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N Palestini

Publications and source records attributed to N Palestini.

At least 19 recordsLinked to original sources
PubMed2005

[Post-thyroidectomy cervical hematoma].

AIM: Postoperative hematoma is a complications of thyroid surgery uncommon but potentially life threatening. It has implications for the trend toward outpatient procedures. METHODS: Retrospective review of 1.221 thyroidectomies performed at our institution over a 6-years period, to identify patients with hematomas requiring reoperation. Symptoms, treatment and findings at reoperation were evaluated. A control group (n=120) was compared for perioperative risk factors and outcome. RESULTS: Eighteen patients (1.5%) developed a postoperative hematoma. Symptoms included neck pain/pressure in 10 patients, respiratory distress in 9, wound drainage in 2, dysphagia in 1, agitation and sweating in 1. Mean time to symptom onset was 12 hours (range: 1.3-40 hours). Six hematomas presented between 7 and 24 hours, and 3 beyond 24 hours. Six patients required bedside hematoma evacuation. The bleeding source was identified in 15 patients. All patients recovered well, but one required a temporary tracheostomy. Case/controls comparison yielded in the study group a higher prevalence of hyperthyroidism (55.6% vs 25.8%, P=0.022) and intrathoracic goiter (50% vs 22.5%, P=0.029), and a longer mean hospital stay (5.22 vs 4.1, P=0.012); morbidity was not increased. CONCLUSIONS: Postoperative hematoma is an uncommon complication of thyroid surgery. If treated promptly, serious consequences can be avoided. The relatively long interval between the initial operation and the hematoma development needs to be considered when establishing outpatient practice guidelines.

Adolescent↗
PubMed2004

[Multiple endocrine neoplasia type 2. Biological and clinical aspects].

CLASSIFICATION: Medullary thyroid carcinoma (MCT), a rare thyroid malignancy originating from the parafollicular C cell, may occur either as a hereditary or a non-hereditary entity. Hereditary MCT can occur either alone, familial MCT (FMCT), or in multiple endocrine neoplasia type 2 (MEN 2), associated with other endocrinopathies such as pheochromocytoma and/or hyperparathyroidism (MEN 2A and 2B). These hereditary disorders are due to germline mutation in the RET proto-oncogene. Early diagnosis and treatment significantly improve the outcome of patients with MCT. DIAGNOSIS: In hereditary MTC, the MTC is usually multifocal and bilateral. Serum calcitonin measurement, a marker of disease, is superior to fine needle aspiration cytology in suggesting the diagnosis of MCT. Other investigations including ultrasonography, chest X-ray, computerized tomography and MRI may provide valuable topographic details in the assessment of the location and size of the primary tumor and metastases. The adrenomedullary disease is usually multicentric and bilateral, often detected after the onset of MCT; this disease is sought by measurement of urinary metanephrines and fractionated catecholamines. The tumor should be localised by computed tomography or MRI scans; 131I-MIBG scintigraphy is used to confirm diagnosis. Primary hyperpathyroidism generally have no symptoms, although hypercalciuria and renal calculi may occur; we screen for this disease by measurement of serum calcium, once hypercalcemia is documented, serum intact PTH should be measured to confirm the diagnosis. High-resolution small part sonography is sometimes used to differentiate parathyroid hyperplasia from solitary adenoma.

Humans↗
PubMed2003

[Treatment of familial medullary thyroid carcinoma].

Medullary thyroid carcinoma (MTC) is a rare thyroid malignancy, which is familial in 25-29% of cases. Familial MTC is due to germ-line mutations in the RET proto-oncogene. It can occur either alone or as the thyroid manifestation of MEN 2 syndromes; the disease is inherited in an autosomal dominant fashion with age-related penetrance. The treatment of choice is surgery. Early diagnosis and an adeguate initial operation provide the best chance of cure. Hence, the diagnosis should be made preoperatively. Genetic testing can identify almost all affected individuals with hereditary disease and permits prophylactic/early thyroidectomy in gene carriers. Total thyroidectomy and lymphadenectomy of the cervicocentral compartment is mandatory in all patients. In addition, bilateral dissection of the cervicolateral compartment should be done in all cases with more than microscopic disease. Plasma calcitonin is an excellent marker for postoperative follow-up. Treatment of persistent/recurrent disease is primarily surgical. Hence, a reoperative cervical lymphadenectomy should be considered in patients with persistently elevated calcitonin levels and no signs of distant metastases. Chemotherapy and external radiotherapy have little impact on the course of avanced disease; more promising is metabolic radiotherapy with Y90-DOTATOC in patients with somatostatin receptor-positive tumours.

