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This study was aimed to investigate the relationship of miR-17-5p, miR-30b, miR-30d, miR-216a and miR-216b associated with autophagy gene beclin 1, and beclin 1 gene with colorectal cancer (CRC).Forty-seven patients with CRC and 50 healthy individuals with no cancer history were included in this study. In the serum, tumor and non-tumoral tissue samples of the CRC patients, and in the serum samples of the healthy subjects, expression levels of miRNAs were detected by qRT-PCR. The beclin 1 gene expression levels were determined by qRT-PCR, and protein levels were determined by Western blot method in tumor and non-tumor tissue samples of the patients.The miR-17-5p and miR-30d expressions were found to be higher in tumor tissue as compared to patient non-tumor tissues, while expressions of beclin-1, miR-30b and miR-216a were found to be lower. In addition, the beclin-1 protein levels were significantly decreased in the tumor tissue as compared to those in the patient non-tumor tissues. The miR-30d expression was significantly reduced in the serum of the patients when the serum samples of CRC patients and healthy controls were compared.The beclin 1 gene may play a role as a tumor suppressor in CRC. Moreover, these miRNAs cannot be used as highly reliable biomarkers in serum for CRC diagnosis (Tab. 2, Fig. 6, Ref. 46).

Introduction Hypophosphatasia (HPP) is a rare inherited disorder of bone and mineral metabolism due to mutations in the Alkaline Phosphatase-Liver (ALPL) gene encoding the tissue nonspecific alkaline phosphatase (TNSALP). Clinical features of HPP in adults include early loss of teeth, muscle weakness, musculoskeletal pain, osteoporosis and fragility fractures with delayed healing. The most typical biochemical manifestation of the disease is persistently low level of alkaline phosphatase (ALP). Primary hyperparathyroidism (PHPT) is a relatively common endocrine disorder leading to increase in bone turnover markers including ALP. Coexistence of HPP and PHPT is a very rare condition. Herein we present an adult HPP patient who presented with primary hyperparathyroidism and normal serum ALP levels, which decreased significantly after parathyroidectomy. Clinical Case A 33-year-old female with a past medical history of Hashimoto's thyroiditis and acne rosacea admitted to our outpatient clinic because of gradually increasing bone pain, fatigue and weakness. She had early teeth loss and dental problems, but she denied history of fractures and kidney stones. Her family history was remarkable for nephrolithiasis in both parents. On physical examination the patient had facial rash and telangiectasia. She also had teeth loss and many dental cavities. Her vital signs were within normal limits. In biochemical investigations creatinine was 0.45 mg/dL (0.7–1.4), ALP 81 U/L (35–105), PTH 531 pg/mL (15–65), calcium 10.84 mg/dL (8.5–10.5), albumin 4.9 g/dL (3.2–5.5), phosphorus 2.25 mg/dL (2.7–4.5), Vitamin D 5 ng/mL and urine calcium excretion 613 mg/day. Laboratory results were compatible with normocalcemic hyperparathyroidism and severe vitamin D deficiency. Bone mineral density of the lumbar spine and the femoral neck revealed osteopenia and 1/3 distal radius revealed osteoporosis. There was no evidence of nephrolithiasis and nephrocalcinosis on abdominal ultrasound. Neck ultrasound and CT scan and Tc-99m MIBI scanning of the patient revealed a parathyroid adenoma in the posteroinferior of thyroid gland's left lobe. A successful parathyroidectomy was performed. During follow-up the patient's serum ALP levels decreased significantly to 29 U/L with a repeat being 26 U/L. Bone-specific ALP was 4.2 μg/L (3–14 μg/L). Urine phosphoethanolamine was elevated to 68.6 μmol/g.Cr (0–48), which supported the diagnosis of HPP. Genetic analysis was performed and heterozygous p.N190del (c.568_570delAAC/c.566_568delACA) mutation was detected. This mutation was previously reported as pathogenic and has been associated with adult hypophosphatasia. Conclusion Although persistently low level of ALP is characteristic of HPP, disorders that increase bone turnover may result in an increase in serum ALP levels, which may mask underlying HPP. Acknowledgements We are thankful to Alexion Pharmaceuticals, Inc for providing fund for ALP substrates and genetic analysis of the patient.

Background: The most effective treatment for permanent weight loss is bariatric surgery. The present study aimed to evaluate the early period effects of laparoscopic Roux-en-Y gastric bypass (LRYGB...

Objectives The accumulation of genetic damages in onset of cancer induce activation of protooncogenes or inactivation of tumor suppressor genes thus cause disruption of the balance between cell proliferation and programmed cell death. As a member of the apoptosis inhibitory protein family (IAP), survivin play important roles in carcinogenesis process. The evidence suggests that polymorphisms located in survivin promoter region may be important in determining genetic susceptibility of cancer. In this study, we aimed to examine a possible role of survivin −31 and −625 G/C gene polymorphisms in breast cancer. Methods A total of 160 breast cancer cases and 153 healthy controls were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methodology. Results Genotype and allele distributions and of −31 and −625 G/C polymorphisms were not significantly different between two groups. However, we observed the carriers of survivin −625 C/G polymorphism homozygous genotypes (GG/CC) were the significantly higher in patients with tumor necrosis (p=0.047). Conclusions Our results suggest that survivin −625 C/G polymorphism may be related with tumor prognosis, but we are opinion of that our result require to be validated in larger samples and further comprehensive research may explore the correlation.

Background: Revision of any neck surgeries is usually associated with increased rate of complications compared to the initial surgery due to adhesions. Especially, recurrent laryngeal nerve injury and hypoparathyroidism are most important postoperative complications of thyroid revision surgery. This study aimed to reveal anti-adhesive effects of cross-linked hyaluronic acid gel (NCHAG) in thyroid surgery. Materials and methods: This study was performed in 16 adult male rats who underwent hemithyroidectomy in the right lobe and randomized into two experimental groups: Group I (control group) was given any substance and Group II (NCHA group) received NCHA spray into their perithyroidal area. The rats were sacrificed after three weeks of thyroidectomy for assessment. Results: Gross adhesions score (x = 2.500) was significantly higher in Group I than Group II (x=1.750; P = 0.031). Group II showed significantly less fibrosis compared to the Group I (P = 0.002). The rate of inflammation was found to be significantly higher in group I (P = 0.008). Vascular proliferation was not different between two groups (p=0.083). Conclusions: Our study showed that NCHA can reduce postoperative adhesion and might be effective in preventing fibrosis after the thyroidectomy. Although this study could not demonstrate that application of NCHA is able to reduce complication rate in revision neck surgery, it could be safely used after thyroidectomy and neck surgeries to prevent adhesions.

