Muhittin Yaprak

Risk Factors of Breast Cancer-Related Lymphedema

INTRODUCTION Secondary lymphedema is one of the major important long-term complications of breast cancer treatment. The aim of this study is to determine patient- and treatment-related risk factors of lymphedema in breast cancer patients. PATIENTS AND METHODS Patients, who had been operated on for primary breast cancer at Akdeniz University Hospital and followed regularly between August 1984 and December 2009 were included in the study. In order to evaluate the arm swelling objectively, measurements were performed with a flexible tape measure for both arms, and limb volume was calculated using a truncated cone volume formula. Participants, whose volume difference between the two arms was ≥ 5%, were considered as lymphedema-positive patients. The SPSS program (SPSS inc. Chicago, IL) was used for statistical analysis. RESULTS The mean age of 455 patients was 50.6 years and the median follow-up time was 53 months. Lymphedema was found in 124 (27%) patients. Most of the patients with a history of postoperative wound infection (52%) and lymphangitis (57%) had lymphedema (p=0.003 and p=0.002, respectively). Addition of radiation therapy increased lymphedema risk 1.83 times (p=0.007). The mean duration of the axillary drainage and number of the removed lymph nodes were 7.8 days and 19, respectively. The rate of lymphedema in patients with early stage breast cancer was less than patients with advanced breast cancer (24% and 35.3%, respectively, p=0.018). Most of the patients (92%) with lymphedema had a high body mass index (BMI ≥ 25 kg/m²), and obesity was another important factor for lymphedema (p<0.001). CONCLUSIONS The most important treatment and patient-related risk factors for breast cancer-related lymphedema were obesity (≥ 25 kg/m²), axillary lymph node dissection, postoperative radiotherapy, wound infection, history of lymphangitis, and duration of axillary drainage. Elimination or prevention of these risk factors may reduce the incidence of lymphedema.

Real-time monitoring for recovery of gastrointestinal tract motility detection after abdominal surgery

Loss of gastrointestinal motility occurs for patients who experience abdominal surgery and in order to avoid postoperative nausea and vomiting a period of fasting is commonly practiced. This study presents a system which acquires bowel sound signals by means of a devised stethoscope, performs real-time signal processing and notifies clinicians if bowel activity is present. The idea behind this practice is to provide enough time for intestinal motility to return to normal and benefit from early feeding in order to shorten hospital stay. Research findings indicate that a detection algorithm using statistical approach is suitable for real time monitoring in noisy clinical environments.

Bioacoustic sensor system for automatic detection of bowel sounds

This study presents a bioacoustic sensor system developed for early detection of the recovery of bowel activity after abdominal surgery and to perform analysis on bowel sounds. Different than other studies, in order to be able to attenuate noise, two capacitive microphones oriented in opposite directions are used. Bowel sounds are typically observed at a frequency between 100 Hz and 1500 Hz and amplitude between 0 and 20mV. The signal strength is boosted 48 times with an amplifying circuit. The second microphone is used to observe environmental noise such as examination room noise. Both signals are digitized using an ADC (NI DAQ Data Acquisition USB 6009). Finally, we developed a software that can extract spectral properties of the signal and present the results in real time.

Wireless bioacoustic sensor system for automatic detection of bowel sounds

Due to anesthesia loss of gastrointestinal motility is a common situation for patients who underwent abdominal surgery. The aim of this study is to present the bioacoustic sensor system developed for real time detection of recovery of gastrointestinal tract motility by observing bowel sounds and for bowel sound signal analysis. Different than other studies, in this study, in order to be able to attenuate environmental noise, bowel sounds were observed using two microphones. Bowel sounds were observed between 100 Hz and 1 kHz with maximum amplitude of 20mV. The signal was amplified 121 times and final signal amplitude was between 0-2, 4V. Similarly, environmental noise observed by the second microphone was amplified. Both of the signals were digitized using 12 bit analog digital converter of the ZigBee module (JN5139-Z01) and were transferred with wireless connection. With the developed software, spectral and temporal properties were obtained and presented in real-time. Finally, a stethoscope shaped box was designed for easy use of the sensor system.

Effect of a new cross-linked hyaluronan gel on the staple line after sleeve gastrectomy in a rat model

PURPOSE To evaluate the effect of a new cross-linked hyaluronan (NCHA) gel on healing of the staple line in an experimental sleeve gastrectomy. METHODS Eighteen rats were randomly divided into three groups. The control group (n = 6) received no medication. In the saline group (n = 6) and NCHA gel group (n = 6), saline and NCHA gel were respectively administered onto the staple line and intraperitoneally into the abdominal cavity after the standard stapling procedure. RESULTS The fibroblast activity and collagen deposition were significantly higher in the NCHA gel group than in the control group (p = 0.00, p = 0.017) and saline group (p = 0.004, p = 0.015). The tissue hydroxyproline protein level was significantly higher in the NCHA gel group than in the control group (p = 0.041). Adhesion formation was significantly lower in the NCHA gel group than in the control and saline groups (p = 0.015, p = 0.041). CONCLUSIONS New cross-linked hyaluronan gel could be an effective approach to improve staple line wound healing and prevent potential leakage after sleeve gastrectomy. Moreover, NCHA gel helps to prevent adhesion formation without compromising healing of the staple line.

Perianal lymphoma presenting as an abscess in a heterosexual and nonimmunocompromised patient: report of a case.

Primary lymphoma of the anus and rectum constitutes only 3% of all non-Hodgkin lymphomas (NHLs) [1]. Their incidence may be higher in individuals with acquired immune deficiency syndrome (AIDS), particularly in homosexuals [1–4]. However, primary lymphomas at this localization in nonimmunocompromised patients are exceedingly rare [4–6]. In this report, we present a case of primary diffuse large B-cell lymphoma (DLBCL) of the anal margin in a human immunodeficiency virus (HIV)-negative heterosexual man presenting as perianal abscess, aiming to demonstrate clinical and therapeutical particularities of this exceptional entity.