Rhomboid Flap Technique in Breast-conserving Surgery: An Alternative Method for the Reconstruction of Lumpectomy Defects.

OBJECTIVE: We aimed to present our experience with rhomboid flap reconstruction, which is a simple technique, in breast cancer patients who underwent breast-conserving surgery. METHODS: We reviewed the medical records of 13 patients with breast cancer who underwent rhomboid flap reconstruction. The patients were evaluated for tumor size, safe surgical margin, and other clinical and pathological features. RESULTS: The mean age of the patients was 43.1 years (range: 28-69 years). The mean tumor diameter was 30.8 mm (range: 15-60 mm). The mean of the safe margin of resection was evaluated to be 17.8 mm (range: 5-30 mm). Re-excision was required for one patient in the same session. CONCLUSION: Rhomboid flap reconstruction can facilitate the applicability of breast-conserving surgery in early breast cancer patients with large tumor-to-breast-size ratio or tumors close to the skin.

The effect of psychoeducation on anxiety and pain in patients with mastalgia.

BACKGROUND: Mastalgia is a debilitating disorder, which has serious effects on one's daily life and causes significant medical costs. AIM: Mastalgia patients determine the overall approach and improve the quality of life of patients. METHODS: In this study, the outcomes of psychoeducation on anxiety and pain in a group of patients with mastalgia without an organic etiology have been investigated. 88 patients were included in this study. The socio-demographic data form, the Symptom Checklist 90 (SCL-90), the Toronto Alexithymia Scale-20 (TAS-20), the Hamilton Anxiety Scorer (HAM-A), the State-Trait Anxiety Inventory (STAI-I, STAI-2) and the Visual Analogue Scale (VAS) were all applied to the patients. 64 randomly selected patients (Group 1) were given psychoeducation while the remaining 24 (Group 2) were not. All patients were called back after 1 month for repeats of the HAM-A, STAI-I, STAI-2 and VAS tests. RESULTS: The results of this study demonstrated that psychoeducation has positive impacts on the perception of pain besides stationary, contemporary and total anxiety scores. CONCLUSIONS: It is concluded that the administration of psychoeducation is a good choice in the degradation of anxiety symptoms and pain.

Virginal Breast Hypertrophy and Symptomatic Treatment: A Case Report.

Virginal breast hypertrophy is a rare benign disease. It is characterized by rapid and excessive growth of one or two breasts during peripubertal period. There is no specific treatment algorithm, subcutaneous mastectomy and prosthesis replacement, reduction mammoplasty, medical treatment with particularly tamoxifen are all recommended in the literature. Unfortunately, all treatment methods have some disadvantages in this patient group who have not completed their sexual and physical maturation. Although these treatments are usually required, it should be noted that spontaneous remission could rarely be seen in virginal hypertrophy. We aimed to present a case of virginal hypertrophy, in whom symptomatic treatment has been used and breast growth regressed spontaneously.

[General approach to penetrating abdominal traumas of Turkish general surgeons: survey of practice]. / Türkiye'deki genel cerrahlarin penetran karin travmalarina yaklasimi: Uygulama anketi.

BACKGROUND: In patients with penetrating abdominal traumas (PATs), selective non-operative management (SNOM) has been widely accepted. This study was designed to investigate the practice trends among Turkish surgeons regarding SNOM. MEHTOHDS: The study was conducted as an online survey. Participants' demographic characteristics and their management trends and opinions regarding patients with PATs and SNOM were studied. Data were recorded using MS Excel® and analyzed. RESULTS: A total of 180 surgeons participated in the survey. SNOM approach rate in patients with stab injuries (SI) was 64%, whereas in patients with gunshot injuries (GSI), this rate was 52%. However, more than 90% of the surgeons declared that additional diagnostic studies were required before selecting SNOM approach in both SI and GSI. In addition, most of the surgeons who did not use SNOM in practice reported that they did not want to risk the patients' lives or their careers. DISCUSSION: Although our surgeons have constructive opinions and tendencies regarding contemporary approaches in the management of PATs, it is seen that nearly half of them prefer not to perform SNOM in practice for various reasons. We believe that approval of trauma and emergency surgery disciplines as subspecialties and funding- centralized trauma centers might correct this deficiency.

