Regional Clinical and Biochemical Differences among Patients with Primary Hyperparathyroidism

This study had been presented at the 6th ESES Biennial Scientific Meeting held in Cardiff (15-17 May 2014).Address for Correspondence: Dr. Özer Makay, Department of General Surgery, Division of Endocrine Surgery, Ege University School of Medicine, İzmir, TurkeyPhone: +90 232 390 50 50 Received: 13 July 2015 e-mail: [email protected]: 27 January 2016 o DOI: Background: Environmental habitat may play a role in clinical disparities of primary hyperparathyroidism (pHPT) patients. Aims: To compare preoperative clinical symptoms and associated conditions and surgical findings in patients with pHPT, living in different geographical regions from the Black Sea, Mediterranean and Anatolia regions. Study Design: Retrospective, clinical-based multicentric study of 694 patients with pHPT.Methods: Patients from 23 centers and 8 different geographical regions were included. Data related to baseline demographics, clinical, pathologic and treatment characteristics of 8 regions were collected and included age, gender, residential data, symptoms, history of fracture, existence of brown tumor, serum total Ca and p levels, serum parathormone (PTH) levels, serum 25-OH vitamin D levels, bone mineral density, size of the resected abnormal parathyroid gland(s), histology, adenoma, and multiple endocrine neoplasia (MEN)- or familial-related disease.Results: The median age was 54. Asymptomatic patient rate was 25%. The median PTH level was 232 pg/mL and serum total Ca was 11.4 mg/dL. Eighty-seven percent of patients had an adenoma and 90% of these had a single adenoma. Hyperplasia was detected in 79 patients and cancer in 9 patients. The median adenoma size was 16 mm. Significant parameters differing between regions were preoperative symptoms, serum Ca and p levels, and adenoma size. All patients from South-East Anatolia were symptomatic, while the lowest p values were reported from East Anatolia and the largest adenoma size, as well as highest Ca levels, were from Bulgaria.Conclusion: Habitat conditions vary between geographical regions. This affects the clinicopathological features of patients with pHPT

Puncture ratio of the gloves during colorectal surgery

OBJECTIVE: The intact gloves are excellent barriers between the hands of the surgeon and the patient. Unfortunately, glove perforation is a very common problem during surgery, especially in some disciplines. Aim of this study was, to evaluate invisible glove perforation ratio during colorectal surgery. MATERIALS and METHODS: In our clinic, one thousand gloves were tested for perforation in 89 randomly selected operations, from September 01 2006 to 31 December 2006. RESULTS: The overall perforation rate was 17.9%. The prevalence of glove perforation was 27.2% and 15.3% in more than one hour and less, respectively, with significant difference. The prevalence of glove perforation was 27.09% and 17.06% in pelvic surgery or non-pelvic surgery, respectively, with significant difference. The glove perforation rate for the operator, the first and the second assistant and nurse were 23.5, 18.8, 4.3 and 8.4% for all of the operations, respectively. CONCLUSION: Changing gloves at regular intervals (especially non-dominant hand, less than one hour) is an effective way to decrease the incidence of possible glove perforation during colorectal surgery.Sağlam eldivenler cerrahın eli ile hasta arasında mükemmel bir bariyerdir. Ne var ki; eldivenlerde delinme cerrahi sırasında özellikle bazı disiplinlerde çok yaygın bir problemdir. Bu çalışmanın amacı kolorektal cerrahi girişimler sırasında meydana gelen ve gözle görülmeyen eldiven delinmelerinin oranını ortaya koymaktır. Kliniğimizde Eylül-Aralık 2006 tarihleri arasında rastgele seçilmiş 89 ameliyatta kullanılan1000 adet eldiven delinme oranının araştırılması için test edildi. Tüm eldivenlerde delinme oranı %17.9 olarak saptandı. Aradaki fark istatistiksel olarak anlamlı olmak üzere bir saatten fazla kullanılanlarda delinme oranı %27.23 ve bir saatten az kullanılanlarda %15.37 olarak saptandı. Yine istatistiksel olarak anlamlı biçimde pelvik cerrahide kullanılan eldivenlerde delinmeoranı %27.09 ve pelvis dışı karın cerrahisinde kullanılanlarda %17.06 olmak üzere fark saptandı. Ameliyat ekibinin tüm ameliyatlar için eldivenlerinde meydana gelen delinme oranlarına bakıldığında sırasıyla operatör, birinci ikinci asistan ve ameliyat hemşiresi olmak üzere oranlar%23.5,18.8,4.3ve8.4 olarak izlendi. Kolorektal cerrahi girişimler sırasında eldivenlerin düzenli olarak değiştirilmesi (özellikle pelvik cerrahide, dominant olmayan el için, bir saatten kısa aralıklarla) eldivenlerde delik bulunması olasılığını etkin bir şekilde azaltmanın bir yoludur

