The aim of this study was to systematically evaluate the available literature on minimally invasive surgical (MIS) treatment for hallux valgus and to provide an overview of the different surgical techniques. A systematic review of the literature available in MEDLINE, EMBASE, and the Cochrane database was performed including studies from January 2001 to 1 January 2018. The radiological outcomes (hallux valgus angle (HVA), intermetatarsal angle (IMA)), complication rates, and clinical outcome scores were evaluated. The MINORS scale was used to assess the methodological quality of included articles. Of 278 reviewed articles, 23 met the inclusion criteria. The included studies reported on the results of 2279 procedures in 1762 patients. The surgical techniques were divided into five categories: the Bosch technique, MIS Chevron-Akin, Reverdin-Isham procedure, Endolog system, and techniques involving distal soft tissue release and fixation. Results regarding radiological correction, clinical outcomes, and complication rate varied widely. The studies included were of too little level of evidence to allow for data pooling or meta-analysis. There were too few studies on each surgical technique category to assess whether one is more effective than the rest. However, there is some evidence that the Chevron and Akin showed the most potential for improvement of the HVA and the Endolog for the IMA. An overall complication rate of 13% was obtained among all included studies. Appropriately powered randomized controlled trials, utilizing validated outcome measures, blinded assessors, and long-term follow up are needed to assess the efficacy of MIS techniques.

Minimally invasive surgery for hallux valgus: a systematic review of current surgical techniques

Background: Energy-based hemostatic devices are increasingly being used in thyroid surgery. However, there are several limitations with regard to the existing evidence and a paucity of guidelines on the subject. The goal of this review is to employ the novel evidence synthesis technique of a network meta-analysis to assess the comparative effectiveness of surgical technologies in thyroid surgery and contribute to enhanced governance in the field of thyroid surgery. Methods: Articles published between January 2000 and June 2012 were identified from Embase, Medline, Cochrane Library, and PubMed databases. Randomized controlled trials of any size comparing the use of ultrasonic coagulation (harmonic scalpel) or Ligasure either head-to-head or against the “clamp-and-tie” technique were included. Two reviewers independently critically appraised and extracted the data from each study. The number of patients who experienced postoperative events was extracted in dichotomous format or continuous outcomes. Odds rat...

Which Hemostatic Device in Thyroid Surgery? A Network Meta-Analysis of Surgical Technologies

Many studies have investigated the efficacy of Endostar combined with platinum-based doublet chemotherapy (PBDC) versus PBDC alone for treating advanced non-small cell lung cancer (NSCLC). This study is a meta-analysis of available evidence. Fifteen studies reporting Endostar combined with PBDC versus PBDC alone for treating advanced NSCLC were reviewed. Pooled odds ratios and hazard ratio with 95% confidence intervals were calculated using either the fixed effects model or random effects model. The overall response rate (ORR) and disease control rate (DCR) of Endostar combined with PBDC for treating NSCLC were significantly higher than those of PBDC alone, with 14.7% and 13.5% improvement, respectively (P < 0.00001). In addition, the time to progression (TTP) and quality of life (QOL) were improved after the treatment of Endostar combined with PBDC (P < 0.00001). The main adverse effects found in this review were hematological reactions, hepatic toxicity, and nausea/vomiting. Endostar combined with PBDC had a similar incidence of adverse reactions compared with PBDC alone (P < 0.05). Endostar combined with PBDC was associated with higher RR, DCR, and TTP as well as superior QOL profiles compared with PBDC alone. Endostar combined with PBDC had a similar incidence of adverse reactions compared with PBDC alone.

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Systematic review and meta-analysis of Endostar (rh-endostatin) combined with chemotherapy versus chemotherapy alone for treating advanced non-small cell lung cancer

This systematic review aims to illustrate the published results of “minimally invasive” procedures for correction of hallux valgus. Based on former systematic reviews on that topic, the literature search was organised by two independent investigators. MEDLINE was systematically searched for available studies. The keywords used were “hallux valgus”, “bunion”, “percutaneous surgery”, “minimally invasive surgery”, “arthroscopy”, “Bosch” and “SERI”. Studies were assessed using the level of evidence rating. A total of 21 papers were included in this review. These studies described a total of 1,750 patients with 2,195 instances of percutaneous, minimally invasive or arthroscopic hallux valgus surgery. Clinical reports of results after minimally invasive hallux valgus surgery at meetings are common. Published results in peer-reviewed journals are less common and the majority of papers are level IV studies according to the level of evidence ratings. We found one level II and three level III studies. Reported complications seem to be less than one may see in one’s own clinical practice. This possible bias may be related to the fact that most studies are published by centres performing primarily minimally invasive hallux valgus surgery.

Minimally invasive hallux valgus surgery: a critical review of the evidence

Encapsulated classic and follicular variants of papillary thyroid carcinoma: comparative clinicopathologic study.

