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Article: Papillary Thyroid Cancer Presenting with Incidental Skin Lesion: Critical Management of Distant Metastasis.

Tanal, Mert / Aygun, Nurcihan / Uludag, Mehmet

2022 Volume 56, Issue 2, Page(s) 299–302

Abstract: Papillary thyroid cancer can usually metastasize to neck lymph nodes. Distant metastases are generally seen as solid organ metastases, in contrast, skin metastasis can rarely be seen. We present a case with papillary thyroid cancer diagnosed with skin ... ...

Abstract	Papillary thyroid cancer can usually metastasize to neck lymph nodes. Distant metastases are generally seen as solid organ metastases, in contrast, skin metastasis can rarely be seen. We present a case with papillary thyroid cancer diagnosed with skin metastasis as first clinical sign of distant organ metastasis. A 63-year-old male patient admitted with a skin lesion in the left lateral neck. He had undergone subtotal thyroidectomy 14 years ago without relevant history of malignancy. Follicular variant papillary thyroid cancer was detected in the excisional biopsy performed from the cutaneous lesion. A 12 × 10 × 8 mm hyperechoic nodule in the left lobe was detected in USG and evaluated as Bethesta-III in fine needle aspiration biopsy. Bilateral multiple lung metastases were detected on thorax CT, trucut-biopsied from largest nodule and confirmed as metastasis. Carcinoma was not detected in total thyroidectomy, and post-operative multiple RAI therapies were applied. Patients without history of thyroid cancer rarely present with skin metastases and thyroid cancer should not be overlooked in differential diagnosis. Despite meticulous evaluation of the thyroidectomy specimen, tumor may not be detected in the gland. Skin metastasis in papillary thyroid cancer should be evaluated as distant metastasis and investigations for other metastases should be done, and the treatment should be planned in a multidisciplinary manner.
Language	English
Publishing date	2022-06-28
Publishing country	Turkey
Document type	Case Reports
ZDB-ID	3026862-X
ISSN	1308-5123 ; 1302-7123
ISSN (online)	1308-5123
ISSN	1302-7123
DOI	10.14744/SEMB.2021.70846
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: The effects of neuromonitorization in thyroidectomies can be safely evaluated with the standardized technique.

Tanal, Mert / Uludag, Mehmet

Northern clinics of Istanbul

2019 Volume 5, Issue 3, Page(s) 274–275

Language	English
Publishing date	2019-01-28
Publishing country	Turkey
Document type	Journal Article
ZDB-ID	3031921-3
ISSN	2536-4553 ; 2148-4902
ISSN (online)	2536-4553
ISSN	2148-4902
DOI	10.14744/nci.2018.67625
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Article ; Online: Positive lymph node ratio as a prognostic factor for gastric cancer patients: Is it going to supersede positive lymph node number in guidelines?

Çapkinoğlu, Emir / Tufan, Aydin Eray / Ömeroğlu, Sinan / Tanal, Mert / Güven, Onur / Demir, Uygar

Medicine

2023 Volume 102, Issue 20, Page(s) e33757

Abstract: Gastric malignancies constitute the sixth most common cancer with regards to incidence and have the fifth most mortality rates. Extended lymph-node dissection is the surgical modality of choice while treating advanced stage gastric cancer. It is yet a ... ...

