Carlotta Giani

Università di Pisa, Pisa, Tuscany, Italy

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Publications (4)13.41 Total impact

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    ABSTRACT: La maggior parte dei pazienti con carcinoma tiroideo guarisce con i trattamenti convenzionali (chirurgia e iodio radioattivo). Tuttavia, alcuni tumori tiroidei sono resistenti al radioiodio, perché perdono le caratteristiche della cellula follicolare da cui originano o perché originano dalle cellule C (carcinoma midollare della tiroide). Fino al 2011 nessuna terapia efficace era approvata per il trattamento di queste neoplasie. Di recente, una nuova classe di farmaci, gli inibitori tirosino-chinasici, che agiscono sul prodotto degli oncogeni che determinano lo sviluppo tumorale (es. BRAF V600E e RET) e sui recettori che favoriscono la proliferazione dell’endotelio vascolare (es. VEGFRs), ha offerto nuove prospettive terapeutiche per i pazienti con malattia avanzata e in progressione.
    No preview · Article · Feb 2014
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    ABSTRACT: Background: Minimally invasive video-assisted thyroidectomy (MIVAT) proved to be safe and effective in the treatment of both benign and malignant disease. The aim of the present study is to compare MIVAT approach with conventional approach for total thyroidectomy in a group of 99 pediatric patients operated in the Department of General Surgery of the University of Pisa between March 2007 and July 2012. Patients: A total of 99 pediatric patients under the age of 18 years with thyroid disease referred to our Department to undergo total thyroidectomy. Patients were divided into two groups according to the surgical technique performed: 34/99 (34.3%) patients (MIVAT group [MG]) and 65/99 (65.7%) patients, (conventional group [CG]) who underwent total thyroidectomy, respectively, with MIVAT approach and conventional approach. Results: In MG mean operative time for total thyroidectomy was 40 ± 6.57 minutes (range 30-60 min); postoperative hospital stay was 1 day for 18 patients (53%), 2 days for 12 patients (35.25%), 3 days for 4 patients (11.8%); transient hypoparathyroidism (hypoPTH) was observed in 12 cases (35.3%) and permanent hypoPTH in 2 cases (5.9%); transient postoperative unilateral vocal cord palsy was observed in 2 patients (5.9%). In CG mean operative time for total thyroidectomy was 49.3 ± 12.9 minutes (range 30-80 min); postoperative hospital stay was 1 day for 16 patients (24.6%), 2 days for 40 patients (61.5%), 3 days for 8 patients (12.3%), and 4 days for 1 patient (1.6%); transient hypoPTH was observed in 23 cases (35.4%) and permanent hypoPTH in 4 cases (6.1%), who needed therapy with calcitriol and calcium carbonate; transient postoperative unilateral vocal cord palsy was observed in 4 patients (6.1%). There were no cases of permanent vocal cord paralysis in both groups. The correlation between two groups of patients showed that mean operative time was significantly lower in MG (p = 0.0007). Conclusion: Pediatric patients of MG showed a significantly lower operative time and postoperative hospital stay with respect to pediatric patients of CG if compared with conventional technique. This result with the evidence of similar degree of completeness and rate of postoperative complications make MIVAT a valid option for the treatment of pediatric patients when performed by a well-trained staff in a third referral center.
    No preview · Article · Sep 2013 · European Journal of Pediatric Surgery
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    ABSTRACT: Background:No long-term follow-up data are available for differentiated thyroid carcinoma (DTC) patients prepared with either exogenous or endogenous TSH and treated with low-activity (1.1 GBq [30 mCi]) radioiodine ((131)I).Aim:The aim of this study was to evaluate the 10-year follow-up of DTC patients who underwent remnant ablation with 1.1 GBq of (131)I after levothyroxine (LT4) withdrawal, or following recombinant human TSH (rhTSH) administration, or both.Patients:159 DTC patients treated with total thyroidectomy and 1.1 GBq (30 mCi) of (131)I for remnant ablation and stimulated with rhTSH and/or endogenous TSH were separated into ablated (n=115) and not ablated (n=44) patients and prospectively followed-up for at least 10 years. Besides, we evaluated several features that could correlate with the final status of patients.Results:During the follow-up, 4/115 (3.5%) ablated patients showed a recurrence and one was successfully cured. Among not ablated patients, 16/44 (36.4%) had a persistent disease. At the end of the 10-year follow-up, 140/159 (88.1%) patients were disease-free while 19/159 (11.9%) remained affected. No correlation was found with the type of TSH stimulation and no other clinical and pathological features showed any correlation with the final status. However, low levels of stimulated serum thyroglobulin (<5.4 ng/ml) at first control after remnant ablation identified a subgroup of not ablated patients who became spontaneously cured.Conclusions:Long-term outcomes are similar in DTC patients treated with 1.1 GBq (30 mCi) of (131)I and prepared either with rhTSH or endogenous TSH. It is of interest that serum thyroglobulin at first control after ablation can have a prognostic role.
    No preview · Article · Apr 2013 · The Journal of Clinical Endocrinology and Metabolism
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    ABSTRACT: Background: Evidence for an increased prevalence of BRAF(V600E) mutations has been documented in recent decades. The aim of this study was to evaluate the prevalence of both RET/PTC rearrangements and BRAF(V600E) mutations in an Italian cohort of papillary thyroid carcinoma (PTC) patients followed at the Endocrine Units of Pisa, Milano, and Perugia from 1996-2010. Patients and methods: In total, 401 PTC patients were examined and grouped according to the time of surgery: group 1, 1996-2000; group 2, 2001-2005; and group 3, 2006-2010. Patients were analyzed for clinical, pathological, and molecular features. In parallel, the molecular characteristics of 459 PTC from Sicily were studied. Results: The genetic profiles of the three groups were significantly different (P < 0.0001). In particular, the frequency of RET/PTC rearrangements decreased from 1996-2010, occurring in 33 of 100 (33%) of the patients in group 1, 26 of 148 (17%) in group 2, and 15 of 153 (9.8%) in group 3. The incidence of BRAF(V600E) mutations increased over the same period, from 28% in group 1 (28 of 100) to 48.9% in group 2 (73 of 148) and 58.1% in group 3 (89 of 153). A consistent increase in BRAF(V600E) prevalence was observed in the Sicilian group (P < 0.0001). Moreover, a statistically significant increase in the mean age at diagnosis and decrease in tumor size over the study period was observed. Conclusion: The genetic profile of PTC changed over the last 15 yr, with a significant decrease in the prevalence of RET/PTC rearrangements and an increase in BRAF(V600E) mutations. In addition, the mean age at diagnosis increased and tumor size decreased over the study period.
    Full-text · Article · Jun 2012 · The Journal of Clinical Endocrinology and Metabolism