Purpose: One of the most common and significant complications following thyroid surgery is postoperative hypocalcemia due to postoperative hypoparathyroidism. This study aimed to observe the effect of parathyroid gland autotransplantation on postoperative hypocalcemia in cases of incidental parathyroidectomy in total thyroidectomy cases. Methods: Patients who underwent bilateral total thyroidectomy surgery were retrospectively analyzed. Patients in the study population were divided into group A (no incidental parathyroidectomy), group B (incidental parathyroidectomy with no autotransplantation), and group C (incidental parathyroidectomy with autotransplantation). The patients' calcium levels on day 1, transient and permanent hypocalcemia times, time to return to normocalcemia, and surgery duration were examined. Results: A total of 647 patients meeting the research criteria were included in the study. Group A consisted of 443 patients (68.5%), group B consisted of 176 patients (27.2%), and group C consisted of 28 patients (4.3%). The rate of incidental parathyroidectomy in the entire patient population was 31.5% (n = 204). Transient and permanent hypocalcemia rates in the entire patient population were 27.7% (n = 178) and 0.6% (n = 4), respectively. It was observed that the frequency of day 1 hypocalcemia was higher in group B than in group C among incidental parathyroidectomy groups (P = 0.005). Furthermore, group B had a significantly higher frequency of transient hypocalcemia compared to group C (P = 0.006). There was no significant difference in terms of permanent hypocalcemia. Conclusion: This study showed that parathyroid gland autotransplantation reduces transient hypocalcemia in patients with 2 or fewer incidental parathyroids. [Ann Surg Treat Res 2025;108(1):64-70]

Objectives: To experimentally evaluate the effects of preoperative fasting duration on distant organ liver in renal ischaemia-reperfusion (IR) injury. Methods: This is an experimental study. In the study, 3 groups were formed. In Group A, abdominal laparotomy was carried out after 12 hours of preoperative fasting without any IR damage. In Group B, IR injury was carried out after 12 hours of preoperative fasting, and abdominal laparotomy was carried out, in Group C after 2 hours of fasting after IR injury. Apoptosis, congestion, balloon degeneration, nuclear pleomorphism, and leukocyte infiltration were examined histopathologically and tumor necrosis factor-alpha (TNF-α), interleukin (IL) -1 beta, IL-6, and IL-10 were evaluated biochemically. Results: A statistically significant difference was determined between the groups in respect of postoperative IL-10 levels (p=0.020) with significantly lower levels determined in Group C than in Groups A and B (p=0.021). Similar rates of mild nuclear polymorphism were seen with no statistically significant difference determined between the groups (p>0.167). A statistically significant difference was determined between the groups in respect of the congestion scores (p<0.001), with a lower score in Group C than in Groups A and B, where the scores were similar (p<0.001, p=0.017). Conclusion: With this result, it would be correct to say that the short preoperative fasting period has protective effects on the liver tissue.

BACKGROUND The sensitivity of cytological (CY) evaluation after fine-needle aspiration (FNA) for detecting medullary thyroid carcinoma (MTC) is a subject of controversy. The routine use of serum calcitonin (CT) in patients with thyroid nodules is not universally adopted. The authors conducted CT screening of FNA washout fluid (FNA-CT) to address the diagnostic challenges. The objective was to assess the contributions of serum CT, FNA cytology (FNA-CY), and FNA-CT to the diagnosis. METHODS Between February 2019 and June 2022 (group 1), the authors prospectively screened the CT of patients with thyroid nodules. Both FNA-CY and FNA-CT were performed for patients with persistently elevated CT values. The sensitivity of FNA-CY, serum CT, and FNA-CT for accurate diagnosis was evaluated. Additionally, the authors retrospectively examined data from patients with thyroid nodules before CT screening (2008-2019) (group 2). They compared the characteristics of MTC patients in groups 1 and 2. RESULTS MTC was identified in 30 patients (0.25%) in group 1 and 19 (0.07%) in group 2. A FNA-CT cutoff value of 4085.5 pg/mL detected MTC with a sensitivity of 96.8%, and a serum CT cutoff value of 28.3 pg/mL detected MTC with a sensitivity of 86.7%. In contrast, FNA-CY detected MTC with a sensitivity of 42.4%. In group 1, 18 patients (60%) with MTC were diagnosed with microcarcinoma, whereas only two patients (10.5%) in group 2 had microcarcinoma. CONCLUSIONS This study detected MTC earlier by routinely measuring serum CT in all patients with nodular thyroid disease and performing FNA-CT in those with elevated values. FNA-CT and serum CT sensitivities were significantly higher than those of FNA-CY. This study revealed different FNA-CT cutoff values compared to other studies, emphasizing the need for determining clinic-specific cutoff values.

