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Parathyroid adenoma is the most common cause of primary hyperparathyroidism and rarely reaches huge sizes. As the gland enlarges it may exhibit atypical morphology and extension to the mediastinum which may complicate the excision of the tumor while preserving the capsular integrity. We present a 35-year-old male patient who was referred to our department with a complaint of severe hypercalcemia. Neck ultrasound and parathyroid scintigraphy revealed an adenoma of 45x25 mm in size in the left parathyroid lobe extending to the retrosternal area. The patient underwent an uneventful parathyroidectomy. The patient remained well with no evidence of biochemical recurrence during the 4-year follow-up. Here, we presented a very original case of one of the largest parathyroid adenomas (8 cm) with atypical configuration (having multiple spicular extensions from the main body) ever reported in the literature which was completely retrieved from the posterior mediastinum via cervical route. [ABSTRACT FROM AUTHOR]

Von Hippel--Lindau (VHL) disease is an autosomal dominant syndrome and affects many organs. We aim to report an adult patient with VHL disease having bilateral adrenal pheochromocytoma and multiple neuroendocrine tumors of the pancreas who was successfully treated with simultaneous function-preserving adrenalectomy and pancreatectomy. A 27-year-old woman was admitted to hospital with hypertension. The computed tomography of the abdomen revealed a solid tumor in both adrenal glands with the sizes of 12x7 cm on the right and 4x4 cm on the left. She also had two pancreatic solid masses in the head and three in the tail with varying sizes. The laboratory tests are all within normal limits except elevated 24-hour urinary metanephrine and normetanephrine. I-123 MIBG scanning showed increased uptake in both adrenal glands. Fine needle aspiration biopsy of the tumor on head of pancreas via endoscopic ultrasonography showed neuroendocrine tumor. Those findings were compatible with bilateral pheochromocytoma and multiple pancreatic neuroendocrine tumors and genetic tests revealed the mutation which confirmed the diagnosis of VHL disease. After suppression with alpha-1 inhibitor, right total, left cortical-sparing adrenalectomy, Whipple procedure for the pancreatic head lesions and spleen-preserving distal pancreatectomy were performed and pancreatic corpus was preserved. This case showed that multiple function-preserving procedures can be safely performed with oncological principles in patients with VHL disease. [ABSTRACT FROM AUTHOR]

Background/aim: Accurate preoperative localization of the culprit gland is the key point for the surgical treatment of primary hyperparathyroidism. Conventional imaging techniques (ultrasound and Tc99m sestamibi scintigraphy) are usually adequate for preoperative localization. However, in some patient groups, additional imaging modalities may be required since noninvasive techniques may fail. In this study, we aimed to evaluate the diagnostic value of selective parathyroid venous sampling in patients with unclear noninvasive localization tests. Materials and methods: Among 513 cases who underwent parathyroidectomy due to primary hyperparathyroidism, twelve cases (2.3%) were undergone selective parathyroid venous sampling and were included in the study. Age, sex, presenting symptom, presence of a genetic disease, medical and surgical history, serum calcium (Ca)-parathormone (PTH) levels (preoperative, intraoperative, and postoperative), imaging reports (US, SM, and SVS), surgery reports, pathology reports, and complications were retrospectively reviewed. Results: Seven cases (58.3%) had persistent primary hyperparathyroidism and one patient (8.3%) had past surgical history of total thyroidectomy. The remaining four patients (33.3%) had no previous neck surgery. The sensitivity of selective venous sampling was 75%. According to the medical history, accurate localization was achieved in 85.7% of persistent cases and 60% of primary cases. Eight cases (66.6%) underwent unilateral neck exploration and four cases (33.3%) underwent four gland exploration. A single adenoma was detected in ten cases (90.9%) while one patient (9.1%) had double adenoma. Conclusion: Selective venous sampling is a prominent technique with high accuracy in persistent cases when the conventional imaging methods are negative or equivocal. Although the cost and invasiveness are the most common confusing facts about selective venous sampling, its benefits such as improving the surgical success and saving the patients from repeated operations may surpass them. [ABSTRACT FROM AUTHOR]

