Fibula allograft sandwich technique for the reconstruction of sternal nonunion after cardiac surgery

Sternal dehiscence is an untoward complication of cardiac surgery that leads to increased morbidity as well as length of hospital stay and costs. Although many different conventional and creative techniques have been described using both synthetic and biologic materials, the ideal method of sternal reconstruction is still controversial. In this case, we describe a simple and reproducible "fibula allograft sandwich technique" for the reconstruction of sternal nonunion in a cardiac surgery patient. This technique also facilitates the conventional wiring by creating bilateral landing zones for the wires at both sides of the sternum

Poor Biological Factors and Prognosis of Interval Breast Cancers: Long-Term Results of Bahceehir (Istanbul) Breast Cancer Screening Project in Turkey

PURPOSE The Turkish Bahceehir Breast Cancer Screening Project was a 10-year, organized, population-based screening program carried out in Bahceehir county, Istanbul. Our aim was to examine the biologic features and outcome of screen-detected and interval breast cancers during the 10-year study period. METHODS Between 2009 and 2019, 2-view mammograms were obtained at 2-year intervals for women aged 40 to 69 years. Clinicopathological characteristics including ER, PR, HER2-neu, and Ki-67 status were analyzed for those diagnosed with breast cancer. RESULTS In 8,758 screened women, 131 breast cancers (1.5%) were detected. The majority of patients (82.3%) had prognostic stage 0-I disease. Contrarily, patients with interval cancers (n = 15; 11.4%) were more likely to have a worse prognostic stage (II-IV disease; odds ratio [OR], 3.59, 95% CI, 0.9 to 14.5) and high Ki-67 scores (OR, 3.14; 95% CI, 0.9 to 11.2). Interval cancers detected within 1 year were more likely to have a luminal B (57.1% v 31.9%) and triple-negative (14.3% v 1%) subtype and less likely to have a luminal A subtype (28.6% v 61.5%; P = .04). Patients with interval cancers had a poor outcome in 10-year disease-specific (DSS) and disease-free survival (DFS) compared with those with screen-detected cancers (DSS: 68.2% v 98.1%, P = .002; DFS: 78.6% v 96.5%, P = .011). CONCLUSION Our findings suggest the majority of screen-detected breast cancers exhibited a luminal A subtype profile with an excellent prognosis. However, interval cancers were more likely to have aggressive subtypes such as luminal B subtype or triple-negative cancers associated with a poor prognosis requiring other preventive strategies. (c) 2020 by American Society of Clinical OncologyRocheRoche Holding; Basaksehir (Basaksehir county in Istanbul) MunicipalitySupported by a grant from Roche (V.O.) and Basaksehir (Bahcesehir is a region in the Basaksehir county in Istanbul) Municipality

Cost-Effectiveness of Breast Cancer Screening in Turkey, a Developing Country: Results from Bahçeşehir Mammography Screening Project

Objective: We used the results from the first three screening rounds of Bahcesehir Mammography Screening Project (BMSP), a 10-year (20092019) and the first organized population-based screening program implemented in a county of Istanbul, Turkey, to assess the potential cost-effectiveness of a population-based mammography screening program in Turkey. Materials and Methods: Two screening strategies were compared: BMSP (includes three biennial screens for women between 40-69) and Turkish National Breast Cancer Registry Program (TNBCRP) which includes no organized population-based screening. Costs were estimated using direct data from the BMSP project and the reimbursement rates of Turkish Social Security Administration. The life-years saved by BMSP were estimated using the stage distribution observed with BMSP and TNBCRP. Results: A total of 67 women (out of 7234 screened women) were diagnosed with breast cancer in BMSP. The stage distribution for AJCC stages O, I, II, III, IV was 19.4%, 50.8%, 20.9%, 7.5%, 1.5% and 4.9%, 26.6%, 44.9%, 20.8%, 2.8% with BMSP and TNBCRP, respectively. The BMSP program is expected to save 279.46 life years over TNBCRP with an additional cost of $677.171, which implies an incremental cost-effectiveness ratio (ICER) of$ 2.423 per saved life year. Since the ICER is smaller than the Gross Demostic Product (GDP) per capita in Turkey ($ 10.515 in 2014), BMSP program is highly cost-effective and remains cost-effective in the sensitivity analysis. Conclusion: Mammography screening may change the stage distribution of breast cancer in Turkey. Furthermore, an organized population-based screening program may be cost-effective in Turkey and in other developing countries. More research is needed to better estimate life-years saved with screening and further validate the findings of our study.Roche Turkey; Breast Health Society of Turkey (MEMEDER); Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS)United States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Center for Advancing Translational Sciences (NCATS) [UL1TR000427]; NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCESUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Center for Advancing Translational Sciences (NCATS) [UL1TR000427] Funding Source: NIH RePORTERThe study was funded by Roche Turkey and in part by the Breast Health Society of Turkey (MEMEDER). Also, it was partially supported by the Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH

