Turkish Journal of Surgery - 2001; 17(5)

MINIMALLY INVASIVE AXILLARY INTERVENTION IN BREAST CANCER SURGERY: SENTINEL LYMPH NODE BIOPSY

2001-10-01

Modern breast surgery has been evolving over the last century by changing to a less aggressive approach including the less invasive axillary procedures. Today, the major role of axillary surgery is limited to staging and prognostication. Sentinel lymph node (SLN) biopsy is a recently developed, minimally invasive approach for staging the regional nodal basin in the primary management of early-stage breast cancer. By definition, the SLN is the first node to receive direct lymphatic drainage from a primary tumor within the breast and the most likely to contain metastatic disease, if present, Since conventional axillary level I-II dissection results with significant morbidity and decreased guality of life, SLN biopsy has been performed to overcome this problem by obtaining accurate information reflecting axillary status. It has been suggested that this technique avoids the complications associated with more extensive axillary dissection. Many authors have confirmed the high efficacy of SLN in correctly predicting the disease status of the lymph node basins in patients with breast cancer. However, there remain controversial issues which require to be resolved before SLN biopsy becomes a widely accepted part of breast cancer care. More data are needed before defining the definitive role of SLN biopsy. In this article, the studies pertaining to SLN biopsy procedure were reviewed. The ongoing trials on the role of SLN biopsy in the management of clinically node negative patients are discussed. Altogether, this review covers the rationale, indications, complications, present controversies, validity and prospects of SLN biopsy.

AMEL�YATIN GEN��LET�LMES� DURUMLARINDA HUKUK� SORUMLULUK

Ali R�za T�MER, �zer KEND�, Ya�ar B�LGE — 2001-10-01

This article concerns the extended operations or procedures where during an operation, previously agreed between surgeon and the patient and while the patient is anesthetised the surgeon realizes that further or totally different measures should be or may be taken. The question that arises whether it is in the patient's best interest for the surgeon to proceed without having had the opportunity to fully inform his patient or to terminate the operation and obtain a new consent for the second pration. The legal concerns were discussed in this article.

ANTIOXYDANT EFFECTS OF HYPERTONIC SALINE RESUSCITATION OF HEMORRHAGIC SHOCK IN RATS

2001-10-01

The aim of this study was to investigate the effect of hypertonic saline solution (HTS) on the tissue injury caused by oxygen free radicals in rats. The abdominal aorta was catheterized and animals were bled via catheter until their mean arterial pressure came down to 35mmHg indicating the hemorrhagic shock established. After 60 minutes of shock, the animals were divided into two groups, each of which includes ten rats. First group resuscitated with HTS (7.5% NaCl, 4 ml/kg) plus shed blood and second group with twice the shed blood volume of lactated Ringer's (RL) plus shed blood. Arterial pressure was recorded before and during shock and in post-resuscitation period. Blood samples were obtained to determine plasma malondialdehyde levels. There was no significant difference between two groups with regard to arterial blood pressure. Post-resuscitation plasma malondialdehyde levels were lower in first group (HTS animals) compared with second group (RL animals) (p<0.05). Inconclusion, the results of this study showed that the resuscitation of hemorrhagic shock with HTS in rats decreased free radicals-induced tissue injury.

DEMOGRAPHIC DATA AND TUMOR LOCALISATION OF 34095 CANCER PATIENTS TREATED IN �STANBUL UNIVERSITY ONCOLOGY INSTITUTE BETWEEN 1988-2000

Rian D��, Hakan �AMLICA, Adnan AYDINER, Erkan TOPUZ — 2001-10-01

In this study we aimed to show the profile of 34095 patients who applied to the Oncology Institute between the years 1988 and 2000. The data of the archive of the Oncology Institute was collected into a computer database and the statistical analyses were performed with SPSS 7.5. Tumor location was coded with the ICD-O criteria. The sex distribution among our patients was for women and men 47.8% and 52.2%, respectively. Mean age of the patients was 50.52 � 18.18, in the whole group the first five tumor distribution sites were "respiratory system" (%25.26), "breast" (%17.81),"digestive system" (%15.1),"female genital system"(%9.27) and "1ymphomas" (%5.6). We have no reliable database in our country for the incidence of cancer organ site distributions. We need a broader database for a relieable comparison with other data.

