[Show abstract][Hide abstract] ABSTRACT: Background: Seroma formation is the most frequent postoperativecomplication after axillary dissection for breastsurgery with an incidence of 10 - 50 %. This prospectiveclinical randomized study was carried out to evaluate the Ligasure vessel sealing system and its effect on seromaformation and other complications for axillary dissection.Methods: Between January 2006 and November 2007, thepatients with histopathological diagnosis of breast cancer wereanalysed prospectively. The patients with positive sentinellymph node biopsy or clinical axillary involvement wereincluded in the study, and the patients who underwent neoadjuvanttherapy or using anticoagulants have been excludedfrom the study. Patients were divided into two study groups.Axillary dissection was performed in the first group byLigaSure and in the second group by linking and electrocautery.Results: There were a total of thirty three patients with amean age of 51.4 +- 13.7. In group one, mean age of patientswas 54.1 +- 13.2 and 48.68 +- 14.1 in group two. There wasno significant statistical difference between the groupsregarding age, body mass index, excised tissue weight,tumour size and number of excised lymph nodes. The use ofLigasure reduced drainage amount and duration of drain tillremoval, but increased operative time.Conclusion: There were no significant differences between studygroups regarding the complications. LigaSure electrothermalbipolar vessel sealing system can be safely used in axillarydissection as an alternative to traditional methods.
[Show abstract][Hide abstract] ABSTRACT: Lithium-associated hyperparathyroidism is the leading cause of hypercalcemia in lithium-treated patients. Lithium may lead to exacerbation of pre-existing primary hyperparathyroidism or cause an increased set-point of calcium for parathyroid hormone suppression, leading to parathyroid hyperplasia. Lithium may cause renal tubular concentration defects directly by the development of nephrogenic diabetes insipidus or indirectly by the effects of hypercalcemia. In this study, we present a female patient on long-term lithium treatment who was evaluated for hypercalcemia. Preoperative imaging studies indicated parathyroid adenoma and multinodular goiter. Parathyroidectomy and thyroidectomy were planned. During the postoperative course, prolonged intubation was necessary because of agitation and delirium. During this period, polyuria, severe dehydration, and hypernatremia developed, which responded to controlled hypotonic fluid infusions and was unresponsive to parenteral desmopressin. A diagnosis of nephrogenic diabetes insipidus was apparent. A parathyroid adenoma and multifocal papillary thyroid cancer were detected on histopathological examination. It was thought that nephrogenic diabetes insipidus was masked by hypercalcemia preoperatively. A patient on lithium treatment should be carefully followed up during or after surgery to prevent life-threatening complications of previously unrecognized nephrogenic diabetes insipidus, and the possibility of renal concentrating defects on long-term lithium use should be sought, particularly in patients with impaired consciousness.
[Show abstract][Hide abstract] ABSTRACT: The adrenal glands are a potential site of metastasis for various malignancies. Although laparoscopic
adrenalectomy is the gold standart approach for adrenal glands diseases, it’s controversial
for primary or metastatic adrenal cancers because when adrenal metastases are symptomatic,
the adrenal mass is usually adjacent or have invased vena cava inferior (VCI), liver or kidney.
So laparoscopic adrenalectomy is diffi cult to perform at that cases. We present a laparoscopic
adrenalectomy for metastatic right adrenal cancer adjacent to VCI. The abdominal magnetic
resonance imaging and computed tomography of 66-years-old male patient, treated for lung cancer,
demonstrated a mass in right adrenal gland adjacent to IVC. At laparoscopic exploration the
mass had seen adjacent to VCI. For curative resection, lateral side of VCI had resected partially
by endoscopic vasculer staples and adrenalectomy was performed. The patient was discharged
at post operative third day uneventfully. Proper adrenal tumor in patients with cancer, even if
invasion to VCI, laparoscopic adrenalectomy can be done safely by endoscopic vasculer staples.
Key Words: Laparoscopic adrenalectomy, metastatic adrenal carcinoma, vena cava inferior resection.
