3Linked to original sources

PubMedDate not supplied

[Total thyroidectomy technique: suggestions and proposals of surgical practice].

Total thyroidectomy at present depicts a diffuse surgical procedure in the management of benign and malignant disease of thyroid gland. It is followed by a low incidence of iatrogenic damages (nervous lesions or permanent hypoparathyroidism), just like subtotal thyroidectomy and lower than surgery for nodular recurrences. Authors present the surgical technique they follow to perform total thyroidectomy, used in over 400 cases of benign thyroid diseases operated since 1986. The most important points of this surgical procedures are represented by exposure and sparing of inferior laryngeal nerve and by preservation of parathyroid function. Parathyroid glands can be exposed to direct surgical trauma but, more often, they are injured by damage of their vascular supply. To avoid this complication, vascular ligations of inferior thyroid artery have to be done never on the trunk of the artery, but on its branches just near the glandular capsula. Sparing of inferior laryngeal nerves comports the exposure of this structure for all its cervical course especially in the terminal edge, when the nerve is nearest to the gland. Systematical application of illustrated procedure has produced no operative mortality, no inferior laryngeal nerve permanent palsy, transient hoarseness in 0.5%, and transient symptomatic hypocalcemia in 2.7%.

Goiter, Nodular↗

PubMedDate not supplied

[Small cell carcinoma of the esophagus: a case report].

The authors present the case of a primitive small cell esophageal carcinoma. It is a rare and biologically aggressive neoplasm which occurs mainly in the elder male. The case observed concerns a 69 year old female treated with surgical therapy consisting in esophagectomy and intrathoracic esophagealgastrictype plasty. Diagnostic problems either histological or immunohistochemical and the choice of the following treatment are discussed. The cases of patients treated in other Surgical or Oncological centers are reported. Therapeutic orientation adopted by our group is stressed. In this case we have chosen surgical therapy because a sure diagnosis come be given only on the base of the attent histological examination of the entire specimen (endoscopic biopsies are not sufficient); survival data reported are in favour of surgical treatment where secondary metastases are not evident in the respect of antiblastic therapy and/or radiotherapy. Neoplastic recurrence occurred ten months after and a metallic endoscopic esophageal prothesis was positioned. The patient died 1 year after surgery by mediastinal syndrome.

Aged↗

PubMedDate not supplied

Surgical treatment of paragangliomas of the neck.

Of a total of 5,700 surgical procedures on the neck performed at our Institution between 1984 and 1995, 13 operations (0.22%) have been done on 11 patients with 16 cervical paragangliomas. A woman underwent resection of synchronous bilateral carotid body tumours and of an intravagal paraganglioma. Ten years later, after preoperative angiographic embolization, she underwent resection of a paraganglioma of the left hypoglossal nerve. Her sister, at age 21, underwent resection of a carotid body tumour and, respectively 19 and 20 years later, of a right and left intravagal paraganglioma. An interposition graft for replacement of the carotid bifurcation was necessary in one patient only. During resection of a left carotid body tumour, acute hypotension occurred resulting in an ischemic lesion of the right temporal lobe. Postoperatively, she also complained of respiratory distress that responded to medical therapy with difficulty. The related neurologic symptoms completely resolved three months after surgery. The operation for a paraganglioma of the left hypoglossal nerve resulted in a temporary motor deficit of the tongue and in permanent considerable difficulty in swallowing. Unilateral recurrent nerve palsy occurred in two patients. No patients during the postoperative follow-up showed signs of local recurrence or metastatic disease. In conclusion, surgery is an effective treatment for cervical paraganglioma, but because of the high surgical complication rate, an experienced and skilled surgeon is called on to optimize outcome. An adequate perioperative care is advisable.

Adult↗

PubMedDate not supplied

[Riedel's thyroiditis: a case report and review of the literature].

Riedel's thyroiditis is a very rare disease of unknown aetiology, occasionally associated with retroperitoneal and mediastinal fibrosis. It is a benign condition, but may be confused with an anaplastic carcinoma of the thyroid. The differential diagnosis with anaplastic carcinoma is assured only by intraoperative biopsy. The Authors report a clinical case: symptoms were a progressive enlargement of the thyroid gland, left recurrential palsy, dyspnoea and dysphagia. The surgical treatment was total thyroidectomy, performed with bilateral neurolysis of recurrent nerves. The patient was also under adjuvant corticosteroid treatment.

Diagnosis, Differential↗

PubMedDate not supplied

Total versus subtotal thyroidectomy in the management of multinodular goiter.

BACKGROUND: The choice between subtotal and total thyroidectomy for multinodular goiter is controversial. MATERIAL AND METHODS: Subtotal and total thyroidectomy have been respectively performed in 108 and 451 euthyroid patients with multinodular goiter. RESULTS: After subtotal and total thyroidectomy, transient recurrent laryngeal nerve (RLN) palsy occurred in 1 patient (0.9%) and 3 (0.6%), transient asymptomatic hypoparathyroidism in 27 (25%) and 131 (29%), and transient symptomatic hypoparathyroidism in 2 (1.8%) and 13 (2.9%), respectively (P = NS). After subtotal thyroidectomy, recurrence occurred in 27 patients (26%) Re-operation in 14 patients resulted in transient RLN palsy in 2 patients (14%), transient asymptomatic hypoparathyroidism in 6 (43 %) and transient symptomatic hypoparathyroidism in 2 (14%). CONCLUSIONS: The failure to demonstrate any 'hormonal advantage' in preserving thyroid tissue by subtotal thyroidectomy, and the low morbidity rate and no need for re-operation after primary total thyroidectomy, make the latter the procedure of choice for the management of non-toxic multinodular goiter.

Adult↗