Abstract	Gastric malignancies constitute the sixth most common cancer with regards to incidence and have the fifth most mortality rates. Extended lymph-node dissection is the surgical modality of choice while treating advanced stage gastric cancer. It is yet a topic of debate, whether or not the amount of positive lymph nodes after a pathological examination following the surgical intervention is of prognostic value. In this study, it is aimed to evaluate the prognostic significance of positive lymph nodes following the surgery. A total of 193 patients who underwent curative gastrectomy between January 2011 and December 2015 have been considered for a retrospective data collection. The cases with R1-R2 resections, palliative or emergent surgeries are excluded. Metastatic to total number of lymph nodes, corresponded a ratio which was analyzed in this survey and practiced as a predictive parameter of disease outcome. This survey includes 138 male (71.5%) and 55 female (28.5%) patients treated between 2011 and 2015 in our clinic. The survey follow-up duration of the cases range between 0, 2, and 72 months, corresponding an average of 23.24 ± 16.99 months. We calculated cutoff value of 0.09 with, sensitivity is 76.32% for positive to total number of lymph nodes ratio, whereas specivity applies for 64.10%, positive predictive value for 58% and negative predictive value for 80.6%. Positive lymph node ratio has a prognostic value in terms of predicting the prognosis of the patients with gastric adenocarcinoma following a curative gastrectomy. This might in long term contribute to the prognostic analysis of patients if integrated in the current staging system.
MeSH term(s)	Humans ; Male ; Female ; Prognosis ; Stomach Neoplasms/pathology ; Retrospective Studies ; Neoplasm Staging ; Lymph Node Ratio ; Lymph Node Excision ; Lymph Nodes/surgery ; Lymph Nodes/pathology ; Gastrectomy
Language	English
Publishing date	2023-06-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000033757
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Article: Giant parathyroid adenoma diagnosed by brown tumour, a clinical manifestation of primary hyperparathyroidism: A case report.

Yigit, Banu / Tanal, Mert / Citgez, Bulent

JPMA. The Journal of the Pakistan Medical Association

2021 Volume 71, Issue 4, Page(s) 1266–1269

Abstract: Brown tumour (BT) is the pathological expression of osteitis fibrosa cystica which is caused due to primary and secondary hyperparathyroidism (HPT). It is a rare benign lesion of skeletal system that usually affects the facial bones, clavicles, ribs, ... ...

Abstract	Brown tumour (BT) is the pathological expression of osteitis fibrosa cystica which is caused due to primary and secondary hyperparathyroidism (HPT). It is a rare benign lesion of skeletal system that usually affects the facial bones, clavicles, ribs, pelvis and extremities. The purpose of this case report is to present the clinical, pathological and radiological findings of BT - rarely seen in adults - originating from the giant parathyroid adenoma and emerging as the first clinical sign of HPT. The patient underwent a successful parathyroidectomy and was discharged on the first postoperative day without any complications. Histopathologically, it was confirmed as parathyroid adenoma. With the increased use of biochemical tests, HPT is diagnosed and treated early and so the frequency of symptomatic HPT due to parathyroid adenoma has decreased in developed countries, but we still sometimes encounter cases of primary hyperparathyroidism (PHPT) occurring as BT. With multidisciplinary preoperative evaluation, surgical resection of bones is refrained from in order to prevent unnecessary morbidity and mortality, unless these osteolytic bone lesions cause a pathological fracture.
MeSH term(s)	Adult ; Fractures, Spontaneous ; Humans ; Hyperparathyroidism, Primary/diagnosis ; Hyperparathyroidism, Primary/etiology ; Hyperparathyroidism, Primary/surgery ; Osteitis Fibrosa Cystica/diagnostic imaging ; Osteitis Fibrosa Cystica/etiology ; Parathyroid Neoplasms/diagnosis ; Parathyroid Neoplasms/diagnostic imaging ; Parathyroidectomy
Language	English
Publishing date	2021-06-14
Publishing country	Pakistan
Document type	Case Reports
ZDB-ID	603873-6
ISSN	0030-9982
ISSN	0030-9982
DOI	10.47391/JPMA.393
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Article: Unexpected tendency to bleeding in COVID-19 patients: A case of spontaneous retroperitoneal hematoma.

Tanal, Mert / Celayir, Mustafa Fevzi / Kale, Zulfiye Sumeyye

SAGE open medical case reports

2021 Volume 9, Page(s) 2050313X211067907

Abstract: While COVID-19 pandemic has become an enormous and devastating pandemic for today's world, studies on the morbidity of the disease mainly show the disease's progress with pneumonia and thromboembolic pathologies. In this disease with a predisposition to ... ...

