Interstitial Fibrosis as a Common Counterpart of Histopathological Risk Factors in Papillary Thyroid Microcarcinoma: A Retrospective Analysis.

PURPOSE: Interstitial fibrosis in papillary thyroid microcarcinoma is a subject which is under-investigated. The aim of this study is to determine the relationship between interstitial fibrosis, the subtypes of papillary microcarcinoma, and the established prognostic factors. MATERIAL AND METHODS: A total of 75 patients diagnosed with papillary microcarcinoma of the thyroid from January 2011 to December 2020 have been evaluated retrospectively, using demographic features, tumor size, subtype of the tumor, surgical margin status, unifocality, lymphovascular invasion, extracapsular spread and lymph node metastasis as parameters. Hematoxylin and eosin slides were reviewed for interstitial fibrosis. RESULTS: The study includes 13 males and 62 females, in a total of 75 patients. There were 51 patients (68%) with interstitial fibrosis and 24 (32%) patients without interstitial fibrosis. Among them, 45 (60%) were classic, 27 (36%) were follicular variant and 3 (4%) were other subtypes. Interstitial fibrosis is significantly associated with bilaterality (p = 0.023), multifocality (p = 0.004), capsule invasion (p < 0.001) and lymph node metastasis (p = 0.043). Evaluation of tumor sub groups showed significant increased risk of lymphovascular invasion in the follicular variant (p = 0.019). CONCLUSION: Although the relationship of interstitial fibrosis and prognosis of other cancer types has been discussed, there are few studies in the literature regarding its effect on the prognosis of papillary microcarcinoma. Our results show that interstitial fibrosis can be used as a risk factor. However, new studies are needed to clearly reveal the physiopathology of interstitial fibrosis and its effect on tumorigenesis.

Effects of Patient and Tumor Characteristics on Central Lymph Node Metastasis in Papillary Thyroid Cancer: A Guide for Selective Node Dissection.

BACKGROUND: Prophylactic central lymph node dissection (CLND) in papillary thyroid carcinoma (PTC) is still controversial. This study aimed to analyze the factors related to the patient and tumor characteristics affecting central lymph node metastasis (CLNM) in PTC patients and to evaluate the contribution of the results to shaping the surgical treatment algorithm. METHODS: Two hundred and fifty-five PTC patients who underwent total thyroidectomy and CLND were evaluated retrospectively. Histopathology reports were examined to reveal tumor characteristics. The CLNM ratio and the relationship between CLNM with clinicopathological and demographic characteristics were analyzed. RESULTS: The incidence of CLNM was 54.9% (95 CI%: 49-60.8). Male gender (P=0.027), age<45 years (P=0.016), tumor size≥9.5 mm (P<0.001), lymphovascular invasion (P<0001) and extracapsular invasion (P=0.007) were factors that increased the risk of metastasis. The follicular variant decreased the risk (P=0.010). There was no relationship between CLNM and focality (P=0.054). A low-to-moderate correlation was found between tumor diameter and the metastatic lymph node (MLN) number/total lymph node number ratio (r=0.396, P<0.001). CONCLUSION: A selective prophylactic CLND strategy can be applied in cN0 patients. As the tumor diameter increases in PTC, both the risk of CLNM and the number of MLN increase. Lymphovascular and extracapsular invasion are other factors that increase the risk. The follicular variant is associated with a lower risk of CLNM. Male patients who are under the age of 45 and have a tumor diameter of 9.5 mm or more are definite candidates for prophylactic CLND.

Tryptophan Degradation and Antioxidant Status in Patients With Thyroid Disorders.