Objective: To determine the effect of post-thyroidectomy head-neck stretching exercises on postoperative level of neck pain and disability.Methods: This randomized controlled study was conducted between January 2019 and August 2020 in a university hospital in Istanbul. The sample consisted of 82 patients randomized to receive head-neck stretching exercises or routine care. The head-neck exercises were applied to the intervention group in synchronously with the researcher on the first postoperative day. The patient was asked to perform the exercises 3 times a day, in the morning, noon and evening for a month. Only scales were applied to the same ranges in the control group.Results: Most of the patients (79.2%) participating in the study were women. The diagnosis of 62.19% was multinodular goiter. 70.73% of them had undergone total thyroidectomy surgery. The average of the Visual Analogue Scale (VAS) of patients in intervention group on first postoperative day was lower (2.20± 2.22) than in control group (3.00 ± 2.10). There was no significant difference between patients in intervention and control groups in discomfort and pain in the neck after 1 week and 1 month of surgery. However, a significant difference within the groups in neck pain and discomfort at first week and first month was observed (p, Amaç: Tiroidektomi sonrası baş-boyun germe egzersizlerinin ameliyat sonrası boyun ağrısı ve rahatsızlık düzeyine etkisini belirlemek.Yöntem: Bu randomize kontrollü çalışma, İstanbul'da bir üniversite hastanesinde Ocak 2019-Ağustos 2020 tarihleri arasında yapıldı. Örneklem, baş-boyun germe egzersizleri veya rutin bakım almak üzere randomize edilmiş 82 hastadan oluşuyordu. Müdahale grubuna ameliyat sonrası birinci gün araştırmacı ile eş zamanlı olarak baş-boyun egzersizleri uygulandı. Hastadan egzersizleri bir ay boyunca sabah, öğle ve akşam olmak üzere günde 3 kez yapması istendi. Kontrol grubunda ise aynı aralıklara sadece ölçekler uygulandı.Bulgular: Çalışmaya katılan hastaların çoğu (%79.2) kadındı. %62.19'unun tanısı multinodüler guatrdı. %70,73'ü total tiroidektomi ameliyatı geçirmişti. Müdahale grubundaki hastaların postoperatif birinci gün Görsel Analog Skalası (GAS) ortalaması (2.20±2.22) kontrol grubuna göre (3.00±2.10) daha düşüktü. Ameliyattan 1 hafta ve 1 ay sonra boyunda rahatsızlık ve ağrı açısından müdahale ve kontrol grubundaki hastalar arasında anlamlı bir fark yoktu. Ancak birinci hafta ve birinci ayda boyun ağrısı ve rahatsızlıklarında gruplar arasında anlamlı fark gözlendi (p

PurposeTo describe a very rare variant adrenal venous anatomy in a left-sided pheochromocytoma case with left adrenal vein draining into the inferior vena cava (IVC).Case ReportA 66-year-old female with an incidentally discovered left adrenal mass was referred to our clinic for further diagnostic work up. She had a 3-years history of hypertension. Abdominal magnetic resonance imaging which has been performed for essential thrombocytopenia revealed a left adrenal mass. She was diagnosed as pheochromocytoma by further laboratory workup. Preoperative imaging with computed tomography (CT) angiography showed that left kidney was ectopically localized in pelvis, and left adrenal vein was draining directly into the IVC. A laparoscopic transabdominal left adrenalectomy was performed. Final pathology result was consistent for pheochromocytoma. DiscussionVariant adrenal venous anatomy is rare. There are only a few case reports on patients with left adrenal vein draining into the IVC. Although there are handful of autopsy studies, these studies were performed on normal adrenal glands. The number of clinical reports on variant adrenal venous anatomy is limited. Clinical studies revealed that most commonly seen variant adrenal venous anatomy were number based and were associated with larger tumor size and pheochromocytoma. Preoperative CT imaging could be used too improve the identification of venous anatomy. ConclusionIn this report, we present a very rare case of an adult patient with left ectopic kidney who had undergone laparoscopic adrenalectomy for left adrenal tumor and had left adrenal vein draining into the IVC. Preoperative CT imaging identified the variant adrenal venous anatomy in this patient.

Objective Metastatic chest wall tumors resulting from thyroid carcinomas are not unusual; however, the late onset of metastasis of a follicular thyroid carcinoma (FTC) is extremely rare. We aim to present a report of a case with chest wall metastasis of an FTC 10 years following thyroidectomy. Methods Among the studies performed were chest wall tumor imaging, serum thyroid stimulating hormone determination, and histopathology of the chest wall tumor and thyroid tissue examination. Results An asymptomatic 28-year-old woman was noted to have a left-sided chest wall mass on a chest X-ray performed for a job application. She had a history of right hemithyroidectomy 10 years prior to her admission, which had been reported as a thyroid follicular adenoma. Computed tomography showed a tumor measuring 75 × 50 mm in diameter localized at the left paravertebral region. The maximum standardized uptake value of the tumor was seven in positron emission tomography. Histopathologic finding of the trucut biopsy of the chest wall tumor revealed metastasis of a differentiated thyroid carcinoma. The patient underwent a completion left hemithyroidectomy with chest wall resection and reconstruction. Previous right hemithyroidectomy material was examined and diagnosed as minimally invasive FTC. Histopathologic finding of the resected chest wall tumor was consistent with metastasis of an FTC. Conclusions Although extremely rare, the late metastasis of a thyroid carcinoma should be considered in the differential diagnosis of patients with chest wall tumors who have a previous history of thyroidectomy even with a diagnosis of benign tumor.

OBJECTIVES: Parathyroid glands and recurrent laryngeal nerves (RLNs) are at risk during thyroid surgery. However, the identification of the nerves has reduced these risks. Intraoperative nerve monitoring (IONM) during thyroid surgery has gained widespread acceptance as an aid to the gold standard of visually identifying the RLN. The aim of the present study was to evaluate the effect of the identification of the RLN during thyroidectomy by using IONM. MATERIAL AND METHODS: Seven hundred forty-eight patients were included in our prospectively designed study. Of these 748 patients, 1496 nerves at risk were studied. Group 1 consisted of 736 nerves that were identified using IONM, whereas Group 2 consisted of 760 visually identified nerves. RESULTS: In the non-IONM group, the rate of temporary nerve palsy was lower in patients operated by experienced surgeons than in patients operated by residents (p= 0.001). In the IONM group, RLN injury rates were similar between experienced surgeons and residents. CONCLUSION: In spite of the fact that the duration of the operation was lower with IONM, the abbreviated duration may not appear to have clinical significance. The main advantage is for less experienced surgeons. IONM significantly decreases RLN palsy rates of the surgeons with limited experience in thyroid surgery.

