Ali Cihat Yıldırım

Mastalgia-Cancer Relationship: A Prospective Study

OBJECTIVE Mastalgia is an important symptom affecting approximately 70% of women and it disrupts the quality of life especially due to the worry of having cancer. In our study, the type and severity of mastalgia symptom of patients who presented to the outpatient clinic with mastalgia complaint were assessed along with their physical examination findings and radiology results. The purpose of the study is to demonstrate the relationship between mastalgia and malignity when assessed in combination with the risk factors of patients. MATERIALS AND METHODS The age, family history, menopausal status, age at the first childbirth, menarche, presence/absence of hormone replacement therapy, type of mastalgia, comorbidities and examination findings of 104 patients, who presented to the General Surgery outpatient clinic with mastalgia symptom, were recorded and assessed in the light of radiological study results. RESULTS With respect to the mastalgia types of the patients, 38.5% had cyclic pain, 57.7% non-cyclic pain and 3.8% other types of pain. Mild mastalgia was present in 46.2% of the patients, moderate mastalgia in 24% and severe mastalgia in 29.8% of them. According to the BIRADS category, 48.1% of the patients were identified to have BIRADS 1 mass lesions, 39.4% BIRADS 2, 9.6% BIRADS 3 and 2.9% BIRADS 5 mass lesions. The patients who were identified to have BIRADS 5 mass lesions described non-cyclic and severe pain in the post-menopausal period. They had palpable masses along with the pain symptom. CONCLUSION Our study suggests that mastalgia symptom does not per se result in suspicion of malignancy, but physical examination and radiological imaging should also be used as needed for confirmation. Studies with a larger patient population are needed to shed light on the mastalgia epidemiology and its relationship with cancer.

Giant serous microcystic pancreas adenoma

Serous cystadenomas are rare tumors comprising 1–2% of exocrine pancreas tumors. They are mostly known as benign conditions but malign transformation as serous cystadenocarcinoma is also reported. It is usually seen in females. Non-specific symptoms, such as abdominal pain or symptoms due to mass affect, are usually seen. A 64-year old female patient was investigated for abdominal pain. Physical and laboratory findings were normal. Abdomen ultrasonography confirmed an 11×9.5 cm solid cystic lesion and abdomen computed tomography scan confirmed a 12×11 cm lobulated cystic solid lesion which had central cystic necrotic areas extending from liver hilus inferiorly. Fine needle biopsy confirmed benign cytology and trucut biopsy of the pancreatic mass reported chronic inflamation. Nevertheless, this mass could have malignant contents and transformation potential. A laparatomy was decided due to patients symptoms and mass effect. Due to vascular invasion of the tumor, Whipple procedure was performed. The pathology report confirmed serous microcystic adenoma. These rare tumors are usually benign but pre-operative malignity criterias are not identified. There are few differential diagnostic tools for excluding malignity. We suggest surgical resection as best treatment approach for selected cases.

Do elevated blood calcium levels in patients with peptic ulcer facilitate perforation

Aim: Calcium is primarily stored in bones in the body. The increase in blood calcium level due to primary or secondary causes leads to several impairments of the gastrointestinal system like anorexia, nausea-vomiting, peptic ulcer (PU), and abdominal pain. In this study, we want to compare and analyse the difference in blood calcium levels of patients who underwent surgery for peptic ulcer perforation (PUP) and those diagnosed with PU by endoscopy. Material and Methods: Between May 2012-January 2017, patientsÂ’ data for PU disease were recorded and our study was planned retrospectively Patients were sorted into two groups: Group1 included patients operated for PUP; and Group2 included the patients with administered medical therapy for PU disease. Blood calcium levels during admission, age, gender and drug history of patients were recorded. Study exclusion criteria were patients whose data were missing (113 patients), patients who had metabolic bone disease, patients who had been using calcium channel blockers and who were administered anti-ulcer drugs. Results: Twenty-eight patients had PUP and 176 patients had PU disease. Group 1 had a lower mean age (p=0.017), and higher male gender rate (p

Kabergolinle Tedavi Edilen Postoperatif Süt Fistülü

Ozet Sut fistulu, laktiferoz bir kanal ile cilt arasinda genellikle cerrahi sonrasi olusan bir yoldur. Olusum surecini aciklayan cesitli hipotezler ortaya atilmistir.23 yasinda emziren bir anne klinigimize mastalji sikayeti ile basvurdu. Yapilan muayenede saptanan palpabl kitlenin ultrasonografisi 21x15 mm’lik lobule irreguler sinirli malign suphesi tasiyan kitleyi ortaya koydu. Eksizyonel biyopsi sonrasi 3. Gunde sut fistulu gelisti. Yara pansumani ve genis spektrumlu antibiyotik baslandi. Sut fistulune yonelik kabergolin 0,5 mg tablet haftada iki kez oral yolla uygulandi. Postoperatif ikinci haftada drenaj tamamen kesildi ve yara spontan olarak iyilesti. Sut fistulu her ne kadar yaygin olmasa da,can sikici bir komplikasyondur.Fistuller,primer suturasyon veya spontan granulasyonla iyilesir. Siklikla oral antibiyotikler kullanilir. Vakamizda kabergolin hassas yara bakimi tedavisi ile birlikte etkili olmustur,fistul primer suturasyona gerek kalmadan spontan granulasyonla iyilesmistir