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INTRODUCTION: Steroid therapy is known to be effective against granulomatous mastitis. We aimed to compare the efficacy of local versus systemic steroid administration in patients with idiopathic granulomatous mastitis. MATERIALS AND METHODS: This prospective cohort study included 58 patients who had either local (n = 42) or systemic (n = 16) treatment due to granulomatous mastitis between 2015 and 2019. Recurrence rates were determined as per ultrasound and magnetic resonance imaging examinations and the rate of side effects was evaluated as per patient complaints and physical examinations at the end of a 2-year follow-up period. RESULTS: Median doses of 140 mg and 3810 mg were administered to the local and systemic group, respectively. Six (14.3%) patients in the local treatment group and 13 (81.3%) in the systemic treatment group had steroid-related side effects. The local treatment group had significantly fewer side effects than the systemic treatment group (P < 0.001). The recurrence rates were similar in both groups (P > 0.05). CONCLUSIONS: Local steroid injection was as effective as systemic steroid therapy. Compared to systemic therapy, local steroid administration can be considered as a new therapeutic protocol with a lower dose and side effect rate.
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Mastitis Granulomatosa , Estudios de Cohortes , Femenino , Mastitis Granulomatosa/tratamiento farmacológico , Humanos , Imagen por Resonancia Magnética , Estudios Prospectivos , Esteroides/uso terapéuticoRESUMEN
BACKGROUND: More evidence shows that primary surgery for de novo metastatic breast cancer (BC) prolongs overall survival (OS) in selected cases. The aim of this study was to evaluate the role of locoregional treatment (LRT) in BC patients with de novo stage IV bone only metastasis (BOM). METHODS: The prospective, multicenter registry study BOMET MF14-01 was initiated in May 2014. Patients with de novo stage IV BOM BC were divided into two groups: those receiving systemic treatment (ST group) and those receiving LRT (LRT group). Patients who received LRT were further divided into two groups: ST after LRT (LRT + ST group) and ST before LRT (ST + LRT group). RESULTS: We included 505 patients in this study; 240 (47.5%) patients in the ST group and 265 (52.5%) in the LRT group. One hundred and thirteen patients (26.3%) died in the 34-month median follow-up, 85 (35.4%) in the ST group and 28 (10.5%) in LRT group. Local progression was observed in 39 (16.2%) of the patients in the ST group and 18 (6.7%) in the LRT group (p = 0.001). Hazard of death was 60% lower in the LRT group compared with the ST group (HR 0.40, 95% CI 0.30-0.54, p < 0.0001). CONCLUSION: In this prospectively maintained registry study, we found that LRT prolonged survival and decreased locoregional recurrence in the median 3-year follow-up. Timing of primary breast surgery either at diagnosis or after ST provided a survival benefit similar to ST alone in de novo stage IV BOM BC patients.
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Neoplasias de la Mama , Neoplasias de la Mama/cirugía , Femenino , Humanos , Mastectomía , Estudios Multicéntricos como Asunto , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia/cirugía , Sistema de Registros , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
OBJECTIVES: This study aimed to investigate the relationship between breast magnetic resonance imaging (MRI) parameters; clinical features such as age, tumor diameter, N, T, and TNM stages; and serum human epididymis protein 4 (HE4) levels in patients with breast carcinoma and use this as a means of estimating possible signaling pathways of the biomarker, HE4. METHODS: Thirty-seven patients with breast cancer were evaluated by breast MRI and serum HE4 levels before therapy. Correlations between parameters including age, tumor diameter T and N, dynamic curve type, enhancement ratio (ER), slope washin (S-WI), time to peak (TTP), slope washout (S-WO), and the serum level of HE4 were investigated statistically. Human epididymis protein 4 levels of early and advanced stage of disease were also compared statistically. RESULTS: Breast MRI parameters showed correlation to serum HE4 levels and correlations were statistically significant. Of these MRI parameters, S-WI had higher correlation coefficient than the others. Human epididymis protein 4 levels were not statistically different in early and advanced stage of disease. CONCLUSIONS: High correlation with MRI parameters related to neoangiogenesis may indicate signaling pathway of HE4.
