The effectiveness of methotrexate and low-dose steroid therapy in the treatment of idiopathic granulomatous mastitis.

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a rare, chronic, benign, inflammatory breast disease of unknown cause. Patients usually present with a single breast mass, hyperemia, discharge, skin disorders, and fever. Radiological and clinical findings can mimic carcinoma and infection. OBJECTIVES: To examine the treatment of IGM with methotrexate (MTX) + low-dose steroid, and present the results and follow-up data from our center. MATERIAL AND METHODS: Sixty-two patients, diagnosed with IGM in our center between January 2009 and December 2017 were included in this study. Patients diagnosed with granulomatous mastitis histopathologically underwent testing with anamnesis, physical examination and imaging methods to exclude other diseases that cause granulomatous reactions. Patients with a history of malignancy, chronic infectious diseases such as hepatitis B and pregnant women were excluded from this study. Data collected from 62 patients were reviewed retrospectively for this study. RESULTS: The mean patient age was 36.58 ±5.83 years (range: 28-54 years). Lesions were present in the right breast in 30 (48.38%) patients, the left breast in 26 (41.94%) patients and both breasts in 6 (9.68%) patients. Methotrexate was administered orally at a dose of 15 mg/week and methylprednisolone at a dose of 8 mg/day. The mean clinical and radiological remission periods of these patients were 10.14 ±1.21 months (range: 3-14 months). All patients attended regular follow-up appointments. The recovery rate of patients during follow-up was determined to be 93.71%. CONCLUSION: Methotrexate + low-dose steroid therapy is successful in the treatment of IGM. Prospective, large case series and/or multi-center studies are needed to develop an IGM treatment algorithm.

Are average platelet volume, red cell distribution width and platelet distribution width guiding markers for acute appendicitis treatment options?

BACKGROUND: Acute appendicitis (AA) is the most common cause of surgery performed for the acute abdomen. The standard treatment for AA patients has been appendectomy for more than a century. The use of broad-spectrum antibiotics, the medical treatment option has come to the fore in the treatment of uncomplicated AA. AIM: Evaluate whether white blood cell (WBC), platelet count, mean platelet volume (MPV), platelet distribution width (PDW), red cell distribution width (RDW) and C-reactive protein (CRP) values of patients diagnosed with uncomplicated AA clinically, with laboratory tests and radiologically with abdominal computed tomography (CT) could be a marker for choosing medical or surgical treatment. MATERIALS AND METHODS: 519 patients aged between 20 and 65 years who were diagnosed with uncomplicated AA by abdominal CT in our centre between January 2016 and January 2019 were retrospectively analysed. The presence of at least one of the criteria of 7 mm or more appendix diameter and oedema or fluid accumulation around the appendix was accepted as uncomplicated AA. After the diagnosis of AA, 223 patients were treated medically, while 296 patients underwent laparoscopic appendectomy. The first group included patients who were treated medically and the second group included patients who underwent laparoscopic appendectomy. RESULTS: Group 2 patients had higher mean platelet count (P < .005) and RDW (P = .003) values compared to Group 1 patients, while mean PDW (P < .001) values were lower compared to those of Group 1 patients. The differences between the mean WBC, CRP and MPV values of the groups were not statistically significant (P > .05). CONCLUSIONS: Recently, studies supporting antibiotic therapy have been conducted in patients diagnosed with AA. As a result, we think that PDW, RDW, and platelet values in patients diagnosed with uncomplicated AA may be a guide in choosing patients to be treated with surgery or antibiotics.

Reliable treatment of perianal fistulas using laser ablation. Results in 67 patients.

BACKROUND: We aim to show that fistula ablation with laser (FAL) is a reliable method to repair a perianal fistula, and we share the results of a 24-month follow-up on FAL treatments of different perianal fistula types. STUDY DESIGN: The FAL procedure was performed using a ceramic diode laser platform (30-50 J/cm of energy at a wavelength of 1470 nm). All operations were performed under spinal anesthesia in the jackknife position. RESULTS: Of the 67 patients, 48 (71.6%) were male and 19 (28.4%) were female. Of these, 40 (59.7%) had intersphincteric fistulas, 21 (31.3%) had transsphincteric fistulas, 3 (4.47%) had suprasphincteric fistulas, and 3 (4.47%) had extrasphincteric fistulas. Based on perianal fistula disease severity scores, 40 patients (59.70%) experienced complete healing, 10 (14.92%) had persistent symptomatic drainage, 14 (20.89%) had slight drainage with minimal symptoms, and 3 (4.47%) had painful, symptomatic drainage. No major complications were observed in any patient. CONCLUSIONS: The FAL is a minimally invasive initiative with the lowest morbidity and highest curative recovery rate, especially for simple fistulas. KEY WORDS: Anal fistula, Fistula ablation with laser, Reliable surgery.

Selecting a surgical modality to treat a splenic hydatid cyst: total splenectomy or spleen-saving surgery?

AIM: We analyzed the outcomes and effectiveness of surgical treatments and clinical manifestations of splenic hydatid cysts. PATIENTS AND METHODS: Between 2000 and 2011, we retrospectively reviewed the cases of 11 patients who were operated on for a splenic hydatid cyst. The demographic features, medical history, physical examinations, biochemical and serological tests, imaging modalities, and surgical treatment of the patients were noted. RESULTS: The mean patient age was 36.45 years (range, 20-66 years). While isolated splenic hydatid disease was present in five patients, other abdominal hydatid cysts were accompanied by a splenic hydatid cyst in six patients. Left upper abdominal pain was present in seven (64%) patients, whereas four (36%) patients were asymptomatic. Eight patients (72.72%) had undergone a total splenectomy and three (27.28%) had undergone spleen-preserving surgery. Postoperative complications developed in four (36%) patients at 5-15 days postoperatively. CONCLUSION: Management of a splenic hydatid cyst is not consensual. Total splenectomy is optimal because it provides definitive treatment. However, spleen-preserving surgery is the preferred treatment in selected patients. The choice of technique depends on the localization, number, and size of hydatid cysts, and the absence or presence of other hydatic organ cysts.