APPROACH TO CAUSTIC ESOPHAGEAL AND GASTRIC BURNS

Cemalettin ERTEK�N, Erol AYDIN, Korhan TAV�LO�LU, Recep G�LO�LU, Mehmet KURTO�LU — 2001-10-01

Caustic burns of the esophagus and stomach are serious injuries which frequently require surgical or medical treatment. Sixty-two patients were admitted to the Emergency Surgery service of University of �stanbul, �stanbul Medical School between January 1995 and January 2001. Thirty-five patients with clinical and/or endoscopic signs of caustic burns were included in this study. Twenty-four of these patients were hospitalized. Twenty-two patients underwent endoscopy, 10 of whom had Grade I, 12 had Grade II esophagitis. Furthermore; two patients with Grade II esophagitis had gastric, and one patient had gastro-duodenal burns. Six patients (17%) with signs of acute abdomen required urgent laparotomy. Four of these patients had esophageal necrosis and gastric perforation, one had local necrosis in the gastric fundus, and one had normal findings. Two patients (5.7%) who had gone surgical operation died on the lst and 10th day of operation. One patient with Grade II esophagitis and stomach burn was lost by sudden respiratory arrest although there was regression of the endoscopic findings. The mean follow-up period was 10 months. One patient with esophageal and gastric burn presented with pyloric stenosis, which reguired pyloroplasty. One patient with esophagectomy, expired following reconstruction after 9 months. Stricture was not detected in our nonoperative cases. In corosive burn cases, early admission to the hospital, clinical and endoscopic close follow-up, early surgery when required, reduces morbidity and mortality significantly.

INVAGINATION IN ADULTS AS A RARE CAUSE OF ILEUS

2001-10-01

While invagination is one of the leading cause of acute abdominal pathology in children, it is a rare clinical entity in adults. Our aim was to evaluate the incidence of invagination as a cause of ileus and re-evaluate the clininical features of patients. The records of 1200 patients who had been operated with the diagnosis of intestinal obstruction in Emergency Surgical Department of Ankara Numune Teaching and Research Hospital during last 10 years were reviewed. 16 (2F) patients with median (range) age of 54 (34-69) years were found to be operated for invagination (1.3%). invagination was ileo-ileal in 13 patients, colo-colic in 1patient; jejuno-duodenal in one patient and jejuno-colic in other one. The patients presented with complaints ranging for hours to months and from nonspesific complaints to signs and symptoms of acute intestinal obstruction. Bowel resection was procedure of choice in 14 patients, 2 patients underwent reduction only, and one of whom also had gastric polip removed. Intraluminal polipoid lesions were identified in 3 patients and one of them was found to be malignant. Invagination was due to adhesions in two patients. No additional pathology was found in remaining 10 patients. Although invagination in adults is very rare, it is commonly due to underlying pathology and diagnosis usually made during operation. Surgery is the treatment of choice in patients with the correct diagnosis. As the suspicion of malignancy will remain as an unanswered question in patients without resection, resection should be done without any attempt to reduce it.

REPAIR OF THE INCISIONAL HERNIA WITH POLYPROPYLENE MESH

Ramazan ERYILMAZ, Mustafa �AH�N, Adem AK�AKAYA, G�rhan BA�, Orhan AL�MO�LU — 2001-10-01

The incidence of incisional hernia is 2-11% after abdominal surgery. Since the recurrence rate following primary repair of incisional hernia is 30-50%, synthetic materials are widely used in repair. In our study, early and late results of 99 patients with incisional hernia who underwent surgery with polypropylene mesh repair were evaluated. There were 23 male, 76 female and median age was 55.3 (24-82) years. In 97 patients, extraperitoneal only mesh was used, and in 2 cases laparoscopic underlay mesh was performed. Follow-up was 4-96 months, the rates of recurrence infection, seroma and displacement of the mesh were 2%, 8%, 3% and 1% respectively. Total morbidity was 14% and no mortality was seen. Because of its strenght, inertness, resistance to infections, and lower recurrence rate, repair with polypropylene mesh which was used in our study is suggested in repair of incisional hernias.