Post-operative therapy with L-Tiroxine can have a suppressive or substitutional aim. After a total thyroidectomy the patients need a substitutional therapy, while after subtotal thyroidectomy the aim of the therapy is to suppress the TSH secretion. In the second case we want either to avoid the recurrence, either to give the hormones that residual gland cannot produce. The drug of choice is L-Tiroxine for both suppressive o substitutional therapy: There is a difference in dosage, that must be greater in first case. While there are some doubts in the literature on the success of the suppressive therapy, we believe that there is enough evidence of his utility.

A consecutive series of 556 women were subjected to radical mastectomy for breast cancer between 1981 and 1987 at our institute ; of these, 39 (7%) were less than 35 years old and 112 (20.1%) were over 65 years old. The study analyzed, in particular, the influence of age upon prognosis. After a follow-up period of 5 years, death due to breast cancer had occurred in 16 (41% ) patients in the under-35 group and in 23 (20.5%) patients in the over-65 group. Univariate (survival rate) and multivariate (Cox's model of regression) analyses indicated that only age and involvement of metastasized axillary lymph nodes had a significant effect upon survival (P < 0.001 and P < 0.005, respectively). Furthermore, the effect of age as a prognostic factor is independent of the other histopathological parameters that were examined, such as the size of primitive tumor, histotype, grading, receptor status for estrogens and progesterone, lymphatic and blood vessel invasion, and necrosis of the tumor. Hazard ratios indicated that mortality among patients with positive lymph nodes was 3.6 times greater than that among patients with negative lymph nodes and that among young women it is 4.4 times greater than that among old women.

During the last 6 months of 1991 we operated on 250 patients for thyroid diseases; among them, 116 were studied to evaluate the effects of a fibrin sealant (Tissucol, Immuno) in thyroid surgery. We analyzed our data with regard to the technique performed (total lobectomy, subtotal thyroidectomy, or total thyroidectomy), without considering basic illness. Patients treated with fibrin glue (n=51) formed group 1. Untreated patients (n=65) formed group 2.

In the past 5 years (1987-1991), we admitted for thyroid surgery 12 patients older than 80 years. Indications for surgery were represented by goiter causing tracheal compression and severe dyspnoea in 6 cases, and by preoperative cytological report of malignancy in the other 6 cases. The dyspnoea represented an absolute surgical indication. All patients but one were treated by cervicotomy; in one case we performed a median sternotomy. Frozen section was performed in all patients with cytological report of malignancy. Histology detected 3 differentiated cancers, 2 anaplastic cancers, and one follicular adenoma. The patients with benign disease were treated by 4 subtotal thyroidectomies and 3 total lobectomies. Three out of 5 affected by malignant lesions were submitted to a total thyroidectomy (differentiated carcinomas) and 2 to palliative thyroidectomy (anaplastic carcinoma). In this series there were neither intraoperative mortality nor major surgical complications. All the patients with dyspnoea were cured by surgery. All the patients affected by differentiated cancer were alive and well 8, 13 and 18 months after surgery. The mean survival of patients with anaplastic cancer was 12 months.

In this report the Authors present the case of an old patient treated for chronic recurrent bleeding from small bowel angiodysplasia. The diagnosis was missed by the conventional methods: angiography and scintiscan with marked erythrocytes. Diagnosis was instead possible by using intraoperative enteroscopy. The Authors stress the usefulness of this technique that permits the exploration of the mucosal by trans-illumination to discover bleeding and vascular anomalies of the bowel.

Multicentric tumours (MT) represent a potential limit to the treatment by conservative surgery of cancer of the breast. In order to determine which anatomical-clinical features of breast cancer would indicate the highest risk of MT, we studied 100 patients with MT and 452 patients with unicentric tumours (UT), all of whom had been subjected to radical mastectomy during the period 1980 to 1988. Statistical analysis showed a significant difference between the two groups of parameters for bilateral breast cancer (with regard both to metachronous and synchronous lesions), for primary tumours of over 2 cm in size, for both lobular and invasive ductal histotypes and for involvement of the nipple-areola complex. Therefore, if the indications in favour of conservative surgery are applied accurately in combination with radiation therapy, the clinical and biological significance of multicentricity is minimized.

Between 1968 and 1988, eight patients with carotid body tumour have been operated on at Istituto di Clinica Chirurgica at the University of Pisa. We undertook the follow-up of all these patients. Two of them presented with bilateral and familial lesions. There was no mortality or morbidity, except in one patient, who had the vagus resected because it was invaded by tumour. For investigation of familial occurrence we have found ultrasound very useful for screening.