The use of a vessel sealing system in thyroid surgery

Thyroidectomy is one of the most common operations performed for thyroid diseases throughout the world and has an extremely low morbidity rate. Although the technique of thyroidectomy has changed little for several years, different techniques have been developed for haemostasis in addition to the conventional methods. The vessel sealing system (Ligasure) is a new technology that can be applied in several surgical situations. However, there is no data in the literature regarding its use in thyroid surgery. Fifteen consecutive euthyroid patients (ten women, five men) with a range of 37-71 years of age who met the inclusion criteria were studied. The surgical procedures were performed by a single surgeon using standard techniques, but all vascular structures encountered were sealed by Ligasure and no suture material was used. The pre-operative, intraoperative and postoperative parameters were recorded and analyzed. Fluid collection was evaluated by ultrasonography and clinical examination on the 3rd postoperative day, The results were compared with the conventional knot tying method in a group of 25 patients. A Ligasure device was successfully used in 15 consecutive procedures, including ten total thyroidectomies, three hemithyroidectomies, one subtotal thyroidectomy and one near-total thyroidectomy. There was no operative mortality or technique-related morbidity in patients. The operating time was 75 +/- 11 minutes. The mean volume of the resected thyroid specimens was 68.3 +/- 18.9 cm3. The mean fluid collection at postoperative day three was 7.5 +/- 1.6 cm3. In conclusion, we have found that a Ligasure device can be safely used for haemostasis in thyroid surgery. It has the potential to decrease the operating time, fluid collection and blood loss.     

Analysis of MTHFR 1298A>C in addition to MTHFR 677C>T polymorphism as a risk factor for neural tube defects in the Turkish population

Maternal folic acid intake in the periconceptional period is strongly related to reduction in recurrence and occurrence of birth defects involving the neural tube. Among the single nucleotide polymorphisms (SNPs) influencing the folate metabolism, the methylenetetrahydrofolate reductase (MTHFR) gene has been the one most exclusively studied. Many studies have reported significant association between MTHFR 677C>T and increased risk of neural tube defects (NTDs). Our previous study did not support this observation. The present study aimed to determine the prevalence of 1298A>C polymorphism in addition to 677C>T in the same Turkish population as a risk factor for NTDs. We genotyped case (95 offspring with NTDs, 80 mothers, 72 fathers) and control (93 healthy children) populations for MTHFR 677C>T and MTHFR 1298 A>C polymorphisms. The comparison demonstrated a significant increase in the 1298AA/677TT genotype frequency among mothers of offspring with NTDs (OR 5.23 [1.06-25.9]; p=0.067). The 677CT genotype was only 1.35 times higher than controls among mothers when 677C>T polymorphism was evaluated alone, while 677CT/1298AC in the current study demonstrated a 3.8 times increase in this risk. These observations led us to conclude that although not statistically significant, MTHFR 1298AC polymorphism might be a risk factor for the occurrence of NTDs in the Turkish population.     

Tear clearance measurement in patients with dry eye syndrome using quantitative lacrimal scintigraphy

OBJECTIVE: The aim of this study was to evaluate the tear clearance in patients with dry eye syndrome using quantitative lacrimal scintigraphy. MATERIALS AND METHODS: We investigated 21 patients (42 eyes; 18 women, 3 men; mean age, 63.19 +/- 13.33 years) with dry eye syndrome. Additionally, for the sake of comparison, 12 normal subjects of the same age group (24 eyes; 10 women, 2 men; mean age, 68.25 +/- 2.63 years) were included. Lacrimal scintigraphy, Schirmer-1 test, BUT, and rose bengal ocular surface vital staining were performed in these cases. RESULTS: According to the results of lacrimal scintigraphy, the mean value of T 1/2 was 4.16 +/- 1.22 minutes and the mean value of RI was 14.15% +/- 2.30% in normal subjects. However, in patients with dry eye syndrome, these values were 20.59 +/- 1.97 minutes and 55.64% +/- 6.90%, respectively. Consistent with the results of ophthalmologic tests, the mean Schirmer-1 value was 12.46 +/- 2.10 mm, the mean value of BUT was 14.36 +/- 3.40 seconds, and the mean staining value of the rose bengal was 1.98 +/- 0.80 in normal subjects, whereas these values were 1.36 +/- 0.49 mm, 5.46 +/- 1.33 seconds, 6.62 +/- 0.86, respectively, in patients with dry eye syndrome. When we compared the results of lacrimal scintigraphy and the results of ophthalmologic tests, an inverse correlation was noted between both the T1/2 and RI values and both the Schirmer-1 and BUT values in all subjects (p < 0.001). However, there was a greater positive correlation between the rose bengal ocular surface staining value and both the T1/2 and RI values in all cases (p < 0.001). CONCLUSION: In the current study, it was concluded that although the lacrimal drainage system was normal, tear clearance was significantly delayed in dry eye patients. With this study, we have shown that quantitative lacrimal scintigraphy, which is an objective, practical, and noninvasive method, appears to be useful for the assessment of the tear clearance in patients with dry eye syndrome.     

