Favorable outcome with sentinel lymph node biopsy alone after neoadjuvant chemotherapy in clinically node positive breast cancer at diagnosis: Turkish Multicentric NEOSENTI-TURK MF-18-02-study.

PURPOSE: Factors affecting local outcome were evaluated in patients with clinically node-positive (cN+) breast cancer at diagnosis, who underwent sentinel lymph node biopsy (SLNB) alone after neoadjuvant chemotherapy (NAC). METHODS: Between 2004 and 2018, 303 cytopathology-proven cN (+) patients in a multicentric registry, who received NAC and underwent SLNB alone were analysed. All patients had regional nodal irradiation. RESULTS: Median age was 46 (23-70). Of those, 211 patients had ypN0 disease (69.6%), whereas 92 patients had ypN (+) disease including 19 (20.6%) isolated tumor cells (ITC), 33 micrometastases (35.9%) and 40 macrometastases (43.5%). At a median follow-up of 36 months (24-172), one patient (0.3%) with macrometastatic SLN was found to have locoregional recurrence as chest wall and supraclavicular LN metastases at the 60th month. Five-year disease-free survival (DFS) and disease specific survival (DSS) rates were 87% and 95%, respectively. Patients with cT3/4 (HR = 2.41, 95% CI; 1.14-5.07), non-luminal molecular pathology (HR = 2.60, 95% CI, 1.16-5.82), and non-pCR in the breast (HR = 2.11, 95% CI, 0.89-5.01) were found to have an increased HR compared to others in 5-year DFS. However, no difference could be found between ypN0 and ypN ITC and micrometastasis (HR = 1.23, 95% CI, 0.44-3.47), whereas there was a slight increase in HR of patients with ypN macrometastasis versus ypN0 (HR = 1.91, 95% CI, 0.63-5.79). CONCLUSION: ALND could be avoided in meticulously selected cN (+) patients who underwent SLNB after NAC having breast and/or nodal pCR, cT1-2, or low volume residual nodal disease with luminal pathology, as long as axillary radiotherapy is provided.

The use of Ligasure vessel sealing system in axillary dissection; effect on seroma formation.

BACKGROUND: Seroma formation is the most frequent postoperative complication after axillary dissection for breast surgery with an incidence of 10 - 50 %. This prospective clinical randomized study was carried out to evaluate the Ligasure vessel sealing system and its effect on seromaformation and other complications for axillary dissection. METHODS: Between January 2006 and November 2007, the patients with histopathological diagnosis of breast cancer were analysed prospectively. The patients with positive sentinel lymph node biopsy or clinical axillary involvement were included in the study, and the patients who underwent neoadjuvant therapy or using anticoagulants have been excluded from the study. Patients were divided into two study groups.Axillary dissection was performed in the first group by LigaSure and in the second group by linking and electrocautery. RESULTS: There were a total of thirty three patients with a mean age of 51.4 +- 13.7. In group one, mean age of patients was 54.1 +- 13.2 and 48.68 +- 14.1 in group two. There was no significant statistical difference between the groups regarding age, body mass index, excised tissue weight,tumour size and number of excised lymph nodes. The use of Ligasure reduced drainage amount and duration of drain till removal, but increased operative time. CONCLUSION: There were no significant differences between study groups regarding the complications. LigaSure electrothermal bipolar vessel sealing system can be safely used in axillary dissection as an alternative to traditional methods.

The use of fibrin sealant after total thyroidectomy for benign disease obviates the need for routine drainage. Results of a randomized controlled trial.

