Sancar Bayar

REPAIR OF MIDLINE INCISIONAL HERNIAS USING POLYPROPYLENE GRAFTS

We report herein our results of routinely performing tension-free repair for midline incisional hernias larger than 3 cm using a woven polypropylene graft between January 1990 and December 1995. Included in this study were 45 patients, 34 (73.1%) of whom had previously undergone a primary repair which had failed. The follow-up period ranged from 3 to 56 months with a mean of 36 months. Only one patient (2.2%) suffered a recurrence of the hernia. Although three (6.6%) developed a wound infection, one (2.2%) developed a wound sinus, and two (4.4%) developed wound seroma, none of these complications required removal of the graft. The findings of this study led us to conclude that Prolene grafts could be used as routine prosthetic material in the repair of incisional hernias. Moreover, during the follow-up period we observed that the modifications we made in the operative technique had a significantly positive effect on the outcome of the patients.

Primary Hydatid Cyst of the Axillary Region: Report of a Case

Abstract A 53-year-old woman presented to our hospital with a painful mass in her axilla. Magnetic resonance imaging revealed a lobular cystic mass localized in the right pectoralis major muscle, with no significant invasion of the peripheral soft tissue or bone structures and no pulmonary or hepatic involvement. An echinococcal hemagglutination test was positive. Excision of the cystic mass as definitive therapy and histopathologic examination of the resected specimen confirmed that it was a hydatid cyst. For treating hydatidosis in uncommon sites, the cyst must be totally removed whenever possible. The combination of albendazole and praziquantel seems to be the most effective medical treatment, but not an alternative to surgery. This case report serves to demonstrate that hydatid disease should be borne in mind as the possible cause of a palpable lesion in the breast, axillary region, or chest wall, especially in endemic locations.

Malpositioning of Hickman catheters, left versus right sided attempts

BACKGROUND Central venous catheters (CVC) are frequently used for stem cell collection and recurrent therapeutic hemapheresis procedures for patients with poor peripheral venous access. There is a tendency to prefer a right sided approach for insertion of a CVC via the subclavian route. We designed a sequential randomized study to examine the issue of catheter insertion side and analyzed all the technical data on surgical skill and observed complications. METHOD Seventy-five patients who are candidates for stem cell collection and high dose chemotherapy underwent placement of Hickman catheters via the percutaneous subclavian vein (SCV) route. One experienced surgeon inserted 12F, double lumen, tunnelled, silicon based catheters in the operation room via fluoroscopic control. All of the procedure related complications, morbidity and mortality were analyzed on the basis of the side of catheter insertion. RESULTS The total rate of malpositioning in this series was 14.66%. The Jugular vein was the most common malpositioning site (66.6%). We observed a statistically significant difference in malpositioning between left versus right sided attempts, at 5.55% versus 20.51%, respectively (p = 0.032). The routes of malpositioning encountered for left sided attempts were the right SCV and the left internal jugular vein, the right internal jugular vein (n = 5), the left SCV vein (n = 2), and one left internal jugular vein. There was no significant difference between the right and left sided attempts for mechanical complications other than malpositioning (p < 0.05). CONCLUSION In this study the rate of malpositioning was greater in the right sided approach (p = 0.032) and the other mechanical complication rates did not differ for the two methods. Our results indicate that there is no need for hesitancy in using left sided attempts at CVC insertion.

Lupus mastitis is not a surgical disease.

Abstract:  A 23‐year‐old woman with a 2‐year history of discoid lupus (SLE) presented with a right lateral upper quadrant breast mass. Physical examination revealed a 5 cm irregular, hard lesion suggestive of a breast malignancy. Ultrasound‐guided fine needle aspiration biopsy of the mass confirmed the diagnosis as lupus mastitis. Differential diagnosis of a breast mass in a patient with SLE must include the possibility of lupus mastitis. Surgical resection is usually not necessary, and medical treatment can be implemented successfully.

Is there an association between mastalgia and fibromyalgia? Comparing prevalence and symptom severity.

To determine the prevalence of mastalgia in patients with fibromyalgia (FM) and the prevalence of FM in patients with mastalgia in order to investigate coexistence, and to compare the pain patterns in the case of mastalgia or FM alone versus the two in combination. Fifty consecutive patients with mastalgia and 50 consecutive patients with FM were assessed and examined both for the existence and severity of mastalgia and FM. A high proportion of patients with mastalgia (36%) fulfilled the criteria for FM and 42% had mastalgia in the FM group. Two distinctive entities mastalgia and FM, being both unexplained pain syndromes, seem to frequently coexist. Patients with mastalgia or FM should be thoroughly questioned considering each of the diseases so that in case of coexistence an appropriate therapy might be implemented for a successful pain management.

DNA copy number changes in gastric adenocarcinomas: high resolution-comparative genomic hybridization study in Turkey.

