Nihat Yavuz

Impact of initial surgical treatment on survival of patients with differentiated thyroid cancer : Experience of an endocrine surgery center in an iodine-deficient region

This retrospective clinical study was designed to analyze the impact of the initial surgical procedure on the survival of 1000 patients with differentiated thyroid cancer of follicular cell origin who had a thyroid operation and were followed for the 30 years between 1968 and 1998 (median 14 years) in an iodine-deficient region where goiter is endemic. There were 753 women and 247 men with a mean age of 42.8 ± 6.7 years (range 17–86 years). Patients were divided into three groups. All patients had undergone thyroxine treatment and thyroid-stimulating hormone (TSH) suppression, and most had had iodine-131 treatment postoperatively. Group A consisted of 336 patients with differentiated thyroid cancer (DTC) who were treated with bilateral subtotal thyroidectomy in our institution or elsewhere. Group B consisted of 158 patients with DTC who were treated initially with unilateral total lobectomy and contralateral subtotal lobectomy in our institution or elsewhere and underwent reoperation in our department. Group C consisted of 506 patients with DTC who were treated initially with total or near-total thyroidectomy in our department. Kaplan-Meyer survival analysis was used. Recurrence was seen in 23% and death in 8% of the patients. The 20-year survival rates were 76%, 85%, and 92% for groups A, B, and C, respectively. The survival difference among the patients of group A and groups B and C was found to be statistically different (p < 0.001). Long-term survival of patients with differentiated thyroid cancer living in endemic areas for goiter can be influenced by the initial surgical treatment. Patients treated initially with total or near-total thyroidectomy appear to have a better prognosis.

Thoracoscopic enucleation of a giant submucosal tumor of the esophagus.

Since the introduction of thoracoscopy in the surgical field, many thoracic interventions have been considered feasible via thoracoscopic route. The authors reported a case of thoracoscopic enucleation of a giant esophageal submucosal tumor (8.5 cm in diameter) situated along the left side of the midesophagus. Histopathologic evaluation revealed a gastrointestinal stromal tumor (GIST). Postoperative period was uneventful and the patient was discharged on the eighth postoperative day. Given the well-known advantages of minimally invasive surgery, we assume that the removal of esophageal submucosal tumors can first be attempted by thoracoscopic approach, even if the tumor is of a big size. In cases of histopathologically unknown tumors preoperatively, definitive examination of the complete specimen provides the basis for further therapeutic decisions.

Comparison of the Electrothermal Vessel-Sealing System Versus Endoclip in Laparoscopic Appendectomy

BACKGROUND Various techniques have been used for the division of mesoappendix, such as endoloops, endoscopic linear cutting staplers, an electrothermal vessel-sealing system (LigaSure), the Harmonic Scalpel, clips, and bipolar coagulation. In the present study, LigaSure and an endoclip were compared in laparoscopic appendectomy (LA). MATERIALS AND METHODS This study included patients who underwent LA for acute appendicitis at Istanbul University, Cerrahpasa Medical Faculty, Emergency Unit (Istanbul, Turkey) between May 2003 and April 2007. The patients were assigned to two groups according to the mesoappendix dissection device: LigaSure and endoclip groups. The main outcome measures (e.g., operating time, conversion rate, hospital stay, postoperative complications, etc.) were then compared. RESULTS LA was performed in 280 patients with acute appendicitis. LigaSure and endoclips were used in 127 and 153 patients, respectively. The mean operative times were 41 and 54 minutes in the LigaSure and endoclip groups, respectively. Conversions to open rates were found to be 9.4% (12 patients) in the LigaSure and 11.1% (17 patients) in endoclip groups. No statistically significant differences regarding hospital stay or complications were found, whereas significant differences were observed in surgical time and conversion rate. CONCLUSION The use of LigaSure facilitates the dissection of mesoappendix and shortens the operation time in LA. We believe that LigaSure is a safe, useful tool for mesoappendix dissection.

