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Öğe Adrenalectomy for incidental and symptomatic phaeochromocytoma: retrospective multicentre study based on the Eurocrine (R) database(Oxford Univ Press, 2021) Thompson, L. Hallin; Makay, O.; Brunaud, L.; Raffaelli, M.; Bergenfelz, A.Background: Phaeochromocytoma is sometimes not diagnosed before surgery and may present as an adrenal incidentaloma. The aim of this study was to investigate differences in clinical presentation and perioperative outcome in patients with subclinical and symptomatic phaeochromocytoma, and in patients operated with and without preoperative alpha-blockade. Methods: This was a retrospective observational study of patients with a histopathological diagnosis of phaeochromocytoma registered in Eurocrine (R), the European registry for endocrine tumours, between 1 January 2015 and 31 March 2020. Patient characteristics, clinical presentation, tumour detection, and perioperative variables were analysed. Results: Some 551 patients were included. Of these, 486 patients (88.2 per cent) had a preoperative diagnosis of phaeochromocytoma. Tumours were detected as incidentalomas in 239 patients (43.4 per cent) and 265 (48.1 per cent) had a preoperative diagnosis of hypertension. Preoperative alpha-blockade was more frequently used in patients with a known phaeochromocytoma (350, 90.9 per cent) than in patients with other indications for adrenalectomy (16, 31 per cent). Complications did not differ between patients who had surgery because of catecholamine excess compared with those who had other indications for surgery (19 (3.9 per cent) versus 2 (3 per cent); P=0.785), nor did the conversion rate from minimally invasive to open surgery differ between the groups. There were no obvious differences in complications, according to the Clavien-Dindo classification, based on preoperative alpha-blockade or not. Conclusion: Subclinical phaeochromocytoma detected incidentally is common. A significant proportion of patients with phaeochromocytoma did not have alpha-blockade before surgery, without an apparent effect on complications.Öğe Author response to: European multicentre study on outcome of surgery for sporadic primary hyperparathyroidism(Oxford Univ Press, 2021) Bergenfelz, A.; van Slycke, S.; Makay, O.; Brunaud, L.[No Abstract Available]Öğe Can preoperative diagnosis affect the choice of treatment in Amyand's hernia? Report of a case(Springer, 2009) Karatas, A.; Makay, O.; Salihoglu, Z.Amyand's hernia (AH) is defined as an appendix located in the inguinal hernia sac. Most cases are diagnosed intraoperatively and might undergo appendectomy besides hernia repair. Computerized tomography is effective in the preoperative diagnosis. Meanwhile, the number of reports concerning the preoperative diagnosis of AH is increasing. There is no standard protocol for the management of AH. Factors such as the presence of an inflamed appendix, contamination of the surgical field, patient age and anatomic features of the tissue are important determinants for appropriate surgery. Herein, we report an adult male patient with AH.Öğe Co-existence of Gastrointestinal Stromal Tumors with Malign Epithelial Tumors : a Report of Two Cases(Acta Medical Belgica, 2009) Firat, O.; Yazici, P.; Makay, O.; Aydin, A.; Tuncyurek, M.; Ersin, S.; Guler, A.Aim : To emphasize the importance of a detailed observation for incidental simultaneous tumoral masses during surgery for gastrointestinal stromal tumors (GISTs) at any location in the gastrointestinal system. Case presentations : Case 1 : a 39 years old female patient with an esophageal squamous cell carcinoma and a synchronous small intestinal GIST discovered incidentally during esophagectomy. Case 2 : a 73 years old female patient with a gastric GIST and a synchronous colorectal cancer detected incidentally during gastrectomy. In both cases, immunohistochemical examinations of the resected specimens confirmed the coexistences of GISTs and epithelial malignancies. Conclusion : The coexistences of GISTs with epithelial tumors have been increasing in recent years. In any case of a GIST or gastrointestinal adenocarcinoma, the surgeon should be alert to recognize a possible coexistent tumor with different histological origin.