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Biomarcadores de Tumor/sangre , Neoplasias de la Mama/sangre , Neoplasias de la Mama/diagnóstico por imagen , Interpretación de Imagen Asistida por Computador/métodos , Imagen por Resonancia Magnética , Proteínas/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Transducción de Señal , Estadística como Asunto , Proteína 2 de Dominio del Núcleo de Cuatro Disulfuros WAPRESUMEN
INTRODUCTION: Papillary breast lesions constitute a pathological heterogeneous group and are characterized by growth in the milk ducts. In this study, we aimed to present in view of literature patients who underwent lumpectomy due to breast mass and with papillary lesion in histopathological examination. MATERIAL METHOD: The pathology records and informations of 42 patients who were operated between 2006-2014 in our clinic and considered to have papillary lesion in histopathological examination were examined retrospectively. The patients were evaluated for age, gender, complaints, lesion localizations, performed surgery, histopathological type, follow-up period and the lesions occurring during follow-up. FINDINGS: The excisional biopsy in the form of lumpectomy was made to 34 patients who were reported as benign papillary lesion in coreneedle biopsy performed. The lesion in 11 patients were marked preoperatively by radiology clinic. 33 patients who had benign papillary lesion in excisional biopsy were followed. Modified radical mastectomy was performed to a total of 9 patients including 1 patient with malignant papillary lesion in excisional biopsy and 8 patients with malignant papillary lesion in coreneed lebiopsy. RESULT: Histopathological diagnosis should be confirmed by performing definitely excisional biopsy in patients who detected benign papillary lesions by coreneedle biopsy and strict clinical follow-up should be made for developing malignancies in patients who detected benign papillary lesions.
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Neoplasias de la Mama/patología , Carcinoma Papilar/patología , Papiloma Intraductal/patología , Adolescente , Adulto , Anciano , Biopsia con Aguja , Neoplasias de la Mama/cirugía , Carcinoma Papilar/cirugía , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Mastectomía Segmentaria , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Papiloma Intraductal/cirugía , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Antiinflamatorios/administración & dosificación , Mastitis Granulomatosa/tratamiento farmacológico , Acetato de Metilprednisolona/administración & dosificación , Adulto , Antiinflamatorios/uso terapéutico , Femenino , Mastitis Granulomatosa/diagnóstico por imagen , Humanos , Inyecciones Intralesiones , Imagen por Resonancia Magnética , Acetato de Metilprednisolona/uso terapéutico , Estudios Prospectivos , Retratamiento , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: Completion thyroidectomy is recommended in patients who have been diagnosed with differentiated thyroid cancer on histopathological evaluation, if their first operation was a conservative approach. The critical issue is when to do the second operation. MATERIAL AND METHODS: The medical records of 66 patients who underwent completion thyroidectomy for the treatment of differentiated thyroid cancer in our clinic between 2006-2013 were retrospectively analyzed. All data were compared after patients were divided into two groups according to the interval between the first surgery and completion thyroidectomy. RESULTS: Fifty-two patients (78.8%) were women and 14 patients (21.2%) were male. Completion thyroidectomy was performed 10-90 days after the initial surgery (group 1) in 26 patients, whereas it was performed later than 90 days in 40 patients (group 2). Temporary hypoparathyroidism occurred in two patients (7.7%) in group 1, and in 3 patients (7.5%) in group 2. Transient recurrent laryngeal nerve palsy was observed in 1 patient (3.9%) in group 1, and in 1 patient (2.5%) in group 2. There were no permanent morbidities in both groups. Residual tumor rate after completion thyroidectomy was 45.5%. There was no statistically significant difference between the two groups in terms of complications after completion thyroidectomy. CONCLUSION: Although in some studies it is recommended that completion thyroidectomy should be performed either before scar tissue development or after clinical remission of scar tissue, edema and inflammation, we believe that timing of surgery has no effect on morbidity.
