Sutureless Thyroidectomy With Intraoperative Neuromonitoring and Energy-Based Device Without Sternotomy for Symptomatic Substernal Goiter Harboring Thyroiditis of Gland Parenchyma.

Since substernal goiter first being described by Haller in 1749, a consensus on the definition of this entity has not been ensured, yet. Despite substernal goiter or retrosternal goiter is delineated as an enlarged thyroid gland with a component extending into the mediastinum, at least 10 definitions have described being able to depict the most accurate definition for substernal goiter. Of note, no consensus still has been declared on the therapeutic management of asymptomatic substernal goiter. It should be pointed out that, the American Association of Endocrine Surgeons (AAES), Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults reported approximately 9% to 13% of substernal goiters are being harbored thyroid malignancy. The following vignette case describes the clinical features of a symptomatic substernal goiter with chronic lymphocytic thyroiditis, her treatment by sutureless total thyroidectomy with intermittent-intraoperative neural monitoring (I-IONM), and the energy-based device without sternotomy, and the response of an adult who presented with a family history of malignant histopathology, differentiated thyroid carcinoma, which was exposed to the postoperative radioactive iodine ablation. We may recommend dividing the branches of superior thyroid arteries and the superior thyroid veins individually and exploring the fibrous Ligament of Berry, the true Ligament of Berry, with its safe interrelation to the inferior laryngeal nerve, finically, which may be regarded as different peas in a pod in a complete sutureless thyroidectomy for substernal goiter with thyroiditis in thyroidology.

Helicobacter pylori and association between its positivity and anatomotopographic settlement in the stomach with the host age range.

Helicobacter pylori (H. pylori) is a Gram-negative, helically shaped flagellated bacterium. Major diseases associated with H. pylori infection include peptic ulcer, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. The incidence of H. pylori in the anatomotopographic regions of the stomach, such as antrum, corpus, fundus, and incisura angularis, has been investigated. Do the rates of H. pylori in the settlements change over time according to the age ranges of the hosts? Does this change affect the diseases caused by or related to H. pylori? It is estimated that the outcomes, which have been obtained, may provide a new perspective in terms of understanding the etiopathogenesis of H. pylori-induced diseases. A comprehensive literature search of PubMed/MEDLINE databases had been conducted using a combination of terms, "Helicobacter pylori," "Sydney System," "stomach," "pyloric antrum," "gastric corpus," "stomach cancer," and "Helicobacter pylori and age." There are very few articles examining the relationship between the topographic locations of H. pylori and host age range in the English language literature. Therefore, it is also purposed to emphasize the outcomes of our current research about the mentioned topic. In our opinion, similar studies should reveal the settlement and age range in the different geographic locations and societies as in our study. We believe that these findings will contribute to the efforts for understanding overtly of H. pylori-induced disease of the stomach.

Résumé Helicobacter pylori (H. pylori) est une bactérie flagellée à Gram négatif de forme hélicoïdale. Les principales maladies associées à l'infection à H. pylori comprennent l'ulcère gastro-duodénal, l'adénocarcinome gastrique et le lymphome du tissu lymphoïde associé à la muqueuse. L'incidence de H. pylori dans les régions anatomotopographiques de l'estomac, telles que l'antre, le corpus, le fond d'œil et l'incisura angularis, a été étudiée. Les taux de H. pylori dans les colonies changent-ils avec le temps en fonction des tranches d'âge des hôtes? Ce changement affecte-t-il les maladies causées par ou liées à H. pylori? On estime que les résultats obtenus peuvent fournir une nouvelle perspective en termes de compréhension de l'étiopathogenèse des maladies induites par H. pylori. Une recherche documentaire complète des bases de données PubMed/MEDLINE a été effectuée en utilisant une combinaison de termes, "Helicobacter pylori", "Sydney System", "estomac", "antre pylorique", "corpus gastrique", "cancer de l'estomac" et "Helicobacter pylori et l'âge". Il existe très peu d'articles examinant la relation entre les emplacements topographiques de H. pylori et la tranche d'âge de l'hôte dans la littérature de langue Anglaise. Par conséquent, il vise également à souligner les résultats de nos recherches actuelles sur le sujet mentionné. À notre avis, des études similaires devraient révéler l'établissement et la tranche d'âge dans les différentes géographies, les emplacements géographiques et les sociétés, comme dans notre étude. Nous pensons que ces résultats contribueront aux efforts visant à comprendre ouvertement la maladie de l'estomac induite par H. pylori.

Laterality of the thyroid nodules, anatomic and sonographic, as an estimator of thyroid malignancy and its neoplastic nature by comparing the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) and histopathology.

