Biomedical subjects
Publications and source records attributed to M Ruggieri.
Authors emphasize the surgical risk in elderly. Mortality and morbidity are pointed out in male and female patients. They report on 30 aged patients operated for various pathologies also discussing the results.
BACKGROUND: After first endoscopic parathyroidectomy, performed and described by Gagner in 1996, several surgeons reported their experiences with minimally invasive and video-assisted (MIVA) surgery of the neck. The patients were considered eligible for MIVA hemithyroidectomy and thyroidectomy on the basis of some criteria. METHODS: Completely gasless procedure, is carried out through a 15-30 mm central incision above the sternal notch. Dissection is performed mainly under endoscopic vision using conventional endoscopic instruments. Video assisted group in our experience included 5 patients. All patients were women with mean age of 56 years. RESULTS: We performed in three cases a total thyroidectomy and in two an hemithyroidectomy. Operative mean time was 189 minutes. No complications are happened. No conversion have been necessary. DISCUSSION: Traditionally, open thyroidectomy require a 6 to 8 cm, or bigger, transverse wound on the lower neck. The minimally invasive approach wound is very small in length (1.5 cm for small nodules, maximum 2-3 cm for the biggest, in respect of the exclusion criteria) upon the suprasternal notch. Wound pain following the MIVA surgery is much less when compared with the conventional thyroidectomy, because there is less dissection and destruction of tissues. The treated pathologies are prevalently nodular goiter; the only kind of thyroid cancer what it may be attacked with endoscopic surgery is a small papillary carcinoma without lymph node involvement. The complications, there are the same complications of the traditional thyroidectomy. Conversion to the traditional approach sometimes may it be required. CONCLUSIONS: At the present this kind of surgery, in selected patients, clearly demonstrate excellent results regarding patient cure rate and comfort, with short hospital stay, few postoperative pain and attractive cosmetic results.
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BACKGROUND: Breast cancer in patients under 40 years is uncommon. Surveillance, Epidemiology and End Results (SEER) program reveals that 75% of breast tumors occur in women age > 50 years, only 6.5% in women age < 40 years, and a mere 0.6% in women age < 30 years. Breast-conserving surgery with subsequent chemo-radiotherapy has become the treatment of choice in women with breast neoplasm. CASE REPORT: Two young patients, 30 and 28 years respectively, with breast cancer. One patient with an atypical medullary breast carcinoma diagnosis, pT2 pN1 bipMx, Grade 3 Stage IIB, negative for receptors, Ki 67: 47%, cERB-2 negative; the other with an intraductal breast carcinoma, pT1c pN0 pMx, Grade 2 Stage I, negative for receptors, Ki 67: 85%, cERB-2 negative, p53 negative, Bcl-2 negative. The first patient underwent right radical mastectomy sec. Madden and axillary lymphoadenectomy in October 2001, started six cycles of adjuvant chemotherapy and radiotherapy on the right side of the chest and on axillary and supraclavicular lymph nodes area. After 2 years an ecotomography revealed small hypoechogenic nodules in the left breast. In December the patient underwent left radical mastectomy with positioning of an expander device. The histological exam revealed a not much differentiated intraductal carcinoma, pT1a N0 Mx, Stage I. After the surgical therapy, she follows another adjuvant chemotherapy. The second patient underwent left quadrantectomy with axillary limphoadenectomy in November 2004. Like the first-will follow several cycles of adjuvant chemotherapy and radiotherapy. DISCUSSION: Breast cancer in women under 40 years of age differ from breast cancer in older women in numerous clinical, pathological and biological features. The studies demonstrate that breast cancer arising in women under 40 years have a more aggressive profile than those of older patients. In both our patients family history of breast cancer was reported. That suggests a possible genetic susceptibility of these patients through BRCA1 and BRCA2 germ-line mutations. Breast conservative surgery with chemio-radiotherapy is the most commonly used treatment breast cancer, expecially in consideration of the aggressiveness of the lesions.
A female patient was admitted to our Department for total thyroidectomy in amiodarone-induced thyrotoxicosis. The drug was prescribed for ventricular arrhythmia and atrial paroxysmal fibrillation in dilated cardiomyopathy due to chronic aortic regurgitation with left ventricular dysfunction (ejection fraction 35%; Class Functional NYHA III) and moderate-severe respiratory insufficiency. The cardiologist-anesthetist team has allowed to evaluate the surgical-cardiovascular-anesthesiologic risks and the balance between the improvement by the amiodarone administration for the arrhythmia, and the discontinuation of this treatment in order to prevent aggravation of the thyrotoxicosis. These hypotheses were subsequently discharged for the two reasons listed below: - several other antiarrhytmic drugs (that didn't show equivalent efficacy as amiodarone in preventing or converting such ventricular and atrial arrhythmias) may be proposed in the place of amiodarone. However, this could expose the patient to an arrhythmia; - a clear proof that the suspension of amiodarone can allow restoring normalization of the thyroid function doesn't exist. Therefore, the patient has been successfully submitted to the surgical intervention and in the follow-up we brought her back to a state of normalized thyroid function and cardiovascular conditions. In patients that cannot safely discontinue amiodarone or when medical therapy is ineffective in controlling thyrotoxicosis, thyroidectomy is the treatment of choice.
