Can Parathormon Levels after Ipsilateral Lobectomy Predict Postoperative Hypocalcemia in Patients Undergoing Total Thyroidectomy?

The purpose of this study was to investigate the relationship between the serum parathormone (PTH) levels measured after completion of hemithyroidectomy on the first side during total thyroidectomy and the postoperative hypocalcemia. The patients were divided into two groups, as those who demonstrated a decrease in PTH levels measured after completion of hemithyroidectomy of the first side (Group 1, n = 43) and those who did not demonstrate a decrease in PTH levels (Group 2, n = 24). The serum PTH levels were measured just before the incision (PTHi), when the hemithyroidectomy stage had been completed (PTHht), at the end of the operation (PTHtt), and at the postoperative 24th hour (PTH24hr). The serum total calcium (Ca2+) levels were also measured. The median percentage differences in PTHtt levels based on basal PTHi levels of Groups 1 and 2 were -60.6 and -15.7 per cent, respectively, P = 0.001. The frequency of postoperative biochemical hypocalcemia was higher in Group 1, P < 0.05. It was determined that a 10 per cent or higher decrease in PTHht levels in Group 1 could predict biochemical hypocalcemia at the postoperative 24th hour. In conclusions, postoperative hypocalcemia is seen more frequent in patients with a decrease of PTHht during total thyroidectomy. A decrease of 10 per cent in PTHht levels measured after ipsilateral lobectomy and a 62 per cent or higher decrease in PTHtt levels measured in the end of the total thyroidectomy could be helpful for prediction of postoperative hypocalcemia in these patients.

Outcomes of Parathyroid Autotransplantation During Total Thyroidectomy: A Comparison with Age- and Sex-Matched Controls.

PURPOSE: To determine the effect of parathyroid autotransplantation (PA) on postoperative hypocalcemia in cases of total thyroidectomy. MATERIALS AND METHODS: Cases undergoing total thyroidectomy and PA were compared with age and sex-matched controls who had not undergone PA. The postoperative percentage changes (PC) of parathyroid hormone (PTH) and calcium (Ca+2) in the first 12-24 hours (12-24hr→preop), between the 1st-3rd weeks (1-3wk→preop) and at the 6th month (6mo→preop), the rates of hypocalcemia (Ca+2< 8mg/dL) and low PTH level (PTH< 15 pg/mL), permanent hypocalcemia, inadvertent parathyroidectomy in both groups were compared. RESULTS: The number of patients with PTH12-24hr<15 pg/mL was significantly higher (n:34,(55.7%)) than the number of patients in the control group (n:16(26.2%)), (p=0.001). The rate of decrease in the blood Ca+2 median PC (6mo→preop) was significantly higher in the PA group (4.2%) than the control group (1.1%), (p=0.008). There was no significant difference between the 2 groups in terms of the postoperative frequency of hypocalcemia (p>0.05). In the PA&age≤50 group, the rate of inadvertent parathyroidectomy was higher than that of cases over age 50 (p=0.029). CONCLUSION: In spite of the presence of an increased postoperative hypocalcemia trend in cases requiring PA during total thyroidectomy, the rates of transient and permanent hypocalcemia were not different to the control cases. But the frequency of cases with low PTH level in cases undergoing PA was higher than that of the control cases. In cases of 50 years of age and under, who had undergone PA, the possibility of inadvertent parathyroidectomy increased.

Characteristics of patients operated for primary hyperparathyroidism at university hospitals in Türkiye: differences among Türkiye's geographical regions.

PURPOSE: The aim of this study was to define the clinical and laboratory characteristics of patients operated on for primary hyperpatathyroidism (PHPT) at university hospitals in Türkiye, and to investigate the differences in the clinical presentations of the disease between different geographical regions. METHODS: Patients operated on for PHPT in the university hospitals of Türkiye were included in the study. The demographic, clinical, and laboratory findings and the operational data of the patients were investigated according to the whole country and to different geographical regions. Comparisons were performed according to whole country and regions. RESULTS: A total of 1,162 cases were included in the study from different regions and 20 university hospitals. The mean age of patients was 52.4 ± 0.38 (mean ± standard error) in the general population of Türkiye. The rates of hypertension, urolithiasis, bone disease and 25-hydroxyvitamin D insufficiency were 35%, 18.6%, 67.6%, and 63%, respectively. The median parathormone (PTH), serum total calcium (Ca(+2)) and phosphorus value were 220 pg/mL (range, 70-2,500 pg/mL), 11.2 mg/dL (range, 9.5-11.2 mg/dL), and 2.4 mg/dL (range, 1-4.7 mg/dL), respectively. The median size of the adenomas resected was 16 mm (range, 4-70 mm). Significant differences were observed in the clinical and laboratory findings of the patients operated on due to PHPT between different geographical regions of Türkiye (P < 0.05). CONCLUSION: The clinical and laboratory characteristics of the patients with PHPT in different geographical regions of Türkiye differ. Furthermore, the general findings of the cases in Türkiye give us a hint that the severity of the disease here is somewhere between Eastern and Western countries.

