Thyroid malignancy in hypoactive nodules in endemic nodular goitre

Amaç: Bu çalışma endemik nodüler guatrlarda hipoaktif tiroid nodüllerinin malignite oranlarını araştırmak amacı ile planlandı. Gereç ve Yöntem: Nisan 2001-Mayıs 2002 tarihleri arasında Genel Cerrahi Kliniği'nde tiroid cerrahisi uygulanan hastalar değerlendirildi. Multinodüler guatrı olan 30, soliter nodülü olan 2 hastadaki (26 kadın, 6 erkek) hipoaktif nodüllerden ince iğne aspirasyon biyopsisi yapıldı. Hastalara hipoaktif nodülün olduğu loba istmektomi ile birlikte total lobektomi, kontrlateral loba ise totale yakın lobektomi uygulandı ve histopatolojik bulgular değerlendirildi. Bulgular: Tiroid cerrahisi uygulanan 79 hastanın 32'sinde (26 kadın, 6 erkek) hipoaktif tiroid nodülü mevcuttu. Hastaların kadın/erkek oranı 3/1 (58/21) ve ortalama yaş 43.57 (21-75) olarak tespit edildi. 36 olguda (%46) hipertiroidi mevcuttu. İnce iğne aspirasyon biyopsilerinin sitolojik incelemelerinde malignite veya şüpheli bulgular saptanmadı. Cerrahi rezeksiyon sonucunda histopatolojik değerlendirmelerde hipoaktif nodüllerden birinde okült papiller karsinom tespit edildi. Sonuç: Endemik multinodüler guatrlardaki hipoaktif nodüllerin malignite açısından değerlendirilmesinde tiroid ince iğne aspirasyon biyopsisi önemli bir yere sahip olmakla birlikte güvenilirliği tartışılabilir. Endemik multinoduler guatrlardaki hipoaktif nodüllerin malignite oranlarını daha sağlıklı olarak ortaya koyabilmek için daha geniş hasta serilerine ihtiyaç vardır.Objective: The aim of the study was to present the epidemiology of thyroid cancers in hypoactive nodules in endemic multinodular goitres. Material and Methods: The patients who underwent thyroid surgery in general surgery between April 2001 and May 2002 were evaluated. We performed fine-needle aspiration biopsy (FNAB) of cold nodules who had multinodular goitres. We perform a total lobectomy on the hypoactive nodule side with isthmectomy and a near total contralateral lobectomy on the other lobe and pathologic findings were evaluated. Results: In 32 (26 women, 6 men) of 79 patients who were treated surgically had hypoactive nodules. The female/male ratio was 3/1 (58/21) and the mean age was 43.57 (21-75). 36 patients (%46) had hyperthyroidism. The FNAB results of the patients who had hypoactive nodules were normal cytologic findings. In the pathologic evaluations of hypoactive nodules there was an occult papillary carcinoma. Conclusion: In the malignancy evaluation of hypoactive nodules in endemic multinodular goitre, fine needle aspiration biopsy has an important role but it's reliability can be discussed. In order to show the malignancy ratios of hypoactive nodules in endemic multinodular goiter we need larger patient series

Safe surgical approach to extrahepatic pseudocyst, a rare shunt complication: 2 case reports

Abstract Background Hepatic pseudocysts are not a common complication and “extrahepatic” pseudocysts are rarer complications but may occur in every ventriculo-peritoneal shunt patient. Case presentation We present two patients with ventriculo peritoneal shunt induced extrahepatic pseudocysts, who underwent shunt surgery for different etiologies. Etiology, treatment strategies and our choice of treatment have been discussed. Conclusions When a ventriculoperitoneal shunt patient is presented with non-specific abdominal symptoms, the possibility of this complication should always be considered. In the treatment of this complication, it is shown that repositioning the catheter is sufficient for cyst regression

Algorithms for reducing the complications of laparoscopic cholecystectomy

Amaç: Kolelitiazis tedavisinde laparoskopik kolesistektomi günümüzde altın standart olarak kabul edilmekle birlikte açık kolesistektomideki son derece düşük komplikasyon oranları bu metotla artış göstermiştir. Açık kolesistektomiye göre daha fazla deneyim gerektiren laparoskopik kolesistektomi için belirli algoritmalar ve cerrahi prosedür standardizasyonları geliştirmek komplikasyonları azaltmada yararlı olmaktadır. Gereç ve Yöntem: ZKÜ Tıp Fakültesi Genel Cerrahi Kliniği'nde Nisan 2001 ile Nisan 2004 tarihleri arasında yapılan 120 laparoskopik kolesistektomi vakası komplikasyonlar açısından ele alınarak uyguladığımız algoritmaların güvenilirliği gözden geçirilmiştir. Bulgular: Toplam 120 hastanın hiç birinde majör komplikasyon görülmemiştir. Altı hastada açık cerrahiye dönme, bir hastada 15 gün süren safra sızıntısı görülmüş ve endoskopik retrograd kolanjiopankreatografi sonrası gerilemiştir. Uyguladığımız preoperatif hasta değerlendirme algoritması ve cerrahi prosedürlerde uyguladığımız tehlikeli noktaların standardizasyonu ile 120 vakalık serimizde majör komplikasyon ile karşılaşılmamıştır. Sonuç: Sonuçta laparoskopik kolesistektomi vakaları için iyi bir preoperatif değerlendirme ve cerrahi detaylarda dikkatli olunması daha başarılı sonuçlar doğuracaktır.Objective: Laparoscopic cholecystectomy is accepted as a gold standard in the surgical treatment of cholelithiasis. As laparoscopic cholecystectomy needs more training then open cholecystectomy there is a need for algorithms for surgical procedures in order to have low complication rates. Material and Method: We tested our algorithms using 120 laparoscopic cholecystectomy performed in Zonguldak Karaelmas University General Surgery Department between April 2001 and April 2004. Results: There were no major complications. In six cases, cholecystectomy was performed by open surgical procedure. In one case there was a biliary leakage which lasted more than fifteen days and needed an endoscopic retrograde cholangiopancreatography. By the use of preoperative evaluation algorithm and the standardization of surgical procedures there were no major complications in our patient group. Conclusion: In conclusion, we can say that using preoperative evaluation and performing intensive surgery lower the complication rates in laparoscopic cholecystectomy

Comparison of the measurement methods of bursting pressure of intestinal anastomoses.

BACKGROUND/AIMS: This study was designed to determine whether there exists a difference between in vivo and in vitro measurements of bursting pressure (BP) of experimental intestinal anastomosis studied in Wistar-albino rats. METHODOLOGY: In the first group (n=8), the BP was measured using in vivo method without detaching the adhesions around the anastomosis. BP was determined with digital manometer, and then anastomotic region was removed to measure tissue hydroxyproline (HP) levels. In the second group (n=8), the BP was measured with in vitro method after the segment of intestine including the anastomosis was dissected and isolated. The isolated specimen was then submerged in a normal saline bath. BP was determined with a digital manometer and anastomotic region was removed to measure tissue HP levels. RESULTS: While HP value in the first group was 105.60 +/- 9.43 microg/mg dry tissue, it was found to be 121.11 +/- 16.26 microg/mg dry tissue in the second group and this difference was not statistically significant (p=0.195). The BP was determined as 240.71 +/- 11.65 mmHg in the first group, 144.71 +/- 16.41 mmHg in the second group and the difference was statistically significant (p=0.002). The anastomotic resistances to intraluminal pressure were found to be statistically different whereas tissue HP levels were normal between the groups. CONCLUSIONS: These results make us consider that mechanical changes occur about the isolated anastomotic line and dissection of adhesions weakens the anastomosis