OBJECTIVEThis study aimed to investigate the presence of indoleamine-2,3-dioxygenase and bacterial translocation after the administration of 3-aminobenzamide and infliximab in the TNBS model of rat colitis.METHODSThe study group was divided into five categories as follows: group 1: (control), group 2: colitis+saline, group 3: colitis+3-aminobenzamide, group 4: colitis+infliximab, and group 5: colitis+3-aminobenzamide+infliximab. Intestinal mesenteric cultures were incubated on specific agar media plates under aerobic and anaerobic conditions, bacterial translocation was evaluated and assessed as colony-forming units per gram of tissue. Colonic tissue samples were evaluated by Western blotting method to detect the presence of indoleamine-2,3-dioxygenase.RESULTSThe results obtained were as follows: group 1: normal gut flora; group 2: eight of nine samples had bacterial translocation, of which six of them had positive indoleamine-2,3-dioxygenase protein; group 3: five of nine samples had bacterial translocation, of which seven of them had positive indoleamine-2,3-dioxygenase; group 4: three of nine samples had bacterial translocation, of which seven of them had positive indoleamine-2,3-dioxygenase; and group 5: only one sample had exact indoleamine-2,3-dioxygenase protein.CONCLUSIONAltered expression of indoleamine-2,3-dioxygenase results in a lower bacterial translocation via infliximab compared with 3-aminobenzamide treatment. Combined treatments emphasized different approaches for the new molecules related to indoleamine-2,3-dioxygenase.

This study aimed to establish a strong regression model by revealing the preoperative predictive factors for sentinel lymph node (SLN) positivity in patients with early stage breast cancer (ESBC). In total, 445 patients who underwent SLN dissection for ESBC were included. All data that may be potential predictors of SLN positivity were retrospectively analyzed. Tumor size >2 cm, human epidermal growth factor receptor 2 (HER2) + status, lymphovascular invasion (LVI), palpable tumor, microcalcifications, multifocality or multicentricity, and axillary ultrasonographic findings were defined as independent predictors of SLN involvement. The area under the receiver operating characteristic (ROC) curve (AUC) values were 0.797, 0.808, and 0.870 for the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram, MD Anderson Cancer Center (MDACC) nomogram, and our regression model, respectively (P < .001). The recent model for predicting SLN status in ESBC was found to be stronger than existing nomograms. Parameters not included in current nomograms, such as palpable tumors, microcalcifications, and axillary ultrasonographic findings, are likely to make this model more meaningful.

Aim: The aim of the study is examining the factors determining the need for thoracic approaches to remove an intrathoracic goitre. Material and Method: This retrospective study was conducted between 2011 and 2018. Patients were categorized into two groups; Group A consisted of patients who underwent surgery via the transcervical approach, and Group B consisted of patients who underwent surgery via the transcervical plus thoracic approaches. The extension, size, and localization of the intrathoracic goitre was measured on computed tomography scans. Histopathological examination results were recorded. Results: Group A was consisted of 268 patients, Group B was consisted of 17 patients. There was statistically significant difference in terms of recurrence between groups. There were no statistically significant difference for length of goitre in computed tomography, volume and superoinferior size of the specimen between groups. There was a statistically significant correlation between the choice of thoracotomy and the localization of the intrathoracic goitre. There was a statistically significant correlation between the choise of thoracotomy and pathological subtypes. Conclusion: While dimentions of the goitre were not important in determining the necessity of thoracic approaches; recurrence, localization, and histopathological features were found to be determinants in removing an intrathoracic goitre.

