Turkish Journal of Surgery - 2000; 16(4)

THE EXPERIENCE OF ULUDAG UNIVERSITY IN 17 AUGUST EARTHQUAKE

2000-08-01

This study describes the experience of our hospital situated close to the earthquake region. Were viewed the medical records of 665 earthquake victims admitted to our hospital and analysed the injury sites, operative procedures, complications and mortality. The most frequent injury sites were crush injury (118 patients) and limp fractures (53 patients). Fasiotomy was performed on 118 patients. The overall mortality rate was 7.6% (51/665). Documented surgical infection rate was 9.9% (66 patients),60 patients (9%) required dialysis for acute renal failure and the mortality rate in this group was 35% (21patients). Infection and acute renal failure due to crush injury were the two most important causes of morbidity and mortality in earthquake victims. A multidisciplinary but integrated approach is the key to decrease morbidity and mortality in these patients.

SENTINEL LYMPH NODE BIOPSY IN PATIENTS WITH INVASIVE BREAST CARCINOMA

G�NAY G�RLEY�K, EM�N G�RLEY�K, D�LEK K��KERCAN, SEL�UK �NALMI�ER — 2000-08-01

The aim of this study is to investigate the accuracy of sentinel lymph node (SLN) biopsy for defining axillary histopathological status. Pathologically negative axilla rate is increased parallel to increasing diagnosis of early breast carcinoma due to screening methods. The dissection of axillary lymphatic tissue carrying a significant risk of complication is questioned as an unnecessary procedure in breast cancer patients with pathologically negative axilla. The recent studies have been focused on SLN biopsy in order to avoid complete axillary dissection. SLN biopsy was carried out on 22 invasive breast cancer cases with clinically negative axilla, Blue dye (isosulfan blue 1.5%) was used for lymphatic mapping. Primary tumor, SLNs and axillary lymphatic tissue were examined with routine histopathological methods. According to pathologic size of primary tumor, five cases (23%) were T1, 10(45%)T2, and 7 (32%) T3. SLNs were successfully identified in 82% (18/22) of patients. SLNs were metastatic in the half of cases. SLN was the only side of metastasis in one (11%) patient. Results were false negative in 11%. SLN biopsy accurately reflected pathological status of the axilla in 94% (17/18) of patients. Lymphatic mapping with blue dye and SLN biopsy is an easy method with high accuracy in patients with invasive breast cancer. Unnecessary axillary dissection can be avoided if false negativity is minimized with increasing experience.

THE ROLE OF INTRAOPERATIVE FINE NEEDLE ASPIRATION BIOPSY: A PROSPECTIVE ANALYSIS

2000-08-01

Fine needle aspiration biopsy (FNAB) has become increasingly popular as a diagnostic technique, asit provides a sensitive and useful method of obtaining cytologic material for examination. It's also a rapid and economical method to use intraoperatively. In order to evaluate the efficacy of the technique in this manner, prospectively, we performed FNAB s in 58 lesions in 43 patients aged 22 to 73 years, FNAB was carried out in the standard fashion by using 17 or 20-gauge needle fitted to a 20 mL syringe andMay-Grunwald-Giemsa staining. The locations and the number of the lesions were as follows: intraabdominal lymph nodes (13), liver (9), colon (8), stomach (8), rectum (4), thyroid (5), breast (3),pancreas (2), small bowel (2), esophagus (1), adrenal (1),spleen (1),and gall bladder (1), However, in three lesions the aspirate was inadequate for cytologic examination. Forty-two lesions were malignant, though three of these were not available f or excision to be confirmed by histopathological examination. Only one false positive result belonged to a pheochromocytoma case which was reported as adenocarcinoma with FNAC. In search of metastasis in the lymph nodes of different patients, 3 false negative results were obtained. Overall results for intraoperative FNAC were: sensitivity, 93.2 %; specificity, 91%; positive predictive value, 97.6%; and negative predictive value, 77%. We concluded that intraoperative FNAC is a complementary method of choice providing the surgeon to perform rapid and safer serial biopsies for avoidance of the risks of open biopsy.

THE RELATION OF TUMORAL P53 IMMUNOREACTIVITY, CELL PROLIFERATION RATE AND MICROVESSEL DENSITY WITH THE PATHOLOGICAL STAGE IN ADVANCED STAGE GASTRIC CARCINOMA

