ARE THYROID NODULES AN OBSTACLE TO MINIMAL INVASIVE PARATHYROID SURGERY? A SINGLE-CENTER STUDY FROM AN ENDEMIC GOITER REGION.

CONTEXT: Minimally invasive parathyroidectomy (MIP) procedure has become a widely accepted alternative to the standard four-gland exploration nowadays. OBJECTIVE: The aim of this study was to evaluate patients with primary hyperparathyroidism (PHPT), who had been treated with thyroidectomy and bilateral neck exploration (BNE), rather than MIP alone, due to coexisting thyroid nodules and to determine the benefits of simultaneous thyroidectomy and the possible negative outcomes of not performing this additional procedure. DESIGN: There were 185 patients who were operated for PHPT at our clinic from January 2014 to November 2016. SUBJECTS AND METHODS: 50 patients meet inclusion criteria: have thyroidectomy at the same time of parathyroid surgery, have concordant findings of parathyroid adenoma localization at preoperative MIBI-SPECT and the cervical US and have not had malignancy on fine needle aspiration biopsy (FNAB). RESULTS: The mean age of the patients was 55.3±10.4, and female to male ratio was 7:1. All patients had parathyroidectomy with BNE and thyroidectomy: 11 (22%) patients had micropapillary thyroid cancer (mPTC), 2 (4%) had papillary thyroid cancer (PTC). CONCLUSION: The results were inconclusive in clearly demonstrating which patients presenting with coexisted thyroid nodules should undergo thyroidectomy, rather than MIP, and which should be monitored for thyroid nodules after MIP. However, we consider that in cases who are not clearly indicated for thyroidectomy, MIP followed by monitoring of thyroid nodules can be the treatment approach.

Comparison of East and West Survival Nomograms in Turkish Gastric Cancer Patients Who Underwent Radical Surgery.

BACKGROUND AND AIM:: The clinicopathological demonstrations of gastric cancer vary widely between Eastern and Western countries. Turkey is situated in Europe and Middle East which acts as a bridge between east and west. We aimed to validate the two popular nomograms of east and west origin by means of patients who underwent curative surgery for gastric cancer in our country. MATERIAL AND METHODS:: Of the 202 patients diagnosed with gastric cancer between the years 2006 and 2013, 145 of these patients whose data were sufficient were included in the study. For all patients, demographic, laboratory, operative, and pathologic findings were documented. For each patient, prognostic factors were incorporated into the nomograms for estimating 5-year survival probability. RESULTS:: For a Turkish cohort, the western nomogram showed a better discriminative capacity (AUC = 0.721, 95% confidence interval 0.637-0.806) and was better calibrated (the Hosmer-Lemeshow goodness-of-fit test p = 0.323), as compared to the eastern nomogram with AUC = 0.615, 95% confidence interval 0.522-0.708, and p = 0.077, respectively. CONCLUSION:: Western nomogram was found to be more effective than eastern nomogram in prediction of estimating 5-year survival probability in patients with resectable gastric cancer in Turkish population.

Prognostic scores in acute pancreatitis : A review.

Predicting the course of an attack of acute pancreatitis still represents a challenge for the physicians.Some early interventions such as endoscopic retrograde cholangiopancreatography and sphincterotomy, admission to the intensive care unit, enteral feeding, and prophylactic antibiotics have been proven to decrease morbidity and mortality in patients of high-risk groups. However, acute pancreatitis has a potential of morbidity and mortality, and therefore early diagnosis and objective assessment of severity of the disease is fundamental. To date, many different prognostic scores have been applied to the initial management of acute pancreatitis for the evaluation of the severity of disease. However, each of the scoring systems has advantages and disadvantages. In this paper, we tried to summarize the prognostic scoring systems and their performances in assessing severity and prognosis of acute pancreatitis. (Acta gastro-enterol. belg., 2016, 79, 337-347).

Serum uric acid as a surrogate marker of favorable response to bevacizumab treatment in patients with metastatic colon cancer

Bevacizumab is a monoclonal antibody which is a vascular endothelial growth factor inhibitor. It obscures vascularization of tumor tissue and damages intratumoral microcirculation. The damaged intratumoral microcirculation leads to tissue hypoxia and results in increase of uric acid level. The main aim of our study was to investigate the relationship between uric acid change and response to bevacizumab therapy. This study included a total of 158 patients with metastatic colorectal cancer who had received bevacizumab therapy. The number of male patients was 100 (63.3 %) while female patients number was 58 (37.7 %). The median age was 61 (29-83). There was relationship between increase of uric acid level of third month uric acid level and stable disease (p < 0.001). There was a significant overall survival increased in the group with increased uric acid level (p < 0.001). The decline of CEA level was related to uric acid level (p < 0.022). In conclusion, this study is the first showing significant increases of serum uric acid in patients with metastatic colorectal cancer who favorably responded to chemotherapy with bevacizumab. But further studies are justified to test whether monitoring uric acid levels might predict clinical outcomes of patients with metastatic colorectal cancer (AU)

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Effectiveness of breast electrical impedance imaging for clinically suspicious breast lesions.

