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Article: The Total Testing Process of Intra-Operative Parathyroid Hormone. A Narrative Review.

Stenner, Elisabetta / Sandic, Sara / Dobrinja, Chiara / Ruscio, Maurizio / Bernardi, Stella

2020 Volume 66, Issue 3

Abstract: Background: Primary hyperparathyroidism (pHPT) is a common endocrine disorder, due to an excessive secretion of parathyroid hormone (PTH) from one or more parathyroid gland(s), where the only cure remains surgery. The surgical approach has become less ... ...

Abstract	Background: Primary hyperparathyroidism (pHPT) is a common endocrine disorder, due to an excessive secretion of parathyroid hormone (PTH) from one or more parathyroid gland(s), where the only cure remains surgery. The surgical approach has become less invasive over the years, thanks to the advances in the preoperative localization of the enlarged parathyroid gland, as well as to the possibility to measure intra-operative parathyroid hormone (IOPTH). After the targeted removal of a parathyroid gland, IOPTH can confirm biochemically the cure of pHPT, such that it helps the surgeon to judge if the parathyroidectomy has been successful and there is no need of additional dissection. As with all laboratory tests, the quality of IOPTH total testing process is essential to the best utilization of patients' results. However, this can be affected by errors occurring in different phases. This review aims to describe the total testing process of IOPTH. Methods: We performed a search in Pubmed and a review of the literature on the current management of pHPT and the total testing process of IOPTH measurement. Results: Compared to previous studies focusing on single aspects of the IOPTH testing process, here we have analyzed all the steps crucial for the quality of IOPTH from the "pre-pre" to the "post-post" analytical phase. Conclusions: Clinicians and laboratory scientists should be aware of all the potential sources of errors in IOPTH measurement in order to improve their daily management of pHPT.
MeSH term(s)	Humans ; Hyperparathyroidism, Primary/surgery ; Intraoperative Care/methods ; Minimally Invasive Surgical Procedures ; Operative Time ; Parathyroid Glands/surgery ; Parathyroid Hormone/blood ; Parathyroidectomy/methods ; Treatment Outcome
Chemical Substances	Parathyroid Hormone
Language	English
Publishing date	2020-03-11
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	1307629-2
ISSN	1433-6510 ; 0941-2131
ISSN	1433-6510 ; 0941-2131
DOI	10.7754/Clin.Lab.2019.190411
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Article ; Online: Meta-analysis on the Association Between Thyroid Hormone Disorders and Arterial Stiffness.

Bernardi, Stella / Grillo, Andrea / Antonello, Roberta Maria / Cola, Marco Fabio / Dobrinja, Chiara / Fabris, Bruno / Giudici, Fabiola

Journal of the Endocrine Society

2022 Volume 6, Issue 4, Page(s) bvac016

Abstract: Context: Aortic stiffness is an emerging predictor of cardiovascular morbidity and mortality. Current data about the effect of subclinical and overt thyroid hormone disorders on aortic stiffness are often conflicting.: Objective: Primary outcome was ... ...

Abstract	Context: Aortic stiffness is an emerging predictor of cardiovascular morbidity and mortality. Current data about the effect of subclinical and overt thyroid hormone disorders on aortic stiffness are often conflicting. Objective: Primary outcome was to investigate if subclinical and overt thyroid hormone disorders were associated with aortic stiffness. Secondary outcome was to identify disease effect modifiers. Methods: Data sources were PubMed, Google Scholar, SCOPUS, Web of Sciences, and the Cochrane Library. Eligible studies included reports of pulse wave velocity (PWV), which is the gold standard method for measuring aortic stiffness, in patients with subclinical and overt thyroid disorders. Two investigators independently identified eligible studies and extracted data. Pooled mean difference was the summary effect measure. Data were presented in forest plots with outlier and influential case diagnostics. Univariate meta-regression analysis was used to identify effect modifiers. Results: Eleven observational studies were selected, including 1239 patients with subclinical hypothyroidism, 81 patients with overt hypothyroidism, 338 patients with thyrotoxicosis, and 12 715 controls. PWV was significantly higher in subclinical ( Conclusion: This study shows that both overt and subclinical hypothyroidism as well as thyrotoxicosis were associated with an increase of aortic stiffness. The impact of treatment of these conditions on aortic stiffness should be assessed in clinical trials.
Language	English
Publishing date	2022-02-06
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2472-1972
ISSN (online)	2472-1972
DOI	10.1210/jendso/bvac016
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Article: Is the Adrenal Incidentaloma Functionally Active? An Approach-To-The-Patient-Based Review.