Objective The purpose of the study was to evaluate the impact of the coronavirus disease (COVID-19) pandemic on endocrine surgical volumes. Methods There were periodic surgical restriction sin our country in 2020 due to the pandemic. Endocrine surgery volumes at the Division of Endocrine Surgery, Istanbul Medical Faculty were compared between 2019 and 2020. Results The surgical volume reduction in 2020 compared to 2019 was 20%, 54.5%, and 40% for thyroid, parathyroid, and adrenal surgery, respectively. Surgical volume for thyroidectomy for benign nodular goiter and parathyroidectomy significantly decreased, whereas adrenal surgery showed no significant difference in 2020 compared to 2019. No significant difference was found in the rates of thyroid cancer and adrenocortical cancer surgery in 2020compared to 2019. Conclusion The COVID-19 outbreak led to a significant reduction in the annual rates of parathyroidectomy and thyroidectomy for benign goiter, whereas the volume of thyroid cancer and adrenal surgeries were similar to the previous year.

OBJECTIVES: Over the last decade, surgeons have started to think of the ways in which to further reduce the trauma of surgery and improve cosmesis. Consequently, many surgeons have yielded to single incision laparoscopic surgeries (SILS) in order to maximize operative and postoperative outcomes. This study aimed to highlight the feasibility and challenges of different procedures by presenting our data about different fields of abdominal SILS practices with long term follow-up. MATERIAL AND METHODS: We retrospectively analysed an observational cohort of 155 patients who underwent surgery for different indications using the SILS technique. RESULTS: Of the 155 SILS procedures: 75 (48.4%) were cholecystectomies; 22 (14.2%) were splenectomies; 17 (11%) were hernia repairs; 11 (7.1%) were appendectomies; 8 (5.2%) were partial colon resections; 8 (5.2%) were adrenalectomies; 6 (3.8%) were distal pancreatectomy & splenectomies; 3 (1.9%) were subtotal gastrectomies; 3 (1.9%) were partial liver resections; and 2 (1.3%) were Nissen fundoplications. Ten (6.5%) early and 3 (1.9%) late postoperative complications were detected. No mortality or late morbidity (> 30 days) was detected due to SILS procedures. CONCLUSION: SILS is a feasible technique in experienced hands for specific procedures. Meticulous patient selection is also important for good cosmetic results and outcomes.

Pheochromocytoma is an uncommon catecholamine-secreting tumor in which resection is often associated with hemodynamic instability (HI). In this study, we aim to clarify the factors affecting surgical HI in patients who underwent surgery with the diagnosis of pheochromocytoma. All patients who underwent surgery with the diagnosis of pheochromocytoma between 2008 and 2015 were analyzed retrospectively. Patients with inconsistent diagnosis or missing outcomes and follow-up data were excluded. A total of 37 patients were included in this study. Patient demographics, operative time, tumor size, period of medical treatment until surgery, catecholamine levels in urine, and HI patterns were analyzed. There were 23 (62%) male and 14 (38%) female patients. Hemodynamic instability occurred in 13 (35%) patients. Overall, HI was higher in patients with tumor size 2000 mg/24 hours were associated with HI. Preoperative management is essential for preventing hypertensive crisis and HI before or during surgery.

Objectives P-glycoprotein (P-gp) contributes to the disposition of a wide variety of drugs; therefore, single nucleotide polymorphisms (SNPs) in the P-gp coding gene might affect its activity. It is well known that personalized medicine, instead of empirical treatment, is a clinically important approach for enhancing responses among patients. Indeed, there is a need to evaluate the association between SNPs of P-gp encoded multidrug resistance genes (MDR1, ABCB1), and the dosage requirements of these drugs. In the present study, we evaluated the association between the dosage of Levothyroxine (L-T4) and three common SNPs (C1236T, G2677T/A and C3435T). Methods Genotyping was done using a real-time PCR platform with DNA samples isolated from the venous blood of ninety post thyroidectomy hypothyroid patients. Thyroid hormone levels were measured as routine biochemistry laboratories in the Medical School of Istanbul University. Results In the genotype analysis, the minor allele frequencies were 0.48 for C1236T, 0.51 for G2677T/A, and 0.51 for C3435T. In the haplotype-based analysis, T1236T2677T3435 and C1236G2677C3435 were observed as major haplotypes (50.2 and 32.6%, respectively), in agreement with previous studies. The administered dose of L-T4 to achieve physiological thyroid hormone levels was found to be similar in all genotypes and haplotypes, indicating that there is no significant association between MDR1 polymorphisms and L-T4 doses. Conclusion Because of conflicted previous reports about the genetic contribution of MDR1 polymorphisms to drug disposition, further studies with large numbers of participants are required to clarify this influence.

Thyroid hormones play a vital role in the human body for growth and differentiation, regulation of energy metabolism, and physiological function. Hypothyroidism is a common endocrine disorder, which generally results from diminished normal circulating concentrations of serum thyroxine (fT4) and triiodothyronine (fT3). The primary choice in hypothyroidism treatment is oral administration of levothyroxine (L-T4), a synthetic T4 hormone, as approximately 100-125 μg/day. Generally, dose adjustment is made by trial and error approach. However, there are several factors which might influence bioavailability of L-T4 treatment. Genetic background could be an important factor in hypothyroid patients as well as age, gender, concurrent medications and patient compliance. The concentration of thyroid hormones in tissue is regulated by both deiodinases enzyme and thyroid hormone transporters. In the present study, it was aimed to evaluate the effects of genetic differences in the proteins and enzymes (DIO1, DIO2, TSHR, THR and UGT) which are efficient in thyroid hormone metabolism and bioavailability of L-T4 in Turkish population. According to our findings, rs225014 and rs225015 variants in DIO2, which catalyses the conversion of thyroxine (pro-hormone) to the active thyroid hormone, were associated with TSH levels. It should be given lower dose to the patients with rs225014 TT and rs225015 GG genotypes in order to provide proper treatment with higher effectivity and lower toxicity.

