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U Parmeggiani

Publications and source records attributed to U Parmeggiani.

At least 19 recordsLinked to original sources
PubMed2005

Which therapy to prevent post-thyroidectomy hypocalcemia?

Hypocalcemia is one of the most frequent complications after total extracapsular thyroidectomy (TET). In most of cases it is a transient phenomenon. The aim of this study is to evaluate if and how the oral administration of calcium or calcium combined with D-vitamin could effectively prevent post-thyroidectomy hypocalcemia. A randomized prospective study was performed, recruiting 120 patients who underwent total thyroidectomy. The patients in our series were randomly assigned to one of two groups: group A--patients who received calcium lactogluconate/calcium carbonate (mg 300 per day); group B--patients who received calcium carbonate/cholecalciferol therapy (calcium carbonate: 1500 mg per day; cholecalciferol 400 UI per day). The groups were well matched for age, sex and pathologies. Patients of both A and B groups were divided in two subgroups: those operated on for benign thyroid diseases (A1 and B1) and those operated on for malignancy (A2, B2). Serum calcium assays, performed 24, 48 and 72 hours after surgery, showed mean values of calcemia higher in patients of the B1 and B2 group. Statistical analysis was performed using a Student's t test. Mean serum calcium concentrations on post-operative day one, two and three were higher in patients of the group B (p<<0.01). Early and combined oral administration of both calcium and vitamin D seemed to prove major efficacy in preventing and treating post-operative hypocalcemia, showing mean serum calcium levels higher than those of patients who received only oral calcium administration. Nevertheless, further studies are necessary to validate these data.

Adult↗
PubMed2005

Major complications in thyroid surgery: utility of bipolar vessel sealing (Ligasure Precise).

In the present study the Authors tried and assess the advantages of the standard sutureless thyroidectomy performed by the Ligasure Vessel Sealing System, thanks to the use of the dedicated Precise handle. The Authors compared the efficacy of haemostasis and the economical impact of the device, in terms of drug administration and costs. The Authors comparatively analyzed 120 total extracapsular thyroidectomies (TET) performed by the standard operative technique (Group A, control) and 70 TET achieved by the "sutureless technique" (Group B, case). There was a statistically significant decrease of transient postoperative hypocalcemia (5.71% vs 7.5%) and also of mean operative time (about 20 minutes) in patients of the group B. Non significant decrease of other kind of complications (postoperative hemorrhage, transient and permanent inferior laryngeal palsy, stupor of the superior laryngeal nerve, seromas) were also observed. The use of the Ligasure Precise resulted easy, safe and efficient in the Authors' experience. It allowed the decrease of postoperative haemorrhages and mean operative time.

Case-Control Studies↗
PubMed2005

Gastrointestinal tumours in elderly.

The Authors report their experience concerning 129 cases of gastrointestinal neoplasms (gastric, colonic, anorectal), recorded during the last years among patients aged between 70 and 81 years, who underwent radical surgery. The main issues evaluated were: anaesthesiological risk, stage, post-operative mortality and morbidity. Elderly seems not to be a contraindication, nor a limit for surgery if the patient is correctly and strictly managed pre and post-operatively.

Aged↗
PubMed2003

[Cancer risk in breast lesions: diagnostic and therapeutic strategy].

