Prognostic factors of survival and recurrence pattern in differentiated thyroid cancer: a retrospective study from Western Turkey.

OBJECTIVES: The aim of this study was to determine prognostic factors in patients with well-differentiated thyroid cancer (WDTC). METHODS: This retrospective study included 181 well-differentiated thyroid cancer patients who were operated between Decembers 1996-2007. Total of 181 patients [139 (76.8%) women and 42 (23.2%) men with a mean age of 46.3 years] who were subjected to a complete follow-up, were enrolled in the study. The mean follow-up period was 7.1 years (range 3.1 to 14.9 years). Medical records were reviewed regarding to age, gender, extent of surgery, tumor size, multifocality, clinical stage, capsule infiltration, extracapsular invasion, histological type, lymph node metastasis, distant metastasis, radioactive iodine treatment and prognosis. RESULTS: During follow-up, in 41 (22.6%) patients locoregional recurrences were detected and 5 (2.7%) patients passed away. Determined statistically significant prognostic factors were as follows; tumor size (histopathologically), extent of surgery, histological type, lymph node metastasis, tumor invasion (capsule and extracapsular) and clinical stage. CONCLUSIONS: Well-differentiated thyroid cancer is a disease with good prognosis when detected early and appropriate treatment applied. Despite the prognosis, it is good to apply the right treatment and reduce recurrence and mortality rates, prognostic factors are well known and must be considered in patient management.

The role of allopurinol on oxidative stress in experimental hyperthyroidism.

AIM: During hyperthyroidism, production of free oxygen radicals derives, where xanthine oxidase may also play an important role. Allopurinol, a xanthine oxidase inhibitor, has a significant effect on thyrotoxicosis-related oxidative stress. However, the relationship between thyroid hormones, oxidative stress parameters and allopurinol remains to be explored. METHODS: Forty-two Wistar albino rats were divided into three groups. Rats in group A served as negative controls, while group B had untreated thyrotoxicosis and group C received allopurinol. Hyperthyroidism was induced by daily 0.2 mg/kg L-thyroxine intraperitoneally in groups B and C; 40 mg/kg allopurinol were given daily intraperitoneally. Efficacy of the treatment was assessed after 72 h and 21 days, by measuring serum xanthine oxidase (XO), malondialdehyde (MDA), glutathione (GSH), glutathione reductase (GR), glutathione peroxidase (GPx) and nitric oxide derivates (NO*x). RESULTS: In both time periods, serum XO, MDA, GSH and NO*x levels were significantly increased after thyroid hormone induction (p<0.05). Levels of XO, MDA and NO*x decreased with allopurinol treatment (p<0.05). There was a remarkable decrease in triiodothyronine levels in group C after 72 h (p<0.05), and in both triiodothyronine and thyroxine levels in group C after 21 days (p<0.05). There was no difference between groups B and C in means of serum GSH, GR and GPx levels (p>0.05). CONCLUSIONS: This study suggests an association between allopurinol and the biosynthesis of thyroid hormones. Allopurinol prevents the hyperthyroid state, which is mediated predominantly by triiodothyronine and not by XO. This issue has to be questioned in further studies where allopurinol is administered in control subjects.

Completion thyroidectomy for thyroid cancer.

BACKGROUND: Whether thyroid re-operations are associated with an increased complication risk is controversial. The aim of this study was to perform a retrospective analysis of patients undergoing re-operative surgery of the thyroid. We analyzed the safety and the impact of delay on complications before undertaking radicalization thyroidectomy. MATERIAL AND METHODS: From January 1996 to July 2002, 150 consecutive patients with thyroid cancer were treated in our institution. A total of 62 patients underwent completion thyroidectomy. Twenty-seven had undergone their initial operation in our centre. Medical and pathologic data were obtained retropectively. RESULTS: Pathological examination of the specimen after completion surgery revealed malignancy in a total of 35% of 62 patients. The time interval between initial surgery and completion thyroidectomy ranged from 5 days to 24 months (mean 3.1 months). Complications after re-operation were transient recurrent nerve injury in 1.6%, transient hypoparathyroidism in 4.8%, permanent hypoparathyroidism in 1.6% and chylous discharge in 1.6% of the patients. There was no significant difference between complication rates in patients operated on within 90 days or those operated on after this period (p > 0.05). CONCLUSIONS: This study suggests that completion thyroidectomy is safe in the hands of experienced endocrine surgeons and the timing of re-operation has no impact on the development of complications.