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OBJECTIVES: The aim of this study is to present novel diagnostic ultrasonography (USG)-based classification of inflammatory granulomatous mastitis (IGM) and to assess and compare dosage responses of locoregional steroid therapy. METHODS: From January 2017 through March 2023, total of 230 biopsy-proven IGM patients were reclassified (grades I, II, and III) according to USG-based morphological features. The injection applications were grouped in Group1 (40 mg/mL between years 2017 and 2019) versus Group2 (80 mg/mL between years 2019 and 2023), and effectiveness was analysed for each grade in between groups. RESULTS: The mean age was 31 years old (range: 19-60) with median follow-up period of 7 months. The most common clinical presentation was breast mass accompanying draining skin sinuses of the affected skin and hypoechogenic mass with tubular extensions was the most prevalent feature on USG examination. As per USG-based features, 79 (34.3%) patients were redefined as grade I, 64 (27.8%) as grade II, and 87 (37.8%) as grade III. All patients underwent locoregional steroid injection only. The average number of treatments in the first group was 6 (±3 SD) with an effective dose of 40 mg/mL in the first group, and 4 (±2 SD) with an effective dose of 80 mg/mL in the second group. The generalized linear mixed model was used to investigate effects between groups (P < .05). CONCLUSIONS: High-dose steroid treatment was effective in burnout lesions (grades II and III), and it was found to be statistically significant in lowering number of treatments irrespective of grade. ADVANCES IN KNOWLEDGE: This novel classification could be a convenient tool in terms of common language between radiologists and clinicians. In addition, our study is a pioneer in comparing steroid dosage with no relapse in IGM patients.
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Mastitis Granulomatosa , Ultrasonografía Mamaria , Humanos , Mastitis Granulomatosa/diagnóstico por imagen , Mastitis Granulomatosa/tratamiento farmacológico , Mastitis Granulomatosa/patología , Femenino , Adulto , Persona de Mediana Edad , Ultrasonografía Mamaria/métodos , Adulto Joven , Resultado del Tratamiento , Estudios Retrospectivos , Mama/diagnóstico por imagen , Mama/patología , Glucocorticoides/uso terapéutico , Glucocorticoides/administración & dosificaciónRESUMEN
Inflammatory granulomatous mastitis is a benign inflammatory disease of the breast mostly presenting in puerperal women. The disease is characterized by recurrent bouts of mastitis with clinical picture of hyperemia, breast mass, and swelling of the breast with or without purulent discharge depending on the severity of the underlying inflammatory process. Although no true prevalence and incidence have been reported in the literature, there are several reported studies setting forth a predilection in specific ethnic groups and/ or geographical areas. Due to the intricate nature of the disease, quite often inflammatory granulomatous mastitis may be mistaken for malignant processes of the breast and even so, there are no pathognomonic imaging appearances to differentiate one from another. The histopathological analysis is a definite way of diagnosis. In this article, we review the imaging manifestations and clinical and histopathological findings along with current trends of available treatment options in the literature and briefly discussed our institutional perspective regarding grading of inflammatory granulomatous mastitis based on ultrasonographic appearances.