The effect of oral sodium taurocholate on endotoxemia and intestinal anastomotic wound healing in rats with obstructive jaundice

The effect of sodium taurocholate (ST) on endotoxemia and intestinal anastomotic wound healing in obstructive jaundice was evaluated in a rat model. A total of 108 Wistar rats were divided into three main groups. Thus, 36 animals were given ileal anastomosis (IA) alone (IA group), 36 were given IA with bile duct ligation (BDL) (IA+BDL group), and 36 were given IA with BDL and oral sodium taurocholate (ST) (IA+BDL+ST group). These three main groups were then divided into three equal subgroups, A, B, and C, which were killed on postoperative days (POD), 3, 5, and 9, respectively. In the IA+BDL+ST group, ST was administrated perioperatively and ceased from POD 5 onwards. The anastomotic hydroxyproline level and bursting pressure were significantly lower in the IA+BDL animals compared with the others on POD 3, 5, and 9 (P<0.008). Endotoxemia was prominent in the IA+BDL group from POD 3 (P=0.011). After ST was stopped, 42% of the AI+BDL+ST animals developed endotoxemia by POD 9 (P=0.008). Anastomotic wound healing was better in the IA+BDL+ST group (P<0.01). These findings suggest that endotoxemia and its adverse effects on wound healing in obstructive jaundice can be prevented by the oral administration of ST.

Effect of intra-abdominal pressure level on gastric intramucosal pH during pneumoperitoneum.

The present study was designed to examine the effect of intra-abdominal pressure level on gastric intramucosal pH using gastric tonometry during pneumoperitoneum. One hundred patients were prospectively randomized into 5 equal groups (N = 20 each). Intra-abdominal pressure levels were 8, 10, 12, 14, and 16 mm Hg in groups I, II, III, IV, and V, respectively. Intramucosal pH measurement was done 2 times: 30 minutes following insufflation and 1 hour after the ending of the surgery. In the first and second measurements, intramucosal pH values were found as 7.39 ± 0.02 and 7.36 ± 0.03 in group I; 7.41 ± 0.03 and 7.38 ± 0.03 in group II; 7.37 ± 0.03 and 7.37 ± 0.03 in group III; 7.36 ± 0.03 and 7.37 ± 0.03 in group IV; and 7.39 ± 0.03, 7.36 ± 0.03 in group V, respectively. Statistical significance was not found in the comparison of these values within the groups and between the groups (P > 0.005, for each). In conclusion, intra-abdominal pressure between 8 and 16 mm Hg did not cause significant difference in gastric intramucosal pH.

Enteroliths developed in a chronically obstructed afferent loop coexisting with gastric remnant carcinoma: Case report and review of the literature

A case of gastric remnant carcinoma coexisting with a chronic afferent loop syndrome harboring multiple enteroliths in a grossly dilated and elongated afferent loop is presented herein. The patient had undergone a Polya type antecolic Billroth II reconstruction for a stenosing duodenal ulcer 40 years previously. A concise review of the relevant literature is also presented.

Serum Free Prostate-Specific Antigen and Zinc Levels in Experimental Acute Pancreatitis

Serum free prostate-specific antigen (fPSA) is the most useful tumor marker for prostatic cancer screening. However, recently, fPSA has also been detected in sera from patients with pancreatic diseases. In addition, it has been shown that zinc (Zn) concentration might change in both serum and tissues in pancreatic disease. In the present study, we measured serum concentrations of fPSA and Zn as possible markers and prognostic factors in an experimental acute-pancreatitis model. Twenty-five female Wistar albino rats were divided into two groups: the control group (n=10) and the experimental group (n=15). Acute pancreatitis was induced by injection of ethyl alcohol into the common biliary duct. The animals were sacrificed 24 h later to detect the concentrations of serum fPSA and Zn. fPSA values were detected to be significantly higher in the experimental group p<0.001). There was also a significant decrease in the serum Zn level of the acute-pancreatitis group (p<0.001). In conclusion, these findings suggested that a combination of these parameters might represent a significant improvement on the diagnostic value of each of them separately and provide a powerful tool for differential diagnosis and prognosis in pancreatic diseases.

Videoendoscopic parathyroidectomy: gaseous or gasless technique?

ously, stimulation of either of these nerves should alert the anesthesiologist to redirect the needle accordingly. On the other hand, since a subclavian perivascular block is carried out at the level of the trunks, and since the suprascapular nerve arises from the superior trunk, it is obvious that if one evokes a paresthesia to the shoulder or illicits a twitch response to a nerve stimulator of the muscle innervated by C5, C6, as correctly stated in my text (2), it is difficult, if not impossible, to tell whether the needle is stimulating the suprascapular nerve outside the sheath or the superior trunk within it. Therefore, I still believe that with this technique a more distal paresthesia or twitch response is mandatory. To summarize, in view of all of the above, I must disagree with the conclusion of Sukhani and Candido that in performing an interscalene block one must seek a paresthesia distal to the shoulder, but I certainly agree with their conclusion that when performing an interscalene block using a peripheral nerve stimulator, a deltoid motor response is an appropriate end-point.