Total Tiroidektomi Yapılan Hastalarda Post Operatif Komplikasyonların Yaş Gruplarına Göre Karşılaştırılması

Purpose: The incidence of autoimmune hypothyroidism increases with age, and anaplasticthyroid cancers are seen more frequently. Surgical procedures may be risky due to potentialcomorbidities in advanced age. Our study was intended to evaluate the reliability of totalthyroidectomy due to benign thyroid diseases in patients aged 50 and over.Material and method: Following approval from the Karadeniz Technical University Facultyof Medicine Ethical Committee, 150 patients aged between 20 and 80 on whom totalthyroidectomy was performed due to benign thyroid diseases between August 2008 and August2009 were prospectively enrolled. Patients were divided in two groups; age under 50 (Group 1)and age 50 and above (Group 2). The reliability of total thyroidectomy surgery in patients agedover 50 was investigated by analyzing the difference between the two groups in terms ofcomplications arising.Results: Seventy-six of the patients included in the study were aged under 50 (Group 1), and74 were aged over 50 (Group 2). Patients’ demographic characteristics are given in Table 1. Interms of complications, wound site infection was determined in 1 of the 76 patients in Group1, permanent hypocalcemia in 3, unilateral permanent RLN injury in Group 1. Wound siteinfection was determined in 1 of the 74 patients in Group 2, permanent hypocalcemia in 5 andunilateral permanent RLN injury in 1. V.A.S. (Visual Analog Scale) scoring was made inevaluation of the operation scar of the patients and the mean V.A.S. score was 10.11. In Group1 the mean value was 9,36 and in Group 2 the score was 10.88.Conclusion: Thyroid cancer being endemic in the Eastern Black Sea region of Turkey andhyperthyroid-associated clinical findings being manageable has led to surgeons performing totalthyroidectomy more frequently. Our study revealed that with the exception of wound healing,total thyroidectomy was similar in young and older patients in terms of morbidity and length ofhospitalization. We consider that total thyroidectomy can also be performed safely in the elderlywhen indicatedAmaç: Yaşın ilerlemesiyle birlikte otoimmün hipotiroidizm sıklığı artmakta, anaplastik tiroidkanserleri daha sık görülmektedir. İleri yaşta eşlik edebilecek komorbiditeler olması nedeniylecerrahi prosedürler riskli olabilmektedir. Çalışmamızda benign tiroid hastalıkları nedeniyle totaltiroidektomi uygulanan 50 yaş üzeri hastalarda total tiroidektominin güvenilirliğinindeğerlendirilmesi amaçlandı.Materyal ve Metot: Karadeniz Teknik Üniversitesi Tıp Fakültesi etik kurulundan onayalındıktan sonra, Ağustos 2008 - Ağustos 2009 tarihleri arasında benign tiroid hastalıklarınedeniyle total tiroidektomi yapılan 20 ile 80 yaş arasındaki 150 hasta prospektif olarakçalışmamıza dahil edildi. Hastalar 50 yaş altı (Grup 1) ve 50 yaş üstü (Grup 2) olarak iki grubaayrıldı. İki grup arasında gelişen komplikasyonlar açısından farklılık istatistiksel olarakdeğerlendirilerek, 50 yaş üzeri hastalarda uygulanan total tiroidektomi ameliyatının güvenliğiaraştırıldı.Bulgular: Çalışmamıza dahil edilen 150 hastanın 76'sı 50 yaş altı (Grup 1), 74'ü 50 yaş üstüydü(Grup 2). Hastaların demografik özellikleri Tablo 1'de verilmiştir. Komplikasyonlar açısındandeğerlendirildiğinde Grup 1'deki 76 hastanın 1' inde yara yeri enfeksiyonu, 3'ünde kalıcıhipokalsemi, 1'inde tek taraflı kalıcı RLS hasarı saptandı. Grup 2'deki 74 hastanın 1’ inde yarayeri enfeksiyonu, 5'inde kalıcı hipokalsemi, 1'inde tek taraflı kalıcı RLS hasarı saptandı.V.A.S.(visuel analog skala) skorlamasında yara yerinin tüm hasta grubunda V.A.S. skoruortalaması 10,11’ di. Grup 1’ de V.A.S. skoru ortalama değeri 9,36 iken Grup 2’ de 10,88’ di.Sonuç: Doğu Karadeniz'de tiroid kanserinin endemik olarakgörülmesi ve hipertirioidiye bağlı klinik bulguların kontroledilebilmesi, cerrahların total tiroidektomiyi daha sıkuygulamasına neden olmuştur. Çalışmamızda total tiroidektomininhem genç hemde yaşlı hastalar için yara iyileşmesi dışındamorbidite ve hastanede yatış süresi açısından benzer olduğugösterild