Primary thyroid lymphoma.

Primary thyroid lymphoma is an uncommon thyroid malignancy. The treatment modalities significantly differ from other thyroid malignancies. Frequently it is accompanied by Hashimoto's thyroiditis, and it may be difficult to differentiate the two entities histologically. Patients typically present with suddenly growing mass in the thyroid gland. Discrimination between primary and secondary lymphoma is important due to variations in diagnostic tools, treatment modalities and prognosis. Surgery, chemotherapy, radiotherapy or combinations of these modalities may be applied in treatment. In this report, three cases with primary thyroid lymphoma in which three different treatment modalities have been applied are presented.

Alterations in Thyroid Hormones Due to Increased Intraabdominal Pressure in Rats.

PURPOSE: Although the effects of increased intraabdominal pressure on the abdominal organs are well known, there is a limited data regarding its effects on the thyroid hormones. The aim of this study is to investigate the changes in thyroid hormone profiles during stress endocrine response induced by increased intraabdominal pressure, which was obtained by pneumoperitoneum in rats. MATERIALS AND METHODS: A hundred-fifty female wistar albino rats were divided into three main groups, according to intraabdominal pressure applied; Control (Group 1), (n:30), low pressure, 15 mmHg, (Groups 2 and 3), (n:60), and high intraabdominal pressure, 25 mmHg, (Groups 4 and 5), (n:60) groups. Groups 2, 3, 4, 5 were divided into three subgroups separately, according to duration of intraabdominal pressure. Rats in Groups 3 and 5 were decompressed at the end of times indicated (15th, 30th, and 45th min) and blood samples were obtained. Whereas blood samples from Groups 2 and 4 were drawn without decompression at the end of times indicated. Measurements included thyroid stimulating hormone, cortisole, vasopressin, adrenocorticotropic hormone, triiodotronin and thyroxin. RESULT: Our study revealed that blood TSH levels reduce and free T3 and T4 levels increase in case of prolonged intraabdominal pressure increase that cause abdominal compartment syndrome. The change in blood thyroid hormone levels are encountered prominently on 30th and 45th min. CONCLUSION: Secretion of vasopressin, adrenocorticotropic Hormone and cortisol increases with increasing intraabdominal pressure. At high pressures, thyroid stimulating hormone secretion decreases while the secretion of triiodotronin increases. The effect of this case on the clinical findings has not been fully clarified yet and it needs further studies to clarify underlying mechanism. In this perspective, the findings of this study may be used in further clinical and experimental studies.

Thyroid hemiagenesis associated with retrosternal nodular goiter: a case report.

Thyroid hemiagenesis can be associated with various thyroid pathologies such as papillary thyroid cancer or nodular goiter. However, we did not encounter any publication in the literature in which hemiagenesis could be observed together with retrosternal goiter. In this report, a thyroid hemiagenesis associated with a benign nodular goiter extending retrosternally is reported. A 59-year-old male patient presented to the surgery clinic because of swelling in the neck. A mass was observed in the right thyroid lobe extending to the retrosternal region. On ultrasonography, a nodule in the right thyroid lobe measuring 63 mm was determined, which was extended retrosternally. However, the left lobe of the thyroid could not be visualized. Scintigraphy and Computerized Tomography confirmed hemiagenesis. Total thyroidectomy was performed without sternotomy. In conclusion, thyroid hemiagenesis can be associated with a retrosternally located nodular goiter.

[The effect of different lengths and placements of median laparotomy incision on wound dehiscence in the rat]. / Siçanlarda farkli uzunluk ve farkli yerlesimdeki karin orta hat kesilerinin yara ayrismasina etkisi.