We conducted a systematic review to evaluate the role of Ultrasonic dissector (UAS) versus conventional clamp and tie in thyroidectomy. We searched for all published RCT in into electronic databases. To be included in the analysis, the studies had to compare thyroidectomy with UAS versus conventional vessel ligation and tight (conventional technique = CT). The following outcomes were used to compare the total thyroidectomy group with UAS versus CT group: operative duration, operative blood loss, overall drainage volume during the first 24 hours, transiet laryngeal nerve palsy, permanent laryngeal nerve palsy, transiet hypocalcaemia and permanent hypocalcaemia. There are currently 7 RCT on this issue to compare thyroidectomy with UAS versus CT. From the analysis of these studies it was possible to confront 608 cases: 303 undergoing to thyroidectomy with UAS versus 305 that were treated with CT. Actually, it was shown a relevant advantage of cost-effectiveness in patients treated with UAS; there is a statistically significant reduction of the operative duration (weighted mean difference [WMD], -18.74 minutes; 95% confidence interval [CI], (-26.97 to -10.52 minutes) (P = 0.00001), intraoperative blood loss (WMD, -60.10 mL; 95% CI, -117.04 to 3.16 mL) (P = 0.04) and overall drainage volume (WMD, -35.30 mL; 95% CI, -49.24 to 21.36 mL) (P = 0.00001) in the patients underwent thyroidectomy with UAS. Although the analysis showed that the patients who were treated with USA presented more favourable results in incidence of post-operative complications (transient laryngeal nerve palsy: P = 0.11; permanent laryngeal nerve palsy: not estimable; transient hypocalcaemia: P = 0.24; permanent hypocalcaemia: P = 0.45), these data didn't present statistical relevance. This meta-analysis shown a relevant advantage only in terms of cost-effectiveness in patients treated with UAS; it is subsequent to statistically significant reduction of operation duration, intraoperative blood loss and of overall drainage volume during the first 24 hours. Although the analysis showed that the patients who were treated with UAS presented more favourable results in incidence of post-operative complications (transiet laryngeal nerve palsy; transiet hypocalcaemia and permanent hypocalcaemia), these data didn't present statistical relevance.

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Meta-analysis of thyroidectomy with ultrasonic dissector versus conventional clamp and tie

The potential advantages of minimal incision surgery for hallux valgus (HV) correction are the following: reduced surgical exposure, diminished soft-tissue stripping, and less blood supply impairme...

Modified Minimal Incision Subcapital Osteotomy for Hallux Valgus Correction

Abbiamo analizzato un campione omologo di 671 pazienti sottoposti a tiroidectomia totale per diverse patologie valutandone la diagnosi istologica definitiva e ricercando l’associazione tra le tiroiditi ed il cancro. Come e noto in letteratura la coincidenza della patologia autoimmune con il carcinoma non e eccezionale. Nella nostra casistica, l’abbiamo riscontrata in 39 casi (18,6%). Inoltre abbiamo considerato il background genetico RET/PTC che e prevalente in caso di carcinoma papillare in ambiente infiammatorio; potrebbe essere stimolante lo studio di particolari marcatori molecolari al fine di identificare bersagli per inibire lo status infiammatorio tiroideo in un’ottica di prevenzione oncologica.

Associazione tra tiroidite e cancro tiroideo: nostra esperienza.

Well-differentiated thyroid neoplasms may be included among the most frequently occurring thyroid carcinomas. Papillary ca. is without doubt the best behaved type. The aim of the present work is to perform a retrospective case history study to assess patients with con papillary ca. who have been treated surgically over the last 17 years and have been subjected to periodic checks. A sample of patients was therefore extrapolated who had all undergone total thyroidectomy for papillary ca. of the thyroid. The incidence of local recurrence of the disease was verified, together with the results at distance. Furthermore, the assessments performed were evaluated and compared. From the sample of patients observed we inferred that papillary carcinoma of the thyroid can have a good prognosis over time provided periodic random checks are carried out.

Control results on a sample of patients subjected to total thyroidectomy for papillary carcinoma: proposal for a personal diagnostic-therapeutic follow-up.

INTRODUCTION: The prognosis of patients with melanoma varies according to the staging of disease at the moment of diagnosis. Melanoma can metastasize to every organ or tissue, but the most common site involved is locoregional. In selected patients surgery plays a central role with the possibility of changing the prognosis at distance. CASE REPORT: A 65-years old man with a diagnosis of neoplasm of the left thyroid lobe and metastatic melanoma with unknown primitive localization. Since 2003 the patient has undergone many operations to remove metastatic melanoma. Currently he is in good conditions and performs neoadjuvant palliative treatments. DISCUSSION: The indication for surgery in cases of patients with distant disease (IV stage) or metastases in transit (IIIc stage) is linked to the possibility of surgical removal of individual lesions. In particular are candidates for surgery patients who have a visceral localization less than or equal to 2 sites, a number less than or equal to 8 metastases, in good health and having a melanoma-specific survival estimated more than 3 months; surgical approach requires an accurate and early identification by imaging study. The case report shows that in selected cases, some patients may benefit from aggressive surgery, especially in terms of survival at distance.

Vendettuoli D

Papers

Meta-analysis of thyroidectomy with ultrasonic dissector versus conventional clamp and tie

Modified Minimal Incision Subcapital Osteotomy for Hallux Valgus Correction

Associazione tra tiroidite e cancro tiroideo: nostra esperienza.

Control results on a sample of patients subjected to total thyroidectomy for papillary carcinoma: proposal for a personal diagnostic-therapeutic follow-up.

Role of surgery in patients with metastases from melanoma. A case report