Retrosternal goiter prevalence is 5 to 40 per cent according to classifications in goiter series. Goiters with mediastinal extension were reported to be related with higher cancer rates. In our study, we aimed to investigate whether cancer incidence increased in retrosternal goiters compared with the cervical ones. Three hundred and ninety consecutive patients, who had surgery because of retrosternal goiter in Istanbul University Medical Faculty Department of General Surgery between 2005 and 2015 were included in the study (Group 1). Control group included 880 patients who had surgery because of nontoxic multinodular goiter in the same period (Group 2). Preoperative ultrasonography (USG) was performed to each patient. Fine-needle aspiration biopsy was performed in suspicious nodules and results were recorded. Carcinomas in histopathological examination were classified as intrathorasic and extrathorasic. Diagnostic rates of USG results were compared with histopathologic cancer results. Papillary carcinoma was diagnosed in 76 patients with retrosternal goiter (19%) and in 200 patients in the control group (22%). No statistically significant difference was detected between groups regarding the tumor rates (P > 0.05). One hundred and forty-four tumoral foci were detected in 76 patients with papillary carcinoma in retrosternal goiter patients. Three hundred and seventy tumoral foci were detected in 200 patients with papillary carcinoma in the control group. In the retrosternal goiter group, 104 carcinoma lesions of 144 papillary carcinomas were intrathorasic (72%). No statistically significant difference was detected between intrathorasic (2.1 ± 1 cm) and extrathorasic regiones (1.9 ± 0.8 cm) regarding the tumor size P > 0.05. When patients with and without cancer in the retrosternal goiter group were compared regarding familial thyroid cancer history, radiation to the neck, and cervical adenopathy, no statistically significant difference was detected. Cancer incidence of retrosternal goiters was not higher than that of the cervical ones. Yet, cancer foci of retrosternal goiters were commonly located in the intrathorasic area and were not detected with USG. Depending on these findings, we suggest that all retrosternal goiters should be surgically treated.

The purpose of this study was to inquire how patients’ quality of life is affected after thyroid surgery and the factors involved. A semi-structured questionnaire and the World Health Organization Quality of Life Scale (WHOQOL-BREF) were applied to 101 patients prior to surgery. Thereafter data was collected in the early and again in the late post-operative period. Mean general health score for pre-operative quality of life was 6.72 ± 1.53 (3–10), mean physical field score was 22.81 ± 2.77 (17–31), mean psychological field score was 21.69 ± 2.78 (15–28), mean social field score was 11.10 ± 1.94 (5–15) and mean environmental field score was 27.86 ± 4.30 (18–39). In the early post-operative period, mean general health score was 7.05 ± 1.45 (4–10), mean physical field score was 22.84 ± 2.83 (14–29), mean psychological field score was 21.67 ± 2.32 (16–27), mean social field score was 10.89 ± 1.96 (5–15) and mean environmental field score was 28.56 ± 4.18 (18–40). In the late post-operative period, the general health score for quality of life was 7.43 ± 1.34 (4–10), mean physical field score was 23.59 ± 2.70 (17–35), mean psychological field score was 21.75 ± 2.34 (14–29), mean social field score was 11.23 ± 1.94 (6–15) and mean on-field environment score was 29.30 ± 3.96 (16–40). The pre-operative levels of symptoms were found to be higher than early and late post-operative periods. Quality of life increased after total thyroidectomy and statistically significant improvement was observed in late post-operative stage.

Minimal invasive procedures has become increasingly popular during the last decades. The aim of this retrospective study was to evaluate the safety and feasibility of laparoscopic splenectomy in patients with immune thrombocytopenic purpura who has very low platelet counts.Between March 28, 2005 and June 08, 2013, a total of 132 patients with the diagnosis of immune thrombocytopenic purpura were included to study. The patients who underwent laparoscopic splenectomy were alienated into two groups according to their platelet counts lower than 10000 (group 1) and higher than 10000 (group 2) RESULTS: There were 16 patients in group 1 with very low platelet counts, and 116 in group 2. One patient in group 1 had converted to laparotomy due to peroperative bleeding, and there were 5 conversion to open in group 2. There were also 2 patients in group 2 who underwent laparatomy on post operative day 1 due to delayed intra-abdominal bleeding. Moreover, one patient in each group had pancreatic fistula.Laparoscopic splenectomy is a safe technique in patients with ITP even the patients have very low platelet counts.ITP, Laparoscopy, Low platelet count, Splenectomy.Gli interventi chirurgici mininvasivi sono diventati sempre più diffusi negli ultimi decenni. Con questo studio retrospettivo si è voluto valutare la sicurezza e la fattibilità della splenectomia laparoscopica in pazienti con porpora trombocitopenica autoimmune, con una conta piastrinica molto bassa. Sono stati inclusi nello studio tra il 28 marzo 2005 e l’8 giugno 2013 un totale di 132 pazienti con la diagnosi di porpora trombocitopenica autoimmune. I pazienti sottoposti a splenectomia laparoscopica sono stati suddivisi in due gruppi in base alla conta piastrinica inferiore a 10.000 (gruppo 1) e superiore a 10000 (gruppo 2): 16 pazienti nel gruppo 1 con conta piastrinica molto bassa e 116 nel gruppo 2. In un paziente del gruppo 1 l’intervento è stato convertito a laparotomia per un sanguinamento peroperatorio, e cinque riconversione a chirurgia open sono state effettuate per 5 pazienti del gruppo 2. Due pazienti del gruppo 2 sono stati riconvertiti a chirurgia open per primo giorno postoperatorio per sanguinamento intraddominale tardivo. Inoltre un paziente in ciascun gruppo ha presentato lo sviluppo di una fistola pancreatica. In conclusioni la splenectomia laparoscopica si è dimostrata un tecnica affidabile per pazienti con trombocitopenia autoimmune anche se con conta piastrinica molto bassa.