OBJECTIVES AND BACKGROUND: This study was designed to compare the usefulness of the breast electrical conductivity measures performed in a surgical examination room against conventional breast screening modalities for identifying the symptomatic lesions of the breast tissue. METHODS: A group of 181 patients were examined with Ultrasonography (USG), Mammography (MG), Electrical Impedance Scanning (EIS) modalities and were followed-up 24 months to clarify in terms of the lesion tumour progression relationship. Tumour biopsy was determined as an endpoint of the study. RESULTS: According to USG, 13 (7.2 %) lesion were suspicious, where as EIS was reported 22 (12.2 %). 2 of these 9 patients were presented as BI-RADS 4 and histopathologic result was proven as malignant disease during 6 months short-interval follow-up. EIS exhibited compatible sensitivity (81.2 %), accuracy (84.6 %) and PPV (81.8 %) rates with USG in BI-RADS 4 subgroup, combination of these modalities raised sensitivity rates to 92.31 %, accuracy and PPV to 100 %. EIS results in BI-RADS 3 subgroup were pointed out 77.8 % specificity and 87.5 % NPV rates. CONCLUSION: Breast electrical impedance measures should be useful to reduce the number of the unnecessary follow-up and biopsy rates in the clinical setting (Tab. 2, Fig. 2, Ref. 39).

Simple scoring system for prediction of mortality in Fournier's gangrene.

PURPOSE: To create new scoring system for prediction of hospital mortality for patients with Fournier's gangrene(FG). MATERIAL AND METHOD: In total, 84 patients with FG were enrolled into this study. The demographic and clinical characteristics of patients were analyzed retrospectively. RESULTS: The mortality rate was 11.9 %. On multivariate analyses, age >60 years, BUN >40 mg/dl, RDW >14.95 %, albumin level <20 mg/dl and presence of sepsis were significant and independent predictors of mortality. The predictive value of our score for mortality was 95.1 %. CONCLUSION: Our scoring system shows adequate discriminatory function for prediction of mortality in patients with FG. Further larger scale studies can improve the performance of our score.

Calcium level may be a predictive factor for pseudocyst formation after acute pancreatitis.

Pancreatic pseudocysts (PPs) are defined as fluid collections more than 4 weeks old that are surrounded by a nonepithelial wall of fibrous or granulation tissue. Many risk factors have been associated with pseudocyst development but predictive factors remain to be explored. The aim of this study was to investigate the clinical, and biochemical parameters that may predict the development of a PPs after an attack of acute pancreatitis (AP). The medical charts of 102 patients diagnosed with AP were enrolled into the study. Demographic, clinical and laboratory details were recorded at admission and at the 48(th) hour. There were several risk factors on admission and at the 48(th) hour that was predictive of PP formation when evaluated by univariate analysis such as: Alanine aminotransferase level at 48 hrs, calcium level at admission, base excess at 48 hrs, calcium level at 48 hrs, and albumin level at 48 hrs. In multivariate analysis, low calcium level at admission was the only variable that was shown to predict formation of PPs. Lower serum calcium level may be a predictive factor for the development of PPs after AP attack. We advise that patients with calcium levels below 8 mg/dl, after AP should be followed more closely.

Prognostic significance of red cell distribution width in acute mesenteric ischemia.

OBJECTIVE: Acute mesenteric ischemia (AMI) is an infrequent, but complicated, life-threatening condition. Given this poor outcome, an estimation of mortality would aid in decision making for physicians, patients and their families. Red cell distribution width (RDW) is reflective of systemic inflammation. RDW is a remarkable prognostic marker for determining the risk of mortality in a wide range of clinical manifestations. The objective of this study was to investigate the association between RDW and mortality in patients with AMI. METHODS: The medical records of patients who underwent laparotomy with a preoperative diagnosis of AMI were reviewed retrospectively. Primary outcome variable was the hospital mortality rate. RESULTS: Estimating the receiver operating characteristic area under the curve showed that RDW has good discriminative power for mortality (area under the curve = 0.713; 95% confidence interval, 0.584-0.841). With a cut-off value of 14.85 for RDW, mortality could be correctly predicted in approximately 70% of cases. CONCLUSIONS: Increased RDW at admission was a predictor of the extent of necrosis and mortality in AMI patients. Further prospective studies are necessary to more accurately assess the importance of RDW in these patients.

Thyroid cancer in hyperthyroid patients: is it different clinical entity?

OBJECTIVE: In this retrospective study, we aimed to analyze the frequency of thyroid cancer in patients who underwent thyroidectomy for hyperthyroidism. PATIENTS AND METHODS: A total number of 177 patients, who underwent surgery for hyperthyroidism between August 2005 and March 2010, were included in this study. Demographic, clinical, radiologic, and laboratory data were collected retrospectively.Results. Postoperative histopathological examinations revealed thyroid malignancy in 13 (7.3%) patients. Among these 13 patients presenting thyroid malignancy, 53.9% were diagnosed with multinodular toxic goiter (MTG), 38.5% with uninodular toxic goiter (UTG) and 7.6% with Graves' disease. CONCLUSIONS: Thyroid carcinoma is common in hyperthyroidism and thyroid fine-needle aspiration biopsy (TFNAB) is a reliable method in the diagnosis of the thyroid malignancy in these patients. We suggest that it is reasonable to evaluate nodules with TFNAB in hyperthyroid patients prior to surgical intervention.