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PURPOSE: Breast cancer is the most frequent cancer in women, and there is a great variability in surgical practice for treating that cancer in different countries. The aims of this study were to analyze the effect of guidelines from the Turkish Federation of Breast Diseases Societies on academic institutions that have breast centers and to evaluate surgical practice in Turkey in 2018. PATIENTS AND METHODS: Between January and March 2019, a survey was sent to breast surgeons who were working in breast centers in academic institutions. The sampling frame included 24 academic institutions with breast centers in 18 cities in Turkey to evaluate interdisciplinary differences among breast centers and seven regions in Turkey regarding patients' choices, surgical approaches, and academic institutions. RESULTS: All surgeons responded to the survey, and all 4,381 patients were included. Most of the surgeons (73.9%) were working in a breast center. Multidisciplinary tumor boards were performed in 87% of the breast centers. The average time between clinical evaluation and initiation of treatment was 29 days; the longest time was in Southeast Anatolia (66 days). Only 6% of patients had ductal carcinoma in situ. Sentinel lymph node biopsy was available in every region across the country and was performed in 64.5% of the patients. In 2018, the overall breast-conserving surgery rate was 57.3% in Turkey, and it varied from 72.2% in the Black Sea region to 33.5% in Central Anatolia (P < .001). Oncoplastic breast surgery options were available at all breast centers. However, 25% of the breast centers from the Black Sea region and half the breast centers from Eastern Anatolia and the Mediterranean region did not perform this type of surgery. CONCLUSION: Increasing rates of nonpalpable breast cancer and decreasing rates of locoregional recurrences favored breast-conserving surgery, especially in developed countries. Guidelines from the Turkish Federation of Breast Diseases Societies resulted in more comprehensive breast centers and improved breast health in Turkey.
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Neoplasias de la Mama , Mastectomía Segmentaria , Mar Negro , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/cirugía , Femenino , Humanos , Recurrencia Local de Neoplasia , Turquía/epidemiologíaRESUMEN
BACKGROUND: The aim of this study was to determine the incidence of incidental parathyroidectomy, the relationship between incidental parathyroidectomy and postoperative hypocalcemia, and risk factors for incidental parathyroidectomy in patients undergoing thyroid surgery. METHODS: The study was conducted by analyzing the records of patients who underwent thyroid surgery in a tertiary university hospital between January 2012 and December 2017 retrospectively. The risk factors of postoperative hypocalcemia were determined by comparing postoperative Ca values with age, sex, preoperative Ca value, dominant nodule diameter, type of surgery, and histopathological examination of the thyroidectomy material. According to the final pathology results, the patients were divided into two groups - the ones with and without incidental parathyroidectomy. The risk factors for incidental parathyroidectomy were determined by comparing the two groups in terms of age, sex, dominant nodule diameter, type of surgery, and histopathological results (malign/benign). RESULTS: When the risk factors of postoperative hypocalcemia were examined, female gender, age <28.5 years old, low level of preoperative mean Ca value, and total thyroidectomy were found to be critical risk factors (p<0.05). When the risk factors of incidental parathyroidectomy were examined, total thyroidectomy and thyroid malignancy were found to be important risk factors (p<0.05). CONCLUSION: Female gender, age<28.5 years old, low level of preoperative Ca value, and total thyroidectomy were associated with postoperative hypocalcemia, but no relationship was found between incidental parathyroidectomy and postoperative hypocalcemia.
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The prevalence of type 2 diabetes mellitus (T2DM) and obesity shows a gradual increase nowadays. Despite the introduction of multiagent treatment modalities, many patients with T2DM still do not have good results. Bariatric/metabolic surgery performed in obese patients to attain weight loss has been shown to improve T2DM. Type 1 diabetes mellitus is another type of diabetes that also shows an increase in prevalence. The aim of the present study was to evaluate the literature about the bariatric/metabolic surgical procedures performed in patients with type 1 and type 2 diabetes.
