Fikret Ezberci

Tuberculosis of the Thyroid Gland: Review of the Literature

ObjectiveThyroid tuberculosis (TTB) is a very rare condition, even in countries with a high prevalence of tuberculosis. The aim of this article is to review and retrieve data about thyroid tuberculosis from the English-language literature in order to gain a better understanding of the clinical characteristics of TTB.Study DesignWe performed Medline, PubMed, and library searches using the key words “thyroid tuberculosis,” “throid disease,” “tuberculosis and thyroid.” Reference lists of the articles obtained and previous reviews were also examined.ResultsWe retrieved 76 cases matching our selection criteria from the search. Review of the cases with TTB revealed a slight female preponderance. The patients reported in the literature ranged in age from 9 to 83 years, with a median age of 40 ± 16 years for men and 44 ± 17 years for women. In the articles surveyed, TTB presented with a broad spectrum of manifestations, ranging from an isolated nodule to thyrotoxicosis. It seems that diagnosis of thyroid tuberculosis has recently been increasing, perhaps because of the growing incidence of tuberculosis and the diagnostic use of fine-needle aspiration cytology in the diagnosis. Although, in the past, the diagnosis was genarally made by the examination of the specimens, at present, fine-needle aspiration cytology seems to be a useful method in diagnosis tuberculous thyroiditis.The role of surgery is limited after the diagnosis. The choice of treatment should be medical antituberculous therapy.ConclusiıonsPreoperative diagnosis of thyroid tuberculosis is important because of the availability of medical treatment and the limited role of surgery. This condition should be kept in mind in evaluating patients with a thyroid nodule, in communities where the prevalence of tuberculosis is high.

In Vitro Effectiveness of Different Chemical Agents on Scolices of Hydatid Cyst

In the surgical history of hepatic hydatid disease, multiple scolicidal agents have been used for sterilization of the cyst contents. However, none of these agents can be safely used, because most have unacceptable side effects, such as toxicity, caustic sclerosing cholangitis, bile duct stricture, and hypernatremia. Protoscolices were aseptically removed from liver hydatid cysts obtained from sheep slaughtered at the municipal abattoir in Kahramanmaras, Turkey. In this study, the effects of 0.9% NaCl (control group), 20% NaCl (hypertonic saline), 20% silver nitrate, albendazole 20 mg/cm3, 50% dextrose (hypertonic glucose), and 20% mannitol and aminomix-1 solutions on echinococe cysts were investigated under in vitro conditions. After 5, 10, 15, 20, 25, 30, 45, and 60 min for each concentration, the first 100 protoscolices were counted on the 10× microscopical field. Protoscolices, which showed positive staining by eosine were considered as dead ones. The averages of dead and total protoscolices were calculated. Our results showed that all observed protoscolices were dead after the treatments by 20% silver nitrate in 20 min, by 50% dextrose and by aminomix-1 solution in 30 min, and by 20% NaCl and by 20% mannitol in 45 min. Albendazole at 20 mg/cm3 was observed to lead to death of 65% of protoscolices in the first 5 min and 70% of protoscolices at the end of 60 min. Compared with 0.9% NaCl (saline), all of these scolicidal agents were significantly effective (p <. 05). Aminomix-1, 20% mannitol, and 50% dextrose solutions may be used in percutaneous and surgical treatment of hydatid cyst. They may be preferred because they are readily available, can be administered intravenously, and have an equal or greater effectiveness than 20% hypertonic saline.

Intraperitoneal tenoxicam to prevent abdominal adhesion formation in a rat peritonitis model.

PurposeWe investigated the effects of intraperitoneal tenoxicam on the development of postoperative intra-abdominal adhesions and oxidative stress in a model of bacterial peritonitis.MethodsBacterial peritonitis was induced in 24 rats by cecal ligation and puncture. The rats were randomly assigned to one of three groups. Group 1 (n = 8) received 2 ml saline intraperitoneally, group 2 (n = 8) received 2 ml (0.5 mg/kg) tenoxicam (Oksamen) intraperitoneally, and group 3 (n = 8) was a control, which did not receive any injection. All animals were killed 14 days later so we could assess the adhesion score and measure anastomotic bursting pressures. Tissue antioxidant levels were measured in 1-g tissue samples taken from the abdominal wall.ResultsThe adhesion score was significantly lower in the tenoxicam group than in the saline and control groups. The anastomotic bursting pressures were higher in the saline and tenoxicam groups than in the control group. The catalase (CAT) levels were higher in the saline and tenoxicam groups than in the control group. The malondialdehyde (MDH) levels were higher in the saline group than in the tenoxicam and control groups.ConclusionsIntraperitoneal tenoxicam inhibited the formation of postoperative intra-abdominal adhesions without compromising wound healing in this bacterial peritonitis rat model. Tenoxicam also decreased the oxidative stress during peritonitis.