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION Even though laparoscopic adrenalectomy has become the gold standard in benign adrenal tumors, still unclear are the indications to laparoscopic adrenalectomy in case of primary or metastatic adrenal malignant lesions (1,2) . Adrenal gland is a common site of metastasis from lung carcinoma (2,3) . Laparoscopic adrenalectomy for metastatic ad-renal cancer is technically diffi cult. Because usually diagnosed at an advanced stage with invasion of or adherence to the liver, kidney, inferior vena cava (VCI), spleen and pancreas (4,5) . We herein present a case of adrenal metastases which was diagnosed during follow-up for lung cancer. CASE REPORT The 66-years-old male patient suffering from lung cancer had no symptom. An abdom-inal magnetic resonance imaging demonstrated 35 mm diameter, non-adenomatous mass, adjacent to VCI at right adrenal gland (Figure 1). General physical examination was normal. Laparoscopic adrenalectomy was recommended to the patient whom adrenal function tests were normal. The patient was informed about the operation de-tails. The patient was placed in semi-decubitus position and pneumoperitoneum was obtained by Veress needle. Four 5 mm to 10 mm ports were inserted. Laparoscopic ABSTRACT The adrenal glands are a potential site of metastasis for various malignancies. Although laparos-copic adrenalectomy is the gold standart approach for adrenal glands diseases, it's controversial for primary or metastatic adrenal cancers because when adrenal metastases are symptomatic, the adrenal mass is usually adjacent or have invased vena cava inferior (VCI), liver or kidney. So laparoscopic adrenalectomy is diffi cult to perform at that cases. We present a laparoscopic adrenalectomy for metastatic right adrenal cancer adjacent to VCI. The abdominal magnetic resonance imaging and computed tomography of 66-years-old male patient, treated for lung can-cer, demonstrated a mass in right adrenal gland adjacent to IVC. At laparoscopic exploration the mass had seen adjacent to VCI. For curative resection, lateral side of VCI had resected partially by endoscopic vasculer staples and adrenalectomy was performed. The patient was discharged at post operative third day uneventfully. Proper adrenal tumor in patients with cancer, even if invasion to VCI, laparoscopic adrenalectomy can be done safely by endoscopic vasculer staples.
[Show abstract][Hide abstract] ABSTRACT: Introduction. Thyroidectomy creates a potential risk for all parathyroid glands and the recurrent laryngeal nerve (RLN). The identification and dissection of the RLN is the gold standard for preserving its function. In some cases, it may be quite difficult to identify the nerve localization. In such elusive locations, we aimed to identify RLNs using peroperative injection of a blue dye into the inferior thyroid artery. Materials and Methods. This study included 10 selected patients whose RLN identification had been difficult peroperatively during the period from April 2008 to June 2009. When the RLNs became elusive in location, the branches of the inferior thyroid artery (ITA) on the capsule of the thyroid lobe were isolated, and then 0.5 mL isosulphan blue dye was injected into the artery. Results. RLN was carefully dissected in the tracheoesophageal groove. RLN was clearly visualized, in all patients. All RLNs were identified along their course in the dyed surrounding tissue. No RLN palsy was encountered. Conclusion. The injection of blue dye into the ITA branches can be used as an alternate method in case of difficulty in identification of RLNs.
Journal of thyroid research. 01/2013; 2013:539274.
[Show abstract][Hide abstract] ABSTRACT: Background. The purpose of this study was to assess the factors that affect the false-negative outcomes of fine-needle aspiration biopsies (FNABs) in thyroid nodules. Methods. Thyroid nodules that underwent FNAB and surgery between August 2005 and January 2012 were analyzed. FNABs were taken from the suspicious nodules regardless of nodule size. Results. Nodules were analyzed in 2 different groups: Group 1 was the false-negatives (n = 81) and Group 2 was the remaining true-positives, true-negatives, and false-positives (n = 649). A cytopathologist attended in 559 (77%) of FNAB procedures. There was a positive correlation between the nodule size and false-negative rates, and the absence of an interpreting cytopathologist for the examination of the FNAB procedure was the most significant parameter with a 76-fold increased risk of false-negative results. Conclusion. The contribution of cytopathologists extends the time of the procedure, and this could be a difficult practice in centres with high patient turnovers. We currently request the contribution of a cytopathologist for selected patients whom should be followed up without surgery.
International Journal of Endocrinology 01/2013; 2013:126084. · 2.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Current indications for adrenalectomy include functional adrenal tumors and potentially malignant tumors based on imaging studies. We evaluated the effectiveness of magnetic resonance imaging (MRI) in obtaining a correct preoperative diagnosis. METHOD: Fifty-three patients with nonfunctional adrenal lesions were analyzed. Indications for adrenalectomy of nonfunctional adrenal lesions included > 6 cm in size and ≤ 6 cm in size with atypical characteristics on MRI. Lesions with a size of > 6 cm, local invasion, irregular margins, and chemical-shift imaging that demonstrated no loss of signal intensity on out-of-phase images were considered suspected of malignancy. RESULTS: Adrenal lesions of > 6 cm in size exhibited an 80-fold increased prediction of malignancy (OR:80; 95% CI 7.8-813), whereas irregular margins and local invasion exhibited a 45-fold (OR:45; 95% CI 6.4-312.5) and a 12-fold (OR:12; 95% CI 4.6-30.6) increased occurrence of malignancy, respectively. The loss of signal intensity did not affect the prediction of malignancy. CONCLUSION: The rate of unnecessary tumor resections that are < 6 cm in size can be decreased by performing adrenal biopsies in selected cases or by short-term follow-up to prevent the insufficiency of imaging techniques.