Management of endocrine surgical disorders during COVID-19 pandemic: expert opinion for non-surgical options

Purpose The COVID-19 pandemic brought unprecedented conditions for overall health care systems by restricting resources for non-COVID-19 patients. As the burden of the disease escalates, routine elective surgeries are being cancelled. The aim of this paper was to provide a guideline for management of endocrine surgical disorders during a pandemic. Methods We used Delphi method with a nine-scale Likert scale on two rounds of voting involving 64 experienced eminent surgeons and endocrinologists who had the necessary experience to provide insight on endocrine disorder management. All voting was done by email using a standard questionnaire. Results Overall, 37 recommendations were voted on. In two rounds, all recommendations reached an agreement and were either endorsed or rejected. Endorsed statements include dietary change in primary hyperparathyroidism, Cinacalcet treatment in secondary hyperparathyroidism, alpha-blocker administration for pheochromocytoma, methimazole +/- beta-blocker combination for Graves' disease, and follow-up for fine-needle aspiration results of thyroid nodules indicated as Bethesda 3-4 cytological results and papillary microcarcinoma. Conclusion This survey summarizes expert opinion for the management of endocrine surgical conditions during unprecedented times when access to surgical treatment is severely disrupted. The statements are not applicable in circumstances in which surgical treatment is possible

Evaluation of public’s perception of scar cosmesis after thyroidectomy: Results of a survey of Turkish versus South Korean individuals

Purpose: Visible scars on the neck caused by thyroid surgery give rise to significant aesthetic, functional, and psychosocial problems. The objective of this study is to comparatively investigate the public perception of neck scar cosmesis in Turkish and South Korean populations. Methods: This survey was prepared to collect participants’ demographic and socioeconomic data and determine their perception of scar cosmesis on the neck and consisted of 15 questions. One thousand thirty-nine individuals who did not undergo thyroid surgery completed the survey. The P-values of <0.05 were deemed to indicate statistical significance. Results: There were 1,039 respondents, of whom 525 (50.5%) were Turkish and 514 (49.5%) were South Korean. South Korean respondents stated that they would be significantly more uncomfortable with the thought of having a scar due to thyroid surgery, compared to the Turkish respondents (P < 0.001). The South Korean respondents stated that they would be significantly more concerned about the scar’s length, thickness, and darkening color, compared to the Turkish respondents (P < 0.001 for all cases). Conclusion: Patients’ expectations, which are affected by various sociodemographic factors and cultural characteristics, are as important as the medical condition when deciding on the type of thyroid surgery. The study findings clearly indicated that the South Korean population would be significantly more uncomfortable with having a scar on the neck, compared to the Turkish population. Therefore, in selected cases, a scarless thyroidectomy approach, such as transoral endoscopic thyroidectomy, vestibular approach may be preferable for societies like South Korea

