Comparison of Shoulder-Arm Complex Pain, Function, and Scapular Dyskinesia in Women With and Without Unilateral Lymphedema After Breast Cancer Surgery.

INTRODUCTION: Lymphedema is the most important complication seen after breast cancer surgery. The study aimed to evaluate pain, shoulder-arm complex function, and scapular function in women who developed lymphedema after breast cancer surgery and to compare these with women without lymphedema. MATERIALS AND METHODS: Fifty women with lymphedema (age, 54.34 ± 9.08 years; body mass index, 30.10 ± 4.03 kg/cm2) and 57 women without lymphedema (age, 53.68 ± 9.41 years; body mass index, 29.0 ± 5.44 kg/cm2) after unilateral surgery for breast cancer were included. Clinical and demographic information was noted. The severity of lymphedema with perimeter measurements (Frustum model), level of heaviness discomfort sensation with a visual analog scale, pain threshold with a digital algometer, shoulder-arm complex functionality with the Disabilities of the Arm, Shoulder, Hand Problems Survey (DASH), and scapular function with observational scapular dyskinesia and lateral scapular sliding tests were assessed. The t test, χ2 test, and Mann-Whitney U test were used for analyses. RESULTS: The follow-up duration after the surgery was 4.24 ± 2.97 years and 3.19 ± 1.76 years, and the upper extremity volume was 2106.65 ± 510.82 cm3 and 1725.92 ± 342.49 cm³ in the lymphedema group and in the no-lymphedema group, respectively. In the lymphedema group, arm-heaviness discomfort, pain threshold levels in the trapezius and deltoid muscles, and DASH scores were worse (P < .05). The rate of scapular dyskinesia (70.0%) and type 2 scapula (32%) in the surgical side was higher in patients with lymphedema. CONCLUSION: The pain pressure threshold in the trapezius and deltoid muscles, heaviness sensation level, and inadequate upper extremity function are significantly higher in patients with lymphedema, and the scapular dyskinesia rate was higher.

Assessment of prophylactic antibiotic usage habits of the general surgeons in Turkey.

INTRODUCTION: One of the most important aspects of inappropriate antibiotic use among general surgeons in Turkey is the use of surgical antibiotic prophylaxis (SP). In order to shed light on the current situation, we conducted a survey of general surgeons in our country. Our aim was to evaluate the approach taken by our general surgeons in prescribing SP, while providing data pertinent to the effectiveness of the 'Rational Drug Use' (AIK) national action plan. METHODOLOGY: A questionnaire on the subject of personal SP usage and compliance with guidelines was distributed amongst general surgeons between 2018-2019. The questions related to individual approaches taken by surgeons when treating patients with either clean or clean-contaminated wounds. Results of the questionnaires were collated and compliance with ASHP guidelines was evaluated. RESULTS: A total of 317 completed questionnaires were evaluated. According to the questionnaire results, the rate of total compliance with ASHP guidelines was 26.8%. The compliance rate for preoperative SP was 69.7% in the clean wound group and 54.6% in the clean-contaminated wound group. Although 96.5% of the participants reported correct timing for the first dose of SP, this number dropped to 79.5% apropos the adminstration of further doses of prophylaxis. The percentage of surgeons prescribing continued antibiotics at discharge for clean and clean-contaminated cases was 22.7% and 38.5%, respectively. CONCLUSIONS: The results of this study indicate that inappropriate use of SP is widespread in our country, and that antibiotics continue to be prescribed at discharge.

Frequency of Early-Stage Lymphedema and Risk Factors in Postoperative Patients with Breast Cancer.

OBJECTIVE: Lymphedema is a chronic major complication that is seen frequently post-operatively and has negative effects on quality of life. In our study, determining the early-stage postoperative lymphedema frequency and specifying the risk factors in its development has been aimed. MATERIALS AND METHODS: One hundred one cases that were operated on for breast cancer were evaluated regarding the 12-month control of their clinical specifications, histopathological specifications, and specifications related with the surgical intervention retrospectively. The data related to the parameters envisioned as risk factors were evaluated. RESULTS: Lymphedema development was found in 7 (6.9%) out of 101 cases constituting the study group. No significant difference (p>0.05) in terms of lymphedema development was determined among age, body mass index (BMI), chemotherapy (CT), postoperative seroma or infection, mastectomy with the dominant arm, and breast-conserving surgery (BCS), which were evaluated as risk factors. There was a significance (p<0.05) between the other risk factors, which were axillary dissection (AD), number of positive lymph nodes (LN), radiotherapy (RT), the tumor size (T), and lymphedema existence. In every case in which lymphedema was determined, it was seen that there was axillary LN involvement and 15≤LN were ablated in the dissection (p<0.05). CONCLUSION: It is seen that AD, RT applied to the breast cancer patients, and T are important risk factors in early-stage lymphedema development. No early-stage lymphedema development was determined in any of the patients to whom sentinel lymph node dissection (SLND) was applied.

