Association of ventral incisional hernias with comorbid diseases.

BACKGROUND: Ventral incisional hernias are more commonly associated with comorbid diseases when compared to other hernia types. We investigate the hypothesis that unfavourable local factors related to comorbid diseases may lead to incisional hernia development. MATERIALS AND METHODS: The characteristics of incisional hernia (71 patients), primary ventral hernia (114 patients)and groin hernia groups (820 patients) were analysed and compared among each other. RESULTS: Advanced age, female gender, presence of coexisting disease, strangulation, incarceration, bowel or omentum resections, deep venous thrombosis, ileus, wound infections,ASA scores were significantly higher and the duration of hospital stay was longer in the incisional hernia group when compared to the other groups. Presence of coexisting diseases and ASA class scores were independent predictors of length of hospital stay in incisional hernia patients (p 0.05). CONCLUSIONS: Ventral incisional hernias are associated with higher incidence of comorbid diseases in comparison with other types of abdominal wall hernias. Patients with coexisting diseases might have unfavourable local factors that lead to incisional hernia development.

Metaplastic carcinoma of the breast: clinicopathological features and immunohistochemical analysis.

PURPOSE: Metaplastic breast carcinoma (MBC) is a rare and heterogeneous group of neoplasms characterized by a mixture of spindle, squamous and/or mesenchymal cells. The purpose of this study was to assess the immunohistochemical features, biological characteristics and myoepithelial differentiation of a series of MBC patients. METHODS: The archival pathological material from 33 MBC patients was evaluated. Analysed were patient characteristics, pathological and immunohistochemical features and their relevance as prognostic factors of patient survival. RESULTS: The median patient age was 44 years (range 17-82), and the median tumor size 5 cm (range 0.5-17.0). The majority of patients (n=29; 87.8%) were treated by modified radical mastectomy, 1 (3%) patient had breast-conserving surgery and another 1 (3%) had latissimus dorsi flap reconstruction. Metastasis to axillary lymph nodes was found in 14 (42.4%) patients, 18 (54.5%) patients were triple negative, and 22 (66.7%) were epidermal growth factor receptor (EGFR) positive. The 5-year event-free survival was 25.9%, whereas the 5-year overall survival was 27.5%. Immunohistochemical analysis showed the following: vimentin positivity in 31 (93.9%) patients, high molecular weight cytokeratin (HMWCK) positivity in 31 (93.9%), CK 5/6 positivity in 28 (84.8%), P 63 positivity in 19 (57.6%) and calponin positivity in 18 (54.5%) patients. Two particularly interesting findings were noted, namely, myoepithelial differentiation in the carcinomatous and sarcomatous elements of MBC, and EGFR immunopositivity. CONCLUSION: Immunohistochemistry has an important role to play in the diagnosis and treatment decision of MBC. This report presents findings related to a broad panel of immunohistochemical markers for a large series of metaplastic cases, which indicate poor prognosis for this tumor.

Why do we use drains in some inguinal hernia repairs?

BACKGROUND AND AIMS: There is no consensus among surgeons on the indication of putting drains for in groin hernias. In this study we aimed to investigate the factors that are associated with drain usage by comparing the clinical characteristics of patients who had drains with the patients without drains in the repair of groin hernias. MATERIAL AND METHODS: The data of all groin hernia repairs from January 2006 till February 2010 in Ankara Diskapi Research Hospital were collected prospectively. The type of presentation, age, gender, presence of coexisting diseases, type of hernia, American Society of Anesthesiologists (ASA) class, type of anesthesia, postoperative general complications, local wound complications, duration of operation, and length of hospitalization, recurrence and mortality were compared between the groups of patients with drains versus without drains. RESULTS: The drains were used in 66 (8.3%) of 795 open mesh repairs of inguinal hernias. The patients who had drains were older, had cardiovascular disease, higher ASA class, received anticoagulant regimens more often, had indirect type hernia more often, more recurrent hernias, more commonly had emergency operations, had complicated presentations such as incarceration and strangulation, therefore had resections more often, pulmonary complications, had local complications such as hematoma, had longer duration of the operations and stayed longer in the hospital when compared with the patients without drains (p < 0.05). Anticoagulant use, duration of the operation, recurrent hernias and ASA class were statistically significant independent variables predicting drain use in inguinal hernias (p < 0.05). When femoral hernia repairs (n = 35) were analysed; drains were associated with male gender and long operation time (p < 0.05). CONCLUSIONS: Drains are more commonly used in patients on anticoagulants, who had long duration of the operation, recurrent hernias and high ASA class. Drain use in selected patients seems to not increase infection risk but are associated with longer hospital stay.

