Conservative Approach For The Management Of Bilateral Pneumothorax And Pneumomediastinum After Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair.

Laparoscopic totally extraperitoneal inguinal hernia repair is considered a common and safe procedure. Here, we present the case of a 31-year-old male with right indirect inguinal hernia and no medical history. The patient underwent laparoscopic totally extraperitoneal inguinal hernia repair and the operation was completed successfully. During extubation, subcutaneous emphysema was noted at the neck, chest, and above the nipples. Tracheal injury was excluded by the anaesthesiologists and otorhinolaryngologists. On arterial blood gas, the patient's oxygen saturation was 95% with nasal oxygen support. The patient was followed-up closely in the general surgery inpatient clinic. Computed tomography was performed, on which bilateral pneumothorax and pneumomediastinum were noted. Conservative management was planned and the patient was discharged on the fourth postoperative day. Laparoscopic totally extraperitoneal inguinal hernia repair is considered a routinely applied safe procedure, however, appropriate care should be taken to avoid possible complications.

Positive lymph node ratio as a prognostic factor for gastric cancer patients: Is it going to supersede positive lymph node number in guidelines?

Gastric malignancies constitute the sixth most common cancer with regards to incidence and have the fifth most mortality rates. Extended lymph-node dissection is the surgical modality of choice while treating advanced stage gastric cancer. It is yet a topic of debate, whether or not the amount of positive lymph nodes after a pathological examination following the surgical intervention is of prognostic value. In this study, it is aimed to evaluate the prognostic significance of positive lymph nodes following the surgery. A total of 193 patients who underwent curative gastrectomy between January 2011 and December 2015 have been considered for a retrospective data collection. The cases with R1-R2 resections, palliative or emergent surgeries are excluded. Metastatic to total number of lymph nodes, corresponded a ratio which was analyzed in this survey and practiced as a predictive parameter of disease outcome. This survey includes 138 male (71.5%) and 55 female (28.5%) patients treated between 2011 and 2015 in our clinic. The survey follow-up duration of the cases range between 0, 2, and 72 months, corresponding an average of 23.24 ± 16.99 months. We calculated cutoff value of 0.09 with, sensitivity is 76.32% for positive to total number of lymph nodes ratio, whereas specivity applies for 64.10%, positive predictive value for 58% and negative predictive value for 80.6%. Positive lymph node ratio has a prognostic value in terms of predicting the prognosis of the patients with gastric adenocarcinoma following a curative gastrectomy. This might in long term contribute to the prognostic analysis of patients if integrated in the current staging system.

The Reality of Hypoparathyroidism After Thyroidectomy: Which Risk Factors are Effective? Single-Center Study.

Objectives: One of the most common complications of thyroidectomy is hypoparathyroidism and that complication has a multifactorial etiology. The etiology of post-operative hypoparathyroidism is multifactorial, some factors affecting hypoparathyroidism have been revealed in the literature, and there are some conflicting results about this complication. In the present study, we aimed to evaluate pre-operative and intraoperative factors affecting development of hypoparathyroidism. Methods: Data of 542 patients underwent thyroidectomy±central dissection (±lateral dissection) and whose post-operative parathormone values could be obtained, between 2012 and 2020 were collected prospectively and evaluated retrospectively. A parathyroid hormone (PTH) value of <15 pg/mL at the post-operative 4th h was defined as hypoparathyroidism, and a calcium (Ca) value of <8 mg/dl on the 1st post-operative day was defined as biochemical hypocalcemia. Patients were divided into two groups as post-operative hypoparathyroidism (Group 1) and non-hypoparathyroidism (Group 2). In addition, PTH value below the reference value at the post-operative 6th month and/or still needing calcium treatment was defined as permanent hypoparathyroidism. Demographic data of the patients, pre-operative biochemical values, surgical indications, intraoperative findings, post-operative 4th h PTH values, post-operative 1st day calcium values, and pathological examination of the specimen whether there was an unintenionally resected parathyroid gland or not were evaluated as risk factors for hypoparathyroidism. A logistic regression model was used to determine independent risk factors for the development of hypoparathyroidism. Results: Hypoparathyroidism was determined in 124 (22.9%) and hypocalcemia was determined in 120 (22.1%) patients. According to 6-month follow-up period; 110 (20.3%) patients were transient, 7 (1.3%) patients were permanent, and 7 (1.3%) patients data could not be obtained. The hypocalcemia rate was higher in Group 1 (39.3% vs. 14.3%, p<0.0001), also the post-operative 1st day calcium values were lower (8.2+0.7 mg/dl vs. 8.5+0.6 mg/dl; p=0.000). The rate of parathyroid autotransplantation, the rate of parathyroid gland in pathological specimen, and the rate of central dissection were significantly higher in Group 1 compared to group 2 (15.8% vs. 8%; p=0.006; 20% vs. 10.6%; p=0.003; 16.4% vs. 5.3%, p<0.0001, respectively). The difference between the two groups was significant in terms of the number of remaining parathyroids, and the rate of the number of patients with four remaining parathyroids in place was higher in Group 2 than in Group 1 (84.1% vs. 67.9; p=0.000). In the logistic regression analysis, only central dissection is an independent risk factor affecting the development of hypoparathyroidism, and central dissection increases the risk of hypoparathyroidism approximately 2.3 times (p=0.014; OR: 2.336). The other factors were not determined as independent risk factor. Conclusion: Performing central neck dissection with total thyroidectomy may increase the risk of hypoparathyroidism development. The risk of hypoparathyroidism should be considered when evaluating the indications and dissection extent in the central dissection. Maximum effort should be made to preserve the parathyroid glands and their vascularization during central dissection, and if there is a removed parathyroid gland, it should be autotransplanted.

The change in incidence of breast cancer by stage: how is it changed after the COVID-19 pandemic? A single-center retrospective study.

AIM: The impact of COVID-19 pandemic is pronounced in each healthcare process, including the management of breast cancer. The anxiety of COVID-19 changes patient preferences and some delay in routine controls and surgical managements occur. Some disintegration in medical care is to be expected during the pandemic, but the new coping strategies are needed in order to avoid delayed diagnosis of breast cancer. METHODS: A total number of 140 patients assigned for biopsy and diagnosed with breast cancer in our tertiary clinic between December 1st and August 31st were classified into 3 groups; A (December-February), B (March-May) and C (June-August) in order to compare the stage of breast cancer at the time of diagnosis before, during and after the peak period of pandemic. Clinical stage and age at presentation, family history of breast, ovarian and other types of cancer, BRCA (genetic testing), menopausal status, side of involvement (uni- or bilateral), histopathologic subtype, receptor positivity and molecular subtype were recorded for each patient. RESULTS: Group A included 20 stage I (27.77 %), 32 stage II (44.44 %), 16 stage III (22.22 %) and 4 stage IV (5.55 %) breast cancer patients. Group B had 5 stage I (22.72 %), 8 stage II (36.36 %), 7 stage III (31.81 %) and 2 stage IV (9.09 %) breast cancer patients. Whereas in group C there were 4 stage I (8.69 %), 21 stage II (45.65 %), 16 stage III (34.78 %) and 5 stage IV (10.86 %) patients with breast cancer. The number of late-stage cancer patients in group C was significantly higher in comparison with the other groups (p<0.05). CONCLUSION: We speculate that the change in incidence of breast cancer by stage is attributable to a delay in the diagnosis of breast cancer due to COVID-19 related restrictions and presentation of new cases at more advanced stages once the restrictions were eased. KEY WORDS: Biopsy, Breast cancer, COVID-19, PandemicStage.