AMAÇ: Primer hiperparatiroidizm (PHPT), dört paratiroid bezinin bir veya daha fazlasından aşırı paratiroid hormonu (PTH) salgılanmasıyla karakterize bir hastalıktır. Anormal paratiroid bezlerinin cerrahi olarak çıkarılması, hastalığın en etkili tedavi yötemidir. Bu çalışma, PHPT nedeniyle ameliyat edilen hastaların klinik ve cerrahi deneyimlerimizi sunmayı amaçlamaktadır. GEREÇ VE YÖNTEM: Ocak 2014 - Mart 2019 tarihleri arasında hastanemiz meme ve endokrin cerrahisi bölümünde PHPT tanısı ile ameliyat edilen hastaların verileri geriye dönük olarak incelendi. BULGULAR: Bu çalışmaya medyan yaşı 54 olan toplam 334 hasta (dağılım 16-86) dahil edildi. Bunlardan 165'i (% 81,7) kadın, 37'si (% 18,3) erkekti. Preoperatif lokalizasyon çalışmalarında, en yüksek doğru tespit oranı, anormal paratiroid bezlerinin % 85.7'sini tanımlayan sestamibili tek foton emisyonlu bilgisayarlı tomografi ve ultrasonografi ile elde edildi. Hastaların % 22.16'sında minimal invaziv yöntem, %76,94'ünde bilateral boyun eksplorasyonu tercih edildi. 3 hastada sternotomi gerekti. Patolojik bezlerin ektopik lokalizasyonu 26 (% 7.788) hastada mevcuttu. Eş zamanlı tiroidektomi 124 (% 37.12) hastaya uygulandı. 14 (% 11.29) hastada rastlantısal tiroid maligniteleri teşhis edildi. Persitent ve rekürren hastalık görülme sıklıkları sırasıyla 6.88% ve 4.19% olarak tespit edildi. SONUÇ: PHPT, multidisipliner bir yaklaşım gerektirir. Cerrahi tedavi, düşük komplikasyon oranları ile% 95'in üzerinde iyileşme sağlayabilir. Anormal bezler için dikkatli lokalizasyon çalışmaları ve eşlik eden tiroid patolojileri için ayrıntılı incelemelerin ameliyat başarısını daha da artıracağına inanıyoruz.

Objectives: Although the relationship between breast cancer (BC) risk factors and mammographic density (MD) patterns is not clear, high MD is well known as an independent risk factor for BC. Thus, the aim of this study was to examine the association between MD and BC risk factors in BC patients and find a correlation between MD and tumor characteristics in BC patients. Methods: Our data included 242 patients with BC. Furthermore, the MD (type 1- <25%; type II - 25-50%; type III - 51-75%; and type IV - >75%) was categorized according to percentile density, and the various types of MD were compared using risk factors for BC and tumor characteristics of patients. Results: The results of this study indicated that younger age, pre-menopausal status, younger menarche age, nulliparity, low body mass index, and smoking significantly increase the percentage of MD (p<0.001, p<0.001, p=0.04, p<0.001, p=0.003, and p=0.01, respectively). Moreover, the distribution of MD patterns showed significant differences according to tumor subtypes. Type 4 mammographic pattern was higher in patients with human epidermal growth factor receptor 2 (Her2) type of tumor (p=0.01). Conclusion: Higher MD is related to reproductive risk factors and tumor subtypes, especially Her2 type, in BC patients. Further studies are needed to identify the factors related to breast density.

