Parathyroid hormone in washout fluid seems to be superior to cytology for localization of the lesion in MIBI-negative patients with primary hyperparathyroidism

Background/aim: Primary hyperparathyroidism (PHPT) is characterized by increased calcium (Ca) and parathyroid hormone (PTH) levels. Surgical removal of the culprit hyperfunctioning parathyroid gland is the preferred treatment. In this study, we aimed to determine whether PTH-washout or cytological examination of suspicious lesions was superior in MIBI-negative patients diagnosed with PHPT.Materials and methods: We retrospectively evaluated the medical records of 98 patients diagnosed with PHPT. Seventy-six patients who had positive parathyroid scintigraphy and who did not undergo parathyroidectomy in our center due to various reasons were excluded. We evaluated the remaining 22 patients with negative scintigraphy. Medical records including PTH levels in serum and washout fluid of fine-needle aspiration biopsy (FNAB), biochemical data, cytological results of FNAB, and histologic reports were reviewed.Results: The patients had a mean age of 50 +- 9 (31-72) years, serum Ca of 10.9 +- 0.5 (10.3-12.7) mg/dL, serum PTH of 285 +- 156 (107.2-679) pg/mL, and PTH of washout fluid of 19,523 +- 38,632 (1410-166,000) pg/mL. Cytological evaluation revealed insufficient material in 9 patients and cells of indeterminate origin in 4 patients.Conclusion: Our results showed that when evaluating ambiguous lesions on neck ultrasound, measuring the PTH level in washout fluid of FNAB is a reliable and effective method for diagnosis of parathyroid lesions and is superior to FNAB for localization.

The effects of obstructive jaundice on the brain: An experimental study.

BACKGROUND/OBJECTIVE: The study aims to evaluate the alterations in the brain due to oxidative stress and lipid peroxidation resulting from obstructive jaundice. METHODS: Forty-one Wistar albino rats were used in this study. Simple laparotomy was performed in the sham group (n = 5). In the remaining 36 rats, the common bile duct (CBD) was found and ligated. They were divided into six groups. Group I, Group II, and Group III were sacrificed at the 3(rd), 7(th), and 14(th) day of ligation, respectively. In Group Id, Group IId, and Group IIId ligated bile ducts were decompressed at the 3(rd), 7(th), and 14(th) day, respectively. One week after decompression these rats were also sacrificed and samples were taken. RESULTS: After the CBD ligation, serum levels of bilirubin and malondialdehyde were found to be increased progressively in parallel to the ligation time of the CBD. After decompression these values decreased. In electron microscopy evaluation, the damage was found to be irreversible depending on the length of the obstruction period. In Group II, the damage was mostly reversible after the internal drainage period of 7 days. However in Group III, the tissue damage was found to be irreversible despite the decreased values of oxidative stress and bilirubin. CONCLUSION: Ultrastructural changes in brain tissue including damage in the glial cells and neurons, were found to be irreversible if the CBD ligation period was >7 days and did not regress even after decompression. It is unreliable to trace these changes using blood levels of bilirubin and free radicals. Therefore, timing is extremely critical for medical therapies and drainage.

Russell Body Gastritis: an Unusually Presentation of the Chronic Gastritis.

Russell body gastritis is a rare form of chronic gastritis. It is characterized by the invasion of lamina propria by plasma cells that included eosinophilic cytoplasmic inclusion. In the literature, most of the cases are associated with Helicobacter pylori. Russell body gastritis and Helicobacter pylori infection are generally seen together incidentally. We report here two cases of Russell body gastritis with Helicobacterpylori infection in a 51-yr-old woman and a 39-yr-old man from Eskisehir, Turkey.

An atypical cause of rapidly progressing breast lump with abscess formation: Pure squamous cell carcinoma of the breast.

Squamous cell carcinoma (SCC) is a rare type of breast malignancy and little is known about long-term outcome. In the present report, the clinical features, histopathologic findings and postoperative course of a patient with squamous cell carcinoma are described. We have treated a 47-years-old woman who admitted for right breast mass without any discharge, bleeding and pain. The tumor was, 3 × 2 × 1.5 cm in size with central abscess formation. The result of surgical biopsy revealed large cell keratinizing type of SCC. The metastatic work-up studies ruled out any other probable sources of primary tumor. The patient was performed modified radical mastectomy and axillary dissection and received two cycles of chemotherapy. Squamous cell carcinoma of the breast (SCCB) is a rare entity and should be considered in patients with rapidly progressing breast mass. It should also be considered in breast lesions with abscess formation. The initial therapeutic approach should be surgical excision after histopathological diagnosis.

Modified elliptical rotation flap for sacrococcygeal pilonidal sinus disease.