The management of penetrating abdominal trauma by diagnostic laparoscopy: a prospective non-randomized study.

BACKGROUND: Penetrating abdominal trauma (PAT) has been traditionally treated by exploratory laparotomy (EL). The aim of our study was to examine the use of diagnostic laparoscopy (DL) in the management of hemodynamically stable patients with PAT. METHODS: A prospective study was performed to compare the outcomes of hemodynamically stable patients with suspected intra-abdominal injuries due to abdominal stab wounds who underwent either EL or DL. Data extracted for analysis included demographic information, operative findings, rates of non-therapeutic laparotomy, operation time, length of hospital stay, mortality, and postoperative complications. RESULTS: Fifty-two hemodynamically stable patients were admitted to the trauma service. There were 45 male (86.5%) and 7 female (13.5%) patients. The average age was 34.5 years-old (18-60). 26 (50%) patients underwent EL, and 26 (50%) patients underwent DL. Re-exploration by laparotomy was required in 9 of the 26 cases (34.6%). Patients who underwent DL had significantly shorter hospital stays (1.82±0.63 days vs. 5.4±2.1 days, p<0.05) and shorter operation time (17.9±6.38 vs. 68.4±33.2 min, p<0.05) than patients who underwent EL. CONCLUSION: Selective use of DL in the hemodinamically stable penetrating trauma patients effectively decreased the rate of negative laparotomies, minimized morbidity, and decreased hospital stay.

Ectopic breast cancer: A case report.

Ectopic breast may be present at any site, from the axilla to the vulva, other than its normal location. Cysts, adenofibromas and rarely carcinomas have been reported in ectopic breasts. In this case report, we present a patient with ectopic breast cancer. The patient had a thickening and enlarging of her ectopic breast tissue, on the left arcus costarium. Tru-cut biopsy revealed "invasive lobular carcinoma". Left ectopic mastectomy and level I-II axillary dissection were performed and then chemotherapy+radiotherapy+endocrine therapy treatment was commenced. During follow up, the patient is doing well; in spite of R1 resection, she has no evidence of local recurrences or distant metastases.

Increased nutritional risk in major trauma: correlation with complications and prolonged length of stay.

BACKGROUND: Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Trauma Injury Severity Score (TRISS) are physiological and anatomical severity scores to predict trauma outcome. Nutritional Risk Screening (NRS-2002) is used for the screening of nutritional risk, which can affect outcome adversely. The objective of this study was to determine the reliability of these scales to predict disease severity, complications and mortality, and to compare the reliability of the NRS-2002 in predicting outcome with different scoring systems in trauma-intensive care unit (ICU) patients. METHODS: The study enrolled 100 consecutive patients who were admitted to the ICU in a training hospital due to trauma in the six-month study period (1 July 2008 and 1 January 2009). Discrimination characteristics of the scoring systems were evaluated using receiver operating characteristic (ROC) curves. RESULTS: Overall mortality was 14%, and the complication rate was 22%. Nutritional risk at admission was found to be increased in 58% of the patients. The NRS-2002 score was increased in patients with complication. ISS, TRISS and APACHE II at admission had a reliable power of discrimination (AUC>0.8) for mortality and complication prediction. The NRS-2002 score had moderate discrimination power for complication prediction (AUC=0.708) but showed high correlation with increased length of stay (LOS). CONCLUSION: A significant percent of trauma patients are at nutritional risk. The NRS-2002 score can be useful in predicting complication and prolonged LOS in trauma patients.

Dermatofibrosarcoma protuberans: A case report of a rare, bulky tumor that was managed with surgical therapy.

We report a case of this rare tumor and describe the surgical approach that we adopted and the clinical outcome; we also report his condition at 24 months' follow-up. Although treatment was with radical surgery, sufficient shoulder function could be obtained in our patient. We also describe the interesting MR findings of this tumor which correlated well with the histopathologic findings.