Objective:The main goal of this study is to determine the clinico-pathological factors that correlate non-sentinel lymph nodes (LNs) involvement in clinically node negative breast cancer (BC) patients with positive macrometastatic sentinel lymph node (SLN) in order to derive future evidence to define a subgroup where completion axillary lymph node dissection (cALND) might not be recommended.Materials and Methods: Total 289 SLN biopsies were performed in clinically node negative BC patients between March 2014 and April 2017. Seventy patients who performed cALND due to positive macrometastatic SLN were retrospectively selected and classified into two groups, according to non-SLN involvement (NSLNI). Clinico-pathological features of patients were examined computerized and documentary archives.Results: Extracapsular extension (ECE) of SLN, number of harvested SLNs, metastatic rate of SLNs, absence of ductal carcinoma in situ (DCIS) and presence of multilocalization were significantly associated with the likelihood of non-SLN involvement after univariate analysis (p<0,05). Absence of DCIS and presence of multilocalization were found to be significant after multivariate analysis.Conclusion:Careful examination of clinico-pathological features can help to decide avoiding cALND if enough LNs are removed and the rate of SLN metastases is low, particularly in case DCIS accompanying invasive cancer in patients without multi localized tumour.

Aim: The aim of this descriptive study is to determine the frequency of thyroid cancer (TC) and evaluate the changing rates of histopathological types, age and sex distribution of thyroid tumours in our region. Material and Methods: A total of 4917 patients who underwent thyroidectomy for different indications between May 2010 and May 2019 were included in this retrospective study. Patients’ age, sex, selected surgical method and postoperative final pathology results were recorded. All data were evaluated using statistical analyses. Results: Of the 4917 patients, 922 were male (18.8%) and 3995 were female (81.2%). The mean age was 48.3 ± 12.3 (17-84) years. Among all cases 27.1% (1335) of them were malignant and 2.6 % (125) of them were well-differentiated tumours of uncertain malignant potential. The 1335 cases diagnosed with a malignant thyroid tumour had a mean age of 44.7±11.6 years and a female-to-male ratio of 4,3. Of these, 94.9% of them had papillary thyroid carcinoma (PTC), 1.72% had follicular thyroid carcinoma (FTC), 2.32% had medullary thyroid carcinoma (MTC), and 0.45% had anaplastic thyroid carcinoma. Of the cases with PTC, 62.66% of them had microcarcinoma. Conclusion: Papillary thyroid microcarcinoma (PTMC) frequency increases especially in the younger and female population in our region, FTC frequency decreases significantly and MTC is the second most common type of TCs after papillary cancers. In all TCs, the 59.47% PTMC share (mostly detected incidentally, 83.7%) appears to be the result of pathologists examining more tissue blocks and histological sampling over time.

Objectives Papillary thyroid cancer (PTC) is the most common well-differentiated thyroid cancer. Lymph node (LN) metastasis is frequently seen in PTC. The effect of BRAFV600E mutation on PTC-associated LN metastasis has not been clearly established. Therefore, we aimed to evaluate the effect of the BRAFV600E mutation in patients with PTC on regional LN metastasis. Material and Methods Between January 2013 and 2017, sixty-three PTC patients who underwent central lymph node dissection were included into the study. The patients were divided into two groups according to the pathology results of the LN dissection, and these groups were compared for positive BRAFV600E mutations and other clinicopathological findings. Results BRAFV600E mutation was found to be more significant in the pLN1 group (p= 0.005). Multivariate analysis revealed that nodule size, microcalcifications, and BRAFV600E mutation were associated with lymph node metastasis independent of other parameters. ROC analysis also evaluated the adequacy of the BRAFV600E mutation in predicting the presence of LN involvement. AUC: 0.738 (95%CI:0.6110.866,p: 0.002). Conclusion In our study, independent of other parameters, BRAFV600E gene mutation was found to be effective on lymph node involvement.

