Is local resection sufficient for parathyroid carcinoma?

OBJECTIVES: Parathyroid carcinoma is a rare malignant disease of the parathyroid glands that appears in less than 1% of patients with primary hyperparathyroidism. In the literature, the generally recommended treatment is en bloc tumor excision with ipsilateral thyroid lobectomy. Based on our 12 years of experience, we discuss the necessity of performing thyroid lobectomy on parathyroid carcinoma patients. RESULTS: Eleven parathyroid carcinoma cases were included in the study. All operations were performed at the Department of Endocrine Surgery at Ankara University Medical School. Seven of the patients were male (63.6%), and the mean patient age was 48.9 ± 14.0 years. Hyperparathyroidism was the most common indication for surgery (n ϝ 10, 90.9%). Local disease was detected in 5 patients (45.5%), invasive disease was detected in 5 patients (45.5%) and metastatic disease was detected in 1 patient (9.1%). The mean follow-up period was 99.6 ± 42.1 months, and the patients' average disease-free survival was 96.0 ± 49.0 months. During the follow-up period, only 1 patient died of metastatic parathyroid carcinoma. CONCLUSION: Parathyroid carcinoma has a slow-growing natural progression, and regional lymph node metastases are uncommon. Although our study comprised few patients, it nevertheless showed that in selected cases, parathyroid carcinoma could be solely treated with parathyroidectomy

What necessitates the conversion to open cholecystectomy? A retrospective analysis of 5164 consecutive laparoscopic operations

OBJECTIVE: Laparoscopic cholecystectomy (LC) has become the gold standard for the surgical treatment of gallbladder disease, but conversion to open cholecystectomy is still inevitable in certain cases. Knowledge of the rate and impact of the underlying reasons for conversion could help surgeons during preoperative assessment and improve the informed consent of patients. We decided to review the rate and causes of conversion from laparoscopic to open cholecystectomy. METHOD: This study included all laparoscopic cholecystectomies due to gallstone disease undertaken from May 1999 to June 2010. The exclusion criteria were malignancy and/or existence of gallbladder polyps detected pathologically. Patient demographics, indications for cholecystectomy, concomitant diseases, and histories of previous abdominal surgery were collected. The rate of conversion to open cholecystectomy, the underlying reasons for conversion, and postoperative complications were also analyzed. RESULTS: Of 5382 patients for whom LC was attempted, 5164 were included this study. The overall rate of conversion to open cholecystectomy was 3.16% (163 patients). There were 84 male and 79 female patients; the mean age was 52.04 years (range: 26-85). The conversion rates in male and female patients were 5.6% and 2.2%, respectively (

Physical Trauma among Refugees: Comparison between Refugees and Local Population Who Were Admitted to Emergency Department—Experience of a State Hospital in Syrian Border District

Background. Hundreds of thousands of people have fled to Turkey since the civil war started in Syria in 2011. Refugees and local residents have been facing various challenges such as sociocultural and economic ones and access to health services. Trauma exposure is one of the most important and underestimated health problems of refugees settling in camps. Aims. We aimed to evaluate refugee admissions to emergency department because of trauma in means of demographics of patients and mechanism of trauma and compare the results with the local population. Methods. Retrospective evaluation of results and comparison with the results of local population. Results. We determined that the ratio of emergency admission of refugee patients because of trauma was significantly higher than the local population for most types of trauma. Conclusion. Further studies with more refugee participants are needed to fully understand the underlying reasons for this high ratio to protect refugees as well as for planning to take caution to attenuate the burden on healthcare systems

Is local resection sufficient for parathyroid carcinoma?