BACKGROUND: The aim of this study was to evaluate the degradation of tryptophan (Trp), neopterin production and antioxidant capacity in patients with benign and malignant thyroid disease. METHODS: For this reason, the levels of tryptophan, kynurenine (Kyn) and neopterin, and superoxide dismutase (SOD) and catalase (CAT) enzyme activities in 67 thyroid patients were evaluated in our study and the results were compared with 30 healthy controls. RESULTS: Tryptophan and kynurenine levels in thyroid patients decreased compared to the control group. Patients with thyroid disease had lower CAT activity than the control group. The neopterin and tryptophan levels in malignant and benign patients were also significantly different. CONCLUSION: The results of the present study suggest that thyroid disorders may lead to changes in tryptophan degradation, neopterin production and CAT enzyme activities.

Nonfunctional double parathyroid carcinoma with incidental thyroid micropapillary carcinoma: a rare case.

Parathyroid carcinomas are rare endocrine tumors which comprise 0.3-5.6% of all causes of hyperparathyroidism. 90% of them are hormonally active, while 10% of them may be non-functional. They mostly occur in a single parathyroid gland. Concurrent involvement of both parathyroid glands is quite rare. A 57-year-old male patient was admitted to emergency department with the complaint of dyspnea. Thorax tomography revealed a retrosternal mass. The mass was thoracoscopically excised by thoracic surgeons. Histopathological examination result of the mass was reported as parathyroid carcinoma. Parathyroid scintigraphy performed and focal activity increase in the lower pole of the left lobe. Parathyroid hormone level was 118 pg/ml and calcium level was measured as 11.4 mg/dl. The patient with these findings was operated and pathological examination of excised left lower parathyroid tissue was reported as carcinoma. In addition, micropapillary carcinoma was detected in left thyroid lobectomy specimen.Our case was also unusual in that double parathyroid carcinoma, which is a rare condition, was hormonally inactive. We aimed to present our case in the light of the literature due to its rare occurrence.

An Approach to Macroscopic Central Lymph Nodes Detected during Surgery in Patients with Thyroid Micropapillary Carcinoma: Should We Resort to Dissection?

Background. High-resolution ultrasonography and the ability to perform fine-needle aspiration biopsy even for nodules smaller than three millimeters have considerably increased the detection rate of thyroid micropapillary carcinoma (TMPC). Despite favorable prognosis, the prevalence of cervical lymph node metastases in patients with TMPC is approximately 30%. Aim. In this study, we aimed to determine the central lymph node metastasis rate and its relation to the characteristics of the tumor. Methods. One hundred nine patients who underwent surgery due to TMPC between December 2009 and January 2014 were analyzed retrospectively. Patients were divided into two groups according to whether they underwent lymph node dissection and the two groups were then compared with respect to tumor size and multicentricity, age, and presence of lymphocytic thyroiditis. Results. There were no statistically significant differences between the two groups of patients in terms of tumor size, tumor multicentricity, age, and presence of lymphocytic thyroiditis. When the patient group that received lymph node dissection was further analyzed, it was found that patients with lymphocytic thyroiditis had a significantly lower number of metastatic lymph nodes. Conclusion. Central lymph node dissection in TMPC patients with macroscopic lymph node detected intraoperatively would ensure accurate staging without an increase in morbidity.

Ultrasound-guided thyroid nodule fine-needle biopsies--comparison of sample adequacy with different sampling techniques, different needle sizes, and with/without onsite cytological analysis.

INTRODUCTION: The aim of this study was to compare the diagnostic adequacy of thyroid samples obtained by aspiration or capillary biopsy techniques, with 22 or 27 gauge needles, and with or without on-site cytological analysis (OCA). MATERIAL AND METHODS: Four hundred patients with thyroid nodules underwent ultrasound (US)-guided fine-needle biopsies. Patients were divided into eight groups according to needle size (22 vs. 27 gauge), biopsy technique (aspiration vs. capillary), and whether or not OCA was performed. Sample adequacy rates were calculated for each group and subgroups and compared using chi-square tests. RESULTS: When all nodes were evaluated (n = 400), the adequacy rate was significantly greater with the capillary than with the aspiration technique (97% vs. 91.5%, p = 0.032) and when OCA was than was not performed (97% vs. 91.5%, p = 0.032). When only solid nodules were evaluated (n = 205) the adequacy rate was also significantly greater with the capillary than with the aspiration technique (98.9% vs. 89.7%, p = 0.008) and when OCA was than was not performed (97.9% vs. 89.6%, p = 0.014). In contrast, the adequacy rate was similar for 22 and 27 gauge needles (94.2% vs. 93.1%, p = 0.733). CONCLUSIONS: Optimal results were obtained with the capillary technique and OCA. The capillary technique and OCA should be the preferred approach in thyroid nodule biopsy, optimising adequacy rates and patient comfort.