BACKGROUND: The classification, diagnostic recognition and surgical treatment of breast lesions at risk of neoplastic transformation represent some of the most important objectives in breast research. Attention has been focused on lesions at risk of neoplastic transformation in breast pathology, such as: atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), multiple intraductal papilloma and sclerosing adenosis. METHODS: Our experience regards activity carried out from 1996 to 2001; the diagnostic approach included routine performance of echotomographic examination, mammography screening indicated in women >40 and, in selected cases, in women <40; FNAB was carried out in all lesions containing suspicious cells. In the case of non-palpable lesions we carried out a CT-guided FNAB using the stereotaxic technique. In cases of secreting breast, galactography proved useful. As regard clinically suspect nipple secretions, cytology was useful in the diagnosis of intraductal papillomatous lesions. Surgery was indicated for: mammographically negative nodular lesions with cytological finding of suspect lesions. Continuous, spontaneous mono-orificial, serous, sero-hematic or hematic secretion of the nipple also in the presence of negative and/or inconclusive galactographic and cytological findings. From a nosological viewpoint we have distinguished 3 groups: A) 49 women (average age 47.3 years) with suspect lesions subjected to biopsy. On the basis of the cytological response we carried out: 37 quadrantectomies with extemporary examination, 4 excisional biopsies, 5 radical ductectomies and 3 microductectomies. B) 26 patients (36.7 years) subjected to mammary biopsy for non-suspect lesions; in 24 cases excisional biopsy of the lesion and in 2 cases radical ductectomy. C) Control group consisting of 141 women (average age 44.5 years) suffering from benign pathology not suspected of lesions at risk and not subjected to surgery. RESULTS: The final histological examination evidenced: Group A: 7 cases of T1aN0M0 carcinoma (14.3%); 20 lesions at risk (40.8%); 22 lesions not at risk; Group B: 25 (96.1%) lesions not considered at risk, in 1 case (3.9%) area of sclerosing adenosis with ductal proliferation and slight atypias; Group C: in 4 cases (3.1%) the onset at follow-up of lesions at risk made it necessary to remove the lesion. Histology did not confirm the presence of cancer in any case. CONCLUSIONS: The diagnostic and therapeutic protocol proposed enables us to identify and radically treat high risk patients (Group A) and follow them up closely. On the contrary, Group B evidenced a very low incidence of lesions at risk which escaped preoperative diagnosis and in confirmation of this in Group C, during follow-up, the onset of only 4 lesions at risk was identified in which histological examination however excluded the presence of cancer.

Adult↗
PubMed2002

[Post-thyroidectomy hypocalcemia. Personal experience].

BACKGROUND: The study evaluates the incidence of both early and protracted post-thyroidectomy hypocalcemia over a 6-year period (1995-2000) in a series of 330 consecutive thryoid operations. The aim was to identify the profile of patients with the greatest risk of permanent parathyroid functional insufficiency and a suitable treatment protocol. METHODS: Having performed a statistical ana-lysis of all the variables, we divided the entire population of 330 patients into 4 groups based on the extent of demolition, the method of organotherapeutic replacement with L-Thyroxine and the (eco-radioguided) procedure used to identify the parathyroids: 59 patients undergoing subtotal thyroidectomy; 155 patients undergoing total thyroidectomy who commenced replacement organotherapy from postoperative day 15-30; 94 patients undergoing total thyroidectomy who commenced replacement organotherapy from postoperative day 1; 22 patients undergoing total thyroidectomy who underwent routine intraoperative parathyroid assay. RESULTS: The results show that the impact of more radical surgery in determining hypocalcemia, in particular protracted hypocalcemia, represents the most striking characteristic of patients with the greatest probability of permanent parathyroid insufficiency. We emphasise that early correction of postoperative hypothyroidism can drastically reduce the incidence of both early and protracted hypocalcemia. CONCLUSIONS: In conclusion, hypoparathyroidism is an exceptional event, whereas hypocalcemia is relatively common after total thyroidectomy. The effects of the early correction of postoperative hypothyroidism are undoubtedly beneficial, as is the use of eco- and radioguided methods for the intraoperative identification of the parathyroid glands, although they are not free from limits and criticism.

Adult↗
PubMed2001

Impact of surgical treatment on quality of life of patients with gastrointestinal tumors.

Quality-of-life assessment is becoming an important concern even of surgeons. The new trend applies specifically to surgical oncology, where particular attention is now being paid to the outcome of surgical treatment. Gastrointestinal cancers are heterogeneous in their presentation and in treatment, but they share common aspects related to the surgical approach. A functional outcome is fundamental in all the operations performed for gastrointestinal cancers and many improvements have been made thanks to the increased rate of conservative approaches and the amelioration of the technology applied to surgery. The measurement of the surgical outcome and the methods to be applied is still undergoing extensive evaluation but the flourishing interest in the issues concerning quality of life all over the surgical community will rapidly lead to a better definition of goals and results.

Colorectal Neoplasms↗
PubMed2001

[Primary lymphoma of the gastrointestinal tract].

