Thyroid Diseases: Nasi PG

Rosato L, Miccoli P, Pinchera A, Lombardi G, Romano M, Avenia N, Bastagli A, Bellantone R, De Palma M, De Toma G, Gasparri G, Lampugnani R, Marini PL, Nasi PG, Pellizzo MR, Pezzullo L, Piccoli M, Testini M. · Dipartimento di Chirurgia - ASL TO/4, Ospedale di Ivrea, Italy. · G Chir. · Pubmed #19351456 No free full text.

Abstract: AIM: To review and to update the management protocols in thyroid surgery proposed two years ago by 1st Consensus Conference called on the topic by the Italian Association of Endocrine Surgery Units (UEC Club). METHOD: The 2nd Consensus Conference took place November 30, 2008 in Pisa within the framework of the 7th National Congress of the UEC Club. A selected board of endocrinologists and endocrine surgeons (chairmans: Paolo Miccoli and Aldo Pinchera; speaker: Lodovico Rosato) examined the individual chapters and submitted the consensus text for the approval of several experts. This plain and concise text provides the rationale of the thyroid patient management and wants to be the most complete possible tool for the physicians and other professionals in the field. CONCLUSIONS: The diagnostic, therapeutic and healthcare management protocols in thyroid surgery approved by the 2nd Consensus Conference are officially those proposed by the Italian Association of Endocrine Surgery Units (UEC Club) and are subject to review by two years.

Rosato L, Nasi PG, Porcellana V, Varvello G, Mondini G, Bertone P. · Ivrea Hospital, Ivrea (TO), Italy. · G Chir. · Pubmed #17475117 No free full text.

Abstract: Unilateral phrenic nerve paralysis is a rare complication of cervico-mediastinal goitre. It occurs when adhesions grow between the intrathoracic part of the thyroid and the nerve, specially where the goitre enters the mediastinum behind the first rib. The damage may be caused by strain of the nerve due to the descent of the goitre into the chest or may be caused by the surgical manoeuvres during thyroidectomy performed by cervical approach. Two patients operated on for large cervico-mediastinal goitre are reported: a 70-year-old male with a large intrathoracic growth of the left thyroid lobe and a 54-year-old male with a large intrathoracic growth to the right lobe. A few days after total thyroidectomy they showed signs of exertional dyspnoea. The exams performed showed hemi-diaphragm relaxatio due to phrenic nerve paralysis, with resulting reduction of respiratory space. Phrenic nerve paralysis may follow total thyroidectomy for large cervico-mediastinal goitres; is not due to the operative technique, but rather to the particular anatomic conditions which may be found.

Anonymous00050, Rosato L, Pinchera A, Bellastella A, De Antoni E, Martino E, Miccoli P, Pontecorvi A, Torre G, Vitti P, Pelizzo MR, Avenia N, Nasi PG, Bellantone R, Lampugnani R, De Palma M, Pezzullo L, Ardito G, De Toma G. · S.C. di Chirurgia, UEC, Ospedale di Ivrea. · Chir Ital. · Pubmed #16734162 No free full text.

Abstract: The aim of the study was to draw up a management protocol in thyroid surgery promoted by the Italian Association of Endocrine Surgery Units (Club delle UEC), shared by the experts and applied by the operators in the sector. The management protocols already presented in February 2002 and drawn up by the first Author of the present publication on the occasion of the current review were examined by the I Consensus Conference called on the topic by the Italian Endocrine Surgery Units. The conference comprised two distinct sessions, the first on 18 June 2005 within the framework of the 4th National Congress of the Club delle UEC in Naples, and the second on 17 September 2005 within the framework of the 8th Multidisciplinary Scanno Prize Meeting. A selected board of endocrinologists and endocrine surgeons, chaired by Aldo Pinchera and comprising the first nine Authors of this paper, examined the individual chapters in close collaboration with the other Authors, comparing their findings with the opinions of the experts cited in the text and submitting the consensus text for the approval of all those present. The diagnostic, therapeutic and healtcare management protocols in thyroid surgery approved by the I Consensus Conference are officially those proposed by the Italian Association of Endocrine Surgery Units (Club delle UEC) and are subject to review by October 1, 2007.

Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, Pelizzo MR, Pezzullo L. · Department of Surgery, Endocrine Surgical Unit, Ivrea Hospital, Piazza della Credenza, 2-10015 Ivrea, Italy. · World J Surg. · Pubmed #14961204 No free full text.

Abstract: Complication rates associated with thyroid surgery can be evaluated only through analysis of case studies and follow-up data. This study covers postoperative data from 14,934 patients subjected to a follow-up of 5 years. Among them, 3130 (20.9%) underwent total lobectomy (TL), 9599 (64.3%) total thyroidectomy (TT), 1448 (9.7%) subtotal thyroidectomy with a monolateral remnant (MRST), and 757 (5.1%) subtotal thyroidectomy with bilateral remnants (BRST). A total of 6% of the patients had already been operated on. Persistent hypoparathyroidism occurred after 1.7% of all the operations, and temporary hypoparathyroidism was noted in 8.3%. Permanent palsy of the laryngeal recurrent nerve (LRN) occurred in 1.0% of patients, transient palsy in 2.0%, and diplegia in 0.4%. The superior laryngeal nerve was damaged in 3.7%; dysphagia occurred in 1.4% of cases, hemorrhage in 1.2%, and wound infection in 0.3%. No deaths were reported. A significant rate of LRN damage was noted, which has an important impact on the patient's social life. Hypoparathyroidism after total thyroidectomy is an important complication that can be successfully treated by therapy, although it is not always easily managed in special circumstances such as in young persons or pregnant women. The complications associated with thyroid surgery must be kept in mind so the surgeon can carefully evaluate the surgical and medical therapeutic options, have more precise surgical indications, and be able to give the patient adequate information.