A study on 107 patients with acute mesenteric ischemia over 30 years

AbstractAcute mesenteric ischemia (AMI) is a life threatening cause of acute abdomen. The purpose of this study is to define risk factors that predict the adverse outcome of AMI and to present our experience in the last 30 years. Hospital records and clinical data of 107 patients undergoing surgical intervention for AMI during the last 30 year period were reviewed and clinical outcomes as well as factors influencing mortality were analyzed. Mesenteric arterial thrombosis, arterial embolism and nonocclusive mesenteric ischemia (NOMI) were the cause of AMI in 68 (63.6%), 28 (26%), and 11 patients (10.2%), respectively. Abdominal pain was the most common presenting symptom (90.6%). Peritonitis was observed in 96 patients (89.7%) and 24 patients (22.4%) were in shock. Abdominal ultrasonography was performed in 46 patients (42%), abdominal CT angiography in 36 patients (33%) and mesenteric angiography in 12 patients (10.5%). All patients were operated and 11 (10%) patients underwent a second-look operation. Bowel resection was necessary in 101 patients (93.4%) during the initial operation and in seven patients (6.5%) during the second-look operation. The hospital mortality was 55.1%. Mortality was mainly due to multiorgan failure (43%). Diabetes mellitus, use of digoxine and antiplatelet drugs, duration of the symptoms until before surgery, existence of shock, low levels of the pH and bicarbonate and re-laparotomy were found to be negative predictors of the perioperative mortality. The use of total parenteral nutrition and CT angiography was found to be a protective factor against mortality. A high index of suspicion with prompt diagnostic evaluation with CT angiography may reduce time prior to surgical intervention which may lead to improved patient survival

A giant retroperitoneal hemangiopericytoma: Case report

Hemangioperisitoma, kapiller perisitlerden köken alan, genellikle agresif seyreden, nüks-metastaz yapmaya meyilli ve nadir görülen bir yumuşak doku tümörüdür. Tümörün 5cm’den büyük olması, artmış mitotik aktivite, yüksek sellülarite, immatür veya pleomorfik tümör hücreleri, kanama ve nekroz odaklarının gözlenmesi malignitenin göstergeleridir. Temel tedavisi radikal cerrahidir. Bu olguda dev retroperitoneal hemanjioperisitoma nedeniyle opere edilen 48 yaşındaki erkek hastayı sunmayı amaçladık.Hemangiopericytoma is a rare soft tissue sarcom that originates capillary pericyte and usually shows agressive prognosis and tendency to metastasis or recurrence. It is reported that a malignant course is asssociated with a large tumor (greater than 5 cm), an increased mitotic rate, high cellularity, immature and pleomorphic tumor cells and foci of hemorrhage and necrosis. Basic therapy is radical surgery. In this case we aim to present a 48 year old man who operated for giant retroperitoneal hemangioperyctoma

Low Density Granulocytes and Dysregulated Neutrophils Driving Autoinflammatory Manifestations in NEMO Deficiency

NF-kappa B essential modulator (NEMO, IKK-gamma) deficiency is a rare combined immunodeficiency caused by mutations in the IKBKG gene. Conventionally, patients are afflicted with life threatening recurrent microbial infections. Paradoxically, the spectrum of clinical manifestations includes severe inflammatory disorders. The mechanisms leading to autoinflammation in NEMO deficiency are currently unknown. Herein, we sought to investigate the underlying mechanisms of clinical autoinflammatory manifestations in a 12-years old male NEMO deficiency (EDA-ID, OMIM #300,291) patient by comparing the immune profile of the patient before and after hematopoietic stem cell transplantation (HSCT). Response to NF-kB activators were measured by cytokine ELISA. Neutrophil and low-density granulocyte (LDG) populations were analyzed by flow cytometry. Peripheral blood mononuclear cells (PBMC) transcriptome before and after HSCT and transcriptome of sorted normal-density neutrophils and LDGs were determined using the NanoString nCounter gene expression panels. ISG15 expression and protein ISGylation was based on Immunoblotting. Consistent with the immune deficiency, PBMCs of the patient were unresponsive to toll-like and T cell receptor-activators. Paradoxically, LDGs comprised 35% of patient PBMCs and elevated expression of genes such as MMP9, LTF, and LCN2 in the granulocytic lineage, high levels of IP-10 in the patient's plasma, spontaneous ISG15 expression and protein ISGylation indicative of a spontaneous type I interferon (IFN) signature were observed, all of which normalized after HSCT. Collectively, our results suggest that type I IFN signature observed in the patient, dysregulated LDGs and spontaneously activated neutrophils, potentially contribute to tissue damage in NEMO deficiency