Corticosteroid treatment and timing of surgery in idiopathic granulomatous mastitis confusing with breast carcinoma.

Idiopathic granulomatous mastitis (IGM) is an uncommon chronic inflammatory lesion of the breast with an uncertain optimal treatment regimen, the physical examination, and radiologic features of which may be confused with breast carcinoma. In this study, we aimed to describe the clinicopathologic characteristics of 33 patients who admitted to our breast policlinic and took the diagnosis of granulomatous (idiopathic and non-idiopathic) mastitis, and report the place of corticosteroids and the timing of surgery in the treatment of patients with IGM. The clinical features of 33 patients who presented to our breast policlinic with the complaint of breast mass and reached the final diagnosis of GM between March 2005 and October 2009 were reported. The most common symptoms were mass (n: 27) and pain (n: 11). Ultrasonography (USG) and biopsy were performed in all of the patients. Mammography (MMG) was performed in 9, and magnetic resonance imaging (MRI) in 10 patients. The diagnosis of idiopathic lobular granulomatous mastitis (ILGM) was made in 25 patients and tuberculous mastitis (non-idiopathic GM) in the remaining 8 patients. Twenty-four patients received steroid treatment except one who was pregnant. After giving birth, she also received steroids. One of the patients who developed recurrence after 11 months repeated the steroid therapy. Eight patients with tuberculous mastitis were placed on a regimen of antituberculosis therapy for 6 months. In the diagnosis of IGM, physical examination, USG, MMG, and even MRI alone may sometimes not be enough. They should be discussed altogether and the treatment should begin after definitive histopathologic result. Fine needle aspiration biopsy for cytology will result in a high level of diagnostic accuracy, however, core biopsy will reinforce the exact result. Corticosteroid therapy has been shown to be efficacious for IGM, but in the existence of complications such as abscess formation, fistulae, and persistent wound infection, surgical treatment has been the first method of choice.

Primary subcutaneous cyst hydatid of abdominal wall: a case report.

Human body is an intermediate host for Echinococcus granulosus which is a cestode causing hydatid disease. The most common type is E. Granulosus. E. Granulosus most often affects the liver and the lung. Primary subcutaneous cyst hydatid without involving other organs is extremely rare. A 60-year-old Turkish woman came to our hospital with a growing mass in the left periumblical region of the abdominal wall. In the superficial tissue ultrasonography a cystic mass measuring 3×2 cm was detected in the subcutaneous tissue of left periumblical region of the abdominal wall and it was doubtful for hydatid cyst. The patient had no history of surgery for a hydatid cyst in any other organ and the hydatid serology was negative. The cyst was surgically, and carefully excised. Macroscopic exploration suggested a hydatid cyst with its germinative membrane and the histopathological examination of the specimen was reported as a hydatid cyst. Hydatid cyst should be considered when a subcutaneous cytic mass is detected in a patient living in the region where the disease is endemic. The best treatment is complete removal of the cysts.

Large animal-related injuries in a rural population in northeastern Turkey.

Animal-related injury is a serious health problem for people living in rural areas. This type of injury could be of great consequence and life-threatening. There are insufficient data regarding this issue. The purpose of this study was to evaluate the causes and treatment outcomes of large animal injuries. We reviewed the medical records of 157 patients with large animal-related injuries in a State Hospital in Northeastern Turkey, between September 2004 and April 2007. Demographic and etiological characteristics of patients and injury and outcome data were analyzed. A total of 157 patients were included in the study. One hundred and thirty-two (84.1 %) of them were male and 25 (15.9 %) female. The mean age of patients was 29.1 years (range 3-83 years). One hundred and twelve patients (71.3 %) had horse-related injuries and 45 patients (28.7 %) had bovine-related injuries (P = 0.096). Twenty-one (13.4 %) patients were referred to a tertiary center due to their need for intensive care, whereas 1 (0.6 %) patient died. Large animal-related injuries constitute an important health problem for people living in rural areas. This type of injury could be serious and mortality could be observed.

