Adnan Isgor

Autonomously functioning thyroid nodule treated with radioactive iodine and later diagnosed as papillary thyroid cancer.

The malignancy risk is low in hot thyroid nodules verified by scintigraphy. We present a rare case of papillary carcinoma, initially treated as an autonomous hot nodule. Case report. A 36- year old male patient with a hot thyroid nodule and subclinical hyperthyroidism was treated with 10mCi 131I. On admission, both 99mTc and 131I thyroid scintigraphic imaging revealed a hot nodule at the right lobe accompanied by lower uptake in the remaining thyroid tissue. After treatment, there was a progressive increase in the nodule size; a fine needle aspiration biopsy was thus performed which showed findings compatible with papillary thyroid cancer. The patient was referred to our department for further management. Total thyroidectomy with right central neck dissection was performed. The pathologic examination showed that the whole nodule (1.5 cm diameter) was a columnary type papillary thyroid cancer. Conclusion: In the case of a small-sized toxic thyroid nodule, the possiblility of malignancy cannot be totally ruled out. Suspicious hot nodules should be cytologically evaluated before radioactive iodine treatment to determine the existing malignancy risk. Fine needle aspiration biopsy should be performed in all hot thyroid nodules that increase in size after radioactive iodine treatment.

Effects of amniotic membrane on the healing of primary colonic anastomoses in the cecal ligation and puncture model of secondary peritonitis in rats

PurposeWe aimed to investigate the effects of amniotic membrane on primary colonic anastomoses in a rat peritonitis model.Materials and methodsFifty female Sprague Dawley rats were used in the study. Bacterial peritonitis was induced in all rats by performing a cecal ligation and puncture. Ten rats served as controls for the bursting pressure measurement, while the other 40 animals were divided into two groups (the anastomosis group (P) or the amniotic membrane group (PA)), and all of them underwent colonic anastomosis. The latter group had amniotic membrane covering their anastomoses. Half of the PA and P groups were sacrificed on the third postoperative day (PA3, P3), and the other half on the seventh postoperative day (PA7, P7).ResultsThe bursting pressures were significantly higher in groups PA3 and PA7 compared with P3 (p < 0.01) and P7 (p < 0.05), respectively. Inflammatory cell infiltration and adhesion scores were significantly lower in groups PA3 and PA7 compared with groups P3 (p < 0.001, p < 0.01, respectively) and P7 (p < 0.001, p < 0.05, respectively). Neoangiogenesis, fibroblast activity, collagen deposition, and hydroxyproline concentrations were significantly higher in groups with amniotic membrane than in groups without amniotic membrane (p < 0.05, for all comparisons).ConclusionThis study showed that the covering of colonic anastomoses with amniotic membrane significantly prevented the delaying effect of intraperitoneal sepsis and provided a safer and stronger anastomosis than suture and that this was the case for both the early and late phases of anastomotic healing in the colon.

Effects of amniotic membrane on the healing of normal and high-risk colonic anastomoses in rats

BacgroundThis study was aimed at examining whether or not the addition of amniotic membrane to a sutured colonic anastomosis improves its healing.Material and methodsNinety female Sprague Dawley rats were used in the study. Ten served as controls for bursting pressure measurement, while the other 80 animals were divided into four groups: Anastomosis group (NA), high-risk anastomosis group (HRA), anastomosis plus amniotic membrane group (NA-AM), and high-risk anastomosis plus amniotic membrane group (HRA-AM). The last two groups had amniotic membrane covering their anastomoses. Anastomotic evaluation was carried out on the third (NA3, HRA3, NA-AM3, and HRA-AM3, respectively) and seventh (NA7, HRA7, NA-AM7, and HRA-AM7, respectively) postoperative days. The main outcome measures were gross anastomotic healing, adhesion formation, mechanical strength, hydroxyproine content, and parameters of histopathological healing.ResultsAnastomotic dehiscence rate was 66.7%, 40%, 20%, and 10% in group HRA7, HRA3, NA7, and NA3, respectively. However, there was no significant difference between groups regarding the dehiscence rate. The adhesion scores were significantly higher in groups NA3 and HRA3 compared with groups NA-AM3 and HRA-AM3, respectively (p < 0.05, p < 0.001). Bursting pressure was significantly higher in groups with amniotic membrane compared without amniotic membrane (p < 0.05, for all comparison). Inflammatory cell infiltration was significantly lower in groups with amniotic membrane compared with groups without amniotic membrane (p < 0.05, for all both comparisons). Neoangiogenesis was significantly higher in the NA-AM3 and HRA-AM3 groups compared with the NA3 (p < 0.01) and HRA3 (p < 0.05) groups, respectively. Fibroblast activity was significantly higher in groups NA-AM3 and NA-AM7 compared with groups NA3 (p < 0.05) and NA7 (p < 0.05), respectively. Collagen deposition and hydroxyproline concentrations were significantly higher in groups with amniotic membrane compared with groups without amniotic membrane (p < 0.05, for all both comparisons).ConclusionThe covering of both normal and high-risk colonic anastomoses with amniotic membrane provides a beneficial effect over conventional suturing of healing.