BACKGROUND: Drains are usually left after thyroid surgery to prevent formation of hematoma and seroma in the thyroid bed. This prospective randomized clinical trial was conducted to evaluate the necessity of drainage after total thyroidectomy for benign thyroidal disorders. METHODS: The patients were assigned randomly into two groups (group 1: with suction drain, group 2: fibrin glue). In the study, operating time, postoperative pain, the total amount of intramuscular analgesic administration, hospital stay, complications (such as wound infection, seroma, bleeding, hematoma, recurrent laryngeal nerve palsy or hypoparathyroidism), were recorded. RESULTS: The drained group (group 1) consisted of 2 men and 48 women with a mean age of 47.76±11.22 years. The nondrained (plus fibrin sealant)( group 2) (comprised of 10 men and 40 women with a mean age of 44.72±11.32 years. There was no significant difference in the gender, age, hormonal status and histopathological results of the patients between the two groups (P=0.18, P=0.36, P=0.28 and P=0.40, respectively). The operations performed were total thyroidectomy in all patients. Twenty-five patients (50%) in the non-drained group did not need intramuscular analgesic, whereas 15 patients (30%) did not in the drained group (P=0.01). In addition, the mean amount of intramuscular analgesic requirement was significantly less in the non-drained group than in the drained group (P=0.02). The complication rates were similar between the two groups. One case of hematoma (2%), two cases of seroma (4%) and three cases of transient hypoparathyroidism (6%) occurred in the non-drained group, whereas one case of hematoma (2%), two cases of seroma (4%), two cases of wound infections (4%) and two cases of transient hypoparathyroidism (4%) occurred in the drained group (P=0.69). No patient needed surgical revision or re-operation for any complication and all complications were successfully managed conservatively. CONCLUSION: Routine drainage of thyroid bed following thyroid surgery may not be necessary. Not draining the wound results in lesser morbidity and decreased hospital stay.

The results of surgical treatment for hepatic hydatid disease.

BACKGROUND: Hydatid disease is an important health problem worldwide and surgery remains the gold standard in terms of treatment for patients with echinococcosis of the liver. In this study we aimed to present our recent surgical experience in treating patients with hepatic hydatidosis. PATIENTS AND METHODS: Fourty-eight patients with Liver Echinococcosis (LE) who were operated in our department between 2007 and 2008 were reviewed retrospectively. It was observed that cystectomy or hepatectomy had been preferred in certain patients with cysts of small size or subcapsular location. RESULTS: There was no significant difference in the type of surgical procedures and early post-operative complications. Recurrence rates and mean duration of hospitalization were significantly lower in patients treated by radical procedures than the patients in drainage and obliteration group. CONCLUSION: Radical operations for hydatid cyst disease are safe methods and may be preffered in selected cases.

Parasitic infestation as cause of acute appendicitis.

AIM: The role of parasitic infestation in the cause of acute appendicitis has been long time discussed. The aim of this study is to evaluate the role of parasitic infestation in the etiology of acute appendicitis. PATIENTS AND METHODS: This retrospective study includes 5.100 patients undergoing surgical therapy for acute appendicitis between 1996 and 2005. Patients were divided into two groups according to the presence of the parasites in the appendix lumen: in Group 1 (n=24) we observed parasitic infestation, whereas in patients of the Group 2 (n=5.076) no parasitic infestation was present. RESULTS: Parasitic infestation was detected in 24 (0.5%). Of 24 parasitic infestation, 12 (50%) were enterobiasis, 6 (25%) were schistosomiasis, 4 (17%) were Ascaris lumbricoides, and 2 (8%) were Taenia saginata. The ratios of the patients with suppurative, gangrenous or perforative appendicitis were similar in both groups. The ratio of the normal histological findings in the Group 1 patients (25%) was significantly higher than that in the Group 2 patients (4.8%, p=0.001). CONCLUSION: Although parasitic infestation may result in symptoms resembling acute appendicitis, parasitic infestation can't be considered in the etiology of acute appendicitis.

Anterior versus modified combined instrumentation for burst fractures of the thoracolumbar spine: a biomechanical study in calves.