Effects of montelukast on the healing of ischemic colon anastomoses.

BACKGROUND: The aim of this study was to examine whether treatment with montelukast, a selective leukotriene antagonist, would affect anastomotic healing in a reperfused colon rat model with remote ischemia/reperfusion injury. METHODS: Rats (n = 12 per group) were intraperitoneally administered normal saline or 10 mg/kg montelukast sodium 60 minutes before and for 5 days after surgery. Ischemia was induced for 45 minutes through superior mesenteric artery occlusion. A left colon anastomosis was made. Blood and perianastomotic tissue samples were obtained on postoperative day 5. RESULTS: Mean anastomotic bursting pressures of the control and montelukast groups were 159.17 ± 29.99 and 216.67 ± 26.40, respectively (P < .001). Compared with saline, montelukast treatment increased the mean tissue hydroxyproline level (2.46 ± .30 vs 3.61 ± .33 µmol/L) and decreased tissue caspase-3 activity (36.06 ± 5.72 vs 21.78 ± 3.87) and malondialdehyde levels (3.43 ± .34 vs 2.29 ± .34 nmol/g) (P < .001 for all). Other plasma markers of injury also showed differences. CONCLUSIONS: Montelukast prevented ischemia/reperfusion-induced damage in a rat model of colonic anastomotic wound healing.

Left gastric and right hepatic artery anomalies in a patient with gastric cancer: images for surgeons.

BACKGROUND: Surgical resection remains the principal treatment for advanced gastric cancer, but one of the difficulties in a curative or extended gastrectomy is the identification of the vascular supply of the stomach. METHODS: A patient had gastric cancer hospitalized for planning and performing his surgical therapy. A multidetector-row computed tomography scan showed us a large tumor mass and numerous lymph nodes invading perigastric and second tiers of stomach and revealed a left gastric artery and right hepatic artery in which branched directly from aorta. A 3-dimensional construction showed a demonstrative vascular anomaly as well during operation. RESULT: We were able to perform total gastrectomy and D2 lymph node dissection as surgical therapy for patient. The patient's postoperative clinical course was uneventful, and after postoperative 36 months, there was no evidence of recurrence. CONCLUSION: We recommend that a multidetector-row computed tomography scan is very useful for the preoperative staging in gastric cancer patients because of its diagnostic value for showing any vascular anomaly and aiding in decision making on the appropriate surgical strategy.

Unusual locations of hydatid disease: diagnostic and surgical management of a case series.

BACKGROUND: Hydatid disease is endemic in many areas of the world, where it is an important public health problem. The aim of this study was to describe a series of patients with atypically located primary hydatid disease, accompanied by a literature review. METHODS: Six male and four female patients with atypically located hydatid cysts who presented to the Kars State Hospital between September 2004 and March 2008 were evaluated. The mean age was 42.5 years (range 17-72 years). Hydatid cysts were identified by using a combination of serology tests, ultrasonography, and computed tomography (CT). RESULTS: Six of the patients underwent surgical treatment. Three patients (two with pericardial hydatid involvement and one with pancreatic involvement) were sent to a tertiary medical center for surgery, and one patient died from cardiac and renal failure two days after diagnosis. CONCLUSIONS: Although this disease is seen most often in the liver and lungs, it can be found in any part of the body. Hydatid disease must be considered in the differential diagnosis of cystic lesions, especially in patients who have spent time in endemic areas.

Laparoscopic cholecystectomy and postoperative pain: is it affected by intra-abdominal pressure?

