Retrosternal goiter should be suspected if the lower poles could not be palpated on physical examination and when postoperative TSH levels remained unchanged.
Objective: Parathyroid glands and recurrent laryngeal nerves (RLNs) are at risk during thyroid surgery. However, the identification of the nerves has reduced these risks. Intraoperative nerve monitoring (IONM) during thyroid surgery has gained widespread acceptance as an aid to the gold standard of visually identifying the RLN. The aim of the present study was to evaluate the effect of the identification of the RLN during thyroidectomy by using IONM. Material and Methods: Seven hundred forty-eight patients were included in our prospectively designed study. Of these 748 patients, 1496 nerves at risk were studied. Group 1 consisted of 736 nerves that were identified using IONM, whereas Group 2 consisted of 760 visually identified nerves. Results: In the non-IONM group, the rate of temporary nerve palsy was lower in patients operated by experienced surgeons than in patients operated by residents (p= 0.001). In the IONM group, RLN injury rates were similar between experienced surgeons and residents. Conclusion: In spite of the fact that the duration of the operation was lower with IONM, the abbreviated duration may not appear to have clinical significance. The main advantage is for less experienced surgeons. IONM significantly decreases RLN palsy rates of the surgeons with limited experience in thyroid surgery.
The rate of unnecessary tumor resections that are <6 cm in size can be decreased by performing adrenal biopsies in selected cases or by short-term follow-up to prevent the insufficiency of imaging techniques.
OBJECTIVE:In this study, the effect of mesalazine was studied on TNF alpha IL-1 beta, IL-6, and C-reactive protein (CRP) levels and inflammatory changes in rat lungs with experimental peritonitis.METHODS:In total, 24 male Sprague–Dawley rats weighing 250–280 g were used in the study.The rats were divided into three groups based on no irrigation or irrigation with isotonic solution or mesalazine. Secondary peritonitis was generated by cecum penetrations. Group I, no irrigation was given after the development of peritonitis; Group II, irrigation was performed using isotonic solution 24 h after the development of peritonitis;Group III:irrigation was performed using mesalazine 24 h after the development of peritonitis. Blood samples were taken in the 48th hour for measuring TNF alpha, IL-1 beta, IL-6, and CRP levels. Lung tissue samples were taken for examining the effect of mesalazine in the development of systemic sepsis.RESULTS:TNF alpha, IL-1 beta, and CRP levels were significantly low in Group III than in the other groups (p<0.005). In the histologic examination, leucocyte infiltration in the lung was found low in Group III.CONCLUSION:TNF alpha, IL-1 beta, and CRP levels and leucocyte infiltration in the lung were found to be low in rats that were administered peritoneal irrigation using mesalazine after the development of secondary peritonitis. Peritoneal irrigation using mesalazine may be useful in patients requiring surgery due to secondary peritonitis.
Kist hidatik çoğunlukla Echinococcus granulosus ve nadiren de Echinococcus alveolaris'in neden olduğu ülkemizde sık görülen paraziter kistik bir hastalıktır. Tüm organlarda görülebilse de en sık yerleştiği organlar karaciğer ve akciğerdir. Adneksiyal alanda görülen kist hidatik hastalığı ise oldukça nadirdir. Olgu: 24 yaşında karın ağrısı ve karında şişkinlik şikayeti ile kliniğimize başvuran hasta, yapılan ultrasonografi ve bilgisayarlı tomografi tetkikleri neticesinde bilateral müsinöz adneksiyal kitle düşünülerek opere edilmiştir. Frozen inceleme sırasında hidatik kist olduğu tespit edilip post-operatif dönemde buna yönelik tedavi başlanmıştır. Sonuç: Türkiye gibi endemik bölgelerde adneksiyal kitlelerin ayırıcı tanısında hidatik kist de akılda bulundurulmalı ve tanıyı kolaylaştırmak için kistin tipik ultrasonografik bulgularına aşina olunmalıdır. Tedavisinde tüm kitlelerin çıkarılması esastır ve kist içeriğinin saçılmasını önlemek için gerekli tedbirler alınmalıdır.
Amaç: Fekal inkontinans, halen kolorektal cerrahların günlük pratiği içinde kompleks bir sorun olmayı sürdürmektedir. Sinir stimülasyonu ve dolgu madde enjeksiyonu bu hastalığın tedavisi için kullanılan iki minimal invaziv tedavi yöntemidir. Bu çalışmamızda, fekal inkontinans tedavisinde, perkütan tibial sinir stimülasyonu (PTSS) ile dolgu madde enjeksiyonu yöntemlerinin kısa dönem sonuçlarını değerlendirmeyi amaçladık. Yöntem: İstanbul Üniversitesi İstanbul Tıp Fakültesi'nde fekal inkontinans nedeniyle bu iki yöntemin uygulandığı 41 hasta çalışmaya dahil edildi. İki grup demografik veriler, fekal inkontinans etiyolojisi, anorektal fizyolojik testler, Wexner Fekal İnkontinans Skoru ve Modifiye Fekal İnkontinans Yaşam Kalite Skoru açısından değerlendirildi. Anketler tedavi öncesi ve tedavi sonrası 12. ayda yapıldı. Bulgular: Hastaların 24'ü (%59) kadın, 17'si (%41) erkekti. Ortalama yaş 50 (25-71) ve ortalama vücut kitle indeksi ise 27,7 kg/m 2 (20-41) idi. Yirmi iki (%54) hastaya PTSS uygulanırken, 19 hastaya (%46) dolgu madde enjeksiyonu yapıldı. Her iki grup demografik veriler, tedavi öncesi yapılan fekal inkontinans değerlendirme ve yaşam kalite ölçümü açısından benzeşik bulundu. Tedavi öncesi ve sonrası, inkontinans ve yaşam kalite ölçek skorları karşılaştırıldığında, her iki yöntem de fekal inkontinans tedavisinde etkin bulundu (p<0,001). Her iki yöntem kendi arasında karşılaştırıldığında, eşdeğer oldukları görüldü (p=0,315 ve 0,501). Sonuç: Her iki teknik, fekal inkontinansın tedavisinde etkin bulunmuştur. PTSS daha az invazivken, dolgu madde enjeksiyonu ile daha hızlı düzelme elde edilmekte ve hasta geliş sayısı daha az olmaktadır. Anahtar Kelimeler: Fekal inkontinans, sinir stimülasyonu, dolgu madde enjeksiyonu ÖZ ABSTRACTAim: Fecal incontinence is still a complex disorder in the daily practices of colorectal surgeons. Nerve stimulation and injection of bulking agent are two minimal invasive methods in the treatment of fetal incontinence. In the present study, the aim was to compare the short-term effectiveness of percutaneous tibial nerve stimulation (PTNS) and injection of bulking agent in the treatment of fecal incontinence. Method: A total of 41 patients with fecal incontinence, who were treated with PTNS or bulking agent injection at İstanbul University İstanbul Faculty of Medicine, were enrolled in the study. Both groups were evaluated in terms of demographic data, the etiology of fecal incontinence, anorectal physiology test results, Wexner Fecal Incontinence Score and Modified Fecal Incontinence Quality of Life-Scale scores. The questionnaires were performed in the 12 th month of the pre-and post-treatment periods. Results: Of the patients, 24 (59%) were female, and 17 (41%) were male. The median age was 50 years (in between 25-71 years), and the mean body mass index was 27.7 kg/m 2 (in between 20-41 kg/m 2 ). Twenty-two (54%) patients underwent PTNS; whereas, 19 (46%) patients underwent bulking agent injection. Both groups were found to be similar in terms of demographic data, pre-treatment feca...
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