Pericardial Type 1 Parathyromatosis: A very rare cause of primary hyperparathyroidism.

BACKGROUND: Parathyromatosis is a rare clinical condition where hyperfunctioning parathyroid tissue is scattered in the neck and the mediastinum. It is difficult to diagnose and manage due to recurrent or persistent hyperparathyroidism. CASE REPORT: We present a peculiar case of hyperparathyroidism as the parathyroid tissue was in unusual location. Scintigraphy done revealed a lesion suspicious for ectopic parathyroid tissue in the retrosternum in a 58 years old female patient with primary hyperparathyroidism. No pathologic lesions were found on neck exploration, subsequently, sternotomy was performed and suspicious lesion removed but microscopic evaluation of the frozen section found no parathyroid tissue in the resected specimen. A decision to perform thymectomy and total resection of pericardial fatty tissue was made. Final histopathology revealed parathyromatosis and confirmed the first case of pericardial type 1 parathyromatosis. CONCLUSION: Long-term remission is rare in these patients, sometimes needing medical treatment and multiple surgeries. In this patient, there was no recurrence during the four years follow-up. In patients with no history of neck surgery, primary parathyromatosis should be considered in the differential diagnosis of hyperparathyroidism.

Lateral sided trocar site hernia following laparoscopic hernia repair: results of a long-term follow-up.

PURPOSE: Trocar site hernias (TSH) at the umbilical site following laparoscopic cholecystectomy forms the majority of the studies about TSH and there is a missing data in literature about lateral sided TSH. We aimed to evaluate the incidence and factors affecting lateral sided TSH occurrence following laparoscopic abdominal wall hernia repair (LAHR). METHODS: Patients who underwent LAHR between March 2013 and 2015 were included in the study. Open approach with blunt dissection for optical trocar insertion and z-shaped suture for closure were used in 22 cases initially (Group 1). Sharp dissection and continuous suture for closure were used for the rest of the patients (Group 2). RESULTS: 285 patients-237 females (83.2%) and 48 males (16.8%)-with a mean age of 50.14 ± 12.03 were included in the study. Most of the patients were overweight or obese and mean BMI was 29.25 ± 5.04 kg/m2. BMI was significantly higher in patients with TSH (p:0.025) and TSH occurrence is significantly higher in Group 1 patients (p < 0.001). CONCLUSIONS: Trocar insertion and closure technique have a major role in lateral sided TSH occurrence. Trying to avoid blunt dissection during trocar insertion, closure of trocar site with continuous suture and enlargement of skin incision to provide good view decreases lateral sided TSH occurrence. In addition, increase at the level of BMI has increased the probability of TSH occurrence and further studies are needed to evaluate efficiency of prophylactic prosthetic closure for obese patients.

Anal melanoma: Outcomes of current surgical approaches.

AIM: In this study, we aimed to evaluate the clinical characteristics and outcomes of the patients with anal melanoma (AM), who underwent surgical treatment. MATERIALS AND METHODS: This study was conducted in Kartal Training and Research Hospital between January 2010 and December 2017. All patients, who underwent surgical resection with a diagnosis of AM, were enrolled. RESULTS: A total of 10 patients were examined, 8 of them were females, and their average age was 69.2 years (range, 47-85 years). Abdominoperineal resection (APR) was performed in five (50%) patients, and local excision (LE) was performed in other five (50%) patients. Three patients (30%) had stage I disease, two (20%) had stage II disease, and five (50%) had stage III disease. All five patients in APR group had stage III disease. In the comparison of the survival period after surgery, the mean survival period of the APR group was 6.2 months (range, 1-16 months) while that of the LE group was 19.6 months (range, 7-43 months). CONCLUSION: LE with adjuvant radiation seems to offer good locoregional control without reducing the survival and may be an option of treatment for patients with small, superficial AM. However, APR should be offered for patients with locally advanced disease or as a salvage following recurrence.

Effect of pH in an Aqueous Medium on the Surface Area, Pore Size Distribution, Density, and Porosity of Montmorillonite.

Surface area, pore volume distribution, and porosity of montmorillonite are determined after being exposed to aqueous solutions with various pH values. For measurement, after each pH treatment the clay samples were freeze-dried in order to keep the structure of the clay same as that in the aqueous solution. Surface area and pore size distribution measurements were performed on an unmodified and four pH (2.5, 4.0, 5.5, 9.0)-adjusted clay samples using N(2) and CO(2) as adsorbates. The surface area measurements at lower pH are lower than those measured at higher pH due to the replacement of Na(+) ions from interlayers at lower pH which may be followed by the reduction of repulsive forces. As the pH of the montmorillonite increases to 9.0, the surface area increases almost seven times compared to that at pH 2.5. Pore size distribution was determined by CO(2) adsorption at 273 K for micropores (<20 Å), by N(2) adsorption at 77 K for mesopores (between 20 and 500 Å), and by using both Hg intrusion and N(2) adsorption for macropores (>500 Å). Since N(2) molecules undergo a molecular sieving at 77 K, CO(2) gas at 273 K was used to measure the micropore surface area and gave higher surface area measurements than those measured by N(2). Surface area values measured by CO(2) adsorption ranged between 30 and 200 m(2)/g for montmorillonite while those measured by N(2) adsorption were 13.7-70 m(2)/g in the pH range studied. Copyright 1999 Academic Press.