Araştırma Çıktıları | WoS | Scopus | TR-Dizin | PubMed
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Publication Open Access Tiroid cerrahisi sonrası hipokalsemi gelişimini etkileyen faktörler(2015) Yetkin, Sıtkı Gürkan; Mihmanlı, Mehmet; Uludağ, Mehmet; Çitgez, Bülent; Aygün, Nurcihan; Besler, Evren; İşgör, Adnan; T.C. Sağlık Bakanlığı; T.C. Sağlık Bakanlığı; T.C. Sağlık Bakanlığı; T.C. Sağlık Bakanlığı; T.C. Sağlık Bakanlığı; T.C. Sağlık Bakanlığı; Bahçeşehir ÜniversitesiAmaç: Tiroidektomi sonrası geçici hipokalsemi en sık görülen komplikasyondur ve oluştuğunda kolaytedavi edilir. Geçici hipokalsemi ile ilişkili esas problem hastanede kalış süresini uzatmasıdır. Bu çalış -manın amacı tiroid cerrahisi uygulanan hasta grubunda postoperatif geçici hipokalsemi için risk fak -törlerini belirlemekti.Gereç ve Yöntem: Ocak 2012 - Aralık 2013 tarihleri arasında total tiroidektomi uygulanan 177 has -tanın verileri retrospektif olarak değerlendirildi. Hipokalsemi total serum kalsiyum düzeyinin 8 mg/dl altında olması olarak tanımlandı. Geçici hipokalsemi total tiroidektomiyi takiben 6 ayda hipokalse -minin iyileşmesi olarak tanımlandı. Geçici hipokalsemi için risk faktörleri olarak cinsiyet, preopera -tif D vitamini eksikliği, reküren hastalık için cerrahi girişim, hipertiroidi varlığı, görülen ve korunanparatiroid bez sayısı, paratiroid bez ekimi yapılması, patolojik spesmende çıkarılan paratiroid bezivarlığı değerlendirildi. İstatistik değerlendirmede Nominal Lojistik Regresyon analizi, Ki-kare testive Fisherin Kesinlik testi kullanıldı.Bulgular: Çalışmadaki 177 hastanın (150K, 27E) 37sinde (%20.9) geçici hipokalsemi gelişti. Nominalregresyon analizinde sadece patolojik spesmende çıkarılan paratiroid bezi varlığı (p=0.025) geçicihipokalsemi için bağımsız değişken faktör olarak belirlendi.Sonuç: Patolojik spesmende paratiroid bezi varlığı yüksek oranda geçici hipokalsemiden sorumludur.Tiroidektomi esnasında cerrahi spesmenin intraoperatif dikkatli incelenmesi uygunsuz paratiroidek -tomi insidansını azaltabilir.Publication Open Access Main Surgical Principles and Methods in Surgical Treatment of Primary Hyperparathyroidism(2019) Uludağ, Mehmet; Aygün, Nurcihan; İşgör, Adnan; Sağlık Bilimleri Üniversitesi; Sağlık Bilimleri Üniversitesi; Bahçeşehir ÜniversitesiThe only curative treatment for primary hyperparathyroidism (pHPT) is surgery. The most important factors that increase the success rate of a parathyroidectomy are the establishment of the correct diagnosis and the surgeon’s good knowledge of anatomyand embryology. The lower parathyroid glands develop from the dorsal portion of the third pharyngeal pouch, and the upperparathyroid glands from the fourth pharyngeal pouch. Humans typically have 4 parathyroid glands, however, more than 4 andfewer than 4 have been observed. Typically, the upper parathyroid glands are located in the cricothyroid junction area on theposterolateral portion of the middle and upper third of the thyroid, while the lower parathyroids are located in an area 1 cm indiameter located posterior, lateral, or anterolateral to the lower thyroid pole. Ectopic locations of parathyroid glands outside thenormal anatomical regions due to the abnormal migration during embryological development or acquired ectopy due to migration of enlarged parathyroids are not uncommon. There are various surgical techniques to treat HPT, however, 2 main surgical options are used: bilateral neck exploration (BNE) and minimally invasive parathyroidectomy (MIP). While there are open, endoscopic,and video-assisted MIP (MIVAP) approaches, most often an open lateral MIP technique is used. In addition, endoscopic or roboticparathyroidectomy methods performed from remote regions outside the neck have been reported. Although currently MIP is thestandard treatment option in selected patients with positive imaging, BNE remains the gold standard procedure in parathyroidsurgery. In 80% to 90% of patients with pHPT, a pathological parathyroid