Adolescent↗
PubMed1997

[Integration of B-mode and color Doppler ultrasonography in the preoperative diagnosis of thyroid lesions. Preliminary experience in 91 cases].

Ninety-one patients affected with thyroid diseases (97 lesions) were examined with conventional B-mode and color-Doppler US. To verify if color-Doppler is able to provide additional elements in the US diagnosis, for each lesion were expressed two diagnosis: the first found on conventional US patterns and the second on color-Doppler patterns. US diagnosis was compared with histologic findings that identify 73 benign lesions and 24 malignant lesions. With conventional B-mode US the diagnosis was correctly expressed in 62/73 benign lesions (85%) and in 18/24 malignant lesions (75%) while it misdiagnosed as positives 11/73 case (15%) and as negatives 6/24 cases (25%). If we completed the conventional US diagnosis with color-Doppler patterns, the false negative reduced to 4% and false positive to 6.8%. On the whole, although any correlation between color-Doppler patterns and different histological types was found, the color-Doppler had a high predictive value of benignity in patterns I, II, and IV while pattern III is not peculiar because it includes either malignant or benign lesions.

Adult↗
PubMed1996

Multiple endocrine neoplasia (MEN IIB) with Cushing's syndrome due to medullary thyroid carcinoma producing corticotropin-releasing hormone.

We describe a case of Cushing's syndrome caused by a medullary thyroid carcinoma (MCT) secreting corticotropin-releasing-hormone (CRH) in a young woman presenting mucosal neuromas located on the top of the tongue and eyelid areas. Laboratory studies showed, basally and after dexamethasone suppression test, serum cortisol and plasma pituitary corticotrophin (ACTH) levels agreed with an ectopic Cushing's syndrome. Immunohistochemical studies of the MCT tissue revealed a production of CRH and scattered cells containing vasopressin but not ACTH peptides. This is the first demonstrated case of a CRH-secreting tumor in multiple endocrine neoplasia (MEN IIB) syndrome.

Adult↗
PubMed1996

[Acute diverticulitis of the appendix. A clinical case].

The authors describe a case of acute diverticulitis of the appendix presenting as an inflammatory mass in the right lower quadrant of the abdomen. The histologic and clinical findings are discussed. This uncommon condition may mimic acute appendicitis, but in most instances it departs from typical appendicitis for later age of appearance, more indolent clinical course and increased tendency to perforation. In these cases the disease may progress with subacute interstitial inflammation, with or without abscess formation, and present as a tumor-like mass of the cecum.

Acute Disease↗
PubMed1994

[Precedents of benign thyroid pathology in carcinoma of the thyroid].

The clinical history of 125 thyroid cancer (99 women and 26 men) operated on between 1985 and 1992 is reviewed. Previous benign thyroid disease is recorded in 52% of all cancers; this was generally goitre or a thyroid nodule, and in few cases hyperthyroidism. Previous disease is observed in 75% of insular, in 68% of follicular, in 51.5% of papillary, in 35% of anaplastic carcinomas. It is supposed that previous thyroid disease is a risk factor in the development of cancer.

Adenocarcinoma↗
PubMed1993

Poorly differentiated thyroid carcinomas with primordial cell component. A group of aggressive lesions sharing insular, trabecular, and solid patterns.

Poorly differentiated carcinomas of the thyroid share insular, trabecular, and solid histological patterns that are different from those of papillary, follicular, medullary, and anaplastic varieties. We have collected 63 cases of poorly differentiated thyroid carcinomas. Thirty-one tumors (Group A) corresponded to the so-called insular carcinomas, and 32 tumors (Group B) had predominant trabecular and solid or focally follicular patterns in the presence of a minor insular component. The cells characterizing these lesions were relatively small and globoid, with uniform nuclei and intracytoplasmic deposits of thyroglobulin. They were in every respect similar to primordial cells present in the early stages of fetal thyroid development. None of the tumors proved fatal within 6 months, and most responded to radioiodine therapy. Although no differences in survival between the two groups were found, a significantly (p < 0.01) higher percentage of recurrences or distant metastases was observed with Group A tumors. The term primordial cell carcinoma appears appropriate for this type of tumor, which displays characteristic histocytological features and production of thyroglobulin. Clinically, these tumors are aggressive but generally show a slow course and good response to radioiodine therapy.

Carcinoma↗
PubMed1993

[Poorly differentiated "insular" carcinoma of the thyroid: long-term survival].

