Ercan Korkut

Granulomatous Mastitis: A Ten-Year Experience at a University Hospital

OBJECTIVE In this study we aimed to define clinical, radiologic and pathological specialties of patients who applied to General Surgery Department of Atatürk University Medical Faculty with granulomatous mastitis and show medical and surgical treatment results. With the help of this study we will be able to make our own clinical algorithm for diagnosis and treatment. MATERIALS AND METHODS We searched retrospectively addresses, phone numbers and clinical files of 93 patients whom diagnosed granulomatous mastitis between a decade of January 2001 - December 2010. We noted demographic specialties, ages, gender, medical family history, main complaints, physical findings, radiological and laboratory findings, medical treatments, postoperative complications and surgical procedures if they were operated; morbidity, recurrence and success ratios, complications after treatment for patients discussed above. RESULTS In this study we evaluated 93 patients, 91 females and 2 males, with granulomatous mastitis retrospectively who applied to General Surgery Department of Atatürk University Medical Faculty between January 2001 and December 2010. Mean age was 34.4 years. The diagnosis was confirmed by histopathologic examination of the lesions. Seventy three patients had idiopathic granulomatous lobular mastitis and 20 patients had specific granulomatous mastitis IGM (18 tuberculosis mastitis, 1 alveolar echinococcosis and 1 silk reaction). All the patients had surgical debridement or antibiotic, and anti-inflammatory treatment with results bad clinical response before applied our clinic. CONCLUSION Empiric antibiotic therapy and drainage of the breast lesions are not enough for complete remission of idiopathic granulomatous mastitis. The lesion must be excised completely. In selected patients, corticosteroid therapy can be useful. In the patients with tuberculous mastitis, abscess drainage and antituberculous therapy can be useful, but wide excision must be chosen for the patients with recurrent disease.

Factors related to recurrence in surgical treatment of hydatid cyst

Amac: Kist hidatigin kuratif tedavisi cerrahi veya girisimseldir. Bununla birlikte kist hidatik tedavisinde rekurrens cok onemli bir sorun olarak karsimiza cikmaktadir. Biz calismamizda klinigimizde hidatik kist nedeniyle opere edilen hastalarda rekurrensi ve rekurrense etki eden faktorleri belirlemeyi amacladik. Yontemler: Retrospektif olan bu calismada, hidatik kist hastaligi nedeniyle cerrahi uygulanan 228 hasta dosyasi incelenerek veriler kayit altina alindi. Bu hastalardan calismaya dahil edilme kriterlerine uymayan 72 hasta calisma disi tutuldu. Sonuclarimiz incelenerek rekurrense etkili faktorler irdelendi. Bulgular: Hastalarin 14’unde (%8.9) rekurrens tespit edildi. Kistin lokalizasyonu, Gharbi siniflandirmasi, uygulanan cerrahi teknik, kistin icerigi, safra yolu istiraki ve tedavisi, postoperatif komplikasyonlar, kistin sayisi ve capi ile nuks arasinda bir iliski tespit edilmedi. Sonuc: Karaciger kist hidatiginde cerrahi sonrasi nukse etkili faktorlerin tespiti hususunda ileriye donuk olarak planlanmis ve daha genis hasta gruplarini iceren calismalarin yapilmasina ihtiyac vardir.

How to close open choledochotomy: primary closure, primary closurewith T-tube drainage, or choledochoduodenostomy?

BACKGROUND/AIM Although common bile duct stones are generally treated endoscopically, surgery is required if endoscopic removal is impossible. The aim of this study was to compare the surgical options in such patients. MATERIALS AND METHODS A total of 282 patients with common bile duct stones underwent open choledochotomy; primary closure was applied in 48 (17.0%), primary closure with T-tube drainage in 81 (28.7%), and choledochoduodenostomy in 153 (54.3%) patients. RESULTS Postoperative complications were seen in 8 (16.7%) patients in the primary closure, 33 (40.7%) patients in the primary closure with T-drainage, and 37 (24.2%) patients in the choledochoduodenostomy group. No significant differences were observed among the groups (P > 0.05). The mean postoperative hospital stays in the primary closure, primary closure with T-tube drainage, and choledochoduodenostomy groups were 5.5, 13.5, and 8.9 days, respectively. The mean postoperative hospitalization was significantly shorter in the primary closure group than in the other groups (P < 0.05). CONCLUSION Primary closure is a safe and feasible method in selected patients.

Typhoid Intestinal Perforations: Has the Clinical Importance Decreased in Eastern Anatolia for 36 Years?

OBJECTIVE Typhoid fever (TF) is an important health problem in developing countries, and typhoid intestinal perforation (TIP) is a serious complication of TF. The present report aims to determine the clinical importance of TIPs for the last 36 years in our region, eastern Anatolia. MATERIALS AND METHODS The clinical records of 84 surgically treated cases with TIPs were reviewed retrospectively. RESULTS When the last 36-year period was sectioned by 6-year periods, the distribution of TIPs was found as 39 (46.4% of total), 31 (36.9%), 7 (8.3%), 4 (4.8%), 2 (2.4%) and 1 (1.2%), respectively. The mean age of the patients was 37.1 years (range: 7-68 years), and 66 patients (78.6%) were male. As a surgical procedure, 34 patients (40.5%) had primary repair, 9 (10.7%) had wedge resection with primary repair, 9 (10.7%) had resection with primary anastomosis, 28 (33.3%) had resection with ileostomy, and 4 (4.8%) had exteriorization. Complications were seen in 71 patients (84.5%), while the mortality rate was 10.7% (9 patients). CONCLUSION Although eastern Anatolia is an endemic region for TF, a certain decrease in the incidence of TIPs was found for the last 36 years. Keeping in mind the TIP, patients with TF may improve the prognosis of this serious disease.

Incidental isolated pancreatic hydatid cyst.

Isolated pancreatic hydatid cysts are a rare parasitic disease even in endemic areas. It is difficult to discriminate primary pancreatic hydatid cysts from other cystic and solid lesions of the pancreas. This is a case report of an incidental isolated pancreatic hydatid cyst. A heterogeneous cystic lesion in the body of the pancreas was identified on magnetic resonance imaging of a patient previously diagnosed patient with cholelithiasis, and because of the malignant possibility of the lesion, splenectomy with distal pancreatectomy and cholecystectomy was performed. The histopathologic diagnosis was reported as a hydatid cyst. Pancreatic hydatid cysts should be kept in mind in the differential diagnosis of pancreatic pseudocysts and cystic malignancies.