Objectives: single-incision laparoscopic procedures have been gaining popularity in recent years due to their minimal incisional morbidity and improved cosmetic outcomes. Herein, we will compare the feasibility and outcomes of single-incision and conventional multiport laparoscopic distal pancreatectomy. Methods: this study involves consecutive patients who underwent either single-incision or conventional multiport laparoscopic distal pancreatectomy from March 2007 to February 2014. The patients were divided into two groups, based on the surgical approach: single-incision laparoscopic surgery (Group 1) and conventional multiport laparoscopic surgery (Group 2). The parameters evaluated included estimated blood loss, operative time, postoperative pain, duration of hospital stay, complications, conversion, and final pathology. Results: there were a total of 20 patients, 10 in each study group. Baseline characteristics were similar, and there was no mortality in either of the groups. The low-flow pancreatic fistula was the most commonly seen morbidity, but it was ceased spontaneously in each group by a ratio of 30%. The operative time was significantly shorter in Group 2, with a mean of 116 minutes versus a mean of 180 minutes for Group 1 (p, NA

Objective Parathyroid glands and recurrent laryngeal nerves (RLNs) are at risk during thyroid surgery. However, the identification of the nerves reduced these risks. Intraoperative nerve monitoring (IONM) during thyroid surgery has gained widespread acceptance as an aid to the gold standard of visually identifying the RLN. The aim of the present study was to evaluate the effect of the identification of the RLN during thyroidectomy by using IONM. Material and methods Seven hundred forty-eight patients were included in our prospectively designed study. Of these 748 patients, 1496 nerves at risk were studied. Group 1 consisted of 736 nerves that were identified using IONM, whereas Group 2 consisted of 760 visually identified nerves. Results In the non-IONM group, the rate of temporary nerve palsy was lower in patients who were operated by experienced surgeons than in patients who were operated by residents (p=0.001). In the IONM group, RLN injury rates were similar between experienced surgeons and residents. Conclusion In spite of the fact that the duration of the operation was lower with IONM, the abbreviated duration may not appear to have clinical significance. The main advantage is for less experienced surgeons. IONM significantly decreases RLN palsy rates of surgeons with limited experience in thyroid surgery.

The hydatid disease caused by Echinococcus granulosus is an endemic parasitic disease affecting several Mediterranean countries. Echinococcal cysts are mostly located in the liver and the lung, but the disease can be detected anywhere in the body. In this study, we present uncommon extrahepatic localizations of primary hydatid disease. Patients who were operated on for hydatid disease or cystic lesions, which were later diagnosed as hydatid disease, between 2004 and 2010 were retrieved retrospectively. Patients with lesions localized outside the liver and the lung were enrolled in the study. Eight patients with extrahepatic primary hydatid disease were treated surgically at our clinic. The cysts were located in the scapular region, spleen, pancreas, lumbosacral region and gluteal muscle. Surgical techniques were partial or total cystectomy with or without tube drainage. Splenectomy was performed for splenic hydatid disease and partial pericystectomy, Roux-en-Y cystojejunostomy, cholecystectomy and T-tube drainage for pancreatic hydatid disease. There were no complications or mortality in the postoperative period. Hydatid cyst should be considered in the differential diagnosis of cystic lesions, especially in endemic areas. Surgical technique should be planned according to the location of the cyst.

Primary hyperparathyroidism (PHPT) is often seen in conjunction with an underlying thyroid disorder. Imaging methods that are used to localize the parathyroid adenoma also detect associated thyroid nodules and thyroid cancer. The aim of this study was to detect the rate of thyroid cancer identified while performing parathyroidectomy and thyroidectomy in patients with PHPT.Files of all patients who were operated for PHPT and who underwent simultaneous thyroidectomy were analyzed. Data regarding parathyroid pathology, surgical procedures, indications of thyroid surgery, and pathology results were retrospectively recorded. The indications for thyroid surgery included presence of suspicious thyroid nodules in ultrasonography, increase in size of thyroid nodules in follow-up ultrasound, or presence of suspicious thyroid fine needle aspiration biopsy (FNAB) findings. Rates of thyroid cancer detection were investigated according to definite pathology reports.Eighty-three patients who underwent parathyroidectomy with a diagnosis of PHPT with concurrent thyroidectomy in Department of General Surgery, İstanbul University İstanbul Faculty of Medicine were included in the study. Eighteen patients were male (22%) and 65 were female (78%). The median age was 53 (18-70) years. The primary indication for parathyroidectomy was primary hyperparathyroidism in all patients. The thyroid procedures applied in addition to parathyroidectomy were lobectomy + isthmusectomy in 29 patients (35%), bilateral subtotal thyroidectomy in 20 patients (24%), bilateral total thyroidectomy in 23 patients (28%), and total thyroidectomy on one side and near total thyroidectomy to the other side in 11 patients (13%). The only indication for thyroidectomy was the presence of thyroid nodules until 2000 (20 patients, 24%). Indications in the remaining 63 patients included the presence of multiple nodules that cannot be followed up by ultrasonography in 25 patients (30%), presence of a suspicious nodule on ultrasonography in 33 patients (40%), growth in nodule size in 2 patients (2%), and detection of suspicious findings on FNAB in 3 patients (4%). Five patients (6%) were diagnosed with papillary thyroid cancer, four of whom were micropapillary cancer.Imaging methods performed to localize the pathological parathyroid gland for a diagnosis of PHPT are useful in estimating other accompanying pathologies. Presence of thyroid nodules should be evaluated before all parathyroid procedures, and if the nodule has an indication for surgery, thyroid surgery should be considered at the same operation with parathyroid surgery.

Sustained normocalcemia throughout postoperative 6 months is considered as a complete recovery achieved by surgery. Parathyroid hormone (PTH) and calcium levels not being reduced or becoming higher again during 6 months after the surgery are defined as persistent hyperparathyroidism, whereas hypercalcemia and high levels of PTH more than 6 months later are defined as recurrent hyperparathyroidism. The most common cause of persistent HPT is multiglandular disorder and ectopic adenomas. Persistent HPT occurs as a result of an insufficient surgery. The most critical factor that lowers the rate of HPT is surgical experience. In this article, we presented a case of 36-year-old woman with persistent hypercalcemia following an unsuccessful operation due to failure of localization of her parathyroid adenoma by conventional imaging modalities and became normocalcemic only after an operation guided by an 18F-choline PET/CT imaging spotting the adenoma in the mediastinum.

WOS: 000360993700019 PubMed ID: 26231993 Introduction: Current study aims to analyze the impact of previous vertical laparotomy on safety and feasibility of laparoscopic sigmoid colon and rectal cancer operations. Methods: All consecutive patients who underwent a laparoscopic resection for sigmoid colon or rectal cancer were included. These aspects were abstracted and compared within no laparotomy and previous vertical laparotomy groups: demographics, perioperative aspects, pathological features and survival. Results: There were 252 patients in no laparotomy group, and 25 cases with previous vertical incisions including lower (n = 12,48%), upper (n = 7, 28%), and lower&upper (n = 2, 8%) midline and paramedian (n = 4, 16%) laparotomies. Veress insufflation and open technique were used in 19 (76%) and 6 (24%) cases, respectively, during the insertion of the first trocar in previous laparotomy group. Patients in previous laparotomy group were significantly older (59.2 +/- 13.4 vs. 66.2 +/- 0.1, p = 0.01), but gender, ASA scores, tumor and technique related factors were similar within the groups, including operation time (200 [70-600] vs. 200 [130-390] min, p = 0.353), blood loss (250 [100-1500] vs. 250 [0-2200] ml, p = 0.46), additional trocar insertion (10 [4%] vs. 3 [12%], p = 0.101), conversion (20 [7.9%] vs. 4 [16%], p = 0.25), postoperative complication (59 [23.4%] vs. 4 [16%], p = 0.06) and 30-day mortality (7 [2.8%] vs. 1 [4%], p = 0.536) rates. Oncological outcomes regarding pathological features and 5-year survival rates (65% vs. 73.2%, p = 0.678) were not different. Conclusion: The presence of a previous laparotomy does not worsen the outcomes in patients undergoing laparoscopic removal of sigmoid or rectal cancer, thus laparoscopy may be considered to be safe and feasible in these cases.

