To evaluate the incidence of postoperative complications, hemostatic effects and safety of Total Thyroidectomy (TT) performed using the Harmonic Scalpel (HS), the Harmonic Focus (HF) or Conventional Hemostasis (CH). The meta-analysis was performed according to PRISMA guidelines. A literature search was conducted from 2003 to 2014 and stringent criteria were required for inclusion. Thirteen studies concerning an overall population of 1458 compared HS versus CH, whilst 8 studies with 1667 patients compared HF versus CH. There was a significant reduction of operative time (Mean Difference [MD] = -25.49 min.; 95% CI -32.43 to -18.55), intraoperative blood loss (MD = -30.49 mL; 95% CI -53.01 to -7.97), postoperative drainage volume (MD = -12.90 mL; 95% CI -22.83 to -2.98) and postoperative pain (MD = -0.87; 95% CI -1.27 to -0.46) in patients underwent TT with HS. Regarding HF group, a significant reduction of operative time (MD = -25.99 min., 95% CI -34.56 to -17.41), length of hospital stay (MD = -0.57; 95% CI -0.97 to -0.17), transient hypocalcemia (OR = 0.56; 95% CI 0.39 to 0.81) and postoperative pain (MD = -1.33 days; 95% CI -2.49 to -0.17) resulted. HS TT can be a safe, useful and fast alternative to conventional TT. The newer HF can reduce the rate of hypocalcemia. Future RCTs of larger patient cohorts with more detailed data of postoperative complications, cost-effectiveness and cosmetic results, randomization procedures, intention-to-treat analyses and blinding of outcome assessors are needed to draw more meaningful conclusions.

Erythropoiesis is affected during deep saturation dives. The mechanism should be related to a downregulation of serum Erythropoietin (s-EPO) concentration or to a toxic effect of the hyperbaric hyperoxia. We evaluated s-EPO and other haematological parameters in 6 scuba divers before, during and after a 14-days guinness saturation dive (8–10 m). Athletes were breathing air at 1.8–2 ATA, under the control of a team of physicians. Serum parameters were measured before diving (T0) and: 7 days (T1), 14 days (T2) after the beginning of the dive and 2 h (T3) and 24 h (T4) after resurfacing. Hgb, and many other haematological parameters did not change whereas Ht, s-EPO, the ratio between s-EPO predicted and that observed and reticulocytes (absolute, percent) declined progressively from T0 to T3. At T4 a significant rise in s-EPO was observed. Hgb did not vary but erythropoiesis seemed to be affected as s-EPO and reticulocyte counts showed. All these changes were statistically significant. The experiment, conducted in realistic conditions of dive length, oxygen concentration and pressure, allows us to formulate some hypotheses about the role of prolonged hyperbarism on erythropoiesis. The s-EPO rise, 24 h after resurfacing, is clearly documented and related to the “Normobaric Oxygen Paradox”. This evidence suggests interesting hypotheses for new clinical applications such as modulation of s-EPO production and Hgb content triggered by appropriate O₂ administration in pre-surgical patients or in some anemic disease.