Bernardi, Stella / Calabrò, Veronica / Cavallaro, Marco / Lovriha, Sara / Eramo, Rita / Fabris, Bruno / de Manzini, Nicolò / Dobrinja, Chiara

Journal of clinical medicine

2022 Volume 11, Issue 14

Abstract: Adrenal incidentalomas are a common occurrence. Most of them are adrenocortical adenomas that do not cause harm and do not require surgery, but a non-negligible proportion of incidentalomas is represented by functionally active masses, including cortisol- ...

Abstract	Adrenal incidentalomas are a common occurrence. Most of them are adrenocortical adenomas that do not cause harm and do not require surgery, but a non-negligible proportion of incidentalomas is represented by functionally active masses, including cortisol-secreting adenomas (12%), pheochromocytomas (3-6%), aldosterone-secreting adenomas (2-3%), as well as malignant nodules, such as adrenocortical carcinomas (2-5%), which can be either functioning or non-functioning. All patients with an adrenal incidentaloma should undergo a few biochemical screening and confirmatory tests to exclude the presence of a functionally active mass. In this approach-to-the-patient-based review, we will summarize current recommendations on biochemical evaluation and management of functionally active adrenal incidentalomas. For this purpose, we will present four case vignettes, whereby we will describe how patients were managed, then we will review and discuss additional considerations tied to the diagnostic approach, and conclude with practical aspects of patient perioperative management. To improve the perioperative management of patients with functional adrenal incidentalomas, multidisciplinary meetings are advocated.
Language	English
Publishing date	2022-07-14
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11144064
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Article ; Online: Acute and complicated diverticulitis: are there significant differences between young and elderly patients?

Dobrinja, Chiara / Bortul, Marina / Silvestri, Marta / Tretjak, Martina / Turoldo, Angelo / de Manzini, Nicolò

Annali italiani di chirurgia

2020 Volume 91, Page(s) 378–384

Abstract: Aim: The aim of our study was to assess if there were any differences in clinical presentation, management, and outcome, between younger and elderly patients with acute diverticulitis (AD).: Material of study: 279 patients with diagnosis of AD ... ...

Abstract	Aim: The aim of our study was to assess if there were any differences in clinical presentation, management, and outcome, between younger and elderly patients with acute diverticulitis (AD). Material of study: 279 patients with diagnosis of AD treated at the General Surgery Department of Trieste from January 2007 to December 2015 were retrospectively examined and then followed for a minimum of 4 years. We divided patients in two categories: young ≤ 50 years and elderly > 50. Gender, American Society of Anesthesiologists status (ASA score), Hinchey's stage, type and timing of surgery, morbidity, length of hospital stay, recurrence, and overall mortality were retrospectively analyzed. Results: There were 279 patients, 64 (22,9 %) were young and 215 (77,1%) were elderly. Female gender was more frequent in elderly cohort (150 pts 69,7 % F vs 65 pts 30,3 % M) than in the young (16 pts, 25% F vs 48 pts, 75% M), (p<0,001). Higher ASA scores were registered in elderly patients with statistically significant correlation with Hinchey's stage. 229 patients ( 82,07 %) received as initial treatment antibiotic therapy (conservative treatment), 50 (17,93 %) pts underwent EM-S, and 11 underwent to DEL-S. Discussion: In our experience, none significant differences were recorded about Hinchey's stage, timing of surgery, morbidity, length of hospital stay, and recurrence; whereas, regarding the type of surgery (resection-anastomosis (R-A), Hartmann's procedures, and Lavage/Drainage) there were a significant difference (p=0,04). Conclusions: Hartmann's procedures have been effectuated more frequently in the elderly than in the young with recanalization in less than half of elderly. These data seems to confirm that there is no significant difference in incidence or the natural course of acute and complicated colonic diverticulitis among the young or the elderly. The best surgical treatment, with the least morbidity, may be resection with primary anastomosis. Key words: Diverticular Disease, Elderly Patients, Sigmoidectomy, Young Patients.
MeSH term(s)	Age Factors ; Aged ; Anastomosis, Surgical ; Colon, Sigmoid/surgery ; Colostomy ; Diverticulitis, Colonic/epidemiology ; Diverticulitis, Colonic/surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies
Language	English
Publishing date	2020-11-06
Publishing country	Italy
Document type	Journal Article
ZDB-ID	418927-9
ISSN	2239-253X ; 0003-469X
ISSN (online)	2239-253X
ISSN	0003-469X
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Article ; Online: Touch Imprinting Cytology may be useful in the intraoperative evaluation of the sentinel lymph node in melanoma.