OBJECTIVES: Parathyroid carcinoma is a rare malignant disease of the parathyroid glands that appears in less than 1% of patients with primary hyperparathyroidism. In the literature, the generally recommended treatment is en bloc tumor excision with ipsilateral thyroid lobectomy. Based on our 12 years of experience, we discuss the necessity of performing thyroid lobectomy on parathyroid carcinoma patients. RESULTS: Eleven parathyroid carcinoma cases were included in the study. All operations were performed at the Department of Endocrine Surgery at Ankara University Medical School. Seven of the patients were male (63.6%), and the mean patient age was 48.9 ± 14.0 years. Hyperparathyroidism was the most common indication for surgery (n ϝ 10, 90.9%). Local disease was detected in 5 patients (45.5%), invasive disease was detected in 5 patients (45.5%) and metastatic disease was detected in 1 patient (9.1%). The mean follow-up period was 99.6 ± 42.1 months, and the patients' average disease-free survival was 96.0 ± 49.0 months. During the follow-up period, only 1 patient died of metastatic parathyroid carcinoma. CONCLUSION: Parathyroid carcinoma has a slow-growing natural progression, and regional lymph node metastases are uncommon. Although our study comprised few patients, it nevertheless showed that in selected cases, parathyroid carcinoma could be solely treated with parathyroidectomy

Znaczenie laparoskopowej oceny zaawansowania w leczeniu raka żołądka

Cel: Laparoskopia z oceną zaawansowania (ang. staging laparoscopy; SL) pozwala na wdrożenie leczenia paliatywnego, terapii neoadjuwantowej przed leczeniem operacyjnym lub na bezpośrednią resekcję radykalną oraz na ustalenie strategii postępowania, co pozwala ograniczyć śmiertelność poprzez uniknięcie niepotrzebnych laparotomii. W naszym badaniu retrospektywnie oceniliśmy znaczenie laparoskopii z oceną zaawansowania w oparciu o dane kliniczne i histopatologiczne. Metody : Analizie retrospektywnej poddano dane 70 z 350 pacjentów poddawanych diagnostycznej laparoskopii z powodu raka żołądka w Klinice Chirurgii Onkologicznej od sierpnia 2013 do stycznia 2020 roku. Wyniki: Biopsja otrzewnej była dodatnia na obecność komórek nowotworowych u 41 (58,5%) pacjentów i ujemna u 29 (41,5%) pacjentów poddawanych SL. Cytologia płynu z otrzewnej była ujemna u 32 (45,7%) pacjentów i dodatnia u 38 (54,3%) pacjentów. Wyniki biopsji i cytologii były równocześnie dodatnie u 35 pacjentów i jednocześnie ujemne u 26 pacjentów. Wnioski: Podsumowując, nawet najbardziej zaawansowane metody obrazowania nie pozawalają w 100% ocenić zaawansowania procesu nowotworowego, tym samym SL odgrywa istotną rolę w leczeniu pacjentów z rakiem żołądka. Laparoskopowa ocena zaawansowania, jako zabieg prosty, tani, bezpieczny i dobrze tolerowany, powinna stanowić podstawę postępowania u pacjentów z podejrzeniem zajęcia otrzewnej, u których nie udaje się w pełni ocenić zaawansowania choroby badaniami przedoperacyjnymi

The role of laparoscopic staging for the management of gastric cancer

AİM Staging laparoscopy enables us to perform palliative treatment, neo-adjuvant therapy for curative resection or direct curative resection and making a decision with minimal morbidity by avoiding from unnecessary laparotomies. In the present study, the importance of staging lapafoscopy was retrospectively investigated by using clinical and pathologic data. METHODS Data of 70 out of 350 patients who underwent diagnostic laparoscopy due to gastric cancer at Surgical Oncology department between August 2013 and January 2020 were retrospectively analyzed. RESULTS Peritoneal biopsy was positive for malignity in 41 (58.5%) and negative in 29 (41.5%) of the patients who underwent SL. Peritoneal cytology (PC) results were negative in 32 (45.7%) patients and positive in 38 (54.3%) patients. Peritoneal biopsy and cytology results were concurrently positive in 35 patients and concurrently negative in 26 patients. CONCLUSİONS In conclusion, even the most developed imaging methods cannot provide 100% staging, therefore SL plays an important role in treatment of gastric cancer and laparoscopic staging is essential as a simple, inexpensive, safe and well tolerated method in patients who have the suspicion of peritoneal disease and who cannot be clearly evaluated with pre-operative methods