BACKGROUND: A retrospective analysis of 12 years' experience (1987-1999), concerning gastro-intestinal lymphomas (LNH-GI) has been performed, to offer a contribution for the identification of the diagnostic and prognostic criteria. METHODS: During this period, 11 cases (9 male and 2 female) have been treated: 8 with gastric localization and 3 with intestinal localization, with age ranging between 12 and 78 years. Most of the analyzed cases (5 cases out of 8 with gastric localization and all the cases with intestinal localization) underwent surgical treatment without a sure understanding of the nature of lymphoma. Clinical observation showed forms in an advanced state of local development. RESULTS: However, the low specifity of available diagnostic tools and the therapeutic delay are factors that seems do not influence the prognosis, as well as the stage of the disease determined with traditional classification methods. The aspect that seems to be crucial for the prognosis of the disease is the histotype (5 low grade cases free of desease from 36 months to 10 years, vs 4 high grade cases died between 46 days and 40 months after the surgical treatment). CONCLUSIONS: Some interesting considerations arise from the analysis of the diagnostic procedure and from the method of treatment: the specifity and precocity of the diagnosis could be improved by a large use of endoscopic ultrasonography that allow to obtain deep biopsy; the identification of histotype before surgical treatment can address and modulate the therapeutic strategy eliminating the over treatment for L.G. forms.

Adolescent↗
PubMed2001

[Differentiated thyroid carcinoma. Prognosis and therapy].

BACKGROUND: We have conducted retrospective analysis of 90 cases of Differentiated Thyroid Cancer (DTC) operated between 1978 and 1998. The aim of this study was to verify the most widely used prognostic factors and to try to identify differences in the development of these tumors. METHODS: The DTCs, selected from the histopathologic reports of the Institute of Pathologic Anatomy, were divided into high, intermediate and low malignancy tumors according to the classification of Carcangiu and Rosai. RESULTS: We found that age >45 years associated with a cancer larger than 1.5 cm and intermediate malignancy was related to the most dismal prognosis. Ten of the 90 cases had a dismal prognosis; 6/10 (60%) had disease recurrence. Four of those six patients died; one has disease recurrence 5 months after surgery, and one patient with disease recurrence after one year was lost to follow-up. The identification of metastases at the primary operation is of course an unfavourable prognostic factor. In fact, all of the six cases with metastases had disease recurrence after the treatment: three patients have died; two survive (one have a disease period of 5 months and the other a disease period of 2 years); one patient with disease recurrence one year after surgery was lost to follow-up. CONCLUSIONS: The most significant negative factors for prognosis purposes were the higher degrees of T, the presence of metastases at diagnosis or their appearance at follow-up, age greater than 45, male sex and areas of dedifferentiation within the histological pattern. Total thyroidectomy remains the treatment of choice.

Adult↗
PubMed2001

[Efficacy of somatostatin analogs in the treatment of neuroendocrine tumours and paraneoplastic syndromes].

BACKGROUND: The authors report their experience with octreotide LAR in the adjuvant treatment of 10 patients suffering from neuroendocrine tumours and paraneoplastic syndromes. METHODS: All patients were studied preoperatively using traditional radiology and scintigraphy using octreoscan. RESULTS: Octreoscan was positive in all cases for somatostatin receptors. All patients with neuroendocrine tumours underwent surgery of the primary neoplasm; treatment with somatostatin was commenced at a later stage. CONCLUSIONS: The authors' experience with octreotide LAR proved to be an efficacious means of controlling symptoms and stabilising disease without collateral effects. They conclude by affirming that octreotide LAR represents a valid therapeutic choice in the symptomatic treatment of neuroendocrine tumours.

Aged↗
PubMed2001

[Carotid glomus tumours. Personal experience in the surgical treatment of chemodectoma].

The authors present 6 cases of carotid glomus tumours referred to their attention over the past 10 years. Their experience shows that colour ultrasonography (using both morphological and functional evaluation) is the diagnostic key for defining the treatment of paraganglioma. More recent experience highlights the role of 111In Pentreotride using a multidisciplinary therapeutic approach.

Adult↗
PubMed1997

Prolactin response to thyrotropin-releasing hormone as a guideline for cyclical mastalgia treatment.