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OBJECTIVES: Our aim in the present study was to investigate the relation between thyroid nodule diameter and malignancy, and the diagnostic accuracy of fine needle aspiration biopsy (FNAB) for thyroid nodules larger than 4 cm. MATERIAL AND METHODS: Preoperative patient demographics such as age and gender, thyroid nodule diameter, FNAB results and postoperative pathology results were recorded. The relation between age, gender, thyroid nodule size of the patients and malignancy was examined. Also, the sensitivity, specificity, false negativity, false positivity and accuracy rates of FNBA of the patients whose thyroid nodule size was lower than 4 cm and the ones whose thyroid nodule size was higher than 4 cm were analyzed. RESULTS: There was no significant difference between males and females in terms of malignancy rate (p= 0.15). There was no significant relation between malignancy and patient age (p= 0.92). No significant difference was found between the group with thyroid nodule diameter of > 4 cm and the group thyroid with nodule diameter of <4 cm in terms of malignancy (p= 0.91). In the group with thyroid nodule diameter of > 4 cm, sensitivity, specificity, false negativity, false positivity, and accuracy rates of FNAB were 15%, 100%, 84%, 0%, and 70%, respectively. In the group with thyroid nodule diameter of <4 cm, sensitivity, specificity, false negativity, false positivity, and accuracy rates of FNAB were 53%, 100%, 46%, 0% and 80%, respectively. CONCLUSION: Our study put forward that thyroid nodule diameter is not the only predictor parameter whilst predicting malignancy. However, it was observed that FNAB sensitivity and false negativity were higher when the thyroid nodules with > 4 cm diameter were compared to the thyroid nodules with <4 cm diameter.
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Purpose of the study: Hypofunctioning breasts are typically considered a dysfunction of higher brain centers that regulate hormonal feedback, and olfactory information has been proposed as a triggering factor for lactation in the maternal body. However, there are no substantive studies regarding whether olfaction disorders and/or loss of olfactory sense may result in breast gland atrophy by causing diminished olfactory stimulation. To fill this gap in the literature, we studied the histologic features of breast glands as a sample model in animals that had undergone an olfactory bulb lesion (OBL). Materials and methods: This study was conducted on 22 rats. Six, eight, and six of them were used as control, SHAM, and OBL groups, respectively. After 10 weeks, the animals were decapitated. Olfactory bulbs and breast glands were stained with Hematoxylin-eosin and tunnel dye. Specimens were analyzed stereologically to evaluate the loss in volume of the olfactory bulbs, total breast follicle volume (TBFV) and Meissner's corpuscles per cubic centimeter, and these two senior metrics were compared with each other statistically. Results: Olfactory bulb volume loss and breast gland atrophy were both detected in study group. Mean TBFV and OB volumes were measured as: (296 ± 89) × 106 µm3/cm3 and 4.43 ± 0.98 mm3 in control (Group I); (264 ± 63) × 106 µm3/cm3 and 3.86 ± 0.81 mm3 in SHAM (Group II) and (194 ± 52) × 106 µm3/cm3 and 1.52 ± 0.36 mm3 in OBL group (Group III). It was noted that the TBFV was significantly diminished, with apoptotic degradation in the olfactory bulbs and breast glands of OBL-applied animals (p < 0.001). Conclusion: It seems that diminished milk secretion is attributable to the degradation of breast glands that results from olfaction loss in OBL animals.
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Enfermedades de la Mama/etiología , Glándulas Mamarias Animales/patología , Red Nerviosa/lesiones , Trastornos del Olfato/complicaciones , Bulbo Olfatorio/lesiones , Animales , Atrofia/etiología , Atrofia/patología , Atrofia/fisiopatología , Enfermedades de la Mama/patología , Enfermedades de la Mama/fisiopatología , Modelos Animales de Enfermedad , Femenino , Lactancia/fisiología , Glándulas Mamarias Animales/fisiopatología , Trastornos del Olfato/etiología , RatasRESUMEN
Tandir is the name given to an oven used for baking bread in the eastern and south-eastern part of Anatolia. Tandir burn is a special kind of burns in which primarily women and small children fall in it and have deep extensive burns (TBSA %). The records of 60 patients with tandir burn who were treated in our Burn Center from September 1999 to January 2006 were reviewed. The patients consisted of 9.2% of all burned patients. The mean age was 17.10 years (1-60 years) and 61.50% of the patients were female. The mean total body surface area (TBSA) burned was 21.09% (6-58) and 88% of the patients had third-degree burns. Eight of the patients underwent amputation of an extremity, 10 had fasciotomies, and 25 partial thickness skin grafts. The mean hospitalization period was 31.64 days (3-73 days). Fifteen patients (25%) died. Tandir burn is a severe kind of burn with a higher morbidity and mortality.
