Comparison of transoral endoscopic thyroidectomy vestibular approach and open conventional thyroidectomy regardıng inflammatory responses, pain, and patient satisfaction: a prospective study

IntroductionThe application of transoral endoscopic thyroidectomy vestibular approach (TOETVA) is becoming widespread throughout the world. We primarily aimed to evaluate the severity of surgical trauma in TOETVA and conventional open thyroidectomy (COT) regarding the inflammatory response including the comparison of surgical stress markers [interleukin-6 (IL-6), C-reactive protein (CRP), white blood cell (WBC)].Material and methodThis non-randomized prospective study enrolled two groups with 20 patients each: COT group and TOETVA group. Patients aged 18–65 years with benign thyroid disease; with fine needle aspiration biopsy results of Bethesda III, IV or Bethesda V, VI (<1 cm nodule); thyroid volume <50 cm3; nodule diameter <4 cm; female gender without a previous neck, chin, and/or oral surgery; without vocal cord paralysis preoperatively; and patients in euthyroid state were enrolled to the study. Preoperative, postoperative second hour, first day, and second day CRP, WBC, and IL-6 levels were evaluated. Pain intensity was evaluated with the visual analog scale (VAS) score on the 2nd and 12th hour, 1st and 2nd days postoperatively.ResultsAll the patients were female and mean age was significantly higher in the COT group. The operative time was significantly longer in the TOETVA group. No significant difference was found between the two groups regarding IL-6 levels. In the TOETVA group, postoperative second hour WBC value (p = 0.044) and first (p = 0.002) and second day (p = 0.005) CRP values were significantly higher. In the TOETVA group, the lower lip and lower chin VAS scores were significantly higher at 2nd and 12th hour, on the first and second days. The anterior neck VAS score was significantly higher in the TOETVA group at the second hour (p = 0.025). General and cosmetic satisfactions were similar at the 15th and 30th days in both groups.ConclusionThe longer operative time and higher postoperative CRP level and VAS score in the chin and lower lip in the TOETVA group suggested that the method is not a minimally invasive technique compared to COT. However, the presence of similar total complication rates and early postoperative general and esthetic satisfaction that improves over time in both groups suggests that the clinical effect of increased magnitude of systemic inflammatory response in TOETVA might be temporary and acceptable

Investigation of the (DDAH1) T87M mutation of dimethylarginine dimethylaminohydrolase (DDAH E.C. 3.5.3.18) (DDAH 1) enzyme and the levels of asymmetric dimethylarginine (ADMA) in patients with coronary heart disease

Koroner kalp hastalığı olan bireylerde genetik olarak polimorfizm olması kardiyovasküler olaylara yatkınlığı arttırabilir. Dimetilarjinin Dimetilamino Hidrolaz (DDAH) enziminde bu genetik değişimin saptanması ile bu hastalık grubunda daha ileri tedavi protokolleri geliştirilmesine katkı sağlamak için koroner kalp hastalarında Asimetrik Dimetil Arjinin (ADMA) seviyeleri ve DDAH 1 (E.C. 3.5.3.18) enziminin T87M mutasyonu incelendi.Background: Genetic polymorphism may enhance the predisposition to cardiovascular events in patients with coronary heart disease (CHD). The aim of this study is to contribute further treatment protocol development via investigation serum ADMA levels and dimethylarginine dimethylaminohydrolase DDAH 1 (E.C. 3.5.3.18) T87M mutation of CHD patients. Material and Methods: 50 CHD patients and 50 healthy volunteers from Konya region were included to this study. Serum ADMA levels were analyzed by high performance liquid chromatograpy. DDAH (E.C. 3.5.3.18) T87M mutation were determined by PCR from extracted whole blood DNA samples. Results: ADMA levels were significantly higher in patient group compared to control group and there was no statistically diffference between groups for Arginine / ADMA ratio (p>0.001, p0.08 respectively). Triglyceride levels were significantly higher in patient group compared to control group (p0.033) and HDL- cholesterol levels were significantly lower in patient group compared to control group (p>0.001). In DDAH 1 T87M polymorphism gene analysis, there was only one heterozygote patient, the other participiants were wildtype. Conclusions: Polymorphism studies with wider population and detailed investigation of risk factors in these polymorphic subjects will contribute to ensure the role of high ADMA levels in cardiovascular diseases

Homocysteine levels in patients with masked hypertension

WOS:000338109400011PubMed ID: 24818625Objective: Masked hypertension is a clinical condition, the importance of which is agreed in recent years and which is characterized by increased cardiovascular mortality and morbidity and is thought to be important endothelial dysfunction in the pathophysiology. Plasma total homocysteine levels are accepted as a major independent biomarker for endothelial dysfunction and/or a contributor to hypertension and coronary artery disease. In this study, we aimed to measure the level of serum homocysteine and to evaluate the relationship between the parameters of ambulatory blood pressure monitoring in patients with masked hypertension. Methods: This cross-sectional observational study included 37 subjects with normal blood pressure, 30 with masked-hypertension and 27 patients with obvious hypertension. Masked hypertension (MHT) was defined as office blood pressure >140/90 mm Hg and mean daytime ambulatory systolic blood pressure in 24 hours monitoring ≥135/85 mm Hg. Homocysteine levels of the subjects were measured by using HPLC system with fluorescent detector. Lipid parameters were measured by routine methods. Mann-Whitney U test was used for statistical analysis. Results: In the analysis of homocysteine, it was observed that there was no difference between the control group and patients with masked hyper- tension. Patients with high blood pressure showed higher homocysteine levels when compared to masked hypertension (p0.02). Homocysteine levels showed a weak positive correlation with average systolic blood pressure (r0.335, p0.043). Homocysteine levels were higher in smokers than non-smokers. compared with non-smokers group in all participants (p0.036). Conclusion: We have reached the opinion that in the individuals with no obvious health problems but with masked hypertension, homocysteine levels may not have any significant effect upon high blood pressure levels

Original Investigation 357 Homocysteine levels in patients with masked hypertension

Objective: Masked hypertension is a clinical condition, the importance of which is agreed in recent years and which is characterized by increased cardiovascular mortality and morbidity and is thought to be important endothelial dysfunction in the pathophysiology. Plasma total homocysteine levels are accepted as a major independent biomarker for endothelial dysfunction and/or a contributor to hypertension and coronary artery disease. In this study, we aimed to measure the level of serum homocysteine and to evaluate the relationship between the parameters of ambulatory blood pressure monitoring in patients with masked hypertension. Methods: This cross-sectional observational study included 37 subjects with normal blood pressure, 30 with masked-hypertension and 27 patients with obvious hypertension. Masked hypertension (MHT) was defined as office blood pressure <140/90 mm Hg and mean daytime ambulatory systolic blood pressure in 24 hours monitoring ≥135/85 mm Hg. Homocysteine levels of the subjects were measured by using HPLC system with fluorescent detector. Lipid parameters were measured by routine methods. Mann-Whitney U test was used for statistical analysis. Results: In the analysis of homocysteine, it was observed that there was no difference between the control group and patients with masked hypertension. Patients with high blood pressure showed higher homocysteine levels when compared to masked hypertension (p=0.02). Homocysteine levels showed a weak positive correlation with average systolic blood pressure (r=0.335, p=0.043). Homocysteine levels were higher in smokers than non-smokers. compared with non-smokers group in all participants (p=0.036). Conclusion: We have reached the opinion that in the individuals with no obvious health problems but with masked hypertension, homocystein