Is testicular perfusion influenced during laparoscopic inguinal hernia surgery?

BACKGROUND: The influence of laparoscopic inguinal hernia surgery is still unclear. The aim of this study was to compare the possible early effects of laparoscopic and open inguinal hernia repair on testicular perfusion. METHODS: In this prospective trial, 44 patients underwent mesh repair of a primary inguinal hernia assigned to one of two procedures: open anterior mesh repair (n = 29) or a laparoscopic totally extraperitoneal approach (n = 15). Doppler ultrasound was used to determine the hemodynamic characteristics of the testicular blood flow. RESULTS: No statistically significant differences were found between the two groups in terms of Doppler flow parameters for the preoperative, very early (day 1), and early postoperative (day 7) periods. When Doppler flow parameters of the testicular artery were compared in the conventional group, statistically significant differences were found between preoperative and very early postoperative values (p < 0.05). Meanwhile, comparison among flow parameters of the testicular, capsular, and intratesticular arteries of the laparoscopic group showed statistically significant differences between preoperative and very early postoperative and between preoperative and early postoperative values (p < 0.05). There were no statistically differences in postoperative complications between the two groups. CONCLUSION: Testicular blood flow is influenced during laparoscopic inguinal hernia surgery. Whether changes in flow parameters remain in the late postoperative period, and whether they have an impact on complications will be evaluated in further studies.

Variations of hepatic veins: helical computerized tomography experience in 100 consecutive living liver donors with emphasis on right lobe.

Anatomical variations in the venous system of liver are not a rarity. A prospective helical computerized tomography (CT) study was undertaken to determine the prevalence of surgically significant hepatic venous anatomic variations among 100 consecutive living liver donors. The studies evaluated the ramification pattern of hepatic veins, the presence of accessory hepatic veins, and of segment 5 or 8 veins (or both) draining into middle hepatic vein. These data obtained by CT influenced surgical planning. Sixty-four donors donated their right lobes and 24 donors, left lateral segments. Only one donor candidate was refused due to combined hepatic and portal venous variations accompanied by multiple bile ducts. Eleven donors were also refused due to reasons other than anatomical variations. Seventeen segment 5 and 17 segment 8 veins draining into middle hepatic vein were anastomosed to inferior vena cava in 23 (36%) of the right lobe liver transplantations. The middle hepatic vein was harvested in only one of the donors. Among the 100 cases, 47 had accessory right inferior hepatic veins, 13 of which were multiple. Twenty-two of the right lobe grafts required surgical anastomoses of these accessory hepatic veins (34%). An isolated hepatic vein anomaly or the presence of accessory hepatic veins are not contraindications to be a living liver donor candidate. However, preoperative knowledge of vascular variations alters surgical management. Helical CT is a valuable tool to delineate the hepatic venous anatomy for surgical planning in living liver donors.

Perforation of the stomach due to chest tube complication in a patient with iatrogenic diaphragmatic rupture.

Diagnosis of diaphragmatic injury is difficult. A case of iatrogenic diaphragmatic rupture is reported in which perforation of a herniated stomach occurred following left lobectomy and partial resection of the diaphragm for lung cancer. On the second postoperative day, bile-stained fluid coming out from the chest tube revealed gastrointestinal leakage. This rare complication of chest tube insertion, early diagnosis and treatment are emphasized.