BACKGROUND: Oncotype DX R © test is beneficial in predicting recurrence free survival in estrogen receptor positive (ER+) breast cancer. Ability of the assay to predict response to neoadjuvant chemotherapy (NCT) is less well-studied. OBJECTIVE: We hypothesize a positive association between the Oncotype DX R © recurrence score (RS) and the percentage tumor response (%TR) after NCT. METHODS: Pre-therapy RS was measured on core biopsies from 60 patients with ER+, HER2− invasive breast cancer (IBC) who then received NCT. Pre-therapy tumor size was measured using imaging. %TR, partial response (PR; >50%), pathologic complete response (pCR) and breast conserving surgery (BCS) rates were measured. RESULTS: Median RS was 20 (2–69). Median %TR was 42 (0–97)%. PR was observed in 43% of patients. There was no association between %TR and pre-NCT tumor size, age, Nottingham score or nodal status (p > 0.05). No statistically significant association with %TR was seen with RS as a categorical or continuous variable (p = 0.21 and 0.7, respectively). Response to NCT improved as ER (p = 0.02) by RT-PCR decreased. Lower ER expression by IHC correlated with response (p = 0.03). CONCLUSIONS: In patients with ER+ IBC receiving NCT, RS did not predict response to NCT using %TR. The benefit of the assay prior to NCT requires further study.

BACKGROUND:The presence of pigment in axillary lymph nodes (LN) secondary to migration of tattoo ink can imitate the appearance of a blue sentinel lymph node (SLN) on visual inspection, causing the operator to either miss the true SLN or excise more than is needed.OBJECTIVE:We present patients with tattoos ipsilateral to an early stage breast cancer who underwent a SLN biopsy.METHODS:Patients were retrospectively reviewed from medical records and clinicopathologic data was collected. A total of 52 LNs were retrieved from 15 patients for sentinel mapping and 29 of them had tattoo pigmentation on pathologic evaluation.RESULTS:Of those 29 SLNs, 2 of them (6.9%) were pigmented, but did not contain either blue dye or Tc-99m (pseudopigmented SLN). Two (3.8%) SLNs were positive for metastasis; both of these had either blue dye or Tc99m uptake, and 1 demonstrated tattoo pigment in the node.CONCLUSIONS:In this cohort of patients with ipsilateral tattoos, removed more LNs lead to unnecessary excision which may important for increasing the risk of arm morbidity from SLN biopsy. However, the presence of tattoo pigment did not interfere with understaging for axillary mapping and it did not effect of pathological identification of SLNs positivity.

BACKGROUND: Atypical Ductal Hyperplasia (ADH) is a disease of the proliferative breast lesion characterized with atypia and when diagnosed on core needle biopsy (CNB), excisional biopsy is the current management to exclude adjacent cancer, which may found 10 to 20%.OBJECTIVE: The purpose of the study is to investigate the role of biomarkers on surgical decision after the diagnosis of ADH on CNB.METHODS: Patients with pure ADH on core biopsy were retrospectively selected, and categorized according to final pathology after excision into three groups: Group I (n: 39) ADH; Group II (n: 27) ductal carcinoma in situ (DCIS), and Group III (n: 9) invasive cancer (IC). Immunohistochemical analyses were performed using biomarkers MUC1, Ki67, Cyclin B1, and Cyclin D1.RESULTS: Only Cyclin D1 was significant in between group analysis by one-way ANOVA (64.74, 49.44, and 51.11, respectively; p = 0.01). However when appropriate cut-off levels (2%-50%) were used for each biomarkers using X2 test, no statistical significance was found.CONCLUSION: MUC1, Ki67, Cyclin B, and Cyclin D1have failed to predict adjacent cancer on core biopsy specimens with ADH. Further surgery is warranted for all ADH cases diagnosed on core biopsies until a new predictor is identified.

Early detection and timely intervention demonstrate the greatest promise of reducing the incidence of late-stage lymphedema in breast cancer patients undergoing axillary lymph node dissection (ALND). A nomogram was developed for predicting the risk of lymphedema (LE) in patients with ALND. This study’s aim was to test the early postoperative prediction model for the diagnosis of clinical and subclinical LE after ALND.

Cecal volvulus as an uncommon cause of acute intestinal obstruction is to axial twist of the cecum and terminal ileum around their mesentery. Cecal volvulus is a surgical emergency requiring urgent laparotomy. Resection and anastomosis is the proposed choice of the operation depending on the general condition of the patient. In this paper, we report a case of gangrenous cecal volvulus seen in a severely mentally retarded 45-year-old woman who presented with abdominal pain and distension.