Management of granulomatous lobular mastitis: an international multidisciplinary consensus (2021 edition)

Granulomatous lobular mastitis (GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence. Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions, etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology. The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidence-based consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.Improving the Ability of Diagnosis and Treatment of Difficult Disease

Idiopathic Granulomatous Mastitis: An Autoimmune Disease?

Purpose. This study aimed to investigate the autoimmune basis of idiopathic granulomatous mastitis (IGM) by determining the anti-nuclear antibody (ANA) and extractable nuclear antigen (ENA) levels of patients diagnosed with IGM. Material and Methods. Twenty-six IGM patients were evaluated. Serum samples were analyzed for autoantibodies by indirect immunofluorescence (IIF) using a substrate kit that induced fluorescein-conjugated goat antibodies to human immunoglobulin G (IgG). IIF patterns were read at serumdilutions of 1 : 40 and 1 : 100 for ANA positivity. Using the immunoblot technique, the sera of patients were assayed at dilutions of 1 : 40 and 1 : 100 for human autoantibodies of the IgG class to 15 lines of highly purified ENAs. Results. In the IIF studies for ANA, positivity was identified for four different patterns in the 1 : 40 diluted preparations, for three different patients in the 1 : 100 diluted preparations and only one pattern was identified at the 1 : 320 dilution. In the ENA studies, positivity was identified for four different pattern in the 1 : 40 dilution, and only one pattern was identified at the 1 : 100 dilution. Conclusion. This study was not able to support the eventual existence of an autoimmune basis for IGM

Retrospective Review of Pilonidal Sinus Patients With Early Discharge After Limberg Flap Procedure

The aim of this study was to evaluate the results of cases with pilonidal sinus (PS) disease that underwent Limberg flap (LF) transposition and to compare the short and long-term results of early discharge cases with those in the literature. A total of 345 patients who underwent rhomboid excision and LF transposition for PS were evaluated retrospectively. No major anesthetic or surgical complications occurred. Partial wound dehiscence, localized flap necrosis, hematoma, wound infection, and seroma rates were determined as 4.0, 2.1, 1.5, 3.3, and 3.7% respectively. All patients other than those with a hematoma or localized necrosis were discharged with a drain in place 24 hours after the operation. The recurrence rate was 3.9% after a mean 33.1-month follow-up (range, 6-72 months). As a result, we found that short and long-term results of patients who underwent LF and were discharged 24 hours after the operation were similar to those in the literature. We suggest that patients without postoperative complications, such as hematoma or flap necrosis, can be discharged early

Topical Steroids Are Effective in the Treatment of Idiopathic Granulomatous Mastitis

Topical steroids seem to be effective in the treatment of IGM characterized by skin changes. Prospective clinical studies would be useful in determining the clinical efficacy of topical steroids in the treatment of IGM

Meme kanser cerrahisinde torakal paravertebral blok sonrasi gelişen epidural yayilim: Olgu sunumu

The aim of this study was to determine that very rare anecdotal reports such as intra-neuronal and spinal cord injections, local anesthetic toxicity, and epidural spread of local anesthetic despite it is known that continuous catheter implementation is safer than paravertebral techniques, primary central neuraxial techniques. We presented a bilateral epidural block case developed due to epidural spread in a patient performed modified radical mastectomy with axillary dissection under thoracic epidural block.Paravertebral teknikler primer santral nöroaksiyel tekniklere göre kateter uygulamaların daha güvenli olduğu bilinmesine rağmen intranöral ve spinal kord enjeksiyonları, lokal anestezik toksisitesi ve lokal anesteziklerin epidural yayılımı gibi komplikasyonları içeren son derece nadir anektodal raporlar vardır. Biz de torakal epidural blok altında axiller diseksiyonlu modifiye radikal mastektomi uygulanan bir hastada epidural yayılım sonucu gelişen bilateral epidural blok olgusunu sunduk

Comparision of the Limberg flap with the V-Y flap technique in the treatment of pilonidal disease

Conclusion: The early postoperative and long-term results of the LF and V-Y flap techniques for the treatment of pilonidal sinus were similar. Because the resumption of daily activities at work is achieved later in patients undergoing the V-Y flap compared with the LF technique, patients' employment (or position in working life) must be considered when determining the most appropriate surgical technique

Intestinal obstruction due to bezoars: a retrospective clinical study

Conclusions The frequency of previous abdominal surgery in patients suffering from an intestinal obstruction due to bezoars causes diagnostic conflict. The location of bezoars in the small intestine should also be considered when deciding the surgical procedure, as well as the physical properties of the bezoars. Our opinion is that conducting the milking procedure should not be insisted on, and that an enterotomy should be conducted when necessary

A retrospective review of patients with non-traumatic spontaneous intramural hematoma

Background/aims: Non-traumatic spontaneous intramural hematoma of the small intestine is a rare clinical condition, most commonly caused by over-anticoagulation. In this study, the clinical approach algorithm for patients diagnosed with a spontaneous isolated intramural hematoma of the small intestine associated with over-anticoagulation and the long-term outcomes of the patients are presented. Material and Methods: The records of patients who were diagnosed with intramural hematoma in 3 different medical faculty hospitals between 2007 and 2011 were retrospectively analyzed. After excluding patients with trauma history, hematoma in organs other than the small intestine, and with etiological factors other than over-anticoagulation, 15 patients with an isolated intramural hematoma of the small intestine were evaluated within the scope of the study. Results: The sites of first admission were emergency departments for 10 patients (66.6%) and other clinics for 5 patients (33.3%). Thirteen patients (86.6%) received medical treatment and two patients (13.3%) underwent surgical treatment. During the hospitalization period, a total of two patients (13.3%) died. Out of the 11 patients with an average follow-up of 22 months (range: 4-48 months), no patient had a relapse of intramural hematoma and three patients (27.7%) died due to reasons not related to intramural hematoma. Conclusion: Intramural hematoma diagnosis should be known by all physicians, because the site of first admission may be different clinics, since the clinical presentation begins with non-specific complaints. Early and accurate diagnosis by non-invasive methods will preclude unnecessary surgical interventions

CT Findings of Patients with Small Bowel Obstruction due to Bezoar: A Descriptive Study

Purpose. The aim of this study was to present the computed tomography (CT) findings of bezoars that cause obstruction in the small bowel and to emphasize that some CT findings can be considered specific to some bezoar types. Materials and Methods. The records of 39 patients who underwent preoperative abdominal CT and subsequent operation with a diagnosis of intestinal obstruction due to bezoars were retrospectively analyzed. Results. In total, 56 bezoars were surgically removed from 39 patients. Bezoars were most commonly located in the jejunum(n = 26/56, 46.4%). Sixteen (41.0%) patients had multiple bezoar locations in the gastrointestinal tract. Common CT findings in all patients were a mottled gas pattern and a focal ovoid or round intraluminal mass with regular margins and a heterogeneous internal structure. Furthermore, some CT findings were determined to be specific to bezoars caused by persimmons. Conclusions. Preoperative CT is valuable in patients admitted with signs of intestinal obstruction in geographic regions with a high bezoar prevalence. We believe that the correct diagnosis of bezoars and the identification of their number and location provide a great advantage for all physicians and surgeons. In addition, some types of bezoars have unique CT findings, and we believe that these findings may help to establish a diagnosis