Optimal Surgical Approaches for Thyroid Cancer: A Comparative Analysis of Efficacy and Complications.

BACKGROUND Completion thyroidectomy (CTx) is performed following hemithyroidectomy (HTx) when the risk of malignancy persists or is discovered postoperatively. Different surgical approaches, including CTx after HTx (CTx-HTx), total thyroidectomy (TTx), and revision surgery after TTx (RTx-TTx), offer varying risks and benefits, including pathological outcomes and complication rates. Understanding the predictors and rates of malignancy in these procedures is crucial for optimizing surgical management of thyroid disorders. MATERIAL AND METHODS This retrospective study analyzed data from January 2014 to October 2019, including 60 patients each in the CTx-HTx and TTx groups, and 47 in the RTx-TTx group. The CTx-HTx group was subdivided based on benign or malignant findings in CTx specimens. Clinicodemographic data and pathological features such as tumor type, size, side, capsular and vascular invasion, extrathyroidal spread, multifocality, and lymph node metastasis were reviewed. RESULTS Age and sex distributions were similar across groups. In the CTx-HTx group, 76.7% of specimens were benign and 23.3% malignant. No significant predictors of malignancy were found between the benign and malignant subgroups in univariate and multivariable analyses. In the TTx group, 75.0% of initial lobes and 13.3% of contralateral lobes were malignant. TTx was associated with a significant postoperative decrease in calcium and longer hospital stays. Multivariable analysis identified TTx as an independent risk factor for hypocalcemia. CONCLUSIONS Reducing overtreatment in thyroid cancer may involve limiting CTx after HTx and considering more conservative initial surgeries, particularly when indications for TTx are not definitive.

Intraperitoneal Infusion of Neutral-pH Superoxidized Solution in Rats: Evaluation of Toxicity and Complications on Peritoneal Surface and Liver.

BACKGROUND Superoxidized water (SOW) is known to be a potent disinfectant. The aim of this study was to evaluate the toxicity and complications on the peritoneal surface and liver after infusion of pH-neutral SOW into the peritoneal cavity of rats. MATERIAL AND METHODS Thirty Wistar-Albino rats weighing 250-300 g were randomly divided into 3 groups (10 rats/group). Group1 (control group) rats received single dose of 10 mg/kg saline solution intraperitoneally. Group 2 (single-dose group) rats received a single dose of 10 mg/kg pH-neutral SOW intraperitoneally. Group 3 (multiple-doses group) rats received multiple doses of 10 mg/kg pH-neutral SOW intraperitoneally on days 1, 3, and 5. All animals were killed at 1 week after infusion. Blood specimens were taken to the laboratory and macroscopic and microscopic examinations were performed on each rat. RESULTS All 30 rats survived after the infusion. The gross-macroscopic examinations revealed no pathologic findings in any of the 3 groups. The microscopic examination of peritoneum and liver showed no signs of toxicity or complications in any of the 3 groups. There were no statistically significant differences among the 3 groups with regards to the blood biochemistry, including hemoglobin, hematocrit, platelets, aspartate aminotransferase, alanine aminotransferase, urea, or creatinine levels (p>0.05). However, the leucocyte counts were lower in group 3 than in groups 1 and 2, but this was not statistically significant (p=0.189). CONCLUSIONS Intraperitoneal infusion of pH-neutral SOW does not result in any significant toxicity or complications on the liver and peritoneal surface. However, multiple infusions lead to low leucocyte counts and future studies with longer follow-up times are needed.

Maternal and fetal outcomes after laparoscopic vs. Open appendectomy in pregnant women: data from two tertiary referral centers.

Objectives: Appendectomy is the most common cause of non-obstetric surgery in pregnant women. Our aim was to compare the clinical characteristics, peri-and post-operative data of pregnant women undergoing either laparoscopic appendectomy (LA) or open appendectomy (OA). Materials and methods: This was a retrospective study of medical records of all pregnant women diagnosed and treated surgically for acute appendicitis at two referral centers of Yuzuncu Yil University Medical Faculty and Kafkas University Medical Faculty, from January 2010 to January 2015. Results: The study included 48 patients, divided to two groups (12 - LA and 36 - OA). There were no significant differences in demographic characteristics of the studied population, including age, BMI, gestational age at operation, gravidity, parity, and history of cesarean sections. A far as obstetric and fetal outcomes are concerned, no significant differences were found in terms of preterm delivery, fetal loss, delivery mode, birth weight, APGAR score, and maternal death between the two investigated groups. One perioperative complication of intra-abdominal abscess was noted in the OA group. However, the LA group had shorter hospital stay (3.25±2.45 vs. 4.28±3.31, p=0.004), earlier mobilization time (8.1±2.2 vs. 10.1±1.6, p=0.025), and shorter time to first flatus (2.3±0.3 vs. 4.0±1.6, p=0.032) as compared to the OA group. The OA group had statistically shorter operation time than the LA group (38.61±11.5 vs. 49.42±11.38, p=0.007). Conclusion: LA is related to shorter hospital stay, faster return to daily activities, and shorter time to first flatus. LA appears to be as safe and effective as OA in pregnant patients without increasing adverse perinatal outcomes.