Poorly differentiated "insular" thyroid carcinoma is a rare, aggressive and often lethal variant of thyroid cancer. Thirty-one cases of this entity were encountered over a 18-yr period. In most of them surgical therapy consisted of total or near-total thyroidectomy. Six patients had distant metastases and/or mediastinal or tracheal infiltration at presentation. Fifteen out of 25 apparently cured after surgery (60%) developed recurrence in the neck and/or distant sites. Radioiodine was employed to destroy thyroid remnants (22 cases) and subsequently to treat persistent/recurrent disease (17 cases). Thirteen patients showed radioiodine uptake in neoplastic lesions and in 3 cases complete resolution was observed. After a mean follow-up of 4.5 years (range 1-16) 6 patients had died of their tumor, 12 are alive with persistent/recurrent disease, 13 do not show any evidence of disease. This experience confirms that "insular" carcinoma tends to have an aggressive behavior, but therapy can be effective. Recognition of this entity is therefore important for planning adequate surgical approach and subsequent patient management.

Female↗
PubMed1993

[Parathyroid transplantation and cryopreservation techniques].

This report reviews several aspects of parathyroid transplantation, including some technical aspects of cryopreservation. The problems concerning the control of autograft are also presented, with a little review of the more recent references. These results lead to the recommendation that total parathyroidectomy and autotransplantation should be considered as the method of choice in the treatment of secondary hyperparathyroidism.

Cryopreservation↗
PubMed1992

[Ischemic colitis manifested as Crohn's disease. A case report].

Ischaemic colitis has many and different clinical features as it is often linked to the severity of ischaemic injury. In this paper two patients with clinical features of Crohn's disease are reported. In both patients the diagnosis has been confirmed with endoscopy and biopsy. They have been treated with specific therapy until they developed bowel obstruction in one case and peritonitis in the other. Both patients underwent laparotomy and the histological specimen showed a picture of ischaemic colitis. In one case a Dixon's resection was done, in the other Hartmann's operation.

Adult↗
PubMed1990

[Diagnostic approach to extra-renal pheochromocytoma].

Stress is laid on certain principles of diagnostic research in the event of extra-suprarenal pheochromocytomas. The importance of CT is recalled, specifying the usefulness of complementary examinations such as selective venous catheterism and above all of scintigraphy with 131I MIBG.

3-Iodobenzylguanidine↗
PubMed1989

Multifactorial study of prognostic factors in differentiated thyroid carcinoma.

Using survival corrected for intercurrent deaths as an endpoint, the prognostic significance of age, sex, histology, clinical extent of disease, size of primary tumor, type and result of treatment, was assessed in a series of 133 patients with differentiated thyroid carcinomas treated over a 16-year period. The following parameters were shown to be unfavourably related to survival: old age, follicular moderately-differentiated histological type, extrathyroid growth of the primary tumor and/or presence of distant metastases at diagnosis. In patients not cured after surgery, postoperative radioiodine therapy was correlated with, better survival rates. A multivariate statistical analysis (Cox model) showed that tumor stage and age at diagnosis were the major determinants of prognosis. Based on this data a risk index was worked out and three low/intermediate/high risk subgroups, characterized by significantly different survival rates, were identified in the study population.

Adolescent↗
PubMed1989

[Blood cholesterol in patients with cancer].

Cholesterolaemia values have been investigated in a simple of colon cancer patients and in two control samples consisting of age and sex corresponding subjects suffering respectively from peripheral arteriopathy and minor pathologies (hernias and varices). The study was extended subsequently to a sample of subjects suffering from thyroid neoplasia and two similarly constituted control samples. Cholesterolaemia was significantly lower in colon cancer patients than in the control samples whereas in subjects suffering from thyroid cancer, statistical significance was not attained even though a similar reduction was recorded. The reduction in cholesterol in cancer patients is, in the light of the most recent studies, an effect of cancer on cholesterolaemia, thus giving the lie to the theory that low blood cholesterol is a factor favouring the onset of cancer, and is a finding with by no means indifferent repercussions on the study of the behaviour and physiopathology of cancers.

Aged↗
PubMed1988

[Bandage of the common femoral artery after intervention of disobliteration or aneurysmectomy (considerations on surgical technic apropos of 4 cases)].

The Authors refer their surgical experience in those particular cases in which, after performing an aneurysmectomy or an endarterectomy of common femoral artery, the residual arterial wall appears too thin and weakened. In these not very rare cases, can be indicated, as an additional and prudent manoeuver in order to avoid a possible evolution towards suture disruption or pseudoaneurysm formation, the wrapping or banding of the endarterectomized tract of artery by the mean of dacron prosthesis, sutured around the artery longitudinally. This simple technique, performed in 4 patients, appears easy and safe to perform, offering the advantage to guarantee a biological arterial lumen.

Aged↗