G. Ansaldo | Università degli Studi di Genova (original) (raw)
Papers by G. Ansaldo
World Journal of Endocrine Surgery, 2020
Background: Adrenal cysts are uncommon and generally asymptomatic, thus often discovered only inc... more Background: Adrenal cysts are uncommon and generally asymptomatic, thus often discovered only incidentally. In the case described here, two giant bilateral adrenal cysts were diagnosed in an emergency setting based on the onset of acute compressive symptoms. Only after a complete diagnostic workup aimed at excluding any suspicion of malignancy, the patient underwent elective and adrenal-preserving surgery. Case description: A 26-year-old man was hospitalized in the emergency room for abdominal pain and dyspepsia. The ultrasound (US) scan showed two giant masses of both the adrenals. The workup allowed a diagnosis of nonfunctioning giant adrenal cysts, one with evidence of intracystic bleeding. Bilateral surgery was indicated and, on both sides, a wide resection of the cyst wall was performed laparoscopically, trying to preserve the adrenal function. At follow-up, the patient shows no evidence of recurrent disease. Conclusion: Despite an acute onset of compressive symptoms that led the patient to hospitalization in an emergency setting, the symptoms of the patient were cured at first. A correct and thorough subsequent workup was then performed that allowed to make a diagnosis of bilateral giant adrenal cysts without any sign of malignancy. This diagnosis indicated a bilateral adrenal-sparing decompressive procedure that, after follow-up, resulted in long-term cure. Clinical significance: A correct imaging played a key role in planning the treatment since it could exclude any suspicion of malignancy, thus allowing to indicate a "functional" approach aimed at avoiding a lifelong and difficult-to-manage substitutive therapy in a young patient.
Minerva chirurgica, Jan 31, 1989
Until a few years ago, surgical technique and the age-old convictions of oncological radicality r... more Until a few years ago, surgical technique and the age-old convictions of oncological radicality rejected very low rectal resections for cancer, particularly as the problem of postoperative incontinence did not exist. Currently, on the other hand, with the advent of mechanical staplers, the surgeon attempts increasingly to reconcile the possibility of using new sphincter-saving techniques with adequate oncological radicality, backed by accurate pre- and intraoperative staging. It is underlined that postoperative assessment of sphincter function in all its aspects, both clinical and instrumental, may be useful for the purpose of clarifying what anatomical structures should really be saved, delegated to retaining sphincter sensitivity and reflexes, so improving the functional results of operations. In addition, the almost rare identification of manifest or latent postoperative incontinence would make it possible to intervene in operated patients, for example by functional reeducation t...
Clinical Immunology, 2007
proliferation and cytotoxicity. CD4+CD25+ T regulatory lymphocytes associate with CD8+CD28− T sup... more proliferation and cytotoxicity. CD4+CD25+ T regulatory lymphocytes associate with CD8+CD28− T suppressor cells so that the immunosuppressive activity of tumor infiltrating regulatory T cell subsets, altogether considered, may become predominant. The infiltration of regulatory T cells seems tumor-related, being present in metastatic but not in metastasis free satellite lymph nodes; it likely depends on both in situ generation (via cytokine production) and recruitment from the periphery (via chemokine secretion). Collectively, these results have pathogenic relevance and implication for immunotherapy of cancer.
Giornale di Chirurgia - Journal of Surgery, 1989
The authors review the modern knowledge of sepsis, asepsis and antisepsis in surgery; they underl... more The authors review the modern knowledge of sepsis, asepsis and antisepsis in surgery; they underline some surgeon's customary attitudes and convictions no more scientifically significant today.