Turoldo, Angelo / Pascuali, Arianna / Bortul, Marina / Silvestri, Marta / Dobrinja, Chiara / Zanconati, Fabrizio / di Meo, Nicola / Zalaudek, Iris / De Manzini, Nicolò

Annali italiani di chirurgia

2020 Volume 90, Page(s) 491–496

Abstract: Purpose: The aim of the study was to assess whether the reliability of Touch Imprinting Cytology (TIC) of Sentinel lymph node biopsy (SLNB) in skin melanoma patients allows intraoperative decisions regarding simultaneous radical lymphadenectomy to be ... ...

Abstract	Purpose: The aim of the study was to assess whether the reliability of Touch Imprinting Cytology (TIC) of Sentinel lymph node biopsy (SLNB) in skin melanoma patients allows intraoperative decisions regarding simultaneous radical lymphadenectomy to be made. Previous experiences have shown that the limit of TIC in extemporaneous diagnosis was represented by the minimal deposits of the tumor. Many current data seem to show that in this situation radical lymphadenectomy is no longer necessary, so we wondered if TIC could regain importance in the intraoperative management of these patients. Methods: TIC results of Sentinel Lymph Nodes Biopsy (SLN) were compared with those of standard histopathological and immunohistochemical examinations. Results: A total number of 110 SLN were detected from 50 melanoma patients.TIC revealed the presence of metastases only in 1 out of 13 melanoma-positive SLN (sensitivity 7.6%). There were no false-positive results of TIC (specificity 100%). The negative predictive value was 75.5%, the positive one 100% with a total diagnostic accuracy of 76%. Conclusions: TIC for SLNs is a reliable method, relatively fast and not very expensive. Although with a very high specificity, its sensitivity was very low, and almost exclusively limited to macro-metastases (>2mm). Furthermore, it was not possible to identify a subgroup of patients, based on the characteristics of the primary tumor, in which the method could have been more useful. Finally, even in positive cases, the method rarely reduced the need of a tactic in two stages, principally for the management of the operating room. Key words: Melanoma, Sentinel lymph node (SLN), Touch Imprinting Cytology (TIC).
MeSH term(s)	Adult ; Axilla ; Extremities ; Female ; Groin ; Histocytological Preparation Techniques ; Humans ; Intraoperative Care/methods ; Lymph Nodes/pathology ; Lymphatic Metastasis/pathology ; Male ; Melanoma/pathology ; Melanoma/secondary ; Melanoma/surgery ; Middle Aged ; Organ Specificity ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity ; Sentinel Lymph Node/pathology ; Sentinel Lymph Node Biopsy/methods ; Skin Neoplasms/pathology ; Skin Neoplasms/surgery ; Torso ; Melanoma, Cutaneous Malignant
Language	English
Publishing date	2020-01-13
Publishing country	Italy
Document type	Comparative Study ; Evaluation Study ; Journal Article
ZDB-ID	418927-9
ISSN	2239-253X ; 0003-469X
ISSN (online)	2239-253X
ISSN	0003-469X
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Article ; Online: The quality control in pancreatic surgery.

Dobrinja, Chiara / Urbani, Monica / Roseano, Mauro / Liguori, Gennaro

Annali italiani di chirurgia

2013 Volume 84, Issue 1, Page(s) 41–46

Abstract: Aim: Over the past decade, several centralization programs for major pancreatic surgery have been implemented in hospitals with high procedural volumes. Although the impact of this process was altogether positive, also possible negative effects have ... ...