Objectives: Although cervical incisions are usually sufficient in mediastinal located thyroid and parathyroid pathologies, sometimes mediastinal approaches are required. In recent years, less invasive methods have been used instead of median sternotomy. In this study, the adequacy of the incision and morbidity in patients who underwent split sternotomy due to retrosternal goiter (RG) and mediastinal parathyroid pathology in our clinic were investigated. Methods: The files of patients who underwent split sternotomy in addition to cervical incision or split sternotomy extending from the sternal notch to the third intercostal space with a separate vertical incision due to retrosternal thyroid pathology or mediastinal ectopic parathyroid adenoma between January 2010 and January 2021 were retrospectively reviewed. Operative success, exposure provided by split sternotomy, and complication rates were investigated. Results: Twelve patients who underwent split sternotomy were included in the study. The mean age of the patients was 57.25±12.62 (44-83) years. Eight (66.7%) of the patients were female and 4 (33.3%) were male. The indication for surgery was multinodular goiter (MNG) in 3 (25%) patients, recurrent MNG in 3 (25%) patients, hyperparathyroidism in 3 (25%) patients, and thyroid cancer in 3 (25%) patients. Transient hypocalcemia in 6 (50%) patients and unilateral vocal cord paralysis in 1 (8.3%) patient developed postoperatively, and all complications resolved spontaneously in an average of 3 weeks. Median sternotomy was not required for any of the patients. Conclusion: Split sternotomy is an adequate and applicable method for the success of the surgery in RG and mediastinal parathyroid pathologies that cannot be excised with the cervical approach. [ABSTRACT FROM AUTHOR]

Background: Liver is one of the most frequently injured organs in abdominal trauma. However, there are still many controversies in its management. Purpose: We aimed to evaluate the clinical presentation and management of the patients with liver trauma. Methods: This is a retrospective study on patients with liver trauma admitted between 2012 and 2020. Demographic data, vital signs, type of trauma, laboratory findings, imaging findings, grading according to AAST scoring, surgical techniques, morbidity and mortality were evaluated. Results: Of the 100 patients included in the study, 77 (77%) were male and 23 (23%) were female. 51 (51%) of these patients were treated non-operatively and 49 (49%) were treated operatively. While 3.9% of non-operatively managed patients became excitus, 8.1% of operative patients became excitus. Conclusion: As a result; currently, the most effective factor in the decision-making process concerning the management of liver trauma is the patient's hemodynamic status. Although non-operative management is getting widespread in blunt traumas, operative treatment is still more preferred in penetrating traumas. In order to spread non-operative management in liver traumas, in addition to conventional equipment, hybrid operating rooms that allow angiographic and endovascular interventions should be established in regional trauma centers and trauma centers. [ABSTRACT FROM AUTHOR]

Background: Cholecystectomy is one of the most commonly performed surgical procedures. However, it may result in some unpleasant conditions such as bile duct injury (BDI), bile leak, and vessel injury. Subtotal cholecystectomy (SC), which has been introduced as an alternative method for reducing the complication rates, has been reported to have lower risk of BDI when compared to total cholecystectomy. This study aimed to evaluate the indications for SC, its early and late complications and their management, and the risk factors affecting the bile leak. Methods: Fifty‐seven patients who underwent SC were included in the study, and their medical records were retrospectively reviewed. Results: Thirty‐three patients were male (57.9%) and the mean age was 64.84 ± 11.35 (range: 29‐86). All patients had at least one episode of cholecystitis. Forty‐seven (82.5%) patients underwent surgery under emergency conditions. Postoperative bile leak/fistula, surgical site infection, and fluid collection were developed in 12 (21.1%), eight (14%), and six (10.5%) patients, respectively. Leaving the remnant tissue pouch open, presence of comorbidity and emergency operative condition were found to increase the risk of leak development (P <.001). During the average follow‐up of 49 months (range: 13‐98), symptomatic choledocholithiasis, symptomatic gallstones in the remnant tissue, and incisional hernia were detected within the first year of surgery in three (5.3%), four (7%), and seven (12.3%) patients, respectively. Conclusions: Although SC is not an equivalent to total cholecystectomy, its vital benefit of lowering the risk of BDI should be considered in difficult cases. [ABSTRACT FROM AUTHOR]