The American surgeon, 2000
A surgical series of 30 cervico-mediastinal thyroid cancer patients operated on has been retrospe... more A surgical series of 30 cervico-mediastinal thyroid cancer patients operated on has been retrospectively reviewed. Results were compared with those obtained in patients operated on for benign cervico-mediastinal goiter and thyroid cancer confined to cervical region. Of 4688 thyroidectomies performed, 30 patients were operated on for thyroid carcinoma with cervico-mediastinal extension. There were 15 males and 15 females. The mean age was 67 years (range, 21-86 years). Patients with cervico-mediastinal cancer were significantly older than patients with benign cervico-mediastinal goiter (P < 0.0001). Time between onset of first symptoms and surgery was significantly longer in patients with cervico-mediastinal cancer than in those with benign cervico-mediastinal goiter (P < 0.0001) and cervical thyroid cancer. Signs and symptoms at the time of surgery were cervical mass in 28 patients (93%), cervical lymphadenopathy in 20 patients (66%), dyspnea in 21 (70%), dysphagia in 9 (30%),...
Annali italiani di chirurgia
Reoperative surgery for thyroid disease still plays a predominant role in the treatment of goiter... more Reoperative surgery for thyroid disease still plays a predominant role in the treatment of goiter recurrences. At the moment, neither useful biological nor clinical indicators exist to prevent such recurrences. The effectiveness of TSH-suppressive therapy is still debatable and some authors have proposed total thyroidectomy for this benign disease in order to eliminate the risk of relapse. We analyzed 134 patients who underwent reintervention for recurrence of goitre in order to: 1) study possible clinical or epidemiological characteristics that could influence recurrence, 2) to verify the indications to reoperation, and 3) to evaluate the incidence of complications. For the study of complications, we adopted as a control group a series of 361 patients operated on by the same medical staff and undergoing subtotal thyroidectomy for multinodular goitre, with a minimal follow-up of 10 years. The surgical technique is described and several peculiarities are discussed. In the group of pa...
The American surgeon, 1995
Between 1968 and 1991, 237 patients underwent thyroidectomy for substernal goiter. Sixteen of the... more Between 1968 and 1991, 237 patients underwent thyroidectomy for substernal goiter. Sixteen of them presented malignancies (6.8%). Mean age of the 159 women and 78 men was 57.7 years. Twenty-five patients had undergone previous thyroid surgery. The initial symptoms were cervical mass (72%), compression (16.2%), hyperthyroidism (13.1%), hypothyroidism (1.3%), and 5.5 per cent were asymptomatic. Most patients had long-standing goiter (mean duration: 12.9 yrs). All but eight operations were performed through a cervical incision. There were two postoperative deaths (0.8%), both in patients with advanced neoplasms. Early postoperative complications were hemorrhage (0.8%), dysphonia (4.6%), and transient hypocalcemia (2.9%). Five patients (2.1%) required tracheotomy. Complications were more frequent after total thyroidectomy than partial resection (P < 0.05), after surgery for malignancy than for benign disease (P < 0.05), and in complex than in simple forms (P < 0.05). One hundre...
Minerva chirurgica, 1991
The paper describes the carbohydrate, lipidic and nitrogen metabolism of the postoperative period... more The paper describes the carbohydrate, lipidic and nitrogen metabolism of the postoperative period which is subdivided into an early and a late phase. Since the metabolism of caloric substrates in the early postoperative period is a stress metabolism with glucose intolerance and wide protein catabolism, the authors emphasise that an insufficient caloric intake is worse than the fasting state and suggest that alternative caloric sources, such as branched chain amino acids, fatty acids and, even, ketonic bodies, should be used.
Minerva chirurgica, 1995
After investigation of the international literature on this subject, the authors describe a case ... more After investigation of the international literature on this subject, the authors describe a case report of adhesive-stenotic and retractile peritonitis, very likely caused bt a foreign body reaction (surgical stitches, gloves, rice powder, etc.?). This case-report is interesting both to remember the existence of this pathology and to limit its iatrogenic development. In conclusion, it is advisable to wash surgical gloves with sterile solutions and to limit enlarged bowel resections mostly in young people.