BACKGROUND AND AIMS Multiple genetic alterations are responsible for development and progression of gastric cancer which is one of the leading causes of cancer-related deaths worldwide. The aim of this study was to identify the genomic imbalances of gains and/or losses in gastric adenocarcinomas from Turkish patients and to investigate their association with development and progression of this type of cancer. METHODS Forty three patients with gastric adenocarcinoma were enrolled in this study and genomic imbalances were analyzed by high-resolution-comparative genomic hybridization (HR-CGH). RESULTS In 36/43 cases (84%) of gastric adenocarcinomas, genomic imbalances have involved all chromosomes in various combinations. The mean number of gains was 3.95+/-4.19 and the most common gains observed were 7q (35%), 8q (35%), 7p (28%), 1q (26%), 13q (26%), and 20q (21%). The calculated mean number of losses was 3.65+/-3.55 and the most common losses were found on arms 18q (26%), 5q (21%), and 14q (21%). High-level amplifications involved chromosomes 1, 7, 8, 9, 13, and 16. No significant differences in chromosomal imbalances were observed in different tumor stages, tumor grades, and Helicobacter pylori infection status groups. The most striking result in this study was the involvement of the 13q gains with increased lymph node metastasis (p=0.046). Late-stage tumors displayed a somewhat significantly higher number of losses than early-stage tumors (p=0.053). CONCLUSIONS A series of gains, losses and amplifications concerned with gastric adenocarcinoma identified in this study are presented in detail. In particular, 13q21-q32 was prominent because it has been linked to increased lymph node metastasis.

A rare gastric neoplasm: gastric medullary carcinoma

A 57-year-old female patient with early stage gastric medullary carcinoma is presented with review of the literature.

Myoid hamartoma of the breast: a very rare entity.

A34-year-old woman was admitted to our clinic with a right upper quadrant breast mass. There was no family history of breast cancer and general risk assessment didn’t reveal any increased risk. A previous breast ultrasound was consistent of a heterogenous breast mass that was suspicious for breast carcinoma. On physical examination the mass was 6 cm, rubbery in content, and freely movable on palpation. With the suspicion of malignancy we performed a mammogram which showed a circumscribed mass with a thin capsule and ‘‘breast within a breast’’ appearance that was suggestive of a breast hamartoma (Fig. 1). Ultrasound examination demonstrated a heterogeneous hypoechoic lesion with minimally lobulated contour and a thin capsule (Fig. 2). Core biopsy of the mass revealed fibrous and adenomatoid pathology. Although the suspicion for malignancy was very low at that moment, given the fact that sometimes hamartomas may contain malignant tissue we offered lumpectomy to the patient.

Physical Effects of Unilateral Mastectomy on Spine Deformity

Micro‐Abstract As mastectomy is known to effect body posture, we evaluated the long‐term physical effects of unilateral mastectomy on spine deformity by radiographic examination of 60 women taken before and 12 months after the mastectomy. The results indicated long‐term spinal deformation in women with unilateral mastectomy, suggesting informing patients of the possible change in body posture in the long‐term. Objective: Mastectomy is known to effect body posture after a change in the center of gravity of women due to a missing breast. Although previous studies on short‐term postural changes in mastectomy patients using photogrammetry or Moiré topography suggested ipsilateral inclination of the trunk, our clinical observations during breast reconstruction surgeries indicated a contralateral shoulder elevation in women with unilateral mastectomy. Because the change in body posture can affect spinal alignment, we aimed to evaluate the long‐term physical effects of unilateral mastectomy on spine deformity by radiographic examination. Methods: Posteroanterior chest radiographs of 60 women (mean age 56.3 ± 8.5 years) taken before and 12 months after the mastectomy were evaluated for Cobb angle and the presence or absence of a tilt from the midline in the coronal plane of vertebral body alignment. Results: Cobb angle decreased in 14 and increased in 38 of 60 patients after unilateral mastectomy, and the angular change was found to be independent of the mastectomy side (P < .001). A shift in Cobb angle to the mastectomy side was observed in 11 of 53 patients (P > .05), whereas a statistically significant shift in Cobb angle to the opposite of the mastectomy side was observed in 33 of 53 patients (P < .001). The results of this observational retrospective study indicated long‐term spinal deformation in women with unilateral mastectomy. Two patients with idiopathic scoliosis before mastectomy even developed scoliosis. Conclusion: We recommend informing the patients of the possible change in body posture in the long term, which should be supported or limited with physical therapy.

Long-term survival after regional chemotherapy for liver metastases from breast cancer. A case report.

The prognosis of patients with liver metastases from breast cancer has to be regarded as rather unfavorable. A 45-year-old woman with cancer of the left breast and multiple simultaneous liver metastases was initially treated with cyclophosphamide, methotrexate, and 5-fluorouracil. After two treatment cycles a sonogram of the left breast revealed reduction of the tumor size and she underwent a modified radical mastectomy and hepatic artery catheterization. There was no change in the multiple lesions of the liver on abdominal ultrasonography. One week later a regional chemotherapy regimen was given through a hepatic arterial catheter with subcutaneous implanted reservoir. After completion of the seventh course of chemotherapy, ultrasonography revealed that the multiple liver metastases had regressed completely. To date (July 2001) there has been no relapse during the seven-year follow-up period. In conclusion, we suggest that intra-arterial regional chemotherapy may have an important role to play in the management of breast cancer patients with isolated liver metastases.