Semih Aydintug

Evaluation of vocal cord function after thyroid surgery.

OBJECTIVE To compare clinical evaluation and indirect laryngoscopy with videolaryngostroboscopy (VLS), which is a new method of diagnosing abnormalities and dysfunction of the vocal folds. DESIGN Prospective study. SETTING Teaching hospital, Turkey. SUBJECTS 218 patients who required thyroidectomy and who had no vocal abnormality preoperatively. INTERVENTIONS Clinical evaluation, indirect laryngoscopy, and VLS before operation and on the second postoperative day. MAIN OUTCOME MEASURES Sensitivity and specificity. RESULTS The specificity of all three investigations was 100%. The sensitivity of VLS was 100%, of clinical evaluation 81%, and of indirect laryngoscopy 67%. CONCLUSIONS Clinical evaluation and indirect laryngoscopy are safe ways of evaluating abnormalities of the vocal cords postoperatively. It would probably not be cost-effective to use VLS routinely, but for differential diagnosis and evaluation of prognosis of vocal abnormalities after thyroidectomy it is more accurate.

Papillary microcarcinomas of the thyroid gland and immunohistochemical analysis of expression of p53 protein in papillary microcarcinomas

BackgroundThyroid papillary microcarcinoma (TPM) is defined according to WHO criteria as a thyroid tumor smaller than 1–1.5 cm. TPMs are encountered in 0.5–35.6 % of autopsies or surgical specimens where carcinoma had been unsuspected. The purpose of the present study was to evaluate patients who had TPMs in terms of clinical findings, histopathological features and immunohistochemical evidence of expression of the tumor suppressor gene p53.MethodsA total of 44 patients with TPMs less than 1.0 cm in diameter were included in the study. The patients were evaluated clinically and the tumors were evaluated in terms of their histopathological and immunohistochemical features, including expression of p53.ResultsThe female/male ratio was 2.8/1, and the median age at time of diagnosis was 49 years (range 20–71 years). The maximum diameter of the smallest focus was 0.1 mm, and that of the largest was 10 mm microscopically. The mean diameter of all tumors was 5.7 mm. There was no correlation between tumor size and age or gender. Of the TPMs, 72 % were found in the right lobe, 24 % in the left lobe and 4 % in the isthmus. Fine-needle aspiration biopsy provided the diagnosis of TPM in only 43.2 % of the patients. All patients were treated with surgery, with 20 undergoing conservative surgery, i.e. lobectomy or isthmusectomy, and 24 undergoing total thyroidectomy. Frozen section provided the diagnosis of TPM in only 56.8 % of the patients. We found lymphocytic thyroiditis in 13.6% of patients, follicular variants in 11.9%, capsular invasion in 26.8%, lymph node involvement in 11.9%, soft tissue metastases in the neck in 12.1% and multifocality in 31.7 %, and none of these were related to age or gender (p > 0.05). No distant metastases were observed during approximately 10 years of follow up. We found p53 positivity in 34.5 % of TPM tumors. However, p53 expression was not statistically related to age or gender.ConclusionOur findings imply that TPMs may not be entirely innocent since they are associated with signs of poor prognosis such as capsular invasion, multifocal presentation, lymph node involvement and p53 positivity. Therefore, TPMs should be evaluated and followed like classical papillary cancers.

The Importance of Lifelong Follow-Up for Patients with Pheochromocytoma: Report of a Case

We report herein the case of a patient who developed a malignant recurrence of pheochromocytoma 13 years after undergoing complete resection of a histologically benign, unilateral, sporadic tumor. A discussion on the importance of lifelong follow-up for patients undergoing surgery for pheochromocytoma follows this case report.

Effects of postoperative parenteral nutrition with different lipid emulsions in patients undergoing major abdominal surgery.

Purpose This study was designed to investigate the effects of total parenteral nutrition (PN) using different lipid emulsions in patients undergoing major abdominal surgery. Methods Fifty-two patients were randomized to receive soybean oil + medium chain triglycerides (MCT) (group I), soybean oil + olive oil (group II), soybean oil + olive oil + fish oil (group III) as a lipid source. PN was started on postoperative day 1 and patients were maintained on PN for a minimum period of 4 days. Laboratory variables (CRP, prealbumin, transferrin) were measured before surgery and on postoperative days. Results Three treatment groups were included in the study. Patients in group I received long chain triglycerides (LCT) + LCT/MCT emulsion (%75 LCT + %25 LCT/MCT); Patients in group II received olive oil based emulsion (80% olive oil + 20% soybean oil, ClinOleic); Patients in group III received fish oil in addition to olive oil based emulsion (%85 ClinOleic + %15 Omegaven; Fresenius Kabi). The following 14 parameters were assessed: body weight, CRP, prealbumin, transferrin, tumor necrosis factor-α, interleukin-6, total antioxidant status, thiobarbituric acid reactive substances, oxidized low density lipoprotein-2, complete blood cell, international normalized ratio, D-dimer, activated partially thromboplastin time, prothrombin time. All other parameters showed no differences among the groups. Conclusion The results of our trial demonstrate a potential beneficial effect of soybean oil/olive oil based lipid emulsions for use in PN regarding inflammatory response and oxidant capacity in the treatment of patients.

Nonpalpabl rekürren papiller tiroid kanseri reeksplorasyonu öncesinde ultrasonografi eşliğinde tel ile işaretleme tekniği

GIRIŞ Papiller tiroid kanseri en sik tiroid kanseri olup sagkalim orani diger kanserlere gore daha iyidir. Nuks hastalik genellikle servikal lenf nodulunde veya operasyon lojunda izlenir (1). Operasyona bagli fibrozis nedeni ile lenf nodullerinin palpasyonu zorlasmakta olup onemli vaskuler ve noral yapilar iceren kompartmanlarin operasyonda ayrimi zorlasir (2). Bu nedenlerle lenf nodulu metastazi tarzinda nuks eden nonpalpabl lezyonlarda reeksplorasyonun etkinligi dusuk olup komplikasyon orani nisbeten fazladir.