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

[The prognostic significance of the vascular invasion of colorectal tumors].

The authors report their experience about the clinical significance of the invasion of veins (BVI) in 68 patients with colorectal carcinoma, submitted to potentially curative surgery in the period 1980-1988. Every patient was screened for BVI. The tumoral spreading was differentiated into endovascular and perivascular permeation. The authors also considered the incidence and kind of BVI, the recurrence rate of the tumour and five-year survival rate. BVI was present in 33 patients (48.5%). Recurrence was observed in 22 patients (22.3%): 19 patients in the group with BVI (33 patients): 3 in the group of 35 patients without BVI. BVI was related to tumour stage, but it may be considered as an independent factor in its relationship with a poorer prognosis in patients affected by tumours in stages II or III; in fact, the patients in stage II had a poorer prognosis than those in stage III without BVI. These results suggest that BVI, as a prognostic factor, is independent from tumoral stage in determining the recurrence rate and the long term prognosis.

Colorectal Neoplasms↗

PubMedDate not supplied

[Colonic neoplasms: long-term survival after surgical treatment. Our experience].

The surgery is still the only treatment for large bowel tumours. The patients who underwent a radical operation and then were treated with chemo and/or radiotherapy have not shown a longer free-disease survival. Palliative resection should be preferred to by pass operation, since the latter has shown less postoperative morbility and mortality. The authors report their experience on 139 patients with large bowel tumours operated between 1979 and 1988, and they analyze the surgical results and the five-years survival according to the stage of disease.

Adult↗

PubMedDate not supplied

[On a case of traumatic carotid-jugular fistula].

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Adolescent↗

PubMedDate not supplied

[Hyperthyroidism and carcinoma of the thyroid gland].

The incidence of thyroid carcinoma in hyperthyroidism varies considerably from as low as 0.3% to as high as 16.6% with a higher rate in toxic nodular goiters. Occult thyroid carcinoma (< 1.5 cm or microscopic foci) is the rule and only a few tumors are suspected preoperatively with ultrasonography or fine needle aspiration or 131 I scan. In 408 patients who underwent surgery for hyperthyroidism in our Surgery Department from January 1967 through December 1994 the incidence of thyroid carcinoma was 5.6% (23 cases). In detail, a neoplasm occurred in 5 cases of Graves' disease (specific incidence: 3.8%), in 13 cases of toxic nodular goiter (12.5%) and in 5 cases of hyperfunctioning adenomas (2.8%). 19 cancers were papillary (12 in toxic nodular goiter, 3 in Graves' disease, 4 in hyperfunctioning adenomas), three were follicular (1 in Graves' disease, 1 in toxic nodular goiter, 1 in hyperfunctioning adenomas) and 1 medullary in Graves' disease. A papillary carcinoma was diagnosed preoperatively on fine needle aspiration with ultrasonography in only two patients with Graves' disease and confirmed by postoperative histological examination on permanent section. We do not believe in the frozen-section examination intraoperatively because it's not diagnostical for follicular lesions and evaluates rarely capsular invasion. Twenty patients received total thyroidectomy and four of them also lymphoadenectomy. Three patients received emithyroidectomy: in two cases for occult papillary carcinoma and in the last case for local cancer invasion (T4N0M0). Twenty patients are alive and with no evidence of cancer recurrence. Mean follow-up is 59.6 months. Our retrospective study shows a progressive increase of the incidence of coexisting thyroid malignancy and hyperthyroidism especially in toxic nodular goiter, probably related to extended surgical indications. Our findings do confirm that, even in the presence of hyperthyroidism, all thyroid nodules require careful diagnostics for exclusion of malignancy.

Adenocarcinoma, Follicular↗