Background: Breast pain is one of the leading complaints that ends up with referral to breast surgery clinics. The purpose of the present study was to investigate the factors that cause mastalgia, and its relation with benign or malignant breast disease. Methods: The study was performed in 700 patients. Data obtained from surveys, and imaging findings were prospectively recorded, and analyzed. Results: The mean age was 45.20 ± 10.78 years. The mastalgia group included 500 cases; the asymptomatic group comprised 200 individuals. Stressful lifestyle, caffeine consumption, and smoking were associated with mastalgia (p < 0.05). Rates of women who had breast fed 3 times or more were higher in the mastalgia group (p < 0.05). Increased breast density, and breast imaging-reporting and data system (BI-RADS) 2 mammography findings were related with mastalgia (p < 0.05). Cysts and fibroadenomas were more common in the mastalgia group (p < 0.05). The incidence of a past history of malignant breast disease was significantly higher in the mastalgia group (p < 0.05). Conclusions: Stress, caffeine, smoking, lactation frequency, and benign disorders were factors detected to be related with mastalgia. Although a significant relation between mastalgia and malignant breast disease was detected in our study, more controlled studies are still required to investigate this issue further.

Surgical excision still seems to be the best treatment method for IGM patients. Administration of steroids for large lesions prior to surgery may help minimize the lesion size and obtain better cosmesis.

Hyperbilirubinemia, especially with elevated direct bilirubin levels, may be considered as an important marker for the prediction of appendiceal gangrene/perforation.

Glasgow prognostic score (GPS) has been found to be a useful tool in various cancer types. Our aim was to evaluate the significance of GPS in patients operated on for colorectal cancer (CRC). Patients with CRC who underwent radical resections between April 2010 and January 2015 were retrospectively evaluated. GPS was estimated based on the preoperative measurement of C-reactive protein and serum albumin levels. Data including demographics, laboratory and pathological parameters, surgical outcomes, and late-term follow-up results were analyzed. The study group of 115 patients consisted of 51 (44 %) women and 64 (56 %) men with a median age of 66 (range 32-91) years. The mean follow-up period was 20 (range 7-41) months. Tumor size and wound infection rates were significantly increased in patients with higher GPS (p = 0.019 and p = 0.003, respectively). According to multivariate analyses, CEA and GPS were found to be independent risk factors significantly effecting mortality (p = 0.001 and p = 0.009, respectively). At the end of the late-term follow-up period, it was detected that cancer-specific survival significantly decreased as the GPS increased (p = 0.016). The GPS is a significant prognostic factor in CRC and should be included in the routine preoperative assessment of all surgically treated CRC patients.

PurposeOur aim was to investigate the predictive factors indicating strangulation, and the requirement for surgery in patients with acute mechanical intestinal obstruction due to adhesions.MethodsThis study retrospectively evaluated the records of patients with adhesive acute mechanical intestinal obstruction. The surgical treatment (group S), conservative treatment (group C), intraoperative bowel ischemia (group I), and intraoperative adhesion only (group A) groups were statistically evaluated according to the diagnostic and surgical parameters.ResultsThe study group of 252 patients consisted of 113 women (44.8%), and 139 men (55.2%). The mean age was 62.79 ± 18.08 years (range, 20-98 years). Group S consisted of 50 patients (19.8%), and 202 (80.2%) were in group C. Group I consisted of 19 patients (38%), where as 31 (62%) were in group A. In group S, the prehospital symptomatic period was longer, incidence of fever was increased, and elevated CRP levels were significant (P < 0.05). Plain abdominal radiography, and abdominal computerized tomography were significantly sensitive for strangulation (P < 0.05). The elderly were more prone to strangulation (P < 0.05). Fever, rebound tendernes, and urea & creatinine levels were significantly higher in the presence of strangulation (P < 0.05, P < 0.05, and P < 0.05, consecutively).ConclusionFever, rebound tenderness, urea & creatinine levels, plain abdominal radiography, and abdominal computerized tomography images were important indicators of bowel ischemia. Longer prehospital symptomatic period was related with a tendency for surgical treatment, and the elderly were more prone to strangulation. CRP detection was considered to be useful for the decision of surgery, but not significantly predictive for strangulation.

Background. The purpose of this study was to assess the factors that affect the false-negative outcomes of fine-needle aspiration biopsies (FNABs) in thyroid nodules. Methods. Thyroid nodules that underwent FNAB and surgery between August 2005 and January 2012 were analyzed. FNABs were taken from the suspicious nodules regardless of nodule size. Results. Nodules were analyzed in 2 different groups: Group 1 was the false-negatives (n = 81) and Group 2 was the remaining true-positives, true-negatives, and false-positives (n = 649). A cytopathologist attended in 559 (77%) of FNAB procedures. There was a positive correlation between the nodule size and false-negative rates, and the absence of an interpreting cytopathologist for the examination of the FNAB procedure was the most significant parameter with a 76-fold increased risk of false-negative results. Conclusion. The contribution of cytopathologists extends the time of the procedure, and this could be a difficult practice in centres with high patient turnovers. We currently request the contribution of a cytopathologist for selected patients whom should be followed up without surgery.