BACKGROUND: To assess the effect of different lengths and placements of median laparotomy incision on wound dehiscence in the rat. METHODS: Eighty female Wistar rats were divided into 8 groups of 10 rats each. Groups underwent median laparotomy with different incision lengths (2, 3, 4, 6 cm) at two sites (upper and lower abdomen). Pneumoperitoneum was established in all rats using an insufflator on postoperative day 3. When gas leakage through the wound with an instantaneous decrease in intraabdominal pressure was noticed, these values were recorded as dehiscence pressure. In addition, the time until wound breakage was recorded. The different incision groups were compared. RESULTS: After excluding 4 rats for various causes, statistical analysis was performed on the remaining 76 rats. When the different incisional lengths were compared, there were no significant differences in dehiscence pressures and time (p>0.05). Similarly, there were no significant differences between the incision groups according to upper or lower abdominal wall site of incision (p>0.05). CONCLUSION: Midline abdominal wall incisions of different lengths and placements (upper or lower abdomen) have similar dehiscence pressures against the pneumoperitoneum in the early postoperative period (p>0.05).

[Assessment of effectiveness of different doses of methylprednisolone on intraabdominal adhesion prevention]. / Kariniçi yapisikliklarin önlenmesinde metilprednizolonun farkli dozlarinin etkinliginin incelenmesi.

BACKGROUND: To assess the effectiveness of different doses of methylprednisolone on preventing intraabdominal adhesions established experimentally in rats. METHODS: Forty female Wistar rats were divided into four groups: high-dose steroid (16 mg/kg), low-dose steroid (10 mg/kg), serum physiologic, and control. Following median laparotomy and procedure for adhesion formation in all rats, 16 mg/kg methylprednisolone (high-dose steroid group), 10 mg/kg methylprednisolone (low-dose steroid group), or serum physiologic (serum physiologic group) was administered into the intraperitoneal space, topically. No additional procedure was applied to rats in Group 4 (Control). All rats were sacrificed on day 15 postoperatively, and intraperitoneal adhesions were assessed according to Linsky's scale. RESULTS: No significant differences were determined between the groups with respect to severity (p=0.867), degree (p=0.919), extent (p=0.876), and general scores (p=0.574) of adhesion formation. Wound infection rates were also similar in the four groups (p>0.05). CONCLUSION: There was no difference in the effectiveness of different methylprednisolone doses, administered topically, in preventing intraabdominal adhesion formation, and furthermore, steroids do not prevent intraabdominal adhesion development.

Impact of a basic nutrition course for residents at a faculty hospital. Did it make a difference in demand for nutrition consultations?

BACKGROUND/AIMS: To assess whether a basic nutrition course for residents at a faculty hospital improves their knowledge of nutrition and increases the number of consultation requests for nutrition by alerting participants to the high prevalence of undernutrition in hospitals. METHODS: The residents from 34 departments of basic, internal and surgical sciences were recruited to take a 1-day course. Questionnaires, designed to assess knowledge of nutrition, were completed at the beginning and at the end of the course. The results of the questionnaires and the number of consultation demands for nutrition before and after the course were compared. RESULTS: The results of 161 participants were evaluated. The mean (+/-SE) numbers of correct answers given to the first and second questionnaires were 14.9 +/- 0.22 and 18.7 +/- 0.21, respectively (p < 0.01). When the number of requests for nutrition consultation during 7-month periods (just before and after the course) were compared, the mean number of requests in each month during these periods were found to be 1.81 +/- 0.58 and 4.06 +/- 1.20, respectively (p < 0.01). CONCLUSIONS: A short course of basic nutrition for residents improves their basic knowledge and leads to an increase in the number of consultation requests for nutritional support.

Thyroid carcinoma with insular component: report of three cases with different clinical pictures.

Insular carcinoma of the thyroid is situated morphologically and biologically in an intermediate position between the well-differentiated and undifferentiated tumors and presents a variable clinical course in a widely heterogeneous spectrum. The present cancer staging system (TNM) for thyroid cancer considers differentiated and undifferentiated tumors while ignoring this intermediate type, which is also called poorly differentiated tumor. In addition to the limited data on this rare disease, some poorly differentiated thyroid tumors contain differentiated cancer areas at various rates. These factors may cause difficulties in estimating disease aggressiveness and prognosis. To solve this problem, various microscopic and immunohistochemical parameters can be assessed. In this paper we describe 3 patients affected by thyroid carcinoma with an insular component, who presented different clinical pictures. When these cases were examined, the TNM system failed in stage grouping for poorly differentiated thyroid tumors. Case 1 and case 2 had similar clinical stages according to the TNM staging system for differentiated tumors, but had different prognoses. Case 3, with more limited disease, had the highest rate of poorly differentiated areas but the lowest Ki-67 proliferation index. In conclusion, it is difficult to make claims about the clinical behavior and prognosis of thyroid carcinoma with an insular component based on the 3 cases reported in this study, but it can be speculated that there is a gap in the TNM system with regard to the staging of insular thyroid carcinoma. In this situation the assessment of microscopic and immunohistochemical features of the tumor may help to predict disease aggressiveness and patient risk. However, it is clear that there is a need for large-scale studies evaluating the prognostic importance of histopathological and immunohistochemical features in determining risk groups.

