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Öğe Displacement of the Recurrent Laryngeal Nerve in Patients with Recurrent Goiter Undergoing Redo Thyroid Surgery(Hindawi Ltd, 2018) Gürleyik, Emin; Çetin, Fuat; Doğan, Sami; Yekenkurul, Erman; Önsal, Ufuk; Gürsoy, Fatih; İpor, AlperThyroid reoperations are surgically challenging because of scarring and disturbances in the anatomy of the recurrent laryngeal nerve (RLN). This study was conducted on 49 patients who underwent redo surgery. 61 RLNs were identified and completely exposed. Their functional integrity was evaluated using intraoperative nerve monitoring (IONM). Indications for secondary surgery, anatomical changes secondary to recurrent goiter mass and prior surgery, and results of IONM were studied. Frequent indications for redo surgery were multinodular goiter (MNG) in 19 (38.8%) and results of cytology in 14 (28.5%) patients. The mean time interval between primary and redo thyroid surgery was 23.4 years. We laterally approached 41 (67.2%) thyroid lobes between the sternocleidomastoid and sternohyoid muscles. 16 (26.2%) RLNs were found to be adherent to the lateral surface of the corresponding thyroid lobe. The functional integrity of all RLNs was confirmed by IONM. The remnant thyroid tissue can then lead to goiter recurrence requiring secondary surgery after a long period of time. The indications for redo surgery were similar to primary cases. Lateral displacement of the RLN which is adherent to the lateral surface of recurrent goiter mass is common anatomic variation. Thyroid reoperations based on awareness of anatomical disturbances can be performed safely by an experienced surgeon with support of ancillary electrophysiological technology.Öğe Intraabdominal hemorrage due to acute pancreatitis: Case report(Duzce University Medical School, 2018) Yekenkurul, Erman; Yaşar, Mehmet; Yekenkurul, Dilek; İskender, AbdulkadirAcute pancreatitis is acute inflammation of pancreatic cells that may presents with non-specific findings such as abdominal pain and vomiting. Haemorrhage is a rare complication of acute pancreatitis, while complications such as pseudocyst, abscess, necrosis may also occur. Here, we present a case of 39-years-old male patient with intraabdominal bleeding due to idiopathic acute pancreatitis. Patient presented to emergency department with abdominal pain and lack of appetite; as a result of history, findings and investigations acute pancreatitis were considered. Oral feeding was stopped and nutritional support was given by vascular access and pain control was achieved. Due to decrease in hemoglobin and hemotacrit level diagnostic laparoscopy were performed. On exploration fragile and hemorrhagic pancreas was observed. Bleeding control was achieved; after symptomatic treatment abdominal pain regressed. Laboratory findings were completely recovered and patient was discharged. As a result; should also be noted that the rare complications of acute pancreatitis, such as hemorrhage,can be seen, so considering the patient's symptoms can mislead us further investigations should be made. © 2018, Duzce University Medical School. All rights reserved.Öğe Postoperatif peritoneal adezyonların önlenmesinde intraperitoneal sinovyal sıvı, bal, propolis, vitamin E ve zeytinyağının etkinliği(Düzce Üniversitesi, 2020) Yekenkurul, Erman; Doğan, SamiPostoperatif Peritoneal Adezyonların Önlenmesinde İntraperitoneal Sinovyal Sıvı, Bal, Propolis, Vitamin E ve Zeytinyağının Etkinliği Cerrahi tekniklerin geliştiği modern hayatta dahi birçok komplikasyona ve maliyete sebep olması açısından, postoperatif adezyonlar önemini koruyan bir sorundur. Bu çalışma; ratlar üzerinde postoperatif peritoneal adezyonları engellemek için sinovyal sıvı, bal, propolis, vitamin E ve zeytinyağının intraperitoneal olarak uygulanmış olduğu deneysel bir çalışmadır. Çalışmamızda her grupta yedi ratın olduğu yedi grup oluşturulmuştur. Grup 1: kontrol grubu; grup 2: sinovyal sıvı, grup 3: bal, grup 4: propolis, grup 5: vitamin E, grup 6: zeytinyağı ve grup 7: vitamin E+zeytinyağı uygulanan gruplardır. Ratlara bu tedaviler uygulandıktan 14 gün sonra relaparotomi yapılmış ve makroskopik skorlama, histopatolojik inceleme ve biyokimyasal olarak IL-6, GSH, HSP-70 seviye kontrolleri yapılmıştır. Makroskopik değerlendirmede; vitamin E+zeytinyağın kontrol ve propolis grubuna göre, zeytinyağın yine kontrol ve propolis grubuna göre, vitamin E'nin propolis grubuna göre adezyonları daha belirgin azalttığı görülmüştür (p<0,001). Mikroskopik değerlendirmede; vitamin E'nin propolis grubuna göre (p=0,04) daha fazla fibrozisi azalttığı görülürken, inflamasyon (p=0,067) ve vasküler proliferasyon (p=0,159) açısından gruplar arasında anlamlı bir fark tespit edilmemiştir. Biyokimyasal değerlendirmede; IL-6 seviyesini bal ve eklem sıvısının propolis grubuna göre (p=0,001), HSP-70 seviyesini balın kontrol grubuna göre (p=0,011) daha belirgin azalttığı; GSH seviyesini eklem sıvısının propolis grubuna göre (p=0,031) daha belirgin arttırdığı görülmüştür. Sonuç olarak çalışmamızda bu bazlı propolisin makroskopik, mikroskopik ve biyokimyasal olarak etkin olmadığı; zeytinyağı ve vitamin E'nin makroskopik adezyonda, vitamin E'nin mikroskopik adezyonda engelleyici bir ajan olarak denenebileceği; bal ve eklem sıvısının ise antiinflamatuvar etkinliğinden faydalanarak uygulanabileceği ön görülmüştür. Ancak daha yüksek dozlarla, daha geç relaparotomi yapılarak geniş çaplı deneyler yapılmalıdır. ANAHTAR KELİMELER: Peritoneal adezyon, eklem sıvısı, HSP-70, IL-6, GSH.Öğe Retrosternal thyrothymic remnant affects completeness of thyroidectomy: A case report(Elsevier Sci Ltd, 2024) Gurleyik, Emin; Gonullu, Emin; Yekenkurul, Erman; Gursoy, FatihIntroduction and importance: The majority of surgical thyroid disorders are treated by thyroidectomy (total or hemithyroidectomy). Anatomical variants of embryologic origin may threaten the effectiveness of thyroid surgery and complete removal of thyroid tissue. Case presentation: A female patient who underwent a total thyroidectomy, postoperatively had normal serum thyroid-stimulating hormone (TSH) levels without hormone replacement. Serum TSH and thyroglobulin levels were within normal range. A thyroid nuclear scan and chest magnetic resonance imaging (MRI) indicated a large retrosternal thyroid remnant. Clinical discussion: Separated thyroid remnant in the thyrothymic tract, forgotten during primary surgery, was the source of hormone production. Total thyroidectomy was not achieved due to embryologic remnant, and complete resection of thyroid tissue was affected by separated retrosternal thyrothymic rest. Conclusion: Surgeon awareness of anatomic variants of embryological origin undoubtedly improves thyroid surgery outcomes. Beside the anatomically based approach, total thyroidectomy could be achieved by an embryologically based approach.