BACKGROUND AND PURPOSE: Intra-abdominal pressure created during laparoscopic cholecystectomy is accepted as a factor for postoperative pain. In this prospective, randomized, clinical study, the goal is to determine the effects of different intra-abdominal pressure values on visceral type pain. MATERIALS AND METHODS: Sixty women who underwent laparoscopic cholecystectomy were included in this study. Low-pressure (8 mm Hg), standard-pressure (SP: 12 mm Hg), and high-pressure (HP: 14 mm Hg) groups were designed for the study. The statistical analysis included mean age, weight, analgesic consumption, postoperative pain assessed by the Numeric Scale, duration of anesthesia, and operation. RESULTS: No statistically significant difference was found between the groups comparing age, weight, analgesic consumption, and Numeric Scale values. In terms of duration of anesthesia, statistically significant difference was found between the groups low-pressure and HP and SP and HP, and statistically significant difference was found regarding operative duration between the groups SP and HP. There was no difference between the others groups. CONCLUSIONS: We think that intra-abdominal pressure has no effect on postoperative visceral pain, but has effect on duration of anesthesia and operation.

Impact of slit and nonslit mesh technique on testicular perfusion and volume in the early and late postoperative period of the totally extraperitoneal preperitoneal technique in patients with inguinal hernia.

AIMS: Using slit and nonslit mesh in laparoscopic totally extraperitoneal preperitoneal (TEPP) inguinal hernia repair are well-known approaches. The aim of this prospective, randomized, clinical study was to assess testicular perfusion after these procedures. METHODS: In the study period, 40 male patients with unilateral inguinal hernia were assigned into 2 equal groups as follows: slit (S) and nonslit (NS). TEPP hernia repair was performed in all patients. In the 2 groups, testicular arterial blood flow and testis volumes were measured by Doppler ultrasonography preoperatively, on the 5th postoperative day, and 6 months postoperatively, respectively. RESULTS: No statistically significant difference was found between the preoperative, 5th day postoperatively, and 6-month arterial resistance index (ARI) results when comparing the S and NS groups in ultrasonographic testicular blood flow studies. There was no statistically significant difference of testicular volume between the preoperative period, the 5th postoperative day, and 6 months postoperatively in the 2 groups. CONCLUSIONS: According to the results, no statistically significant difference was found in terms of testicular perfusion and volume between those 2 methods of TEPP repair for inguinal hernia.

The shrinking rates of different meshes placed intraperitoneally: a long-term comparison of the TiMesh, VYPRO II, Sepramesh, and DynaMesh.

AIM: The aim of our study was to determine and compare the shrinking rates of different prosthetic materials used in ventral hernia repair and to establish a possible correlation with macroscopic adhesions, histopathologic inflammation, and fibrosis. METHODS: Thirty-six Wistar albino rats were divided into 4 groups (T, V, S, and D). A midline laparotomy was performed under general anesthesia. A 30x40 mm-sized mesh was placed intraperitoneally and fixed with an interrupted 4/0 polypropylene suture to the anterior abdominal wall. In group T, TiMesh; group V, Vypro II; group S, Sepramesh; and group D, DynaMesh-IPOM were used. All rats were killed at the 90th day postoperatively and the mesh area and the shrinking rate were calculated. Each group was evaluated in correlation with shrinking, adhesion, histopathologic inflammation, and fibrosis, and compared with each other. RESULTS: The mean area was 1013.33 mm2 in the T group, 930.44 mm2 in the V group, 1024.44 mm2 in the S group, and 1073.8 mm2 in the D group. The shrinking areas were found as 186.67 mm2, 269.55 mm2, 177.55 mm2, and 126.2 mm2, respectively. The shrinking rates were statistically significant in each group. The lowest shrinking rate was found in group D and highest in group V, but the results were statistically insignificant. In terms of macroscopic adhesion, histopathologic inflammation, and fibrosis no statistically significant differences were found among all the groups in comparison with each other. CONCLUSIONS: Although the shrinking rate of DynaMesh is lowest among all the groups, the results are statistically insignificant. The results of our experimental study revealed no superiority in the means of mesh shrinkage among TiMesh, Vypro II, Sepramesh, and DynaMesh in the rats.