International Journal of Surgery (London, England) 12/2012; · 1.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: "Forgotten" goiter is an extremely rare disease which is defined as a mediastinal thyroid mass found after total thyroidectomy. PRESENTATION OF CASE: We report two cases with forgotten goiter. One underwent total thyroidectomy due to thyroid papillary cancer and TSH level was in normal range one month after surgery. The thyroid scintigraphy scan revealed mediastinal thyroid mass. The second case underwent total thyroidectomy due to Graves' disease and TSH level was low after surgery. At postoperative seventh year, patients were admitted to our Endocrinology Division due to persistent hyperthyroidism and CT scan revealed forgotten thyroid at mediastinum. Both patients underwent median sternotomy and mass excision, there was no morbidity detected after second surgical procedures. DISCUSSION: In the majority of cases forgotten goiter is the consequence of the incomplete removal of a plunging goiter. Although in some cases, it may be attributed to a concomitant, unrecognized mediastinal goiter which is not connected to the thyroid with a thin fibrous band or vessels. Absence of signs like mediastinal mass or tracheal deviation in preoperative chest X-ray do not excluded the substernal goiter. CONCLUSION: Retrosternal goiter should be suspected if the lower poles could not be palpated on physical examination and when postoperative TSH levels remained unchanged.
International journal of surgery case reports. 12/2012; 4(3):269-271.
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: Neurofibromatosis type 1 is a genetic disease characterized by neoplastic and non neoplastic disorders involving tissues of neuroectodermal and mesenchymal origin. Herein, we present a case with von Recklinghausen's disease, right adrenal heochromocytoma and multiple gastrointestinal stromal tumors. PRESENTATION OF CASE: A forty-eight year old male patient was admitted to our Emergency Department with melena. His physical examination revealed multiple neurofibromas all over the skin, kyphosis, multiple cafe au lait spots and Lisch nodules on the eye and, melena on digital rectal examination. Abdominal computerized tomography scan showed a mass on right adrenal gland and multiple soft tissue mass lesions between distal part of pancreas and small bowel. Adrenal mass was determined as a pheochromocytoma and small bowel lesions were verified as stromal tumors. DISCUSSION: In patients with NF1, pheochromocytomas and GISTs are well known neoplasms seen with increased incidence than the general population. CONCLUSION: In patients with NF1, any symptoms with other systems should be managed carefully for underlying malignity.
International journal of surgery case reports. 11/2012; 4(2):216-218.
[Show abstract][Hide abstract] ABSTRACT: Autopsy series have shown that metastasis to the thyroid gland has occurred in up to 24% of patients who have died of cancer. Neuroendocrine tumors may metastasize to thyroid gland.
Case 1 was a 17-year-old Turkish woman who was referred from our Endocrinology Department for a thyroidectomy for treatment of neuroendocrine tumor metastasis. She was treated with a bilateral total thyroidectomy. Histopathological examination results were consistent with a neuroendocrine tumor; neoplastic cells showed strong immunoreactivity to chromogranin A and synaptophysin, but the immunohistochemical profile was inconsistent with medullary thyroid carcinoma in that the tumor was negative for calcitonin, carcinoembryonic antigen, and thyroid transcription factor-1.Case 2 was a 54-year-old Turkish woman who presented with a 3-cm nodule on her right thyroid lobe. She had undergone surgery for a right lung mass four years previously. After a right pneumonectomy, thymectomy and lymph node dissection, a typical carcinoid tumor was diagnosed. Under ultrasonographic guidance, fine needle aspiration biopsy of her right thyroid pole nodule was performed and the biopsy was compatible with a neuroendocrine tumor metastasis. She was treated with a bilateral total thyroidectomy. Histopathological examination indicated three nodular lesions, 5 cm and 0.4 cm in diameter in her right lobe and 0.1 cm in diameter in her left lobe. The tumors were consistent with a neuroendocrine phenotype, showing strong immunoreactivity to chromogranin A and synaptophysin.
Thyroid nodules detected during follow-up of neuroendocrine tumor patients should be thoroughly investigated. A fine needle aspiration biopsy of the thyroid confirms the diagnosis in most cases and leads to appropriate management of those patients and may prevent unnecessary treatment approaches.
