Enver Ozkurt

Mezenter Ven Trombozuna Yaklaşım: Tek Merkez Deneyimi

BACKGROUND Mesenteric vein thrombosis occurs rarely and is responsible for approximately 5-15% of all cases of acute mesenteric ischemia. The aim of this report was to discuss the management of mesenteric vein thrombosis based on our experience with 34 patients. METHODS In the present study, 34 patients who were admitted to our emergency surgery department between January 2007 and January 2010 with a diagnosis of acute mesenteric vein thrombosis were assessed retrospectively. Patients with peritoneal signs first underwent diagnostic laparoscopy to rule out perforation or bowel gangrene. We performed a second-look laparoscopy within 72 hours of the first operation. All patients were administered 100 mg/kg of the anticoagulant enoxaparin twice daily. In the 6th and 12th months of follow up, CT angiography was performed to evaluate recanalization of the veins. RESULTS CT angiography revealed superior mesenteric vein thrombosis in 25 (73%) patients, portal vein thrombosis in 24 (70%) patients, and splenic vein thrombosis in 12 (35%) patients. Eleven patients with peritoneal signs underwent diagnostic laparoscopy; eight of the patients underwent small bowel resection, anastomosis, and trocar insertion. During second-look laparoscopy, small bowel ischemia was found in two patients and re-resection was performed. CONCLUSION Early diagnosis with CT angiography, surgical and non-surgical blood flow restoration, proper anticoagulation, and supportive intensive care are the cornerstones of successful treatment of mesenteric vein thrombosis.

Acute myocardial infarction associated with blood transfusion: case report and literature review.

A 62-year old patient with a history of chronic anemia associated with malabsorption secondary to short gut syndrome, experienced acute chest pain the second hour after the transfusion of a crossmatch-compatible erythrocyte suspension. His electrocardiogram (ECG) revealed widespread ST-segment depressions and he had an elevated troponin level. Laboratory findings and physical examination did not indicate the presence of immunological or non-immunological blood transfusion reactions. Cardiac catheterization was performed and showed angiographically non-obstructive, atherosclerotic plaques and the absence of vasospasm or thrombus formation. Following antiischemic therapy his symptoms resolved completely. The ECG obtained 24 hours after the emergence of chest pain demonstrated normal sinus rhythm with no ST-T wave changes. We present a rare case of acute myocardial infarction induced following a blood transfusion. To the best of our knowledge, a few cases of acute myocardial infarction associated with blood transfusion have been formally recorded in the medical literature and the clinical experience regarding such cases is indeed quite limited. The present case is reviewed in the context of the relevant literature as a practical resource for clinical practice.

Favorable Outcome with Close Margins in Patients Undergoing Nipple/Skin Sparing Mastectomy with Immediate Breast Reconstruction: 5-year Follow-up

Background: Implant-based breast reconstruction after mastectomy has recently been reported to be the preferred type of surgery among breast-specific surgeons and plastic surgeons. Aims: To explore the significant clinicopathological factors associated with long-term outcome related to local recurrences of the nipple among patients who underwent immediate breast reconstruction with tissue expander or implant after mastectomy. Study Design: Retrospective cohort. Methods: From January 2007 to January 2013, 51 breast cancer patients who underwent immediate breast reconstruction with tissue expander or implant were retrospectively analysed. Patients’ demographic data, clinicopathological characteristics, and clinical outcome by disease-free survival and disease-specific survival analyses were determined. Results: The median follow-up was 64 (31-114) months. Of the 57 mastectomies, 41 were skin sparing mastectomy (72%) and 16 were nipple-areola sparing mastectomy (28%). Immediate breast reconstruction surgery included tissue expander (n=46, 81%) or implant (n=11, 19%) placement. The molecular subgroups of 47 invasive cancers were as follows: luminal A (n=23, 49%), luminal B (n=16, 34%), non-luminal HER2 (n=5, 10.6), triple negative breast cancer (n=3, 6.4%). The 5-years disease-specific survival, disease-free survival, and locoregional recurrence-free survival rates were 96.8%, 90%, and 97.6% respectively. Patients with luminal A cancer were found to have an improved 5-year disease-free survival time than other (luminal A; 100% vs. non-luminal A; 78%; p=0.028). Of the 14 nipple-areola sparing mastectomy, 13 had a close median tumour distance to nipple-areola complex (<20 mm) with a 5-year locoregional recurrence free survival of 100%. Conclusion: Immediate breast reconstruction with implant or tissue expander can be safely applied in patients undergoing skin sparing mastectomy or nipple-areola sparing mastectomy. Patients with luminal-A type show the most favourable outcome. During the 5-year follow-up period, patients even with close margins (<20 mm) to nipple-areola complex with nipple-areola sparing mastectomy have excellent locoregional and overall survival when treated by contemporary multidisciplinary oncological management.

