Turkish Journal of Surgery - 2000; 16(6)

THE EFFECTS OF ESTRADIOE, ESTRONE, ESTRIOL AND PROGESTERONE ON RAT MAMMARY GLANDS

ERAY KARA, S�NAN ERS�N, YAMA� ERHAN, RAS�H YILMAZ, YILDIZ ERHAN, ORHAN �ZBAL — 2000-12-01

The aim of the study was to determine the histopathological changes and to evaluate the results when the estrogens and progesterone hormones were enjected intraparanchimaly on the rat mammary gland in an experimental animal model. The lobuloalveolary progress was demonstrated by the enjection of estrogen to the areola of mammary gland of donkey, rabbit and pig, invivo studies. Fifty Sprague-Dowley female rats weighing 200 to 250 grams were divided into five groups. Estradiol (5 mg/kg), estriol (0.5mg/kg), estrone (0.5 mg/kg), progesterone (0.6 mg/kg) and serum phisyology (2 cc/kg) were enjected intramammary. The blood samples were taken prior to the sacrification of animals for tumor markers, CEA and Ca 15.3 and simple mastectomy was performed. In the study, higher rates of mitosis, increasing in cell sequence and pleomorphism was observed especially in estradiol and estrone groups. Serum CEA and Ca 15.3 levels were also higher in the same group of animals, Mitosis, increasing in cell sequence and pleomorphism were statistically significant in estradiol and estrone groups (p<0.05). Serum CEA and Ca 15.3 levels were also found to be higher in the same groups (p<0.05). We consider that estrogens especially estrone and estradiol when enjected intramammary may cause histopathologic changes which so called precancerogenic in ductal cells of rats in time.

THE EFFECT OF BIORESORBABLE MEMBRANE ON PORTAL VEIN BLOOD AND PERITONEAL FLUID CYTOKINE LEVELS IN THE PREVENTION OF POSTOPERATIVE ADHESIONS

�MER G�NAL, Y�KSEL ARIKAN, MEVLUT PEHL�VAN, EM�N G�RLEY�K — 2000-12-01

Postoperative intraabdominal adhesion formation is one of the leading problems of surgery. An understanding of the pathogenic mechanisms of adhesion formation is important for developing strategies for their prevention. In the current study, the effect of a bioresorbable membrane that isused for the prevention of postoperative intraabdominal adhesions on the portal venous blood and peritoneal fluid cytokine levels were investigated. The effectiveness of the bioresorbable membrane on adhesion prevention was evaluated in an adhesion model that was created on adult Wistar-Albino rats, A total of 30 rats which were equally divided into three different groups-control, sham, and bioresorbable membrane groups-were subjected to adhesion model operation. Portal vein blood and peritoneal fluid IL-6 and TNF-alpha levels were measured. Adhesion scores and tissue cytokine levels of the groups compared to each other. Although the portal venous blood IL-6 and TNF-alpha levels were found to be lower than the peritoneal fluid levels, that was not statistically significant. No significant fail in peritoneal fluid IL-6 and TNF-alpha levels were observed in bioresorbable membrane group compared to control group. Adhesion formation was almost completely inhibited in bioresorbable membrane group, IL-6 levels were higher in portal vein blood than the peritoneal fluid in three study groups, TNF-alpha levels were similar in portal venous blood and peritoneal fluid in bioresorbable membrane group. In conclusion; bioresorbable membrane prevents the postoperative intraabdominal adhesion formation, in bioresorbable membrane group portal vein cytokine levels were lower than the control group levels. This decrease has not been observed in peritoneal fluid samples. That was thought us that IL-6 and TNF-alpha response in adhesion formation was of intestinal origin.

CAN LOCAL EXCISION BE ADEQUATE IN THE TREATMENT OF DUCTAL CARCINOMA IN SITU?

EM�N YILDIRIM, ERSAN SEMERC�, U�UR BERBERO�LU — 2000-12-01

In this study, the medical records of 46 patients with ductal carcinoma in situ (DCIS) who were treated with mastectomy between 1989 and 1999 after excisional biopsy were reviewed retrospectively. The clinico-pathologic features at diagnosis which could be related to residual tumour in mastectomy specimens were evaluated by the univariate and multivariate statistical tests. There were residual tumours in mastectomy specimens of 28 cases (60.9%). The rates of residual tumour were 100% (15/15) for patients with positive surgical margin, 53.8% (7/13) for those with close margin (>2mm), and 27.8% (5/18) for those with negative margin (>2mm). in multivariate logistic regression analysis, multifocal disease, comedo subtype and surgical margin status were the most important independent factors related to residual tumors in mastectomy specimen. In the patients with unifocal DCIS who had non-comedo subtype, the probability of residual tumour were 10% for negative margin, 20% for close margin, and 100% for positive margin. In those with multifocal disease and comedo subtype, this probability was 100% regardless of surgical margin status. We conclude that the probability of residual tumour related to the factors mentioned above must be taken into consideration where local excision for the treatment of ductal carcinoma in situ is planned

THE EFFECTIVE USE OF POSTOPERATIVE DIAGNOSTIC FOLLOW-UP METHODS IN BREAST CANCER PATIENTS

2000-12-01

Breast cancer is the most common malignancy effecting women today. Recently, clinical trials have established the roles of conservative surgery, radiation, and adjuvant chemo/hormonal therapy in the primary therapy of breast cancer. Another important issue is the follow-up of breast cancer patients following primary therapy. In this study, we reviewed follow-up records of 255 breast cancer patients who underwent surgical therapy in our surgical oncology department. These patients were evaluated by age, gender, stage, local recurrence, contralateral primary breast cancer, distant metastasis and cost of follow-up methods. Mean follow-up time was 49 months (range 6 to 76 months). In 11 (%4.31) of 255 patients, local recurrence was determined. 72.7 percent of them were symptomatic and all of the local recurrences were detected by physical examination. However, 64.7 percent of patients who had distant metastasis were smyptomatic. Following standard follow-up protocol, total of 14.000 tests were utilized in 255 patients of which only 58 revealed pathologic findings. Our findings have supported the follow-up of breast cancer patients with history and physical examination that has been suggested in recent years. Different follow-up programs should be tailored according to stage and prognostic factors. However, history, physical examination and mammography should be standard follow-up methods.

