Aslan Sakarya

Comparison of three methods in surgical treatment of pilonidal disease

Background: The present study was designed to compare three methods that are still used for the surgical treatment of pilonidal disease: marsupialization, primary midline closure and skin flaps.

p53 and Ki‐67 Expression as Prognostic Factors in Cystosarcoma Phyllodes

We have reviewed the histopathological, clinical outcome and immunohistochemical status in 21 women with cystosarcoma phyllodes (CSP) tumors of the breast. We assessed 12 tumors as histopathologically benign and 9 tumors as malignant. The median patient ages in benign and malignant CSP tumors were 39.6 and 45.4 years of age, respectively. The stromal cellularity, stromal cellular atypism, high mitotic activity, atypic mitoses, stromal overgrowth, infiltrative tumor contour, and heterologous stromal elements were significant features of the malignant CSP tumors. Benign CSP tumors were predominantly of fibroadenomatous architecture with cellular stroma (mild or moderate) and some distortion and elongation of glandular elements. Five malignant CSP tumors were stained positively with p53, and 6 malignant CSP tumors were stained immunohistochemically with Ki‐67. All benign CSP tumors were negatively stained for p53 and Ki‐67. The patients with benign CSP tumors were treated with local excision (n = 11) and with subcutaneous mastectomy (n = 1). Malignant CSP tumors were treated with wide local excision (n = 1), partial mastectomy (n = 1), simple mastectomy (n = 2), and modified radical mastectomy (n = 5). Two patients with a high mitotic rate and high values of p53 and Ki‐67 received additional radiotherapy and chemotherapy. One case had liver metastasis. This tumor had high mitotic figures, stromal overgrowth, severe stromal cellularity, and 20% Ki‐67 and mild p53 positivity. We suggest that p53 and Ki‐67 can play an important role in predicting prognosis and yielding additional therapy besides conventional prognostic factors in the treatment of the CSP patients.

Laparoscopic repair of acquired lumbar hernia.

Lumbar hernias are rare; approximately 300 cases have been described in the literature since their first description. They are typically subdivided by categories such as congenital or acquired and by their location. Acquired lumbar hernias may follow trauma, poliomyelitis, loin incision, and the use of iliac crest as a donor site for bone grafting. Although they tend to grow in size and have a 25% risk of incarceration and 8% risk of strangulation, surgery is indicated once the lesion is confirmed. Many techniques have been described for surgical repair of lumbar hernias, including primary repair, local tissue flaps, and conventional mesh repair. All these open techniques require a large incision plus extensive dissection to expose the area. The first laparoscopic repair of lumbar hernia was described in 1996. The laparoscopic approach for lumbar hernia has significant advantages: it enables exact localization of the anatomic defect, the mesh can be placed deep into the defect allowing intraabdominal pressure to hold it in position, and it also has all the well-known advantages of the laparoscopic approach. We present two cases of laparoscopically repaired acquired lumbar hernias.

A Case of Large Mucinous Adenocarcinoma Arising in a Long-Standing Fistula-in-Ano

Background: Chronic anal fistulas are not rare conditions, however, the development of a carcinoma in a long-standing fistula-in-ano is rare. Methods: The case of a 77-year-old male with a large perianal mucinous adenocarcinoma arising in a long-standing fistula-in-ano is presented. Results: Perianal biopsy revealed mucinous adenocarcinoma. Abdominal CT, double contrast barium examination and flexible sigmoidoscopy revealed no other tumoral lesion in the colon and rectum. Conclusion: The patient underwent abdominoperineal resection including wide tumor excision on the gluteal region. The final reconstruction was performed by bilateral gracilis musculocutaneous flaps. Due to clinical and histopathological evidence it was thought that a curative resection had been performed. To date he is clinically disease free.

The Effect of Tadalafil on Anastomotic Healing in Ischemic Small Intestine in Rats

PurposeTo investigate the effect of tadalafil on anastomotic healing in an ischemic small intestine.MethodsStandardized transection and anastomosis in the small intestine were performed in 48 male Sprague-Dawley rats divided into four equal groups (n = 12): group 1, normal anastomosis; group 2, ischemic anastomosis; group 3, normal anastomosis+tadalafil treatment; group 4, ischemic anastomosis+tadalafil treatment. Ischemia was established by ligating 2 cm of mesentery on either side of the anastomosis. Tadalafil was given to the rats once a day at dose of 5 mg/kg. The anastomotic bursting pressures and hydroxyproline concentrations were measured on postoperative day 4. A histopathological evaluation of the anastomoses was also performed.ResultsThe bursting pressure and hydroxyproline concentration in group 2 were significantly lower than those in the other groups. There was no difference in the hydroxyproline concentration among groups 1, 3, and 4. While there was no difference between groups 3 and 4, the bursting pressures were significantly higher in groups 3 and 4 than in group 1. The histopathological evaluation revealed no significant differences in inflammatory cell infiltration, vascularization, or anastomotic collagen deposition among the groups.ConclusionTadalafil treatment improved the anastomotic bursting pressure and the hydroxyproline concentration in both normal and ischemic small intestine anastomosis.

AKUT KOLESİSTİTİN TANISINDA POWER DOPPLER USLTRASONOGRAFİK-PATOLOJİK KORELASYON

Power Doppler ultrasonography is a new Doppler examination technique which is relatively independent from flow and angle, and it is superior to color Doppler ultrasonography to display small vessels and slow lows. The aim of this study was to investigate the role of Power Doppler ultrasonography in diagnosing acute cholecystitis and differentiating acute from chronic cholecystitis. In one hundred twenty patients with acute right upper quadrant pain or clinically suspected cholecystitis, gallbladder wall vascularity underwent color Doppler ultrasonography and Power Doppler ultrasonography as an adjunct to gray-scale ultrasonography. Imaging findings were compared with pathologic findings in the 48 patients who underwent cholecystectomy. In histopathologic examinations of the operated 48 patients, 23 patients had acute cholecystitis, 25 patients had chronic cholecystitis. With power Doppler ultrasonography, 22 (95%) of 23 patients with acute cholecystitis had hypervascularity in gallbladder wall. Sensitivity and specificity of Power Doppler ultrasonography for revealing acute cholecystitis were 95% and 100%, respectively. As a result, Power Doppler ultrasonography is a very sensitive method for diagnosing acute cholecystitis and differentiating it from chronic cholecystitis. It should be routinely performed in patients with suspected cholecystitis to improve the diagnostic capabilities of gray-scale ultrasonography.