Several studies indicate that in young patients (less than 21 years of age at the time of diagnosis), the prognosis of thyroid carcinoma (TC) is more favorable than in older patients. However, a more radical treatment approach is recommended in children and adolescents due to the higher prevalence of local lymph-node involvement in these cases. Since the extent of primary surgical treatment is closely related to the overall prognosis, preoperative diagnosis becomes essential in the management of thyroid neoplasms in young patients. In this retrospective study (1987 - 1998), we analyzed a surgical series of 50 children and adolescents with thyroid nodules in an attempt to establish the role of diagnostic studies in detecting malignant lesions prior to surgery. Our diagnostic protocol for evaluating thyroid nodules was based on clinical evaluation, measurement of thyroid-hormone and thyroglobulin (TG) levels, anti-TG and anti-TPO antibody titers, calcitonin, CEA, and TPA levels, sonography, scintigraphy, and fine-needle aspiration cytology (FNAC) of the thyroid nodules and any enlarged lymph nodes. Eleven of the 15 cases of histologically confirmed carcinoma were preoperatively identified as malignant lesions with the aid of FNAC. The authors conclude that the preoperative work-up of children and adolescents with thyroid nodules requires the collaboration of an experienced team of professionals, and recommend FNAC as the initial test. Plusieurs études démontrent que chez les patients les plus jeunes (moins de 21 ans au moment du diagnostic) le pronostic du carcinome thyroïdien (TC) est plus favorable par apport aux patients plus agés. Néanmoins chez les enfants et les adolescents un traitement radical du fait de l'atteinte ganglionnaire est recommandé. Le diagnostic préopératoire de l'extension est essentiel pour la conduite à tenir. Dans notre étude rétrospective (1987 - 1998) nous avons analysé 50 enfants et adolescents opérés pour un nodule thyroïdien. Notre protocole diagnostique repose sur: l'évaluation clinique, le dosage des hormones thyroïdiennes et de la thyréoglobuline (TG), le dosage des anti-corps anti-TG et anti-TPO, de la calcitonine, du CEA, du TPA de l'échographie, de la scintigraphie et de la ponction biopsie (FNAC). Onze des 15 cas de carcinome confirmés histologiquement avaient été identifiés à l'aide de la FNAC. Les auteurs concluent que l'approche diagnostique d'un nodule thyroïdien chez l'enfant et l'adolescent demande la collaboration d'une équipe entrainée et recommande la FNAC comme examen initial. Varios estudios indican que en pacientes de menos de 21 años el pronóstico del carcinoma tiroideo (TC) es mejor que en adultos. Sin embargo, se recomienda un tratamiento más radical en niños y adolescentes debido a la más alta prevalencia de afectación linfática regional en estos casos. Ya que la extensión del tratamiento quirúrgico primario está relacionada directamente con el pronóstico final, el diagnóstico preoperatorio es esencial para el tratamiento de los tumores tiroideos en niños. En este estudio retrospectivo (1987 - 1998) analizamos una serie quirúrgica de 50 niños y adolescentes con nódulos tiroideos para establecer el papel de los estudios diagnósticos en la detección de las lesiones malignas antes de la cirugía. Nuestro protocolo diagnóstico se basó en la evaluación clínica, la medida de la hormona tiroidea y de la tiroglobulina (TG) de los titulos de anticuerpos anti-TG y anti-TPO, de los niveles de calcitonina, CEA y TPA, en la sonografía, escintigrafía y aspiración con aguja fina (FNAC) de los nódulos tiroideos y de los ganglios linfáticos agrandados. 11 de los 15 casos de carcinoma histológicamente confirmado fueron identificados preoperatoriamente como lesiones malignas con ayuda de la FNAC. Los autores concluyen que el diagnóstico preoperatorio de niños y adolescentes con nódulos tiroideos requiere la colaboración de un equipo de profesionales con experiencia y recomiendan la FNAC como la prueba inicial. Mehrere Studien beweisen, dass bei jungen Patienten mit Schilddrüsenkarzinom (unter 21 Jahre zum Zeitpunkt der Diagnose) die Überlebenschancen höher sind als bei Erwachsenen. Trotzdem ist eine radikale Behandlung empfehlenswert, da bei Kindern und Jugendlichen häufiger die Halslymphknoten mit befallen sind. Auf der anderen Seite könnte die günstigere Prognose bei einem eventuellen Nichtbefall der Lymphknoten zu einem weniger ausgedehnten chirurgischen Eingriff führen. Für die Behandlung von Schilddrüsentumoren bei Jugendlichen ist daher eine möglichst exakte präoperative Diagnosestellung von größter Wichtigkeit. In der vorliegenden retrospektiven Studie werden 50 Fälle, die zwischen 1987 und 1998 behandelt wurden, im Hinblick auf die angewandten diagnostischen Methoden analysiert. Die diagnostischen Maßnahmen umfassen die klinische Untersuchung, die Messung der Schilddrüsenhormone und des Thyreoglobulins, die Bestimmung von Calcitonin, CEA, TPA, der Anti-TG und Anti-TPO-Antikörper, sowie die Sonografie, Szintigrafie, und die Feinnadelpunktion einschließlich Zytologie. Dabei wurden nicht nur die Schilddrüsenknoten punktiert, sondern auch eventuell vergrößerte Lymphknoten. In 11 von 15 Fällen mit später gesichertem Schilddrüsenkarzinom konnte durch die Feinnadelbiopsie ein bösartiger Tumor nachgewiesen werden. Die Autoren schließen daraus, dass der chirurgische Eingriff bei Kindern erst nach exakter Diagnose...

The implementation of barbed sutures appears to enhance the process of suturing and knot tying, particularly in the field of bariatric surgery, where they can offer significant advantages. The objective of this study is to evaluate the safety and effectiveness of utilising barbed sutures for gastric pouch-jejunal anastomosis (GPJA) and jejuno-jejunal anastomosis (JJA) anastomosis in Roux-en-Y Gastric Bypass (RYGB). Data from patients who underwent primary RYGB between January 2012 and October 2018 were retrospectively collected using Propensity Score Matching (PSM) to randomise groups (barbed sutures—BS-G and conventional sutures—CS-G). The primary outcome was postoperative early complications. The secondary outcomes were late complications (internal hernias and small bowel obstructions), operative time and postoperative hospital stay. A total of 969 patients were included. After PSM, 322 (161 in BS-G vs. 161 in CS-G) patients were compared (chi-square 0.287, p = 0.862). Postoperative early and late complications were comparable between the two groups. BS-G had a significantly shorter median operative time (65 vs. 95 min p < 0.001). Median postoperative hospital stay was significantly shorter for BS-G (2 vs. 5 days, p < 0.001). Barbed sutures effectively reduce the operation duration and are as safe as conventional sutures for closing anastomotic defects during RYGB.