Annali italiani di chirurgia, 1990
Elster's classification differentiates epithelial gastric polyps on the basis of cells origin... more Elster's classification differentiates epithelial gastric polyps on the basis of cells origin and relative tendency to change into a malignancy. Out of 3.920 endoscopy of upper digestive tract during the last 10 years, we found 41 gastric polyps, 50% asymptomatic. Endoscopic polypectomy were performed in 61% of cases, without any complication. The other 39% were followed-up and/or surgically resected, according to the results of biopsy. Endoscopy is mandatory for detection of lesions often asymptomatic and histological study of surrounding gastric mucosa. Small polyps must be treated by radical endoscopic polypectomy. If they are too big for endoscopic polypectomy, it's well advised and safer to perform periodic biopsy for hyperplastic type and a surgical resection for adenomatous ones. The detection of intestinal metaplastic or malignant changes beyond basal membrane suggests a resection both subtotal or total according to topography of the lesions. In conclusion the role o...
The American surgeon, 2000
A surgical series of 30 cervico-mediastinal thyroid cancer patients operated on has been retrospe... more A surgical series of 30 cervico-mediastinal thyroid cancer patients operated on has been retrospectively reviewed. Results were compared with those obtained in patients operated on for benign cervico-mediastinal goiter and thyroid cancer confined to cervical region. Of 4688 thyroidectomies performed, 30 patients were operated on for thyroid carcinoma with cervico-mediastinal extension. There were 15 males and 15 females. The mean age was 67 years (range, 21-86 years). Patients with cervico-mediastinal cancer were significantly older than patients with benign cervico-mediastinal goiter (P < 0.0001). Time between onset of first symptoms and surgery was significantly longer in patients with cervico-mediastinal cancer than in those with benign cervico-mediastinal goiter (P < 0.0001) and cervical thyroid cancer. Signs and symptoms at the time of surgery were cervical mass in 28 patients (93%), cervical lymphadenopathy in 20 patients (66%), dyspnea in 21 (70%), dysphagia in 9 (30%),...
Minerva chirurgica, 1992
Six groups of patients for a total of 120 cases were examined for cervical wound suture results. ... more Six groups of patients for a total of 120 cases were examined for cervical wound suture results. Different synthetic absorbable sutures and different suture techniques were employed. Good aesthetic results were always obtained in long-term follow-up. The patients sutured with Polydioxanone, a monofilament with prolonged breaking strength retention, had a lower incidence of local complications.
The American surgeon, 1995
Between 1968 and 1991, 237 patients underwent thyroidectomy for substernal goiter. Sixteen of the... more Between 1968 and 1991, 237 patients underwent thyroidectomy for substernal goiter. Sixteen of them presented malignancies (6.8%). Mean age of the 159 women and 78 men was 57.7 years. Twenty-five patients had undergone previous thyroid surgery. The initial symptoms were cervical mass (72%), compression (16.2%), hyperthyroidism (13.1%), hypothyroidism (1.3%), and 5.5 per cent were asymptomatic. Most patients had long-standing goiter (mean duration: 12.9 yrs). All but eight operations were performed through a cervical incision. There were two postoperative deaths (0.8%), both in patients with advanced neoplasms. Early postoperative complications were hemorrhage (0.8%), dysphonia (4.6%), and transient hypocalcemia (2.9%). Five patients (2.1%) required tracheotomy. Complications were more frequent after total thyroidectomy than partial resection (P < 0.05), after surgery for malignancy than for benign disease (P < 0.05), and in complex than in simple forms (P < 0.05). One hundre...
Differentiated thyroid carcinoma accounts for 90% of all thyroid cancers and occurs as papillary ... more Differentiated thyroid carcinoma accounts for 90% of all thyroid cancers and occurs as papillary carcinoma in 90% of cases. It was shown as this is characterized by an excellent long-term prognosis, although in follow-up long series, were described recurrence rates up to 35%. Although in the past has not been attributed prognostic significance to the lymph nodes, in the last decade has shown how these can affect the rate of locoregional recurrence of differentiated thyroid carcinoma. This renewed interest in lymph node metastatic disease has prompted a shift in surgical treatments more aggressive, with a view to achieving a low incidence of locoregional recurrence. Analyzing the more recent guidelines formulated at the international level, we can highlight how we gradually consolidated the role of prophylactic central compartment lymphadenectomy in the surgical treatment of patients with differentiated thyroid carcinoma. The aim of this treatment, in fact, is not only to reduce the ...