WOS: 000433094100010 PubMed ID: 29607432 OBJECTIVE: This study aimed to reveal the risk factors and outcomes of gallbladder perforation (GP) during laparoscopic cholecystectomy. METHODS: Videotapes of all patients who underwent an elective cholecystectomy at our department were retrospectively analyzed, and the patients were divided into two groups based on the presence of GP. The possible risk factors and early outcomes were analyzed. RESULTS: In total, 664 patients [524 (78.9%) females, 49.7 +/- 13.4 years of age] were observed, and GP occurred in 240 (36.1%) patients, mostly while dissecting the gallbladder from its bed (n=197, 82.1%). GP was not recorded in the operation notes in 177 (73.8%) cases. Among the studied parameters, there was no significant risk factor for GP, except preoperatively elevated alanine transaminase level (p=0.005), but the sensitivity and specificity of this measure in predicting GP were 14.2% and 7.4%, respectively. The two groups had similar outcomes, but the operation time (35.4 +/- 17.5 vs 41.4 +/- 18.7 min, p=0.000) and incidence of drain use (25% vs 45.8%, p=0.000) increased in the GP group. CONCLUSION: The present study reveals that GP occurs in 36.1% of patients who undergo laparoscopic elective cholecystectomy, but it may not be recorded in most cases. We did not find any reliable risk factor that increases the possibility of GP. GP causes an increase in the operation time and incidence of drain use; however, the other outcomes were found to be similar in patients with GP and those without.

Pancreatic surgery has been greatly influenced by the advent of laparoscopic surgery and increasing experience in its performance and by advances in techniques and surgical devices. This study aimed to represent two centers' initial experiences in laparoscopic distal pancreatic surgery.This study was a bi-centric study including 30 patients undergoing distal pancreatectomy for pancreatic disorders. All the patients were operated on from November 2006 to November 2013 in Turkey and Spain.Laparoscopic spleen-preserving distal pancreatectomy was performed in 9 patients, laparoscopic distal pancreatectomy was performed in 14 patients, laparoscopic enucleation was performed in 4 patients, and single-incision laparoscopic distal pancreatosplenectomy with splenectomy was performed in 3 patients.Laparoscopic distal pancreatectomies for pancreatic disorders are feasible and safe procedures if performed by experienced laparoscopic surgeons.Laparoscopy, Pancreas, Multi-port, Tumor, SILS.La chirurgia del pancreas è stata grandemente influenzata dall’avvento della chirurgia laparoscopica e dalla crescente esperienza nella sua realizzazione e dai progressi delle tecniche e della strumentazione chirurgica. Questo studio è finalizzato alla presentazione dell’esperienza iniziale di due centri chirurgici nella pancreasectomia distale laparoscopica. Lo studio comprende 30 pazienti di due centri diversi sottoposti a pancreasectomia distale per patologia del pancreas. Tutti gli interventi chirurgicisono stati eseguiti tra novembre 2006 e novembre 2013 in Turchia e in Spagna. La pancreasectomia distale laparoscopica con conservazione della milza è stata eseguita su 9 pazienti, la pancreasectomia distale laparoscopica in 14 pazienti, una enucleoresezione laparoscopica in 4 pazienti ed una pancreasectomia distale laparoscopica con una singola incisione in 3 pazienti. Si conclude affermando la possibilità dell’esecuzione della pancreasectomia distale per via laparoscopica con sicurezza se l’esecuzione è eseguita da chirurghi esperti nella tecnica laparoscopica.

2016 IEEE International Ultrasonics Symposium, IUS 2016 -- 18 September 2016 through 21 September 2016 -- 124585 Purpose: The current study aims to analyze the risk factors for the failure of ileostomy reversal after laparoscopic low anterior resection for rectal cancer. Methods: All patients who underwent a laparoscopic low anterior resection for rectal cancer with a diverting ileostomy between 2007 and 2014 were abstracted. The patients who underwent and did not undergo a diverting ileostomy procedure were compared regarding patient, tumor, treatment related parameters, and survival. Results: Among 160 (103 males [64.4%], mean [± standard deviation] age was 58.1 ± 11.9 years) patients, stoma reversal was achieved in 136 cases (85%). Anastomotic stricture (n = 13, 52.4%) was the most common reason for stoma reversal. These were the risk factors for the failure of stoma reversal: Male sex (P = 0.035), having complications (P = 0.01), particularly an anastomotic leak (P < 0.001), or surgical site infection (P = 0.019) especially evisceration (P = 0.011), requirement for reoperation (P = 0.003) and longer hospital stay (P = 0.004). Multivariate analysis revealed that male sex (odds ratio [OR], 7.82; P = 0.022) and additional organ resection (OR, 6.71; P = 0.027) were the risk factors. Five-year survival rates were similar (P = 0.143). Conclusion: Fifteen percent of patients cannot receive a stoma reversal after laparoscopic low anterior resection for rec tal cancer. Anastomotic stricture is the most common reason for the failure of stoma takedown. Having complications, particularly an anastomotic leak and the necessity of reoperation, limits the stoma closure rate. Male sex and additional organ resection are the risk factors for the failure in multivariate analyses. These patients require a longer hospitalization period, but have similar survival rates as those who receive stoma closure procedure.