gland can be detected with preoperative imaging methods and MIP can be applied. However, the pathological gland may not be found during a MIP procedure as a result of false positiveresults. The parathyroid surgeon must also know the BNE technique and be able to switch to BNE and change the surgical strategyif necessary. If the intended gland is not found in its normal anatomical site, possible embryological and acquired ectopic locationsshould be investigated. It should be kept in mind that MIP and BNE are not alternatives to each other, but rather complementarytechniques for successful treatment in parathyroid surgery.Publication Open Access The Effectiveness of Preoperative Ultrasonography and Scintigraphy in the Pathological Gland Localization in Primary Hyperparathyroidism Patients(2019) Uludağ, Mehmet; Aygün, Nurcihan; İşgör, Adnan; Sağlık Bilimleri Üniversitesi; Sağlık Bilimleri Üniversitesi; Bahçeşehir ÜniversitesiObjectives: Primary hyperparathyroidism (pHPT) is a common disease, and its curative treatment is surgical. Nowadays, preoperative localization studies have become standard before surgical treatment, and the first stage imaging methods are ultrasonography and/or scintigraphy. With the contribution of these studies to the localization of the pathological gland, focused surgery hasbecome the first standard of choice. In this study, we aimed to evaluate the efficacy of ultrasonography and scintigraphy in thepreoperative localization of the pathologic gland or glands in patients who underwent surgical treatment and cure for pHPT.Methods: In this study, the data of the biochemically diagnosed pHPT patients, who had Tc 99m-MIBI scintigraphy and/or ultrasonography for localisation preoperatively, were evaluated retrospectively. The lesion, which was positive in USG or scintigraphyfor localization, was evaluated according to the neck side or neck quadrant, and the results were compared with intraoperativelocalization findings. The effectiveness of both methods and combinations was evaluated with the localization rates, sensitivityand positive predictive values (PPV). The three methods were compared with the Youden index (J).Results: The mean age of 380 patients included in this study was 54.8±12.8 years (20-83). Three hundred eight of them werefemale, and 72 were male. Scintigraphy was performed in 339 patients, USG was performed in 344 patients, and both USG andscintigraphy were performed in 306 patients. One hundred twenty patients (32%) underwent bilateral neck exploration (BNE), and260 patients (68.4%) underwent minimally invasive parathyroidectomy (MIP) (unilateral exploration or focused surgery). Singleadenoma was detected in 358 (94%), double adenoma in 10 (3%) and hyperplasia in 12 (3%) patients.Localization rates of USG, scintigraphy, USG and scintigraphy combinations were 53%, 74%, 75%, their sensitivity was 56%, 85%,89%, PPDs were 90%, 86%, 83%. The efficiency of scintigraphy is higher than USG (J: 0.743 vs 0.527). The contribution of scintigraphy to USG in combination with USG was limited (J: 0.743 vs 0.754).The localization rates of USG, scintigraphy, USG and scintigraphy combinations were 46%, 64%, 66%, their sensitivity was 51%,83%, 88%, PPDs were 79%, 74%, 73%. The efficiency of scintigraphy is higher than that of USG (J: 0.64 vs 0.427). The contribution ofscintigraphy to USG in combination with USG was limited (J: 0.64 vs 0.66).Conclusion: In patients with pHPT, scintigraphy is a more effective method for USG as the first step preoperative imaging andshould be preferred as the first method if there is no contraindication. A combination of scintigraphy with USG may contributeminimally to the efficacy of scintigraphy. It may be advantageous for early detection of the pathologic gland in patients with incompatible two imaging and initiating surgery on the positive side of the first scintigraphy. Scintigraphy and USG methods mayallow successful MRP surgery in the majority of patients with pHPT.