PURPOSE: To assess the association between the topographic and sonographic laterality of the thyroid nodules and the malignancy for those who had undergone ultrasonography (US)-guided fine-needle aspiration (FNA) (US-FNA) and following relevant indicated thyroidectomy. METHODS: A retrospective analysis from April 2011 to October 2015 was conducted by enrolling the documents of 501 consecutive eligible patients with 601 thyroid nodules who had undergone neck US, Doppler US, and US-FNA. The prediction of malignancy by means of laterality of 95 thyroid nodules with undetermined cytology on the basis of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was evaluated histopathologically with comparison of three locations, separately. RESULTS: Six hundred and one nodules in 501 cases were studied and 249 nodules (49.8%) were topographically located at the right lobe (Location 1/Loc1), while 255 (42.4%) at the left lobe (Location 2/Loc2), 46 (7.7%) at the isthmus (Location 3/Loc3), and 1 (0.2%) was an accessory thyroid gland (Location 4/Loc4). Three different comparisons were performed regarding the locations, which revealed that the specificity did not change regarding the locations while the sensitivity of Loc3 was higher than that of Loc1 and Loc2. CONCLUSIONS: The preliminary data of 4.5-year single-center study proved that the isthmus location may be more beneficial to estimate the malignancy on the basis of toposonographic laterality of the nodules with undetermined cytology. This notewothy outcome may be considered particularly for the challenging cases with undetermined cytology in Endocrine Surgery and Thyroidology.

Can cut-off points of 10 and 15 mm of thyroid nodule predict malignancy on the basis of three diagnostic tools: i) strain elastography, ii) the Bethesda System for Reporting Thyroid Cytology with 27-gauge fine-needle, and iii) histopathology?

PURPOSE: This study evaluated whether the cut-offs 10 and 15 mm can help distinguish malignant from benign nodules regarding three diagnostic tools: i) strain elastography (SE), ii) the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), iii) histopathology. METHODS: From 2012 to April 2015, a retrospective analysis was conducted by enrolling the data of 425 consecutive eligible patients with 500 thyroid nodules. The efficacy of the nodule size, as of the cut-offs, on the estimation for malignancy had been analysed on the basis of the three diagnostic tools. RESULTS: Of the 500 thyroid nodules examined, 80 (16.0%) were under 10 mm and 420 (84.0%) were over 10 mm in diameter. No significant difference was found between over 10 mm with i) TES (Tsukuba Elasticity Score) 4 and 5, area under the curve (AUC) 0.531, ii) TBSRTC (The Bethesda System for Reporting Thyroid Cytopathology) III, IV, V, VI, undetermined and malignant cytology, AUC 0.517, iii) malignant histopathology, AUC 0.509. Similarly, no significance difference was recognized between over 15 mm with i) TES 4 and 5, AUC 0.623, ii) undetermined and malignant cytology, AUC 0.455, iii) malignant histopathology, AUC 0.515 by McNemar test. However, size over 15 mm may strengthen the prediction among TES 4 and 5 and malignant histopathology, as weakens in undetermined and malignant cytology. CONCLUSIONS: These preliminary data of 3-year single-center study suggest that assignment of 10 and 15 mm as the cut-off points of the thyroid nodules may not be predictive of malignancy on the basis of three diagnostic tools. Nevertheless, higher cut-off may corrobarate the correlation with TES 4 and 5 and malignant histopathology while attenuation with TBSRTC III, IV, V, and VI, confront with the lower one, 10 mm.

Cancer Statistics in Giresun Province, Turkey: A 12-Years Retrospective Review.

AIM: The aim of this retrospective study was to analyze 6,613 diagnosed cancer cases in the Black Sea Turkish province of Giresun over a period of 12 years. MATERIAL AND METHOD: Data of this retrospective crosssectional study was collected from 6,613 cancer patients at Prof. Dr. A. Ilhan Özdemir Education and Research Hospital between 2005- 2016. MINITAB 15 package software was used for statistical analysis. Chi-Square test and differences between two ratios significance test were used to calculate the relationship between two nominal (categorical) variables. RESULTS: Total 6,613 cancer patient's (3,759 men, 56.8% and 2,854 women, 43.2%) average age is 66.27±17.17. The most frequent types of cancer found among men included prostate (24.4%), bronchus-lung (12.5%) and colorectal (11.15%) cancer; whilst among for women it was breast (26%), thyroid (14.9%) and skin (10.6%) cancer, respectively. Kidney, bronchus-lung, skin, larynx, breast, bladder and thyroid cancer types were determined to be statistically significant according to gender (p<0.05). CONCLUSION: We reviewed the diagnosed cancer cases in Giresun province from 2005 to 2016. For men, the order of the most frequent cancer types mentioned is consistent with the statistics of both the European Union (EU) as well as the United States of America (USA); whereas for women it was consistent with Turkey's own national statistics. However, our findings state that thyroid cancer is the second most common cancer type among Turkish women, this is in contrast to most other parts of the world, the EU and USA.

Primary aortoduodenal fistula due to a swallowed sewing needle: a rare cause of gastrointestinal bleeding.

A primary fistula between the abdominal aorta and the duodenum is rare and usually fatal. Atherosclerosis remains the most common etiologic factor, accounting for more than two-thirds of the cases reported. Other etiologies include carcinoma, ulcers, radiation, aortitis and foreign bodies including sewing needle, cocktail stick, open safety pin and fishbone. We report a case of a 17 year-old girl who underwent surgical treatment because of severe upper gastrointestinal bleeding which was related to an aortoduodenal fistula caused by a swallowed sewing needle. At operation, a chronic aortoduodenal fistula that contained the sewing needle was found and repaired. This is the fourth case in the literature in which a needle was found to be associated with the development of an aortoenteric fistula.