Turkish Journal of Surgery - 2008; 24(1)

Editorial

Semih Baskan — 2008-03-01

Which is more effective in the care of diabetic foot infections: instructions regarding diabetic foot disorders or the level of education?

Erhan Ay�an, T�rker Ert�rk, Arslan Kaygusuz — 2008-03-01

Purpose:0.05). However, statistical analysis performed through the implementation of Chi-square test resulted in a significant inverse relationship between patients educated in diabetic foot infections and the Wagner stages (p<0.01). Conclusions: The level of schooling of patients and their caregivers has no effect on the infection stage, however, instructing/educating of patients reduces the infection stage.

Prognostic factors of stage III-B breast cancer after downstaging and modified radical mastectomy

Burak Kavlako�lu, Se�kin Akk��k, S�leyman Oral — 2008-03-01

Purpose: The purpose of this study was to determine the prognostic information from mastectomy and axillary node dissection in patients with stage III-B breast cancer after down staging. Materials and methods: Mastectomy and axillary dissection was performed for 97 patients with stage III-B breast cancer after downstaging. Estrogen receptor status, histologic type, median number of axillary lymph nodes, median number of positive axillary lymph nodes, positive lymph nodes / total lymph nodes ratio were analysed. Overall survival and disease free survival were determined for five years. Survival was calculated using the Cox regresion method. Results: Median number of total axillary lymph nodes was 20,2; median number of metastatic axillary lymph nodes was 8,9; positive lymph nodes / total lymph nodes ratio was 0,44. Among the 80 patients (except 17 unknown receptor status) 35%were found to have estrogen receptor positive and 86 cases (%88,7) were invasive ductal cancer on pathologic examination of the axillary contents. Five year overall survival and disease free survival rates were %38,7 and %28 respectively. Conclusion: Estrogen receptor status, ratio of positive axillary lymph nodes and inflammatory breast cancer effect 5 year survival rates after total mastectomy and axillary dissection.

The frequency and rationale of the preference for laparoscopic surgery over open surgery

2008-03-01

Purpose: The procedure choice whether laparoscopic or open surgery appears to be different among both the surgeons recommending surgical procedure and the patients with various diseases. In this study, the choice of technique and the rationale of the choice were investigated in medical staff mainly including general surgeons and the patients attending to surgery polyclinic via using a questionnaire prepared by the authors. Materials and Methods: A questionnaire was prepared to determine the frequency and the rationale of the preference for laparoscopic surgery for the treatment of cholecystolithiasis, incisional hernia and colon cancer. General Surgery specialists and assistant doctors, other assisting medical staff and the patients presenting to our polyclinic with various complaints were informed about the purpose of the questionnaire. Informed consent about the operations was read to the participants and they were asked to complete the questionnaire assuming they had the disease mentioned in the questions. Results: The questionnaire was applied to 150 participants, 83 of whom were males, 67 of whom were females. 36 of participants were General Surgery specialists, 35 were General Surgery assistant doctors, 41 were assisting medical staff, and 38 were patients. The frequency of preference for laparoscopic procedure over open surgery was 96 %, 68,7 %and 30,7 %for the treatment of cholecystectomy, incisional hernia and colon cancer, respectively. There was no significant difference between the medical staff group and patient group in terms of the frequency of preference for laparoscopic surgery. However, the rationale for the choice of method significantly differed between the two groups. When the age factor was assessed establishing 35 as the cutoff point, age was found to be an effective factor in the frequency of the choice for the treatment of colon cancer, but not for cholecystectomy and incisional hernia. Age was found to be an effective factor in the rational of choice for three of the situations. Conclusion: The fact that there was no statistically significant difference in terms of the frequency of preference between medical staff and patients was considered as the reflection of the confidence of the medical staff to the community. On the other hand, the difference in terms of the rationale of preference between two groups was attributed to the different levels of knowledge and experience about the subject of two groups. While the participants over 35 years old had an optimistic approach towards laparoscopic procedures, aesthetics worries appeared to be an important rationale for the participants 35 years old and under.

A survey of 196 general surgeons regarding their approach to groin hernia

2008-03-01

Purpose: To analyze the experiences of general surgeons in Turkey in the field of groin hernia repair. Materials And Methods: A questionnaire (which includes mainly the technique used either Lichtenstein or other techniques and the type of anesthesia used) was mailed to 250 general surgeons in Turkey in 2002. They were asked to reply within a month. Results: 196 (78 %) of the 250 questionnaires were completed and returned. 128 (65.3 %) of the 196 surgeons indicated Lichtenstein technique as their first choice for groin hernia repair, followed in frequency by Mesh Plug (Rutkow) and Bassini. The majority of surgeons preferred general anesthesia. Seroma and hematoma were reported as the most frequent complications. Conclusions: Tension-free techniques, especially Lichtenstein, were the preferred treatment of choice both in primary and recurrent hernias. As more than half of the surgeons preferred general anesthesia for the repair of groin hernia so it is advisable. As most of the patients are discharged from the hospital on the first postoperative day it can be done on day case basis.