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Accidentes Domésticos , Quemaduras/etiología , Utensilios de Comida y Culinaria , Adolescente , Adulto , Distribución por Edad , Superficie Corporal , Quemaduras/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Índices de Gravedad del Trauma , Turquía/epidemiologíaRESUMEN
Axillary region is one of the areas where primary hydatid cyst is rare. In this study, we present a case of isolated axillary hydatid cyst in a 40 year-old female patient having applied to our polyclinic with swelling and pain on right axillary. During the breast examination of the patient on right axillary, well-circumscribed semi-mobile mass lesion was detected. On mammary ultrasonography, both breasts were natural. There was necrotic lymphadenopathy on right axillary that was roughly 10×10 cm sized, and locally included cystic patency. Axillary LAP excision was planned for histopathologic diagnosis. Patient was taken to the operation. After it was understood that cyst was hydatic, it was excised with germanium membrane by encircling it with savlon compresses. In order to differentiate primary secondary on post-operative patient, the patient was taken to thoracic and abdomen tomography. No cystic lesions were detected on tomography. Having no problems on follow-ups, the patient was discharged on 3 post-op days with recommendations, and with starting albendazole 10 mg/kg.
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BACKGROUND: While tuberculosis of the breast is an extremely uncommon entity seen in western populations, it accounts for up to 3% of all treatable breast lesions in developing countries. CASE PRESENTATIONS: We reviewed three female cases of mammary tuberculosis that were diagnosed and treated in Turkey during the same calendar year. All three patients presented with a painful breast mass. In all cases, fine needle aspiration was nondiagnostic for mammary tuberculosis. However, the diagnosis of mammary tuberculosis was confirmed by histopathologic evaluation at the time of open surgical biopsy. All three patients were treated with antituberculous therapy for six months. At the end of the treatment period, each patient appeared to be clinically and radiologically without evidence of residual disease. CONCLUSION: The diagnosis of mammary tuberculosis rests on the appropriate clinical suspicion and the histopathologic findings of the breast lesion. Its recognition and differentiation from that of a breast malignancy is absolutely necessary. Antituberculous chemotherapy, initiated immediately upon diagnosis, forms the mainstay of treatment for mammary tuberculosis.
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Neoplasias de la Mama/diagnóstico , Tuberculosis/diagnóstico , Adulto , Neoplasias de la Mama/patología , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Tuberculosis/patologíaRESUMEN
BACKGROUND: Environmental habitat may play a role in clinical disparities of primary hyperparathyroidism (pHPT) patients. AIMS: To compare preoperative clinical symptoms and associated conditions and surgical findings in patients with pHPT, living in different geographical regions from the Black Sea, Mediterranean and Anatolia regions. STUDY DESIGN: Retrospective, clinical-based multi-centric study of 694 patients with pHPT. METHODS: Patients from 23 centers and 8 different geographical regions were included. Data related to baseline demographics, clinical, pathologic and treatment characteristics of 8 regions were collected and included age, gender, residential data, symptoms, history of fracture, existence of brown tumor, serum total Ca and p levels, serum parathormone (PTH) levels, serum 25-OH vitamin D levels, bone mineral density, size of the resected abnormal parathyroid gland(s), histology, as well as the presence of ectopia, presence of dual adenoma, and multiple endocrine neoplasia (MEN)- or familial-related disease. RESULTS: The median age was 54. Asymptomatic patient rate was 25%. The median PTH level was 232 pg/mL and serum total Ca was 11.4 mg/dL. Eighty-seven percent of patients had an adenoma and 90% of these had a single adenoma. Hyperplasia was detected in 79 patients and cancer in 9 patients. The median adenoma size was 16 mm. Significant parameters differing between regions were preoperative symptoms, serum Ca and p levels, and adenoma size. All patients from South-East Anatolia were symptomatic, while the lowest p values were reported from East Anatolia and the largest adenoma size, as well as highest Ca levels, were from Bulgaria. CONCLUSION: Habitat conditions vary between geographical regions. This affects the clinicopathological features of patients with pHPT.