Effects of verapamil, sodium nitroprusside and glutathione addition into perfusion/preservation solutions on preservation-related ICAM-1 molecule expression in rat liver.

BACKGROUND/AIMS: During cold preservation of liver grafts, expression of tissue adhesion molecules has been reported as a factor indicative of preservation injury. Some biochemical agents as well as increased levels of intracellular calcium also play important roles in preservation injury during cold storage. In the current study, we aimed to test if the addition of a calcium channel blocker, sodium nitroprusside, or glutathione into preservation solution would reduce upregulation of adhesion molecules, thus leading to decreased preservation injury in the rat liver. METHODS: Fifty Albino Wistar rats, weighing 200+/-50 g, were divided into 1 control (perfused with Wisconsin solution, without preservation) and 4 study groups of rat livers (10 livers each). Livers in study groups were harvested, perfused, and preserved for 16 hours in 4 different solutions (Wisconsin solution alone, Wisconsin solution+verapamil, Wisconsin solution+ sodium nitroprusside and Wisconsin solution+glutathione). At the end of the preservation time, levels of graft tissue adhesion molecule (ICAM-1) expression were analyzed. RESULTS: Preservation for 16 hours with Wisconsin solution alone and Wisconsin solution+verapamil perfusates caused significantly more ICAM-1 expression than did preservation for 16 hours with Wisconsin solution+sodium nitroprusside and Wisconsin solution+ glutathione perfusates (p=0.010). No significant difference was found in ICAM-1 expression between the Wisconsin solution+ sodium nitroprusside and Wisconsin solution+glutathione groups. In the control group, perfusion with Wisconsin solution alone, without preservation, represented minimal ICAM-1 expression, reflecting minimum preservation injury (p=0.0003). CONCLUSIONS: Addition of sodium nitroprusside and glutathione into the Wisconsin solution decreased levels of ICAM-1 molecule expression, which reflects lower levels of preservation injury. In this study, the addition of verapamil to the perfusate/preservation solution for reducing the intracellular calcium accumulation had no effect on tissue ICAM-1 molecule expression.

Preoperative detection of parathyroid adenomas with Tc-99m MIBI and Tc-99m pertechnetate scintigraphy: histopathological and biochemical correlation with Tc-99m MIBI uptake.

AIM: The objective of this study was to compare the dual phase MIBI scinitgraphy with MIBI and Tc-99m pertechnetate (MIBI + Tc-99m) study in defining the parathyroid adenomas, and to evaluate the effect of histologic and biochemical characteristics on the imaging of parathyroid adenomas with Tc-99m methoxyisobutylisonitrile (MIBI) scintigraphy. METHODS: Thirty-six patients with parathyroid adenomas were studied prospectively. All patients were evaluated with both MIBI and (MIBI + Tc-99m) study. MIBI uptake of adenomas correlated with oxyphill, chief cell and tumour weight of the surgically excised glands. MIBI uptake was also compared with serum calcium (Ca), phosphorus (P) and intact parathormone (iPTH) levels. RESULTS: A total of 38 parathyroid adenomas were surgically excised from 36 patients. MIBI + Tc-99m identified 35 of the parathyroid lesions (92%). Whereas, MIBI study detected 30 of the 38 parathyroid adenomas (79% sensitivity) (p=0.0001). There were no false positives. Adenoma weight showed significiant correlation with MIBI uptake (p=0.001). Oxyphyill cell content also showed high correlation with MIBI uptake. Delayed images showed better correlation than the early views (Early MIBI p=0.033; Delayed MIBI; p=0.001). CONCLUSION: MIBI + Tc-99m pertechnetate interpretation is more sensitive than only dual MIBI imaging for the detection of parathyroid adenoma. Oxyphill cell content and weight of the lesions proved to be important determinants of 99mTc-MIBI accumulation in parathyroid adenoma. We found no significant correlation between MIBI accumulation, Ca, P and iPTH serum levels (Tab. 2, Fig. 2, Ref. 15). Full Text (Free, PDF) www.bmj.sk.

