Aydin Inan

Breast abscesses in lactating women.

We designed a prospective study to assess the contributing factors in puerperal breast abscess and to evaluate the treatment options. During the 4-year study period, 128 nursing women with breast infection were followed. Of these, 102 had mastitis (80%) and 26 had breast abscess (20%). Ultrasonographic examination was performed in all cases. Patient age, parity, localization of infection, cracked nipples, duration of lactation, duration of symptoms, milk culture results, breast infections during previous lactation period, treatment options, healing time, and recurrence were recorded prospectively. All mastitis patients were treated with antibiotics and none developed an abscess. Ten abscesses were aspirated, and 16 abscesses were treated by incision and drainage. Healing times were similar. There was no significant difference between mastitis and abscess groups regarding age, parity, localization of breast infection, cracked nipples, positive milk cultures, or mean lactation time. Duration of symptoms and healing were longer in cases of abscess. Multivariate analyses showed that duration of symptoms was the only independent variable for abscess development. Recurrent mastitis developed in 13 patients (10.2%) within a median of 24 weeks of follow-up. Delayed treatment of mastitis can lead to abscess formation, and it can be prevented by early antibiotic therapy. Ultrasonography is helpful for detecting abscess formation. In selected cases the abscess can be drained with needle aspiration with excellent cosmesis.

Local anesthesia use for laparoscopic cholecystectomy

This study aimed to investigate the effects and timing of local anesthesia during laparoscopic surgery in terms of postoperative pain, nausea, and the need for opioids and antiemetics. This prospective study was carried out on 142 patients who underwent laparoscopic cholecystectomy. Peroperative local anesthesia was not administered to 53 patients (group A). The skin, subcutis, fascia, and parietal peritoneum were infiltrated with 0.5% bupivacaine HCl at trocar sites before trocar insertion in 46 patients (group B). Local anesthesia was given to 43 patients in equal doses at the same sites and the same manner at the end of surgery (group C). The higher requirement for analgesics in group A patients was statistically significant when compared with that in group B and C patients. The mean doses of analgesics postoperatively were significantly higher in group B than in group C. The time delay to the first antiemetics was significantly shorter in group A than in group C. Applying local anesthesia to the skin, subcutis, fascia, and parietal peritoneum through trocar sites reduces the postoperative analgesic requirement and pain intensity. This approach is more effective when applied at the end of an operation than at the start.

The Effect of Purified Micronized Flavonoid Fraction on the Healing of Anastomoses in the Colon in Rats

PurposeAnastomotic leakage of colonic and rectal anastomoses is a major complication after large intestine surgery. Many factors influence the healing of colon anastomoses. Flavonoids have been recognized for centuries as physiologically active constituents that are used to treat human diseases. We studied the effects of a clinically used, micronized, purified flavonoid fraction on the healing of colonic anastomosis in rats.MethodsMale Sprague–Dawley rats were used. The flavonoid group of rats received 100 mg/kg per day of Daflon for 14 days until surgery. Thereafter, a resection and anastomosis were performed. The bursting pressure of the anastomoses and the hydroxyproline levels of the perianastomotic tissue were determined to evaluate the healing on the third and seventh days of surgery for both flavonoid and control groups.ResultsThe bursting pressure of the flavonoid group was higher on the seventh day. The hydroxyproline levels of the flavonoid group were significantly higher than in the control group on both the third and seventh days after surgery.ConclusionsAlthough the micronized purified flavonoid fraction has some inhibitory properties on the healing of the anastomosis, its net effect was to obtain a better anastomotic healing of the colon in rats.

Comparison of Direct Trocar and Veress Needle Insertion in the Performance of Pneumoperitoneum in Laparoscopic Cholecystectomy

Abstract Veress needle insertion, direct trocar insertion and open technique are different methods of establishing pneumoperitoneum to perform a successful laparoscopic procedure. We conducted this study to compare the use of a Veress needle and direct trocar insertion to create pneumoperitoneum. 274 laparoscopic cholecystectomy operations were evaluated. There were no significant differences in the age and gender between Veress needle and direct trocar entry groups. In this study we have seen that the complication rate while performing pneumoperitoneum by direct trocar entrance was less than in Veress needle usage. Direct trocar entrance also reduces the operation time. In laparoscopic cholecystectomy the direct trocar entrance method is a more reliable and less time consuming method than Veress needle usage.

