Muammer Karaayvaz

Primary leiomyosarcoma of the breast

Sarcomas of the breast are rare, accounting for about 1% of all malignant breast tumors. Leiomyosarcoma of the breast was an almost unknown tumor until some 20 years ago, and the few previously published cases lacked detailed information. Only 11 well-documented cases of leiomyosarcoma of the breast had been reported in the literature up to February 1992. The clinical features, diagnosis, therapy, and prognosis are discussed here in the light of the previously published literature.

The effect of lymphatic blockage on the amount of endotoxin in portal circulation, nitric oxide synthesis, and the liver in dogs with peritonitis.

This study was performed to investigate the effect of lymphatic blockage on the amount of endotoxin in portal venous blood, nitric oxide synthesis, the release of aspartate aminotransferase (AST) from the liver, hepatic damage, and survival in an experimental model of dogs with peritonitis. The dogs were divided into a control group (group 1), an unligated thoracic duct peritonitis group (group 2), and a ligated thoracic duct peritonitis group (group 3). Peritoneal fluid and blood from the portal vein and femoral artery were taken for peritoneal culture, endotoxin, and AST assay, respectively, and liver biopsies were performed to assess for hepatic damage and for nitric oxide assay. There was a higher bacteria count in the peritoneal fluid from group 3 than in that from group 2 (P<0.0001). Bacteria grew in all of the blood cultures from the group 2 animals, but growth was seen only in blood cultures from four of the group 3 animals. The levels of endotoxin, nitrite, and AST levels in group 3 were significantly increased in comparison with those in group 2 (P<0.0001). Extensive hepatocellular necrosis with hemorrhage was observed in the livers of the group 3 animals, and all of them died within 48 h. The results of this study suggest that the blockage of lymph flow has a negative effect on liver and survival in dogs with peritonitis, and that hepatic damage is directly related to the amount of endotoxin to which the liver is exposed.

Effects of spinal anesthesia and laryngeal mask anesthesia on mood states during hemorrhoidectomy.

The present study was undertaken to compare the effects of laryngeal mask anesthesia (LMA) and spinal anesthesia on mood states in patients undergoing hemorrhoidectomy. A total of 46 patients who underwent hemorrhoidectomy for grade III and IV hemorrhoids were included in this study. LMA with fentanyl plus propofol was given to 23 patients, and spinal anesthesia with bupivacaine was administered to 23 patients. Mood changes were assessed preoperatively and 2 h postoperatively with the Profile of Mood States (POMS), which consists of 65 questions that are designed to measure 6 identifiable mood states (tension, depression, anger, vigor, fatigue, and confusion). No significant differences were noted between the 2 groups in terms of baseline POMS global and subscale scores, except for scores regarding vigor. No significant mood changes were observed after hemorrhoidectomy in patients who were given LMA; however, an increase in total POMS score was reported in patients given spinal anesthesia. These findings suggest that mood score is affected by spinal anesthesia but not by LMA in patients who are about to undergo hemorrhoidectomy.

Use of an Autologous Vein Graft and Stent in the Repair of Common Bile Defects: An Experimental Study

We investigated the effectiveness of using an autologous vein graft and stent in the repair of large defects of the common bile duct (CBD) in a canine model. A 3-cm segment of the vena cephalica antibrachii and a 2-cm segment of the CBD were removed from eight healthy mongrel dogs with normal blood biochemistry levels. A stent was passed through the vein segment, and one end was introduced into the proximal end of the CBD while the other end was introduced into the distal end. The venous graft was then sutured to the CBD. A liver biopsy was taken for histopathological examination during laparotomy and relaparotomy. Blood samples were obtained on postoperative days 7, 14, and 20 for biochemical examination. The defect was effectively repaired by the autologous vein graft and stent in 7 dogs, after the exclusion of 1 dog that died of hemorrhage 3 days after the operation. No change in blood biochemistry was observed postoperatively, and no histopathological change in the liver was found in the preoperative or postoperative periods. These findings indicate that the use of an autologous vein graft and stent to repair CBD injuries may be a feasible and alternative method of treatment.