Comparing reduction mammaplasty specimens between superior and central pedicle techniques: a retrospective study.

UNLABELLED: The aim of this study was to evaluate the histologic diagnoses of the reduction mammaplasty specimens in two retrospective series of patients operated using superior and central pedicle mammaplasties. Between November 2000 and December 2011, 60 consecutive patients (120 breasts) underwent breast reduction using the superior pedicle technique with a vertical scar (Lejour's technique). These patients were compared with another series of 80 patients (150 breasts) who underwent breast reduction using a vertical scar mammaplasty with a central pedicle (Copcu's technique). The characteristics of the patients were statistically similar between the two groups. Therefore, 140 patients who had undergone reduction mammaplasty were analyzed with respect to their histologic diagnoses, age, and specimen's weight. In the superior pedicle technique, we found that 30% of these women had pathologic alterations in at least one of their breasts, whereas the pathologic changes in patients who underwent Copcu's technique were 35%. In terms of tumor diagnosis, the upper quadrant excision technique (e.g. Copcu's method) may be safer. If there is no other special condition, it is better to use the pedicle technique in which the upper lateral and upper medial pole is removed. LEVEL OF EVIDENCE: Level I, therapeutic study.

Cognition of breast cancer among gestational age Turkish women: a cross-sectional study.

The aim of the study is to describe the cognition of breast cancer with respect to knowledge, beliefs, attitudes and behavior in a group of gestational age Turkish women. A questionnaire survey was therefore performed on 201 randomly selected women registered to the health database in Aydin. In age, marital status, and occupation were found to significantly impact on breast self-examination (BSE) performance, which should still be considered as an important tool for early diagnosis, although it does not substitute clinical examination and education. As delayed diagnosis is the leading problem in the management of disease, well-structured education should be supported to increase awareness of breast cancer. Given to the remarkable role of nurses in the community on women's health, a more focused approach on education of young female populations by nurses in Turkey should be considered.

Peri-operative antibiotic prophylaxis: adherence to guidelines and effects of educational intervention.

BACKGROUND: This study was aimed to determine the propriety of perioperative antimicrobial prophylaxis, to evaluate the effects of a training intervention on correction. METHODS: This prospective educational intervention study was performed on clean, clean-contaminated, and contaminated wounds in elective procedures. The accuracy of the antimicrobial prophylaxis was analyzed according to international guidelines. The outcome measures were appropriateness of prophylactic antibiotic indication, choice, dose and duration; and cost of inappropriate administration. RESULTS: Before the intervention, 312 procedures were recorded compared with 322 after the intervention. Total compliance rate decreased from 34.3% to 28.5% after the intervention, though insignificantly (p=0.59). Educational training intervention did not change the rate of inappropriate antibiotic choice statistically, and prolonged antibiotic use was significantly higher after the intervention (p=0.01). The positive impact of the intervention was observed in decreased "not indicated but administered" rate (p=0.009) and absence of procedures with "indicated but not administered" and "inappropriate antibiotic dose" which also decreased significantly (both p<0.001). The total cost of irrational antibiotic use was US$26,230.20. CONCLUSIONS: Although this educational intervention study achieved improvements in indications, choice, and dosing of surgical antimicrobial prophylaxis, it failed to improve prolonged use and total compliance rate, and to lower the costs sufficiently. It will probably provide better results by means of compulsory measures for surgeons to comply with available protocols and guidelines, as well as education programs, in order to change the antibiotic utility habits on surgical prophylaxis and to achieve accurate prophylactic administrations.

[The comparative evaluation of Enzyme Linked Immunosorbent Assay (ELISA), Indirect Hemagglutination Test (IHA) and Indirect Fluorescent Antibody Test (IFAT) in the diagnosis of cystic echinococcosis]. / Kistik Ekinokokkozis Tanisinda ELISA (Enzym Lynked Immunosorbent Assay), Indirekt Hemaglütinaston Testi (IHA) ve Indirekt Fluoresan Antikor Testi (IFAT)'nin Karsilastirmali Olarak Degerlendirilmesi.