The value of breast ductoscopy in radiologically negative spontaneous/persistent nipple discharge.

Breast ductoscope is a fiberoptic endoscope used for examining the distal breast ducts under direct vision in order to identify the source of pathologic nipple discharge. The purpose of this study was to investigate the reliability of intra-operative breast ductoscopy in patients with pathologic nipple discharge, which could not be identified by radiologic tests. Between April 2002 and March 2007, breast ductoscopy was performed in 34 patients who had pathologic nipple discharge with no radiologic evidence about the source. The procedures were carried out under general anesthesia and ductoscopic findings were as well as the histopathology of the specimens were recorded and documented. In 88%, (30 of 34) of the patients, endoscope was successfully introduced into the external orifice of the ducts at the nipple and proximal breast ducts were successfully visualized. Ductoscopy revealed intraductal lesions (i.e., ductal obstruction, intraductal papilloma, red patches, and erythematoid platter) in 20 patients (66%). Among the 20 patients with visible endoluminal pathology, nine had a papilloma and eight had signs of either acute inflammation (bleeding, erythema) or previous inflammation with healing (adhesions and blocked ducts). In two cases, invasive breast carcinoma was identified, one of which was ductal carcinoma in situ (DCIS) with minimal invasion. In both cases, there had been blocked ducts. In one case DCIS was identified. Breast ductoscopy is a reliable and easy-to-use method to demonstrate the source of pathologic nipple discharge in cases with bleeding and other intraductal lesions.

Analysis of surgical complications of thyroid diseases: results of a single institution.

BACKGROUND: The purpose of this study is to compare the complications of different types of thyroidectomy for benign and malignant thyroidal diseases. METHODS: Between January 2001 and March 2006, 982 patients underwent thyroidectomy in single institute. A retrospective analysis was performed on demographic characteristics and pathology reports of patients, complications of surgery as well as the follow-up of patients. Sixty patients could not be fully followed up and were excluded. RESULTS: The types of the surgical procedures were as follows; 451 (48.9%) total, 137 (14.9%) subtotal, 60 (6.5%) near-total thyroidectomy and 274 (29.8%) lobectomy with isthmectomy. In the benign group, temporary recurrent laryngeal nerve injury (RLNI) was the most common complication in patients with toxic diffuse goiter (TDG 2%) while this complication occurred in patients with differentiated thyroid cancer (DTC 1.5%) in the malign group. Permanent RLNI in benign thyroidal diseases was seen more commonly in patients with toxic multinodular goiter (1.3%). In benign thyroidal diseases, temporary hypoparathyroidism (THPT) was mostly found in patients with TDG (8%), whereas in malignant thyroidal diseases this was found more in patients with DTC (2%). Permanent HPT (PHPT) in benign thyroidal diseases was observed more commonly in patients with multinodular goiter (0.9%). In malignant thyroidal diseases, it was more frequently observed in patients with DTC (0.5%). Infective complications after thyroid surgery are rarely observed and have a low incidence (0.4%). CONCLUSION: RLNI and HPT are the most common complications of after thyroid surgery but they may be avoided with an accurate technique (Tab. 3, Ref. 15). Full Text (Free, PDF) www.bmj.sk.