Deneysel alkali özofagus yanıklarında allopürinol kullanımının etkinliği

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.ABSTRACT Background: Many methods are described for the treatment of caustic esophageal bums concerning the control of stricture formation. Nevertheless, narrowing of the esophagus after healing of severe bums remains an inevitable problem. It is well known that during the acute necrotic phase of esophageal bums the production of free oxygen radicals derives from the wounded tissue, where xanthine oxidase plays also an important role. This study was conducted to investigate the effects of allopurinol on oxidative stress and stricture formation after caustic esophageal burn. Materials and Method: The study was performed in 60 Wistar albino rats divided into 6 experimental groups. Caustic esophageal bum was induced by application of 37.5% NaOH to the distal esophagus according the modified technique of Gehanno. Allopurinol was given at a dose of 40 mg/kg via intraperitoneal route. Group A, B and C consisted of rats where changes during the acute phase were evaluated, while Group X, Y and Z consisted of rats for the assessment of the chronic phase. Group A and X (sham) were uninjured. Rats in Group B and Y had untreated oesophageal bums. Group C and Z had oesophageal bums treated with a single dose of allopurinol. Efficacy of the treatment for the acute phase was assessed after 72 hours by measuring tissue malondialdehyde (MDA), nitric oxide (NO) and glutathione (GSH); for the chronic phase by determining tissue hydroxyproline content, histopathologic damage score and stenosis index. Results: When compared to group A, the mean GSH levels were higher in group B and lower in group C (p>0.05), while mean NO levels were decreased in group B (p>o.05). Moreover, tissue MDA levels were significantly higher in group B (pÖZET Amaç : Kostik özofagus yanıklarının tedavisinde, darlık gelişmesini engellemeye yönelik bir çok tedavi yöntemi bildirilmiştir. Ancak, bütün bu tedavilere rağmen ciddi yanıklardan sonra gelişen darlık hala kaçınılmaz bir sorundur. Diğer taraftan, kostik yanığı takiben, akut nekrotik faz olarak bilinen dönemde, serbest oksijen radikallerinin özofagus dokusunda arttığı, ksantin oksidaz enziminin bunda rolü olduğu bilinmektedir. Bu amaçla, bu enzimi inhibe eden allopürinol'ün oksidatif stres ve striktür gelişimi üzerindeki etkilerini araştırmayı amaçladık. Gereç ve yöntem: Çalışmada 60 adet Wistar albino sıçan, her birinde 10 adet olmak üzere 6 gruba ayrılarak çalışıldı. Grup A, B ve C'de kostik yanığın akut dönemdeki etkileri, Grup X, Y ve Z'de ise geç dönemde darlık oluşumu üzerindeki etkileri araştırıldı. Grup A ve X' teki hayvanlara sham operasyonu uygulanırken, diğer grupları oluşturan hayvanlarda, Gehanno tarafından tarif edilen yöntemin modifikasyonu ile 1ml %37.5'luk NaOH solüsyonu ile standart kostik özofagus yanığı oluşturuldu. Grup B ve Y'deki hayvanlara herhangi bir tedavi uygulanmazken, Grup C ve Z'dekilere allopürinol (40mg/kg; intraperitoneal) tedavisi uygulandı. Akut dönemdeki etkiler, doku malondialdehit (MDA), nitrik oksit (NO) ve glutatyon (GSH) düzeyleri, geç dönemdeki etkiler hidroksiprolin seviyeleri ve histopatolojik hasar skoru ve stenoz indeksi ile değerlendirildi. Bulgular Doku GSH düzeyi, A grubu ile karşılaştırıldığında, B grubunda daha yüksek saptanırken (1.37 ± 0.92'ye 1,90 ± 0.95 mg/g yaş doku), C grubunda daha düşük saptandı (1.37 ± 0.92'ye 1,35 ± 0.65 mg/g yaş doku), (p>o.05). Doku NO düzey ortalaması, A grubu ile karşılaştırıldığında B grubunda azaldı (2.99 ± 2.09'a 1,26 ± 0.78 umol/g yaş doku), (p>o.05). NO düzeyi, C grubunda A grubunun ortalaması altına düşmekle birlikte gruplar arasında anlamlı fark saptanmadı (p>0.05). Doku MDA düzeyi, A grubuna göre B grubunda artış gösterdi (407.5 ± 183.6'ya 960.4 ± 384.8 nmoi/g yaş doku) (p0.05). Tedavi grubunda ise doku MDA düzeyleri azaldı (546.1 ± 338.2 nmol/g yaş doku), (p>o.05). Hidroksiprolin düzeyleri ve stenoz indeksi açısından gruplar arasında anlamlı fark saptanmadı (p>0.05). Grup Y'nin histopatolojik hasar skoru, X ve Z gruplarının değerleri ile karşılaştırıldığında bu gruptaki yüksek skorun anlamlı olduğu belirlendi (p0.05). Sonuç: Kostik özofagus hasarında allopürinol'ün etkisinin literatürde ilk kez araştırıldığı bu çalışmada ilaç, erken dönemde GSH, NO ve MDA düzeylerini çeşitli derecelerde etkilemiş ve MDA'nın doku düzeylerini azaltmıştır. Allopürinol, bu modelde kronik dönemde gelişen özofageal fıbrozisi anlamlı şekilde azaltmaktadır