Is total thyroidectomy more difficult in Hashimoto's thyroiditis?

AIM: Hashimoto's thyroiditis (HT) is accepted as a difficult thyroidectomy for surgeons in practice, but there is not enough data in the literature to support this. The aim of this study was to evaluate whether HT belongs to difficult thyroidectomy class or not. MATERIAL AND METHODS: 614 patients who undergoing total thyroidectomy were evaluated. 270 patients with factors that prolong the operation were excluded from the study. Group 1 consisted of 132 patients reported as benign diseases accompanied by HT. Group 2 consisted of 212 patients reported as other benign diseases with no HT as a result of pathology. Patients were statistically analyzed for age, sex, finding for (Recurrent Laryngeal Nerve) RLN, time for reaching RLN, time for operation, transient or permanent RLN injury and other postoperative complications. RESULTS: There were statistically significant differences in terms of age, sex, time for operation and time for reaching RLN (respectively; p=0.01, p=0.007, p<0.001 and p<0.001). There was no significant difference between the groups in terms of finding for RLN rates, transient or permanent RLN injury and other postoperative complications (p>0.05). CONCLUSION: The mean time for operation and mean time for reaching RLN in patients with HT was significantly longer than in patients with other benign pathology results. It has been scientifically shown that HT should be among the causes of difficult thyroidectomy. This result can provide a legal advantage for surgeons who face such a sad complication. KEY WORDS: Hashimoto thyroiditis, Recurrent laryngeal nerve, Thyroiditis.

Irritable Bowel Syndrome on Inflammatory Bowel Disease in Deep Remission: No Relation with Remission Deepening and Inflammation.

BACKGROUND: The aim of the study was to establish the frequency of irritable bowel syndrome (IBS) in patients with inflammatory bowel disease (IBD) in clinical, endoscopic, and histologic remission and in relation to both the depth of remission and inflammation markers. METHODS: Patients with ulcerative colitis (UC) and with Crohn's disease (CD) in clinical remission for at least 6 months were enrolled in the study. All of the patients underwent colonoscopy, and biopsy specimens were taken to evaluate endoscopic and histopathologic remission. Patients were evaluated according to Rome III criteria for IBS. Fecal calprotectin level and blood samples for C-reactive protein (CRP), sedimentation rate, and fibrinogen levels were studied. RESULTS: IBS frequency was 20.9% in UC cases and 28.9% in CD cases in clinical remission. Rates with and without endoscopic remission in UC (20.5% vs. 22.2%, P = .727) and CD (25% vs. 33.3%, P = .837, respectively) were not different. Similarly, rates with and without histopathologic remission in UC (15.7% vs. 26.6%, P = .723), and CD (21.4% vs. 33.3%, P = .999) were not statistically different. Also, it was not related to inflammation markers. CONCLUSION: IBS frequency among IBD patients with remission was in a substantial rate; these rates kept up with the process of deep remission and even complete mucosal healing and were irrelevant to inflammation.

Perifosine and vitamin D combination induces apoptotic and non-apoptotic cell death in endometrial cancer cells.

Endometrial cancer is the most common cancer of the female reproductive system. Combination treatment with specific agents has been widely used as a targeted therapy for cancer. In this study, we aimed to investigate the anti-proliferative and apoptotic effects of varying concentrations of perifosine and vitamin D on the human endometrial cancer cell line (HEC-1A). HEC-1A cells were exposed to perifosine (10 µM, 30 µM), vitamin D (50 nM, 200 nM) and combinations of both for 48 h and 72 h. Monitoring of cell proliferation in a time-dependent manner was performed with the xCELLigence RTCA DP system. The levels of BCL2, BAX and P53 mRNA expression were examined using RT-qPCR. Apoptosis was determined using Annexin V, which were followed by flow cytometry analysis. Ultra-structural morphology of cells was analyzed by transmission electron microscopy (TEM) for 72 h. The anti-proliferative and apoptotic effects of the perifosine+vitamin D combination (30 µM + 200 nM at 48 h and 10 µM + 200 nM at 72 h) on HEC-1A cells were higher than in perifosine and vitamin D alone. It was observed that perifosine has increased the expression of BAX mRNA in HEC-1A cells in a dose-dependent manner. While perifosine+vitamin D combinations increased P53 mRNA expression in HEC-1A cells we did not find any significant change in BCL2, BAX mRNA expression levels. In TEM examinations of HEC-1A cells, perifosine appeared to lead autophagic cell death, whereas vitamin D caused paraptosis-like cell death and combination of perifosine+vitamin D caused apoptotic and non-apoptotic (paraptotic, autophagic and necrotic) cell death. Therefore, it is considered that the combination of both drugs in the treatment of endometrial cancer might be an alternative and effective treatment option through activating the apoptotic and non-apoptotic cell death mechanisms in cancer cells.