Does unilateral lobectomy suffice to manage unilateral nontoxic goiter

OBJECTIVE To evaluate the effectiveness of ipsilateral lobectomy to treat unilateral, nontoxic, benign nodular goiter and to define predictive factors for recurrence. METHODS Patients undergoing thyroid lobectomy for unilateral, nontoxic, benign nodular goiter between 2002 and 2007 were included. Patients were excluded if coincidental thyroid cancer was detected at histopathologic examination and completion thyroidectomy was performed. Potential predictors of recurrence including age; sex; family history; preoperative volume of the thyroid gland; preoperative number, size, and ultrasonography characteristics of the nodules; duration of postoperative follow-up; postoperative use of thyroxine; and histopathologic diagnoses were recorded at baseline. Follow-up visits were scheduled every 3 months during the first year and every 6 months thereafter. Recurrent disease was defined as a hypoechogenic or hyperechogenic nodule larger than or equal to 3 mm detected in the remaining contralateral lobe during ultrasonography. Patients with a thyrotropin value greater than 5 mIU/L received thyroxine. Fine-needle aspiration biopsy was performed for nodules greater than 10 mm or for nodules with characteristics suggestive of malignancy. Reoperation was indicated if a nodule was greater than 3 cm in diameter, posed a risk of malignancy, or caused compression signs or symptoms. RESULTS A total of 104 patients were included. Histopathologic diagnoses at initial operation were adenoma in 45 patients, colloidal nodular goiter in 45 patients, and chronic lymphocytic thyroiditis in 14 patients. Average duration of follow-up was 39.75 +/- 21.75 months (range, 5-87 months). Recurrence was seen in 63 patients (60.6%). Histopathologic characteristics of the lobectomy material (P<.001), preoperative volume of the thyroid gland (P<.006), and multinodularity (P<.011) were significant predictors of recurrence. CONCLUSIONS Higher preoperative thyroid volume, histopathologic characteristics of nodules, and multinodular disease are associated with an increased risk of recurrence in patients with unilateral nodular goiter. Unilateral lobectomy is an effective therapeutic option with low reoperation rates in unilateral benign thyroid disease.

Anatomic variations of the non-recurrent inferior laryngeal nerve

The non-recurrent inferior laryngeal nerve (NIRLN) is a rare anomaly (0.5–0.6% on the right side, extremely rare on the left side (0.004%)), which increases the risk of damage to the nerve during surgery. The right NRILN is associated with a right subclavian artery arising directly from the aortic arch. The left NRILN is associated with situs inversus.1–3 The origin of the NRILN is cervical. Three types can be …

Wound complications and clinical results of electrocautery versus a scalpel to create a cutaneous flap in thyroidectomy: A prospective randomized trial

PurposeThe use of electrocautery for tissue dissection is becoming increasingly popular, despite the associated risk of poor wound healing and excessive scarring. We conducted this study to compare the wound complications and early and late clinical results resulting from electrocautery versus the scalpel to create a cutaneous flap during thyroidectomy.MethodsThe subjects of this study were 100 patients, randomized prospectively to either a scalpel group (group S, n = 50) or an electrocautery group (group E, n = 50).ResultsThickness of tissue damage, postoperative thickness of the flap, discomfort in the neck 7 days after surgery, and hypoesthesia and paresthesia in the neck 3 months after surgery were significantly higher in group E than in group S. There were no significant differences in overall postoperative wound complications, postoperative pain, satisfaction with the cosmetic result, or overall outcome of the operation between the groups. Although the incidence of seroma was higher in group E (20%) than in group S (8%), the difference was not significant.ConclusionAlthough electrocautery was associated with increased histological tissue damage, postoperative flap edema, discomfort, and other complications in the early stage, the clinical and cosmetic results of flaps made using electrocautery or a scalpel were similar and satisfactory 6 months after surgery.