Abstract	While COVID-19 pandemic has become an enormous and devastating pandemic for today's world, studies on the morbidity of the disease mainly show the disease's progress with pneumonia and thromboembolic pathologies. In this disease with a predisposition to thromboembolism, findings of nontraumatic focused hemorrhages are unexpected. As spontaneous retroperitoneal hematoma is a serious condition with the absence of symptoms, creating a challenge for diagnosis, it should also be considered in COVID-19 which is thought to be predisposed to thromboembolism. Here, a 47-year-old woman with COVID-19 pneumonia diagnosis (diagnosed by computed tomography (CT) scan and approved by nasopharyngeal swab test) is presented with spontaneous retroperitoneal hematoma, and its management is reported. This case highlights the importance of considering both thromboembolic events and bleeding in cases with COVID-19 positivity. The balance between two sides of clotting mechanisms needs to be understood with novel research.
Language	English
Publishing date	2021-12-23
Publishing country	England
Document type	Case Reports
ZDB-ID	2736953-5
ISSN	2050-313X
ISSN	2050-313X
DOI	10.1177/2050313X211067907
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Article ; Online: Short- and mid-term results of diode laser treatment in pilonidal sinus disease and the role of endoscopic camera use on outcomes.

Bilgin, I A / Tanal, M / Ramoglu, N / Ozben, V / Sahin, I / Aghayeva, A / Sahar, A A / Saylik, O / Baca, B / Hamzaoglu, I / Karahasanoglu, T

Techniques in coloproctology

2023 Volume 27, Issue 10, Page(s) 921–928

Abstract: Purpose: Nowadays, surgical treatment of pilonidal sinus disease (PSD) with novel techniques is a topic of interest since conventional methods are associated with longer return to daily life and higher complication and recurrence rates. Recently, use of ...

Abstract	Purpose: Nowadays, surgical treatment of pilonidal sinus disease (PSD) with novel techniques is a topic of interest since conventional methods are associated with longer return to daily life and higher complication and recurrence rates. Recently, use of laser as a minimally invasive approach has become popular in the surgical treatment of PSD. In this study, we analyze the short- and mid-term results after laser treatment and the effect of endoscopic camera use on outcomes. Methods: A total of 106 patients with PSD who underwent laser treatment between November 2017 and September 2021 were included in this study. All patients were treated with a 1470-nm diode laser. Endoscopic camera was used in 73 patients and results of these were compared with those in whom camera was not used. Follow-up period was determined as a minimum of 1 year. Data were analyzed retrospectively. Results: There were 80 (75%) male and 26 female patients. The median age was 26 (range 13-50) years. On the first postoperative day, 26 (26.5%) patients did not have any pain and 42(42.8%) patients reported low-grade pain. The mean time to return to daily life was 4.5 ± 5.5 (median 2, range 1-30) days. The complication rate was 10.4%. Eighty-six (87.8%) patients completely recovered and the mean complete recovery time was 27.4 ± 15.9 days. The patient satisfaction rate was 99.0%. The recurrence rate was 11.0%. Neither history of previous surgery nor abscess was associated with recurrence. Use of an endoscopic camera had no effect on postoperative pain, complete recovery, complications, patient satisfaction, and recurrence (p < 0.05). Conclusion: Laser treatment for PSD is a promising approach with the advantages of less postoperative pain, early return to daily life, high patient satisfaction, and acceptable complication and recurrence rates. Nevertheless, further studies are needed to investigate the role of endoscopic camera use in this procedure since its possible advantages could not be clarified.
MeSH term(s)	Humans ; Male ; Female ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Treatment Outcome ; Pilonidal Sinus/surgery ; Lasers, Semiconductor/therapeutic use ; Retrospective Studies ; Pain, Postoperative/etiology ; Skin Diseases ; Recurrence
Language	English
Publishing date	2023-06-25
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2083309-X
ISSN	1128-045X ; 1123-6337
ISSN (online)	1128-045X
ISSN	1123-6337
DOI	10.1007/s10151-023-02831-0
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Article: Protective Loop Ileostomy Closure Techniques: Comparison of Three Different Surgical Techniques.