PURPOSE: To compare stability after anterior instrumentation alone versus modified combined anterior and posterior instrumentation for burst fractures of the thoracolumbar spine in calves. METHODS: Thoracolumbar spines of 10 calves were used. An axial compression force was applied on each specimen using a material-testing machine, until there was a burst fracture at T12 or L1. Five specimens were fixed with anterior instrumentation alone, using 2 rods connected by 2 screws above and 2 screws below the fractured vertebra plus one tranverse connector. Another 5 were fixed with our modified technique of combined anterior and posterior instrumentation. This entailed one rod connected with one screw above and one screw below the fractured vertebra anteriorly, and another rod connected with one transpedicular screw above and one transpedicular screw below the fractured vertebra posteriorly. After instrumentation, the experiment was conducted again on each specimen and the compressive stiffness and vertebral height loss between the 2 groups compared. RESULTS: The mean compressive stiffness was significantly greater after modified combined anterior and posterior instrumentation than anterior instrumentation alone (5508 vs 2888 N, p=0.0256), whereas the respective vertebral height losses were 37 and 33 mm (p=0.3808). CONCLUSION: Our modified technique of combined anterior and posterior instrumentation provides greater stability than traditional anterior instrumentation alone.

Graves' disease, with and without nodules, and the risk of thyroid carcinoma.

OBJECTIVE: Thyroid nodules are frequently present in Graves' disease. The aim of this study was to evaluate the risk of thyroid carcinoma in Graves' disease patients, with and without ultrasonographically identified nodules, who subsequently underwent surgical treatment. DESIGN: The study group included 150 consecutive patients with diagnosed Graves' disease who subsequently underwent surgery. SUBJECTS: The patients were divided into two groups according to whether the pre-operative ultrasound scan showed diffuse parenchyma (group one; n = 70) or nodules (group two; n = 80). RESULTS: Of the 150 patients, 18 (12 per cent) were found to have papillary thyroid carcinoma. Papillary carcinoma was found in seven patients (10 per cent) in group one and in 11 patients (1.7 per cent) in group two. After evaluating the overall groups, the incidence of carcinoma in the parenchyma outside a nodule was 67 per cent, whereas the incidence of carcinoma in a nodule was 33 per cent. CONCLUSION: Carcinoma can occur in Graves' disease patients without nodules, and the absence of nodules on ultrasonographic examination does not reduce the risk of malignancy.

Determination of remnant thyroid volume: comparison of ultrasonography, radioactive iodine uptake and serum thyroid-stimulating hormone level.

PURPOSE: We aimed to evaluate the accuracy of ultrasonography, radioactive iodine uptake and serum thyroid-stimulating hormone level in predicting the volume of remnant thyroid gland. METHODS: Sixty-six thyroidectomy patients were divided into two groups according to their functional status, i.e. those operated upon for nontoxic multinodular goitre (group one) and those operated upon for hyperthyroidism (group two). Ultrasonography, radioactive iodine uptake and thyroid-stimulating hormone assay were performed in all patients during the first post-operative month. The two groups were subdivided according to the amount of remnant thyroid volume detected on ultrasonography: <2 ml, 2-5 ml and >5 ml. RESULTS: The remnant thyroid volume was positively correlated with the radioactive iodine uptake (rs = 0.684, p = 0.0001). The increase in remnant thyroid tissue radioactive iodine uptake was significantly greater in the patients operated upon for hyperthyroidism compared with those operated upon for nontoxic multinodular goitre (p = 0.0001). There was a negative correlation between remnant thyroid volume and post-operative serum thyroid-stimulating hormone level (rs = -0.865, p = 0.0001) and between remnant thyroid tissue radioactive iodine uptake and post-operative serum thyroid-stimulating hormone level (rs = -0.682, p = 0.0001). CONCLUSION: Ultrasonography is a more accurate measure of remnant thyroid volume than radioactive iodine uptake in patients operated upon for hyperthyroidism, compared with those operated upon for nontoxic multinodular goitre.

Salter innominate osteotomy for treatment of developmental dysplasia of the hip.