Volpi E, Ferrero A, Nasi PG, Sismondi P. · Department of Gynecologic Oncology, University of Turin, Turin, Italy. · Gynecol Oncol. · Pubmed #12821363 No free full text.

Abstract: BACKGROUND: Struma ovarii is a rare disease. Malignant transformation is even rarer. Data about its management are lacking. We describe the first reported case of a malignant struma ovarii treated and staged by laparoscopy. CASE: A 49-year-old patient was operated by laparoscopy for a right ovarian teratoma. The patient did not show symptoms of hyperthyroidism. The ovarian teratoma was removed in a plastic bag and definitive histology showed foci of papillary adenocarcinoma in a struma ovarii. The patient was then staged by laparoscopic surgery undergoing left adnexectomy, multiple peritoneal and omental biopsies, and common iliac and paracaval lymph node sampling. Hysterectomy was not performed. The postoperative course was uneventful and the patient was released on the second day. Thyroglobulin level was monitored and the patient is free of disease after more than 1 year. CONCLUSION: The preoperative diagnosis of malignant struma ovarii is difficult. Even with cautious evaluation of the patient, some risk of wrong diagnosis is possible. This is why a meticulous technique of laparoscopic surgery in removing the ovary is important. Laparoscopic staging may also intervene in very limited cases; the expertise to perform open staging of the patient is necessary but the postoperative course is fast.

Rosato L, Avenia N, De Palma M, Gulino G, Nasi PG, Pezzullo L. · S.C. di Chirurgia, Modulo di Endocrinochirurgia, Ospedale di Ivrea. · Chir Ital. · Pubmed #12469460 No free full text.

Abstract: The range of indications for total thyroidectomy in the treatment of thyroid disease is steadily increasing, but any attempt to assess its real efficacy necessarily calls for a knowledge of the incidence of complications, amongst other things in order to provide the patient with complete information regarding the operation before obtaining his or her consent. Retrospective and observational analysis of 14,934 thyroidectomies performed in 42 Endocrine Surgery Units in Italy has made it possible to compare total thyroidectomy (TT) versus subtotal thyroidectomy with a bilateral remnant (ST-BR), subtotal thyroidectomy with a unilateral remnant (ST-UR) and total lobectomy-isthmectomy (TLI). The correlation between the number of total thyroidectomies and each of the other surgical procedures and the number of complications occurring with each of them was also assessed in order to quantify the effective risk of complications by determining the Odds Ratios on the basis of univariate analysis of the variables considered. The cases reviewed consisted of 9,599 TT (64%), 3,130 TLI (21%), 1,448 ST-UR (22%) and 757 ST-BR (5%); 13,023 (87%) cases were suffering from benign disease and 1,911 (13%) from malignancies. Recurrent laryngeal nerve injuries were present in 4.3% of the TT cases with 2.4% transient and 1.3% definitive (as against 3% in ST-BR and 2% in ST-UR with 1.4% and 1.1% transient, and 1% and 0.6% definitive, respectively; and 1.4% transient and 0.6% definitive in TLI). Hypocalcaemia after TT was transient in 14% and definitive in 2.2% (as against transient rates of 5% in ST-BR and ST-UR and 0.4 in TLI; and definitive hypocalcaemia in 0.6%, 0.8% and 0.07%, respectively). Haemorrhage occurred in 1.6% of TT cases (as against 2.1%, 0.5% and 0.4% in ST-BR, ST-UR and TLI, respectively). The Odds Ratios showed that TT presented a 16% higher complication rate than ST-UR which was assigned a value of 1, a 3% higher rate than ST-BR and a 5% lower rate than TLI. This greater incidence of complications with TT is attributable mainly to the greater incidence of transient hypoglycaemia and to a lesser extent to the slightly higher incidence of definitive hypoglycaemia, whereas the incidences of recurrent laryngeal nerve injuries were very similar in TT and ST-BR. Haemorrhagic complications were more frequent in ST-BR than in TT. Bearing in mind that TT is the absolute indication in the more demanding thyroid diseases (tumours, retrosternal goitre, Basedow's disease, recurrences) and in view of its fairly low complication rate, we believe that TT is a safe, reliable procedure, provided it is performed in a technically scrupulous manner. ST-BR is a technique which should be abandoned owing to the fact that its complication rate is comparable to that of TT and to the recurrences it may give rise to. ST-UR may be indicated if the surgeon is not sure of safeguarding the anatomical integrity of the recurrent nerve on one side.