The most frequently used methods for the diagnosis of cystic echinococcosis are ELISA, IHA and IFAT methods in routine laboratories. The aim of this study was to detect the optimum serological method which can be used routinely with the highest sensitivity and specificity. Forty CE cases with 40 controls, making a total of 80 patients, were included in the study. In 80 sera specimens, specific antibody response to metacestodes was investigated using ELISA, IHA and IFAT methods. The antibody response in CE cases was found to be 35 (87.5%), with ELISA, 33 (82.5%) with IFAT and 36 (90.0%) with IHA. The sensitivity-specificity of ELISA, IFAT, and IHA were 87.5%-100%, 82.5%-100% and 90.0%-97.5%, respectively. A cross reaction of a 1/160 titer was detected with the IHA method in one patient with taeniasis in the control group. In conclusion, using more than one serologic method seems to increase the sensitivity and specifity of the serologic diagnosis of CE.

C-reactive protein may be a marker of bacterial translocation in experimental intestinal obstruction.

BACKGROUND: C-reactive protein (CRP) is used as a marker of intestinal ischaemia. This study evaluated whether CRP levels can be used to detect ischaemia-induced (strangulated) intestinal obstruction and subsequent bacterial translocation. METHODS: Forty-eight rats, divided into four groups underwent the following procedures: anaesthesia alone (native controls), laparotomy (sham-operated controls), or surgical induction of simple or strangulated intestinal obstruction (simple and strangulated obstruction groups, respectively). Blood samples were collected for culture and serum CRP analysis. In addition, liver and mesenteric lymph node (MLN) specimens were collected for culture, to determine the presence of bacterial translocation; and ileal segments, for histopathological investigation. RESULTS: CRP levels and rates of bacterial translocation, expressed as colony forming units (cfu) per gram wet tissue, were higher in both intestinal obstruction groups than in the native and sham-operated control groups (P < 0.001 for both). The increases in CRP levels paralleled increases in the number of cfu in the MLN and liver cultures (P < 0.01). Compared to controls, animals in the obstruction groups also had a higher incidence of positive blood cultures (P < 0.005) and greater histopathologic evidence of inflammatory infiltration of the lamina propria (P < 0.01). However, no significant difference between the simple and strangulated obstruction groups was observed. CONCLUSION: CRP levels increase with the severity of bacterial translocation in acute intestinal obstruction but do not permit discrimination between simple and strangulated intestinal obstruction.

Effects of pneumoperitoneum with or without colostomy on rat colonic anastomotic healing.

BACKGROUND: Elevated intra-abdominal pressure and colostomy have adverse effects on colonic anastomoses. The aim of the present study was to investigate the effects of laparoscopic colon surgery with and without diverting colostomy on healing of colonic anastomoses in an experimental model. METHODS: Thirty-six male rats were divided into three equal groups: group 1, control (colonic anastomosis and anaesthesia for 180 min only); group 2, 180 min pneumoperitoneum and colonic anastomosis; and group 3, similar to group 2 with a proximal colostomy. On day 7, bursting pressures, tissue hydroxyproline and nitric oxide concentrations and histopathological inflammation scores were determined and compared. RESULTS: Mean bursting pressures were higher in the control group than the two pneumoperitoneum groups (P=0.0003). Mean tissue hydroxyproline concentrations showed no difference (P>0.05). Mean tissue nitric oxide concentrations were significantly increased in the control group (P=0.0013). Histopathological scores demonstrated increased inflammatory response in group 3 compared to the controls (P=0.0009). CONCLUSION: Pneumoperitoneum delays collagen maturation and impairs anastomotic strength in the colon. Following pneumoperitoneum, performance of a diverting loop colostomy to protect the anastomosis will not have additional detrimental effects on anastomotic healing.

Nitric oxide regulates bacterial translocation in experimental acute edematous pancreatitis.

BACKGROUND/AIMS: The role of nitric oxide (NO) in bacterial translocation (BT) associated with acute pancreatitis is controversial. We investigated the effects of the NO synthase substrate, L-arginine, and the NO synthase inhibitor, N-nitro-L-arginine methyl ester (L-NAME), on BT in caerulein-induced acute pancreatitis in rats. METHODS: Acute pancreatitis was induced by subcutaneous injections of caerulein (12 microg/kg) at 6-hour intervals for 2 days. Subcutaneous injections of L-arginine (100 mg/kg) or L-NAME (10 mg/kg) were administeredonce daily for 2 days. At 48 h, pancreatic injury and BT to the mesenteric lymph nodes (MLN), liver, and peritoneum were assessed. RESULTS: Compared with controls, rats that received caerulein injections alone had increased BT to the MLN and pancreatic inflammatory changes. L-Arginine significantly reduced the inflammation and BT caused by caerulein. L-NAME did not significantly alter pancreatic inflammation. Although caerulein + L-NAME-treated rats had increased BT to the peritoneum, MLN, and liver compared with controls, rates of BT did not significantly differ between caerulein alone- and caerulein + L-NAME-treated rats. CONCLUSION: In acute edematous pancreatitis, BT is increased and is regulated by NO. NO substrates limit BT and pancreatic inflammation associated with acute pancreatitis, probably by their bactericidal actions and ability to improve pancreatic blood flow.

