Effectiveness of subtotal parathyroidectomy for secondary hyperparathyroidism: Results from a single center

2007-06-01

Purpose: The aim of this study was to evaluate the efficacy of subtotal parathyroidectomy performed in end stage renal disease patients for secondary hyperparathyroidism in our center.

Magnetic resonance staging in rectal cancer patients before total mesorectal excision: Efficacy of MR imaging with body coil, small FOV and thin section parameters

2007-06-01

Purpose: To evaluate the efficacy of thin slice and small FOV MRI technique using body coil, performed after distending the rectum with saline solution in the preoperative staging of rectum cancer. Materials and Methods: MR imaging of 36 patients with rectum cancer was done by distending the rectum with saline solution, using body coil, with thin slices and small FOV parameters. MR staging was done according to the TNM system by consensus of two radiologists using the MR findings of local tumoral invasion, distance to the mesorectal fascia and involvement of local and distant lymph nodes. 12 patients who weren't operated were excluded from the study. 24 patients (13 men, 11 women) who underwent operation with total mesorectal excision technique were included in the study. Histopathologic staging of 24 patients were T1,2 and 3 in 2, 10 and 12; and N0,1 and 2 in 13, 7 and 4 patients, respectively. Comparing MR staging results with the histologic staging, sensitivity, specificity, accuracy and predictive values of the MR technique were determined. Results: The accuracy of the MRI for determining the T and N stages was 70.8% (17/24) and 58.3% (14/24), respectively. In T staging, accuracy of MR for stages T1, 2 and 3 were 100% (2/2), 70% (7/10) and 66.7 % (8/12), respectively. For stages N0, 1 and 2, accuracy of MR was 53.7% (7/13), 85.7% (6/7) and 25% (1/4), respectively. In determining the T stage, overstaging and understaging rates were 12.5% (3/24) and 16.7% (4/24), respectively. For lymph node involvement sensitivity, specificity, positive predictive value (PPV) and the negative predictive value (NPV) were 90.9% (10/11), 53.8% (7/13), 62.5% (10/16) and 87.5% (7/8), respectively. For determination of tumor deposits accuracy, sensitivity, specificity and NPV were 83.3% (20/24), 20% (1/5), 100% (19/19) and 82.6% (19/23), respectively. Accuracy for the distance to the mesorectal fascia in T3 tumors was 75% (6/8). Accuracy of circumferential resection margin was 66.7% (4/6) and 100% (2/2) in patients with a positive and negative margin, respectively. Conclusion: The small FOV and thin section MR technique using body coil was efficient in staging of rectal cancers. To provide rectal distension with saline was useful for distinguishing stage T2 and T3 tumors.

Comparison of surgical outcome of rectopexy with and without sigmoid resection for full-thickness rectal prolapse

2007-06-01

Purpose: This study was undertaken to evaluate the necessity of sigmoid resection for rectal prolapse. Materials and Methods: Between January 2000 and January 2007, a total of 31 patients underwent rectopexy with and without sigmoid resection for rectal prolapse. The data were retropectively collected for the age, sex, previous abdominal surgery, morbidity, concomitant disease, recurrence, duration of operation, and length of hospital stay. Results: Rectopexy was performed in 18 patients (Group I), and sigmoid resection plus rectopexy was performed in 13 patients (Group II). The mean age of the patients was 57 (range,34-76) years and 74% were woman. Atelectasis and wound infections were the most frequent morbidities. The medical and surgical complication rates were not significantly different between the rectopexy and rectopexy with resection groups (P = 1.00 and P= 0.09). Although operation time was significantly different (P=0.01), length of hospital stay was not significantly different (P=0.34) among the groups. There were no recurrence or mortality. Conclusion: Although the number of patients is small and this feature restricts the study, our experience indicates that rectopexy with and without sigmoid resection were safe, and effective for the treatment of rectal prolapse. Sigmoid resection did not increase morbidity. It is well suited to patients with a long redundant sigmoid and history of constipation.

Changing trends in thyroid cancer: From 1995 to 2006

�zer Makay, Tayfun Yolda�, G�khan ��z, Mahir Aky�ld�z, Enis Yetkin — 2007-06-01

Purpose: In this study, we aimed to investigate the changing pattern in thyroid cancer histology and cancer stage. Materials and Methods: A total of 321 thyroid cancer patients who admitted to our institute between December 1995 and December 2005 were retrospectively analyzed in 2 different time intervals (Period I = 174 patients, December 1995 - December 2001 and Period II = 147 patients, January 2002 - December 2005). Results: The incidence of cancer increased significantly between both groups (11.6% vs. 20.7% and p<0.05). Papillary cancer incidence increased from 73.8% to 84.6% (p>0.05), while follicular cancer decreased from 16% to 2.7% (p<0.05). Nevertheless, according to DeGroot's prognostic index, rate of patients in Class 1 and 2 increased (p>0.05), while it decreased in Class 3 (p<0.05). Conclusion: This study reveals a change in thyroid cancer. Whether iodine substitution has a major impact on it has to be studied by determining the sufficiency of iodine prophylaxis and measuring urine iodine excretion of the population.