Minimally invasive parathyroidectomy results for primary hyperparathyroidism without using intraoperative parathyroid hormone assays

2008-03-01

Purpose: The need for introperative parathyroid hormone (iPTH) assays in minimally invasive parathyroidectomy (M�P) remains controversial, because of the high cost. In this study, we have planned to evaluate the results of M�P without using the use of iPTH assays, in patients with primary hyperparathyroidism (PHPT). Methods: Thirty-one patients with PHPT, who had pre-operative localization studies, including technetium -99m sestamibi scintigraphy (MIBI) and ultrasonography (US), and underwent radio-guided parathyroidectomy using introperative gama probe and frozen pathology examination between May 2004 and July 2007 were retrospectively reviewed, Results: The mean pre-operative calcium and PTH levels were 10,3�0,9mg/dl (8,5-12 mg/dl) and 324�238 pg/ml (109-799 pg/ml), respectively. All patients had normal calcium and PTH levels in the post-operative 48th hour and 3rd month. The final pathology was reported as hypercellular parathyroid gland in all patients. The patients had a mean follow-up period of 17,1�9,9 (4-42) months and none of the patients developed recurrent hyperparathyroidism. Conclusion: Using a combination of pre-operative MIBI, intra-operative gamma probe localization and frozen pathology, our success rate was %100 in M�P. We conclude that, M�P can be performed safely and successfully without using iPTH assays.

A case report of peritoneal carcinomatosis of colorectal cancer treated with cytoreduction and hyperthermic intraperitoneal chemotherapy, and an overview of related medical literature

2008-03-01

The peritoneum is one of the most frequent site of the metastasis of colorectal cancer. Until recently, treatment of peritoneal carcinomatosis has been limited to palliative surgery and systemic chemotherapy with a median survival 4-12 months. But, cytoreductive surgery (including peritonectomies) and hyperthermic intraperitoneal chemothereapy has resulted in an unprecedented median survival > 20 months. The use of hyperthermia as an adjunct to chemotherapy in the treatment of peritoneal carcinomatosis of colorectal cancer is a new and very promising technique. We, herein, report of the first case of Turkey who had cytoreductive surgery and hyperthermic intraperitoneal chemothereapy with the diagnosis of peritoneal carcinomatosis of colon cancer. We also present the description of technique of hyperthermic intraperitoneal chemothereapy and an overview of the releted medical literature.

An unusual diaphragmatic injury: A case report

Osman Y�ld�r�m,�mit Turan, B�lent �nal, Ebru Menek�e — 2008-03-01

The diaphragmatic injury is often associated with thoracoabdominal traumas and it is often located at the left diaphragm. A 23 years old man who had sharp penetrating trauma was admitted to emergency department. In his physical examination a 1.5 cm incision was seen on the left upper anterior chest. There was no associating pneumothorax, hemithorax or abdominal trauma. Unexpectedly, one day after the incident, a knife was recognized at left upper quadrant at a control chest X-ray. Laparotomy was performed and the knife was found located among left lobe of liver, spleen, stomach and colon. There was no injury at these organs. The diaphragm was repaired and patient was transferred to psychiatry clinic on the second post-operative day. Penetrating thoracoabdominal traumas can be concomitant with abdominal injuries, so the patient must be examined systematically and carefully.

Cystic neoplasms of pancreas: Importance of differential diagnosis

Yunus Yavuz, R�fat Yal�n — 2008-03-01

Cystic neoplasms of pancreas consist approximately 15-20%of all cystic lesions. The most prominent tumors are serous, mucinous and intraductal papillary mucinous ones. In the absence of pancreatitis history, all of the cystic pancreatic lesions must be accepted as neoplasms until otherwise proven. Diagnostic process is difficult and has an outmost importance for choosing the treatment modality. Whereas serous cystic tumors are generally of benign character, mucinous ones are either premalignant or malignant. Asymptomatic serous cystic neoplasms may be followed without treatment. Mucinous cystic and intraductal papillary mucinous neoplasms should be resected. The best treatment for these tumors is anatomic resection. The prognosis is quite good if there is no tumor invasion. Invasive tumors have a worse prognosis and may be followed with CT and/or endoscopic ultrasonography.