Strangulated ventral hernia model in rats.

This study was performed to describe a new model of strangulation obstruction mimicking the situations relevant to abdominal hernias. The strangulation obstruction was induced either by intra-abdominal ligation of an ileal segment 2 cm in length (n = 20) or by a pursestring suture around a fascial defect with a strangulated intestinal loop placed subcutaneously (n = 20). Ten animals served as sham operated controls (n = 10). All animals were euthanized at 12 h postoperatively; strangulated ileum segments were collected for histopathological examination. Microscopic injury scores were similar in both strangulation groups, which were significantly different from the control group (p <.001). The model described here seems to be appropriate for use in further experimental studies concerning strangulation obstruction injury and its consequences, with the added advantage of visualization of the strangulated intestinal loop beneath the skin.

A patient with liver trauma and incomplete behcet s disease.

Behcet' s Disease (BD ) is a complex multisystemic disease, which is characterized by recurrent oral and genital aphteous ulcers and iritis in which vasculitis can also be one of the possible clinical manifestations. A thirty seven year-old female patient with incomplete BD was admitted to emergency service, with intra-abdominal hemorrhage more severe than that would be expected, with the degree of related trauma. We decided to manage the patient conservatively, observing vital signs, haemogram, computed tomography (CT) and angiography instead. Subcapsular hematomas were detected in the right and left lobes of the liver. No data was encountered in the literature and textbooks referring to liver trauma with BD, except a case of fatal hemobilia. H ere in we present a liver trauma case with hemorrhage and hepatic fragility due to vasculitis in Behcet' s disease and review the literature. Key words: liver trauma, incomplete Behcet' s disease

Lexipafant inhibits postsurgical adhesion formation.

BACKGROUND: PAF and its antagonists have been studied in the pathophysiology of various inflammatory conditions. This study investigates the effects of a platelet activating factor antagonist, lexipafant, on peritoneal adhesion formation and wound healing. MATERIALS AND METHODS: Forty-eight Wistar albino rats (300-350 g) were divided into four equal groups; adhesion-induced lexipafant (AL), adhesion-induced saline (AS), sham-operated lexipafant (SL), and sham-operated saline (SS). All rats underwent a midline laparotomy under sterile conditions. The anterior wall of the left uterine horn was scraped to cause hemorrhages in adhesion-induced groups. Following peritoneal injections of either saline or lexipafant, the incisions were closed in layers. On the 14th day, the rats were killed and adhesions were scored from 0 (none) to 4 (dense). Tissue samples from the adhesions and the left horn of uterus were examined biochemically for hydroxyproline content, and serum IL-6 levels were determined. RESULTS: The adhesion formation score was significantly increased in the AS group compared to the SL and AL groups (P < 0.001). The IL-6 levels of the AS group were higher than those of the other groups (P < 0.05). There was no significant difference in hydroxyproline content between groups (P > 0.05). CONCLUSIONS: Lexipafant plays a role in the prevention of adhesion formation without affecting wound healing.

Comparison of local, spinal, and general anaesthesia for inguinal herniorrhaphy.

OBJECTIVE: To compare local, spinal, and general anaesthesia for inguinal hemiorraphy in otherwise healthy patients with respect to duration of operation, time in operating room, postoperative pain, complications, rehabilitation, and satisfaction. DESIGN: Prospective randomised controlled trial. SETTING: University hospital, Turkey. SUBJECTS: Seventy-five men with unilateral primary inguinal hernias, Nyhus type II and III, and ASA I and II. INTERVENTIONS: Lichtenstein repairs with standard local, spinal, or general anaesthesia. MAIN OUTCOME MEASURES: Duration of operation and anaesthesia, postoperative pain scores, analgesic requirements, complications, length of hospital stay, postoperative rehabilitation, and satisfaction. RESULTS: With local anaesthesia, we recorded shorter time spent in the operating room, lower incidence of nausea and urinary retention, and more satisfaction. In the local and spinal anaesthetic groups, postoperative analgesic requirements and length of hospital stay were less than in the general anaesthesia group. CONCLUSIONS: Local anaesthesia is suitable for day-case hernia repair with fewer postoperative problems and less analgesia requirement. Patients also reported greater satisfaction. Local anaesthesia may be preferred to other methods.