Inflammatory pseudotumour of the sigmoid colon mesentery: US and CT findings (2004:12b)

The concept of inflammatory pseudotumor has evolved from meticulous pathological studies; some of its histological features resemble a spindle-cell sarcoma. Despite the fact that it usually affects children and young adults, only limited numbers of childhood cases have been reported in the pediatric literature. Recognition of this rare entity is important because the clinical manifestations and radiological features may be indistinguishable from a malignant lymphoproliferative disorder. This entity has been reported to be anywhere in the body, including a variety of intra-abdominal organs. Although one of the most common intra-abdominal sites is the mesentery, localization within the mesentery of the sigmoid colon is particularly rare. We present a case of abdominal inflammatory pseudotumor of the sigmoid colon mesentery, defining its radiological and primarily ultrasound and Doppler ultrasound findings, with a review of additional examples from the literature.     

Effects of splenohepatopexy and omentopexy in experimentally induced infrahepatic portal hypertension in rats

The purpose of this study was to determine whether splenohepatopexy (SHP) or omental transposition (OP) could reverse the portal hypertension (PH) induced by portal vein ligation (PVL). Fifty-eight Wistar rats divided into four groups: in group A (22 rats) PH was produced by calibrated PVL. In group B (8 rats), SHP was performed. Group C animals (13 rats) underwent SHP and PVL. In group D (15 rats) both PVL and OP were done. In all of the rats, the portal pressures (PP) were measured before and after the production of PVL. For SHP, small areas on the spleen and liver capsula were stripped off, and these two areas were placed together. In group D, an omentum patch was tied on the prepared liver surface. Twelve weeks after surgery, the PP were measured again and portal angiography was done. The liver, omentum and spleen were histopathologically examined. In all of the groups, the PP after PVL were significantly higher than before PVL. Twelve weeks after surgery, the PP of SHP and OP groups were significantly lower than those with PVL alone. Angiographic study showed many collaterals between transposed tissue and liver. Histopathologically, the collaterals of animals with SHP or OP were found to be well developed to allow sufficient flow for PP reduction. Both SHP and OP may reverse the increased PP in PVL model of PH. In the future; these methods may be alternative techniques for PP reduction in human beings as well.     

The prevalence of stress urinary incontinence among women operated on for abdominal wall hernias

The high co-occurrence of an abdominal wall hernia (AWH) and stress urinary incontinence (SUI) suggests that there is a common factor in the etiopathogenesis of these disorders in these patients.     

Effects of coasting on the outcome of intracytoplasmic sperm injection-embryo transfer cycles

OBJECTIVES: To determine the effects of 'coasting' on the outcome of controlled ovarian hyperstimulation (COH) and intracytoplasmic sperm injection-embryo transfer (ICSI-ET). DESIGN: Retrospective study. SETTING: IVF Centre, Ozel Ege Tup Bebek Merkezi, Izmir, Turkey. SAMPLE: Twenty-six coasted and 52 non-coasted COH and ICSI-ET patients were enrolled in this retrospective study. METHODS: Coasted patients were enrolled consecutively during the study period, and two non-coasted controls were selected from our database for each coasted patient. Coasting was decided when serum oestradiol level was > or = 4000 pg/mL. Groups were compared using chi2 and Mann-Whitney U-tests for statistical analysis. MAIN OUTCOME MEASURES: Number of oocytes collected, metaphase II (MII) oocytes and cleaving embryos, the fertilisation rate and clinical pregnancy rate were the main outcome measures. RESULTS: Number of oocytes collected, number of MII oocytes, number of cleaving embryos, fertilisation rate and clinical pregnancy rate for the coasted and non-coasted groups were 15.5 +/- 5.2 and 14.0 +/- 7.1, 9.7 +/- 4.8 and 9.3 +/- 3.9, 6.8 +/- 3.9 and 5.8 +/- 3.1, 0.85 +/- 0.18 and 0.78 +/- 0.18, 13/26 and 24/52, respectively; these differences were not statistically significant. None of the patients in the coasted group were hospitalised for signs or findings of severe ovarian hyperstimulation syndrome. CONCLUSIONS: Coasting does not adversely affect the number and the function of mature oocytes and the clinical pregnancy rate.     