Abstract	Aim: Over the past decade, several centralization programs for major pancreatic surgery have been implemented in hospitals with high procedural volumes. Although the impact of this process was altogether positive, also possible negative effects have been evidenced, above all the lack of comprehensive coverage and access to specialized centers. In order to solve these problems, it was proposed the utilization of an outcome-based and not volume-based center selection. For this purpose the choice of an appropriate outcome assessment system is crucial. Material of study: We retrospectively reviewed 74 patients undergoing pancreatoduodenectomy. The outcomes were evaluated utilizing the Accordion Severity Classification of Postoperative Complications. Results: The morbidity of 58 % and the mortality of 4 % were comparable with the ones reported in large series utilizing the same classification system. Conclusions: The Accordion system is an effective method of quality control for pancreatic surgery both in high- and low-volume hospitals.
MeSH term(s)	Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Pancreaticoduodenectomy/standards ; Quality Control ; Retrospective Studies
Language	English
Publishing date	2013-01
Publishing country	Italy
Document type	Journal Article
ZDB-ID	418927-9
ISSN	2239-253X ; 0003-469X
ISSN (online)	2239-253X
ISSN	0003-469X
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Article: Initial Ablation Ratio Predicts Volume Reduction and Retreatment After 5 Years From Radiofrequency Ablation of Benign Thyroid Nodules.

Bernardi, Stella / Cavallaro, Marco / Colombin, Giacomo / Giudici, Fabiola / Zuolo, Giulia / Zdjelar, Adrian / Dobrinja, Chiara / De Manzini, Nicolò / Zanconati, Fabrizio / Cova, Maria Assunta / Stacul, Fulvio / Fabris, Bruno

Frontiers in endocrinology

2021 Volume 11, Page(s) 582550

Abstract: Background: Radiofrequency ablation (RFA) has gained ground as an effective and well-tolerated technique to treat benign thyroid nodules. Most of the available studies have described the short-term outcomes of RFA, whereas there is a limited number of ... ...

Abstract	Background: Radiofrequency ablation (RFA) has gained ground as an effective and well-tolerated technique to treat benign thyroid nodules. Most of the available studies have described the short-term outcomes of RFA, whereas there is a limited number of studies evaluating long-term issues, such as regrowth and the likelihood of retreatments. In addition, risk markers of regrowth and retreatment remain to be defined. The initial ablation ratio (IAR) is an index that measures the amount of ablation after RFA, which has been associated with technique efficacy (i.e. volume reduction >50% after 1 year from the procedure). This study aimed at evaluating i) IAR reproducibility and ii) IAR predictive value for RFA 5-year outcomes. Materials and methods: This is a retrospective single center study on patients with benign thyroid nodules treated with RFA and followed for 5 years after initial treatment. IAR interobserver reproducibility was evaluated with Bland-Altman method and Lin's concordance correlation coefficient (ρc). IAR predictive value for RFA 5-year outcomes was evaluated with linear and logistic regression models, as well as with Cox models, while receiver operating characteristic (ROC) analyses were used for cut-offs. Results: We selected 78 patients with 82 benign thyroid nodules. The procedure significantly reduced nodule volume and this reduction was generally maintained over time. Technique efficacy was achieved in 92% of patients, while 23% of nodules regrew and 12% of nodules were retreated. Median IAR was 83%. Lin's concordance and Pearson's correlation coefficients suggested a good interobserver reproducibility of this index, consistent with the limits of agreement of the Bland-Altman plot. IAR was significantly associated with technique efficacy, 1- and 5-year volume reduction ratio, and with the likelihood of a retreatment, but not with nodule regrowth. ROC analyses showed that IAR cut-off was 49% for technique efficacy and 73% for retreatment. Conclusions: Our results show for the first time that IAR is reproducible and that it predicts the volume reduction and the likelihood of a retreatment after 5 years from RFA.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Observer Variation ; Prognosis ; Radiofrequency Ablation/methods ; Retreatment/statistics & numerical data ; Retrospective Studies ; Thyroid Nodule/pathology ; Thyroid Nodule/surgery ; Time Factors ; Young Adult
Language	English
Publishing date	2021-02-01
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2592084-4
ISSN	1664-2392
ISSN	1664-2392
DOI	10.3389/fendo.2020.582550
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Article ; Online: Does sigmoidectomy for diverticular disease have a negative impact on patients' quality of life and bowel function?

Turoldo, Angelo / Bortul, Marina / Ceglar, Samuele / Dobrinja, Chiara / de Manzini, Nicolò

Annali italiani di chirurgia

2017 Volume 87, Page(s) 564–571

Abstract: Aim: Aim of this study was to evaluate bowel function after colonic resection for diverticular disease and assess its impact on patients' quality of life.: Material of study: 47 patients who underwent urgent or elective surgery for diverticular ... ...