Celayir, Mustafa F / Tanal, Mert / Besler, Evren / Koksal, Hakan

Cureus

2020 Volume 12, Issue 10, Page(s) e10977

Abstract: Objective Anastomotic leaks can be very dangerous in colorectal cancers. Protective loop ileostomy is life-saving in low anterior rectal tumors to prevent pelvic sepsis. The aim of this study is to compare early morbidities for stapled, handsewn closure ( ...

Abstract	Objective Anastomotic leaks can be very dangerous in colorectal cancers. Protective loop ileostomy is life-saving in low anterior rectal tumors to prevent pelvic sepsis. The aim of this study is to compare early morbidities for stapled, handsewn closure (end to end) or handsewn closure (anterior wall only) of loop ileostomy, and to further assess efficacy and safety for each technique. Methods Patients who underwent loop ileostomy closure from January 2014 and December 2019 retrospectively were analyzed. Multivariate logistic regression was used to determine the effect of the potential risk factors on the rate of each complication. The patients were divided into three groups based on the anastomoses. The first group included patients who had handsewn anterior closure; the second group included patients who had side-to-side anastomosis using linear stapler, and the third group included patients who had end-to-end handsewn anastomosis. The primary endpoint of the study was the postoperative 30 days. IBM Statistical Package for the Social Sciences (SPSS), version 22.0 (SPSS Inc., Chicago, IL) was used for statistical analysis. Results A total of 198 patients underwent reversal. There was a statistical difference between the handsewn anterior wall and stapler anastomosis in terms of postoperative ileus and wound infection. The handsewn group was superior to anastomosis with stapler (p: 0.027 and p: 0.042, respectively). A statistical difference was found between handsewn anterior wall closure and handsewn end-to-end anastomosis in terms of postoperative ileus, wound infection, and postoperative hospital stay (p: 0.013, p: 0.037, and p: 0.046, respectively). When stapled anastomosis and handsewn end-to-end anastomosis techniques were compared, a statistical difference was found in terms of postoperative ileus risk (p: 0.043), but no significant difference was found in terms of postoperative wound infection and hospital stay. Conclusions There was no significant difference in the rate of anastomotic leakage between the handsewn and stapled techniques. The rate of small-bowel obstruction was higher in the handsewn group. As a result, in this study, it was revealed that the handsewn anterior wall closure technique is the best among all ileostomy closure techniques.
Language	English
Publishing date	2020-10-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.10977
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Article: A Review of Methods for the Preservation of Laryngeal Nerves During Thyroidectomy.

Uludağ, Mehmet / Tanal, Mert / İşgör, Adnan

Sisli Etfal Hastanesi tip bulteni

2018 Volume 52, Issue 2, Page(s) 79–91

Abstract: The recurrent laryngeal nerve (RLN) provides motor innervation to the abductor and adductor muscles of the vocal cord, whereas the external branch of the superior laryngeal nerve (EBSLN) provides motor innervation to the cricothyroid muscle, which is the ...

