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PubMed | Ankara Numune Education and Research Hospital Ankara, Isparta State Hospital Anesthesia and Critical Care Unit Isparta, Suleyman Demirel University of Turkey, Izmir Bozyaka Education and Research Hospital Izmir and Antalya Education and Research Hospital Antalya
Type: Journal Article | Journal: International journal of clinical and experimental medicine | Year: 2014

Minimally invasive surgical techniques have attracted interest in all surgical specialties since 1980. The thyroidectomy technique requires meticulous surgical dissection, absolute hemostasis, en bloc tumor resection and adequate visualization of the operative field, all of which can be accomplished with minimally invasive techniques.The study group comprised all patients undergoing MITS from its introduction in 2010 until July 2012. All data were prospectively recorded in the Elbistan Hospital and Suleyman Demirel University in Turkey. This study was designed to demonstrate our experience with mini-incision-technique in thyroidectomy.Over the 2-year period, 37 patients underwent bilateral MITS procedures. The procedure made with a small (2.5 cm) anterior incision made above the isthmus. The final diagnoses were benign multinodular goitre (37%), follicular adenoma (28%) incidental carcinoma (11%), Hashimotos thyroiditis (15%), Hurtle cell adenoma (5%), subacute thyroiditis (3%), residual thyroid-non carcinoma (2%), simple cyst (1%), diffuse hyperplasia (1%) and other (1%). Of the carcinomas, 80% were papillary thyroid cancer, 13% were follicular, and the remaining 7% were Hurtle cell carcinomas. We dont need to extend our incision in any cases. Two patients had temporary recurrent laryngeal nevre paresis and one patient had temporary hypocalcemia.It is not easy to demonstrate the advantages of MIT over conventional and video-assisted surgery. The main complications, such as nerve injury, hypoparathyroidism, or hemorrhage, are the same as in other surgical approaches. MIT has demonstrated advantages over conventional open approaches for both hemi- and total thyroidectomy and the benefits do not depend on the open or video-assisted approach. The anterior mini-incision approach can be performed with an operative time and postoperative complication profile equivalent to conventional thyroidectomy while providing excellent cosmesis with a 2 cm scar in both total thyroidectomy and lobectomies.

PubMed | Izmir Bozyaka Education and Research Hospital Izmir
Type: Journal Article | Journal: International journal of clinical and experimental medicine | Year: 2015

HLA typing is the cornerstone of kidney transplantation. Here, we present two full-match kidney transplants with early uneventful course but late c4d-mediated rejection and recurrent pauce-immune necrotizing crescentic glomerulonephritis, as each in one. Case 1: A 49 years old Caucasian female patient, received a six-matched cadaveric kidney and had nonspecific changes in 6th and 12th month protocol biopsies. The first and third year serum creatinin value was 1.8 and 2.0 mg/dl. Immunosuppressive drugs were gradually reduced due to recurrent infections at the 3rd year. She admitted with allograft dysfunction and serum creatinin 5.8 mg/dl. Kidney biopsy of graft dysfunction at the 4th year was diagnosed C4d-mediated rejection. Case 2: A 61 years old Caucasian female patient received a HLA-identical kidney 8.5 years ago from her sibling had a primary vasculitis mediated necrotizing crescentic glomerulonephritis. Her serum creatinin values in the 1st and 8th years were 1.3 and 1.7 mg/dl. In recent years, immunosuppressive dosage has been gradually reduced due to recurrent lower respiratory tract infections. She admitted with hematuria, purpuric rash, dyspnea. and serum creatinin 5.7 mg/dl. Renal biopsy revealed necrotizing crescentic glomerulonephritis. The patient was treated with pulse steroid, double filtration plasmapheresis and rituximab. She is being followed with a functioning graft and with serum creatinin 2.0 mg/dl. In case of recurrent infection, immunosuppressive drugs should be modified cautiously even in patients with full-match grafts to prevent late acute rejection or recurrence of the primary disease.

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