Relationship between MTHFR Gene Polymorphisms and Gastrointestinal Tumors Development: Perspective from Eastern Part of Turkey.

BACKGROUND: Gastric and esophageal cancers are 2 of the most prevalent cancer types worldwide. Polymorphisms in the genes that code the methylenetetrahydrofolate reductase (MTHFR) enzyme increase the formation of both cancer types. In this study, it was aimed to research the relationship between the existence of MTHFR C677T and A1298C polymorphisms in patients with gastric and esophageal cancer and the lifespans of patients. METHODS AND MATERIALS: This prospective study was performed at Van Yuzuncu Yil University. Included in the study were 30 patients with esophageal tumors, 70 patients with gastric tumors, and 61 healthy volunteers. From each of the patients, 5 mL of blood was drawn. DNA was isolated via kits with spin-column technology. RESULTS: It was concluded that the risk of developing gastric cancer was 4.13 times higher in individuals who had the AC genotype of the A1298C polymorphism when compared to those who had the AA genotype, while the risk was 2.91 times higher in individuals who had the CC genotype when compared to those who had the AA genotype (P = 0.001, P = 0.027). Carriers of the AC genotype of the A1298C polymorphism had 2.89 times higher risk of developing esophageal cancer when compared to those who had the AA genotype (P = 0.033). It was determined that individuals who had the 1298 CC genotype were not at higher risk of developing esophageal cancer when compared to those with the AA genotype (P = 0.863). It was concluded that individuals who had the TT genotype of the C677T polymorphism were not at higher risk of developing gastric and esophageal cancers when compared to those who had the 677CC genotype (P > 0.05). There was no difference in terms of the life spans of the patients with regards to the genotypes (P > 0.05). CONCLUSION: The results showed that the A1298C polymorphism on the MTHFR gene can be a risk factor for gastric and esophageal cancer in eastern Turkey. These polymorphisms may have no effect on the life spans of the patients.

Factors affecting mortality in emergency surgery in cases of complicated colorectal cancer.

AIM: To evaluate retrospectively demographic, clinical and histopathological variables effective on mortality in patients who had undergone emergency surgery due to complicated colorectal cancer. METHODS: A total of 39 patients underwent urgent surgical interventions due to complicated colorectal cancer at the Department of General Surgery, Dursun Odabas Medical Center, between January 2010 and January 2015. Thirty three of these were included in the study. Six patients were excluded because complete medical records had been missing. Medical records of the 33 cases were retrospectively reviewed. RESULTS: There were 14 (42.5%) male and 19 (57.5%) female patients. Mean age was 60 years (range: 32- 83 years); 14 (42.5%) patients were less than 60 years old , while 19 (57.5%) were 60 years old or older. Operations were performed due to perforation (39.3%) and obstruction (60.6%) in 13 and 20 patients, respectively. Tumor localization was in the right and transverse colon in nine (21.2%) and in the left colon in 24 cases (72.7%). Eleven (33.3%) patients underwent resection and anastomosis, 13 (39.3%) resection and ostomy, and nine (27.2%) patients underwent ostomy alone without any resection. Postoperative mortality occurred in nine cases (27.2%). CONCLUSIONS: High mortality should be expected in females older than 60 years with a left sided colon tumor or with another synchronous tumor and in perforated tumors. Unnecessary major resections should be avoided and primary pathology should be in the focus of treatment in order to decrease the mortality and morbidity rates.

Successful Treatment of a Large Pelvic Abscess Using Intraluminal VAC: A Case Report.

The most feared complication of the surgical treatment of rectal cancer is anastomotic leakage, which is related to high rates of mortality and morbidity. Here, we present a patient who could not be treated with surgical drainage but treated by intraluminal Vacuum Associated Closure (VAC). A 34-year-old male patient was treated for rectal cancer by low anterior resection, colorectal anastomosis, and diverting ileostomy following neoadjuvant CRT. The patient reported with a postoperative anastomotic disruption and a large pelvic abscess. Due to the continuation of foul-smell drainage inspite of perianal incision and drainage, intraluminal VAC was applied and the pelvic abscess and the foul-smell were successfully treated. The presence of an adequate anal sphincter tonus is a disadvantage in anastomotic leakage, since it prevents the emptying of the intestinal content and also precludes the drainage of the pelvic abscess. The endoluminal application of VAC, similar to the results of application of VAC in open wounds, has been demonstrated to decrease fibrin and necrotic tissue in the pelvic cavity and increase granulation tissue. VAC, which has long been used in the treatment of open wounds, is a promising method in the treatment of large pelvic abscesses due to anastomotic leakage following rectum resection.

