Ekmel Tezel

Total thyroidectomy for the treatment of Hashimoto's thyroiditis coexisting with papillary thyroid carcinoma.

The coexistence of Hashimoto’s thyroiditis (HT) and papillary thyroid carcinoma (PTC) is controversial. This study was conducted to evaluate the correlation between HT and PTC and to identify predictive factors for the coexistence of PTC and HT. A total of 922 patients underwent surgery for thyroid disorders between January 2001 and August 2005. In all, 199 patients had been diagnosed with PTC, 37 of whom had coexistent HT; in 689 patients, benign thyroid disease had been diagnosed. Patients’ age and sex, as well as histopathology, tumor size, nodal involvement status, multicentricity, presence of metastasis, and serum thyroglobulin levels, were retrospectively reviewed. A significant correlation was observed between HT and PTC, although no statistical significance was noted between PTC and HT type (nodular or diffuse). Most patients with PTC+HT were female and younger (<40 y old) than those with PTC only. The rate of occult tumor in patients with PTC+HT was higher than that in patients with PTC alone. Data indicate the coexistence of PTC and HT and suggest that PTC may develop even in cases of diffuse HT. Total thyroidectomy is the surgical procedure of choice, especially in young, female patients with HT.

A prospective comparative study of the efficacy of conventional lichtenstein versus self-adhesive mesh repair for inguinal hernia

PurposeLichtenstein repair has been the gold standard in inguinal hernia surgery. The aim of this study was to investigate the role of mesh fixation in terms of postsurgical chronic pain and recurrence.MethodsSixty patients with primary inguinal hernias were treated between March 2007 and December 2008. Thirty patients underwent conventional Lichtenstein repair while a self-adhesive mesh was used for the second group. The primary outcome parameters were the rate of recurrence and chronic pain. The operating time, postoperative pain, complications, and time when patients returned to work were recorded.ResultsFifty-one patients completed the survey. Early pain scores were lower in the self-adhesive mesh group. The main advantage of the self-adhesive mesh was the shorter operating time (23.70 ± 5.57 vs 36.90 ± 11.36, P = 0.006). Both techniques were almost identical in terms of long-term chronic pain (P = 0.294), and the rates of recurrence at the end of a median of 31 months’ follow-up were identical.ConclusionSelf-adhesive mesh repair of inguinal hernias is superior to the conventional Lichtenstein method in terms of shorter operative time and less pain in the early postoperative period. The rates of chronic pain and recurrence are similar with the suture-fixed repairs.

Intermittent pneumatic sequential compression of the lower extremities restores the cerebral oxygen saturation during laparoscopic cholecystectomy

BackgroundPneumoperitoneum causes intracranial pressure elevation and blood stasis at lower extremities. This study investigates cerebral oxygen saturation changes during laparoscopy and the effects of intermittent sequential compression (ISC) of the lower extremities in patients during elective laparoscopic cholecystectomy.Patients and methodSixty patients were randomly divided into two groups according to the application of ISC to the lower extremities. Group I served as control group whereas ISC was applied to group II. Cerebral oxygen saturation, peripheral blood oxygen saturation, heart rate, mean blood pressure, and associated changes have been recorded during the operation.ResultsPeripheral blood oxygen saturation and mean blood pressure values did not change significantly after pneumoperitoneum. Cerebral oxygen saturation levels of the group II patients were higher in than the group I patients and the difference between the groups was statistically significant (p = 0.0001). The difference became more prominent following the 35th minute of the operation. Mean heart rate of the patients in group II was lower than the patients in group I and the difference was also statistically significant (p = 0.0001).ConclusionIn this study, it was found that the decrease in cerebral oxygen saturation was recovered with ISC application. This simple and reliable technique helps to restore cerebral oxygen saturation levels while increasing blood return from the lower extremities.

Wegener's granulomatosis with massive gastrointestinal hemorrhage due to jejunal and colonic involvement: report of a case.

