Minimally invasive surgery in primary hyperparathyroidism

Aim:  To describe the general and laboratory characteristics of patients with primary hyperparathyroidism (PHPT) who underwent surgery in our clinic, as well as surgery-related morbidity. Methods: The study population were selected: Patients with clinical and radiological diagnosis of PHPT were included in the study. Minimal invasive parathyroid surgery, aimed only the affected gland, was chosen for the patients. Preoperative calcium (Ca), parathyroid hormone (PTH), and postoperative Ca and PTH levels were recorded. Preoperative sonography and scintigraphy studies to determine localization were obtained from the same database. Results: 116 patients were undergone minimal invasive surgery for hyperparathyroidism, which is mainly focused on the pathological gland. The mean preoperative PHT was 397 ng/L and postoperative PTH was 53 ng/L. Preoperative and postoperative Ca levels were 11.7 mg/dL and 9.3 mg/dL, respectively. Histopathological evaluation revealed following results: 108 patients had adenoma. None of the subjects had malignancy. The mortality rate was 0% and the morbidity was 1.7%, related to this procedure. Conclusion: According to the data in present study, we suggest that minimally invasive surgical techniques should be preferred in sake of higher success and lower postoperative morbidity in patients with a single gland disease

Preoperative MELD-Na Score Predicts 30-day Post-operative Complications After Colorectal Resection for Malignancy

Introduction:Predicting possible complications in colon surgery is important in terms of reducing postoperative mortality and morbidity rates. Various scoring methods have been used to predict these complications. The MELD score was developed to predict mortality following Transjugular Intrahepatic Portosystemic Shunt (TIPS) placement in cirrhotic patients. This model was revised by adding Na data and used to predict complications in non-cirrhotic patients. We investigated the value of the MELD-Na score in predicting postoperative 30-day complications in patients undergoing colorectal resection for malignancy.Methods:Patients who underwent colorectal resection for malignant diseases were included in the study. Demographics and clinical outcomes were recorded. The MELD-Na scores of the patients were calculated within 48 h before the surgery. Patients were divided into 2 groups according to the status of development of any complication.Results:Age, gender, operative time, and length of stay was not statistically significant for developing complications. The MELD-Na score was significantly higher in patients with any complications. Also, MELD-NA score, stoma creation, and postoperative erythrocyte suspension replacement were found to be independent risk factors for developing complications in patients undergoing surgery for colon cancer.Conclusion:The MELD-Na score may predict the complications that may develop in the first 30 days postoperatively in patients undergoing colorectal resection for malignant diseases

Evaluation of pleural effusions developed after abdominal operations

Respiratory problems may develop after abdominal operations. It is more common especially in upper abdominal surgeries than in lower abdominal surgeries. In this study, patients with pleural effusion developed after abdominal operations were evaluated retrospectively in terms of etiology and drainage indications. A total of 56 patients who underwent abdominal surgery between March 2012 and November 2018 with pleural effusion were included in the study. Age, sex, smoking history, concomitant diseases, operative diagnoses, and operations performed and treatment results of the patients were recorded. 19 (33.9%) of the cases were female, 37 (66.1%) were male, and the mean age was 52.5±12.16 (24-82). In the postoperative period; pleural effusion developed in 12 (21.4%) bilaterally, in 15 (26.8%) on the right side, and in 29 (51.8%) on the left side. 18 (32.1%) of the cases underwent liver cyst and tumor surgery; 15 (26.8%), splenic surgery; 17 (30.3%), gastric tumor surgery; 2 (3.6%), calculous pouch-cholecystitis surgery; and 4 (7.1%), colon-rectum surgery. Fluid transfer to the intrathoracic area may occur due to the high intra-abdominal pressure as a result of the disruption in the integrity of the diaphragmatic peritoneal face after abdominal surgery. Additionally, hypoalbuminemia in the postoperative period has a role in the development of pleural effusion. Pleural fluid drainage may be required to prevent possible morbidities and mortalities in such cases. [Med-Science 2022; 11(2.000): 537-9

