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

Risk factors of breast cancer-related lymphedema

WOS: 000320503900003PubMed ID: 23772716Introduction: Secondary lymphedema is one of the major important long-term complications of breast cancer treatment. The aim of this study is to determine patient- and treatment-related risk factors of lymphedema in breast cancer patients. Patients and Methods: Patients, who had been operated on for primary breast cancer at Akdeniz University Hospital and followed regularly between August 1984 and December 2009 were included in the study. In order to evaluate the arm swelling objectively, measurements were performed with a flexible tape measure for both arms, and limb volume was calculated using a truncated cone volume formula. Participants, whose volume difference between the two arms was >= 5%, were considered as lymphedema-positive patients. The SPSS program (SPSS inc. Chicago, IL) was used for statistical analysis. Results: The mean age of 455 patients was 50.6 years and the median follow-up time was 53 months. Lymphedema was found in 124 (27%) patients. Most of the patients with a history of postoperative wound infection (52%) and lymphangitis (57%) had lymphedema (p = 0.003 and p = 0.002, respectively). Addition of radiation therapy increased lymphedema risk 1.83 times (p = 0.007). The mean duration of the axillary drainage and number of the removed lymph nodes were 7.8 days and 19, respectively. The rate of lymphedema in patients with early stage breast cancer was less than patients with advanced breast cancer (24% and 35.3%, respectively, p = 0.018). Most of the patients (92%) with lymphedema had a high body mass index (BMI >= 25 kg/m(2)), and obesity was another important factor for lymphedema (p = 25 kg/m(2)), axillary lymph node dissection, postoperative radiotherapy, wound infection, history of lymphangitis, and duration of axillary drainage. Elimination or prevention of these risk factors may reduce the incidence of lymphedema

Sequential water swallowing in normal adults and patients with neurogenic dysphagia

Sequential water swallowing (SWS) is usual ingestive behavior. SWS was used previously on the criteria just in the clinical bases of laryngeal penetration or incomplete drinking of the amount of 90-150 mL water. They did not use any kind of physiological monitoring. Invasive methods such as Videoflouroskopy could not be suitable for continuous deglutition in that time and the amount of fluids because of possible hazardous side effects. Last methods is a kind of discrete swallowing (5-15 mL). Thus we need SWS from a cup or straw. SWS is favorable method for longutidinal studies. SWS investigations from our and other laboratories are not commonly published compared to the other kind of tremendeous swallowing studies. There is a need for a comprehensive review about SWS with the physiological and the clinical results. Four chan-nel electromyography is necessary for submental muscle complex, nasal sensor for respiration, electrocardiogram and the electrodermal activity. A coordination in between swallowing and respiration was found significantly pathologic even in asymptomatic dysphagia in the chronic neurological disorders such as multiple sclerosis, Parkinson’s disease, Parkinson plus syndromes and brainstem infarctions. in amyotrophic lateral sclerosis there was an irregularity in swallowing behavior in almost half of the patients. Guillain Barre syndrome with cranial nerve involvement showed silent dysphagia. Alzheimer disease had a risk of dysphagia in early period and dysphagia was increased, progressively, until the late stage of disease. Therefore the SWS is easy to use, repeatable, safe and a cheap method and this field is especially important and suitable use of neurologist and electromyographer

Impact of COVID-19 on operating assignments in residency training of endocrine surgery: A retrospective cohort study

Purpose: Airborne pandemics illustrate a significant problem in training grounds. From the endocrine surgery point of view, we scrutinized the impact of Covid-19 on general surgery residency training in our university hospital. Methods: The number of endocrine procedure curves was forecasted using the expert modeler in a time series model from March to September 2020 based on data from previous years. We then compared the estimation curves to actual numbers. Results: There were 1340 resident participants in thyroid procedures, 405 in parathyroid procedures, 65 in other neck procedures, and 304 in adrenal procedures. In 884 of the endocrine procedures, the operating surgeon was a resident. The median experience of operating residents in endocrine procedures was 3.2 years (interquartile range 2.7–3.6) before the impact and 3.8 years (interquartile range 3.1–4.1) after it (p = 0.023). The monthly number of actual procedures with at least one resident participation in the Covid-19 period was significantly lower (8.7 ± 7.5 vs. 19.9 ± 3.7, p = 0.012) than the forecasted numbers. There were no semi-autonomous operating chief residents, although we expected a moderate level (0 actual vs. 0.5 ± 0.2 predicted, p = 0.002). Conclusion: This study clearly represents sustainability in surgical training and includes usual trends. Essential endocrine surgical procedures the pandemic disrupted the most were the treatment of thyroid and parathyroid diseases. Covid-19 reduced our surgical volume and resulted in delays in training. A full-scale disaster plan is necessary for possible crises threatening surgical education