The effect of calcitonin gene-related peptide on healing of intestinal anastomosis in rats with experimental obstructive jaundice.

PURPOSE: Intestinal anastomotic healing is a complex procedure in which several mediators and cytokines play roles. Calcitonin gene-related peptide is an important neuropeptide in inflammation. In this study we aimed to investigate the effect of calcitonin gene-related peptide on healing of intestinal anastomosis in rats with obstructive jaundice. MATERIALS AND METHODS: Obstructive jaundice was induced in rats by the ligation and division of the common bile duct. Four days after the operation, intestinal anastomosis was performed, and either calcitonin gene-related peptide or 0.9% NaCl was administered intraperitoneally to these jaundiced rats and controls. The concentrations of serum tumor necrosis factor-alpha (TNF-alpha) and triglyceride levels of all rats were measured, and healing of the anastomosis was evaluated by measuring the bursting pressure and hydroxyproline content on the 7th postoperative day. RESULTS: Calcitonin gene-related peptide was found to have positive effects on healing of the anastomosis by inhibiting the effects of TNF-alpha and increasing the bursting pressure and hydroxyproline content of the anastomosis. CONCLUSION: Calcitonin gene-related peptide increases anastomotic wound healing in experimental anastomosis in the presence of obstructive jaundice in rats.

Infliximab "TNF-alpha antagonist" decreases intraabdominal adhesions.

OBJECTIVE: To evaluate the effect of infliximab on adhesion formation and it's associated morbidity and complications. METHODS: This study was performed in the Faculty of Medicine, Gazi University, Turkey between July 2005 and October 2005. Thirty-five rats were randomly divided into 4 groups. Laparotomy was performed in the Sham group (n=5), whereas cecal abrasion was carried out in all other groups. After cecal abrasion 0.9% sodium chloride was administered in the saline group (n=10), infliximab was administered to the study group (n=10) and nothing was administered to the last group (n=10). Adhesion formation was evaluated with macroscopic and microscopic adhesion scoring systems. Peritoneal fluid samples and mesenteric lymph node biopsies were taken to rule out bacterial peritonitis. Blood and peritoneal irrigation fluid samples were taken to measure the Tumor necrosis factor-alpha (TNF-alpha) levels. RESULTS: Macroscopic adhesion scores showed fewer adhesions in the infliximab group. The infliximab group had significantly fewer adhesions than the abrasion control and saline groups. According to the histological findings, there were no statistically significant differences between the groups. CONCLUSION: Early blocking of the activity of TNF-alpha after cecal abrasion resulted in lower rates of adhesion formation, macroscopically. The TNF-alpha, a proinflammatory cytokine appears to be an important mediator for postoperative adhesion formation.

Total thyroidectomy for the treatment of Hashimoto's thyroiditis coexisting with papillary thyroid carcinoma.

The coexistence of Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC) is controversial. This study was conducted to evaluate the correlation between HT and PTC and to identify predictive factors for the coexistence of PTC and HT. A total of 922 patients underwent surgery for thyroid disorders between January 2001 and August 2005. In all, 199 patients had been diagnosed with PTC, 37 of whom had coexistent HT; in 689 patients, benign thyroid disease had been diagnosed. Patients' age and sex, as well as histopathology, tumor size, nodal involvement status, multicentricity, presence of metastasis, and serum thyroglobulin levels, were retrospectively reviewed. A significant correlation was observed between HT and PTC, although no statistical significance was noted between PTC and HT type (nodular or diffuse). Most patients with PTC+HT were female and younger (<40 y old) than those with PTC only. The rate of occult tumor in patients with PTC+HT was higher than that in patients with PTC alone. Data indicate the coexistence of PTC and HT and suggest that PTC may develop even in cases of diffuse HT. Total thyroidectomy is the surgical procedure of choice, especially in young, female patients with HT.

Potential benefit of oral calcium/vitamin D administration for prevention of symptomatic hypocalcemia after total thyroidectomy.