Use of ligasure in thyroidectomy procedures: results of a prospective comparative study.

The thyroidectomy procedure requires many manupulations to achieve prompt hemostasis. This study assessed whether the outcomes of thyroidectomy using the Ligasure electrothermal vessel sealer were comparable with the conventional suture-ligation technique. We prospectively evaluated 58 consecutive patients who underwent thyroidectomy. Patients were allocated into two groups according to their preference. There were 30 patients in the Ligasure group and 28 patients in the conventional surgery group. Complications, operating time, and hospital stay were compared between the two groups and suture-ligations performed in the Ligasure group were recorded. The age, sex, and indications were similar in the two groups (p > 0.05). Complication rates and hospital stays did not show any difference according to the techniques used. Operating time was shorter in the hemithyroidectomy and total thyroidectomy patients of the Ligasure group (mean +/- SD: 77.38 +/- 13.71 vs. 99.80 +/- 12.53 minutes, p = 0.005; and 102.50 +/- 16.69 vs.128.89 +/- 19.74 minutes, p = 0.010). The mean +/- SD number of suture-ligations for each patient in the Ligasure group was 1.83 +/- 2.12. Thyroid surgery using the Ligasure is safe, and its complication rates are comparable to these found with the conventional surgical technique. Use of the Ligasure during hemithyroidectomy and total tyhroidectomy operations provides a significantly shorter operating time.

Staged abdominal repair in the treatment of intra-abdominal infection: analysis of 102 patients.

Surgical treatment of intra-abdominal infections remains a challenge for the surgeon. Staged abdominal repair is being commonly used in patients with intra-abdominal infections. This study presents our experience with staged abdominal repair and analyzes factors affecting mortality. A total of 102 patients who underwent staged abdominal repair procedures for intra-abdominal infections during a 12-year period were retrospectively reviewed. The effects of several risk factors on mortality were evaluated. The investigated risk factors included age, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, number of operations prior to staged abdominal repair, number of repeat laparotomies, anatomic origin of infection, and etiology of intra-abdominal infections. The overall mortality rate was 40% (41/102). The mean number of operations prior to staged abdominal repair (0.72 +/- 0.1 in survivors vs. 1.37 +/- 0.21 in nonsurvivors), age (24.5% mortality under 55 years vs. 53.6% mortality between 55 and 65 years vs. 75% mortality over 65 years), and APACHE II score (13.4 +/- 3.4 in survivors vs. 20.3 +/- 6.64 in nonsurvivors) were correlated with mortality rates (P < 0.05). Our results showed that the physiologic status of patients, severity of sepsis, and decision time for staged abdominal repair were all associated with higher mortality.

[Total pharyngolaryngoesophagectomy and gastric pull-up: an evaluation of 10 cases]. / Total farengolarengoözofajektomi ve gastrik pull-up girisimi uygulanan 10 olgunun degerlendirilmesi.

OBJECTIVES: We evaluated the patients who underwent total pharyngolaryngoesophagectomy (T-PLE) and gastric pull-up (GPU) for hypopharyngeal tumors extending to the cervical esophagus. PATIENTS AND METHODS: Ten patients (8 females, 2 males; mean age 50 years; range 39 to 60 years) were treated with T-PLE and GPU, total thyroidectomy, and bilateral neck dissection including zone VI. Histopathologic diagnoses were squamous cell carcinoma (n = 8), basaloid squamous cell carcinoma (n = 1), and adenoid cystic carcinoma (n = 1). Clinical stage, tumor stage, and nodal status were as follows: eight patients IVA, two patients III; eight patients T4a, two patients T3; seven patients N+ (6 N2, 1 N1), three patients N0. RESULTS: Three patients (30%) died within a month after surgery. Two patients were alive after the seventh and first postoperative years, respectively. The remaining five patients died because of causes related (n = 3) to or unrelated (n = 2) to carcinoma. Survival was 20% for one year, and 14.3% for five years. Histopathologically, surgical margins were free of tumor in nine cases. The mean time to the initiation of oral feeding was nine days (range 4 to 14 days), and the mean hospital stay was 23 days (range 12 to 36 days). CONCLUSION: Early initiation of oral feeding and relatively short hospitalization periods make T-PLE and GPU an appropriate palliative procedure, increasing the quality of life for many patients.