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Aim: The purpose of the study was to investigate the effective prognostic factors on recurrence and mortality in patients with differential thyroid cancer. Material and Methods: The effects of various parameters of demographic characteristics, the admission symptoms, physical examination, laboratory findings, pathological examination, and surgical method of 184 patients, who underwent surgery due to differential thyroid cancer between January 1986 and December 2009 in 4th General Surgical Clinic of Ankara Numune Training and Research Hospital, on prognosis were examined. The information of the patients was obtained from automation system of the hospital and Thyroid Cancer Information and Follow-Up Form of 4th General Surgical Clinic of Ankara Numune Training and Research Hospital. Results: The sample group consisted of 172 papillary cancer patients and 12 follicular cancer patients. The mean age of the patients was 45.4 years (15-78). There were 159 (86.4%) female patients and 25 (13.6%) male patients. The mean follow-up period of 161 (87.5%) patients, who were followed up regularly, was 73.26 months (1-231). The mean recurrence period was 77.66 months (1-150). Mortality was observed in eight (4.3%) patients during their follow-up period. The mean life expectancy of those who died was 66.87 months (1-150 months).*. Single variable analysis revealed that the T stage and pathologic final stage were effective on recurrence. Painful nodules and palpable lymph nodes in the neck and the papillary histological malignant subtype variant, as well as the presence of vascular and adjacent organ invasion, multicentricity, T stage, the lymph nodes, distant metastasis, and the clinical stage during the admission were identified to be effective on mortality. Conclusion: The risk of recurrence is high in DTC patients with high T stage and advanced pathologic stage. The rate of survival of those with multicentric tumors and advanced pathologic stage is low. Therefore, it is important for patients to be followed up closely within a postoperative multidisciplinary context. [ABSTRACT FROM AUTHOR]

Background: Hepatic ischemia–reperfusion injury may lead to remote organ failure with mortal respiratory dysfunction. The aim of the present study was to analyze the possible protective effects of methimazole on lungs after hepatic ischemia–reperfusion injury. Methods: Forty male Wistar albino rats were randomized into five groups: a control group, in which bilateral pulmonary lobectomy was done; a hepatic ischemia–reperfusion group, in which bilateral pulmonary lobectomy was done after hepatic ischemia–reperfusion; a thyroidectomy–ischemia–reperfusion group (total thyroidectomy followed by, 7 days later, bilateral pulmonary lobectomy after hepatic ischemia–reperfusion); a methimazole–ischemia–reperfusion group (following methimazole administration for 7 days, bilateral pulmonary lobectomy was done after hepatic ischemia–reperfusion); and a methimazole +l-thyroxine–ischemia–reperfusion group (following methimazole andl-thyroxine administration for 7 days, bilateral pulmonary lobectomy was performed after hepatic ischemia–reperfusion). Pulmonary tissue specimens were evaluated histopathologically and for myeloperoxidase and malondialdehyde levels. Results: All of the ischemia–reperfusion intervention groups had higher pulmonary injury scoring indices than the control group ( P < 0.001). Pulmonary injury index of the ischemia–reperfusion group was higher than that of both the methimazole-supplemented hypothyroid and euthyroid groups ( P = 0028; P = 0,038, respectively) and was similar to that of the thyroidectomized group. Pulmonary tissue myeloperoxidase and malondialdehyde levels in the ischemia–reperfusion group were similar with that in the thyroidectomized rats but were significantly higher than that in the control, and both the methimazole-supplemented hypothyroid and euthyroid groups. Conclusion: Methimazole exerts a protective role on lungs during hepatic ischemia–reperfusion injury, which can be attributed to its anti-inflammatory and anti-oxidant effects rather than hypothyroidism alone. [ABSTRACT FROM AUTHOR]

Objective: To compare primary repair and grafting with one of two materials (one biological human dura mater, and one synthetic polypropylene mesh) or autologous skin, with primary repair alone in abdominal wall hernias in rats. Design: Randomised experiment. Setting: Teaching hospital, Turkey. Animals: 72 male Wistar albino rats randomised into 4 groups of 18 rats each. These were further randomly divided into subgroups of 6 each that were killed on days 15, 30, and 45 postoperatively. Interventions: Each test material was sutured to the abdominal wall by an onlay technique. Main outcome measures: Macroscopic and microscopic appearance, and strength of the abdominal wall. Results: Macroscopically, dura mater grafts lost their original shape, but polypropylene and skin did not. When completely incorporated the skin grafts had developed a new fascia. Dura mater and polypropylene induced a pronounced inflammatory reaction at all three times postoperatively, and there were significantly more fibroblasts in the dura mater group on days 15 and 30, and in the skin graft group on day 45, than in the other groups (p < 0.05). Mechanical resistance and mean breaking strength were significantly greater in the skin graft group than in the other groups at all times tested (p < 0.05). Conclusion: Full thickness autologous skin grafts were stronger than both human dura mater and polypropylene mesh when used to reinforce primary repairs of abdominal wall hernias in rats. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of truncal ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy on the incidence of hypocalcaemia after thyroidectomy. :Design: Prospective non-randomised study. :Setting: Teaching hospital, Turkey. :Subjects: 216 patients who had bilateral subtotal thyroidectomy for non-toxic nodular goitre between 1990 and 1996. :Interventions: The trunk of the each inferior thyroid artery was simply ligated during bilateral subtotal thyroidectomy. :Main outcome measures: Clinical examination, and measurement of serum calcium, ionised calcium, and inorganic phosphate concentrations before and after operation. :Results: Four patients (2%) had low concentrations of total and ionised calcium during the postoperative period. On physical examination three of them had spasms of the facial nerve, as seen in tetany. They were given calcium supplements orally and their laboratory results returned to reference ranges within 180 days. No patients developed permanent hypocalcaemia. :Conclusion: Truncal ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy has no effect on the incidence of hypocalcaemia after thyroidectomy. [ABSTRACT FROM AUTHOR]