The Safety and Accuracy of Sentinel-Node Biopsy in Early-Stage Invasive Breast Cancer—Turkish Experience

The purpose of this prospective study was to investigate the correlation of sentinel lymph node (SLN) and axillary lymph node (ALN) metastasis in early-stage invasive breast cancer in a single institution. One hundred and fifteen patients with early-stage invasive breast cancer first underwent SLND followed by an appropriate surgical procedure (modified radical mastectomy, lumpectomy + axillary dissection, simple mastectomy + mammoplasty). In this series, a radioactive agent (technetium) was used to investigate the sentinel lymph node/nodes. In 28 (24.3%) patients, metastases were found in both SLN and axillary dissections. There were no metastases in either of these procedures in 69 (60%) patients. SLN metastasis was found in 13 (11.3%) patients, but no axillary metastasis was found. No skip metastasis was detected. Five patients in whom the sentinel node was not found were also negative for axillary metastasis. As the studies progress in this direction, it might be possible to avoid axillary dissection in patients with early breast cancer in whom metastasis in SLN cannot be detected. We believe this will reduce morbidity from breast cancer surgeries.

Ectopic mediastinal thyroid tissue: cervical or mediastinum originated?

A 22-year-old female patient was admitted to our clinic after both clinical and laboratory findings suggested hyperthyroidism. At pre-operative magnetic resonance imaging (MRI), we detected a substernal goitre with lobulated outlines at the inferior of the right lobe that extended 5 cm inferior to the carina. The thyroid mass extended to the mediastinum and was totally extracted by cervical incision. Postoperatively, a residual thyroid mass of 8.5×9×10 cm in size, was detected on MRI at the median part of the anterior mediastinum. The isolated mediastinal thyroid mass was then extracted by sternotomy. We believe that, because of the close anatomical relationship between the thyroid tissue extending cervically and the mass detected in the mediastinum, the mediastinal mass might have developed from the cervical thyroid tissue residues by pushing the cervical thyroid or it might have mechanically entered the mediastinum.

Extralaryngeal division of the recurrent laryngeal nerve: A common and asymmetric anatomical variant

OBJECTIVE Recognition of extralaryngeal branching of the recurrent laryngeal nerve is crucial because prevention of vocal cord paralysis requires preservation of all branches of the recurrent laryngeal nerve. We assessed the prevalence of extralaryngeal branching of the recurrent laryngeal nerve and the median branching distance from the point of bifurcation to the entry point of the nerve into the larynx. MATERIAL AND METHODS Prospective operative data on recurrent laryngeal nerve branching were collected from 94 patients who underwent thyroid or parathyroid surgery between September 2011 and May 2012. RESULTS A total of 161 recurrent laryngeal nerves were examined (82 right, 79 left). Overall, 77 (47.8%) of 161 recurrent laryngeal nerves were bifurcated before entering the larynx. There were 36 (43.9%) branching nerves on the right and 41 (51.9%) branching nerves on the left, and there was no significant difference between the sides in terms of branching (p=0.471). Among 67 patients who underwent bilateral exploration, 28.4% were found to have bilateral branching, 40.3% had unilateral branching, and the remaining 31.3% had no branching. The median branching distance was 15 mm (5-60mm). CONCLUSION Extralaryngeal division of recurrent laryngeal nerve is a common and asymmetric anatomical variant. These variations can be easily recognized if the recurrent laryngeal nerve is identified at the level of the inferior thyroid artery and then dissected totally to the entry point of the larynx. Inadvertent division of a branch may lead to vocal cord palsy postoperatively, even when the surgeon believes the integrity of the nerve has been preserved.

Scarless thyroidectomy: transoral endoscopic thyroidectomy by vestibular approach

Date of acceptance / Kabul tarihi: September 22, 2017 / 22 Eylül 2017 ABSTRACT: Scarless thyroidectomy: transoral endoscopic thyroidectomy by vestibular approach Transoral endoscopic thyroidectomy by vestibular approach (TOETVA) is a minimally invasive, natural orifice transluminal endoscopic surgery (NOTES) technique with no visible scarring. Endoscopic lobectomy or total thyroidectomy can be performed completely under low CO2 pressure level with the aid of one 10 mm and two 5 mm ports applied from vestibular region through the mouth. Its application is increasing worldwide. It can be safely performed in selected patients in experienced centers. In this study, the development of minimally invasive thyroid surgery, patient selection and exclusion criteria for TOETVA, regional anatomy, surgical technique, preoperative and postoperative care, advantages and disadvantages and possible complications of the procedure will be discussed.