Characteristics and risk factors for colorectal cancer recurrence.

PURPOSE: To evaluate the characteristics of recurrence and examine the clinicopathological factors related to disease- free (DFS) and overall survival (OS) of patients with colorectal cancer (CRC) recurrence. METHODS: One hundred and sixteen CRC patients with stage II and III disease that had been resected curatively in our clinic between 1999 and 2006 were retrospectively evaluated. The parameters evaluated were gender, age, preoperative CEA levels, tumor localisation, duration of surgery, the units of perioperative blood transfusion, tumor differentiation, TNM stages and adjuvant therapies. The presence of preoperative intestinal obstruction, radical abdominopelvic lymph node (RAPL) dissection and lymphatic, vascular and perineural invasion were also evaluated. RESULTS: With 36.6+/-2 months follow-up, 49 (42%) patients developed local recurrence and/or distant metastases. Twenty-three (19.8%) patients presented with isolated local recurrence. Thirteen of 49 patients with local recurrence were successfully operated with R0 curative resection. The OS survival rates for those with curatively and palliatively resected recurrences were 29 and 19 months, respectively. In multivariate analysis, the factors related to DFS were tumor localisation and differentiation, neurovascular invasion, blood transfusion and RAPL dissection. Among these factors, only RAPL dissection was not statistically significant for OS. CONCLUSION: The factors increasing local recurrence rates of CRC should be clearly described. Local and systemic treatment modalities, like preoperative chemoradiotherapy should be planned for patients carrying these risk factors.

Comparison of incisional hernia models in rats: an experimental study.

PURPOSE: Incisional hernia repair is a frequently performed operation worldwide. In this experimental study, our aim is to present the incisional hernia model after creating midline laparotomy and several type of defects on abdominal wall of the rats. Thereby, the method determined here may be used in future experimental incisional hernia repair studies. METHODS: After approval, 32 male rats were randomly seperated into 4 groups of 8 animals each, and were operated to form an incisional hernia; Sham group, 5 cm incision group, 5 cm incision plus capitonnage group, and 5 cm incision plus 2 × 4 cm muscle excision group, respectively. On the 28th postoperative day after killing, the abdominal anterior wall of rats were removed for histopathological and biomechanic examination. RESULTS: The incisional hernia size was found to be statistically different in at least one group (p = 0.001). The incisional hernia size in Group 4 was found to be significantly higher than Group 2 (p = 0.001). When the tension and elongation values were examined, there was a difference in at least one group (p < 0.001 and p = 0.029, respectively). Histopathological examination shows that the degree of inflammation and fibrosis varies significantly (p = 0.001 and p = 0.002, respectively). CONCLUSION: This study has lead us to believe that the rat model created by applying muscle excision from the midline of the abdomen is the ideal incisional hernia model that can be used in future experimental incisional hernia studies.

Prognosis in hormon receptor negative breast cancer patients according to ERBB2 status.

Breast carcinomas represent a heterogenous group of tumors and recent studies have demonstrated several subtypes of breast cancer by gene expression profiles. This study aimed to compare hormon receptor negative (ER-/PR-/ERBB2+) and triple negative (ER-/PR-/ERBB2-) patients in terms of prognosis and to show that molecularly defined subtypes can be distinguished by conventional laboratory methods. Patients treated between 2001-2007 for hormon receptor negative breast cancer were retrospectively studied. In addition to the conventional prognostic factors, effect of ERBB2 status of the patients on disease-free and overall survival was evaluated. Hormon receptor and ERBB2 status were determined by immunuhistochemistry and fluorescence in-situ hybridization. 141 patients were eligible for the study. Number of patients with ERBB2 positive and triple negative tumors was 70 and 71, respectively, and two groups were comparable in terms of study parameters. Tumor size, grade, axillary status, patient groups, and adjuvant chemotherapy and radiotherapy showed significant impact on disease-free survival and overall survival was significantly dependent on axillary status, type of surgery, and patient groups in univariate analysis. In multivariate analysis, patient groups, tumor grade, and axillary status were independent prognostic factors for disease-free survival whereas patient groups, extent of surgery, and axillary status were independent prognostic factors for overall survival. This study has indicated that ERBB2 negative patients had worse survival among hormon receptor negative breast cancer patients and showed that molecularly defined subtypes of breast cancer can be differentiated by immunuhistochemistry in terms of prognosis.