OBJECTIVE:The present study evaluated effects of incidental parathyroidectomy, surgical technique, and presence of thyroiditis or hyperthyroidism on occurrence of postoperative persistent or transient hypocalcemia.METHODS:Patients who underwent thyroidectomy at İstanbul Medeniyet University between 2013 and 2015 were included in the study. Patient information, postoperative serum calcium levels, and pathology reports were investigated retrospectively. Group 1 was made up of patients who were found to have hypocalcemia (calcium ≤8.5 mg/dL) according to postoperative serum level and normocalcemic patients were placed in Group 2. Groups were compared statistically in terms of rate of incidental parathyroidectomy, surgical technique, and presence of thyroiditis or hyperthyroidism.RESULTS:Mean age was 49.8±12.8 years (range: 20-88). A total of 417 patients were included in the study, 74 (17.7%) were male and 343 (82.3%) were female. Group 1 consisted of 205 (49.2%) patients who had hypocalcemia according to postoperative serum level, and remaining 212 (50.8%) patients were placed in Group 2. In Group 1, 38 (18.5%) patients had incidental parathyroidectomy, and with only 18 (8.5%) patients in Group 2, a statistically significant relationship was found between incidental parathyroidectomy and hypocalcemia (p=0.003). There was no statistically significant difference in terms of presence of thyroiditis or hyperthyroidism between groups. There was statistically significant decrease in postoperative hypocalcemia rate in patients with lobectomy compared to patients with bilateral total thyroidectomy or central neck dissection (p<0.01).CONCLUSION:Risk of postoperative hypocalcemia may be reduced with lobectomy for selected patients. In addition, delicate dissection during thyroidectomy is important in order to protect parathyroid glands and prevent hypocalcemia.

The chyle duct (CD) lies close to the spine behind the right renal vein and vena cava. Forces capable of tearing the CD may also injure other adjacent structures or organs. Cases of isolated chylous injury are rarely reported in the literature. Our aim was to report a case of isolated chylous injury due to blunt abdominal trauma that was successfully treated non-operatively. A 54-year-old man was involved in a deceleration-type traffic accident. His physical examinations, radiologic evaluations, paracentesis, and laboratory findings revealed isolated chylous injury resulting from intra-and retroperitoneal chylous fluid collection. The patient was treated via percutaneous drainage and medical therapy. This condition is generally self-limited and resolves without the necessity of any surgical interventions. However, if medical treatment is unsuccessful, the decision of diagnostic laparoscopy or exploratory laparotomy becomes inevitable. Keywords: Abdominal trauma, chylous ascites, chyloretroperitoneum INTRODUCTIONThe cisterna chyli is an important structure because it receives the lymphatic drainage from the intestinal trunk, the right and left lumbar lymphatic trunks, and small lymph vessels that descend from the lower part of the thorax. Injury to the cisterna chyli is rare and eventful. It may manifest with chylous ascites and chyloretroperitoneum (1, 2).Chylous ascites is the accumulation of a milk-like peritoneal fluid that is rich in triglycerides, due to the presence of thoracic or intestinal lymph in the abdominal cavity. It develops when there is a disruption of the lymphatic system due to traumatic injury or obstruction (from benign or malignant causes) (3).Many pathological conditions can result in chylous ascites. These conditions include congenital defects of the lymphatic system; nonspecific bacterial, parasitic, and tuberculous peritoneal infections; liver cirrhosis; malignant neoplasm; surgical injury; and blunt abdominal trauma. However, the most common cause in adults is believed to be abdominal malignancy, while congenital lymphatic abnormalities is the most common cause in the pediatric population. The incidence of chylous ascites seems to be increasing because of more aggressive thoracic and retroperitoneal surgeries and with the prolonged survival of patients with cancer (4). Examples for surgical procedures that may be associated with chylous ascites are abdominal aortic aneurysm repair, retroperitoneal lymph node dissection, pancreaticoduodenectomy, liver transplantation, catheter placement for peritoneal dialysis, distal splenorenal shunt, inferior vena cava resection, and laparoscopic Nissen fundoplication (3).Progressive and painless abdominal distention is the major clinical manifestation of chylous ascites, which occurs over the course of weeks to months, depending upon the underlying cause. Acute onset of symptoms may be observed in patients who have undergone either an abdominal or thoracic surgical intervention or had a major traumatic injury.Blunt abdominal trauma resulting in inte...