Minerva chirurgica
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Spontaneous pneumoperitoneum is the radiographic manifestation of free air in the peritoneal cavity without visceral perforations and peritoneal signs, and it occurs in about 10% of the cases of pneumoperitoneum. The etiology can be postoperative, thoracic, abdominal, gynecologic, idiopathic; it generally introduces a benign evolution and does not require surgical treatment but just a conservative approach. ⋯ This case is interesting for the occurrence of pneumoperitoneum without clinical peritoneal signs such as fever and leucocytosis, after closed thoracic trauma in absence of pneumothoracic and pneumomediastinum. Correct clinical approach has allowed a conservative treatment avoiding an useless laparotomy.
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The incidence of well-differentiated thyroid cancers is rising. Follicular cancer represents 10-20% of these lesions. While the vast majority of thyroid nodules of follicular origin are benign, fine needle aspiration cannot provide cytologic evidence of capsular and/or vascular invasion; therefore, patients should undergo surgical excision. ⋯ Patients deemed to have follicular cancer require near-total or total thyroidectomy and postoperative (131)I ablation. The optimal management of minimally invasive follicular cancer remains an area of controversy, but long-term prognosis for these patients is excellent. Areas of research should focus on identification of molecular markers of malignancy and aggressiveness of follicular neoplasia.
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Papillary thyroid cancer (PTC) is the most common endocrine malignancy and commonly metastasizes to regional lymph nodes. Surgical treatment of cervical lymph nodes in PTC remains controversial. It has traditionally been accepted that regional lymph node metastases in PTC may increase local recurrence rates but do not ultimately affect survival. ⋯ Thus, there has been renewed interest in operative control of nodal disease for PTC. A systematic review of central lymph node dissection (CLND) in the recent literature using evidence-based criteria permitted formation of the following five recommendations: 1) limited data suggest benefit with the addition of prophylactic CLND to thyroidectomy (grade C); 2) systematic compartment-oriented CLND may decrease recurrence of PTC and improve disease-specific survival (no grade); 3) the addition of CLND to total thyroidectomy can significantly reduce levels of serum thyroglobulin and increase rates of athyroglobulinemia (no grade); 4) there may be a higher rate of permanent hypoparathyroidism and unintentional permanent nerve injury when CLND is performed with total thyroidectomy than for total thyroidectomy alone (grade C); 5) reoperation in the central neck compartment for recurrent PTC may increase the risk of hypoparathyroidism and unintentional nerve injury when compared to total thyroidectomy with or without CLND, supporting a more aggressive initial operation by experienced endocrine surgeons (grade C). Taken together, these recommendations support the application of routine CLND at the initial operation for papillary thyroid cancer in expert hands.
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Case Reports
Successful stent-grafting for iatrogenic aortic rupture and life-threatening hemoptysis.
Bronchiectasis presenting as massive hemoptysis and iatrogenic lesions of the thoracic aorta are life-threatening processes with very difficult management. We report a case of massive hemoptysis from bronchiectasis complicated with contained rupture of the descending thoracic aorta during bronchial artery embolization. Both lesions were confirmed by angiography and successfully treated by implantation of an endovascular stent-graft in the thoracic aorta. As far as we know, there are no previous reports of successful management of massive hemoptysis from bronchiectasis with an endovascular covered stent-graft prosthesis.
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The term locally advanced breast cancer (LABC) encompasses a heterogeneous group of breast neoplasms; in the last revision of the American Joint Committee on Cancer (AJCC) staging system, all of stage III disease is considered locally advanced. LABC constitutes up to 20% of breast cancer in medically underserved populations in the United States and up to 75% of breast cancers in developing countries. ⋯ However, a multidisciplinary approach is always recommended combining surgery, radiotherapy and systemic therapy (chemotherapy and/or hormone therapy). In this paper, we discuss the possible options in the management of operable (stage IIIA) and inoperable (stage IIIB-IIIC) LABC.