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Fenómenos Bioquímicos , Sistemas de Distribución en Hospital/estadística & datos numéricos , Hiperparatiroidismo Primario/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Mar Negro/epidemiología , Calcio/análisis , Calcio/sangre , Femenino , Humanos , Hiperparatiroidismo Primario/epidemiología , Hiperparatiroidismo Primario/patología , Masculino , Región Mediterránea/epidemiología , Persona de Mediana Edad , Hormona Paratiroidea/análisis , Hormona Paratiroidea/sangre , Estudios Retrospectivos , Turquía/epidemiología , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/epidemiologíaRESUMEN
The prevalence of metallo-beta-lactamases (MBLs) produced by isolates of Pseudomonas aeruginosa and Acinetobacter baumannii and the activities of various antmicrobial combinations against MBL producer strains were investigated. During the period from June 2003 till July 2004, 120 P. aeruginosa and 9 A. baumannii nonduplicate isolates were obtained from burn wounds. Forty strains (37 P. aeruginosa, 3 A. baumannii) were selected because of resistance to carbapenems. Screening for MBL production was performed in the latter isolates by the combined disk method which depends on comparing the zones given by disks containing imipenem with and without ethylenediaminetetraacetic acid (EDTA). Of imipenem resistant P. aeruginosa strains, 21 and 1 of A. baumannii were found metallo-beta-lactamase producers. Disk approximation studies were then performed to test for in vitro activities of various antimicrobial combinations. For a total of 21 P. aeruginosa strains, synergy was demonstrated predominantly by ciprofloxacin in combination with ceftazidime and imipenem, by ofloxacin in combination with astreonam. Against MBL producer A. baumannii strain, synergy was detected only with imipenem-ofloxacin combination. None of the combinations were antagonistic. These results suggest that MBL producing P. aeruginosa and A. baumanni strains have been introduced into burn centers, and to prevent the further spread of MBL producers, it is essential for carbapenem resistant isolates to be screened for MBLs.
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Acinetobacter baumannii/enzimología , Quemaduras/microbiología , Pseudomonas aeruginosa/enzimología , beta-Lactamasas/biosíntesis , Infecciones por Acinetobacter/microbiología , Acinetobacter baumannii/efectos de los fármacos , Acinetobacter baumannii/aislamiento & purificación , Unidades de Quemados , Carbapenémicos/farmacología , Infección Hospitalaria/microbiología , Combinación de Medicamentos , Farmacorresistencia Bacteriana , Humanos , Pruebas de Sensibilidad Microbiana , Infecciones Oportunistas/microbiología , Estudios Prospectivos , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa/efectos de los fármacos , Pseudomonas aeruginosa/aislamiento & purificaciónRESUMEN
OBJECTIVES: In this paper we describe sonoelastography findings for idiopathic granulomatous mastitis (IGM), the clinical and radiological features of which often mimic those of breast carcinoma. MATERIALS AND METHODS: In this retrospective study, sonoelastography findings for patients with pathologically proved IGM were studied. Twenty-seven patients with pathologically proved IGM were enrolled in the study. All were female, and the mean age was 37.81 years (standard deviation 7.10 years; range 24 to 56 years). Elasticity scores (ES), strain ratios (SR), and elastic diameters (ED) were evaluated for the lesions. RESULTS: Ten lesions (37.0 %) were diffuse, six (22.2 %) were tubular, six (22.2 %) were a mass, and five (18.5 %) were cystic in appearance on ultrasonography. On sonoelastography, mean ES ± standard deviation was 1.66 ± 0.55 (between 1.00 and 3.00); mean SR ± standard deviation was 1.10 ± 0.79 (between 0.29 and 4.00). ED was no different between grey-scale and sonoelastogram images. CONCLUSIONS: The features of idiopathic granulomatous mastitis suggest it is benign in nature.