Wegener’s granulomatosis (WG) is a systemic necrotizing vasculitis of unknown etiology characterized mainly by the involvement of the upper airways, lungs, and kidneys. Although most organ systems can be involved, gastrointestinal involvement in WG is notably uncommon. We herein present the case of a WG patient who developed two massive gastrointestinal hemorrhages treated respectively by surgery and angiographic embolization of the bleeding artery. The present case indicates that gastrointestinal manifestations might thus be considered in the natural history of WG.

Coexistence of Gastrointestinal Stromal Tumor (GIST) of the Rectum and Adenocarcinoma of the Prostate in a Patient with Familial GIST

Background: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal system. The rectum is a rare location for GIST. Prostate adenocarcinoma is the most common malignancy in geriatric men. Rarely, rectal GIST mimics prostate pathologies. Case Report: We describe a 58-year-old male patient who was admitted with signs and symptoms of prostatism. A presumptive diagnosis of primary prostate sarcoma was made based on imaging studies and a trucut biopsy. Removal of the mass compressing both the prostate and the rectum revealed the final diagnosis of synchronous prostate adenocarcinoma and high-grade GIST originating from the rectum. The patient also had a family history of GIST. Conclusion: According to our knowledge, there are 5 more reported cases of rectal GIST, which were misdiagnosed as prostate malignancy. Rectal GIST may simulate prostate carcinoma clinically, and should always be kept in mind in the differential diagnosis of prostate pathologies.

Laparoscopic Primary Repair of Ventral Hernias: Early Results of a New Technique

Epigastric, umbilical, incisional, parastomal, and trocar site hernias are all classified as “ventral” hernias, which constitute a great portion of the surgery in a general surgical practice, and debate still continues regarding the optimal surgical strategy to correct these anatomical defects. Although repairing these hernias using a synthetic material, whether placed open or laparoscopically, has gained wide popularity, there are some situations where the use of a mesh is either unnecessary or contraindicated. This article presents the cases of 10 patients with some kind of ventral hernia which were all repaired laparoscopically with a primary suturing technique.

Adult hepatic epitheloid haemangioendothelioma presenting with Kasabach-Merrit syndrome: a case report.

Kasabach-Merrit syndrome (KMS) is a serious consumptive coagulopathy with thrombocytopenia, associated with benign or malignant vascular tumours or malformations. Although it is generally reported with childhood vascular tumours, there is limited data about adult vascular tumours associated with KMS. Hepatic epithelioid haemangioendothelioma (HEHE) is a rare vascular neoplasm of the liver with intermediate malignant potential. In adult patients, HEHE associated KMS has reported in several case reports. A 39-year-old male patient with epitheloid haemangioendothelioma in the liver and KMS is described here. He presented with multiple bilobar liver metastasis and severe thrombocytopenia, anaemia and coagulopathy. Immunohistochemistry showed diffuse cytoplasmic staining with CD34 and vimentin; thus the diagnosis of epitheloid haemangioendothelioma was confirmed. It is believed that this patient is the third case with adult HEHE associated with KMS reported in the literature. Hepatic epitheloid haemangioendothelioma (HEHE) is a rare vascular neoplasm of the liver with low malignant potential.1 Kasabach–Merrit syndrome (KMS) is serious coagulopathy and is rarely associated …

Comparison of laparoscopic primary and open primary repair of ventral hernias.

Prosthetic materials have gained popularity for ventral hernia repair. There are situations when the use of a mesh is either unnecessary or contraindicated. This study compares 51 patients with ventral hernia who underwent laparoscopic or open primary suture repair. Results were determined by a median follow-up of 33 months. Recurrence rates and operative time were the major parameters of outcome. Mean operative time was insignificantly shorter in the laparoscopic group (14.8±4.3 vs. 15.6±3.7 min). There were no short-term complications in groups. One patient in each group had recurrence. Conclusively, laparoscopic primary repair of small ventral hernias is simple and can be performed as an initial approach for small defects. Compared with open repair, it has the advantages of better exposure, reduced pain, and less morbidity. It can also be performed as a component of a combined laparoscopic operation. However, this technique is not recommended for repair of large ventral hernias.