Colonoscopic Perforations, What is Our Experience in a Training Hospital?

The aim of this study was to describe our experience in patients treated with the diagnosis of colonoscopic perforation. A retrospective institutional computer-based search of the patients treated with the diagnosis of colonoscopic perforation between July 2009 and May 2014 was undertaken. Our study included 16 patients. In 9 (56%) patients, perforations occurred during the diagnostic colonoscopy. Snare polypectomy was the causative factor in 5 patients associated with therapeutic colonoscopy. The perforation was significantly higher in patients who underwent therapeutic colonoscopy than those had diagnostic colonoscopy (P<0.007). The sigmoid colon was the most common perforation site (62.5%). Twelve patients (75%) were treated by surgically, 3 (19%) patients by conservatively, and 1 (6%) by endoscopic clipping. Early recognition of the perforation is critical. Therefore, a high index of suspicion is essential for the prompt and accurate diagnosis.

The diagnosis of acute appendicitis in pregnant versus non-pregnant women: A comparative study.

OBJECTIVE:: To investigate whether the diagnosis of acute appendicitis is affected by pregnancy or not. METHOD:: A retrospective study with the analysis of the medical records of all women suspected of having appendicitis who underwent appendectomy at our hospital between June 2010 and March 2015 were reviewed. The patients were divided into two groups according to whether they were pregnant or not during the surgery: group I, pregnant women, and group II, non-pregnant women. RESULTS:: During the study period, 38 pregnant women and 169 non-pregnant women underwent appendectomy. The time from admission to the operation was not statistically different (2.17±1.47 days in group I vs. 1.98±1.66 day in group II; p=0.288). The pregnant group had longer hospital stay than the non-pregnant group (p=0.04). Ultrasonography (USG) was used as the first diagnostic modality in 36/38 patients in group I and 161/169 in group II. The non-visualized appendix on ultrasound was seen in 17 patients in group I and 51 patients in group II, which was not statistically different. Sensitivity and specificity of USG in diagnosis of acute appendicitis were 61.29 and 80.00% in group I, and 93.0 and 31.6% in group II, respectively. CONCLUSION:: Although the diagnosis of appendicitis in pregnant women is not delayed, careful assessment of these patients suspected of having appendicitis should be encouraged when USG examination is normal or nondiagnostic.

Effect of thymoquinone on the healing of left colon anastomosis: an experimental study.

AIM: To evaluate the effect of thymoquinone on the healing of experimental left colon anastomosis in rats. METHODS: Forty Wistar albino rats weighing 250-300 g were randomly divided into four groups (10 rats/group). Group 1 (control group) rats were not administered Thymoquinone (TQ) for 3 days after the operation. Group 2 was administered daily TQ for 3 days starting from the first day after the operation. Group 3 was not administered TQ for 7 days after the operation. Group 4 was administered daily TQ for 7 days starting from the first day after the operation. Thymoquinone was administered as a single dose oral gavage through a 4F feeding catheter per each day. The bursting strength of the anastomosis was measured on 3rd and 7th postoperative days (POD) and resection was performed. Subsequently, the hydroxyproline level in the resected tissue was measured and a histological evaluation was performed. RESULTS: The bursting pressures of the anastomoses were measured to be statistically significantly greater on 7th POD in TQ administered groups compared to those without TQ administration. Tissues were stained with Masson's trichrome dye in order to evaluate the amount of fibrous tissue reaction for histopathological examination; there was no significant difference in the amount of fibrous tissue between groups 1 and 2, while a very marked increase in the fibrous tissue was detected in groups 3 and 4. Mean tissue hydroxyproline levels of the groups 3 and 4 on 7th POD were 1.30 and 2.72 µg/g-protein, respectively. The difference between the groups was statistically significant (p = 0.001). CONCLUSIONS: TQ significantly increased the bursting pressure of the anastomosis, tissue hydroxyproline level, and fibrous tissue production.

Ingested intraabdominal foreign bodies that require surgical intervention.