Öğe Co-existence of Gastrointestinal Stromal Tumors with Malign Epithelial Tumors : a Report of Two Cases(Acta Medical Belgica, 2009) Firat, O.; Yazici, P.; Makay, O.; Aydin, A.; Tuncyurek, M.; Ersin, S.; Guler, A.Aim : To emphasize the importance of a detailed observation for incidental simultaneous tumoral masses during surgery for gastrointestinal stromal tumors (GISTs) at any location in the gastrointestinal system. Case presentations : Case 1 : a 39 years old female patient with an esophageal squamous cell carcinoma and a synchronous small intestinal GIST discovered incidentally during esophagectomy. Case 2 : a 73 years old female patient with a gastric GIST and a synchronous colorectal cancer detected incidentally during gastrectomy. In both cases, immunohistochemical examinations of the resected specimens confirmed the coexistences of GISTs and epithelial malignancies. Conclusion : The coexistences of GISTs with epithelial tumors have been increasing in recent years. In any case of a GIST or gastrointestinal adenocarcinoma, the surgeon should be alert to recognize a possible coexistent tumor with different histological origin.Öğe Completion thyroidectomy for thyroid cancer(Acta Medical Belgica, 2006) Makay, O.; Unalp, O.; Icoz, G.; Akyildiz, M.; Yetkin, E.Background : Whether thyroid re-operations are associated with an increased complication risk is controversial. The aim of this study was to perform a retrospective analysis of patients undergoing re-operative surgery of the thyroid. We analyzed the safety and the impact of delay on complications before undertaking radicalization thyroidectomy. Material and Methods : From January 1996 to July 2002, 150 consecutive patients with thyroid cancer were treated in our institution. A total of 62 patients underwent completion thyroidectomy. Twenty-seven had undergone their initial operation in our centre. Medical and pathologic data were obtained retrospectively. Results : Pathological examination of the specimen after completion surgery revealed malignancy in a total of 35% of 62 patients. The time interval between initial surgery and completion thyroidectomy ranged from 5 days to 24 months (mean 3.1 months). Complications after re-operation were transient recurrent nerve injury in 1.6%, transient hypoparathyroidism in 4.8%, permanent hypoparathyroidism in 1.6% and chylous discharge in 1.6% of the patients. There was no significant difference between complication rates in patients operated on within 90 days or those operated on after this period (p > 0.05). Conclusions : This study suggests that completion thyroidectomy is safe in the hands of experienced endocrine surgeons and the timing of re-operation has no impact on the development of complications.Öğe Ethical and medico-legal issues of TOETVA procedure and simulation on cadavers: a scoping review(Verduci Publisher, 2022) Oliva, A.; Grassi, S.; Zedda, M.; Dionigi, G.; Makay, O.; Filograna, L.; Cazzato, F.Conventional open thyroidectomy is still considered the gold standard for thyroid surgery. Transoral endoscopic thyroidectomy vestibular approach (also known as TOETVA) is often considered to be more advantageous than the other approaches, such as minimally invasive video assisted thyroidectomy, thyroidectomy via breast/axillary/retroauricular access, bilateral axillo-breast approach and axillo- bilateral breast approach. In this scoping review, we discuss the risks and the benefits of this surgical approach and its medico- legal and ethical implications, particularly focusing on the importance of practice on cadavers. Currently, there is little scientific evidence supporting TOETVA, since there are few papers on the comparison with the traditional open thyroidectomy that have been published and thus little data on the long-term outcomes of TOETVA are available. Since the better cosmetic outcome currently represents the main indication for this surgical technique, substantial medico- legal and ethical issues arise. Moreover, practice on cadavers can help surgeons to develop the technical and non-technical skills required to perform efficiently and safely this new surgical procedure.