Abstract	The recurrent laryngeal nerve (RLN) provides motor innervation to the abductor and adductor muscles of the vocal cord, whereas the external branch of the superior laryngeal nerve (EBSLN) provides motor innervation to the cricothyroid muscle, which is the tensor muscle of the vocal cord. Both the RLN and the EBSLN are anatomically close to the thyroid and are therefore at risk of injury during thyroidectomy. These 2 laryngeal nerves must be carefully preserved during surgery to ensure that the function of the vocal cord is not impaired. Currently, complete exposure of the RLN during thyroidectomy is accepted as the gold standard method for the preservation of RLN. Sufficient knowledge of surgical anatomy, clinical experience, and meticulous surgical techniques are key factors in the identification and safe dissection of the RLN. During a thyroidectomy, the RLN can be identified using four different approaches, depending on the type of thyroid growth and choice of the surgeon: There are lateral, inferior, superior, and medial approaches. The lateral approach is the most commonly used technique in primary thyroid surgery. The RLN is usually found by dissection around the inferior thyroid artery at the level of the middle lobe of the thyroid. RLN is generally found at the site of its entry into the neck region devoid of scar formation when the inferior approach is used especially in cases with secondary surgery. The superior approach is recommended for patients with an huge goiter or large substernal goiter. In this approach, the upper pole of the thyroid is first released and then pulled forward and laterally, and the RLN is exposed on the nerve's entry point (NEP), into the larynx, under the cricopharyngeus muscle. The medial approach is preferred for patients with substernally or retropharyngeally enlarged goiters. In this approach, the isthmus is first dissected and divided, and then the isthmus and the medial part of the lobe are dissected away from the trachea to reveal the anterolateral part of the trachea. The fibers between the lateral aspect of the second or third tracheal rings and the thyroid, and the fibers of the Berry ligament are gradually dissected cranially, to allow RLN to enter into the field of view lateral to the trachea. The preservation of the anatomical integrity of the RLN does not indicate that its functional integrity is also preserved. IONM is a tool for the functional assessment of RLN, and so this method is an addition to visually identifying RLN, which is the gold standard. IONM significantly contributes to visual identification of the RLN, determination of its anatomical variations, intraoperative recognition of RLN injury, prevention of bilateral vocal cord paralysis, and detection and preservation of electrical activity in the nerve in patients with preoperative vocal cord paralysis. Although there is no standardized method for the preservation of the EBSLN, 3 methods have been defined during the release of the upper pole of the thyroid. These methods involve dividing the branches of the superior thyroidal artery one by one on the capsule without visually identifying the EBSLN, searching and visually identifying the EBSLN before the dissection of the upper pole vessels, or detecting the EBSLN and dissecting the upper pole under the guidance of IONM. IONM also significantly contributes to the detection and confirmation of the EBSLN and dissection and preservation of the upper pole of the thyroid gland.
Language	English
Publishing date	2018-06-18
Publishing country	Turkey
Document type	Journal Article ; Review
ZDB-ID	3026862-X
ISSN	1308-5123 ; 1302-7123
ISSN (online)	1308-5123
ISSN	1302-7123
DOI	10.14744/SEMB.2018.37928
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Article: Standards and Definitions in Neck Dissections of Differentiated Thyroid Cancer.

Uludağ, Mehmet / Tanal, Mert / İşgör, Adnan

Sisli Etfal Hastanesi tip bulteni

2018 Volume 52, Issue 3, Page(s) 149–163

Abstract: Papillary and follicular thyroid carcinomas arising from the follicular epithelial cells and forming differentiated thyroid cancer (DTC) consist of >95% of thyroid cancers. Lymph node metastasis to the neck is common in DTC, especially in papillary ... ...

