Correlation between c-erbB2 expression, lymphovascular invasion and other biological and clinical prognostic factors and preoperative tumor markers in patients with early-stage and locally advanced breast cancer.

PURPOSE: To evaluate the correlation between c-erbB2 expression, lymphovascular invasion and other biological and clinical prognostic variables and preoperative CA 15-3 and CEA levels in patients with early-stage and locally advanced breast cancer. METHODS: Preoperative serum concentrations of CA 15- 3 and CEA were measured in 123 patients undergoing surgical treatment for stage I-III breast cancer and the association between these markers and clinical and biological variables were evaluated. RESULTS: With cut-off values of 45 U/ml (CA 15-3) and 2.5 ng/ml (CEA), the sensitivity for CA 15-3 and CEA was 10% and 24% and their mean values were 23 U/ml and 2.32 ng/ml, respectively. A significant correlation between preoperative levels of CA 15-3 and CEA was noticed (p=0.023). Preoperative CA 15-3 levels were significantly higher in patients with tumors > 5 cm (p<0.0001), with positive axillary lymph nodes (p=0.04), with increasing nodal burden (p= 0.025) and in patients with stage III disease (p=0.003). Tumor size >5 cm (p=0.002), increasing axillary nodal burden (p=0.02) and stage III disease (p<0.0001) were also significantly correlated with CEA values above the cut-off level. There were no correlations between CA 15-3 and CEA levels and other variables including c-erbB2 expression, age, grade, hormone receptor status, and lymphovascular invasion. CONCLUSION: Preoperative CA 15-3 and CEA levels are significantly correlated with tumor size, axillary nodal status and stage in patients with non-metastatic breast carcinoma. No correlation between preoperative values of CA15-3/CEA and c-erbB2 status, lymphovascular invasion and other prognostic factors was detected.

Surgical experience of hydatid disease of the liver: omentoplasty or capitonnage versus tube drainage.

BACKGROUND/AIMS: The aim of this paper was to report our experience and comparison of surgical treatment methods for hepatic hydatid cyst disease. METHODOLOGY: Between January 1990 and December 1998, 66 patients with hepatic hydatid disease in two centers were operated on. Patients were assessed by clinical examination, laboratory methods and ultrasonography and computed tomography and magnetic resonance. We also compared omentoplasty or cappitonage with external drainage with or without cyctectomy. RESULTS: Common pathology was solitary cysts and most of them were placed in the right lobe. Omentoplasty was performed for 35 cysts and cappitonnage for 36 and external drainage for 31 cysts. No operative mortality was reported. Patients with omentoplasty developed fewer complications and had a significantly shorter hospitalization than those with external drainage. CONCLUSIONS: Although omentoplasty seems to be the best possible surgical alternative for the radical treatment of hepatic hydatid cysts, the management of hydatid cysts should be flexible, taking into consideration a number of factors and variables.

Experimental study on the role of mast cells in peritoneal adhesion formation.

OBJECTIVE: To investigate the potential role of mast cell stabilisation in the prevention of post-operative adhesions. DESIGN: Laboratory animal experiment. SETTING: University hospital, Turkey. SUBJECTS: Ninety Wistar albino rats. INTERVENTION: Under anaesthesia, a lower midline laparotomy was performed, the caecum exposed and grasped until haemorrhage occurred. The rats were divided into three groups. Group 1, 2 and 3 were intra-peritoneally administered 1 ml of saline, disodium cromoglycate 5 mg/kg in 1 ml of saline and 10 mg/kg in 1 ml of saline, respectively thirty minutes prior to laparotomy and immediately subsequent to abdominal closure. They were later sacrificed, laparotomy repeated and the presence and extent of intraabdominal adhesions evaluated. RESULTS: Adhesion scores were best in the high disodium cromoglycate dose group of rats (p < 0.05) and the number of degranulated mast cells was significantly low in this group (p < 0.05). CONCLUSION: Disodium cromoglycate may be an effective agent for attenuating adhesion formation when administered in suitable doses.

Prevention of postherniorrhaphy urinary retention with prazosin.

Urinary retention that necessitates catheterization after herniorrhaphy is a well known, but usually ignored, situation. Increased sympathetic activity resulting from surgery may be the contributing factor. Blockade of alpha receptors in the bladder neck and urethral sphincter may prevent postoperative urinary retention. In this prospective placebo-controlled study, the efficacy of prazosin in preventing postoperative urinary retention after herniorrhaphy was investigated in 156 patients. Patients were randomized into two groups. Patients in Group I (control) were given placebo orally 12 hours before surgery, just before surgery, and 12 and 24 hours after surgery. In Group II, 1 mg of prazosin was given in the same manner of placebo. Nine of 84 patients (10.8%) in the prazosin group and 18 of 72 patients (25%) in the placebo group developed urinary retention. Catheterization was required in only 3 patients (3.5%) in the prazosin group compared to 10 patients (13.8%) in placebo-treated group (P < 0.05). In conclusion, prophylactic use of prazosin after herniorrhaphy significantly reduced the incidence of urinary retention and catheterization.

