Background: Currently, recommended pre-operative risk assessment models including the revised cardiac risk index (RCRI) are not very effective in predicting postoperative myocardial damage after non-elective surgery, especially for elderly patients. Aims: This study aimed to create a new risk prediction model to assess myocardial injury after non-cardiac surgery (MINS) in elderly patients and compare it with the RCRI, a well-known pre-operative risk prediction model. Materials and Methods: This retrospective study included 370 elderly patients who were over 65 years of age and had non-elective surgery in a tertiary hospital. Each patient underwent detailed physical evaluations before the surgery. The study cohort was divided into two groups: patients who had MINS and those who did not. Results: In total, 13% (48 out of 370 patients) of the patients developed MINS. Multivariable analysis revealed that creatinine, lymphocyte, aortic regurgitation (moderate-severe), stroke, hemoglobin, ejection fraction, and D-dimer were independent determinants of MINS. By using these parameters, a model called “CLASHED” was developed to predict postoperative MINS. The ROC analysis comparison demonstrated that the new risk prediction model was significantly superior to the RCRI in predicting MINS in elderly patients undergoing non-elective surgery (AUC: 0.788 vs. AUC: 0.611, p < 0.05). Conclusions: Our study shows that the new risk preoperative model successfully predicts MINS in elderly patients undergoing non-elective surgery. In addition, this new model is found to be superior to the RCRI in predicting MINS.

AIM: Recently, there have been studies on various parameters that can be used to diagnose and follow up thyroid malignancies. These parameters are mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR), and different results have been reported regarding their diagnostic and prognostic effects. Therefore, there is a need for more comprehensive studies on the use of these parameters in diagnosis and follow-up. In this study, we planned to reveal whether MPV, NLR, PLR, and LMR can be used as biomarkers for thyroid carcinomas and whether they differ according to tumor type and size. METHODS: A total of 242 patients aged 18–79 years who underwent thyroidectomy between October 2016 and December 2021 were included in this study. The following variables were analyzed retrospectively: age, sex, pathology results of thyroidectomy materials, and parameters such as MPV, NLR, PLR and LMR of the preoperative complete blood count. The patients included in the study were divided into two groups according to malignant and benign thyroidectomy pathologies. Group 1 (n = 160): Benign pathology. Group 2 (n = 82): Malignant pathology. RESULTS: NLR and PLR were found to be significantly higher in the patients in Group 2 compared to the patients in Group 1 (p = 0.042 and p = 0.003). For the NLR value, sensitivity was calculated as 67.07%, Specificity as 48.75, and cut-off value as >1.503. Area Under Curve (AUC) value for NLR: 0.580. For the PLR value, sensitivity was calculated as 48.78%, Specificity as 70.62, and cut-off value as >111.429. AUC value for PLR: 0.615. A high level, positive and statistically significant correlation was detected between NLR and PLR in patients with tumor size ≥10 mm within Group 2 (r = 0.548, p < 0.001). CONCLUSIONS: We believe that NLR and PLR values may be important predictive biomarkers for thyroid malignancies. As consistent with the literature, NLR and PLR values were statistically significant in our study. An NLR value of >1.503 and a PLR value of >111.429 can be considered a risk factor for thyroid malignancy.

The thyroid gland is an endocrine organ comprising two lobes connected by an isthmus. Thyroid isthmus agenesia (TIA) is a rare anatomical anomaly, which has only been documented in a limited number of case reports. This report presents the case of a 49-year-old female patient who was diagnosed with intraoperative TIA during diagnostic thyroid lobectomy. The patient was arranged for a diagnostic lobectomy of the right thyroid lobe after identifying an atypical nodule of undetermined significance, in the right lobe, which had been confirmed with two distinct biopsies. The patient was discovered to have isthmus agenesia during a neck exploration performed under general anesthesia. Owing to its rarity, the precise clinical and anatomical characteristics of TIA have not been defined, and its underlying cause is still not completely understood. The detection of TIA warrants the considerations of any other accompanying diseases. Prior identification and assessment of surgical approach are crucial for ensuring a secure surgical procedure and mitigating the risk of surgical complications. Nevertheless, caution must be exercised if TIA is detected during operation because preoperative identification is not always feasible. In summation, additional patient reports and studies are required to uncover the underlying cause of this pathological condition.

The most important and serious complication of thyroid surgery is recurrent laryngeal nerve (RLN) injury, and it has been noted that this risk increases considerably in the presence of anatomical variations. Double recurrent laryngeal nerve (DRLN) is very rare among RLN anatomical variations. There are only a few case reports on DRLN in the literature It is crucial to possess surgical expertise and ensure complete visualization of the nerve to minimize the likelihood of RLN injury. Intraoperative nerve monitoring (IONM) is particularly useful in identifying anatomical variations. In a 54-year-old woman undergoing diagnostic left lobectomy+isthmectomy, a left DRLN was identified during intraoperative exploration and meticulous nerve exploration with the assistance of IONM monitoring verified that the impulse conduction in both branches was identical. The surgical procedure was successfully performed without causing any harm to the nerve. Based on the case reports in the literature and our experience with this patient, we believe that surgical expertise and the utilization of IONM can decrease RLN nerve damage and reveal its anatomical variations during thyroid surgery.