Background: Reoperative neck surgery is technically more demanding because of the presence of scar tissue and distorted anatomy. We aimed to investigate the magnetic probe–guided excision of nonpalpable neck lesions in patients with previously operated neck compartments. Methods: This study included 9 patients with recurrent/persistent thyroid carcinoma, recurrent/persistent hyperparathyroidism with previously operated neck compartments. The pathologic lesions were localized by ultrasonography, and magnetic tracer (0.2 mL, iron oxide) was injected directly into the pathologic lesions. Careful dissection was carried out following the area of maximum magnetic activity until the nonpalpable lesions were identified and excised. Result: All neck lesions were removed in 9 patients. The median count from lesion was significantly higher than values from lesion bed (background activity; (9900/5 seconds vs 250/5 seconds, P < .001). During follow-up, all patients had negative ultrasonography. Conclusion: Magnetic probe–guided technique could provide access to nonpalpable lesion localization in centers without readily available access to nuclear medicine facilities.

Reoperative neck surgery is technically more demanding because of the presence of scar tissue and distorted anatomy. We aimed to investigate the magnetic probe-guided excision of nonpalpable neck lesions in patients with previously operated neck compartments.This study included 9 patients with recurrent/persistent thyroid carcinoma, recurrent/persistent hyperparathyroidism with previously operated neck compartments. The pathologic lesions were localized by ultrasonography, and magnetic tracer (0.2 mL, iron oxide) was injected directly into the pathologic lesions. Careful dissection was carried out following the area of maximum magnetic activity until the nonpalpable lesions were identified and excised.All neck lesions were removed in 9 patients. The median count from lesion was significantly higher than values from lesion bed (background activity; (9900/5 seconds vs 250/5 seconds, P.001). During follow-up, all patients had negative ultrasonography.Magnetic probe-guided technique could provide access to nonpalpable lesion localization in centers without readily available access to nuclear medicine facilities.

Chronic atherosclerotic mesenteric ischemia is a debilitating disorder. It may cause postprandial abdominal pain leading to severe weight loss. Patients are usually emotionally affected with major depression. The disease can be treated with open surgical and endovascular techniques and both methods have individual risks and benefits. In this report, the authors present anatomical revascularization of the superior mesenteric artery and the celiac trunk.

BACKGROUND: 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. Materials and Methods: 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. RESULTS: 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. CONCLUSION: 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.

Objective: We aimed to evaluate the value of somatostatin receptor imaging (SRI) with In-111 octreotide and Ga-68 DOTATATE in localizing ectopic ACTH producing tumors. Methods: Nineteen patients who had In-111 octreotide somatostatin receptor scintigraphy (SRS) and/or Ga-68 DOTATATE PET-CT to localize ectopic ACTH producing tumors between the years 2000 and 2012 were included retrospectively in our study. The results of SRI were compared with clinical onset, radiological findings and surgical data of the patients. Results: Sixteen In-111 octreotide SRS and five Ga-68 DOTATATE PET-CT were performed in 19 patients. In eight out of 19 patients, ectopic ACTH secretion site could be detected. In five patients, SRS showed pathologic uptake. In four of these patients, surgery revealed pulmonary carcinoid tumors and in one patient pancreatic neuroendocrine tumor. In one patient, Ga-68 DOTATATE PET-CT revealed pathologic uptake in lung nodule which came out to be pulmonary carcinoid tumor. In another patient who had resection of metastases of atypical carcinoid tumor prior to scans, new metastatic foci were detected both with SRS and Ga-68 DOTATATE PET-CT imaging. In one patient, although SRS was negative, CT which was performed three years later showed a lung nodule diagnosed as pulmonary carcinoid tumor. In 11 patients, ectopic ACTH secretion site could not be detected. In 10 of those patients, scintigraphic and radiological imaging did not show any lesions and in one patient, Ga-68 DOTATATE PET-CT was false positive. Conclusion: SRI has a complementary role with radiological imaging in localizing ectopic ACTH secretion sites. PET-CT imaging with Ga-68 peptide conjugates is a promising new modality for this indication. Conflict of interest:None declared.

OBJECTIVE Determining the blood flow through intra and extra-cranial arteries during neck extension may be helpful but is a controversial issue. We aimed to elucidate the changes in cerebral blood flow related to head positioning during thyroid surgery by carotid Doppler examination and regional oxygen saturation variations. METHODS Thirty patients were recruited to the study. Patients were positioned with a final position of thyroidectomy consisting a 30° semi Fowler with the extension of neck and head. Values of peak systolic velocity, average velocity, arterial diameter and blood flow volume of the common carotid artery were calculated. Bilateral regional cerebral oxygen saturation were monitored continuously. RESULTS At the end of the operation, peak systolic velocity, average velocity and blood flowvolume of the common carotid artery decreased significantly compared to the baseline measurement (p

WOS: 000396361900004, PubMed ID: 28251020, Background: Environmental habitat may play a role in clinical disparities of primary hyperparathyroidism (pHPT) patients. Aims: To compare preoperative clinical symptoms and associated conditions and surgical findings in patients with pHPT, living in different geographical regions from the Black Sea, Mediterranean and Anatolia regions. Study Design: Retrospective, clinical-based multicentric study of 694 patients with pHPT. Methods: Patients from 23 centers and 8 different geographical regions were included. Data related to baseline demographics, clinical, pathologic and treatment characteristics of 8 regions were collected and included age, gender, residential data, symptoms, history of fracture, existence of brown tumor, serum total Ca and p levels, serum parathormone (PTH) levels, serum 25-OH vitamin D levels, bone mineral density, size of the resected abnormal parathyroid gland(s), histology, as well as the presence of ectopia, presence of dual adenoma, and multiple endocrine neoplasia (MEN)- or familial-related disease. Results: The median age was 54. Asymptomatic patient rate was 25%. The median PTH level was 232 pg/mL and serum total Ca was 11.4 mg/dL. Eighty-seven percent of patients had an adenoma and 90% of these had a single adenoma. Hyperplasia was detected in 79 patients and cancer in 9 patients. The median adenoma size was 16 mm. Significant parameters differing between regions were preoperative symptoms, serum Ca and p levels, and adenoma size. All patients from South-East Anatolia were symptomatic, while the lowest p values were reported from East Anatolia and the largest adenoma size, as well as highest Ca levels, were from Bulgaria. Conclusion: Habitat conditions vary between geographical regions. This affects the clinicopathological features of patients with pHPT.

Paget’s disease of the breast is a rare breast tumor that was first identified by Sir James Paget in 1874. It is characterized by eczema-form changes accompanied with erosion and ulceration of the nipple and areolar epidermis. It is mostly correlated with ductal carcinoma in situ (DCIS); additionally, it can be accompanied by invasive ductal carcinoma (IDC). The diagnosis is determined upon microscopically observing Paget cells in a skin biopsy. The width of the lesion is evaluated via mammography and MRI in patients for whom breast-preserving surgery is planned. Depending on the extent of the lesion, sentinel lymph node biopsy and axillary curettage for those having axillary metastases are the treatment alternatives to breast-preserving surgery or mastectomy.