[Show abstract][Hide abstract] ABSTRACT: The etiology of postoperative hypocalcemia after total thyroidectomy appears to be multifactorial, that is, postoperative transient hypoparathyroidism, low 25-hydroxy vitamin D (25-OHD) concentrations, aging, and hyperthyroidism with increased bone turnover. Our aim was to evaluate the factors responsible for postoperative hypocalcemia in euthyroid vitamin D-deficient/insufficient Graves patients who underwent total thyroidectomy at our institution.
Thirty-five consecutive patients with Graves disease treated by total thyroidectomy were included in the present study. All patients were vitamin D deficient/insufficient (ie, 25-OHD concentrations of <20/<30 ng/mL, respectively). Patients were divided into 2 groups according to postoperative serum albumin corrected calcium concentrations: group 1 (n = 13) patients had postoperative serum calcium concentrations of 8 mg/dL or less; group 2 (n = 22) patients had serum calcium concentrations greater than 8 mg/dL. Bone turnover markers (deoxypiridinoline, bone-specific alkaline phosphatase) and 25-OHD were determined the day before surgery.
In group 1 patients, disease duration was significantly longer, 25-OHD and postoperative parathyroid hormone concentrations were significantly lower, and bone turnover markers were significantly higher. Logistic regression analysis revealed that a postoperative parathyroid hormone concentration less than 10 pg/mL was the most powerful parameter to predict postoperative hypocalcemia (odds ratio, 23; 95% confidence interval, 3.3-156).
In Graves patients with vitamin D deficiency/insufficiency, postoperative (transient) hypoparathyroidism is the most significant parameter to determine the development of postoperative hypocalcemia.
American journal of surgery 05/2011; 201(5):685-91. · 2.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Oxidative DNA damage, caused by either endogenous or exogenous sources of reactive oxygen species (ROS), has been linked several diseases including Graves' disease (GD). 7,8-Dihydro-8-oxoguanine (8-oxoG) is a major lesion produced by ROS and is considered a key biomarker of oxidative DNA damage. In humans, 8-oxoG is mainly repaired by 8-oxoguanine DNA N-glycosylase-1 (hOGG1), which is an essential component of the base excision repair (BER) pathway. The functional studies showed that hOGG1 Ser326Cys polymorphism is associated with the reduced DNA repair activity and increased risk for some oxidative stress-related diseases. In this study, we firstly investigated hOGG1 Ser326Cys polymorphism in GD. According to our results, Cys/Cys genotype frequency in the GD patients (23.4%) was significantly higher than the controls (9.2%). Cys/Cys genotype had an 3.5-fold [95% CI (confidence interval): 2.10-6.01, p < 0.001] the Cys allele had 1.83-fold (95% CI: 1.43-2.34, p < 0.001) increase in the risk for developing GD. Our results suggest that Ser326Cys polymorphism of the hOGG1 gene is associated with GD risk.
Cell Biochemistry and Function 04/2011; 29(3):244-8. · 1.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Visceral obesity is one of the main components of the metabolic syndrome (MetS). The retroperitoneal fat area (RFA) is part of the intraabdominal adipose mass. The aim of this clinical trial was to determine whether there is an association between the RFA measurement and MetS components in patients undergoing laparoscopic lateral transabdominal adrenalectomy.
The study population consisted of 61 consecutive patients who underwent laparoscopic adrenalectomy between January 2007 and June 2010 at the Istanbul Faculty of Medicine. Anthropometric, demographic, and biochemical parameters as well as cardiometabolic risk factors were recorded. The RFA was calculated using computed tomography.
The mean body mass index, waist circumference, and RFA in patients with MetS was significantly higher than that of the patients without MetS. There were positive correlations between RFA and central obesity (r=0.675, p=0.0001) and MetS (r=0.894, p=0.0001). The strongest correlation was observed between RFA and MetS. According to receiver operating characteristic analysis, RFA measurement correctly predicted MetS risk in 96% of patients and failed in only 4%.
Our findings indicate that measurement of the RFA may provide a safe, easy assessment of its metabolic risk.
World Journal of Surgery 03/2011; 35(5):986-94. · 2.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Retrosternal goiter incidence rates range between 0.2% and 45% of all goiters, and sternotomy is performed in some of patients. There is no consensus for selecting the patients on whom sternotomy should be performed. We aimed to determine the most important factor for predicting requirement of sternotomy.
