Evaluation of public’s perception of scar cosmesis after thyroidectomy: results of a survey of Turkish versus South Korean individuals

Purpose@#Visible scars on the neck caused by thyroid surgery give rise to significant aesthetic, functional, and psychosocial problems. The objective of this study is to comparatively investigate the public perception of neck scar cosmesis in Turkish and South Korean populations. @*Methods@#This survey was prepared to collect participants’ demographic and socioeconomic data and determine their perception of scar cosmesis on the neck and consisted of 15 questions. One thousand thirty-nine individuals who did not undergo thyroid surgery completed the survey. The P-values of <0.05 were deemed to indicate statistical significance. @*Results@#There were 1,039 respondents, of whom 525 (50.5%) were Turkish and 514 (49.5%) were South Korean. South Korean respondents stated that they would be significantly more uncomfortable with the thought of having a scar due to thyroid surgery, compared to the Turkish respondents (P < 0.001). The South Korean respondents stated that they would be significantly more concerned about the scar’s length, thickness, and darkening color, compared to the Turkish respondents (P < 0.001 for all cases). @*Conclusion@#Patients’ expectations, which are affected by various sociodemographic factors and cultural characteristics, are as important as the medical condition when deciding on the type of thyroid surgery. The study findings clearly indicated that the South Korean population would be significantly more uncomfortable with having a scar on the neck, compared to the Turkish population. Therefore, in selected cases, a scarless thyroidectomy approach, such as transoral endoscopic thyroidectomy, vestibular approach may be preferable for societies like South Korea.

Routine calcitonin measurement in nodular thyroid disease management: is it worthwhile?

PURPOSE: To evaluate the diagnostic accuracy of routine calcitonin measurement in patients with nodular thyroid disease. METHODS: Consecutive patients with nodular thyroid disease (n = 640) were studied. Serum calcitonin levels were measured under basal conditions, and when basal values were between 10–100 pg/mL, testing was repeated after pentagastrin (PG) stimulation. Patients with previously diagnosed or familial medullary thyroid cancer (MTC) were excluded. Patients were operated on when basal or stimulated calcitonin >100 pg/mL or when other surgical indications were present. RESULTS: Four cases of MTC were identified. MTC was diagnosed in 75% of patients with basal calcitonin >100 pg/mL. One out of 11 patients with basal calcitonin between 10–100 pg/mL was diagnosed with MTC. PG stimulation resulted in elevation in 4 cases, where 1 case was diagnosed with MTC. Positive predictive value for basal calcitonin levels in the preoperative diagnosis of MTC was 5% for values between 10–100 pg/mL and 100% for values >100 pg/mL. Possible reasons for false positivity were papillary thyroid cancer in 17%, renal insufficiency in 8.3%, Hashimoto thyroiditis in 17% and β-blocker use in 33%. Positive predictive value for the PG test (>100 pg/mL) was 25% in the entire series. The cost of adding calcitonin measurement (±PG stimulation) to the preoperative work-up, resulted in €912.68 per MTC patient to detect the disease. CONCLUSION: Basal calcitonin measurement together with PG stimulation in cases of basal calcitonin >10 pg/mL detects MTC in 0.62% of patients with nodular thyroid disease.

Effect of portal venous injection of donor spleen cells on skin allograft survival in rat.

BACKGROUND & OBJECTIVES: Pretransplantation injection of donor lymphohaemopoetic cells via portal venous route has been shown to improve allograft survival in mice. In the present study, the effect of perioperative portal venous administration of donor splenocytes on skin graft survival was investigated in comparison with intravenous administration of spleen cells in Swiss albino rat skin transplant model. METHODS: Using a single-donor survival study, skin allograft recipients received either no treatment, a single transfusion of donor spleen cells via portal vein or a single transfusion of donor splenocytes into vena cava. Spleen cell transfusion consisted 25x10(6) viable cells in a volume of 1ml given just before skin grafting. Skin graft survival was assessed by macroscopic appearance. Rejection was defined as the first day on which the entire surface of the graft was necrotic. Histologically necrosis, increased connective tissue, vascularity and polymorphonuclear leucocyte (PNL) infiltration were evaluated under light microscopy. RESULTS: In this survival study of skin allografts, with the injection of viable spleen cells into portal vein concomitant to skin grafting, significant prolongation of mean allograft survival was induced (20.3 days), compared with untreated recipients (6.5 days, P<0.001). In the histopathologic evaluation, less PNL infiltration, necrosis, increased vascularity and connective tissue repair were observed in vena porta group with no statistical significance. INTERPRETATION & CONCLUSION: It may be possible to develop protocols to induce transplantation tolerance based on the historical concept of donor specific antigen administration. However, it appears that donor spleen cell transfusion alone is not sufficient to prevent graft rejection. Thus, more efficient combination treatments are required to induce a state of durable tolerance.