The Effect of Primary Surgery in Patients with De Novo Stage IV Breast Cancer with Bone Metastasis Only (Protocol BOMET MF 14-01): A Multi-Center, Prospective Registry Study.

BACKGROUND: More evidence shows that primary surgery for de novo metastatic breast cancer (BC) prolongs overall survival (OS) in selected cases. The aim of this study was to evaluate the role of locoregional treatment (LRT) in BC patients with de novo stage IV bone only metastasis (BOM). METHODS: The prospective, multicenter registry study BOMET MF14-01 was initiated in May 2014. Patients with de novo stage IV BOM BC were divided into two groups: those receiving systemic treatment (ST group) and those receiving LRT (LRT group). Patients who received LRT were further divided into two groups: ST after LRT (LRT + ST group) and ST before LRT (ST + LRT group). RESULTS: We included 505 patients in this study; 240 (47.5%) patients in the ST group and 265 (52.5%) in the LRT group. One hundred and thirteen patients (26.3%) died in the 34-month median follow-up, 85 (35.4%) in the ST group and 28 (10.5%) in LRT group. Local progression was observed in 39 (16.2%) of the patients in the ST group and 18 (6.7%) in the LRT group (p = 0.001). Hazard of death was 60% lower in the LRT group compared with the ST group (HR 0.40, 95% CI 0.30-0.54, p < 0.0001). CONCLUSION: In this prospectively maintained registry study, we found that LRT prolonged survival and decreased locoregional recurrence in the median 3-year follow-up. Timing of primary breast surgery either at diagnosis or after ST provided a survival benefit similar to ST alone in de novo stage IV BOM BC patients.

Impact of obstructive sleep apnea-related symptoms on surgical wound complications in breast cancer patients: pilot study in a tertiary health center in Turkey.

PURPOSE: Wound healing is an important factor influencing morbidity following surgical procedures. The association of obstructive sleep apnea (OSA) with numerous postoperative complications has been previously reported. In this study, we report the impact of OSA-related symptoms on wound complications in breast cancer patients in the postoperative period. METHODS: Breast cancer patients were enrolled for a prospective observational study. Outcome measures included sociodemographic data, self-reported sleep-wake questionnaires (Berlin questionnaire, STOP-BANG, and Epworth sleepiness scale [ESS]) as well as type of surgery, smoking status, duration of anesthesia, the need for postoperative opioid drugs, and complications for surgical wounds. Patients' general preoperative health status was quantified by using American Society of Anesthesiologists (ASA) scores. RESULTS: A total of 132 women were included in the study, of whom 61% (n = 81) underwent mastectomy, and 39% (n = 51) had breast conserving surgery. Mean ESS score of the study group was 7.7 ± 0.5. Multivariant analysis identified, either being at medium high risk by STOP-BANG questionnaire (OR:1.77, p: 0.04) or being at high risk by Berlin questionnaire (OR:1.96, p: 0.04) as well as high BMI (OR:2.76 95% CI:1.73-4.65, p: 0.02), smoking history (OR:3.04 95% CI: 2.25-3.86, p: 0.01) and type of surgery (OR:2.64 95% CI: 1.63-2.89, p: 0.03) were independent factors for wound healing. CONCLUSIONS: The study results suggest that patients with high risk for OSA have a tendency to develop postoperative wound complications after breast cancer surgery. This study lays groundwork for further scrutiny using more robust methodology.

Lymphoedema after mastectomy for breast cancer: importance of supportive care.

BACKGROUND: Lymphoedema resulting from axillary lymph node dissection remains a challenging complication after modified radical mastectomy. OBJECTIVE: To examine the effects of supportive therapy such as rehabilitation and medical and physical treatment on the development of lymphoedema, in an attempt to establish non-surgical ways to help prevent or reduce it. METHODS: Patients (N=5 064) who underwent breast cancer surgery in the Department of General Surgery, Ankara Oncology Research and Training Hospital, Turkey, between 1995 and 2010 were included. Data were collected by retrospectively examining all the patients' files and the pre- and postoperative breast cancer follow-up forms. RESULTS: Of the patients in the study, 19.9% developed lymphoedema. It was significantly less common in patients who participated in physiotherapy than in those who did not, and it was more common in patients with a body mass index (BMI, kg/m²) between 30 and 34.9 than in patients with lower BMIs. Postoperative axillary radiotherapy did not affect the occurrence of lymphoedema. CONCLUSION: It is clear that the most successful method to reduce the impact of lymphoedema is to prevent it. We believe that educating patients about the risk factors for developing lymphoedema and referring them to postoperative physical therapy and rehabilitation clinics are the most important ways to avoid this distressing condition.

Are the characteristics of thyroid cancer different in young patients?