Abdominal cocoon: a rare cause of intestinal obstruction in two patients

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The Case of Bezoar in a Patient Presenting with Vomiting

Bezoars are solid mass of a indigestible material accumulating in the gastrointestinal tract. Although rarely, bezoars may cause gastrointestinal obstruction. We aimed to present the case of a patient presenting with the complaint of vomiting in whom a diagnosis could not be established for a long period of time

The Comparison of Anterior and Posterior Herniorraphy Operations in Recurrent Inguinal Hernias

Aim: The incidence of recurrent hernia after primary repair of the inguinal hernia ranges from 1% to 20%. There is still controversy over the selection and use of anterior versus posterior approach in the repair of recurrent inguinal hernias. The present study evaluated the outcomes achieved in patients who were operated on using the two methods. Methods: This retrospective study included a total of 109 patients, who underwent an operation due to recurrent inguinal hernia in a period of 15 years. Posterior preperitoneal mesh repair was performed in 60 patients and anterior approach using Lichtenstein technique was used in the remaining 49 patients. Polypropylene mesh graft was used in the repair and the patients were compared after control visits at one week, one month, six moths and one year. The chi-square test and Student’s t-test were used in the statistical analysis. Results: The mean length of hospital stay was 1.9 days in the posterior approach group and 1 day in the anterior approach group. Of the patients who underwent repair using posterior approach, 57 were male and three were female with a mean age of 55.2 (range 25-80) years. Of the patients who underwent repair using anterior approach, 46 were male and three were female with a mean age of 56.6 (18-82) years. The rate of postoperative complications was 8.3% in the posterior approach group and 6% in the anterior approach group. Conclusion: Surgical procedures involving anterior approach are commonly preferred in the repair of inguinal hernias due to short procedure time, favorable safety profile and lower morbidity rates, however, these procedures pose the disadvantages of difficulty of accessing the recurrent hernia area and being time consuming surgery due to inflammation secondary to previous surgery as well as the risk of injury to the cord elements. Anterior approach can be used despite all these risk factors, but placement of mesh into the intact preperitoneal area can also be used as a safe procedure

Assessment of the Pre-operative Nutritional Status of Patients who were Scheduled for Elective Surgery and Determination of Nutritional Support Requirements

Aim: We aimed to evaluate the nutritional status with clinical, antropometric and laboratory methods in patients who were scheduled for elective surgery. Methods: Retrospective evaluation of 90 patients in a period of 4 years was performed. Patients with tumors (group 1) were compared with controls (group 2) in regard to nutritional status. Student t-test, Mann-Whitney U test and chi-square test were used for statistical analysis. Results: The mean age of patients in group 1 (3 males, 8 females) and group 2 (35 males, 44 females) was 62.8±11.0 and 47.7±16.2 years, respectively. The mean body mass index (BMI) was 30.1±6.6. Triceps thickness and circumference of the upper mid-arm were 2.2±0.8 and 28.6±4.2 cm, respectively. All patients had a Subjective Global Assessment (SGA) score A, but two patients were classified as having moderate nutritional risk according to Nutritional Risk Screening (NRS) 2002. The mean length of hospital stay was 2.6±2.4 days. Complications were observed in four patients of group 2 and in two patients of group 1. Gender, SGA score, albumin, prealbumin, BMI, triceps thickness, circumference of the upper mid-arm and complication rates were statistically similar between the groups. There was a statistically significant difference in age, NRS 2002, gastrointestinal system findings, length of hospital stay, sedimentation and fasting blood glucose levels between the groups. Conclusion: Patients with nutritional risk can be detected using the NRS 2002. Nutritional support was necessary in 2% of all cases and in 18% of group 1 patients. However, advantages of antropometric measurements, biochemical tests, BMI and SGA could not be shown

Comparison of Partial Cystectomy and Tube Drainage Technique with Other Surgical Methods in Hydatid Cysts of the Liver

