Treatment results of small bowel perforations due to unusual causes

Objectives: Although non-traumatic Small Bowel Perforations [SBPs] are rare, they have high rates of morbidity and mortality in case of late presentation. Aetiological factors vary across different geographical regions. In this paper, SBPs caused by anything other than trauma and other well-known causes are presented and the current literature is reviewed

Methods: The study was conducted at General Surgery Clinics of two different tertiary university hospitals between January 2008 and September 2016. The authors directly involved in managing the patients This study was approved by the ethical institutional board and was performed at the Department of General Surgery, School of Medicine, Sakarya University. The medical records of patients retained in both hospitals are electronic. Medical records of subjects who had undergone emergency operations with a prediagnosis of acute abdomen in single center, and were determined to have SBPs due to unusual causes, were investigated retrospectively. Patients with aetiological factors such as trauma, mesenteric vascular disease, internal and external hernias, intra abdominal adhesions, inflammatory bowel diseases, and iatrogenic causes were excluded

Results: In total, 35 patients were evaluated, 20 [57.1%] males and 15 [42.9%] females. The mean age of the cases was 51.6 [18-88] years. Mean time until admission at the hospital was 1.4 days [range 0.25-7 days]. The most frequent aetiological factors were various malignancies [10 cases, 28.5%] and perforation of Meckel's diverticulum [8 cases, 22.8%]. It was surprising to detect a considerable rate of perforation due to bezoars [6 patients, 17.1%]

Conclusions: Post-operative consequences of SBPs due to unusual causes are similar with those related to common, known causes. Factors affecting the clinical course are presentation time and patients' clinical status in admission, not aetiology

Postmastectomy Pain: A Cross-sectional Study of Prevalence, Pain Characteristics, and Effects on Quality of Life / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Postmastectomy pain syndrome (PMPS) is defined as a chronic (continuing for 3 or more months) neuropathic pain affecting the axilla, medial arm, breast, and chest wall after breast cancer surgery. The prevalence of PMPS has been reported to range from 20% to 68%. In this study, we aimed to determine the prevalence of PMPS among mastectomy patients, the severity of neuropathic pain in these patients, risk factors that contribute to pain becoming chronic, and the effect of PMPS on life quality.</p><p><b>METHODS</b>This cross-sectional study was approved by the Sakarya University, Medical Faculty Ethical Council and included 146 patients ranging in age from 18 to 85 years who visited the pain clinic, general surgery clinic, and oncology clinic and had breast surgery between 2012 and 2014. Patients were divided into two groups according to whether they met PMPS criteria: pain at axilla, arm, shoulder, chest wall, scar tissue, or breast at least 3 months after breast surgery. All patients gave informed consent prior to entry into the study. Patient medical records were collected, and pain and quality of life were evaluated by the visual analog scale (VAS) for pain, a short form of the McGill Pain Questionnaire (SF-MPQ), douleur neuropathique-4 (DN-4), and SF-36.</p><p><b>RESULTS</b>Patient mean age was 55.2 ± 11.8 years (33.0-83.0 years). PMPS prevalence was 36%. Mean scores on the VAS, SF-MPQ, and DN-4 in PMPS patients were 1.76 ± 2.38 (0-10), 1.73 ± 1.54 (0-5), and 1.64 ± 2.31 (0-8), respectively. Of these patients, 31 (23.7%) had neuropathic pain characteristics, and 12 (9.2%) had phantom pain according to the DN-4 survey. Patients who had modified radical mastectomy were significantly more likely to develop PMPS than patients who had breast-protective surgery (P = 0.028). Only 2 (2.4%) of PMPS patients had received proper treatment (anticonvulsants or opioids).</p><p><b>CONCLUSIONS</b>PMPS seriously impacts patients' emotional situation, daily activities, and social relationships and is a major economic burden for health systems. We conclude that the rate of PMPS among patients receiving breast cancer surgery in Turkey is 64.1% and that challenges to the proper treatment of these patients deserve further investigation.</p>

Comparision of the Limberg flap with the V-Y flap technique in the treatment of pilonidal disease / 대한외과학회지

PURPOSE: In this study, we investigated whether there is a factor that can aid determi nation of the preferred technique by comparing the early and late results of two different surgical techniques for the treatment of pilonidal sinus. METHODS: The medical records of 176 patients in whom the Limberg flap (LF) or V-Y flap techniques were applied for reconstruction after the excision were evaluated retrospectively. RESULTS: The development rates of postoperative hematoma, wound separation, wound infection, and seroma were 2.8%, 5.1%, 5.6%, and 6.3%, respectively, while total flap necrosis was not observed in any patient. Return to daily activities was achieved after a mean of 17.1 days (13 to 21 days) days in the LF group and 32.7 days (18 to 47 days) in the V-Y flap group. During the average follow-up of 65 months (36 to 110 months), nine patients (5.1%) developed recurrent disease. There was no difference between the two groups with respect to early surgical complications (P = 0.286) or disease recurrence (P = 0.094), whereas the resumption of daily activities was longer in patients with a V-Y flap (P < 0.001). CONCLUSION: The early postoperative and long-term results of the LF and V-Y flap techniques for the treatment of pilonidal sinus were similar. Because the resumption of daily activities at work is achieved later in patients undergoing the V-Y flap compared with the LF technique, patients' employment (or position in working life) must be considered when determining the most appropriate surgical technique.

Primary Small Cell Carcinoma of the Lung Presenting with Breast and Skin Metastases

Cutaneous metastases originating from an internal cancer are relatively uncommon in clinical practice, and metastatic lesions to the breast are rarer than those to the skin. Skin metastases of lung cancer, which may be the first sign of the disease, usually indicate progressive disease and a poor prognosis. We describe a 47-year-old male who presented with recurring masses in the lumbar region bilaterally and the right breast. Immunohistochemical findings and radiological imaging suggested lung cancer. This is the first reported case of small cell lung cancer metastasizing to two separate, uncommon sites, the skin and breast.

Topical Steroids to Treat Granulomatous Mastitis: A Case Report

Idiopathic granulomatous mastitis (IGM) is a rare and chronic benign disease of the breast. Histologically, the disease presents as an intense inflammatory reaction with non-caseated granulomas that are the characteristic symptom of the disease. No consensus exists on the best treatment modality for this disease. In this report, we present a patient with granulomatous mastitis who was treated successfully with low-dose oral and topical steroids. Our aim here is to discuss various approaches for IGM in view of the literature and present treatment with topical steroids, which has not been reported.