Factors affecting the rates of incidental parathyroidectomy during thyroidectomy.

BACKGROUND: The most important factors affecting the development of postoperative hypocalcaemia (PH) include intraoperative trauma to the parathyroid glands, incidental parathyroidectomy (IP), and the surgeon's experience. In this study, we aimed to determine the incidence of IP, evaluate its effect on postoperative calcium levels and investigate the effect of surgeon experience and volume on IP incidence and postoperative calcium levels. METHODS: This retrospective study included 645 patients who underwent thyroid surgery at the Department of General Surgery, Kütahya Health Sciences University between September 2016 and March 2020. All patients underwent surgery at a single clinic by general surgeons experienced in thyroid surgery and their residents (3-5 years). RESULTS: Normal parathyroid glands were reported in 58 (8.9%) of 645 patients. In 5 (8.6%) of 58 patients the parathyroid gland was detected in the intrathyroidal region. PH developed in ten patients (17.2%) with incidental removal of the parathyroid glands. A statistically significant difference was found between the number of incidentally removed parathyroid glands and the development of hypocalcaemia (p<0.05). Normal parathyroid glands were reported in the pathology of 37 (7.9%) patients operated on by general surgeons and 22 (12.6%) patients operated on by their residents. PH developed in 39 (8.2%) patients operated on by general surgeons and in 8 (4.5%) patients operated on by their residents. CONCLUSIONS: We found that the complication rate during the resident training process was the same as that of experienced general surgeons. A thyroidectomy can be safely performed by senior residents during residential training.

Adolescent emotion scale for online lessons: A study from Turkey.

People's day-to-day routines have changed drastically since the outbreak of the COVID-19 pandemic. One of the changes to take place has been the transition to online learning due to the changing conditions in learning environments. One of the factors that guide students through learning environments is their emotions. The few existing scales that measure the emotions of adolescents in learning environments have been developed with consideration of face-to-face learning environments and their items do not adequately express the state of online environments. For this reason, this study aimed to develop a scale which reveals the emotions of adolescents that may affect their academic success with regard to this transition of learning environments as they attend online lessons. A total of 3,655 middle and high school students living in Istanbul, Turkey, participated in the study. The scoring system was designed with regard to the frequency with which each student reading an item experiences the relevant emotion for the item in the online learning environment. Exploratory and confirmatory factor analyses conducted show the scale to possess a four-dimensional structure. These dimensions are enjoyment-pride, boredom-hopelessness, loneliness and anxiety. For all dimensions of the scale, Cronbach alpha values range between .93 and .83. 'Positive and Negative Affects Schedule-Children' was used to confirm the scale's criterion-related validity, and correlations between dimensions were examined. After validity and reliability studies, the Adolescent Emotion Scale for Online Lessons was found to be sufficient. The scale can be used by experts and teachers who wish to determine adolescents' emotions during a period of online learning.

Predictive value of neutrophiltolymphocyte ratio in the severity of non-alcoholic fatty liver disease among type 2 diabetes patients.

BACKGROUND: Non-alcoholic fatty liver disease is a progressive inflammatory disease that ultimately results in cirrhosis and liver failure. It is assosiciated with two step hit scenario; the first step is fat accumulationin liver and in the second step inflammation and fibrosis are the major compenents. The incidence of this disease is increasing worldwide, following rising incidences of obesity and diabetes mellitus. AIM: The aim of this study is to analyze the relationship between non-alcoholic fatty liver disease andseverity and neutrophil-to-lymphocyte ratio among the patients having type 2 diabetes mellitus. METHODS: This study involved 143 patients with type 2 diabetes who were placed into four groups (grade 0, 1, 2, 3) based on steatosis level due to blinded ultrasonographic evaluation. Biochemical parameters and counts of total white blood cells, neutrophils, and lymphocytes were determined. Neutrophil-to-lymphocyte ratio was compared across the four patient groups. RESULTS: Levels of hemoglobin A1c, creatinine, alanine aminotransferase, high-density lipoprotein cholesterol and triglycerides were significantly different between the four patient groups (ANOVA p-values: p <0.001, p=0.011, p=0.002, p=0.034, p=0.002, respectively). Counts of white blood cells, neutrophils, lymphocytes, and neutrophil-to-lymphocyte ratio significantly differed between the groups (p <0.001). Neutrophil-to-lymphocyte ratio was positively correlated with steatosis grade (p < 0.001). CONCLUSIONS: Neutrophil-to-lymphocyte ratio increases with increasing grade of non-alcoholic fatty liver disease in patients with type 2 diabetes, and may be a convenient marker to follow progression of non-alcoholic fatty liver disease. (Acta gastro-enterol. belg., 2016, 79, 295-300).