Factors affecting surgical mortality and morbidity in patients with obstructive jaundice.

The importance of clinical and laboratory parameters which have an effect on postoperative mortality and morbidity was evaluated in 124 patients operated on because of obstructive jaundice. The causes of obstructive jaundice were a malign disease in 38 patients (30.6%) and a benign disease in 86 patients (69.4%). Biliary enteric anastomosis in 66 patients (53%), external drainage in 46 patients (37%), and cholecystectomy in 12 patients (10%) were the surgical techniques of choice for correction of obstructive jaundice. There were significantly high mortality rates in patients with weight loss, more than 10 kg during preoperative the month (p < 0.05); jaundice longer than 21 days, (p < 0.001); and malignancy caused jaundice (p < 0.002). Haematocrite less than 30% (p < 0.05), albumin level below 3 g/dl (p < 0.01), blood urea nitrogen level above 30 mg/dl (p < 0.001), and bilirubine above 10 mg/dl (p < 0.01) were determined as risk factors in mortality. Direct relationships between the number of risk factors, complications, and mortality ratios were determined. One or more complications were determined in patients with more than six risk factors. High mortality rate was also determined in patients who had five and more risk factors. The following factors were evaluated: respiratory, circulatory, renal functions, and infection, and metabolic concomitant diseases, and comorbid scores for each patient were calculated. High rate complications in patients with eight and more comorbid scores and high mortality rates in patients with six and more were also determined. Finally, all these parameters were important in demonstrating postoperative mortality in obstructive jaundice patients. We suggest that surgery after treatment of correctable risk factors decreases postoperative morbidity and mortality.

Postoperative retention of urine in general surgical patients.

OBJECTIVE: To find out the incidence of retention of urine after various general surgical operations, and to assess the effects of applying a bag filled with warm water (40-45 degrees C), and encouraging early mobilisation onreducing the necessity for catheterisation. DESIGN: Open study. SETTING: Cumhuriyet University Hospital, Sivas, Turkey. SUBJECTS: 577 consecutive patients who had no history of urinary problems and had not already been catheterised, and who underwent general surgical operations between April 1989 and December 1991. MAIN OUTCOME MEASURE: Ability to pass urine spontaneously. RESULTS: 64 of 272 men (24%) and 47 of 305 women (15%) developed retention of urine (p = 0.02), and 15 and 11, respectively, required catheterisation. Patients were most likely to develop retention after repair of incisional hernia (13/32, 38%), midline laparotomy (19/82, 23%), and subcostal incisions (30/142, 21%), but there were no significant differences among these. Significantly more patients whose operations had lasted 60 minutes or more, and who had opiate analgesia, required catheterisation (5/232 compared with 21/345, p = 0.04, and 11/120 compared with 15 out of 457, p = 0.01, respectively). 85 of the 111 patients who went into retention (77%) were able to pass urine spontaneously after application of a bag containing warm water to the suprapubic region, and walking about. The mean period of catheterisation was 12 hours (range 4-76), and all patients but one passed urine spontaneously when the catheter was removed. Only two of the 26 patients who were catheterised developed microbiologically confirmed urinary tract infections. CONCLUSION: Retention of urine is a common complication after general surgical operations, but the necessity for catheterisation can be kept to a minimum by simple and inexpensive measures.

Ovarian haemangioma.

Although ovaries have a very rich vasculature, haemangiomas of the ovary are extremely rare. There are only another 39 cases of ovarian haemangioma recorded in the literature. We describe an 11-year-old girl with an ovarian haemangioma who presented clinically with an acute abdomen. The patient has been well without complications for a year.

Treatment of experimental peritonitis with intraperitoneal povidone-iodine solution.

Intraperitoneal lavage with povidone-iodine solution has been reported by some to be beneficial in the treatment of peritonitis and by others to cause local and toxic side effects. In this study, 200 white mice, divided into four groups of 50, were subjected to bacterial peritonitis. The first group had no treatment; peritoneal lavage was carried out using povidone-iodine solution in the second group and a 0.9% sodium chloride solution in the third. In the fourth group, antibiotics (clindamycin and gentamicin) were instilled intraperitoneally without peritoneal lavage. The povidone-iodine solution had no beneficial effect, the death rate after 1 week (76%) being similar to that in the control group (78%) and much higher than that in mice treated with sodium chloride lavage (38%) and antibiotics without lavage (16%). A second series of experiments was, therefore, carried out to investigate the toxic effect of povidone-iodine solution intraperitoneally on mice without peritonitis; the solution was found to be toxic.