THE TREATMENT OF INTRAABDOMINAL SEPSIS WITH OPEN ABDOMEN TECHNIQUE

U�UR SUNGURTEK�N, ERG�N ERDEM, H�LYA SUNGURTEK�N, C�HAT TET�K, AKIN �ZDEN — 2000-12-01

The purpose of this study is defining the effectivity of open management of intraabdominal sepsis. Intraabdominal sepsis is usually fatal in surgical patients unless adequate drainage and wide debridman are possible. Leaving the abdomen open has popularized a new concept of multiple laparotomies with abdominal lavage by leaving the abdomen open in a short period time in the surgical literature, 20 patients with intraabdominal sepsis underwent multiple abdominal lavages and left their abdomen open investigated prospectively from the point of recovery, mortality and morbidity rate in this study. The open method of management has not made the treatment of septic abdomen much easier; the morbidity and mortality rates are still high in the secritically ill patients. Mortality and complication rates have been found as 30% (six patients) and 25% (five patients) respectively. Mortality causes were multi organ failure in three patients, nosocomial infections in three patients. Complications were small bowel fistula in three patients and evisceration in two patients after closure of the abdomen. Open management of the septic abdomen followed by planned reoperations is a reasonably successful alternative for the patients with generalized peritonitis. Because of the management and clinical surveillance of these patients require specific expertise, we believe that the care of patients is best undertaken with close surveillance and cooperation among the specialties in medicine.

PERFORATED APPENDICITIS IN CHILDREN: THE RISK FACTORS FOR THE DEVELOPMENT OF COMPLICATIONS

HAYRETT�N �ZT�RK, AL� �HSAN D�K�C�, SEL�UK OT�U, ABDURRAHMAN �NEN — 2000-12-01

Major complications such as wound infection, intestinal obstruction, intraabdominal abscess formation, and delayed ileus may occur after the operation in patients with perforated appendicitis. We aimed to research the risk factors which may effect the developing of these postoperative complications. We have evaluated the potential risk factors (such as delay between the first sign of the disease and the administration time, the age, white blood cell count, the use of abdominal drain, the severity of the disease) and mortality rate in 180 patients operated for perforated appendicitis in our institution between March 1983 and February 2000. Of 180 patients, there was 132 boys and 48 girls. The mean age was 11. Postoperative complication occurred in 14.4% of patients. The most frequent complication was wound infection (65.3%) followed by intestinal obstruction (19.2%). When we compare the potential risk factors in patients; being younger or older than 8 was not a significant factor (p>0.05) but the delaying more than 48h after the first sign of the disease was a significant risk factors (p<0.05) for developing of postoperative complications. The amount of white blood cell less or more than 10.000/mm3 was found not to be significant (p>0.05) as well as the use of abdominal drains (p=0.001). However, the severity of the perforated appendicitis was a significant factor for the developing of complication (p=0.003). We lost a child (0.5%) with generalized peritonitis who has been administered in the hospital 10 days after the first sign of the disease while he was in a septic status. The most important risk factors for the developing postoperative complications was the late administration to hospital and the presence of intense exudes in the abdomen. There was no effects of drains for diminishing the postoperative abdominal complications.

FACTORS AFFECTING RECURRENCE IN LICHTENSTEIN HERNIOPLASTY "A CLINICAL PROSPECTIVE STUDY"

ERHAN RE�S, NUR� AYDIN KAMA, MEHMET G�LER, MUTLU DO�ANAY — 2000-12-01

We examined the factors effecting recurrence in patients with lichtenstein hernioplasty for primary and recurrent inguinal hernias. 357 patients undergoing lichtenstein hernioplasty between January 1993 and December 1997 were investigated prospectively. The early and late complications were found out and the factors effecting recurrence were examined with Fisher's exact test and logistic regression analysis statistically. Total 357 patients underwent 383 inguinal hernia repair (6.8% bilateral), Mean age was 50.8 years and 86% of patients were male. The hernias were classified as direct (n=74), indirect (n=309); or primary (n=354) and recurrent (n=28) types. There was prostate hyperplasia in 54 patients, 20 patients had chronic obstructive lung disease and 17 patient had chronic constipation. We observed early complications in 52 patient (13.6%) and 5(1.6%) recurrence in the mean 39 months (range 16-62 months)follow up period, The recurrence ratios were 25%, 11.8%, 7.4%, 5.8%, and 5.4% in patients with wound infection; chronic constipation; bilateral synchronize hernioplasty; early complications; direct hernias respectively. Direct hernia, wound infection and chronic constipation were found to be independent factors affecting recurrence. Lichtenstein herniopiasty is o safe method with low postoperative complication and recurrent rate in primary and recurrence hernia repair. Development of postoperative early complications especially wound infections should be prevented and serious attention have to be applied on the surgical technique for decreasing the recurrent ratio.