Abstract	Aim: Aim of this study was to evaluate bowel function after colonic resection for diverticular disease and assess its impact on patients' quality of life. Material of study: 47 patients who underwent urgent or elective surgery for diverticular disease were either personally contacted or interviewed by telephone and given a questionnaire. The Memorial Bowel functional index, the short form (36) health survey questionnaire, and the fecal incontinence severity index were used. Results: Fecal Urgency was found in 4,25% of cases, Incomplete Evacuation in 17,03%, and the Lifestyle/Diet Modification Score in 23,4% of patients. Incontinence cases were not found. After surgery we found reduction of abdominal pain (p=0.017) and improved bowel function (p=0.001). The quality of life correlated to bowel function was defined good or very good in 87.2% of cases whereas 4.3% of patients reported poor bowel function. This condition was related to female patients (p=0.02), urgent surgery (p=0.05), and to post-operative complication (p=0.05). Discussion and conclusions: In our experience, both bowel function and abdominal pain improved after surgery and 91.4% of patients were satisfied with the choice of surgery and would agree to do it again. The presence of not recognized inflammatory bowel syndromes can occasionally be responsible for persistent disorders after surgery. Key words: Bowel function, Diverticular disease, Sigmoidectomy.
MeSH term(s)	Aged ; Colectomy ; Colon, Sigmoid/surgery ; Defecation ; Diverticulum, Colon/surgery ; Female ; Humans ; Male ; Quality of Life ; Self Report
Language	English
Publishing date	2017-01-05
Publishing country	Italy
Document type	Journal Article
ZDB-ID	418927-9
ISSN	2239-253X ; 0003-469X
ISSN (online)	2239-253X
ISSN	0003-469X
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Article ; Online: Primary hyperparathyroidism in older people: surgical treatment with minimally invasive approaches and outcome.

Dobrinja, Chiara / Silvestri, Marta / de Manzini, Nicolò

International journal of endocrinology

2012 Volume 2012, Page(s) 539542

Abstract: Introduction. Elderly patients with primary hyperparathyroidism (pHPT) are often not referred to surgery because of their associated comorbidities that may increase surgical risk. The aim of the study was to review indications and results of minimally ... ...

Abstract	Introduction. Elderly patients with primary hyperparathyroidism (pHPT) are often not referred to surgery because of their associated comorbidities that may increase surgical risk. The aim of the study was to review indications and results of minimally invasive approach parathyroidectomy in elderly patients to evaluate its impact on outcome. Materials and Methods. All patients of 70 years of age or older undergoing minimally approach parathyroidectomy at our Department from May 2005 to May 2011 were reviewed. Data collected included patients demographic information, biochemical pathology, time elapsed from pHPT diagnosis to surgical intervention, operative findings, complications, and results of postoperative biochemical studies. Results and Discussion. 37 patients were analysed. The average length of stay was 2.8 days. 11 patients were discharged within 24 hours after their operation. Morbidity included 6 transient symptomatic postoperative hypocalcemias while one patient developed a transient laryngeal nerve palsy. Time elapsed from pHPT diagnosis to first surgical visit evidences that the elderly patients were referred after their disease had progressed. Conclusions. Our data show that minimally invasive approach to parathyroid surgery seems to be safe and curative also in elderly patients with few associated risks because of combination of modern preoperative imaging, advances in surgical technique, and advances in anesthesia care.
Language	English
Publishing date	2012-06-12
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	2502951-4
ISSN	1687-8345 ; 1687-8337
ISSN (online)	1687-8345
ISSN	1687-8337
DOI	10.1155/2012/539542
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Article ; Online: Full-Thickness Skin Burn Caused by Radiofrequency Ablation of a Benign Thyroid Nodule.

Bernardi, Stella / Lanzilotti, Valentina / Papa, Giovanni / Panizzo, Nicola / Dobrinja, Chiara / Fabris, Bruno / Stacul, Fulvio

Thyroid : official journal of the American Thyroid Association

2016 Volume 26, Issue 1, Page(s) 183–184

MeSH term(s)	Adult ; Burns/etiology ; Burns/pathology ; Burns/therapy ; Catheter Ablation/adverse effects ; Female ; Humans ; Skin/pathology ; Thyroid Nodule/surgery ; Time Factors ; Treatment Outcome ; Wound Healing
Language	English
Publishing date	2016-01
Publishing country	United States
Document type	Case Reports ; Letter
ZDB-ID	1086044-7
ISSN	1557-9077 ; 1050-7256
ISSN (online)	1557-9077
ISSN	1050-7256
DOI	10.1089/thy.2015.0453
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