An Incidentally Detected Breast Cancer on Tc-99m MIBI Cardiac Scintigraphy / 한국유방암학회지

Tc-99m methoxyisobutylisonitrile (MIBI) scintigraphy is generally used as a second-line diagnostic tool for obscured breast lesions. When the entire field of view is examined carefully, it is often possible to detect additional lesions unrelated to the initial intent and purpose of the examination. Herein we present a case of breast cancer incidentally detected by cardiac Tc-99m MIBI scintigraphy. An area of uptake was detected in the breast during a cardiac imaging test. Further evaluation of this lesion revealed a histopathological diagnosis of invasive ductal carcinoma of the breast. Sensitivity of this scintigraphic technique is not enough sufficient to use this test as a screening test for breast cancer, but it may provide supplemental information. Since it is not uncommon to find incidental lesions during imaging studies, examination of the image field may help clinicians find otherwise unrecognized or undiagnosed pathologies.

acceptance rate of local anaesthesia for elective inguinal hernia repair among the surgeons working in a teaching hospital

The rates for three different types of anaesthesia used for elective inguinal hernia repairs were retrospectively searched for in the hospital records in 2005 and 2010. In 2005, only 2.1% of elective inguinal hernia repairs were done with local anaesthesia. General anaesthesia was used in 93.7%, whereas regional anaesthesia in 4.2% cases. No day-case outpatient surgery was recorded after any type of anaesthesia. In 2010, local anaesthesia rate increased to 16.2%. Regional anaesthesia rate also reached to 20.6%. Ninety percent of the patients who underwent hernia repair with local anaesthesia were discharged on the day of surgery

Comparing Scalpel, Electrocautery and Ultrasonic Dissector Effects: The Impact on Wound Complications and Pro-Inflammatory Cytokine Levels in Wound Fluid from Mastectomy Patients / 한국유방암학회지

PURPOSE: Introducing the relationship between the surgical instruments used in modified radical mastectomy and wound complications is important for preventing and decreasing complications. This prospective randomized trial was designed to assess the impact of scalpel, electrocautery, and ultrasonic dissector usage on wound complications and tissue damage. METHODS: Eighty-two consecutive patients operated with mastectomy were studied. The postoperative time period needed for hemovac drainage, the amount and duration of seroma, infection, flap ecchymosis and necrosis rates were compared. Tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6) levels in drainage fluids were determined to confirm the inflammatory response and tissue damage. RESULTS: The numbers of patients included in the scalpel, electrocautery and ultrasonic dissector groups were 27, 26, and 29, respectively. The groups were homogenous with respect to age, body mass index, stage, cormorbidities, breast volume and flap area. Operation time and the amount of bleeding were statistically higher in the scalpel group. The incidence of seroma was higher in the electrocautery group and arm mobilization had to be delayed in this group. There were no differences between groups with respect to hematoma, infection, ecchymosis, necrosis, hemovac drainage and the total and first 3 days of seroma volume. TNF-alpha and IL-6 levels were significantly higher in samples obtained from the drains of patients operated with electrocautery. CONCLUSION: Ultrasonic dissector decreases operation time by decreasing the amount of bleeding without increasing the seroma incidence. High cytokine levels in drainage fluids from patients operated with elecrocautery indicates that electrocautery induces more tissue damage and acute inflammatory response. Therefore, seroma, due to acute inflammatory response, was seen more frequently in the electrocautery group. Ultrasonic dissector coagulates protein by breaking hydrogen bonds which may close vascular and lymphatic channels more precisely. But, its actual preventive effect on seroma formation might be related to diminished inflammatory response.

Percutaneous ilioinguinal-iliohypogastric nerve block or step-by-step local infiltration anesthesia for inguinal hernia repair: what cadaveric dissection says? / 대한외과학회지

PURPOSE: The repair of groin hernias with local anesthesia has gained popularity. Two main methods have been described for local anesthesia. This study was aimed at comparing percutaneous truncular ilioinguinal-iliohypogastric block and step-by-step infiltration technique by using cadaver dissections. METHODS: The study was performed on an adult male cadaver by using blue dye injection. A percutaneous nerve block simulation was done on right side and the dye was given in between the internal oblique and transversus muscles. On the left side, a skin incision was deepened and the dye was injected under the external oblique aponeurosis. Following the injections, stained areas were investigated superficially and within the deeper tissues with dissection. RESULTS: There was a complete superficial staining covering the iliohypogastric and ilioinguinal nerves in the inguinal floor at both sides. On the right side, intraabdominal observation showed a wide and intense peritoneal staining, while almost no staining was seen on the left side. Preperitoneal dissection displayed a massive staining including testicular vascular pedicule and vas deferens on the right side. The dye solution also infiltrated the area of the femoral nerve prominently. On the contrary, a very limited staining was seen on the left. CONCLUSION: It may not always be easy to keep the percutaneous block within optimum anatomical limits without causing adverse events. A step-by-step infiltration technique under direct surgical vision seems to be safer than percutaneous inguinal block for patients undergoing inguinal hernia repair.

questionnaire study on the surgeon's preferences for inguinal hernia repair after a decade

During the 20th century, hernia repair trend changed several times. A very interesting competition has been going on between the opponents of Lichtenstein and laparoscopic repairs. We recently questioned the same issue by the same method to see if laparoscopic hernia repair found more opponents and preference rate in surgeons and physicians in Ankara, Turkey. In general 88.9% of the respondents preferred open repair, while only 11.1% chose laparoscopy. The majority of the participants who preferred an open repair stated that it was a better known technique to choice. Almost half considered local anaesthesia an advantage. Laparoscopic repair was mainly preferred for its advantages of less pain and early return to work. When three consecutive surveys among the same population in Ankara in 1997, 2001 and 2007 were compared the laparoscopic repair preference rates did not show a statistical difference [9.1%, 16.1% and 11.1% respectively]