The significance of cervical discopathy diagnosis in patients with mastalgia.

OBJECTIVE: The primary aim of this study was to explore the involvement of cervical discopathy in the development of non-cyclic mastalgia by employing cervical magnetic resonance imaging (MRI). PATIENTS AND METHODS: A total of 407 patients were included in the study. Individualized management plans were developed for each patient. Pathological findings in MRI results were assessed by specialists in physical therapy and neurosurgery, and appropriate treatment was administered. Visual assessments of patients were conducted. The Analog Scale (VAS) scoring system was used at the initial presentation, and patients were evaluated at 1 and 3 months following the treatment. RESULTS: In the MRI examinations of the patients included in the study, simultaneous cervical disc protrusion was observed in 29% (n: 124) of those with annular bulging. Comparing the VAS scores of patients before treatment, at the 1st and at the 3rd month showed a significant decrease in mastalgia pain (p < 0.001). CONCLUSIONS: The diagnosis of cervical discopathy holds significant importance in the treatment of mastalgia patients. Therefore, clinicians should keep the cervical spine in mind as a potential contributing factor to mastalgia.

Intragastric injection botulinum toxin A for obesity management with or without liraglutide.

OBJECTIVE: Obesity is a global public health problem with rapidly increasing prevalence in many countries, including Turkey, and different treatment modalities have been used. This study aimed to compare the effect of intragastric botulinum toxin A (BTA) injection and BTA injection combined with low-dose liraglutide in patients with obesity. PATIENTS AND METHODS: Records of 701 patients (female/male, 660:41; mean age, 45.6 ± 6.2 years) who received an intragastric injection of BTA for weight loss between November 2019 and May 2020 were reviewed retrospectively. The patients were divided into the BTA group, which included patients who received BTA injection alone, and BTA + liraglutide, which included those who used liraglutide after BTA injection. The demographic characteristics and comorbid diseases of the patients and follow-up results 6 months after the procedure were evaluated. RESULTS: In the comparison of the 3-month and 6-month weights of the patients, weight measurements were significantly lower in the BTA + liraglutide group than in the BTA group (p < 0.001 and p  < 0.001, respectively). Adverse effects were observed in 212 (30.2%) of the study participants, of which 25% were observed in the BTA group and 31.8% in the BTA + liraglutide group, with no significant difference. CONCLUSIONS: The intragastric injection of BTA combined with liraglutide is a safe method that provides more effective weight loss than BTA alone, which is minimally invasive without any serious adverse effects.

The effect of mesh fixation on migration and postoperative pain in laparoscopic TEP repair: prospective randomized double-blinded controlled study.

PURPOSE: The development of chronic pain is one of the major post-surgery problems after inguinal hernia repair. Although the possibility of chronic pain formation decreases with laparoscopic methods, pain may develop due to the staples used. It is thought that absence of mesh fixation in total extra-peritoneal (TEP) repair does not increase the recurrence rate. This study aims to investigate the absence of mesh fixation in the TEP on the development of postoperative pain, mesh displacement, and recurrence rate. METHODS: Between December 2019 and December 2020, 100 patients who underwent TEP repair due to unilateral inguinal hernia in the General Surgery Clinic of Hitit University were included in the study. Study was registered at http://Clinicaltrials.gov (NCT05152654). Patients were divided into two groups as repairs in which the mesh was fixed with a tacker and no-fixation (NF) was used. The mesh is marked with radiopaque clips. Patients were compared in terms of postoperative pain, mobilization time, hospital stay, return to work, chronic pain, early-late mesh displacement, and recurrence. RESULTS: While there was no significant difference between the groups in terms of mesh displacement and recurrence, it was observed that the NF group developed significantly less pain in the early and late postoperative period compared to the other group. The time-dependent reduction rate of postoperative pain was higher in NF group than in other group. In addition, operation time was shorter in the NF group. CONCLUSION: While the absence of mesh fixation in TEP hernia repair does not increase the recurrence rate, it can be used safely, because it causes less acute and chronic pain. TRAIL REGISTRATION: Clinicaltrials number: NCT05152654.

Effects of sugammadex and neostigmine on mucociliary clearance in general anesthesia.

OBJECTIVE: The aim of this study was to evaluate the effects of sugammadex and neostigmine used in general anesthesia on postoperative mucociliary clearance. PATIENTS AND METHODS: This prospective, randomized and double-blind study was performed on 60 non-smokers with ASA I-III underwent inguinal hernia repair under general anesthesia. Mucociliary clearance was assessed by nasal saccharine transit time (STT). After the preoperative STT measurement, the patients were taken to the operating room, and divided into two equal groups as group 1 and 2 (n= 30 for each group). Midazolam, propofol, and rocuronium were used in all patients. Anesthesia was maintained by sevoflurane at a flow rate of 6 lt/min (50% O2 - 50% N2O) with a minimum alveolar concentration of 1.3-1.5. After the surgical procedure, atropine-neostigmine (20 mcg/kg - 50 mcg/kg) and sugammadex (2 mg/kg) were administered to group 1 and group 2, respectively, and then the patients were extubated. The postoperative STT was measured in postoperative period. RESULTS: The mean age of the patients was 53 (±16) years, and 56 (93%) of them were male. There were no differences between the groups in terms of age, gender, height, weight, ASA score, and duration of anesthesia, duration of surgery, postoperative period, preoperative STT, and postoperative STT. However, when each group was evaluated separately, there was a statistically significant increase in the postoperative STT compared to the preoperative STT in both groups (p=0.005 for group 1, p<0.001 for group 2). CONCLUSIONS: The effects of sugammadex and neostigmine used in general anesthesia on postoperative mucociliary clearance are similar, and postoperative mucociliary clearance is delayed.