BACKGROUND: The aim of the present study was to review cases that required surgical intervention to remove ingested foreign bodies. METHODS: Medical records of 7 patients who underwent surgical intervention at the Yüzüncü Yil University Department of General Surgery between 2009 and 2014 after ingesting foreign bodies were reviewed. RESULTS: Female:male ratio was 5:2; mean age was 25 (16-35). Four patients had swallowed pins, 1 patient had swallowed a sewing pin, 1 patient had swallowed a safety pin, and 1 patient had swallowed a wristwatch. The patient who had swallowed the wristwatch had psychiatric disorders. All other patients stated that they had swallowed the objects by accident. CONCLUSION: Most ingested foreign bodies pass smoothly through the gastrointestinal (GI) tract within a week, but those that migrate out of the lumen require surgical intervention due to complications including perforation, abscess, fistula, and peritonitis. Early diagnosis and intervention is crucial to reduce morbidity and mortality. It is believed that sharp and pointed objects that migrate outside of the lumen ought to be removed, lest they cause complications.

Colon cancer presented with sigmoid volvulus: A case report.

INTRODUCTION: Sigmoid volvulus is the most prevalent type of colonic volvulus. Colon cancer is seen less where sigmoid volvulus is common, so it is rare to see that colon cancer is synchronous with sigmoid volvulus. PRESENTATION OF CASE: We would like to present a case of sigmoid volvulus caused by colon cancer in a male patient aged 80 who was referred to the hospital with toxaemic shock presentation. DISCUSSION: Sigmoid cancer can be presented as sigmoid volvulus to the emergency department. In intestinal obstruction early diagnosis is of crucial importance. Computarized tomography is a diagnosis tool that should be preferred both in the diagnosis of obstruction and in detecting its cause, localisation, degree and complications. CONCLUSION: When surgery is performed due to the urgent colonic obstruction in colonic volvulus diagnosed patients, a colon tumour should be considered in the same column loops or in the distal colon. We believe that CT is the method that should be preferred in large-bowel obstruction suspected patients.

The diagnosis of acute appendicitis in pregnant versus non-pregnant women: A comparative study / O diagnóstico de apendicite aguda em mulheres grávidas versus não grávidas: um estudo comparativo

Summary Objective: To investigate whether the diagnosis of acute appendicitis is affected by pregnancy or not. Method: A retrospective study with the analysis of the medical records of all women suspected of having appendicitis who underwent appendectomy at our hospital between June 2010 and March 2015 were reviewed. The patients were divided into two groups according to whether they were pregnant or not during the surgery: group I, pregnant women, and group II, non-pregnant women. Results: During the study period, 38 pregnant women and 169 non-pregnant women underwent appendectomy. The time from admission to the operation was not statistically different (2.17±1.47 days in group I vs. 1.98±1.66 day in group II; p=0.288). The pregnant group had longer hospital stay than the non-pregnant group (p=0.04). Ultrasonography (USG) was used as the first diagnostic modality in 36/38 patients in group I and 161/169 in group II. The non-visualized appendix on ultrasound was seen in 17 patients in group I and 51 patients in group II, which was not statistically different. Sensitivity and specificity of USG in diagnosis of acute appendicitis were 61.29 and 80.00% in group I, and 93.0 and 31.6% in group II, respectively. Conclusion: Although the diagnosis of appendicitis in pregnant women is not delayed, careful assessment of these patients suspected of having appendicitis should be encouraged when USG examination is normal or nondiagnostic.

Resumo Objetivo: investigar se o diagnóstico de apendicite aguda é afetado por gravidez ou não. Método: estudo retrospectivo com análise dos prontuários médicos de todas as mulheres que tiveram suspeita de apendicite e foram submetidas à apendicectomia em nosso hospital entre junho de 2010 e março de 2015. As pacientes foram divididas em dois grupos, de acordo com a presença de gravidez durante a cirurgia: grupo I, mulheres grávidas; grupo II, mulheres não grávidas. Resultados: durante o período do estudo, 38 mulheres grávidas e 169 mulheres não grávidas foram submetidas à apendicectomia. O tempo desde a internação até a cirurgia não foi estatisticamente diferente (2,17±1,47 dias no grupo I vs. 1,98±1,66 dia no grupo II, p=0,288). O grupo das grávidas apresentou uma estadia hospitalar mais longa que o grupo das não grávidas (p=0,04). A ultrassonografia foi usada como primeira modalidade de diagnóstico em 36/38 pacientes no grupo I e em 161/169 no grupo II. O apêndice não visualizado na ultrassonografia foi visto em 17 pacientes no grupo I e 51 pacientes no grupo II, e não foi estatisticamente diferente. A sensibilidade e especificidade da ultrassonografia no diagnóstico de apendicite aguda foram 61,29 e 80,00% no grupo I e 93,0 e 31,6% no grupo II, respectivamente. Conclusão: embora o diagnóstico de apendicite em mulheres grávidas não seja protelado, recomenda-se uma avaliação cuidadosa quando o exame de ultrassonografia for normal ou não diagnóstico nessas pacientes.