Centralization of mammography reporting with mobile trucks: Turkish experience.

Screening via mammography is a complex process to be implemented. OBJECTIVE: To report the initial results and the effectiveness of newly implemented Turkey's population based breast cancer screening program performed for 40-69 years old women; and effectiveness of the newly implemented out-sourcing mobile trucks and national central report center. The study is conducted prospectively in one year (March 2016-March 2017) in all 81 provinces of Turkey. Mammography images were transferred via on-line web based system to the central reporting center. BI-RADS Scores and KETEM models (Mobile vs. Stationary) were the parameters were compared. In total mammography images of 414.802 patients were transferred from 155 KETEMs to the central reporting center. From these patients; 95.872 (23,1%) were aged between 40 and 44. Among all images, 21.999 (5,3%) were BI-RADS 0-4-5, 391.123 (94,3%) were BI-RADS 1-2. Totally recall rate of the national reporting center was 5.3%. Number of patients screened per day were significantly higher in out-sourcing mobile trucks compared to stationary KETEMs (31.8 vs. 8.9; p < 0.05). This is the first and the largest breast cancer screening study which results of a population based mammography screening for 40-69 years old women are evaluated at the same time with the evaluation of the efficacy of newly implemented centralized reporting center and the mobile screening trucks in comparison with stationary cancer screening centers. According to the initial results; Turkey's newly implemented population based breast cancer screening system seems to be feasible and effective.

Comparison of different surgical options in the treatment of pilonidal disease: retrospective analysis of 175 patients.

Pilonidal sinus disease is a benign disorder with an unidentified etiology and is observed mainly in young adults. It is an important health problem because it causes work loss. Although various nonsurgical treatment options have been tried up to date, there is a consensus on surgical intervention to treat the disease today. The optimal surgical method should be simple, associated with short hospital stay and low recurrence rates. In this study, patients who have undergone different surgical treatment methods due to pilonidal disease were retrospectively analyzed. The medical records of 175 patients who were operated on between 2002 and 2005 at the General Surgery Departments of Gaziosmanpasa University Medical School and Bartin State Hospital for pilonidal disease were reviewed for treatment option, postoperative complications, hospitalization time, work-off periods, and recurrence rates. The patients consisted of 150 (85.3%) males with a mean age of 26.47 +/- 7.78 years. Marsupialization was applied to 82 (46.9%), unroofing to 20 (14.7%), primary closure to 29 (16.6%), and Limberg flap to 44 (25.1%) patients. The longest hospitalization period of 3.61 +/- 1.08 days was observed in the Limberg flap group. The longest return to work period (20.12 +/- 5.1 days) was observed in the marsupialization group. Both differences were significant. The highest complication rate was observed among the primary closure group (31%) followed by the patients treated by Limberg flap technique (15.8%). In the primary closure group, infection was detected in five (17.2%) and wound dehiscence in four (13.8%) individuals. The highest complication rates (31.03%) and recurrences (13.8%) were observed in the primary closure group. Various operative methods utilized in the treatment of pilonidal disease are associated with a number of advantages and disadvantages. Postoperative complication rates of unroofing and marsupialization are low, but require long wound care. In our study, we did not observe any recurrence among the patients treated by unroofing, but experienced a high recurrence ratio among subjects treated by marsupialization. In addition, there were high complication rates in the primary closure and Limberg flap groups. So, the best option is to explain the advantages and disadvantages of the available surgical methods and respect the patient's decision.

The effect of hyaluronan-based agents on adhesion formation in an intraabdominal sepsis model.

Because of the technical difficulty during subsequent surgical intervention, adhesion remains the most important predictor of outcome in the staged procedures following emergent colorectal surgery. The aim of this study was to assess the long-term effects of hyaluronan (HA)-based adhesion barriers 3 months following the infectious insult to the peritoneal cavity. Wistar albino rats were divided into three sham and four infectious groups, each consisting of 20 rats. Sham groups consisted of a control group (I), which had undergone manipulation of the cecum in the first operation and saline irrigation following the cecal resection in the second operation; an HA-based bioresorbable membrane (BM) group (II), in which 20 x 20- and 35 x 25-mm pieces of HA-based bioresorbable membrane were placed over the cecectomy area and under the midline incision, respectively, with other conditions the same as for the control (I) group; and an HA-based solution (S) group (II), where HA solution was used as an irrigation solution, with other conditions the same as for the control group (I). Infectious groups consisted of a septic group (IV), which had undergone cecal ligation and puncture in the first operation and saline irrigation following the cecal resection in the second operation; a sepsis + HA-BM group (V), in which two sheets of membrane were applied, with other conditions the same as for the septic group (IV); a sepsis + HA-S group (VI), in which HA solution was used as an irrigation solution, with conditions otherwise the same as for the septic group (IV); and a sepsis + HA-BM + HA-S group (VII), where HA solution was used as an irrigation solution and two sheets of membrane were applied, with other conditions the same as for the septic group (IV). At the end of the 3-month period, mortality, septic complications, and intraabdominal adhesions (adhesion scores and adhesion tensile strength measurements) were recorded. Significantly denser adhesions were found in the septic group (IV) when compared to the others (P < 0.001). HA-S significantly reduced not only the incidence of adhesion but also the adhesion tensile strength in infectious groups (P < 0.001 compared to the sepsis group). However, HA-BM significantly reduced adhesion tensile strength only. Irrigation of the peritoneal cavity with HA-S may prove to be useful to shorten the reversal time period and decrease morbidity following staged procedures for intraabdominal sepsis.