Aim: Since radical surgical methods in the treatment of hydatid cysts of the liver have been replaced by less invasive surgical interventions nowadays, partial cystectomy and tube drainage (PCTD) have been more popular. The evaluation of PCTD technique was aimed using the data obtained from the medical records of patients who had been operated on in our surgical clinic. Methods: Data of patients who had been operated on using the PCTD technique between 2007 and 2012 were compared with those of patients in whom different surgical methods had been employed. The PCTD and control groups consisted of 41 and 14 patients, respectively. The study was conducted retrospectively according to the hospital data and patient files, surgery and pathology records in addition to computer data and verbal information of the patients. Chi-square test was used in the statistical analysis where a p value of less than 0.05 was considered statistically significant. Results: The mean age of the subjects in the PCTD and control groups were 48 and 33.21 years, respectively. PCTD (n=41) and control (n=14) groups consisted of 22 females versus 19 males and 11 females versus 3 males, respectively. Single cysts were found in 34 patients in PCTD group versus multiple cysts in the remaining 7. Single cyst was found in 10 patients in the control group versus multiple cysts in the remaining 4. Bilateral cyst/cysts in 7, right-sided in 29 and left-sided in 5 patients in PCTD group versus bilateral cyst/cysts in 1, right-sided cyst/cysts in 11 and left-sided cyst/cysts in 2 patients in the control group were found. Complications occurred in 3 of 41 (7.31%) and in 2 of 14 (14.28%) patients in the PCTD and control groups, respectively. PCTD applicability statistically significantly correlated with male gender and the presence of a single cyst, but age and location of the cyst. Moreover, complication rate was significantly lower in the PCTD group than in controls. Conclusion: PCTD is a reliable and easily applicable method of choice when compared to other surgical interventions with less complication rates

Epidemiologic and clinical characteristics of neonates with late-onset COVID-19: 1-year data of Turkish Neonatal Society

© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.The literature on neonates with SARS-CoV-2 is mainly concerned with perinatal cases, and scanty data are available about environmentally infected neonates. To fill knowledge gaps on the course and prognosis of neonatal cases, we analyzed 1-year data from the Turkish Neonatal Society in this prospective cohort study of neonates with postnatal transmission. Data from 44 neonatal intensive care units (NICUs), of neonates with positive RT-PCR results at days 5–28 of life, were extracted from the online registry system and analyzed. Of 176 cases, most were term infants with normal birth weight. Fever was the most common symptom (64.2%), followed by feeding intolerance (25.6%), and cough (21.6%). The median length of hospitalization was 9 days, with approximately one quarter of infants receiving some type of ventilatory support. Myocarditis (5.7%) was the most common complication during follow-up. Among the clinical findings, cough (odds ratio [OR]: 9.52, 95% confidence interval [CI]: 4.17–21.71), tachypnea (OR: 26.5, 95% CI: 9.59–73.19), and chest retractions (OR: 27.5, 95% CI: 5.96–126.96) were associated with more severe clinical disease. Also, there were significant differences in the C-reactive protein level, prothrombin time (PT), partial thromboplastin time, international normalized ratio, and days in the NICU (p = 0.002, p = 0.012, p = 0.034, p = 0.008, and p < 0.001, respectively) between patients with mild-moderate and severe-critical presentations. A PT above 14 s was a significant predictor of severe/critical cases, with a sensitivity of 64% and specificity of 73%. Conclusions: Our data showed that late-onset COVID-19 infection in neonates who need hospitalization can be severe, showing associations with high rates of ventilatory support and myocarditis. Cough, tachypnea, and retractions on admission suggest a severe disease course. Trial registration: ClinicalTrials.gov identifier: NCT04401540.What is Known:• Neonatal cases of COVID-19 infection are mainly reported as perinatal COVID-19 cases.• Neonates with perinatal transmission have a mild course and favorable prognosis.What is New:• Among symptomatic neonates with late-onset COVID-19 infection, fever was the most common symptom, and almost one quarter of hospitalized cases needed some type of respiratory support. Myocarditis was the most common complication.• The presence of cough, tachypnea, retractions, and a PT above 14 s were associated with an increased risk of severe COVID-19