Histopathological gallbladder morphometric measurements in geriatric patients with symptomatic chronic cholecystitis.

INTRODUCTION: Cholecystectomy for symptomatic cholecystitis is one of the common surgical procedures in the geriatric patients. Increased gallbladder wall thickness is expected due to acute cholecystitis and in some other clinical conditions. Routine histopathological evaluation of cholecystectomy materials are required to confirm the diagnosis and document other pathologies. The aim of this study was to evaluate age-related histopathological gallbladder morphometric measurements. METHODS: A retrospective chart review of 371 cholecystectomy materials was performed. Two groups were designed according to age (<65 and ≥65 years old, respectively). Age and gender analyses for histopathological gallbladder length, diameter and wall thickness were performed. In addition, pathologically confirmed acute inflammation rates were evaluated in this case-control study. RESULTS: Gallbladder morphometric measurements and pathologically confirmed acute inflammation rates were similar in males and females. Histopathological gallbladder diameter was higher with acute inflammatory changes, but no differences were observed in gallbladder length and wall thickness. Gallbladder wall thickness and pathologically confirmed acute inflammation rates were not comparable between the control and geriatric patients (2.8 ± 1.3 vs 2.6 ± 1.2 mm, and 30/281 (10.7 %) vs 10/74 (13.5 %), respectively, p > 0.05). However, higher gallbladder length and diameter were observed in geriatric group. CONCLUSION: Age is an independent factor on histopathological gallbladder length and diameter, but not for gallbladder wall thickness. In addition, pathologically confirmed acute inflammation rate is not higher in geriatric patients. Clinical significance of these findings merits further investigation.

A giant renal calculus treated without nephrectomy.

The case of a patient with a giant renal calculus weighing 770 g in a solitary functioning kidney is reported. A 57-year-old man presented with right lumbar pain and macroscopic hematuria, and a giant stone was diagnosed in his right kidney. Nine days after a percutaneous nephrostomy placement, the patient underwent selective right renal angiography and transcatheter superselective embolization due to a sudden gross hematuria observed from both the nephrostomy tube and urethra. Embolization was successful. Right anatrophic nephrolithotomy was performed after stabilization of the patient. There were no complications during the recovery period. The case reported here is significant not only because it is the 7th biggest and the heaviest stone in the literature but also because it is the first giant stone reported to be in a solitary functioning kidney and treated without nephrectomy.

Hormonal and hemodynamic changes during percutaneous nephrolithotomy.

The aim of this study was to investigate the hormonal and hemodynamic changes during percutaneous nephrolithotomy (PCNL) procedure. Twenty-one patients between 15-65 years of age were included in the study. Invasive blood pressure and heart rate were monitored during PCNL. Serum sodium, potassium, BUN and creatinine levels were measured before and after the operation. Sodium and potassium levels were also measured during the operation. Arterial blood gases, renin, aldosterone and adrenocorticotrophic hormone (ACTH) levels were measured before and during irrigation. The mean systolic and diastolic blood pressure levels were significantly higher (p < 0.05) during PCNL compared to post-procedure levels while heart rate remained constant. Serum sodium, potassium bicarbonate and base-excess levels were decreased during the operation compared to the baseline levels (p < 0.001). BUN and creatinine levels remained unchanged during the study (p > 0.05). In conclusion, a tendency to hyponatremia and metabolic acidosis developed in addition to significant increases in renin, aldosterone and ACTH levels during PCNL procedures. These changes may be due to the invasive nature of the intervention to the kidney and the continuous irrigation of this vital organ. This should be taken into consideration during PCNL. More detailed studies with larger groups are needed for more precise comments on this topic.