This prospective study included 260 patients with retrosternal goiter. The clinical symptoms, history of previous thyroidectomy, presence of tracheal deviation, tracheal compression, site of mediastinal extension, thyroid tissue density, findings of intubation, type of surgical approach, histologic findings of thyroid, weight of thyroid, and postoperative complications were evaluated.
Thyroid tissue density, posterior location, and subcarinal extension were found to be independent factors for predicting requirement of sternotomy. The risk for sternotomy increased 47-fold for patients with harder thyroid tissue density (OR: 47.3; 95% CI: 5.8-385.70), 20-fold for patients with subcarinal extension (OR: 20.5; 95% CI: 2.5-168), and 10-fold for patients with posterior location (OR: 10.5; 95% CI:1.8-60).
Thyroid tissue density was defined the strongest predictive factor for requirement of sternotomy. Preoperatively obtained information thyroid tissue density can be useful for surgical strategy.
Journal of Surgical Research 02/2011; 174(2):312-8. · 2.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Several methods have been recommended to detect parathyroid lesions in patients who have previously undergone neck surgeries, including radio-guided surgery or intraoperative ultrasounds. In this study, we aimed to investigate whether the radio-guided excision of pathologic parathyroid lesions allowed us to find affected lesions in patients who had previously undergone neck operations.
This prospective study included 18 patients with primary hyperparathyroidism who had previously undergone neck surgeries. The pathologic parathyroid lesions were localized by ultrasonography, and a radiotracer was injected directly into the lesions.
Careful dissections were carried out by following the area of maximum radioactivity until the lesions were identified and excised. Eighteen parathyroid adenomas were removed in 18 patients. The median count from each lesion was significantly higher than the values measured from the adjacent tissues and the lesion beds (12550/20 s, 370/20 s, and 35/20 s, respectively; p < 0.001).
Radio-guided excision of parathyroid lesions can be performed safely for re-operative parathyroid surgery.
International Journal of Surgery (London, England) 02/2011; 9(4):339-42. · 1.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim was to investigate whether or not glutamine, an antioxidant effective amino acid, improves the reperfusion-induced oxidative injury of abdominal hypertension.
Wistar Albino rats were used. Group 1: Abdominal compartment syndrome alone: With the rats under anesthesia, intraabdominal pressure was obtained. Three days later, the rats were sacrificed, and intestine, lung and liver samples were removed for determination of tissue malondialdehyde (MDA) and glutathione (GSH) levels as oxidative injury parameters and of myeloperoxidase (MPO) activity as an inflammatory parameter. Trunk blood was analyzed for the alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Group 2: Abdominal compartment syndrome and glutamine: intragastric glutamine was given for seven days before and three days following establishment of the abdominal compartment syndrome model. The same examination procedure was then performed. Group 3: Glutamine administration alone. Group 4: Control group.
Intraabdominal pressure significantly increased the intestine, lung and liver MDA levels and MPO activities in comparison to the control group. Glutamine was associated with decreased MDA levels and MPO activities and increased GSH levels.
Glutamine appears to have protective effects against reperfusion-induced oxidative damage via its anti-inflammatory and antioxidant effect.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 01/2011; 17(1):1-8. · 0.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Better follow-up of patients with papillary thyroid cancer (PTC) and more sensitive detection leads to detection of recurrences in the neck. Despite excellent outcomes, the major challenge is controlling locoregional recurrence. We aimed to investigate whether the radio-guided excision of metastatic lymph nodes makes it possible to find the affected lymph nodes in patients with previously operated neck compartments.
This prospective study included 46 patients with recurrent/persistent PTC who had previously undergone operation of the neck compartment. Prior to operation, the pathologic node was localized by ultrasound (US) and radiotracer ((99m)Tc-labeled rhenium colloid) was injected directly into the pathologic node. Careful dissection was carried out following the area of maximum radioactivity until the metastatic lymph node(s) were identified and excised.
One affected lymph node was removed in 17 patients, and more than one lymph node (affected or additional nodes) was removed in 29 patients. The median count from the lesion was significantly higher than values from the lesion bed (background activity) (16,886 counts/20 s versus 52 counts/20 s; p < 0.001). During follow-up, four patients were lost to follow-up and 27 patients had negative US and basal thyroglobulin (Tg). Five patients had suspicious lymph nodes on the operated side. Although the basal Tg level remained above the normal limit, moderately high in 8 patients, no metastases were detected in the neck.
Radio-guided excision of metastatic lymph nodes can be performed safely for the detection and excision of recurrent thyroid cancer in the central and lateral neck.
World Journal of Surgery 11/2010; 34(11):2581-8. · 2.23 Impact Factor