A comparison of the quantitative evaluation of in situ parathyroid gland perfusion by indocyanine green fluorescence angiography and by visual examination in thyroid surgery

ABSTRACT Objective The most vital complications of thyroidectomy are recurrent nerve damage and hypocalcaemia. We aimed to compare the tissue perfusion scores (PS) of IG fluorescence angiography (IGFA) and visual examination by the surgeon after total thyroidectomy. Subjects and methods Forty-three patients were accepted into the study. Localisation of the parathyroid gland (PG) was determined by the naked eye and scored in terms of tissue perfusion. The averages of fluorescent light intensities for each IGFA were calculated, the perfusions were scored and compared with the PS given by the surgeon. Biochemical parameters were noted. Results 37.2% of patients had autotransplanted PGs, according to their visual scores. The means of IGFA-PS for PGs scored as 0, 1 or 2 on visual inspection were 48.58 ± 4.49 [30-70], 89.65 ± 8.93 [36-144] and 158.76 ± 8.93 [70-253], respectively, which correlated with the visual PSs in a statistically significant manner (P < 0.0001). The predictive cut-off value for IGFA-PS was determined to be 70, given a visual PS of 0 (95% CI [0.72-0.85]), and this was interpreted to be a candidate cut-off point for the autotransplantation of PGs. Conclusion IGFA scoring may be considered as an operative predictor, providing objective criteria to evaluate the tissue and blood perfusion of PGs after thyroidectomy. IGFA scoring may be considered to have value in minimising postoperative permanent hypoparathyroidism in patients.

Evaluation of prophylactic and therapeutic effects of sildenafil on acute radiation proctitis in rats

Abstract Purpose: To investigate the prophylactic and therapeutical effects of sildenafil in a model of acute radiation proctitis (ARP). Methods: All experimental procedures of this study was examined by histopathological, immunohistochemical and transmission electron microscopic analysis. Results: Our histopathological evaluations indicated significant increases in lesion severity, cryptic apsis, cryptitis, cryptic distortion, reactive atypia and infiltration depth of the control (proctitis) group. While the prophylaxis group and the treatment group had significantly lower scores. High-dose group showed similar results as prophylaxis group. Histopathological findings of the prophylaxis group was more significant than the treatment group. Immunoreactivities of IL-1β, FGF-2, TNF- α and HIF-1α increased in the control group especially in the epithelial and cryptic regions. On the contrary, sildenafil application caused significant decreases of inflammatory markers in all treatment groups, specifically better results in the prophylaxis group. Conclusion: The sildenafil has anti-inflammatory effects on ARP, as well as protective effects against ARP and the protective effect of sildenafil surpasses its therapeutic effect histopathologically.

The Impact of Body Mass Index on the Surgical Outcomes in Open Rectal Cancer Surgery.

Technical difficulties which affect the outcomes of abdominal operations are common in obese patients, especially in rectal and gastric cancer cases. In several studies, it has been shown that increased body mass index (BMI) is associated with increased morbidity, reduced lymph node retrieval and prolonged hospital stay after colorectal surgery. The aim of this study was to assess the influence of obesity on the surgical outcomes (surgical margin, number of lymph nodes excised) of rectal cancer patients who were operated by open surgery. One hundred rectal cancer patients who underwent open surgery in a single center between January 2011 and August 2014 were included in this study. Patients were divided into two groups according to their BMI values. According to their preoperative BMI values, patients with a BMI of ≥30 kg/m2 (n=29) were defined as ‘obese’. Patients with a BMI of <30 kg/m2 (n=71) were placed in the normal (non-obese) group. Demographic data, surgical margins, the number of lymph nodes retrieved and surveillance of both groups were compared. Obese and normal groups were statistically indifferent in terms of age, sex and stage of the disease. Comparison of the obese and normal groups showed no statistically significant difference in terms of surgical margins and the number of lymph nodes retrieved. This study showed that obesity does not affect the surgical outcomes in rectal cancer. However, prospective studies with larger patient series are needed.