OBJECTIVE: To evaluate routine oral calcium and vitamin D administration for preventing symptoms of hypocalcemia after total thyroidectomy. SUBJECTS AND METHODS: A total of 487 consecutive patients were prospectively randomized into two groups in terms of routine oral calcium and vitamin D supplementation: In the control group (244 patients) the treatment was not routinely started after surgery, whereas the treated group (243 patients) received routine supplementation that started on postoperative day 1. RESULTS: Patients of treated group had only minor hypocalcemia symptoms, whereas 7 patients of control group experienced carpopedal spasm as a major symptom (p<0.001). None of the patients in the treated group required intravenous calcium administration. Average hospital stay of the treated group patients was significantly shorter than that of control group (p<0.001). CONCLUSIONS: Routine postoperative calcium and vitamin D supplementation therapy may be useful for the prevention of symptomatic hypocalcemia after total thyroidectomy and may allow for a safe and early discharge from the hospital.

Anaplastic thyroid carcinoma with long term survival after combined treatment: case report.

Anaplastic thyroid carcinoma (ATC) is associated with an almost uniformly rapid and lethal clinical course. ATC grows rapidly and invades surrounding tissues at an early stage. Despite surgery, chemotherapy and radiotherapy, few patients with ATC live more than 1 year follow-up diagnosis. The mean survival is reported to be only 7.2 months. Treatment of ATC is still controversial because of its rarity and advanced stage at the time of diagnosis. We report herein an unusual case of ATC, 35 year old woman. She is alive without evidence of recurrence more than 36 months after combined therapy.

Postoperative analgesic effects of lornoxicam after thyroidectomy: a placebo controlled randomized study.

The purpose of the present study was to determine the postoperative analgesic effects of lornoxicam and the reduction in tramadol consumption. Fourty patients of ASA class I-II, 18-70 years of age, undergoing thyroidectomy were assigned in a randomized manner into two groups: GroupL received 8 mg of lornoxicam i.v. at the end of the operation followed by 8 mg of lornoxicam b.i.d., i.v. for 24 hours postoperatively. GroupP received 4 ml of saline solution i.v. at the end of the operation and the same amount b.i.d., i.v. for 24 hours postoperatively. The requirements for supplemental analgesics were recorded at 0-6, 6-12 and 12-24 hour intervals. Postoperative pain scores were evaluated at 15th min. and 1, 2, 4, 6, 8, 12, 18 and 24th hours using Visual Analogue Scale (VAS). The time to first analgesic requirement was significantly longer in GroupL compared to GroupP (101.7 vs 37.9 min, p<0.001). Pain scores were significantly lower in GroupL compared to GroupP at 15th min, 1, 8 ,12 and 18th hours. Twenty four hour analgesic consumption was significantly lower in GroupL compared to GroupP (p<0.05). The amount of tramadol consumed in GroupL was 60% lower compared to GroupP (100 mg and 250 mg (mean), respectively). 100% of the patients in GroupL and 60 % of the patients in GroupP needed supplemental analgesics. The degree of satisfaction with postoperative pain management was excellent in 95 % of patients in GroupL and 25 % of patients in GroupP. Eighteen patients in GroupP and 9 patients in GroupL had nausea (p=0.002), and fifteen patients in GroupP and 8 patients in GroupL had vomiting (p=0.025). Lornoxicam decreased the opioid need, the incidence of nausea and vomiting and postoperative pain scores. Moreover, it was observed that the time needed for the first analgesic requirement was prolonged following thyroidectomies.

Microanatomy of milk ducts in the nipple.

