Gökhan Demiral

Diagnostic Value of Hook Wire Localization Technique for Non-Palpable Breast Lesions

Background The aim of this study was to investigate the validity of hook wire localization biopsy for non-palpable breast lesions which were detected by ultrasonography (USG) or mammography (MMG). Methods In this retrospective study, USG or MMG-guided hook wire localization technique was performed on 83 patients who had non-palpable breast lesions. Then histopathological examination was performed on surgically removed specimens. All patients’ mammograms or ultrasonograms were categorized using Breast Imaging-Reporting and Data System (BI-RADS) classification. Results Radiologically, 27 (32.53%) patients were classified as BI-RADS 3, 49 (59.04%) BI-RADS 4, one (1.2%) BIRADS 5 and six (7.23%) BI-RADS 0. Histopathological results were benign in 68 (81.9%) and malignant in 15 (18.1%) patients. Twenty-seven patients were classified as BI-RADS 3 and definitive diagnoses for all were benign. Besides, 49 patients were classified as BI-RADS 4 and histopathologically 14 of them were reported as malignant, and 35 as benign. Sensitivity of MMG was 93% and specificity was 55%. For USG, the sensitivity was 100% and the specificity was 73%. Conclusion In early diagnosis of breast cancer, the validity of the imaging-guided hook wire localization biopsy of non-palpable breast lesions has been proved. The cooperation of surgeon, radiologist and pathologist increases the successfull results of hook wire localization technique.

A retrospective analysis of early and late term complications in patients who underwent application of retention sutures for gastrointestinal tract malignancies.

OBJECTIVE Complications associated with wound healing after abdominal tumor operations continue to be a significant problem. This study aimed to determine the significance of retention sutures in preventing these complications. For this purpose, early and late term results of patients who underwent application of polydioxanone (PDS) and additional retention sutures for abdominal closure were retrospectively evaluated. MATERIAL AND METHODS Clinical files of 172 patients who were operated due to gastrointestinal tract malignancies in our clinic between January 2007 and January 2011 were retrospectively analyzed. Patients in whom the fascia was repaired only with PDS (Group 1) were compared to patients in whom the fascia was repaired with PDS and retention sutures (Group 2) in terms of age, gender, postoperative evisceration-wound infection (<1 month), incisional hernia (>1 month), incision type, co-morbid factors, and operative time. RESULTS There was no significant difference between the two groups in terms of age or gender (p=0.680 and p=0.763). No significant difference was detected in terms of postoperative incisional hernia (p=0.064). Evisceration and post-operative wound infection were significantly lower in Group 2 as compared to Group 1 (p=0.008 and p=0.002). Operative time was significantly longer in Group 1 than in Group 2 (p<0.0001). Co-morbid features were significantly higher in Group 2 than in Group 1 (p<0.0001). There were no significant differences between the groups in terms of incision type (p=0.743). CONCLUSION In the presence of co-morbid factors that disrupt wound healing in surgical patients with gastrointestinal malignancy, retention suture can be safely used as a supplement for optimal wound care.

Covered self-expandable metallic stents in benign pyloric obstruction: long term results

Background/aim: The Self-Expandable Metalic Stent (SEMS) was firstly used for treatment of malignant obstruction of the esophagus, pylorus and colon. Nowadays some recent studies has been documented the use of SEMS in Benign Pyloric Obstruction (BPO). In this study we aimed to evaluate the efficacy of covered SEMSs in BPO. Method: A total 15 patients hospitalized with BPO and underwent SEMS between June 2012 and May 2016. Data were analysed retrospectively. Results: Study was consisted of 6 female and 9 male patients with a median age of 55.4 (27-73 y) and follow-up time of 42.7 (27-60 months). SEMS technically applied with success in all patients. BPO was due to peptic ulcer in 6 patients (40%) and peptic ulcer perforation surgery in 9 (60%). Gastric Outlet Obstruction Scoring System (GOSS) was used to assess symptom improvement. Significant symptomatic improvement was observed on 3rd day with GOOSS 3 in twelve patients and GOOSS 2 in three patients after stenting. Also sixth month GOOSS scores were 3 in 12 patients (three patients were operated after stenting). Major complications was observed in four patients (26.7%); stent migration in 2, perforation and bleeding in 1. Minor complications were gastoparesis and dyspepsia in 6 patients, abdominal pain in 2, halitosis in 2 and hematemesis in 1, and severe vomiting in 1. Two patients were symptom free (13.3%). Helicobacter pylori test was positive after stenting and Hp eradication was applied to all patients. Conclusion: Covered SEMS has the advantages of low complications, rapid improvement in obstructive symptoms and high patient compliance in BPO.

Cyanoacrylate application on colonic anastomosis: is it safe or not?

Introduction Major complications of colonic anastomosis include fistula, bleeding, and anastomotic stricture, and the most common one is anastomotic leakage. Many organic or inorganic tissue adhesives are being used such as fibrin glue or cyanoacrylate to strengthen or protect colonic anastomosis. Up to now, a great number of studies have been carried out to investigate the effects of these biomaterials. Aim To determine the effect of cyanoacrylate application on anastomosis safety. Material and methods In this experimental study, rats were divided into two groups; a control group and an experimental group. Full-thickness incisions were done on the left colon of the rats, and then end-to-end anastomosis was performed by using 5/0 silk separated sutures. In the experimental group we applied cyanoacrylate over the sutures. The samples were taken on the 7th day. Results In the control group the average tissue hydroxyproline levels and the average bursting pressures were significantly higher than in the experimental group. Conclusions The purpose of all the experimental studies is to prevent and reduce anastomotic complications. Despite all the studies that have been done, colonic anastomosis complications continue to be a problem. As a result, we suggest that cyanoacrylate has a negative effect on the healing process of colonic anastomosis.