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Daily variations of electrolyte excretion have been studied in 8 hypertensive and in 4 normotensive women by collecting urine samples every 3 h for a 48-h span. After noticing the absence of a statistically significant circadian rhythm in the hypertensive group, the Authors suggest the hypothesis that a prolonged treatment with diuretic drugs may cause kidney troubles and suppress the circadian rhythm of urinary electrolyte excretion. The Authors conclude affirming that this hypothesis needs further investigation to allow a better chronotherapy of the hypertensive disease in the future.
The presence of a pleural effusion is a serious complication in the course of neoplastic diseases, where it assumes a determining medical and prognostic role. Thus the applications of adequate therapeutic methodologies becomes of primary importance to drain the effusion and to obtain an efficacious pleurodesis. In view of this the authors describe a case of iterative neoplastic pleural effusion which they have been able to observe recently.
Pectus excavatum, a congenital depressive malformation of the sternum, is described since 1594 by Johannes Schenk and has successively been the subject of many studies because of its various inherent problems. The repercussions on the respiratory and cardiac dynamics caused by the compression on the mediastinal structures and by the reduction of the respiratory volume have only recently been valuated completely with the application of the latest techniques to diagnosis, cardiology and radiology. The aesthetic defect, often the first aspect to attract the attention of patient and doctor, has serious psychological implications, especially for what concerns the affective life and relationships in general. The surgical therapy consists in radical interventions with large sternocostal resections and repositioning of the sternum (turnover), or in interventions with a less invasive technique to correct only the aesthetic defect. In this study have been examined 7 cases of patients affected by pectus excavatum who were operated at the Institute of General Surgery IV and the Department of Plastic surgery of the University of Rome "La Sapienza" between 1983 and 1993. The patients were divided in two groups: a first group of 4 patients who underwent a sternal turnover, and a second group of 3 patients who were operated with conservative methods to correct the aesthetic defect. In both groups the results were good without any post-operatory complications. The experience gained during these years consents us to propose radical interventions for patients who have a severe malformation with evident physiopathological implications; this intervention is especially indicated if the patient is young, to prevent further disabling complications. Less invasive methods, on the other hand, should be applied to all other cases, considering the higher degree of tolerance of the intervention, the absence of postoperatory complications and the minor cost, thanks to a shorter hospital stay.
The obstruction of the airways represents a severe complication in bronchial neoplasia. Endoscopic laser resection associated with the positioning of a stent represents a therapeutic praesidium that ensures the potency of the airways. The authors describe a case of bronchial carcinoma treated with endobronchial laser resection and positioning of a Dumon stent.
To evaluate the role of agricultural exposures in the development of lymphatic and haemopoietic tumors a population-based case-referent study has been carried out in three health districts of Southern Italy. All incident cases of leukemia, lymphoma and myeloma from 1 July 1987 to 30 June 1989, aged 14 years or more, have been identified (71 subjects). The control group is formed by subjects with other neoplasms. A Job Exposure Matrix, specific to 10 areas, to 6 major crops and to 4 calendar periods, was built for assessing pesticide exposure. To date 100 interviews (to the index subject or to proxies) have been carried out (26 cases and 74 referents). The odds ratio (OR) of hematologic malignancies for agricultural workers was 1.63 [95% Confidence Intervals (95% CI): 0.69-4.34] in the whole sample and 6.00 (95% CI: 1.21-25.52) in the female group. Significative increased risks have been observed for exposure to DDT and creolin (OR = 4.11; 95% CI: 1.16-14.55) and, for leukemia, for cattle breeders (OR = 6.38; 95% CI: 1.46-27.83).
In order to evaluate the association between hemolymphoietic tumors and agriculture, we are carrying out a case-control study in the southern province of Bari (Italy). In the period 1st July 1987-30 June 1989, seventy-one incident cases of limphomes, leukemias and multiple myeloma and three fold higher number of controls (other tumors) aged more than fourteen years old were selected. A structured questionnaire was carried out to collect informations, focusing attention to the use of pesticides. For the evaluation of the exposure to specific substances a crop exposure matrix with "multiple circumstantial determinants" (crops and/or type of breeding, phytopatologies, areas and time windows) will be used. In this update a specific pesticides analysis was not conducted. Therefore, we classified as exposed farmers, farm laboures, breeders and whoever affirmed the regular use of pesticides. Up to 1st July 1995, one hundred and seventy-three subjects were contacted. Twenty-three (13%) of them refused to participate to the study, one hundred and fifteen (87%) of them, thirty-one (21%) case and one hundred and nineteen (79%) controls, were interviewed. Nineteen (61%) of cases were males, twelve (39%) of cases were exposed; seventy-two (60.5%) of controls were males, fourty-five (38%) of controls were exposed. The risk of hemolymphoietic tumors associated with exposure was null (O.R. = 1.04; I.C. 95% = 0.42-2.50); no job category (farmer, farm labourer, breeder) was statistically significant associate with cases. An association with farmer (O.R. = 4.87; I.C. 95% - 1.12-20.52) and breeder (O.R. = 4.83; I.C. = 1.19-18.11) was statistically significant if those fourteen subjects with leukemia were considered as cases. Using a logistic model (which independent variables were age, sex, information gathered directly from the subject of from relatives and smoking habit) O.R. for leukemia and farmer resulted statistically significant (O.R. = 5.38; I.C. 95% = 1.31-21.99); instead a considerable decreased O.R. was observed for leukemia and breeder (O.R. = 1.20; I.C. 95% = 0.73-2.00). These results could be subject to variation after the next data input.