Chronic Granulomatous Mastitis

PURPOSE: Granulomatous mastitis is a rare benign inflammatory breast disease of an unknown etiology. Clinically and radiologically, it can mimic a breast carcinoma. Therefore, surgeons, pathologists, radiologists need to be aware of this condition in order to avoid unnecessary mastectomies. This study examined the modalities that are important for diagnosing and treating of the granulomatous mastitis. METHODS: The data regarding 14 patients with histologically confirmed granulomatous mastitis and treated at our hospital were analyzed. Age, associated disease, parity, past history of breast feeding and oral contraceptives, radiology findings were retrospectively evaluated. RESULTS: Among the 14 patients, the mean age was 41 years with 5 being in their thirties. Breast pain was the most common presentation. Of the 14 patients, 11 patients had breast-fed and none had previously used oral contraceptives. No patient suffered from pulmonary tuberculosis. Preoperative mammography and ultrasonography was not helpful in identifying granulomatous mastitis. After ultrasonography, 7 patients were found to have mastitis with an abscess and a benign or malignant tumor was found in 3 patients. Two of the 14 patients were diagnosed using pre-operative fine-needle aspiration, which that showed an epithelial histiocyte or multinucleated giant cell. Three cases completely recovered after an excision. In 11 cases, incision and drainage were performed but there was a recurrence in 4 of these, which needed to be treated more than twice by an incision and drainage and steroid. The average treatment period was 5 months and a recurrence was encountered in 4 patients within a 30-month follow-up period. CONCLUSION: Granulomatous mastitis is rare, but it is important to make a histological diagnosis at the early stages. It is believed that a complete excision of the lesion will help prevent a recurrence, and patients with a frequent recurrence can be treated with steroid after stopping unnecessary antibiotic treatment.

The Early Results for Surgical Treatment of Atherosclerotic Arterial Occlusive Disease in the Ilio-femoral Artery

PURPOSE: To review clinical features and operative results for patients, who underwent surgical treatment. METHOD: A retrospective review of 40 patients who underwent ilio-femoral artery bypasses surgery for ilio-femoral arterial occlusive disease. RESULT: Hypertension (60%) and diabetes (42%) were the most common underlying diseases among the patients according to the result of the patient's records; 35 (87.5%) men and 5 (12.5%) women, the mean age is 63. The operation was done for the patients who have the rest pain (57.5%), and this was followed by claudication (22.5%). The median follow-up period was 25.73 months. The most common occluded site was the superficial femoral artery (62.5%). The most common bypass operation was the femoropopliteal bypass (57.5%). In addition to that, the graft infection was the most common postoperative complication (12.5%). The 1st year and 2nd year primary graft patency rates were 60% and 42%. CONCLUSION: Among the various methods of treatment for the atherosclerotic arterial occlusive disease, bypass surgery is known as the most effective method. Although the early primary patency rates of this analysis were inferior to those of previous reports, a simple comparison was not adequate, because the data of this analysis was not sub-divided according to followings; the sites of occlusion, distal run off, operative indications, operative methods, and etc.