Turkish Journal of Surgery - 2005; 21(3)

Who should perform thyroid surgery? The opinion and inclination of Turkish Surgical Society

Altan T�z�ner, M. Mahir �zmen — 2005-11-01

Interpectoral lymph node involvement in breast carcinoma

2005-11-01

Purpose: To define the patient group who might benefit from appropriate interpectoral lymph node dissection (IPN) and to investigate skip Rotter metastases rates. Materials and Methods: Complete axillary dissection including IPN were performed in 87 female histopathologically proven breast carcinoma patients who underwent modified radical mastectomy between 1998-2000 at Ankara Oncology Hospital. IPN group sent separately to the pathological examination. Age, menopausal status, histological diagnosis, tumoral location, tumoral mass, grade, estrogens and progesterone receptors, multicentiricity, pN stage, lymphoid capsular invasion, level I-II-III metastatic lenfoid status, and TNM stage were dependent parameters. Results: The number of patients who had metastatic IPN were 13 (14,9%) and out of 13, 2 patients had metastatic IPN (2,3%) in the absence of axillary lymph node metastases. The independent parameters found to be statistically significant in IPN metastases are; high grade tumors, the presence of more than 2 metastatic lymph nodes, capsular invasion (pN1biii) (p<0.05). The grade was found to be most significant parameter in this study which can also be evaluated preoperatively. Conclusion: As metastases in unexcised IPN may become a source of local or systemic treatment failure and understaging parameter, IPN should be excised carefully in breast carcinoma patients who have high grade tumors, signs of capsular invasion of the lymph nodes and who have two or more metastatic axillary lymph nodes clinically or during the operation.

Our experience in gallbladder polypoid lesions

Oktay Banl�, Burak Kavlako�lu, Hasan Altun, Bekir K��kkay�k��, Cem Kele�o�lu — 2005-11-01

Purpose: Due to increased use of ultrasonography, more polypoid lesions are being detected in gallbladders. Although most polypoid lesions in gallbladder are benign in nature and are detected incidentally, there is also a risk of malign transformation. There is an ongoing controversy about follow-up and therapy of polipoid lesions of the gallbladder. Material and Methods: In this report we retrospectively analyzed reports of 37 patients who had followups between 2000 and 2005 because of polyps in the gallbladder. Fourteen patients were operated on. Results: One gallbladder carcinoma was detected in a 63-year-old patient with a polyp of greater than 10 mm. No mortality was detected. Morbidity has occurred in two patients. Conclusion: Polyps that are greater than 10 mm (single lesion) and older than 50 years compose important risk factors and can have malign potential. For patients with polyps greater than 10 mm, older than 50 years or for patients with concomitant cholelithiasis, laparoscopic cholecystectomy is advised.

Publication rates of scientific presentations in Turkish National Surgical congress

Burhan Kabay, Zafer Teke, Halil Erbi�, G�ksel Ko�bil, Koray Tekin, Erg�n Erdem — 2005-11-01

Purpose: The aim of the present study was to investigate the publication rates of scientific presentations in Turkish National Surgical Congresses (Conferences) Materials and Methods: Congress abstract books, including oral and poster presentations from 1996 to 2004 were reviewed to determine publication rates. We searched Medline indexed journals using the PubMed and the Web of Science servers, to see which presentations ended up as publications. The rates of publication of the abstracts and the journals in which the presentations have been published were investigated. Results: There were 2118 presentations and 120 of them were published (5.7%). The numbers of oral presentations and posters were 1131 (46.6%) and 987 (53.4%), respectively. Out of total 2118 presentations, 1774 (83.8%) were clinical and 344 (16.2%) were experimental studies. Of those clinical studies, the highest number of presentations and publications were in the breast and endocrine surgery with 309 (17.5%) presentations and with 15 (4.9%) publications, respectively. Of those experimental studies, the highest numbers of presentations and publications were in the hepato-pancreato-biliary surgery with 82 (24.8%) presentations and with 13 (15.9 %) publications, respectively. The number of presentations and the number of publications increased steadily over the years; however the ratio of publication to presentation remained the same. British Journal of Surgery, World Journal of Surgery and Ulusal Travma ve Acil Cerrahi Dergisi were the most commonly selected journals for publications. Conclusion: The publication rates of abstracts presented at Turkish National Surgical Congresses are lower than the previously reported publication rates.

Effect of breast preserving surgery in the treatment of early breast cancer (retrospective analysis)

2005-11-01

Purpose:

A prospective investigation of the inflammatory and neuroendocrine responses in laparoscopic and open cholecystectomy

2005-11-01

Purpose: To determine the advantage of laparoscopic intervention, it is necessary to understand the responses of the organism under stressful conditions. We designed a study to compare the different neuroendocrine and inflammatory responses, which occur during laparoscopic and open cholecystectomy. Materials and Methods: Twenty patients who underwent cholecystectomy divided in two groups (Group I: open cholecystectomy, Group II: laparoscopic cholecystectomy) were studied prospectively. Adrenocorticotrophic hormone (ACTH), cortisole, insulin, C-reactive protein (CRP), and interleukin-6 (IL- 6) levels were measured in the preoperative period, postoperative 4th and 24th hours. Results: According to the comparisons within the groups, in regard to the first group, there were statistically significant differences in the ACTH, cortisole, IL-6 levels between the values measured preoperatively and the values measured both in the 4th and 24th postoperative hours. There were statistically significant differences only in the postoperative 24th hour for insulin and CRP levels. In regard to the second group, there were statistically significant differences only in the postoperative 4th hour for cortisole levels and only in the postoperative 24th hour for insulin and CRP levels, whereas there were statistically significant differences both in the 4th and 24th postoperative hours for IL-6 levels. When the groups were compared with each other, there were no statistically significant differences in the cortisole and insulin levels according to the values measured preoperatively, as well as in the 4th and 24th postoperative hours. The IL-6 levels were found to have statistically insignificant differences according to the values measured preoperatively, however the comparisons were statistically significant both in the 4th and 24th postoperative hours. There were statistically significant differences for ACTH levels in the 4th postoperative hour, but not in the preoperative and in the 24th postoperative hour values. In regard to CRP levels, statistically significant differences were detected according to the values in the 24th postoperative hours, but there were no differences both in the preoperative and in the 4th postoperative hour measurements. Conclusion: Laparoscopic cholecystectomy lessens the acute phase response but does not cause a great difference in regard to neuroendocrine changes when compared to conventional open cholecystectomy.