The aim of the current study is to compare the results after partial and complete splenic flexure mobilization (SFM).The records of laparoscopic and hand-assisted laparoscopic procedures for primary rectal tumor patients were abstracted from a prospectively designed database. The phrenicocolic and splenocolic ligaments were divided via a four-trocar technique in the partial SFM group, and dissection was continued with the separation of gastrocolic and pancreaticomesocolic attachments via a five-trocar procedure in the complete SFM group. The following data were compared between the groups: Demographics, intra- and postoperative information, and pathological features.In total, 122 cases (77 [63.1%] male, 58.2±13.2 years old) who underwent a partial (n=36, 29.5%) or a complete (n=86, 70.5%) SFM were included. Reservoir creation (48.8% versus 19.4%, P=.003) was more common and conversion (8.1% versus 22.2%, P=.039) was less frequent in the complete SFM group, but there were significantly more T4 tumors in the partial group (16.7% versus 2.3%, P=.008). Demographics, other intra- and postoperative parameters, and pathological features were identical.In our study, complete SFM decreased conversion rates, but this finding may be related to the higher rate of T4 tumors in the partial SFM group. Complete SFM assures an increase in reservoir creation in patients receiving a low anterior resection. Because other parameters are identical, the decision for the level of SFM is better left to the surgeon in cases undergoing a low anterior resection, but complete SFM may be preferred in cases who are candidates for a reservoir formation.

OZET Sol kolon ve ust rektum kanserlerinde t›kanma seyrek olmayarak gorulur. Bu durumlarda palyatif veya ameliyata kopru amacl› kendili¤inden geniflleyen metalik stent (self-expandable metallic stents = SEMS) uygulamalar› %80-95 klinik baflar› sa¤layacak oranda uygulanabilmektedir. Yap›lan retrospektif yay›nlar genel durum bozuklu¤u ve kuratif tedavi alamayacak olgularda palyatif amacl› SEMS uygulamas›n›n morbiditeyi ve stoma olas›l›¤›n› azaltt›¤›n› ve yat›fl suresini k›saltt›¤›n› gostermektedir, ancak uygulama s›ras›nda ve hasta kemoterapi alt›ndayken oluflacak perforasyon olas›l›¤›na dikkat cekilmektedir. Ameliyata kopru amac›yla yap›lan SEMS uygulamalar›nda olgu k›yaslamal› ve randomize olmayan cal›flmalar benzer avantajlar gostermifltir. Prospektif randomize cal›flmalar ise morbidite ve stoma olas›l›¤› hakk›nda celiflkili sonuclar vermektedir. Ustelik ABSTRACT Obstruction is not rare in patients with a left colon or upper rectal cancer. In this case, the application of selfexpandable metallic stens (SEMS) can resolve symptoms in 80 to 95% of the patients. Retrospective studies have revealed that SEMS can be used for palliation in severely ill patients and for those who are not candidates for curative resections, and this technique has been shown to decrease morbidity, the possibility of a stoma and length of stay, but there is a certain risk of perforation during application or later when the patient is under chemotherapy. Similar advantages have been shown in case match and non-randomized studies, when SEMS are used as bridge-to-surgery. However, prospective randomized trials revealed controversial results. In addition, considering the fact that the largest prospective randomized trial was prematurely terminated because

Patients with symptomatic primary hyperparathyroidism (pHT) have increased cardiovascular morbidity and mortality. Endothelial nitric oxide synthase (eNOS) intron 4a/b polymorphism is associated with coronary artery disease and hypertension in various populations. Our aim is to evaluate endothelial function in patients with pHT during pre-operative hypercalcemic and post-operative normocalcemic periods and to determine whether intron 4a/b polymorphism of eNOS gene influences endothelial function.Forty patients with pHT (age 48.48+/-11.64 yr) were examined pre-operatively and reexamined 5.8+/-1.9 months after parathyroidectomy. Forty-three healthy subjects (age 47.13+/-8.14 yr) were served as control group. Endothelial function was determined by flow-mediated dilation of brachial artery (FMD). eNOS4a/b polymorphism was detected by polymerase chain reaction.FMD was significantly lower in patients pre-operatively compared with controls (8.48+/-1.78% vs 19.49+/-2.34%, p0.001). FMD improved significantly after parathyroidectomy (16.19+/-2.16%, p0.001 compared with pre-operative measurements), but was still significantly lower than controls (p0.001). The distribution of eNOS4a/b genotype frequencies was not significantly different between patients and controls. Logistic regression analysis showed that increased serum calcium (2.47 mmol/l) and PTH concentrations (7.75 pmol/l) were significant independent predictors of lower FMD (16.7%). ENOS4a/b polymorphism did not enter in this model.Impaired endothelial function in patients with pHT improves after successful parathyroid surgery. No compelling data are evident to suggest that eNOS4a/b polymorphism modifies the endothelial function in patients with pHT.

Background:Although electrocautery has been used widely in surgery, the fear of delayed wound healing and infection persists. We aimed to evaluate the risk factors for wound complications and the rate of wound complications, comparing the use of electrocautery or scissors in cutaneous flap creation during thyroidectomy.Design:The study group comprised 239 consecutive patients scheduled for thyroidectomy.Subjects:Patients were randomly assigned to cutaneous flap dissection by either electrocautery (group one, n = 126) or scissors (group two, n = 113). Age, gender, body mass index, American Society of Anesthesiology score, tissue weight, operating time, incision length, cutaneous tissue depth, thyroid function and surgeon experience were recorded and compared with the rate of post-operative wound complications in both groups.Results:There were no significant differences between the overall rate of post-operative wound complications, comparing groups one and two (7.9 vs 10.6 per cent, respectively; p = 0.74). Significant positive correlations were found between wound complication and age (Spearman's rank coefficient (rs) = 0.135, p = 0.036), body mass index (rs = 0.379, p = 0.0001), cutaneous tissue depth (rs = 0.677, p = 0.0001) and tissue weight (rs = 0.643, p = 0.0001). According to logistic regression analysis, a body mass index of more than 27.5 kg/m2 was associated with a 13.7-fold increased rate of post-operative wound complications.Conclusion:When creating cutaneous flaps during thyroidectomy, the use of electrocautery is as safe as the use of scissors. Such electrocautery does not increase the risk of wound complications in thyroid surgery.

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.