Giuditta Morfino

Total Thyroidectomy Performed With the Starion Vessel Sealing System Versus the Conventional Technique: A Prospective Randomized Trial

Meticulous dissection and accurate hemostasis are required in thyroid surgery. The authors recently performed a number of thyroidectomies using a new device that combines heat and pressure for sealing and cutting tissue. A prospective randomized trial was conducted on 98 patients subjected to total thyroidectomy for benign disease: 49 patients (group A) with the Starion tissue welding system and 49 (group B) with the clamp-and-tie technique. The 2 groups were comparable in mean age, gender, thyroidal volume (20-60 mL), incision length (<35 mm), and pathology. The authors evaluated operative time, postoperative serum calcemia, dosage and length of postoperative calcium and vitamin D treatment, drainage volume, hospital stay, and complications. Student’s t test was used for quantitative variables; for categorical variables, the χ 2 test or Fisher’s exact test, as appropriate, was used. The mean operative time was 53.8 ± 6.1 minutes in group A and 63.2 ± 8 minutes in group B (P < .0001). The difference in terms of postoperative calcemia was significant (group A: 8.35 ± 0.39 mg/dL; group B: 8.08 ± 0.39 mg/dL; P < .001). The duration of postoperative treatment with calcium and vitamin D was significantly different (group A: 4 days; group B: 5 days; P < .039). No significant difference in terms of postoperative complications was found. The new system reduced operative time and the duration of postoperative hypocalcemia, and there was minimal tissue necrosis and thermal spread. The reduction in duration of postoperative calcium and vitamin D treatment is also an indication of improvement in quality of the treatment.

Oligo-Antigenic Diet in the Treatment of Chronic Anal Fissures. Evidence for a Relationship Between Food Hypersensitivity and Anal Fissures

OBJECTIVES:Patients with chronic constipation due to food hypersensitivity (FH) had an elevated anal sphincter resting pressure. No studies have investigated a possible role of FH in anal fissures (AFs). We aimed to evaluate (1) the effectiveness of diet in curing AFs and to evaluate (2) the clinical effects of a double-blind placebo-controlled (DBPC) challenge, using cows milk protein or wheat.METHODS:One hundred and sixty-one patients with AFs were randomized to receive a “true-elimination diet” or a “sham-elimination diet” for 8 weeks; both groups also received topical nifedipine and lidocaine. Sixty patients who were cured with the “true-elimination diet” underwent DBPC challenge in which cows milk and wheat were used.RESULTS:At the end of the study, 69% of the “true-diet group” and 45% of the “sham-diet group” showed complete healing of AFs (P<0.0002). Thirteen of the 60 patients had AF recurrence during the 2-week cows milk DBPC challenge and 7 patients had AF recurrence on wheat challenge. At the end of the challenge, anal sphincter resting pressure significantly increased in the patients who showed AF reappearance (P<0.0001), compared with the baseline values. The patients who reacted to the challenges had a significantly higher number of eosinophils in the lamina propria and intraepithelial lymphocytes than those who did not react to the challenges.CONCLUSIONS:An oligo-antigenic diet combined with medical treatment improved the rate of chronic AF healing. In more than 20% of the patients receiving medical and dietary treatment, AFs recurred on DBPC food challenge.