Öğe European multicentre study on outcome of surgery for sporadic primary hyperparathyroidism(Wiley, 2020) Bergenfelz, A.; van Slycke, S.; Makay, O.; Brunaud, L.Background International multicentre outcome studies of surgery for primary hyperparathyroidism (pHPT), especially for rate of conversion to bilateral neck surgery and persistent hypercalcaemia, are scarce. Methods Eurocrine (R) is a European database for endocrine surgery. Data are entered according to predefined data fields. Outcomes for patients who underwent first surgery for sporadic pHPT were analysed. Multivariable analysis was performed to identify risk factors for adverse outcome using Cox regression with constant follow-up. Results A total of 5861 patients were registered between 2015 and 2018. Preoperative localization procedures were used in most patients, with moderate sensitivity. Intraoperative parathyroid hormone (ioPTH) measurement was used in three-quarters of patients. Bilateral surgery was performed in 1574 patients (26 center dot 9 per cent). Among 4683 patients (79 center dot 7 per cent) for whom unilateral or focused operation was planned, the procedure was converted to bilateral surgery in 396 (8 center dot 5 per cent). the risk of conversion decreased with the use of ioPTH monitoring (relative risk (RR) 0 center dot 77). Persistent hypercalcaemia was registered in 253 patients (4 center dot 3 per cent), and was less likely with the use of two (RR 0 center dot 55) or three (RR 0 center dot 44) localization procedures. in patients with a concordant localized single lesion, the rate of persistent hypercalcaemia was 2 center dot 5 per cent. the risk of persistent hypercalcaemia decreased with the use of ioPTH measurement, but was increased in patients with negative localization procedures and conversion to bilateral surgery. Conclusion the use of ioPTH measurement decreased the risk of conversion and persistent hypercalcaemia. the use of two or three localization procedures decreased the risk of persistent hypercalcaemia; in patients with a concordant single lesion, the risk of persistent hypercalcaemia was low.Öğe Experimental Comparison of Meshes for Rectal Prolapse Surgery(Karger, 2009) Caliskan, C.; Denizli, A.; Makay, O.; Firat, O.; Tanyalcin, T.; Alkanat, M.; Korkut, M. A.Aim: The aim of this experimental study is to investigate the foreign body tissue created by the meshes that are used for rectopexy. Method: Sixty rats were divided equally into 5 groups. Four mesh types (Surgipro (R), Ivalon (R), Gore-Tex (R) and Vypro (R)) were implanted into the retroperitoneal area except for the sham group. After a 5-week follow-up period, all animals were sacrificed. Specimens were evaluated macroscopically by using scoring systems and biochemically by determining tissue hydroxyproline and nitric oxide levels. Results: The most evident foreign body reaction was observed in the Ivalon group, which showed higher 'macroscopic adhesion' scores (p < 0.005), although there were no significant differences in tissue hydroxyproline and nitric oxide levels between the groups (p > 0.05). Conclusion: In rectal prolapse surgery, selecting the ideal mesh type is unclear, depending on evidence-based results. In the present study, we could not prove which mesh was definitely superior to the other, macroscopically, histologically and biochemically. The findings of this experimental rat model suggest that implantation of all 4 types of meshes are suitable for posterior rectopexy. Copyright (C) 2009 S. Karger AG, BaselÖğe Outcomes of surgical treatment for small bowel neuroendocrine neoplasms - The first preliminary results of the international study group for small bowel neuroendocrine neoplasm surgery registry(Wiley, 2023) Kacmaz, E.; Addeo, P.; Hennings, J.; Makay, O.; Pasquer, A.; Pedrazzani, C.; Engelsman, A.[No abstract available]Öğe Radioguided neck surgery applications(Springer, 2007) Yararbas, U.; Argon, A. M.; Mengi, O.; Makay, O.; Icoz, G.; Akyildiz, M.Öğe REVIEW OF THYROID CYTOLOGY AND HISTOLOGY SLIDES IN A TERTIARY CENTRE LEADS TO A CHANGE IN PLANNED SURGICAL TREATMENT FOR PATIENTS WITH THYROID NODULES(Editura Acad Romane, 2011) Erol, V.; Makay, O.; Nart, D.; Ertan, Y.; Icoz, G.; Veral, A.; Akyildiz, M.; Yilmaz, M.; Yetkin, E.Aim. Histology and cytology consultations of thyroid fine needle aspiration biopsy (FNAB) of thyroidectomy specimens can change management of the patient. We aimed to determine compliance rates of pathology results between urban centers and a tertiary institution and its impact on patient management. Methods. This retrospective study includes 101 patients, who were referred to our center, between January 2008 and December 2008. After admission, all FNAB or thyroidectomy specimens of patients managed elsewhere were consulted by the pathology department. Comparison of FNAB and histology reports