SUMMARY OBJECTIVE: In this retrospective study, we aimed to determine factors associated with bleeding complications in patients on long-term warfarin, undergoing inguinal hernia repair using low-molecular-weight heparin (LMWH) bridging. METHODS: Two-year hospital records yielded 44 inguinal hernia repair patients on long-term warfarin (26 men, 4 women, aged 57.4 [38–72] years). All patients were managed with LMWH bridging. Patient and operative characteristics, LMWH bridging characteristics, and international normalized ratio (INR) values were compared between patients with and without postoperative bleeding complications. RESULTS: Indication for warfarin use was heart valve disease (n=15), atrial fibrillation (n=7), deep venous thrombosis (n=3), cerebrovascular event (n=3), and pulmonary embolism (n=2). Four of the operations were urgent, while the remaining were elective. There were four ecchymosis cases and three hematoma cases in a total of seven patients. Baseline (2.94±0.26 versus 2.16±0.38, p<0.001) and preoperative INR values (1.69±0.67 versus 1.31±0.35, p=0.027) were significantly higher, while postoperative INR values (1.04±0.09 versus 1.2±0.13, p=0.004) were significantly lower in patients having bleeding complications. CONCLUSIONS: Baseline, preoperative INR, and postoperative INR were the only variables associated with postoperative bleeding complications in patients undergoing LMWH-bridged inguinal hernia repair. We suggest close monitoring of INR levels in long-term warfarin users, even for relatively low-bleeding risk operations such as inguinal hernia repair.

Summary OBJECTIVE: This study was designed to compare the standard and robotic-assisted laparoscopic donor nephrectomy in terms of perioperative course, short-term postoperative outcome, and to evaluate the effect of surgeon’s learning curve on these parameters. METHODS: This was a prospective randomized study including 60 patients (mean age, 47 years; age, 21–72 years; 26 males, 34 females) who had been planned laparoscopic donor nephrectomies in our clinic. For comparison of standard and robot-assisted techniques and to evaluate the impact of learning curve, patients were randomized into three groups by a computer, each group containing 20 patients. Group 1: standard laparoscopic donor nephrectomies; Group 2: the first 20 patients who underwent robot-assisted laparoscopic donor nephrectomy; and Group 3: the next 20 patients who underwent robot-assisted laparoscopic donor nephrectomy. RESULTS: Operative time was significantly higher in Group 2 (221.0±45.1 min) than both Group 1 (183.5±16.9 min, p=0.001) and Group 3 (186.5±20.6 min, p=0.002). Similarly, time for laparoscopic system setup was significantly higher in Group 2 (39.5±8.6 min), which contained the first cases of robot-assisted laparoscopic donor nephrectomy where surgeon had least experience than Group 1 (19.3±3.7 min, p<0.001) and Group 3 (24.0±9.4 min, p<0.001). On the other hand, duration of operation and time for laparoscopic system setup was similar between Groups 1 and 3. CONCLUSIONS: Learning curve extends the operative time and laparoscopic system setup time in robotic-assisted laparoscopic donor nephrectomy, however, after the learning process was completed, these parameters were similar between robotic-assisted and standard laparoscopic nephrectomy.

ABSTRACT Objective: We aimed to determine the roles of preoperative thyroid nodule diameter and volume in the prediction of malignancy. Subjects and methods: The medical records of patients who underwent thyroidectomy between January 2007 and December 2014 were reviewed. The nodule diameters were grouped as < 1 cm, 1-1.9 cm, 2-3.9 cm and ≥ 4 cm, and volume was grouped as > 5 cm3, 5-9.9 cm3 and > 10 cm3. ROC (Receiver Operating Characteristic) curve analysis was performed to find the optimal cutoff value of diameter and volume that can predict malignancy. Results: There were 5561 thyroid nodules in 2463 patients. Five hundred and forty (9.7%) nodules were < 1 cm, 2,413 (43.4%) were 1-1.9 cm, 1,600 (28.8%) were 2-3.9 cm and 1,008 (18.1%) were ≥ 4 cm. Malignancy rates were 25.6%,10.6%, 9.7% and 8.5% in nodules < 1 cm, 1-1.9 cm, 2-3.9 cm and ≥ 4 cm, respectively. When classified according to volume, 3,664 (65.9%) nodules were < 5 cm3, 594 (10.7%) were 5-9.9 cm3 and 1,303 (23.4%) were ≥ 10 cm3. The malignancy rates were 12.7%, 11.4% and 7.8% for the nodules < 5 cm3, 5-9.9 cm3 and ≥ 10 cm3, respectively (p < 0.001). In ROC curve analysis, an optimal cutoff value for diameter or volume that can predict malignancy in all thyroid nodules or nodules ≥ 4 cm could not be determined. Conclusion: In this surgical series, malignancy risk did not increase with increasing nodule diameter or volume. Although the volume of malignant nodules ≥ 4 cm was higher than that of benign nodules ≥ 4 cm, there was no optimal cutoff value. The diameter or volume of the nodule cannot be used to predict malignancy or decide on surgical resection.