The aim of this study was to determine number and diameter of milk ducts in the nipple and to investigate the possible influences of age, breast weight, and diameter of the nipple on the number of ducts. Two hundred and twenty-six carcinoma mastectomy specimens were weighed and the nipple diameters measured. The number of ducts was counted in histological cross sections. Mean diameter of the nipple and mean breast weight were 13.9 mm and 844.6 g, respectively. There was a small but statistically significant positive correlation between nipple diameter and number of milk ducts (rho = 0.158; p = 0.01), but no correlation with breast weight. The mean number of ducts in the nipple duct bundle was 17.5. This is significantly higher than the number of ducts reported to open on the nipple surface. This discrepancy could reflect duct branching within the nipple or the presence of some ducts which do not reach the nipple surface. Smaller breast ducts (diameter < 0.5 mm) represent nearly 50% of the nipple ducts and could be a challenge to the ductoscopy technology.

Primary hyperparathyroidism due to parathyroid adenoma.

OBJECTIVE: To evaluate the clinical characteristics and outcome of patients with parathyroid adenoma. METHODS: We diagnosed and operated 54 patients with primary hyperparathyroidism in the Faculty of Medicine, Gazi University, Turkey from January 2000 to December 2004. In this study, 52 (96.2%) of these patients who had parathyroid adenoma were retrospectively evaluated. RESULTS: There were 46 female, and 6 male patients with a median age of 54.5 years (range, 18-87 years) at diagnosis. Preoperative mean serum level of calcium was 11.09 +/- 0.9 mg/dL, while phosphorus was 2.3 +/- 0.5 mg/mL, and parathyroid hormone (PTH) was 338.99 +/- 416.43 pg/ml. Ultrasound imaging revealed parathyroid adenoma in 38 of the 52 patients (73%), while 27% of the patients were normal. In 29 (69%) of the 42 patients who had sestamibi scanning, results revealed parathyroid adenoma and in the others (31%), sestamibi scanning was normal. On the postoperative period, the mean serum calcium level was 9.2+/- 0.74 mg/dL (p=0.0001 compared to preoperative level), phosphorus was 2.7 +/- 0.39 mg/mL (p=0.07 compared to preoperative level), and PTH level was 41.01 +/- 43.03 pg/ml (p=0.0001 compared to preoperative level). All patients were cured after operation, as determined by normalization in serum calcium levels in the postoperative period. CONCLUSION: Parathyroid adenoma is the most common cause of primary hyperparathyroidism. Preoperative serum calcium and PTH levels are the most useful parameters for diagnosis. Preoperative screening methods and operative findings are not always correlated so the patients with high serum calcium and PTH should be planned for surgery, independent of radiological results. All patients were cured after operation, as determined by normalization in serum calcium levels in the postoperative period.

The effects of carbon dioxide pneumoperitoneum on tyrosine hydroxylase activity.

PURPOSE: The aim of this study is to investigate the effects of carbon dioxide (CO2) pneumoperitoneum on tyrosine hydroxylase (TH) activity and total protein (TP) levels. METHODS: Forty male Sprague-Dawley rats were randomized into 10 groups, each consisting of 10 rats. Groups 1 and 2 consisted of anesthesia and sham-operated control rats, respectively. In the study groups, 10 mm Hg (group 3) and 15 mm Hg (group 4) pneumoperitoneum with CO2 were accomplished. At the end of the procedures, the brains and adrenals were removed quickly, and the hypothalamus and adrenal medulla separated, weighed, and homogenized. TH activity and TP levels were determined. RESULTS: The adrenal medulla TP and TH activity levels were decreased consistently and this decrease was significant in the sham and pneumoperitoneum groups compared with the control group (P<0.05). The adrenal medulla TP and TH activity levels were reduced significantly in group 4, as compared with the other groups (P<0.05). Elevation of hypothalamic TH activity in group 4 was significantly higher than in the other groups (P<0.05). CONCLUSIONS: These results indicate that CO2 pneumoperitoneum applied with 10 and 15 mm Hg pressure gradually decreases the adrenal medulla TH activity; TH is an indispensable enzyme for the biosynthesis of catecholamines. CO2 pneumoperitoneum with 15 mm Hg pressure significantly elevated hypothalamus TH activity.