Surgical Highlights from the 40th San Antonio Breast Cancer Symposium: 5-9 December 2017, San Antonio, Texas

This year San Antonio Breast Cancer Symposium (SABCS) celebrated its 40th anniversary. As in the past years, this years conference was held in Henry B. Gonzalez Convention Centre, San Antonio, Texas, on 5-9 December 2017. The conference highlighted many different topic on breast cancer including basic science, translational research, local therapies, systemic therapies, survivorship, early clinical trials, and surgical topics. Even though SABCS evolved towards basic science and systemic therapy based manner in recent years, there were some important topics about local therapies and surgical approach. In this conference report, presentations and keynote talks about surgical field and local therapies will be summarised.

Favorable Long-Term Outcome in Male Breast Cancer

Objective Male breast cancer (MBC) is a rare type of cancer in the breast cancer series and in the male population. Data is usually extrapolated from female breast cancer (FBC) studies. We aim to study the clinicopathological characteristics and outcome of MBC patients at our institution and we aim to emphasize the differences compared with FBC. Materials and Methods Between January 1993 and April 2016, 56 male patients who were diagnosed as breast cancer and underwent surgical operation were retrospectively analyzed. Patients were evaluated for demographical characteristics, surgery type, clinicopathological characteristics, adjuvant and neoadjuvant treatments, follow-up time, overall survival (OS), disease free survival (DFS), and disease specific survival (DSS). Results The ratio of MBC among all breast cancers at our institution is 1%. The median age was 64 (34-85). Surgical procedures were modified radical mastectomy (MRM) in 41 patients (77%), simple mastectomy in 11 patients (21%), and lumpectomy in 1 patient (2%). Two patients were Stage 0 (4%), 7 were Stage 1 (13%), 12 were Stage 2 (22.6%), and 32 were Stage 3 (60.4%). Molecular subtypes of the invasive tumors were luminal A in 40 (80%), luminal B in 6 (12%), HER-2 type in 1 (2%), and basal-like in 3 (6%). Median follow-up time was 77 (3-287) months. 5-year and 10-year OS, DFS, and DSS rates were 80.7%, 96%, 95.6% and 71.6%, 81.9%, 91.7% respectively. Conclusion MBC presents different clinicopathological and prognostic factors when compared to FBC. Our survival rates are higher than the average presented in available literature. Because of the high rate of hormone receptor positivity, hormonal therapy is the mainstay for the treatment of estrogen receptor (ER)+ male breast cancer.

Surgical Management of Locally Advanced Breast Cancer

Patients with locally advanced breast cancer (LABC) have historically been considered inoperable cases. However, in light of recent research and studies, even metastatic breast cancers have been down-staged to operable cases using new treatment modalities. The incidence of LABC is less than 5 % [1–3]. Annually, 300,000–450,000 new cases of LABC are diagnosed worldwide.

Paget’s Disease of the Breast

Paget’s disease of the breast is a rare breast tumor that was first identified by Sir James Paget in 1874. It is characterized by eczema-form changes accompanied with erosion and ulceration of the nipple and areolar epidermis. It is mostly correlated with ductal carcinoma in situ (DCIS); additionally, it can be accompanied by invasive ductal carcinoma (IDC). The diagnosis is determined upon microscopically observing Paget cells in a skin biopsy. The width of the lesion is evaluated via mammography and MRI in patients for whom breast-preserving surgery is planned. Depending on the extent of the lesion, sentinel lymph node biopsy and axillary curettage for those having axillary metastases are the treatment alternatives to breast-preserving surgery or mastectomy.

Local-Regional Recurrence After Breast-Conservation Treatment or Mastectomy

Local recurrence after breast-conservation treatment is most often detected by breast imaging followed by a biopsy for histopathological confirmation. Patients with invasive local recurrence should also undergo a staging workup, mostly by a positron emission tomography-computed tomography (PET-CT), to eliminate the possibility of systemic disease. Although mastectomy is the standard treatment, data are also available regarding a repeat breast-conservation approach with or without reirradiation with accelerated brachytherapy or intraoperative radiotherapy with a potential subsequent increased risk for local recurrence.

Male Breast Cancer

Breast cancer is observed in men 100-fold less often than in women. The risk of breast cancer in men is approximately 1 in 1,000 throughout life. The American Association of Cancer predicted that 2,360 men would be diagnosed with breast cancer in 2014 and that 430 male patients with breast cancer would die. Anderson et al. reported on male breast cancer (MBC) from the Surveillance, Epidemiology, and End Result (SEER) database during the period of 1973–2005 and found an annual increase in incidence of 1.19 %, with a peak in 2000 of 1.24 cases per 100,000 men.

Management of Isolated Liver Metastasis

A solitary first metastasis to the liver in breast cancer is an uncommon presentation. Nearly half of all patients with metastatic breast cancer develop liver metastases [1–3], but a minority of patients present with metastatic breast cancer limited to the liver (5–12 %) [3–6]. Among patients who have died of breast cancer, hepatic metastases are found in 55–75 % of autopsies [7]. Overall, the 5-year survival of patients with stage IV breast cancer is currently 23 % [8] and drops to 8.5 % for those patients with liver metastases [4].