Candida albicans translocation in obstructive jaundice: An experimental study

2005-11-01

Purpose: Candida Albicans is the most common fungal pathogen that cause infection. Septic complications and renal failure are the most common causes of death in patients with obstructive jaundice. We investigated the translocation of oral administration of Candida albicans in rats with obstructive jaundice. Materials and Methods: Forty male wistar-albino rats were divided into 4 Groups. In Group I, laparatomi was performed and without any intervention the abdomen was closed with 3/0 prolene suture. In group II, laparatomy was done and abdomen was closed. On first postoperative day, candida inoculation was administered intragastrically. In group III, following laparotomy, common bile duct was ligated and cut than the abdomen was closed. In group IV, common bile duct was ligated and cut and then on 3rd postoperative day oral candida inoculation was administered. On 7th day, blood from vena cava inferior and tissue samples from liver, mesenteric lymph nodes, and cecum were collected for pathological, microbiological and biochemical investigations from all rats. Results: Microbiological lymph node positivity was statistically higher in group IV (p:0.020). When compared with Group II, candida colonization in cecum was higher in Group IV. Lymph node and cecum positivity were statistically higher in Group II and IV than Groups I and III (p<0.001). Histopathological changes in liver were statistically higher in group IV than in Groups I and III (p<0.05). Histopathological changes in the lymph nodes were statistically higher in group IV when compared with other Groups (p<0.01 and p<0.001). Histopathological changes in the cecum were statistically higher in Group IV when compared with Groups I and III (p<0.001 and p<0.05). Also, histopathological changes in the cecum were statistically higher in Group II than Group I (P<0.01). Conclusion: Obstructive jaundice results in increase of colonisation and translocation of orally administrated Candida albicans.

Non-operative treatment of chylous ascites developed after whipple's procedure: A case report

Ekrem Kaya — 2005-11-01

Herein, the author presents a case of a 63-year-old male patient with periampullary tumor operated with Whipple's Procedure and developed chylous ascites soon after enteral feeding at the 3rd day the operation. The patient was successfully treated with medium-chain triglycerides enriched enteral feeding. Over a period of 8-12 weeks, the ascites disappeared and patient fully recovered.

Male breast cancer

�erife �imsek, Metin �akmak�� — 2005-11-01

Carcinoma of the breast in male gender is rare, presents less than 1% of all breast cancers. Risk factors include these following characteristics: family history, genetic abnormalities,conditions associated with relative hyper estrogenism, prior chest wall irradiation and some drugs.Most patients present with a painless, firm, subareolar lump, may be associated by clinical gynecomastia and nipple retraction, a bloody nipple discharge, skin ulceration and Paget's disease. The most common types of invasive carcinoma are infiltrating ductal adeno carcinoma and papillary carcinoma. Diagnostic tools are meticulous history and clinical examination. Mammography may be helpful. Magnetic resonance imaging in male breast cancer might has same benefits and restrictions as in female breast cancer. Surgery remains the most important and effective treatment modality for breast cancer in men. Sentinel lymph node biopsy seems to be a simple and reliable method for staging the axilla accurately, avoiding unnecessary radical treatment of uninvaded lymph nodes. The role of adjuvant therapy in male breast cancer is less well established than those in female cancer and has not been evaluated in randomized clinical trials. Hormonal therapy is recommended in all receptor-positive patients. There is a clear indication for radiotherapy when it is impossible to lift the entire tumour burden from the axilla.

The Gulhane Military Medical Academy Department of General Surgery

Dervi� �en — 2005-11-01

The Gulhane Military Medical Academy Department of General Surgery was founded at the Gulhane Seririyat Hospital located in Sarayburnu/Istanbul under the leadership of Prof.Dr.Robert Rieder. Gulhane was later relocated to the Gumussuyu Military Hospital in 1918 when Istanbul was invaded by the French and returned to its original location on October 2, 1923 when conflicts had ceased. In the meantime the General Surgery Department was divided into the 1st General Surgery Clinic and 2nd General Surgery Clinic. Prof.Dr.M.Kemal �ke was assigned as director of the 1st General Surgery Clinic and Prof. Dr. Murat Cankat was named as director of the 2nd General Surgery Clinic. After that Gulhane was moved from Istanbul to Cebeci / Ankara on July 24, 1941. When The Ankara University School of Medicine was founded and located within the Gulhane Military Medical Academy, Gulhane was then moved to its new buildings which are being used as Turkish Land Forces Buildings after the Gulhane moved out. Later in 1971 when Prof.Dr.Necmi Ayanoglu was the director of the 1st General Surgery Clinic, Gulhane was once again moved to its new modern buildings located at Etlik / Ankara. When The School of Medicine was founded in 1980 both clinics were joined together and became the General Surgery Department. The Gulhane Military Medical Academy, Department of General Surgery, which has a capacity to care for 150 patients as well as 17 patients in its intensive-care unit, continues its work to this day with the expertise and dedication of 17 academic personal and 27 fellows.