BACKGROUND: Although various surgical procedures have been described for pilonidal sinus disease, the best surgical technique is still controversial. The aim of this study was to evaluate the short-term results of modified elliptical rotation flap (MERF) for pilonidal sinus disease in terms of post-operative complications, recurrence and quality of life. METHOD: Data of 121 patients (10 women, 111 men) who were operated on for sacrococcygeal pilonidal sinus disease between 2011 and 2013 were analysed. Elliptical rotation flap procedure which was described by Nessar et al. was modified. Complications, quality of life and recurrence were evaluated. RESULTS: The mean operating time was 31 (range, 20-55) min. The mean time for complete healing was 2.26±0.72 weeks. The mean time for returning to daily activities was 9.0±2.2 days. There were no flap necrosis and recurrence. Post-operative infection developed in five (4.1%) patients, which was managed by removal of a few skin sutures, drainage and prolonged antibiotic use. Four patients (3.3%) developed a seroma, three of them having a partial wound dehiscence (2.5%). Neither haematoma formation nor complete dehiscence were observed. CONCLUSION: MERF seems to be an effective and reliable procedure having low morbidity rates and no recurrence. Further prospective randomized studies comparing the MERF with other flap techniques will provide better information about the technique.

Peritoneal hydatidosis with ileus.

BACKGROUND: The parasitic infection hydatidosis or echinococcosis, is a parasitic infection caused most frequently by flatworm Echinococcus granulosus. Hydatidosis is endemic in Turkey where animal husbandry is common. Eventhough, Hydatid disease can develop anywhere in the human body it is most frequently occurs in the liver and then the lungs. Rupture of hydatid cysts into the peritoneal cavity, although rare, still presents a challenge for the surgeon. CASE: A 20-year-old man presented with ileus after 24 hours of mild abdominal distention, pain and nausea. On examination his abdomen was tender, with guarding and rebound tenderness and had a 3 cm long subcostal incision scar. All laboratory investigations were in the normal range. Exploratory laparotomy revealed multiple peritoneal cyst hydatid lesions with the largest measuring 10 cm in size and one also located in the right lobe of the liver. CONCLUSIONS: Rupture of hydatid cysts into the peritoneal cavity, although rare, still presents a challenge for the surgeon. This pathology should be included in the differential diagnosis of acute abdomen in endemic areas, especially in patients with a history of cyst hydatid (Fig. 1, Ref. 12). Full Text (Free, PDF) www.bmj.sk.

Recovery of sexual function after scrotal hernia repair.

BACKGROUND: Most of the patients with scrotal hernia have sexual dysfunction to some extent. Therefore, we investigated the recovery of sexual function after scrotal hernia repair by using an internationally approved, patient-administered questionnaire. METHODS: In a prospective follow-up study, 34 patients with scrotal hernia were investigated to assess sexual function before and 3 months after hernia repair by using the International Index of Erectile Function (IIEF) questionnaire. The mean scores obtained on pre- and postoperative visits for all domains of sexual function were analyzed and compared with the Wilcoxon test. Hernia repair was performed by using a standardized Lichtenstein technique. RESULTS: The total mean score of the IIEF-15 was 52.08 before surgery and 56.20 after the procedure, with this difference considered statistically significant (P < .001). Eighty-five percent of the patients improved their scores versus 9% and 6% who showed worsening or no change at all in IIEF scores after surgery, respectively. All of the 5 sexual function domains except the orgasm domain presented statistically significant improvement. CONCLUSIONS: This study showed that scrotal hernia repair caused a positive impact on sexual function after surgery. There was no case of surgery-related erectile dysfunction. Therefore, one of the major indications to repair large scrotal hernias may be to improve the quality of sexual life.

Comparison and validation of scoring systems in a cohort of patients treated for perforated peptic ulcer.

BACKGROUND AND AIMS: The aim of this study is to evaluate the predictive accuracy of different scoring systems on surgery for perforated peptic ulcer referred to an academic department of general surgery in a tertiary reference center. PATIENTS AND METHODS: Seventy-five consecutive patients (Male/female ratio = 64:11; mean age, 44 years; range, 16-85) with perforated peptic ulcer disease were investigated. Disease severity scores and mortality predictions were calculated using the collected data during admission. Discrimination and calibration characteristics of each system, namely, the acute physiology and chronic health evaluation II and III, the simplified acute physiology score II, and the mortality probability models (MPM) II, were determined by using the area under receiver operating characteristics curve and the Hosmer-Lemeshow goodness-of-fit test, respectively. RESULTS: Among the 75 patients included, there were eight (10.6%) mortalities. All systems had a reliable power of discrimination and calibration. Among the systems tested, MPM II was the best performing as far as discrimination and calibration characteristics were considered. The parameters of MPM II system that were related to systemic perfusion of the patient were significantly positive in patients who died compared to those who survived. CONCLUSIONS: MPM II that predicted mortality at admission is better than the other systems in predicting mortality. Results also indicate the importance of maintenance of systemic perfusion of the patient at the early phases of peptic ulcer perforation.