Effects of Aloe vera on colonic anastomoses of rats

Background:  Aloe vera is a cactus‐like plant that grows in hot, dry regions. Aloe vera has been known and used in traditional medicine and also in the modern world. Aloe vera has some pharmacological actions including wound healing, anti‐inflammatory and immunostimulatory effects. We have studied the possible effects of Aloe vera gel on the healing of colonic anastomoses of rats.

Effect of Vitamin A on the CD44 Expression in the Small Intestine of Rats with Obstructive Jaundice

Hypothesis: In this study, the influence of obstructive jaundice on the CD44 expression in the rat small intestine and the alterations of this CD44 expression by vitamin A given intraperitoneally (200 IU/g/day) are evaluated. Materials and Methods: In a prospective animal model study, 32 Sprague-Dawley rats were randomized into four groups: group A rats (n = 8) underwent sham operation and were given daily saline intraperitoneally for 2 weeks (sham + saline); group B animals (n = 8) underwent sham operation and were given daily vitamin A intraperitoneally for 2 weeks (sham + vitamin A); group C rats (n = 8) underwent common bile duct ligation and were given daily saline intraperitoneally for 2 weeks (obstructive jaundice + saline), and group D animals (n = 8) underwent common bile duct ligation and were given daily vitamin A intraperitoneally for 2 weeks (obstructive jaundice + vitamin A). After 2 weeks, standardized jejunum and ileum segments were harvested from all animals. The expression of CD44 on the cell surface was evaluated immunohistochemically. Comparisons among the four groups were done. Results: The plasma bilirubin, aspartate transaminase, alanine transaminase, alkaline phospatase, and γ-glutamyltransferase levels in groups C and D (obstructive jaundice groups) were higher than those in groups A and B (sham groups; p < 0.05). There was no difference between groups A and B (sham groups) with regard to the number of cells expressing surface CD44 in jejunum and ileum. When groups A and B were compared with group C (obstructive jaundice + saline) animals, the number of cells expressing surface CD44 was significantly decreased in both jejunum and ileum in group C. The difference between sham groups (A and B) and group C was found to be significant (p < 0.05). When group D (obstructive jaundice + vitamin A) was compared with group C (obstructive jaundice + saline), the number of cells expressing surface CD44 was significantly increased in jejunum and ileum in group D animals (p < 0.05), higher than in the sham groups (A and B). The difference between group D and sham groups (A and B) was found to be significant (p < 0.05). Conclusion: Obstructive jaundice for 2 weeks significantly decreased the CD44 expression in the rat small intestine. We found that daily intraperitoneal administration of vitamin A in rats with obstructive jaundice for 2 weeks significantly restored the impaired CD44 expression.

Incidental giant adrenal lymphangioma presenting as nonfunctional cystic mass

Surrenal masses can be encountered with many different clinical manifestations and a diverse spectrum of etiologies in clinical practice. Recent advances in imaging and laboratory studies as well as their increasingly widespread use and easy accessibility have currently made it possible to diagnose a greater number of surrenal masses than ever. The basic approach principles vary for incidentally detected masses, benign/malignant masses, and hormonoactive masses. Lymphangiomas are benign congenital malformations of lymphatic channels that primarily affect the neck and head region. They are typically found in children younger than 2 years of age, they are uncommon in adults, and they rarely involve surrenal glands. In this paper, we present a woman with a hormonally inactive right giant surrenal mass showing recent rapid growth, which was diagnosed to be a lymphangioma with an atypical localization in the histopathological examination. The patient was operated with right surrenalectomy and total mass excision via laparoscopic lateral transperitoneal approach.