Diffuse cavernous hemangioma of the rectum and sigmoid colon.

We present an 18-year-old man with painless rectal bleeding, hematuria and diffuse cavernous hemangioma of the rectum and sigmoid colon. Thirty units of blood were transfused during the interval preceding definitive surgery. Low anterior resection and partial cystectomy were performed. During the postoperative period no rectal bleeding occurred, but he died of massive intracerebral bleeding 10 months after the operation.

The in vitro bactericidal effect of microwave energy on bacteria that cause prostatitis.

OBJECTIVES: We investigated the in vitro nonthermal effects of microwaves delivered from Prostatron 2.0 on Escherichia coli and Enterobacter cloacae. METHODS: The fingers of powder-free, sterile gloves were ligated, and bacterial solutions were transferred into the remaining area of the glove. The gloves were then sealed using silk ligatures. One set of gloves was subjected to the microwave treatment while another set was placed in a temperature-matched waterbath to act as control samples. The gloves containing the treatment group were taped around the probe, at the site where microwave energy exits the probe. During the treatment period, the temperatures from the urethral probe and the rectal probe were carefully monitored. RESULTS: The mean (+/-SD) energy delivered was 46.6 +/- 9.5 kJ (range 30.0 to 59.5) for the 10 trials on E. coli and colony counts in the experimental microwaved gloves decreased significantly compared with control samples (5.26 +/- 4.5 x 10(5) versus 10.16 +/- 9.3 x 10(5) CFU/mL, P = 0.02). For the experiments on E. cloacae the mean (+/-SD) energy applied was 38.5 +/- 12.5 kJ, and a significant decrease in colony counts of microwaved samples was also observed compared with controls (11.04 +/- 4.8 x 10(5) versus 20.08 +/- 10.1 x 10(5) CFU/mL, P = 0.004). CONCLUSIONS: Microwave energy, delivered from Prostatron 2.0, independent of heat production has an in vitro bactericidal effect on laboratory-cultured E. coli and E. cloacae.

[Studies on pharmacokinetics and biotransformation of ipratropiumbromide in man (author's transl)]. / Untersuchungen zur Pharmakokinetik und Biotransformation von Ipratropiumbromid am Menschen

Studies into the human pharmacokinetics of (8r)-3alpha-hydroxy-8-isopropyl-1 alphaH, 5 alphaH-tropanium-bromide- (+/-)-tropate (ipratropium bromide, Sch 1000, Atrovent) following inhalation and oral and i.v. administration are described. The substance was labelled with 14C. The plasma level (total radioactivity) recorded following oral administration was characterised by a low but broad plateau persisting for several hours. After i.v. injection rapid elimination from the plasma was observed in the first phase. The plasma level following inhalation was characterised by an initially rapid absorption and the curve subsequently resembled that following oral administration. An equi-bronchodilatory dose following inhalation produced a blood level 1000 times lower than those following oral dosing. The half-life of elimination lay between 3.2 and 3.8 h for all routes of administration. The maxima were recorded at 3 h. Cumulative renal excretion was 9.3% following oral administration, 72.1% following i.v. route and 3.2% after inhalation. 88.5% were excreted via the faeces following oral dosing, 6.3% following i.v. application and 69.4% after inhalation. Ipratropiumbromide is partly metabolised. After 4 h, the percentage of unchanged substance in relation to total activity in the urine was 24% (oral), 46% (i.v.) and 13% (inhalation). One of eight metabolites-- six in very small amounts-- was identified as N-isopropyl-methyl-nortropiumbromide.