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.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

Risk Factors of Breast Cancer-Related Lymphedema

Introduction: Secondary lymphedema is one of the major important long-term complications of breast cancer treatment. The aim of this study is to determine patient- and treatment-related risk factors of lymphedema in breast cancer patients

Oncoplastic approach to excisional breast biopsies: a randomized controlled, phase 2a trial

BackgroundOncoplastic surgery has been used in breast cancer patients for better cosmetic outcome over the last decades. The aim of this prospective randomized study is to show its place in excisional breast biopsy.MethodsAn oncoplastic approach excision was compared with conventional excisional breast biopsies. The study included 80 patients, of whom half received oncoplastic intervention and half received the conventional. The primary endpoint was the cosmetic result. Patient, surgeon and independent observers rated the results on a four-point scale. Scores other than self-perceived were based on third-month medical photographs.ResultsBetween May 20, 2015 and April 27, 2016, 40 patients were randomly assigned to oncoplastic biopsy and 40 patients were assigned to conventional excisional biopsy. Median follow-up was 5.6months (IQR 3.0-6.0). Self-perceived perfect scoring for general cosmetic outcome was found significantly higher after oncoplastic biopsy (73 0.5%) comparing with control group (32.4%) (p=0.001). This impact did not change after adjusting patients for potential confounders. Margin clearance rates in malignant cases were comparable in both arms (p=0.999); four patients in oncoplastic biopsy group (40%) and three patients in control group (33%) had positive margins.ConclusionsThe oncoplastic biopsy achieved better cosmetic results with similar surgical margin positivity rates when compared with conventional breast biopsy. It may be a better biopsy option used for patients requiring excisional breast biopsy

Surgical Trends in Breast Cancer in Turkey: An Increase in Breast-Conserving Surgery

PURPOSEBreast cancer is the most frequent cancer in women, and there is a great variability in surgical practice for treating that cancer in different countries. The aims of this study were to analyze the effect of guidelines from the Turkish Federation of Breast Diseases Societies on academic institutions that have breast centers and to evaluate surgical practice in Turkey in 2018.PATIENTS AND METHODSBetween January and March 2019, a survey was sent to breast surgeons who were working in breast centers in academic institutions. The sampling frame included 24 academic institutions with breast centers in 18 cities in Turkey to evaluate interdisciplinary differences among breast centers and seven regions in Turkey regarding patients' choices, surgical approaches, and academic institutions.RESULTSAll surgeons responded to the survey, and all 4,381 patients were included. Most of the surgeons (73.9%) were working in a breast center. Multidisciplinary tumor boards were performed in 87% of the breast centers. The average time between clinical evaluation and initiation of treatment was 29 days; the longest time was in Southeast Anatolia (66 days). Only 6% of patients had ductal carcinoma in situ. Sentinel lymph node biopsy was available in every region across the country and was performed in 64.5% of the patients. In 2018, the overall breast-conserving surgery rate was 57.3% in Turkey, and it varied from 72.2% in the Black Sea region to 33.5% in Central Anatolia (P < .001). Oncoplastic breast surgery options were available at all breast centers. However, 25% of the breast centers from the Black Sea region and half the breast centers from Eastern Anatolia and the Mediterranean region did not perform this type of surgery.CONCLUSIONIncreasing rates of nonpalpable breast cancer and decreasing rates of locoregional recurrences favored breast-conserving surgery, especially in developed countries. Guidelines from the Turkish Federation of Breast Diseases Societies resulted in more comprehensive breast centers and improved breast health in Turkey