of our institution and the medical centers elsewhere had been carried out. Results. A total of 76% concordance rate was found between the FNAB results of other centers and consultation results. The highest concordance was observed in the malignant cytology group (77%). The cytological or histological outcomes of 24 (23.7%) patients were interpreted differently. After second opinion, patient management changed in 21 of the 101 patients. Conclusion. Since FNAB results can change the type of surgical treatment and the management plan, the results especially reported as suspicious may need a second opinion. We suggest that cytology or histology results of thyroid patients referred to tertiary centers for further evaluation and treatment should always be reviewed.Öğe The role of allopurinol on oxidative stress in experimental hyperthyroidism(Editrice Kurtis S R L, 2009) Makay, O.; Yenisey, C.; Icoz, G.; Simsek, N. Genc; Ozgen, G.; Akyildiz, M.; Yetkin, E.Aim: During hyperthyroidism, production of free oxygen radicals derives, where xanthine oxidase may also play an important role. Allopurinol, a xanthine oxidase inhibitor, has a significant effect on thyrotoxicosis-related oxidative stress. However, the relationship between thyroid hormones, oxidative stress parameters and allopurinol remains to be explored. Methods: Forty-two Wistar albino rats were divided into three groups. Rats in group A served as negative controls, while group B had untreated thyrotoxicosis and group C received allopurinol. Hyperthyroidism was induced by daily 0.2 mg/kg L-thyroxine intraperitoneally in groups B and C; 40 mg/kg allopurinol were given daily intraperitoneally. Efficacy of the treatment was assessed after 72 h and 21 days, by measuring serum xanthine oxidase (XO), malondialdehyde (MDA), glutathione (GSH), glutathione reductase (GR), glutathione peroxidase (GPx) and nitric oxide derivates (NO center dot x). Results: In both time periods, serum XO, MDA, GSH and NO center dot x levels were significantly increased after thyroid hormone induction (p<0.05). Levels of XO, MDA and NO center dot x decreased with allopurinol treatment (p<0.05). There was a remarkable decrease in triiodothyronine levels in group C after 72 h (p<0.05), and in both triiodothyronine and thyroxine levels in group C after 21 days (p<0.05). There was no difference between groups B and C in means of serum GSH, GR and GPx levels (p>0.05). Conclusions: This study suggests an association between allopurinol and the biosynthesis of thyroid hormones. Allopurinol prevents the hyperthyroid state, which is mediated predominantly by triiodothyronine and not by XO. This issue has to be questioned in further studies where allopurinol is administered in control subjects. (J. Endocrinol. Invest. 32: 641-646, 2009) (C) 2009, Editrice KurtisÖğe The role of allopurinol on oxidative stress in experimental hyperthyroidism(Editrice Kurtis S R L, 2009) Makay, O.; Yenisey, C.; Icoz, G.; Simsek, N. Genc; Ozgen, G.; Akyildiz, M.; Yetkin, E.Aim: During hyperthyroidism, production of free oxygen radicals derives, where xanthine oxidase may also play an important role. Allopurinol, a xanthine oxidase inhibitor, has a significant effect on thyrotoxicosis-related oxidative stress. However, the relationship between thyroid hormones, oxidative stress parameters and allopurinol remains to be explored. Methods: Forty-two Wistar albino rats were divided into three groups. Rats in group A served as negative controls, while group B had untreated thyrotoxicosis and group C received allopurinol. Hyperthyroidism was induced by daily 0.2 mg/kg L-thyroxine intraperitoneally in groups B and C; 40 mg/kg allopurinol were given daily intraperitoneally. Efficacy of the treatment was assessed after 72 h and 21 days, by measuring serum xanthine oxidase (XO), malondialdehyde (MDA), glutathione (GSH), glutathione reductase (GR), glutathione peroxidase (GPx) and nitric oxide derivates (NO center dot x). Results: In both time periods, serum XO, MDA, GSH and NO center dot x levels were significantly increased after thyroid hormone induction (p<0.05). Levels of XO, MDA and NO center dot x decreased with allopurinol treatment (p<0.05). There was a remarkable decrease in triiodothyronine levels in group C after 72 h (p<0.05), and in both triiodothyronine and thyroxine levels in group C after 21 days (p<0.05). There was no difference between groups B and C in means of serum GSH, GR and GPx levels (p>0.05). Conclusions: This study suggests an association between allopurinol and the biosynthesis of thyroid hormones. Allopurinol prevents the hyperthyroid state, which is mediated predominantly by triiodothyronine and not by XO. This issue has to be questioned in further studies where allopurinol is administered in control subjects. (J. Endocrinol. Invest. 