METHODS: We studied a group of 36 fertile women affected with moderate-to-severe cyclical mastalgia (mean age: 26.0 years) showing a normal menstrual history and normal basal levels of circulating hormones, including prolactin (PRL), luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), progesterone (P), testosterone (T), dehydroepiandrosterone sulphate (delta HEAs), androstenedione (A). Using serial measurements of PRL plasma levels after an intravenous injection of thyrotropin-releasing hormone (TRH), (TRH test), patients were divided in two groups: 19 patients with abnormal PRL response to TRH and the remaining 17 with normal response. RESULTS: Bromocriptine treatment, 2.5 mg b.i.d. for 3-6 months, was effective in 73.6% of patients with abnormal TRH test and in 23.5% of patients with normal TRH test: the difference was statistically significant. On the other hand, 76.9% of patients with either normal TRH test or resistant to bromocriptine therapy had a favourable response to percutaneous progesterone and systemic non-steroidal antiinflammatory drugs (NSAIDs). CONCLUSIONS: These results seem to confirm the hypothesis that PRL response to TRH could be used to identify patients affected with cyclical mastalgia that are likely to benefit by bromocriptine treatment.

Adolescent↗
PubMed1990

Epidermal growth factor receptor and thyrotropin response in human thyroid tissues.

The content of epidermal-growth-factor receptor (EGFr) and its relation to TSH-response were examined in 27 malignant thyroid tumors (5 follicular, 6 papillary, 5 medullary, 11 anaplastic carcinomas) and in 30 tumor-like lesions (21 hyperplastic goiters and 9 toxic adenomatous goiters). Normal 12 thyroid tissues adjacent to benign tumors with no evidence of macroscopic or microscopic abnormalities were used as control. All thyroid plasma membranes tested showed specific EGF binding. In membranes from toxic adenomas (2.18 +/- 0.73 fmoles/mg protein) and papillary carcinomas (2.80 +/- 0.80) the EGF binding was similar to that of normal thyroid membranes (2.32 +/- 0.73). Hyperplastic goiters showed an EGF binding (4.4 +/- 0.82) slightly higher than normal tissue. The highest and the lowest EGF binding values were found in anaplastic (11.8 +/- 2.78) and medullary (0.50 +/- 0.39) carcinomas, respectively. An inverse correlation between EGFr content and TSH-response was found when anaplastic thyroid tumors were compared to tumor-like lesions. However no correlation was observed in medullary carcinomas which also failed to respond to TSH and in papillary carcinomas which partially respond to thyrotropin.

Cell Membrane↗
PubMed1990

Gangliosides and phospholipids in human thyroids responsive and unresponsive to thyrotropin.

The patterns of gangliosides and phospholipids and their relation to TSH response were examined in twenty-six malignant thyroid tumors (4 follicular, 6 papillary, 5 medullary, 11 anaplastic carcinomas) and thirty-six hyperplastic goiters. Thirteen thyroid tissues adjacent to benign tumors with no evidence of macroscopic or microscopic abnormalities were used as normal tissue. In normal thyroids the major ganglioside was GD3 (44%) and GM3 was the second ganglioside (20%). In minor amounts GD1a (8.6%), GD1b (6.2%), GT1b (5.7%) and GM1 (5.6%) were present. In hyperplastic goiters and in follicular carcinomas the patterns of gangliosides were similar to that of normal tissue except for GM3 which, in the last tissue, was higher (34%). In papillary carcinomas low levels of GM3 (11%) and GT1b (0.8%) with a high level of GD1b (12.6%) were found. In anaplastic carcinomas GM3 was very high (47%) whereas GD3 was low (18%). In these tumors also a high percentage (14.0%) of GD1a was found. In medullary carcinomas the lowest levels of GM3 (4%) with the highest level of GD3 (64%) were found. Although large differences of the gangliosides distribution were clearly encountered in the various pathological human thyroid, no correlation between lack of TSH response and some individual ganglioside could be made. No differences in the individual phospholipid in the various tissues studied were found.

Adenocarcinoma↗
PubMed1980

[Total body washout (T.B.W.) in the rat. 1) Perfusion techniques].

Three different techniques of total body washout (T.B.W.) have been used in experiments dealing with rats. The first technique was employing inferior vena cava as input and abdominal aorta as output; the second one performed just the opposite way; finally the third used abdominal aorta at the start of the experiment, whereas inferior vena cava was selected at the end. The last one proved to be the most efficient technique in comparison to the other ones.

Animals↗