Different maternal serum hCG levels in pregnant women with female and male fetuses: does fetal hypophyseal--adrenal--gonadal axis play a role?

Fetal gender has a significant effect on maternal and cord blood hCG levels, particularly during the last trimester of the pregnancy. However, the reason for this difference is obscure. The aim of the present study was to investigate whether term fetal hypophyseal - adrenal - gonadal axis differs between female and male fetuses thereby causing different hCG levels. The study consisted of 60 women with singleton pregnancies in the third trimester. Thirty-one pregnant women were carrying female fetuses, whereas 29 were carrying male. Human chorionic gonadotropin (hCG), estradiol, progesterone, testosterone, dehydro-epiandrosteron-sulfate (DHEAS), prolactin and growth hormone levels were measured in maternal serum and umbilical cord blood. In female bearing pregnancies maternal and cord blood hCG levels were significantly higher than in male bearing pregnancies (P<0.001). Maternal and cord blood estradiol, progesterone, testosterone, DHEAS, prolactin and growth hormone levels were not significantly different in either fetal gender. When all patients were considered as a group there were no correlations between fetal hCG levels and any of the measured hormones. Term fetal DHEAS, estrogen, progesterone, testosterone, growth hormone and prolactin levels do not contribute to different hCG levels between female and male fetuses. It is possible that fetal hypophyseal-adrenal gonadal axis does not play a central role as the cause of different hCG levels.     

Solitary splenic metastasis of squamous cell carcinoma of the uterine cervix: a case report and review of the literature

A 45-year-old patient presented with complaints of vaginal bleeding and pelvic pain. Fractioned probe curettage was performed and reported as Stage IIa, grade 3, squamous cell carcinoma of the uterine cervix. The patient underwent radical hysterectomy type III, bilateral salpingo-oophorectomy, omentectomy, appendectomy, and pelvic para-aortic lymph node dissection according to our clinical protocol. Adjuvant radiation therapy was planned. A splenic mass of 8 cm in diameter was revealed on computed tomography at the end of the third year of the disease-free follow-up period. Fine needle aspiration biopsy was performed and reported as metastatic carcinoma correlated to the previous cervical cancer. Debulking surgery was performed. The patient died one year after the second surgical operation. Spleen metastasis in patients with squamous cell carcinoma of the uterine cervix is exceedingly rare. Nonetheless we recommend screening of all intra-abdominal organs including the spleen as a rare metastastic site in follow-up examination protocols.     

The effect of mid-luteal estradiol level on the outcome of ICSI-ET cycles

Methods We investigated if mid-luteal estradiol levels could predict the outcome in intracytoplasmic sperm injection embryo transfer (ICSI-ET) cycles (n=231). Pregnant and non-pregnant women were compared regarding their peak estradiol levels on human chorionic gonadotropin (hCG) injection day, and mid-luteal estradiol levels on the 7th day following oocyte recovery. Pregnancy rates of the groups that were designed according to the "peak/mid-luteal estradiol level" and the mid-luteal estradiol levels were also compared.Results Peak and mid-luteal estradiol levels in pregnant women were higher than in non-pregnant women in all patients, although the difference between peak and mid-luteal estradiol levels were similar in pregnant and non-pregnants. Pregnant women had higher mid-luteal estradiol levels in good responders, but the peak estradiol levels of pregnant and non-pregnant women were similar. In poor responders, pregnant and non-pregnant women were similar with respect to peak and mid-luteal estradiol levels. Both in all patients and good responders, women with mid-luteal estradiol levels <200 pg/ml had lower pregnancy rates than those with >2,000 pg/ml. Peak/mid-luteal estradiol ratios of pregnant and non-pregnant women were not significantly different in all patients, good responders and poor responders; although a tendency for a lower ratio in pregnants was encountered in good responders. Pregnancy rates of the groups according to the "peak/mid-luteal estradiol ratio" were similar; in all patients, good responders and poor responders.Conclusion A relation between the mid-luteal estradiol level and the outcome is encountered only in good responders.