Synchronous Partial Intestinal Malrotation and Duodenojejunal Junction Adenocarcinoma: An Unusual Clinical Presentation

Asymmetrical but normal arrangement of organs within the chest and abdomen is known as situs solitus. Situs inversus is a congenital abnormality wherein the main visceral organs are located in the opposite or mirror positions of their original positions. Situs viscerum inversus totalis is the most common form wherein all visceral organs are translocated around the sagittal plane, and it affects 1 of every 4000–5000 live births. Situs viscerum inversus partialis occurs more rarely and affects a single or a number of internal organs. Although all organs in the abdominal cavity may be affected, cases with only intestinal transposition have also been reported (1). Here we report a seldom encountered case of concurrent duodenojejunal junction adenocarcinoma and partial intestinal malrotation.

Male Breast Cancer

Male breast cancer (MBC) is a rare disease, accounting for less than 1% of all breast cancer diagnoses worldwide. Although breast carcinomas share certain characteristics in both genders, there are notable differences. Most studies on men with breast cancer are very small. Thus, most data on male breast cancer are derived from studies on females. However, when a number of these small studies are grouped together, we can learn more from them. This review emphasizes the incidence, etiology, clinical features, diagnosis, treatment, pathology, survival, and prognostic factors related to MBC.

Meme kanseri tanısı konmuş kadınlarda risk faktörlerinin güncel veriler ışığında gözden geçirilmesi

Amac : Bu calismada meme malign neoplazm tanisi konmus hastalarda risk duzeyi degerlendirildi ve risk faktorlerinin erken tani icin yapilan tarama calismalarina katkisi arastirildi. Hastalar ve yontemler : Turgut Ozal Universitesi Tip Fakultesi Hastanesi Genel Cerrahi poliklinigine Ocak 2005 - Aralik 2012 tarihleri arasinda meme hastaliklari sikayetiyle basvuran, meme formu tam olarak doldurulmus meme malign neoplazmi tanisi konmus 290 kadin hasta (ort. yas 49.2 yil; dagilim 25-75 yil) calismaya dahil edildi. Veri toplama araci olarak hastanenin elektronik veri tabani ve verilerin degerlendirilmesinde sayi ve yuzdelik dagilimlar kullanildi. Bulgular : Arastirma kapsaminda yer alan kadinlarin %90’inin 35 yas ustu, %86.6’sinin evli, %59’unun fazla kilolu oldugu belirlendi. %93.8’inin 15 yas oncesi menars, %61.7’sinin adetlerinin duzensiz, %44.8’inin premenopozal donemde, %38.3’unun postmenopozal donemde ve %54.5’inin 50 yas sonrasi menopoz donemde oldugu belirlendi. %33.8’inin iki cocuga gebe kaldigi, %52.8’inin bir veya iki kez dogum yaptigi ve %60.4’unun ilk dogumlarini 20-30 yas araliginda yaptigi, %39’unun cocuklarini en cok 12 ay emzirdigi, %72.1’inin oral kontraseptif kullanmadigi, kullananlarin %84’unun bes yildan az kullandigi, %92.4’unun hormon replasman tedavisi kullanmadigi, kullananlarin %81.8’inin bes yildan az kullandigi belirlendi. Kadinlarin %90.7’sinin rahim ve yumurtaliklara ait patolojilerinin olmadigi, %69.3’unun memeyle ilgili herhangi bir ameliyat gecirmedigi, %74.4’unun ailesel meme kanseri oykusu olmadigi, %41.2’sinin yakinmasinin olmadigi ve %52.8’inde fizik muayene bulgusu saptandigi belirlendi. Sonuc : Arastirma kapsamina alinan kadinlarin meme kanseri gelismesine neden olan guncel risk faktorlerine anlamli olcude sahip olduklari ve kadinlarin erken tani icin yapilan tarama islemlerinde etkin rol ustlenmeleri gerektigi kanisina varildi. Bu baglamda kadinlarin bilinclendirilmesi icin yapilmasi gereken calismalarin oldukca onemli oldugu dusunuldu.