Idiopathic granulomatous mastitis

To discuss the clinical and radiological features and treatment approaches in 14 patients diagnosed with idiopathic granulomatous mastitis [GM]. We retrospectively evaluated the clinical features, radiological findings, and treatment approaches in 14 patients with idiopathic GM in the General Surgery Department, Gulhane School of Medicine, Ankara, Turkey between April 2000 and June 2006. The mean age of the patients was 34.5 years [range 27-41 years]. The complaints at admission were a mass in the breast in 7 [50%] patients, an abscess and a mass in 6 [42.8%], and a skin fistula in one [7.2%]. Granulomatous mastitis was unilateral in all subjects [on the right in 5 patients and on the left in 9]. All of the patients underwent ultrasonographic evaluation. Mammography was performed in 8 and magnetic resonance imaging in 5 patients. Seven patients [50%] were suspected to have breast carcinoma according to radiological findings. We performed large excision in 11, incisional biopsy plus abscess drainage in one, and incisional biopsy plus abscess drainage plus medical treatment [prednisolone, methotrexate] in 2 patients. Due to the development of abscess after 9 months, drainage and large excision were also performed in one patient who received medical treatment. Idiopathic GM is a disease that generally affects young women of reproductive age and may be mistaken for breast carcinoma in clinical and radiological evaluations. The gold standard for the diagnosis is histopathologic evaluation

Does the type of resuscitative fluid affect healing of colonic anastomosis in experimentally induced hemorrhagic shock in rats?

The aim of the study was to investigate the effects of different resuscitative fluids on the healing of intestinal anastomosis in a hemorrhagic-shock rat model. Closed-colony Wistar male rats [n = 40; 8 rats per group] were subjected to volume-controlled hemorrhagic shock, followed by a 30-min shock phase. The animals were then resuscitated with one of the following fluids [which also corresponds to their respective groups]: lactated Ringer's solution [LR], hydroxyethyl starch [HES], 7.5% hypertonic saline [HS] and autologous blood [AB]. There was also a control group [CL], which did not experience hemorrhagic shock or receive any resuscitative fluids. All rats underwent laparotomy, segmental resection and anastomosis of the left colon. Five days later, a 2nd laparotomy was performed and the anastomotic bursting pressure was measured in vivo. Thereafter, the anastomosed segment was resected to measure the tissue hydroxyproline level and the grade of anastomotic fibrosis. All experimental groups [LR, HES, HS and AB] exhibited lower anastomotic bursting pressures than the CL group; however, nointergroup differences achieved statistical significance. The mean tissue hydroxyproline level and fibrosis grade also were similar across all 5 groups. In traumatic hemorrhagic shock, anastomosis safety does not appear to be affected by the type of fluid used for resuscitation. Moreover, LR, HES and HS all seemed to reinforce healing as effectively as transfused blood

comparison of different hemorrhoidectomy procedures

To evaluate the pain level, analgesic consumption, operation time, bleeding and early complications after open and closed hemorrhoidectomy using a harmonic scalpel [HS] and classical methods. Between January 2005 and January 2006, 87 patients with grade III-IV hemorrhoids, admitted in General Surgery Clinic, Gulhane Military Medical Academy, Ankara, Turkey were enrolled in the study. They were randomized into open HS [n=22], closed HS [n=22], Miligan Morgan [n = 22], and Ferguson [n = 21] hemorrhoidectomy. Patients were evaluated for postoperative pain, painkiller consumption, bleeding and operation time. Bleeding volume was significantly lower in Groups I-II [p < 0.001]. Operation time was significantly shorter in Group I [p < 0.001]. Postoperative pain and pain at the time of first defecation, was significantly lower in Groups I-III [p < 0.001] compared with the other 2 groups and lower during days 2-6 in Group I compared to the Group III [p < 0.004]. Visual Analogue Scale results were similar in Groups II and IV. Analgesic consumption in Groups I-III was significantly lower than Groups II-IV [p < 0.001]. Oral analgesic consumption during 2-5 postoperative days was lower in Group I than in Group III [p < 0.007] and similar in closed hemorrhoidectomy group. The use of HS in hemorrhoidectomy reduces postoperative pain, analgesic consumption, operation time, and bleeding. Harmonic scalpel hemorrhoidectomy is an effective, comfortable, and safe procedure. Use of suture in hemorrhoidectomy is a major cause of postoperative pain