Protective Effects of N-Acetylcysteine and β -Glucan Pretreatment on Oxidative Stress in Cecal Ligation and Puncture Model of Sepsis

This study was designed to compare the effect of pretreatment with N-acetylcysteine (NAC) and β -glucan (β GLU) on inflammatory response in a rat model of sepsis. The study was performed in the animal laboratory of the Kahramanmaras Sutcu Imam University, School of Medicine. Forty rats were randomized into four groups (control, sham, NAC, and β GLU). Control and Sham groups received saline or NAC (200 mg/kg, po) in the NAC group and β GLU (50 mg/kg, po) in the βGLU group via intragastric gavage once a day for 10 days and 30 min prior to surgery. Sepsis was induced by cecal ligation and puncture (CLP) in rats. In the NAC, β GLU, and control groups, a laparotomy was performed with the CLP procedure. In the sham group, laparotomy was performed and cecum was manipulated but not ligated or perforated. TNF-α and IL-6 levels were significantly elevated in the control group and decreased in the NAC and β GLU groups. IL-10 levels were significantly increased in the β GLU group (p <. 05). Superoxide dismutase and catalase levels in the liver tissue were significantly increased in the NAC and β GLU groups, whereas superoxide dismutase levels were higher in the β GLU pretreatment group than the NAC pretreatment group (p < 0.05). Malondialdehyde levels in the liver tissue were significantly elevated in the control group and decreased in the NAC and β GLU groups (p <. 05). Prophylactic administration of NAC or β GLU similarly ameliorated sepsis syndrome by reduction of the proinflammatory cytokines and increase of the anti-inflammatory cytokine levels and accession of cellular antioxidants, which protect cells from oxidative stress, thereby recruiting inflammatory cells into tissue.

The Effect of Intraperitoneal Catalase on Prevention of Peritoneal Adhesion Formation in Rats

The objective of our study was to investigate the efficacy of catalase in preventing the formation of peritoneal adhesions induced by cecal serosal laceration in rats. A research study was set up using a randomized complete block design. This study was performed in the Experimental Surgical Research Center, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey. Thirty Wistar albino rats were assigned to 3 groups of 10 animals each. The animals were anesthetized, a median laparotomy was performed, and the cecum was traumatized. In the final stages of surgery, the first group received 30,000 U of catalase intraperitoneally (ip) (catalase group), the second group received 2 mL of saline solution ip (isotonic group), and the last group received no treatment (control group). All rats were sacrificed on day 14. Adhesions were counted and blood samples were taken for measuring the catalase level. There were significant differences between the adhesion scores among all groups (p <. 05, Kruskal–Wallis test). The catalase group had significantly lower adhesion scores than the other groups (post hoc Mann–Whitney test). At day 14, blood catalase levels in the catalase group were significantly lower than in the other groups (p <. 05). We conclude that introduction of catalase into the peritoneal cavity during surgery inhibited adhesion formation.

Effects of the intraperitoneal lornoxicam on the formation of intraperitoneal adhesions in rat peritonitis model

Background:  To investigate the effects of intraperitoneally administered lornoxicam on adhesion formation, bursting pressure, tissue antioxidant levels, morbidity and mortality after ileocolic anastomosis in a rat bacterial peritonitis model.

Eggshell calcification after intrathyroidal hemorrhage of retrosternal thyroid

We report a rare event of old hemorrhage into a thyroid causing respiratory distress. A 67-year-old man with chronic cough and recent dysphagia was found to have a retrosternal mass extending into the visceral mediastinum on chest roentgenogram. A computed tomographic (CT) scan confirmed eggshell callcification, which was 53 × 53 × 80 mm in size a retrosternal thyroid mass and revealed significant tracheal deviation to the right due to an extensive mass surrounded by a calcificated capsule in the left lobe of the thyroid gland with extension to the upper mediastinum. He successfully underwent left lobectomy of the thyroid gland with sternotomy. The pathological examination revealed intrathyroidal hemorrhage of the thyroid gland with massive intracystic old bleeding.

Perkütan kolesistostomi: Yaşlı ve yüksek ASA skorlu akut kolesistitli hastalarda küratif tedavi yöntemi

BACKGROUND Acute cholecystitis (AC) is a common emergency seen by general surgeons. Optimal treatment is laparoscopic cholecystectomy (LC); however, in cases where surgery cannot be performed due to high risk of morbidity and mortality, such as in elderly patients with comorbid diseases, other treatment modalities may be used. Percutaneous cholecystostomy (PC) is one alternative method to treat AC. PC can be used to provide drainage of the gall bladder and control infection. Subsequently, interval cholecystectomy can be performed when there are better conditions. Presently described is experience and results with PC in high risk, elderly patients with AC. METHODS Medical records of all consecutive patients who underwent PC between January 2011 and January 2014 were identified. Tokyo Guidelines were used for definitive diagnosis and severity assessment of AC. Senior surgeon elected to perform PC based on higher risk-benefit ratio due to comorbidity, age, or duration of symptoms. All PC procedures were performed by the same interventional radiologist under local anesthesia with ultrasonographic guidance. RESULTS Total of 40 PC procedures were performed during the study period. Of those, 22 (55%) were male and 18 were (45%) were female, with median age of 70.5 years (range: 52-87 years). All of the patients had American Society of Anesthesiologists classification of either 3 or 4. Success rate of PC was 100% with complication rate of 2.5% (n=1). One patient was operated on shortly after PC procedure due to bile peritonitis complication. PC drains were kept in place for 6 weeks. Total of 16 patients (40%) had surgery following removal of PC drain. In 3 (18.8%) cases, conversion from LC was required. Remaining 23 (57.5%) patients did not have subsequent operation after drain removal. No disease recurrence was observed in follow-up. CONCLUSION When elderly patients present in emergency setting with AC and LC cannot be performed due to comorbid disease or poor general condition, PC can be performed safely. After removal of PC drain, LC may be performed with acceptable conversion rate of 18.8%.