32: 641-646, 2009) (C) 2009, Editrice KurtisÖğe Role of hospital and patient factors in the outcome of reoperations for primary hyperparathyroidism: a retrospective multicenter cohort study(2023) Nomine-Criqui, C.; Nguyen-Thi, P.-L.; Van, Slycke, S.; Makay, O.; Brunaud, L.; Bergenfelz, A.BACKGROUND: There are few data on outcomes after reintervention for persistent or recurrent primary hyperparathyroidism (PHPT). The authors hypothesized that the variation in outcomes at the hospital level after reoperation would be significant. After accounting for this variability, some patient-level clinical criteria could be identified to help inform treatment decisions in this patient population. The aim of this study was to determine whether there is significant variation in outcomes after reoperation for PHPT between hospitals (hospital-level analysis) and identify clinical factors (patient-level analysis) that influence postoperative outcomes. MATERIALS AND METHODS: This retrospective multicenter cohort study was performed using the Eurocrine registry. Data from 11 countries and 76 hospitals from January 2015 to October 2020 were extracted. A generalized linear mixed model was used to assess the variation in outcomes at the hospital level and to identify risk factors of postoperative outcomes at the patient level. The primary endpoint (textbook outcome) was achieved when all six of the following postoperative conditions were met: no hypocalcemia or persistent hypercalcemia, no laryngeal nerve injury, no negative exploration, no normal parathyroid gland only on histopathology, and no postoperative death. RESULTS: Among 13 593 patients who underwent parathyroidectomy for PHPT, 617 (4.5%) underwent reoperative parathyroidectomy. At follow-up, 231 patients (37.4%) were hypocalcemic, 346 (56.1%) were normocalcemic without treatment, and 40 (6.5%) had persistent hypercalcemia. Textbook outcomes were achieved in 321 (52.0%) patients. The hospital-level variation in textbook outcome rates was significant ( P <0.001), and this variation could explain 29.1% of the observed outcomes. The criterion that remained significant after controlling for inter-hospital variation was 'a single lesion on sestamibi scan or positron emission tomography (PET) imaging' (odds ratio 2.08, 95% confidence interval 1.24-3.48; P =0.005). CONCLUSION: Outcomes after reoperation are significantly associated with hospital-related factors. A 'single lesion observed on preoperative sestamibi scan or PET' appears relevant to select patients before reoperation. Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.Öğe WARTHIN-LIKE TUMOR OF THE THYROID - A RARE VARIANT OF PAPILLARY THYROID CANCER: REPORT OF TWO CASES(Editura Acad Romane, 2014) Bozbiyik, O.; Makay, O.; Ertan, Y.; Icoz, G.; Akyildiz, M.; Yilmaz, M.; Yetkin, E.Background. Warthin-like tumor of the thyroid (WALTT) is a very rare variant of papillary thyroid cancer. We want to draw attention to this rare condition by reporting two cases. Patient reports. Patient 1 was a 24 year-old woman presented with 14x12 mm solid nodule on the left lobe of the thyroid gland. Fine needle aspiration biopsy of the nodule was reported as suspicious for papillary thyroid carcinoma. Patient 2 was a 40 year-old woman who had multinodular thyroid gland with a 31x26 mm major nodule on the left lobe. On fine neddle aspiration, cytologic findings were consistent with papillary thyroid carcinoma. Both underwent total thyroidectomy and histological examination of the cases revealed Warthin-like tumor of the thyroid. Summary and conclusion. We report two patients with WALTT. This rare variant of papillary thyroid cancinoma has four main histologic criteria: papillary architecture, oxyphilic cytoplasmic changes, papillary nuclear features and dense lymphoid infiltrate. WALTT can be distinguished from other aggressive variants with these distinct histological features. Since variants show different clinical behaviour, classification of these might be helpful to predict patient prognosis.