RESUMO Introdução: Há relatos de uma possível relação entre a melatonina, hormônio secretado pela glândula pineal, e exercício. Objetivo: O presente estudo tem como objetivo investigar como o exercício extenuante diurno e noturno afeta os níveis de melatonina. Métodos: O estudo inscreveu 10 homens sedentários saudáveis que não se exercitavam ativamente. Os sujeitos tinham média de idade de 22,20 ± 0,24 anos, estatura média de 174,60 ± 2,33 cm e peso médio de 69,70 ± 2,42 kg. Duas amostras de sangue foram coletadas dos sujeitos, uma em repouso, às 10h00 da manhã e a outra imediatamente após exercício extenuante. Da mesma forma, foram coletadas amostras de sangue do mesmo grupo de sujeitos depois de 48 horas: às 24h00 em repouso e imediatamente após exercício extenuante. As amostras foram analisadas pelo método ELISA para determinar os níveis séricos de melatonina (pg/ml). Resultados: Ao serem comparados os valores de repouso e depois do exercício, verificou-se que os valores séricos de melatonina permaneceram inalterados após exercício. Os valores séricos de melatonina em repouso e pós-exercício, medidos à noite foram mais elevados em comparação com os valores medidos durante o dia (p < 0,05). Conclusões: Os níveis elevados de melatonina encontrados no estudo parecem resultar do aumento da liberação de melatonina à noite, e não do exercício. Os resultados deste estudo indicam que o exercício extenuante realizado durante o dia ou à noite, não influenciou significativamente os níveis séricos de melatonina.

ABSTRACT Introduction: There are reports of a possible relationship between melatonin, a hormone secreted by the pineal gland, and exercise. Objective: The present study aims to investigate how diurnal and nocturnal strenuous exercise affects melatonin levels. Methods: The study enrolled 10 healthy sedentary males who did not actively exercise. The subjects had a mean age of 22.20±0.24 years, a mean height of 174.60±2.33 cm, and a mean weight of 69.70±2.42 kg. Two blood samples were collected from the subjects, one at rest, at 10:00 am, and the other immediately after strenuous exercise. Likewise, blood samples were taken from the same group of subjects after 48 hours: at 24:00 hours at rest and immediately after strenuous exercise. Samples were analyzed using the ELISA method to determine the serum melatonin levels (pg/ml). Results: By comparing the values at rest and after exercise, it was found that serum melatonin values remained unchanged with exercise. Serum melatonin values at rest or post-exercise measured at night were higher when compared with those measured during the day (p<0.05). Conclusions: Higher levels of melatonin found in the study appear to result from the increased release of melatonin at night, and not from exercise. The results of this study indicate that strenuous exercise carried out day or night, did not significantly influence serum melatonin levels.

RESUMEN Introducción: Hay reportes de una posible relación entre la melatonina, una hormona secretada por la glándula pineal, y el ejercicio. Objetivo: Este estudio tiene como objetivo investigar cómo el ejercicio extenuante diurno y nocturno afecta a los niveles de melatonina. Métodos: En el estudio participaron 10 hombres sanos sedentarios que no hacían ejercicio de forma activa. Los sujetos tenían una edad promedio de 22,20 ± 0,24 años, altura promedio de 174,60 ± 2,33 cm, y peso promedio de 69,70 ± 2,42 kg. Dos muestras de sangre se obtuvieron de los sujetos, una en reposo, a las 10:00 horas de la mañana y la otra inmediatamente después del ejercicio vigoroso. Igualmente, las muestras de sangre se recogieron del mismo grupo de sujetos después de 48 horas: a las 24:00 horas en reposo e inmediatamente después del ejercicio extenuante. Las muestras se analizaron usando el método ELISA para determinar los niveles de melatonina en suero (pg/ml). Resultados: Mediante la comparación de los valores en reposo y después del ejercicio, se encontró que los valores séricos de melatonina se mantuvieron sin cambios después del ejercicio. Ambos valores de melatonina en reposo y después del ejercicio, medidos por la noche fueron más altos en comparación con los medidos durante el día (p < 0,05). Conclusiones: Los altos niveles de melatonina encontrados en el estudio parecen ser el resultado del aumento de la liberación de melatonina en la noche, y no del ejercicio. Los resultados de este estudio indican que el ejercicio extenuante realizado durante el día o por la noche, no afectó significativamente los niveles de melatonina en suero.

ABSTRACT Objective Parathyroid cancer (PC) represents < 1% of cases of PHPT. Tumors demonstrating atypical histopathologic features and don’t fulfill criteria for carcinoma are classified as atypical adenomas (APA). The purpose of this study was to determine a biochemical or ultrasonographic feature that can predict aggressive disease requiring more extensive surgery and closer follow-up. Subjects and methods Twenty eight patients operated for PHPT and diagnosed with atypical adenoma (23 patients) or carcinoma (5 patients) were enrolled in this study. The control group consisted of 102 patients operated between the same dates and diagnosed with classical PA. Classical adenomas, atypical adenomas, and carcinomas were compared according to their biochemical and ultrasonographic parameters. Results Serum Ca levels were significantly higher in the PC group compared with the APA and classical PA groups. Serum median PTH, Serum ALP and UCa was significantly higher in the APA and carcinoma groups compared to the classical PA group. ROC analysis was made to determine the best cut off values for predicting aggressive disease were 12.45 mg/dL, 265.05 pg/mL, 154.5 IU/l, 348.5 mg/day and 21.5 mm for Ca, PTH, ALP, UCa and the adenoma diameter, respectively. Multivariate analysis showed that serum Ca, ALP and isoechoic/cystic appearance were independent predictors for aggressive disease. Conclusion Preoperatively high PTH, ALP, and UCa levels and large lesions with isoechoic or cystic appearances may be predictive of atypical adenoma or carcinoma in patients being evaluated for PHPT. In such cases, surgeons may prefer en bloc parathyroidectomy to minimally invasive surgery.