The importance of oncologic principles in colorectal cancer has been particularly emphasized in recent years. There are several studies on the quality of the conditions of emergency surgery and comparison of stage, mortality and morbidity rates between patient who underwent emergency and elective surgery. This study aimed to investigate and compare the clinicopathologic characteristics of patients with colorectal cancer according to their surgical conditions whether urgent or elective. Medical records of 564 patients, who underwent colorectal resection between January 2011 and March 2017 anddiagnosed with colon/rectum adenocarcinoma after pathological examination, were investigated retrospectively. There were 104 (18.4%) patients in the emergency surgery group and 460 (81.6%) patients in the elective surgery group. Majority of the patients were male61.2%, and the mean age was 64.27. The patients who had rectal tumor were 19.7% of all cases, and the tumor was located in colonic segments in the remaining 80.3%. Low anterior resection was determined as the most common procedure with the percentage of 23.2%. Anterior resection was the most common procedure in emergency surgery group (27.9%). There was no significant difference between the mean lymph node count in terms of the type of the operation, on the basis of surgical condition. When the factors such as age, gender, tumor location, type of the operation and stage of cancer that have effects on adequate lymph node dissection, were analyzed; the only statistically significant difference was found between emergency and elective cases of the transverse colon tumors (p<0.05). While postoperative complications had no effect on the length of hospital stay, having an ostomy and an advanced cancer found to be prolonging this duration (p<0.05). Surgical conditions have been shown to not affect the lymph node dissection which is an important factor determining the oncological process of the patient. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To evaluate the caries experience, oral hygiene status and oral health knowledge of a group of visually impaired students.Materials and Methods: The study was conducted at one of the largest visually impaired children's schools among students aged between 7 and 16 years (n = 178) in Istanbul, Turkey. A 16-item questionnaire was asked in addition to a clinical tooth examination. The 16-item verbal questionnaire was developed to record the students' general health, impairment, the socioeconomic profile and education level of their parents, oral health knowledge, sources of information about oral health and oral hygiene habits. Oral hygiene was assessed according to Greene and Vermillion's Simplified Oral Hygiene Index (OHI-S). To measure the oral hygiene status, OHI-S index scores were recorded. Additionally, DMFT and dft indices were documented.Results: Only 26.40% of children were caries free, and only 2.2% of students had good oral hygiene. A total of 3.3% of these students were mildly retarded and 2.8% of them had a developmental disability. Visually impaired children exhibited a fair-to-poor level of oral hygiene.Conclusion: Maintenance of oral hygiene remains the greatest challenge in the care of visually impaired children. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Non-traumatic intramural hematomas of the small bowel (IHSB) are rare conditions which occur due to anticoagulant therapy. In this study, we aimed to explain our clinical approach to non-traumatic IHSB due to anticoagulant overdose and to present the long-term outcomes of the cases who were hospitalized. Methods: Sixteen patients with non-traumatic IHSB were included and their medical records were retrospectively reviewed. Results: Our patients included ten women and six men, with a mean age of 77.5 ± 8.4 (range: 65-95) years. All patients had been using oral anticoagulants (OACs) due to various cardiovascular and cerebral comorbidities. Common complaints at the time of admission included abdominal pain, vomiting and weakness. Ten patients (62%) had anemia, fifteen (94%) had leukocytosis and all patients (100%) had high levels of C-reactive protein (CRP). Abdominal computed tomography (CT) established the final diagnosis of IHSB in all patients. Fourteen patients (87%) were followed up with conservative therapy. Since the clinical course did not improve in two patients (12%), surgery was mandated. The mean duration of hospitalization was 10.25 ± 3.6 days (range: 3-17 days). Mortality occurred in two patients (12%). Conclusion: IHSB should be considered in patients presenting with abdominal complaints and increased levels on coagulation tests. The diagnosis should be confirmed by abdominal CT scan, if possible. Accurate and timely diagnosis allows patients to be successfully treated without need for surgery. [ABSTRACT FROM AUTHOR]