Abstract	Papillary and follicular thyroid carcinomas arising from the follicular epithelial cells and forming differentiated thyroid cancer (DTC) consist of >95% of thyroid cancers. Lymph node metastasis to the neck is common in DTC, especially in papillary thyroid cancer. The removal of only the metastatic lymph nodes (berry picking) does not help to achieve a potential positive contribution to the survival and recurrence of lymph node dissection in the DTC. Thus, systematic dissection of the cervical lymph nodes is needed. Today, according to the widely accepted and commonly used definitions and lymph node staging, the deep lymph nodes of the lateral side of the neck are divided into five regions. Based on the fact that some groups have biologically independent regions, Groups I, II, and V are divided into the A and B subgroups. The central region lymph nodes contain VI and VII region lymph nodes, which consist of the prelaryngeal, pretracheal, and right and left paratracheal lymph node groups. Radical neck dissection (RND) is accepted as the standard basic procedure in defining neck dissections. In this method, in addition to all the regions of the Groups I-V lymph nodes at one side, the ipsilateral spinal accessory nerve, internal jugular vein, and sternocleidomastoid muscle are removed. Sparing of one or more of the routinely removed non-lymphatic structures in the RND is called modified RND (MRND), whereas the preservation of one or more of the routinely removed lymph node groups in the RND is termed as selective neck dissection (SND). In difference, the procedure with an addition of a lymph node and/or non-lymphatic structures to routinely removed neck structures in RND is called extended RND. Generally, involving one or more regions of SND are applied for DTC. The removal of the paratracheal, prelaryngeal, and pretracheal lymph node groups at one side is termed as ipsilateral central dissection, whereas the removal of the bilateral paratracheal lymph node groups, in other words, the excision of four lymph node groups in the central region (Groups VI and VII), is defined as bilateral central dissection. In conclusion, bilateral central neck dissection (CND) is the SND in which the regions of VI and VII are removed. In the DTC, CND is prophylactically and therapeutically applied, whereas lateral neck dissection is performed only therapeutically in the presence of clinical metastasis (N1b) in the lateral neck region. Debates on the extent of SNDs to be made in the central and lateral neck regions are still ongoing. Central dissection should be made at least unilaterally. In the lateral side of the neck, SNDs can be applied in different combinations in which at least one region from Groups I to V is removed. The main variables that determine the extent of SND in the central and lateral regions in DTC are the complication rates, the effect of the procedure, and its effect on prognosis and recurrence.
Language	English
Publishing date	2018-10-01
Publishing country	Turkey
Document type	Journal Article ; Review
ZDB-ID	3026862-X
ISSN	1308-5123 ; 1302-7123
ISSN (online)	1308-5123
ISSN	1302-7123
DOI	10.14744/SEMB.2018.14227
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Article ; Online: Management of Nonocclusive Mesenteric Ischemia in Patients with Cardiac Failure.

Ömeroğlu, Sinan / Tanal, Mert / Beyaz, Metin Onur / Güven, Onur / Demir, Ibrahim / Kabul Gürbulak, Esin / Demir, Uygar

The heart surgery forum

2022 Volume 25, Issue 5, Page(s) E649–E651

Abstract: Aim: This study aimed to evaluate the surgical procedures, outcomes, and prognostic factors in patients with ischemic heart disease who were operated on due to nonocclusive mesenteric ischemia (NOMI).: Material and methods: This research contains all ...

Abstract	Aim: This study aimed to evaluate the surgical procedures, outcomes, and prognostic factors in patients with ischemic heart disease who were operated on due to nonocclusive mesenteric ischemia (NOMI). Material and methods: This research contains all patients diagnosed with congestive heart failure and NOMI between January 2011 to January 2020. The patients who had angiography or CT that showed occlusion of more than 50% in any of the main branches of the mesenteric artery or patients who presented with symptoms in correlation with a total occlusion were excluded from the study. Patients who underwent coronary heart surgery but were not diagnosed with congestive heart failure and those with atrial fibrillation also were excluded from the study. Patients divided into two groups, according to a medical database. Results: A significant difference was found between the surviving and non-survivor groups in minutes, in terms of median time to segmenter intestinal resection (P = 0.042). Conclusion: An early diagnosis and surgical segmental intestinal resection before peritonitis worsens can be the key to better prognosis for NOMI patients.
MeSH term(s)	Humans ; Mesenteric Ischemia/diagnosis ; Mesenteric Ischemia/surgery ; Cardiac Surgical Procedures ; Heart Failure ; Prognosis
Language	English
Publishing date	2022-09-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2069188-9
ISSN	1522-6662 ; 1098-3511
ISSN (online)	1522-6662
ISSN	1098-3511
DOI	10.1532/hsf.4879
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