Presents a case report which examined primary hydatid disease of the pancreas. Description of hydatid disease; Difficulties in the diagnosis of hydatid cysts; Information on the treatment for hydatid disease.

Background: To identify the preoperative factors predicting resectability in periampullary neoplasms., Methods: Twenty-three different parameters representing the clinical, laboratory and radiological data of 65 patients, who were operated for periampullary neoplasms, were analyzed to determine their value in assessing neoplasm resectability. Coefficients were calculated by Cox regression analysis for significant factors. A scoring system was designed for resectability. All patients were divided into 4 groups according to their scores., Results: Twenty-six patients who had a resectable neoplasm underwent pancreatico-duodenectomy and surgical palliation was performed in the remaining 39 patients. After multivariate analysis, neoplasms larger than 4.5 cm, low leukocyte count (<9500/mm3), high bilirubin levels (>137.5 micromol/L) and tomographic findings indicating neoplasm invasion were found to be independent factors predicting resectability. The score range was between 0 and 12. Patients were grouped as Group-1 (total score 0-2), Group-2 (total score 3-5), Group-3 (total score 6-8), and Group-4 (total score 9 and higher). Resectability rates were 100% in Group 1 (n=13), 44% in Group-2 (n=23), 21% in Group-3 (n=14), and 0% in Group-4 (n=15), respectively. Mean score was 3.3 in patients with resectable lesions and 7.2 in patients with unresectable lesions (p<0.001)., Conclusion: This simple scoring system can be a guide in the management plans of patients with periampullary neoplasms. By using this scoring system, patients with an unresectable neoplasm can be predicted and most unnecessary laparotomies can be avoided (Tab. 3, Fig. 2, Ref. 27). Full Text (Free, PDF) www.bmj.sk.

Background: Pulmonary nodule in patients with breast cancer is a difficult problem and constitutes a therapeutic challenge. This study questioned the significance of solitary pulmonary nodule in breast cancer patients and compared the survival with patients who had normal thorax tomography., Methods: There were 58 breast cancer patients included in the study. From these, 28 patients had normal preoperative tomography (group 1), and 30 patients had pulmonary nodule less than 1 cm on thorax tomography (group 2). Chi-square and Fisher tests were used for comparisons and Kaplan-Meier test for survival., Results: Stage, tumour size, treatment, histology, lymph node involvement, adjuvant therapy, were similar in both groups. We did not find a significant difference in disease-free and overall survival rates, between two groups., Conclusions: For the nodules that show benign properties at tomography, there is no need to do further investigation and no need to change treatment plan in breast cancer patients (Tab. 2, Fig. 2, Ref. 12). Full Text (Free, PDF) www.bmj.sk.

Background: In this study, scald burns in a Turkish population (0-16 years of age) were studied with reference to their occurrence and common causes., Methods: Of the burn victims hospitalized at the Burns Unit of Ankara Numune Education and Research Hospital between April 2001 and December 2003, 354 patients were aged 3 months to 16 years and 228 (64.4%) were male., Results: When burn causes were examined, scald burns were the primary type, reported in 77.7% (275) of the patients (p < 0.001). Scalds were the most frequent burn agents in the pediatric population. Tea is a traditional beverage in Turkey. It is consumed especially at breakfast and throughout the day until late at night. Tea in Turkey is steeped and brewed for consumption. As brewing and steeping is a time-consuming process and the tea is served hot, the appropriate level of care regarding the hot tea is neglected. Consequently, tea carries a serious potential to cause burns in this country. Of the scalded children, 93 scald burns (33.8%) were due to the tea itself or to the boiling water used in steeping tea, and 87.1% of these children were preschoolers. The mortality rate was 7.1% in the hospitalized children group., Conclusion: Traditional behaviors may sometimes have some serious unexpected consequences. In households where family members tend to ignore an ongoing problem, governmental and non-governmental organizations should consider taking preventive measures to protect the children from the devastating consequences of such negligence.

