F. P. Mattioli

Laparoscopic cholecystectomy and gallbladder cancer: a diagnostic and therapeutic dilemma

The correct treatment strategy of patients with unsuspected gallbladder cancer undergoing laparoscopy, and the prevention of delayed diagnosis are current issues. We report a case of late diagnosis with umbilical metastasis and poor survival. A policy of careful inspection of the gallbladder and a cautious strategy in the case of gross alteration of its external morphology seems advisable during laparoscopic cholecystectomy. Although no agreement exists concerning the best treatment in the event of delayed diagnosis, the adopted strategy is contingent on patient status, disease stage and the possibility of performing appropriate follow-up.

Is euthyroidism the goal of surgical treatment of diffuse toxic goitre

OBJECTIVE To find out by studying a homogeneous group of patients whether euthyroidism is achievable by surgical treatment of diffuse toxic goitre. DESIGN Retrospective study. SETTING Teaching hospital, Italy. SUBJECTS 128 of the 152 patients operated on for diffuse toxic goitre during the period January 1971-December 1994 and followed up for a median of 83 months (range 6-289). INTERVENTION. Standard subtotal thyroidectomy. MAIN OUTCOME MEASURES Operative mortality, recurrence, hypothyroidism and late complications. RESULTS There were no operative deaths. After 10 years follow up, 11 patients (9%) had developed recurrences and 61 (48%) were euthyroid. In the univariate analysis the risk of hypothyroidism was significantly associated with the year of operation (p = 0.04), the duration of symptoms (p < 0.01), and the degree of lymphocytic infiltration (p < 0.01). The last two were confirmed by multivariate analysis. CONCLUSION Subtotal thyroidectomy seems to be an effective treatment of diffuse toxic goitre as a stable euthyroid state can be achieved in nearly half the patients after a prolonged follow up.

Differentiated thyroid cancer: surgical treatment of 190 patients

Abstract Between 1968 and 1991, 190 patients (51 men, 139 women) with a mean age of 46.3 years underwent surgery for differentiated thyroid cancer (148 papillary and 42 follicular carcinomas). In 29.5% of the cases a concomitant goitre was histologically demonstrated. These patients were significantly older (mean: 54.7 years) (P 40 years), pT, stage, pM and symptomatic metastases.

EPIDEMIOLOGY OF PERITONITIS

Summary The most relevant epidemiological data concerning different form of peritonitis are reviewed taking into account that secondary peritonitis are those of major interest for surgeons. A review of the literature concerning the epidemiology of peritonitis secondary to peptic ulcer perforation, appendicitis, hollow viscus perforation after endoscopic procedures, colonic perforation and postoperative peritonitis is given. Some details about primary peritonitis and peritonitis occurring in AIDS patients are discussed as well.

Definition and classification of peritonitis

Summary Peritonitis is defined as the inflammation of the peritoneum or of a part thereof, which may not necessarily be due to infection. Authors review the classifications proposed in the light of current etiopathogenetic, microbiologic and pathophysiologic concepts. The classification suggested herein stems directly from the outline that was stated in Hamburg in 1987. A definition of primary, secondary and tertiary peritonitis is given. At moment a thorough classification should be based on a integrated etiopathogenetic and pathologic approach.

Use of human thyroid cell primary cultures for genotoxicity studies

Primary cultures of human thyroid cells prepared from fragments discarded during the course of prescribed surgery were examined for their sensitivity to the DNA-damaging activity of selected chemicals in order to assess if they can represent a reliable model for genotoxicity studies. DNA fragmentation was measured by the alkaline elution technique. Positive dose-related responses in the range of subtoxic concentrations were obtained after 1 hr of exposure to the direct-acting alkylating agents N-nitroso-N-methylurea (0.3-3 mm), N-nitroso-Nethylurea (1-10 mm), methyl methanesulphonate (0.1-1 mm) and ethyl methanesulphonate (1-10 mm). In contrast, any meaningful evidence of DNA fragmentation was absent in cultures exposed for 20 hr to N-nitrosodimethylamine (1-100 mm) and N-nitrosodiethylamine (10-100 mm). This suggests that in human thyroid cells the level of mixed-function oxidase activity is not sufficient to give rise to effective concentrations of the reactive species of the latter two procarcinogens.