Diffuse Lipid İnfiltration and Squamous Metaplasia Accompanying Amyloid Goiter: Case Report / Amiloid Guatra Eşlik Eden Diffüz Yağ İnfiltrasyonu ve Skuamöz Metaplazi: Olgu Sunumu

ÖZ Sistemik amiloidozis, Ailesel Akdeniz Ateşinin (FMF) ciddi komplikasyonlarından biridir. Tiroid bezinde, FMF’e sekonder ve bası semptomu oluşturacak duzeyde amiloid birikimi nadir gorulen bir durumdur. FMF tanısıyla takip edilen 17 yaşında erkek hasta, boyun on tarafında son 3 aydır hızlı buyuyen şişlik ve nefes darlığı şikayeti ile genel cerrahi polikliniğine başvurdu. Yapılan tetkiklerinde tiroid bezinde bası oluşturan, diffuz hiperplazi tespit edilmesi nedeniyle total tiroidektomi yapıldı. Total tiroidektomi materyalinin histopatolojik incelemesinde parankim icerisinde follikulleri basıya uğratan, yoğun amiloid birikimi ve diffuz yağ infiltrasyonu ile birlikte tiroid dokusunda kistik alanlar goruldu. Kistlerin epitelinde skuamoz metaplazi odakları tespit edildi. Bu bulgulara gore olguya metaplazik değişikliklerin eşlik ettiği amiloid guatr tanısı konuldu. Sonuc olarak uzun suredir FMF’i olan hastalarda amiloid guatr’a metaplazik değişikliklerin de eşlik edebileceğini goz onunde bulundurulmalıdır. ABSTRACT Systemic amyloidosis is one of the serious complications of Familial Mediterranean Fever (FMF). Amyloid accumulation secondary to FMF can cause pressure symptoms in thyroid gland rarely. A 17-year-old male patient with the diagnosis of FMF performed the complaints of dyspnea during his follow-up period. He has demonstrated a rapidly increasing mass localized in front of his neck within the last three months that was diagnosed as a diffuse, hyperplasic and pressuring thyroid gland. Total thyroidectomy was performed. Histopathological investigation of the material obtained after thyroidectomy revealed diffuse lipid infiltration in parenchyma, intense amyloid accumulation around and between the follicles that caused pressure on the follicles, and cystic areas in the tissue. Squamous metaplasia foci in cyst epithelium were detected. Upon these findings the case was diagnosed as amyloid goiter accompanied by metaplastic variations. In conclusion, it can be appropriate to take into account the possibility that metaplastic variations could accompany amyloid goiter in patients with long-term FMF.

An unusual cause of hypercalcemic crisis: Water-clear cell double parathyroid adenoma

Objective To evaluate the clinical characteristics of a patient operated for water-clear cell adenoma and to discuss these in the light of relevant literature. Material and Methods PubMed and Google Scholar were searched to identify articles related to water-clear cell adenoma using the following keywords: parathyroid tissue, parathyroid gland, parathyroid cells, parathyroid adenoma, parathyroid hyperplasia, water-clear-cell, and water clear cell. The search included case reports, review articles, and original articles that had been published between January 1990 and November 2014 without any restrictions on language. All articles that contained information on the study population and treatment related data were identified and retrieved. In addition, an evaluation was of a case of a 47-year-old male patient with PHC who was treated at our clinic was conducted. Results A total of 19 patients, including our new case, (age range: 18 to 81 years, mean±SD: 57.47±16.31 years) were included in the analysis. Eleven patients were female. Information about adenoma location was available from studies involving 17 patients and they indicated the following distribution of locations: left inferior (n=10), right superior (n=4). When preoperative imaging methods were examined, a false negative result was given by ultrasonography in 28.5% of patients and only 57.1% were positive on scintigraphy. Concomitant thyroid papillary carcinoma was determined in 1 patient. The mean tissue dimensions were 3.47±1.73 cm (range, 0.8-6.8 cm). Conclusion Water-clear cell adenoma, which shows similar clinical characteristics to other parathyroid adenomas, is an uncommon cause of hyperparathyroidism.