PURPOSE: To compare the results of Salter innominate osteotomy (SIO) for treatment of developmental dysplasia of the hip (DDH) in children. METHODS: Between 1994 and 2002, 53 girls and 8 boys with DDH underwent open reduction and SIO; 21 were on the left side, 22 on the right side, 18 bilateral. They were divided into 2 groups: group 1 included 35 patients aged younger than 3 years (46 hips) and group 2 included 26 patients aged 3 years or older (33 hips). Clinical outcomes were assessed using the modified McKay criteria to measure pain symptoms, gait pattern, Trendelenburg sign status, and the range of hip joint movement. Radiographic outcomes were evaluated using the Severin method to measure the Sharp acetabular angle and the centre-edge angle. RESULTS: Group-1 children achieved slightly better reduction and stabilisation of the hip joint empirically, but clinical and radiographic results and complication rates in the 2 groups were not significantly different. CONCLUSION: Open reduction and SIO without preoperative traction is effective for the management of DDH in children younger than 6 years.

'Use of electrothermal vessel sealing with LigaSure device during laparoscopic splenectomy'.

PURPOSE: Main causes of conversion to open surgery are uncontrolled bleeding from splenic hilum and capsular injury of spleen during laparoscopic splenectomy (LS). We present the use of LigaSure in laparoscopic splenectomy for hemostasis. MATERIAL & METHOD: Between January 2005 and May 2006, LS was performed in a total of 29 patients (6 male and 23 female) with a mean age of 35.44 +/- 13.63. Indications for splenectomy were idiopathic thrombocytopenic purpura (ITP) in 20 patients, thrombotic thrombocytopenic purpura (TTP) in 2, hereditary spherocytosis (HS) in 3, lymphangioma in 2, hodgkin lymphoma in 1 and splenic cyst in one patient. LS was performed in the right semilateral position with three 10 mm trocars. LigaSure was used in dissection and division of splenic ligaments and hilar vascular structures. RESULTS: Conversion to open surgery was necessary in one patient due to peroperative bleeding. The mean duration of the operation was 71.3 +/- 19.8 minutes and the estimated blood loss was 85 +/- 23 ml. The diameter and the weight of the spleen were 10.7 +/- 2.68 cm and 250 +/- 90 g, respectively. There was no mortality. Postoperative complications included pancreatic fistula, trocar site infection and deep venous thrombosis that were encountered in three patients. These were managed without morbidity. The overall complication rate was 10.3% (n = 3). The mean duration of postoperative hospital stay was 2.86 +/- 1.59 days. CONCLUSION: LigaSureTM use in LS had easy application, provided sufficient hemostasis, and shortened the operative time.

One-stage combined surgery with or without preoperative traction for developmental dislocation of the hip in older children.

PURPOSE: To compare one-stage combined surgery with and without preoperative traction, in older children with developmental dislocation of the hip (DDH). METHODS: Records of 9 children who underwent combined surgery for DDH with preoperative traction in 12 hips (group 1) and 12 undergoing the same procedure without preoperative traction in 16 hips (group 2) were retrospectively reviewed. The surgery consisted of open reduction, Salter's innominate osteotomy and femoral shortening with derotation varus osteotomy. The mean age of the patients at the time of operation was 5.8 years. The mean follow-up period was 5.9 years. RESULTS: At final follow-up, clinical outcome in group 1 was worse than that in group 2, though radiographic assessment demonstrated no significant difference between the groups. CONCLUSION: One-stage combined surgery without preoperative traction is effective in the treatment of DDH in older children, and has a lower complication rate, but radiographically the groups did not differ.

A case with spondylo-metaphyseal dysplasia type A4.

We present a case with spondylo-metaphyseal dysplasia type A4 characterized by ovoid vertebral bodies with anterior tongue-like deformities, widened irregular and sclerotic metaphyseal changes, short iliac wings, slightly short long bones and short tubular bones of the hands with irregular metaphyses. She also had bipartite trochlea and irregular patellar margins, which have not been described in spondylo-metaphyseal dysplasia types to date.