BACKGROUND: Thyroid carcinoma in pediatric patients continues to be a rare albeit significant condition because local recurrence or distant metastases may be revealed during its diagnosis, or even years after completion of treatment. METHODS: This study was prepared by retrospective analysis of patient files to focus on the clinical presentation of thyroid carcinoma in pediatric patients, and proposes to investigate the clinical parameters that differ from, or that correspond to, those in adult patients. SUBJECTS: A total of 108 patients, of whom 22 were children and adolescents and 86 were adults, and who were operated on for differentiated thyroid carcinoma during the period 2001-2009, were included in the study. RESULTS: The rate of large thyroid, multinodular goiter, or tumor >1 cm was significantly higher in the adult group than in the pediatric group. Our analysis also revealed that that the frequency of lymph node metastasis was significantly higher in the pediatric group than in the adult group. Moreover, the frequencies of total lymph node and positive lymph node presentations were significantly higher in the pediatric group than in the adult group. CONCLUSION: Although thyroid carcinoma has a good prognosis in young patients, one must stress that late diagnosis and ineffective treatment are the main criteria for poor prognosis and, most important, that it is advisable to keep the management of thyroid carcinoma on a path that differs from the management of adult thyroid carcinomas, in nearly all aspects from presentation to treatment.

The importance of inferior-superior thyroid veins sampling in the diagnosis of thyroid carcinomas.

INTRODUCTION: We aimed to determine whether levels of thyroglobulin measured in blood from the inferior-superior thyroid veins and the peripheral antecubital vein could predict the presence of thyroid carcinoma in patients undergoing surgery for thyroid diseases. MATERIAL AND METHODS: Sixty-one patients were prospectively enrolled in the study. Levels of thyroglobulin were analysed. Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of these markers were investigated. RESULTS: Twenty-six out of 61 patients (42.6%) with malignancy were diagnosed. The levels of thyroglobulin in the inferior-superior thyroid veins were higher than those in the peripheral antecubital vein (p = 0.001). The levels of thyroglobulin in the blood taken from the antecubital vein and the inferior-superior thyroid veins did not differ between benign and malignant thyroid disorders. For thyroglobulin, sensitivity was 33.3%, specificity 60.6%, PPV 27.8%, and NPV 66.7% respectively. CONCLUSION: Thyroglobulin levels in the antecubital vein compared to the inferior-superior thyroid veins were not significant either in benign or malignant disorders.

Risk factors for postoperative ileus.

PURPOSE: This study aimed to examine extended postoperative ileus and its risk factors in patients who have undergone abdominal surgery, and discuss the techniques of prevention and management thereof the light of related risk factors connected with our study. METHODS: This prospective study involved 103 patients who had undergone abdominal surgery. The effects of age, gender, diagnosis, surgical operation conducted, excessive small intestine manipulation, opioid analgesic usage time, and systemic inflammation on the time required for the restoration of intestinal motility were investigated. The parameters were investigated prospectively. RESULTS: Regarding the factors that affected the restoration of gastrointestinal motility, resection operation type, longer operation period, longer opioid analgesics use period, longer nasogastric catheter use period, and the presence of systemic inflammation were shown to retard bowel motility for 3 days or more. CONCLUSION: Our study confirmed that unnecessary analgesics use in patients with pain tolerance with non-steroid anti-inflammatory drugs, excessive small bowel manipulation, prolonged nasogastric catheter use have a direct negative effect on gastrointestinal motility. Considering that an exact treatment for postoperative ileus has not yet been established, and in light of the risk factors mentioned above, we regard that prevention of postoperative ileus is the most effective way of coping with intestinal dysmotility.

Is transdermal nitroglycerin application effective in preventing and healing flap ischaemia after modified radical mastectomy?

OBJECTIVE: We evaluated the efficacy of local nitroglycerin application in preventing and treating flap complications after modified radical mastectomy in a large patient cohort. PATIENTS AND METHODS: Between 1993 and 2008, 6426 patients undergoing surgery for stage II breast cancer were enrolled in this prospective study. Patients were randomised into treatment and control groups. In the treatment group a nitroglycerin preparation (Nitroderm) was applied to the flap area. Major complications, recovery periods, menopausal status, additional diseases (diabetes mellitus, hypertension, atherosclerotic heart disease) and adverse effects related to nitroglycerin use were recorded. RESULTS: The recovery rate without major complications was statistically significantly higher in the nitroglycerin-treated group than in the controls (p < 0.001). CONCLUSION: Our results indicate that topical nitroglycerin reduces flap complications after breast surgery.

Effects of octreotide on healing of mechanical ileus in rats.