British Journal of Surgery
World Journal of Endocrine Surgery, 2020
Background: Adrenal cysts are uncommon and generally asymptomatic, thus often discovered only inc... more Background: Adrenal cysts are uncommon and generally asymptomatic, thus often discovered only incidentally. In the case described here, two giant bilateral adrenal cysts were diagnosed in an emergency setting based on the onset of acute compressive symptoms. Only after a complete diagnostic workup aimed at excluding any suspicion of malignancy, the patient underwent elective and adrenal-preserving surgery. Case description: A 26-year-old man was hospitalized in the emergency room for abdominal pain and dyspepsia. The ultrasound (US) scan showed two giant masses of both the adrenals. The workup allowed a diagnosis of nonfunctioning giant adrenal cysts, one with evidence of intracystic bleeding. Bilateral surgery was indicated and, on both sides, a wide resection of the cyst wall was performed laparoscopically, trying to preserve the adrenal function. At follow-up, the patient shows no evidence of recurrent disease. Conclusion: Despite an acute onset of compressive symptoms that led the patient to hospitalization in an emergency setting, the symptoms of the patient were cured at first. A correct and thorough subsequent workup was then performed that allowed to make a diagnosis of bilateral giant adrenal cysts without any sign of malignancy. This diagnosis indicated a bilateral adrenal-sparing decompressive procedure that, after follow-up, resulted in long-term cure. Clinical significance: A correct imaging played a key role in planning the treatment since it could exclude any suspicion of malignancy, thus allowing to indicate a "functional" approach aimed at avoiding a lifelong and difficult-to-manage substitutive therapy in a young patient.
Minerva chirurgica, Jan 31, 1989
Until a few years ago, surgical technique and the age-old convictions of oncological radicality r... more Until a few years ago, surgical technique and the age-old convictions of oncological radicality rejected very low rectal resections for cancer, particularly as the problem of postoperative incontinence did not exist. Currently, on the other hand, with the advent of mechanical staplers, the surgeon attempts increasingly to reconcile the possibility of using new sphincter-saving techniques with adequate oncological radicality, backed by accurate pre- and intraoperative staging. It is underlined that postoperative assessment of sphincter function in all its aspects, both clinical and instrumental, may be useful for the purpose of clarifying what anatomical structures should really be saved, delegated to retaining sphincter sensitivity and reflexes, so improving the functional results of operations. In addition, the almost rare identification of manifest or latent postoperative incontinence would make it possible to intervene in operated patients, for example by functional reeducation t...
Clinical Immunology, 2007
proliferation and cytotoxicity. CD4+CD25+ T regulatory lymphocytes associate with CD8+CD28− T sup... more proliferation and cytotoxicity. CD4+CD25+ T regulatory lymphocytes associate with CD8+CD28− T suppressor cells so that the immunosuppressive activity of tumor infiltrating regulatory T cell subsets, altogether considered, may become predominant. The infiltration of regulatory T cells seems tumor-related, being present in metastatic but not in metastasis free satellite lymph nodes; it likely depends on both in situ generation (via cytokine production) and recruitment from the periphery (via chemokine secretion). Collectively, these results have pathogenic relevance and implication for immunotherapy of cancer.
Giornale di Chirurgia - Journal of Surgery, 1989
The authors review the modern knowledge of sepsis, asepsis and antisepsis in surgery; they underl... more The authors review the modern knowledge of sepsis, asepsis and antisepsis in surgery; they underline some surgeon's customary attitudes and convictions no more scientifically significant today.
