[Show abstract][Hide abstract] ABSTRACT: Although, there are studies in the literature having shown the feasibility and safety of laparoscopic adrenalectomy, there are still debates for tumour size and the requirement of the minimal invasive approach. Our hypothesis was that the use of laparoscopy facilitates minimally invasive resection of large adrenal tumours regardless of tumour size.
Within 7 years, 149 patients underwent laparoscopic adrenalectomy at one institution. The patients were divided into two study groups according to tumour size. Group 1 included patients with adrenal tumours smaller than 5 cm and group 2 included larger than 5 cm. Patient demographics and clinical parameters, operative time, complications, hospital stay and final pathology were analysed. Statistical analyses of clinical and perioperative parameters were performed using Student's t-test and Chi-square tests.
There were 88 patients in group 1 and 70 in group 2. There were no significant differences between study groups regarding patient demographics, operative time, hospital stay, and complications. Estimated blood loss was significantly higher in group 2 (P = 0.002). The conversion to open rate was similar between study groups with 5.6% versus 4.2%, respectively. Pathology was similar between groups.
Our study shows that the use laparoscopy for adrenal tumours larger than 5 cm is a safe and feasible technique. Laparoscopic adrenalectomy is our preferred minimally invasive surgical approach for removing large adrenal tumours.
Journal of Minimal Access Surgery 07/2015; 11(3):184-6. DOI:10.4103/0972-9941.144091 · 0.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report a 32-year-old patient who underwent laparoscopy with classical symptoms and signs of acute appendicitis. An inflamed, edematous and non-perforated appendix, also a large amount gelatinous ascites, omental and peritoneal implants were seen. Appendectomy performed and multiple biopsies were taken from omentum and peritoneum for definitive diagnosis. Histopathogic diagnosis was a metastatic gastric signet-ring cell carcinoma (GSRCC) involving appendix and other specimens. A flat lesion involving corpus to antrum was diagnosed by gastroscopy and GSRCC was verified histopathologically in a tertiary centre and the case evaluated as Stage IV gastric carcinoma. This case with no sign of gastric cancer was presented as an acute appendicitis. Metastatic carcinoma to the appendix, causing acute appendicitis is extremely rare in clinical practice and usually associated with high morbidity and mortality.
Turkish Journal of Surgery 04/2015; DOI:10.5152/UCD.2015.2863
[Show abstract][Hide abstract] ABSTRACT: Background:
Seroma formation is the most frequent postoperative complication after axillary dissection for breast surgery with an incidence of 10 - 50 %. This prospective clinical randomized study was carried out to evaluate the Ligasure vessel sealing system and its effect on seromaformation and other complications for axillary dissection.
Between January 2006 and November 2007, the patients with histopathological diagnosis of breast cancer were analysed prospectively. The patients with positive sentinel lymph node biopsy or clinical axillary involvement were included in the study, and the patients who underwent neoadjuvant therapy or using anticoagulants have been excluded from the study. Patients were divided into two study groups.Axillary dissection was performed in the first group by LigaSure and in the second group by linking and electrocautery.
There were a total of thirty three patients with a mean age of 51.4 +- 13.7. In group one, mean age of patients was 54.1 +- 13.2 and 48.68 +- 14.1 in group two. There was no significant statistical difference between the groups regarding age, body mass index, excised tissue weight,tumour size and number of excised lymph nodes. The use of Ligasure reduced drainage amount and duration of drain till removal, but increased operative time.
There were no significant differences between study groups regarding the complications. LigaSure electrothermal bipolar vessel sealing system can be safely used in axillary dissection 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.
Turkish Journal of Surgery 08/2014; 2014. DOI:10.5152/UCD.2014.2859
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to consider levels of the proinflammatory cytokines IL-1 and TNFα after thyroid surgery.
A total of 200 patients who underwent total thyroidectomy enrolled in this study. Drain fluid samples were taken. IL-1 and TNFα results and their relationship with other factors were analyzed.
There was a positive correlation between IL-1 and hyperthyroidism (rs=0.614, p<0.001), operative time (rs=0.770, p<0.001), and excised thyroid volume (rs=0.829, p<0.001). Moreover, there was a positive correlation between TNFα and hyperthyroidism (rs=0.430, p<0.001), operative time (rs=0.392, p<0.001), and excised thyroid volume (rs=0.398, p<0.001).
The results of this study showed us that the parameters related to increased proinflammatory cytokine levels after thyroid surgery were hyperthyroidism, operative time, and excised thyroid volume, but this increase did not show us any clinical outcomes related to these parameters.
Turkish Journal of Surgery 06/2014; 30(2):80-84. DOI:10.5152/UCD.2014.2484
[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: 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 06/2013; 2013:126084. DOI:10.1155/2013/126084 · 1.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: . 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.
. 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.
. 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(4):539274. DOI:10.1155/2013/539274
[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.
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.
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.
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; 11(2). DOI:10.1016/j.ijsu.2012.12.014 · 1.53 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.
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.
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. DOI:10.1016/j.ijscr.2012.11.014
[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.
In patients with NF1, pheochromocytomas and GISTs are well known neoplasms seen with increased incidence than the general population.
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. DOI:10.1016/j.ijscr.2012.10.024
[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.
Journal of Medical Case Reports 02/2012; 6:73. DOI:10.1186/1752-1947-6-73
[Show abstract][Hide abstract] ABSTRACT: Objective: Sildenafil is a phosphodiesterase 5 (PDE5) inhibitor that induces vasodilatation and is currently used in treatment of erectile dysfunction and pulmonary hypertension. The aim of this study was to investigate the effects of sildenafil on the regenerative activity of skeletal muscle adjacent to the abdominal wall wound in rats. Material and Methods: This study was conducted in Aegean University Faculty of Medicine Animal Research Laboratory between July 2008 and August 2008, and was performed with adult female Wistar-Albino rats. A control group (n= 50) was fed on a standard laboratory diet until 12 h before surgery. The study group (n= 50) was administered sildenafil therapy (10 mg/kg once a day for 10 days) through an orogastric tube. Each rat was anesthetized, and a 4-cm-long midline laparotomy was performed. Ten animals from each group were killed at postoperative days (PODs) 4, 7, 14, 21, and 35. The abdominal incision wounds and surrounding tissues were examined histologically. Results: Regenerative capacity of the abdominal muscle in sildenafil treatment group was significantly higher than the control group and the difference was statistically significant (p <= 0.01). Conclusion: This study showed that sildenafil augmented the regenerative activity of the skeletal muscle. If this result can be reproduced by other studies, sildenafil may be beneficial therapy for degenerative muscle diseases.
Turkiye Klinikleri Journal of Medical Sciences 08/2011; 31(4):809-815. DOI:10.5336/medsci.2010-17822 · 0.10 Impact Factor
[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. DOI:10.1016/j.amjsurg.2010.04.030 · 2.29 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. DOI:10.1002/cbf.1742 · 2.01 Impact Factor