A case of tetanus mimicking acute abdomen

B�lent G�ng�r, Oktay Karak�se, Koray Topg�l — 2007-06-01

Acute abdomen presenting with generalized abdominal rigidity is usually considered as a surgical emergency. Tetanus infection may also cause abdominal rigidity as in an acute abdomen. Latency of sign and symptoms of tetanus and/or the unawareness of the physician may lead to an unnecessary laparotomy. The nonimmunized middle aged and elderly people of lower socioeconomical status especially in the rural areas are at higher risk of tetanus. In this report a 57 years old patient who was admitted to the emergency unit with dispnea, abdominal pain and operated upon with the finding of abdominal rigidity is presented. Postoperative extubation of the patient could not be achieved and the patient was referred to an intensive care unit for respiratory support with the eventual diagnosis of tetanus. Despite all efforts the patient expired on the thirteenth day postoperatively. Tetanus should be kept in mind in the gamut of causes when a dignosis of “acute abdomen” is entertained especially in the above mentioned risk groups.

Blind subcutaneous jejunal loop for interventional procedures in recurrent benign biliary stricture

Taner Oru�, Erkan Oymaci, G�rel Ne��ar, Fuat Atalay — 2007-06-01

Most of the benign biliary strictures (BBS) occurs as a result of iatrogenic injury of bile ducts during laparoscopic or open cholecystectomies and can effectively be treated surgically by restoring the bilioenteric continuity. However ; recurrent stenosis, stasis, cholangitis and intrahepatic cholelithiasis continue to be a problem with those patients. Creating a permanent access enables endoscopic and radiological interventions in cases with post operative recurrent benign biliary sticture . We present a 36 year old man who developed reccurrent BBS due to biliary injury during cholecystectomy. He was operated twice previously in different centers . The third operation was performed in our department with an Roux en Y Hepaticojejunostomy. Besides we created a blind, subcutaneously located, isolated isoperistaltic jejunal loop to perform percutaneous and endoscopic therapeutic procedures for the treatment of the recurrent stenosis and obstruction. During the follow up period we used permanent access route four times to open and to enlarge the hepaticojejunostomy side. Now the patient has secondery biliary chirosis and is on the waiting list for liver transplantation and under the control of outpatient clinic.

Cholecystoduodenal fistulae: Report of three cases

Osman Y�ksel, �mer �akrak, Ertan Tatl�c�o�lu, Tolga �ahin, Hasan Bostanc� — 2007-06-01

Cholecystoduodenal fistulae is a rare clinical entity resulting from the inflammation of the gallbladder. Preoperative diagnosis of this clinical entity is difficult due to the obscure clinical picture and is frequently established intraoperatively. Since preoperative diagnosis of the clinical entity is hard during planning the surgical treatment, one should consider all its aspects including malignancy. In this report we present three distinct cases with cholecystoduodenal fistulae that were diagnosed intraoperatively. We aimed to discuss the diagnostic approach and the treatment modalities available in the guidance of the current literature.

Development of Surgery in Turkey: comparison to Western World

Orhan Bumin — 2007-06-01

Laparoscopic cardiomyotomy and Dor's fundoplication for the treatment of achalasia: at least two-year follow-up

Tayfun Karahasano�lu, �smail Hamzao�lu, Bilgi Baca, Ahmet Dobrucal� — 2007-06-01

Turkish Journal of Surgery - 2007; 23(2)

Effectiveness of subtotal parathyroidectomy for secondary hyperparathyroidism: Results from a single center

Magnetic resonance staging in rectal cancer patients before total mesorectal excision: Efficacy of MR imaging with body coil, small FOV and thin section parameters

Comparison of surgical outcome of rectopexy with and without sigmoid resection for full-thickness rectal prolapse

Changing trends in thyroid cancer: From 1995 to 2006

A case of tetanus mimicking acute abdomen

Blind subcutaneous jejunal loop for interventional procedures in recurrent benign biliary stricture

Cholecystoduodenal fistulae: Report of three cases

Development of Surgery in Turkey: comparison to Western World

Laparoscopic cardiomyotomy and Dor's fundoplication for the treatment of achalasia: at least two-year follow-up