The American surgeon, 2000
A surgical series of 30 cervico-mediastinal thyroid cancer patients operated on has been retrospe... more A surgical series of 30 cervico-mediastinal thyroid cancer patients operated on has been retrospectively reviewed. Results were compared with those obtained in patients operated on for benign cervico-mediastinal goiter and thyroid cancer confined to cervical region. Of 4688 thyroidectomies performed, 30 patients were operated on for thyroid carcinoma with cervico-mediastinal extension. There were 15 males and 15 females. The mean age was 67 years (range, 21-86 years). Patients with cervico-mediastinal cancer were significantly older than patients with benign cervico-mediastinal goiter (P < 0.0001). Time between onset of first symptoms and surgery was significantly longer in patients with cervico-mediastinal cancer than in those with benign cervico-mediastinal goiter (P < 0.0001) and cervical thyroid cancer. Signs and symptoms at the time of surgery were cervical mass in 28 patients (93%), cervical lymphadenopathy in 20 patients (66%), dyspnea in 21 (70%), dysphagia in 9 (30%),...
Annali italiani di chirurgia
Reoperative surgery for thyroid disease still plays a predominant role in the treatment of goiter... more Reoperative surgery for thyroid disease still plays a predominant role in the treatment of goiter recurrences. At the moment, neither useful biological nor clinical indicators exist to prevent such recurrences. The effectiveness of TSH-suppressive therapy is still debatable and some authors have proposed total thyroidectomy for this benign disease in order to eliminate the risk of relapse. We analyzed 134 patients who underwent reintervention for recurrence of goitre in order to: 1) study possible clinical or epidemiological characteristics that could influence recurrence, 2) to verify the indications to reoperation, and 3) to evaluate the incidence of complications. For the study of complications, we adopted as a control group a series of 361 patients operated on by the same medical staff and undergoing subtotal thyroidectomy for multinodular goitre, with a minimal follow-up of 10 years. The surgical technique is described and several peculiarities are discussed. In the group of pa...
The American surgeon, 1995
Between 1968 and 1991, 237 patients underwent thyroidectomy for substernal goiter. Sixteen of the... more Between 1968 and 1991, 237 patients underwent thyroidectomy for substernal goiter. Sixteen of them presented malignancies (6.8%). Mean age of the 159 women and 78 men was 57.7 years. Twenty-five patients had undergone previous thyroid surgery. The initial symptoms were cervical mass (72%), compression (16.2%), hyperthyroidism (13.1%), hypothyroidism (1.3%), and 5.5 per cent were asymptomatic. Most patients had long-standing goiter (mean duration: 12.9 yrs). All but eight operations were performed through a cervical incision. There were two postoperative deaths (0.8%), both in patients with advanced neoplasms. Early postoperative complications were hemorrhage (0.8%), dysphonia (4.6%), and transient hypocalcemia (2.9%). Five patients (2.1%) required tracheotomy. Complications were more frequent after total thyroidectomy than partial resection (P < 0.05), after surgery for malignancy than for benign disease (P < 0.05), and in complex than in simple forms (P < 0.05). One hundre...
Minerva chirurgica, 1991
The paper describes the carbohydrate, lipidic and nitrogen metabolism of the postoperative period... more The paper describes the carbohydrate, lipidic and nitrogen metabolism of the postoperative period which is subdivided into an early and a late phase. Since the metabolism of caloric substrates in the early postoperative period is a stress metabolism with glucose intolerance and wide protein catabolism, the authors emphasise that an insufficient caloric intake is worse than the fasting state and suggest that alternative caloric sources, such as branched chain amino acids, fatty acids and, even, ketonic bodies, should be used.
Minerva chirurgica, 1995
After investigation of the international literature on this subject, the authors describe a case ... more After investigation of the international literature on this subject, the authors describe a case report of adhesive-stenotic and retractile peritonitis, very likely caused bt a foreign body reaction (surgical stitches, gloves, rice powder, etc.?). This case-report is interesting both to remember the existence of this pathology and to limit its iatrogenic development. In conclusion, it is advisable to wash surgical gloves with sterile solutions and to limit enlarged bowel resections mostly in young people.