Prognostic significance of the preoperative serum levels of soluble form of endoglin in gastric cancer patients.

BACKGROUND: Gastric cancer is the second commonest cause of cancer-associated deaths in the world. Its molecular markers can be useful not only for the diagnostic pursuit but also for prognostic purposes. Endoglin was proposed as a marker of neovascularization in solid malignancies. A circulating form of endoglin is referred to as soluble endoglin (sol-end).The purpose of this study was to investigate the clinical importance of serum level of soluble form of sol-end in gastric cancer patients. MATERIALS AND METHODS: Serum levels of sol-end were measured in 69 healthy controls and in 60 gastric adenocarcinoma patients with ELISA and serum levels of sol-end were compared with clinicopathological features and outcomes in gastric cancer patients. RESULTS: Serum levels of sol-end in gastric adenocancer patients were significantly higher than in control patients (p<0.001). The serum levels of sol-end did not differ relative to clinical and pathologic criteria. CONCLUSION: Presented data suggest that serum levels of sol-end do not seem to be a valuable tool in the assessment of gastric cancer prognosis (Tab. 1, Ref. 11).

Distinguishing between acute appendicitis and appendiceal mucocele: is this possible preoperatively?

PURPOSE: Mucocele of the appendix is an infrequent event, characterized by a cystic dilatation of the lumen. It is often diagnosed clinically from signs and symptoms of acute appendicitis or, if it is asymptomatic, as an incidental finding during ultrasonography, computed tomography, or laparotomy. METHODS: We evaluated the histological data of patients who were believed to have mucocele of the appendix. These patients (n = 23) were compared with sex- and age-matched control subjects (n = 79) with appendicitis. RESULTS: The main reason for emergency surgery was lower right abdominal pain in 15 patients, and intestinal obstruction in three. Univariate analysis using sonography demonstrated that the larger appendiceal outer diameter was positively correlated with the diagnosis of appendiceal mucocele (p = 0.001) and the mean white blood cell count was negatively correlated (p = 0.023). In urine analysis, 41.7 % of the mucocele patients and 10 % of the appendicitis patients had microscopic hematuria, respectively (p = 0.019). An outer diameter of 10 mm or more was predictive of appendiceal mucocele diagnosis, with a sensitivity of 76.5 %, specificity of 81 %, positive predictive value of 76.5 %, and negative predictive value of 94.12 %. The overall diagnostic accuracy was 80.2 %. One point was given for the presence of each of these factors to develop a new score. The resulting area under the receiver operator characteristic curve was 0.855 (95 % CI 0.741-0.969) for the score. The histological examination of the specimens revealed mucocele in 15 cases, mucinous cystadenoma in seven cases and mucinous cystadenocarcinoma in one case. Twenty patients underwent appendectomy, and three patients were treated with right colectomy. CONCLUSIONS: A threshold 10-mm diameter of the appendix under compression is a useful preoperative measurement for differentiating between appendiceal mucocele and acute appendicitis. Microhematuria is simple test that can provide a significant role in supporting the clinical diagnosis of appendiceal mucocele in the emergency department.

Risk of malignancy in non-diagnostic thyroid fine-needle aspiration biopsy in multinodular goitre patients.

OBJECTIVE: Although the majority of biopsies is adequate for a cytological diagnosis, 5-20 % will be insufficient or nondiagnostic. Patients with nondiagnostic FNABs (ND-FNAB) may be further managed by continued observation, repeated FNAB, or thyroidectomy. The aim of this study was to determine the risk of malignancy in ND-FNAB, and to determine if there are any clinical factors that can be used to distinguish malignant versus benign disease in multinodular goitre patients with ND-FNAB. METHODS: A total of 411 multinodular goiter patients who underwent both a FNAB and thyroidectomy was the subject of study. Seventy nine of these patients with ND-FNAB were further reviewed retrospectively, and demographical and clinical factors were investigated to determine if there is any predictor of malignancy in this group of patients. Among these patients, FNAB has been repeated one more time in 5 (6.3 %) patients, and two more times in 9 (11.3 %) patients. RESULTS: Among 79 patients with ND-FNAB, 10 patients (12.6 %) had malignancy as found postoperatively. There were no differences in age, sex, functional status of the thyroid gland, and nodule size between patients with benign versus malignant disease. CONCLUSION: Nondiagnostic FNAB remains a significant problem in the evaluation of thyroid nodules. Despite ultrasound guidance, clinicians should inform patients that there is a 5-15 % malignancy risk of initial nondiagnostic specimens.