Roux-en-Y bleeding after living donor liver transplantation: a novel technique for surgical treatment.

Upper gastrointestinal bleeding (GIB) is one of the most common gastroenterologic complications following liver transplantation. The aim of this study is to define the prevalence of GIB due to Roux- en Y (R-Y) enteral anastomoses after living donor liver transplantation (LDLT) and recommend an anastomotic technique for easy surgical intervention. Ninety-five patients underwent 96 LDLT from June 1999 through January 2003. R-Y biliary reconstruction was employed in 43 patients. Anastomoses were end-to-side (ES) in the first 25 patients and side-to-side (SS) type in the last 18 patients. GIB occurred in 13 patients (30%). The R-Y anastomotic line was shown to be the bleeding site in 10 patients. Anastomoses were in ES fashion in 7 of 10 patients (70%). In other words 28% of ES and 17% of SS anastomoses displayed a bleeding episode after LDLT. Four patients required surgical intervention (Three ES, one SS), namely an operative rate of 9%. The type of the jejunojejunostomy, the UNOS or Child-Pugh scores, the presence of preexisting portal hypertension, the duration of portal vein clamping, the GRWR of patients, revealed no statistical significant difference between bleeding and non- bleeding patients. Although statistical analyses did not reveal any significant difference (P =.47), GIB was higher among patients with an ES type of anastomoses. As a result we recommend a jejunojejunostomy in SS fashion on the antimesenteric borders of the jejunal segments with a 3-4 cm blind intestinal segment. The surgical procedure for R-Y bleeding may then be performed without disrupting the jejunojejunostomy.

Effect of polyethylene glycol 4000 on adhesion formation following thyroid surgery in rats.

BACKGROUND & OBJECTIVES: Difficulties in dissection encountered during reoperative thyroid surgery could be minimised by preventing formation of adhesions in the operative field. We studied the prevention of adhesion formation in rats after thyroid surgery by using polyethylene glycol 4000 (PEG 4000). METHODS: Twenty two rats in two equal groups were studied. Right hemithyroidectomy was performed in both groups with 0.9 per cent saline being instilled in the operative field in the control group and PEG 4000 solution in the study group. After 10 days, all rats were re-explored and the remaining thyroid tissue of the right lobe was excised. The specimens were scored according to the thickness of the connective tissue over the remainder of the thyroid gland. RESULTS: The connective tissue thickness over the remaining tissue of the thyroid gland in the control and study groups was 272.04 +/- 77.10 and 172.90 +/- 48.92 microns respectively. The decrease of the connective tissue thickness over the remainder of thyroid gland in the study group was significant (P < 0.05). INTERPRETATION & CONCLUSION: In this animal model although application of PEG 4000 did not completely prevent adhesion formation, a significantly decreased amount of adhesions was found.

Ulex Europeus Agglutinin (UEA-I) lectin binding in breast carcinoma and its relationship to prognostic factors.

In this study, lectin binding was compared with pathological prognostic factors and clinical follow-up details. Formalin-fixed, paraffin-embedded tissues from 43 cases of breast carcinoma were studied for binding with Ulex Europeus Agglutinin (UEA-I) lectin. Staining results were compared with tumor size, histologic and nuclear grade, lymph node status (number, capsular and pericapsular invasion), blood and lymphatic vessel invasion, ER and PR status, clinical stage and the patients' short-term follow-up details. Analysis of staining with UEA-I showed a significant relationship with blood vessel invasion (P < 0.01) and lymphatic vessel invasion (P < 0.05). Furthermore, PR showed a significant inverse correlation with lectin binding (P < 0.05). Staining with UEA-I related significantly with axilliary lymph node metastases (P < 0.05). UEA-I was positive in four (66.6%) out of six cases with distant organ mestastasis. This study confirms that, in breast cancer, lectin binding to the cancer cells can be a reliable indicator for axilliary metastases, and the need for additional therapeutic interventions.