Annali italiani di chirurgia, 1990
Elster's classification differentiates epithelial gastric polyps on the basis of cells origin... more Elster's classification differentiates epithelial gastric polyps on the basis of cells origin and relative tendency to change into a malignancy. Out of 3.920 endoscopy of upper digestive tract during the last 10 years, we found 41 gastric polyps, 50% asymptomatic. Endoscopic polypectomy were performed in 61% of cases, without any complication. The other 39% were followed-up and/or surgically resected, according to the results of biopsy. Endoscopy is mandatory for detection of lesions often asymptomatic and histological study of surrounding gastric mucosa. Small polyps must be treated by radical endoscopic polypectomy. If they are too big for endoscopic polypectomy, it's well advised and safer to perform periodic biopsy for hyperplastic type and a surgical resection for adenomatous ones. The detection of intestinal metaplastic or malignant changes beyond basal membrane suggests a resection both subtotal or total according to topography of the lesions. In conclusion the role o...
The American surgeon, 2000
A surgical series of 30 cervico-mediastinal thyroid cancer patients operated on has been retrospe... more A surgical series of 30 cervico-mediastinal thyroid cancer patients operated on has been retrospectively reviewed. Results were compared with those obtained in patients operated on for benign cervico-mediastinal goiter and thyroid cancer confined to cervical region. Of 4688 thyroidectomies performed, 30 patients were operated on for thyroid carcinoma with cervico-mediastinal extension. There were 15 males and 15 females. The mean age was 67 years (range, 21-86 years). Patients with cervico-mediastinal cancer were significantly older than patients with benign cervico-mediastinal goiter (P < 0.0001). Time between onset of first symptoms and surgery was significantly longer in patients with cervico-mediastinal cancer than in those with benign cervico-mediastinal goiter (P < 0.0001) and cervical thyroid cancer. Signs and symptoms at the time of surgery were cervical mass in 28 patients (93%), cervical lymphadenopathy in 20 patients (66%), dyspnea in 21 (70%), dysphagia in 9 (30%),...
Minerva chirurgica, 1992
Six groups of patients for a total of 120 cases were examined for cervical wound suture results. ... more Six groups of patients for a total of 120 cases were examined for cervical wound suture results. Different synthetic absorbable sutures and different suture techniques were employed. Good aesthetic results were always obtained in long-term follow-up. The patients sutured with Polydioxanone, a monofilament with prolonged breaking strength retention, had a lower incidence of local complications.
The American surgeon, 1995
Between 1968 and 1991, 237 patients underwent thyroidectomy for substernal goiter. Sixteen of the... more Between 1968 and 1991, 237 patients underwent thyroidectomy for substernal goiter. Sixteen of them presented malignancies (6.8%). Mean age of the 159 women and 78 men was 57.7 years. Twenty-five patients had undergone previous thyroid surgery. The initial symptoms were cervical mass (72%), compression (16.2%), hyperthyroidism (13.1%), hypothyroidism (1.3%), and 5.5 per cent were asymptomatic. Most patients had long-standing goiter (mean duration: 12.9 yrs). All but eight operations were performed through a cervical incision. There were two postoperative deaths (0.8%), both in patients with advanced neoplasms. Early postoperative complications were hemorrhage (0.8%), dysphonia (4.6%), and transient hypocalcemia (2.9%). Five patients (2.1%) required tracheotomy. Complications were more frequent after total thyroidectomy than partial resection (P < 0.05), after surgery for malignancy than for benign disease (P < 0.05), and in complex than in simple forms (P < 0.05). One hundre...
Differentiated thyroid carcinoma accounts for 90% of all thyroid cancers and occurs as papillary ... more Differentiated thyroid carcinoma accounts for 90% of all thyroid cancers and occurs as papillary carcinoma in 90% of cases. It was shown as this is characterized by an excellent long-term prognosis, although in follow-up long series, were described recurrence rates up to 35%. Although in the past has not been attributed prognostic significance to the lymph nodes, in the last decade has shown how these can affect the rate of locoregional recurrence of differentiated thyroid carcinoma. This renewed interest in lymph node metastatic disease has prompted a shift in surgical treatments more aggressive, with a view to achieving a low incidence of locoregional recurrence. Analyzing the more recent guidelines formulated at the international level, we can highlight how we gradually consolidated the role of prophylactic central compartment lymphadenectomy in the surgical treatment of patients with differentiated thyroid carcinoma. The aim of this treatment, in fact, is not only to reduce the ...
British Journal of Surgery