The role of anti-CENP-B and anti-SS-B antibodies in breast cancer.

A close relationship between autoimmunity and malignant diseases has been supposed for a long time. In clinical practice, anti-SS-B and anti-CENP-B antibodies are used as serologic markers for autoimmune diseases. In this study, anti-SS-B and anti-CENP-B autoantibodies were studied in breast cancer patients and compared to a control group surgically treated due to benign diseases. These antibodies were evaluated by enzyme linked immunoassay and serum values >10 U/ml were accepted as positive. Fifty-five patients with breast cancer and 25 patients with benign diseases were prospectively included in the study. In the breast cancer group, both anti-CENP-B (33% vs. 8%) and anti-SS-B (44% vs. 24%) autoantibodies had higher positivity compared to the control group, but this difference reached statistical significance only for anti-CENP-B antibodies (p=0.02). Besides, anti-SS-B positivity was detected more frequently in breast cancer patients with axillary involvement (63% vs. 24%) (p=0.006) and increased as the number of involved lymph nodes increased in the axilla (p=0.03). Although the clinical significance of autoantibody detection in cancer patients is still not clear, autoantibodies especially detected in individuals without proven autoimmune diseases needs to be thoroughly evaluated for early diagnosis and treatment of various cancers.

Prophylactic antibiotic use in elective inguinal hernioplasty in a trauma center.

PURPOSE: In this double-blind prospective randomized trial, our objective was to investigate the effect of antibiotic prophylaxis in patients undergoing elective inguinal hernia surgery with mesh repair in a large-volume tertiary referral trauma center. METHODS: Eligible patients were assigned randomly to either an antibiotic prophylaxis group or a control group. Patients in the prophylaxis group were given 1 g cefazolin by IV bolus injection whereas the placebo control group received an equal volume of sterile saline preoperatively. A Lichtenstein repair was done in all cases. The patients were examined for surgical site infection (SSI) and other postoperative local complications before discharge, and reexamined 3, 5, 7, and 30 days after discharge. RESULTS: Groups were well matched for age, sex, coexisting diseases, ASA scores, type of hernia, type of anesthesia, duration of surgery. Incidence of infection was 7% in the control group (7/100) and 5% in the prophylaxis group (5/100) (P = 0.38). All the infections were superficial and responded well to drainage and proper antibiotic therapy. All other postoperative complications were similar in the two groups. CONCLUSIONS: In our settings antibiotic prophylaxis has no significant effect on the incidence of SSI in elective repair of inguinal hernias with mesh. The most effective way to reduce the incidence of infection in prosthetic repair may be a specific center for treatment of abdominal wall hernias.

Risk factors related with unfavorable outcomes in groin hernia repairs.

PURPOSE: Hernia repairs are a common surgical procedure, and are associated with a significant cost. Despite the acceptance of the advantages of early elective hernia repairs, the incidence of emergency admissions with complicated presentations remains high, and the natural history of an untreated hernia is not obvious. This study aimed to define risk factors related with unfavorable outcomes in groin hernia repairs. METHODS: We analyzed the records of 685 elective or emergency repairs of groin hernias between December 2005 and June 2009. Patient age ranged from 17 to 85 years, with 240 (35%) of patients being older than 60 years of age. Indirect inguinal hernias were the most common hernia type in both sexes of patients. Coexisting cardiopulmonary problems were noted in 294 male and 33 female patients. American Society of Anaesthesiologists (ASA) grades 3 and 4 were encountered in 61 (9%) patients. Data were analyzed by chi-square test. RESULTS: Significantly high incarceration and strangulation rates were found in females and femoral hernia type. The overall morbidity rate was 7%, major complications 3%. No mortality was observed in the series and postoperative complications were significantly more common in patients with high ASA score and severe coexisting cardiopulmonary problems. Advanced age, delayed admission, femoral type hernia and female sex were also linked with unfavorable outcomes. CONCLUSIONS: The risk of complicated presentation and unfavorable outcome in patients with groin hernia is significant in the presence of factors such as advanced age, femoral hernia, female sex, delayed admission, severe coexisting cardiopulmonary problems and high ASA score. Although it is difficult to estimate the natural history of untreated hernia, hernia repairs of patients with the above-mentioned risk factors should be timely and elective.