Effects of extremely low-frequency electromagnetic field exposure on the skeletal muscle functions in rats.

The aim of the present study was to systematically investigate the effects of chronic exposure to extremely low-frequency electromagnetic field (ELF-EMF) on electrophysiological, histological and biochemical properties of the diaphragm muscle in rats. Twenty-nine newly weaned (24 days old, 23-80 g) female (n = 15) and male (n = 14) Wistar Albino rats were used in this study. The animals were randomly divided into two groups: the control group and the electromagnetic field (EMF) group. The control group was also randomly divided into two groups: the control female group and the control male group. The EMF exposure group was also randomly divided into two groups: the ELF-EMF female group and the ELF-EMF male group. The rats in the ELF-EMF groups were exposed for 4 h daily for up to 7 months to 50 Hz frequency, 1.5 mT magnetic flux density. Under these experimental conditions, electrophysiological parameters (muscle bioelectrical activity parameters: intracellular action potential and resting membrane potential and muscle mechanical activity parameter: force-frequency relationship), biochemical parameters (Na+, K+, Cl- and Ca+2 levels in the blood serum of rats; Na+-K+ ATPase enzyme-specific activities in muscle tissue; and free radical metabolism in both muscle tissue and serum) and transmission electron microscopic morphometric parameters of the diaphragm muscle were determined. We found that chronic exposure to ELF-EMF had no significant effect on the histological structure and mechanical activity of the muscle and on the majority of muscle bioelectrical activity parameters, with the exception of some parameters of muscle bioelectrical activity. However, the changes in some bioelectrical activity parameters were relatively small and unlikely to be clinically relevant.

Anatomic Variations of Paranasal Region in Migraine.

PURPOSE: To assess the incidence of anatomical variations of the paranasal region on computed tomography in migraine patients compared with control subjects. METHODS: Paranasal computed tomography scans of 2 groups consisting of 50 migraine patients and 50 control subjects were evaluated, retrospectively. The presence of anatomic variations and the unilateral or bilateral presence of these variations were noted. Appropriate statistical tests were performed to compare the migraine and control groups, using a threshold P value of 0.05 for statistical significance. RESULTS: The migraine group included 39 female and 11 male patients with mean age of 39.9 (range: 18-65) years. The control subject group included 29 female and 21 male patients with mean age of 41.9 (range: 18-73) years. Anatomic variations noted included nasal septal deviation and spur, paradoxical curvature of middle concha, agger nasi cell, infraorbital ethmoidal (Haller) cells, sphenoethmoidal (Onodi) cells, supraorbital ethmoidal air cells, concha bullosa, uncinate bulla, and pneumatized crista galli. Of these variations, only the presence of Haller cells was statistically significantly higher in the migraine group compared with controls (P = 0.007). The unilateral presence of Onodi (P < 0.001), unilateral presence of supraorbital ethmoidal air cells (P = 0.012), and bilateral presence of concha bullosa (P = 0.016) were statistically significantly higher in the migraine group. There was no statistically significant difference between the unilateral or bilateral presence of Haller cells in migraine patients compared with controls (P > 0.05). CONCLUSION: Radiographic assessment of the paranasal sinuses is useful to elucidate potential points of pathology in migraine patients. The specific contribution of Haller cells to migraine headache symptoms and safe methods for surgical decompression warrant further study.

The other side of the coin in renal replacement therapies: the burden on caregivers.

PURPOSE: Living with end-stage renal disease may be burdensome, not only for patients, but also for caregivers. In this study, we aim to compare caregiver burden, psychological symptoms in caregivers of peritoneal dialysis (PD), hemodialysis (HD), and transplantation (TX), and find out associated factors. METHODS: A total of 43 PD, 42 HD, 42 TX patients and a total of 127 caregivers that were actively involved with the care of their patients' dialysis were enrolled. Patients had been on renal replacement therapy at least for 6 months and caregivers had given care at least for 6 months. The World Health Organization Quality of Life short version and hospital anxiety and depression scale (HAD) were applied to the patients. Symptom Checklist-90-Revised and Zarit caregiver burden scale were applied to the caregivers. RESULTS: Zarit caregiver burden score was found highest in HD group, which was significantly higher than PD and TX. All three groups had similar HAD anxiety scores, whereas the HAD depression score was highest in HD group, lower in PD, and lowest in TX. Quality of life was lowest in HD group. Zarit caregiver burden score was found higher in caregivers with symptoms like somatization, anxiety, obsessive-compulsive, depression, interpersonal sensitivity, psychoticism, paranoid ideation, hostility, and additional psychological symptoms than the ones who did not have these symptoms. Psychological symptoms were similar in PD, HD, and TX groups. CONCLUSION: Caregiver burden was found highest in HD group. Educational, social, and psychological support interventions may be considered for caregivers.