OBJECTIVE: To investigate the effects of octreotide on mechanical ileus without surgical intervention. METHODS: This study was organized to investigate the effects of octreotide Sandostatine one microgram/ml- Sandoz, a long acting analogue of somatostatin, in a mechanical ileus model in Sprague-Dowley rats. The study was performed at Ankara Oncology Hospital, Ankara, Turkey in April 2005. The animals were randomly separated into 3 groups. 1 control group n:10 2 ileus group n:12, and 3 ileus + octreotide group n:13. Intraluminal liquid volume, as well as concentrations of sodium, chlorine, calcium, and phosphorous were measured in systemic circulation, proximal, and middle bowel segments. We also evaluated the leukocyte count, and hematocrit levels in all animals. RESULTS: There was no difference in leukocyte count and hematocrit levels. The effects of octreotide in decreasing intestinal liquid volume, and electrolytes were significant. However, these effects were not beneficial on the mortality rates, and intestinal edema (p>0.05). CONCLUSION: We believe additional animal studies, and subsequently controlled clinical trials are necessary before using octreotide as a clinical adjunct in the treatment of small bowel obstruction.

Unusual location of hydatid cyst: soft tissue mass in the neck.

Hydatid disease is a parasitic infestation caused by the larval form of the cestode worm Echinococcus. The most commonly encountered form of the disease is visceral hydatid cyst caused by Echinococcus granulosus or dog tapeworm. We hereby represent an unusual case of hydatid disease located in the neck region in a 22-year-old female patient.

Effects of early versus delayed nutrition on intestinal mucosal apoptosis and atrophy after traumatic brain injury.

PURPOSE: To determine the optimal time to start nutritional support after traumatic brain injury (TBI). METHODS: Rats were divided into six groups of seven. All but one of these groups were subjected to moderate closed head trauma under general anesthesia. Groups Ia and Ib were commenced on immunonutrition and standard enteral nutrition, respectively, 8 h later; groups IIa and IIb were commenced on immunonutrition and standard enteral nutrition, respectively, 72 h later; and group III was commenced on a parenteral saline infusion 8 h later. Group IV was a control group fed a laboratory diet and not subjected to trauma. The rats were killed 7 days later, and ileal segments were examined using light and electron microscopy. We used the deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) technique to detect intestinal mucosal apoptosis. RESULTS: Group III had a lower body weight than the other groups (P < 0.005). The mean villous height was highest in groups Ia and IV and lowest in group III. The villi count was lower in groups Ib, IIa, IIb, and III than in group IV (P < 0.005). The apoptotic index counts were higher in groups IIa, IIb, and III than in group IV (P < 0.005). CONCLUSIONS: The addition of enriching immunonutrients to early enteral feeding helps preserve an almost normal gut mucosa.

Colonoscopic removal of inguinal hernia mesh: report of a case and literature review.

The transabdominal preperitoneal (TAPP) procedure for laparoscopic inguinal hernia mesh repair is being applied with increasing frequency. This technique has an acceptable recurrence rate (0.4-3.9%), but has varying complication rates (1.3-17.4%).1,2 We report the first case of mesh penetration of the colon following laparoscopic TAPP repair, treated with colonoscopy.

Secretory breast carcinoma with extensive intraductal component: case report.

Secretory breast carcinoma is a rare entity. It was first reported in pediatric patients in 1966, and was named juvenile breast carcinoma. Incidences of pediatric and adult patients are similar. Prognosis is favorable in both groups, but distant metastases have been reported. The authors describe a case of secretory breast carcinoma with extensive intraductal component.

Carcinoembryonic antigen to detect hepatic metastases of colorectal cancers.

PURPOSE: The spread of colorectal carcinoma (CRC) affects both staging and treatment. In this prospective study we examined the relationship between carcinoembryonic antigen (CEA) levels in bile, mesenteric venous blood, and peripheral venous blood, and the presence of occult hepatic metastases in patients with CRC. METHODS: Sixty patients who underwent elective surgery at Ankara Oncology Hospital were voluntarily assigned to one of the three groups of 20 patients each. The control group consisted of patients operated on for benign biliary disorders, the second group consisted of patients with CRC without metastases, and the third group consisted of patients with CRC and isolated liver metastases. Bile, mesenteric venous blood, and peripheral venous blood was collected perioperatively for the measurement of CEA levels. RESULTS: The bile CEA levels were significantly higher in the CRC patients with metastases than in those without metastases and the controls. The CEA levels in the mesenteric venous blood and peripheral venous blood were significantly higher in the two groups of CRC patients than in the control group. Overt hepatic metastases later developed in seven patients from the CRC without metastases group who had relatively high CEA levels, but the difference was not significant. CONCLUSION: The CEA levels in bile, mesenteric venous blood, and peripheral venous blood were increased in patients with CRC and liver metastases. The detection of elevated CEA levels in bile taken at surgery did not herald metachronous hepatic metastases in CRC patients without liver metastases.