Background: Advantages of laparoscopic cholecystectomy (LC) such as less pain and short hospital stay make it the treatment of choice for cholelithiasis. There are limited data about LC under spinal anesthesia. This study was designed to evaluate LC under spinal anesthesia., Methods: Twenty-nine patients underwent surgery for LC under spinal anesthesia at the 4th Department of Surgery of the Ankara Numune Education and Research Hospital between April 2005 and January 2006. All patients were informed about spinal anesthesia in detail. The patients also were informed about the risk of conversion to general anesthesia, and all patients provided informed consent. The election criteria for spinal anesthesia were as follows: American Society of Anesthesiologists (ASA) risk group 1 or 2; risk score for conversion from LC to open cholecystectomy (RSCO) less than negative 3; and presence of gallstone disease. Standard laparoscopic technique was applied to all patients. Simple questionnaire forms were developed for both patients and surgeons to provide comments about the operation., Results: The operation was completed laparoscopically on 26 patients, while 3 patients needed general anesthesia due to severe right shoulder pain. None of the patients had cardiopulmonary problems other than transient hypotension during surgery. Intravenous fentanyl (25 microg) was needed in 13 patients due to severe right shoulder pain. Five patients still had severe shoulder pain after fentanyl injection. Local washing of the right diaphragm with 2% lidocaine solution was successful in the remaining 5 patients in whom fentanyl injection failed to stop the pain. All of the patients' answers to the questions regarding the comfort of operation were "very well" at the 1-month postoperative evaluation. All surgeons stated that there was no difference from LC under general anesthesia., Conclusions: All of the patients and surgeons were satisfied with LC under spinal anesthesia. Therefore, LC under spinal anesthesia may be an appropriate treatment choice to increase the number of patients eligible for outpatient surgery.

The treatment strategy of an incidentally detected thyroid nodule is controversial. The aim of this study was to establish management criteria for thyroid incidentalomas by defining and formulating the risk factors predicting thyroid malignancy. A prospective database containing 815 consecutive patients who underwent a thyroidectomy for nodular thyroid disease, between January 1992 and May 2003, was studied. Multivariate analyses demonstrated that the independent clinical predictors of malignancy were a fixed nodule and cervical lymphadenopathy on palpation, a euthyroid patient, and a patient age <23 years or >45 years; and independent nodule features significantly associated with malignancy were punctuate calcifications, irregular nodule margin, solid appearance on ultrasonography, and solitary nodule in an euthyroid patient. Using the regression coefficients of four independent ultrasound (US) features, a malignancy risk score of a nodule was calculated as follows. Depending on the score of a thyroid nodule, a simple follow-up, a US-guided fine needle aspiration biopsy or a thyroidectomy, may be offered for management.

Background/aims: The aim of this study was to evaluate local effects and degree of bacterial translocation related with intestinal ischemia-reperfusion injury in a rat obstructive jaundice model., Methodology: Thirty adult Sprague-Dawley rats (200-250 g) were divided into three groups; including Group 1 (jaundice group), Group 2 (jaundice-ischemia group) and Group 3 (ischemia group). All rats had 2 laparotomies. After experimental interventions, tissue samples for translocation; liver and ileum samples for histopathological examination, 25 cm of small intestine for mucosal myeloperoxidase and malondialdehyde levels and blood samples for biochemical analysis were obtained., Results: Jaundiced rats had increased liver enzyme levels and total and direct bilirubin levels (p<0.05). Intestinal mucosal myeloperoxidase and malondialdehyde levels were found to be high in intestinal ischemia-reperfusion groups (p<0.05). Intestinal mucosal damage was more severe in rats with intestinal ischemia-reperfusion after bile duct ligation (p<0.05). Degree of bacterial translocation was also found to be significantly high in these rats (p<0.05)., Conclusions: Intestinal mucosa is disturbed more severely in obstructive jaundice with the development of ischemia and reperfusion. Development of intestinal ischemia-reperfusion in obstructive jaundice increases bacterial translocation.

Background/aims: This study was planned to investigate the therapeutic value of performing an extended lymphadenectomy in potentially curable gastric cancer., Methodology: A prospective gastric cancer database was used. In total 114 gastric cancer patients (85 male, 29 female) who underwent a gastrectomy for curative intent from 1992 through 1999 were included to this study. Morbidity and mortality, survival rates and factors affecting survival were evaluated., Results: Sixty-six (58%) patients had limited (D1) and 48 (42%) patients had extended (D2) gastric resections. The operative mortality rates were 12% and 8% and the postoperative complication rates were 33% and 25% in the D1 and D2 lymphadenectomy patients, respectively. The mean follow-up period was 34 (range: 8-94) months. The overall mean survival was 32 months (25 months in D1 group, 46 months in D2 group) (P < 0.05). The duration of symptoms, the presence of postoperative complications, the extent of lymphadenectomy, the operative curability and the site of the tumor were all found to be independent prognostic factors based on a multivariate analysis., Conclusions: This study demonstrates that an extended lymph node dissection improves long-term survival without increasing postoperative morbidity and mortality in patients with potentially curable gastric cancer.