M�NE G G�LL�O�LU, NURCAN KILI�LI �AMUR, S�MER YAMANER, FERHUNDE D�ZDARO�LU — 2000-08-01

As it is universally accepted, pathological staging is the primary prognostic determinant for advanced gastric carcinoma which is associated with high mortality. Moreover, some morphological features of the primary tumor have adjunctive prognostic importance. More distinct histological parameters, which can be detected preoperatively, would help to assess the prognosis and to decide the primary treatment modality more precisely. This study was performed to determine the expressions of p53tumor suppressor gene protein, proliferating cell nuclear antigen (PCNA) and micro vessel density in advanced gastric cancers by immunohistopathological methods. The impact of these parameters on staging and morphological features of the turner was also determined. Forty-three patients who were operated upon the diagnosis of gastric cancer are included in the study. The clinical records, operation notes, specimen reports and histological slides of each patient were obtained retrospectively. Tumours were grouped according to their pathological stages, and also to their macroscopic and microscopic features. One paraffin block of each tumor was selected to be assessed for theirp53, PCNAandCD34 expressions by Immunohistochemical methods. Tumors were further divided into either negative or positive groups according to their p53 immunoreactivity. Separately, PCNA index was determined for each tumor by calculating the ratio of tumor cells which has immunoreactivity with the monoclonal antibody against PCNA over 1000 tumor cells at any site on the slide. The endothelial cells were highlighted by anti-CD34 antibody and this procedure was followed by calculation of angiogenesis index by counting the immunoreactive cell groups at areas involving the most distinct small sized vascular structure expression, As a result, in stage IV gastric carcinomas, p53 immunoreactivity and PCNA index were found to be significantly high when compared to other stages. We observed significantly higher PCNA index in tumors of ulcerative and diffuse infiltrative type when compared to polipoid and fungating types. There was a significant increase in angiogenesis index which was similar to the elevation of PCNA index in advanced stages of gastric carcinomas. These immunohistochemical markers may be useful in determining the stage of the tumor. In the light of these findings, we state that detecting these biological parameters maybe helpful in having an idea about the prognosis and deciding on the most appropriate primary treatment modality.

PROSTAGLANDINE-E2 AND I2 DIFFERENCES IN HYPERTHYROIDISM BEFORE AND AFTER MEDICAL TREATMENT

ERDAL KAYHAN, ENG�N OK, ERDO�AN S�Z�ER, MUSTAFA KEREK — 2000-08-01

Prostaglandins (PG) are local hormones secreted from different kinds of cells. They are secreted in the pathologic processes of the body and have vasodilator effects, Aim: To investigate the levels of prostaglandin E; and L, which reflected the general characteristics of PGs on the patients influenced with hyperthyroidism. Materials and Methods: In this prospective study, we compared the levels of plasma and urine PGE2and PGI2 in a group with Basedow disease and in other group with multinod�ler goitre. This comparative study was performed before and after treatment. As patients with Basedow disease were treated medically for6 months including propylthiourasil 150-300 mg/day and propranolol 80 mg/day and the other patients with multinodular goitre underwent operation. Results: Plasma PGE2, PGI2 and urine PGE2 levels were significantly high in the study group before treatment compared with the levels of after treatment in Basedow patients (p<0.05) but PGI2 levels were not statistically different between study and control group (p>0.05). There was no statistical difference between plasma and urine PGE2 and PG12 levels in control group (p>0.05). Only significant difference was found PGE2 levels between before and after treatment in Basedow patients (p<0.05). Conclusions: The synthesis of prostaglandin's enhanced locally into the thyroid gland and peripheral tissues in hyperthyroidism. The enhancement in synthesis of prostaglandins may be responsible for increased vascularity of the thyroid gland and systemic clinical and pathological changes in cases of hyperthyroidism.

LAPAROSCOPIC AND ENDOSCOPIC EXTRAPERITONEAL INGUINAL HERNIA REPAIR

MET�N ERTEM, N�HAT YAVUZ, TAYFUN KARAHASANO�LU — 2000-08-01

Objective: Laparoscopic hernia repair is the second most common laparoscopic operation following cholecystectomy. We present our technique and results in laparoscopic hernia repair. Methods: Between 1993-1999,318 patients underwent 350 laparoscopic hernia repairs. All operations were performed by the same team and under general anesthesia The first 50 patients were treated using TAPP (transabdominal preperitoneal) technique and the remaining group using TEP(Total extraperitoneal) technique. All patients were repaired using keyhole prosthetic mesh and preparing the spermatic cord. Results: Mean operating time was 43 minutes, mean following time was 38 months. The most common complication was seroma The overall complication rate was 7.2 %. Recurrence occurred in 0.6 % and was found to be due to technical insufficiency in two patients. Conclusion: In conclusion, laparoscopic hernia repair gains its popularity showing all advantages of laparoscopic surgery and low recurrence rate though its financial disadvantage for our country.

IS NASOGASTRIC DECOMPRESSION MANDATORY AFTER COLON AND RECTUM SURGERY? A PROSPECTIVE RANDOMIZED STUDY

2000-08-01

Routine nasogastric decompression after colorectal surgery is practiced commonly as an old tradition among surgeons. We questioned the necessity of using nasogastric tubes to drain stomach as a routine procedure after colorectal surgery. Patients were randomly allocated to postoperative treatment with or without nasogastric tubes. In this prospective randomized study 94 patients undergoing colorectal surgery, 49 underwent postoperative nasogastric suction and 45 did not. The distribution of patient and operative characteristics was similar in both groups. Return of bowel function, as determined by bowel tones and flatus, occured significantly earlier in patients without tubes. The subsequent nasogastric tube insertion rate was not different between two study groups. There were nosignificant differences in the presence of wound and pulmonary complications as well perioperative electrolyte imbalances. Therefore, nasogastric decompression did not decrease the incidence of any complication. The study supports that nasogastric decompression is unnecessary and can be safely omitted after colorectal surgery.