The value of preoperative contrast-enhanced breast magnetic resonance imaging on surgical planning in breast cancer patients

Amaç: Meme kanserli olgularda, hastalığın evresinin doğru saptanması ve geri ye tümör dokusunun bırakılmaması uygun tedavi planlamasında belirleyici rol oynamaktadır. Meme manyetik rezonans görüntüleme (MRG), meme kanserli olgularda preoperatif cerrahi planlamasında kullanımı artan bir modalitedir. Bu çalışmanın amacı, prospektif olarak, meme kanserli kadınlarda, cerrahi önce si elde edilen meme MRG’nin cerrahi tedavi planlamaya katkısını araştırmaktır. Hastalar ve Yöntem: Çalışmaya 30 hasta dahil edildi. Lezyonlar Breast Imaging Reporting and Data System (BI-RADS) sınıflamasına göre 6 kategoride tanım landı. Veriler meme MRG incelemesi sonucu cerrahi planlamada yapılan değişik lik açısından analiz edildi. Bulgular: Hastaların primer tümör boyutları ile meme MRG ve histopatolojik değerlendirme ile ölçümlerinin yüksek düzeyde korelas yon gösterdiği saptandı (r:0.796, p:0.00). Meme MRG ile 11 hastada (%36) 14 ek lezyon saptandı. İki hasta hariç tüm olgularda histopatolojik değerlendirme so nuçlarının MRG bulguları ile uyumluluk gösterdiği görüldü. Tüm hasta grubunda meme MRG bulgularının cerrahi değişikliğe neden olduğu hasta oranı %17 idi. Mastektomi planlanan 16 olgunun 1’ine (%6.5) senkron kontrlateral meme kan seri nedeniyle ek meme koruyucu cerrahi (MKC) yapıldı. MKC planlanan olgula rın 4’ünde (%28) cerrahi plan mastektomi olarak değiştirildi. Hastaların 1’inde primer kanserin sınırları ve uzanımları, meme MRG ile daha net ortaya kondu ve MKC’den vazgeçilerek mastektomi uygulandı. Sonuç: Meme MRG bulgularının MKC planlanan hastalarda cerrahi planı de ğiştirebileceği klinik ve mamografik olarak saptanmış olup; preoperatif kont rastlı meme MRG’nin klinik ve mamografik saptanamayan okült invaziv ve no ninvaziv meme kanserlerinin yakalanmasında, tümör evrelemesinde, cerrahi planlamada rol oynadığı düşünülmektedir.Objective: Accurate detection of tumor stage and no recurrent tumor af ter surgery play a determinant role in surgical planning in breast cancer patients. Breast magnetic resonance imaging (MRI) is being increasingly used in preoperative planning for breast cancer. The aim of this study is to evaluate the incremental value of preoperative breast MRI to surgical plan ning in women with diagnosis of breast cancer. Patients and methods: Thirty patients were enrolled in this study. Lesions were categorized according to the Breast Imaging Reporting and Data System (BI-RADS) classification. The data were analyzed according to the benefits and detriments of MRI findings and changes in surgical planning made according to MRI results. Results: There was a high correlation between primary tumor size and breast MRI– histopathologic measurements (r:0.796, p:0.00). Fourteen additional lesions were detected in 11 patients (%36) with MRI. MRI findings were concordant with histopathologic results except in 2 patients. In 17% of total patient group, the surgical approach changed according to breast MRI findings. An additional breast- conserving surgery (BCS) was applied in 1 of 16 (%6.5) patients with synchroneus contrlateral breast cancer whom were planned to undergo mastectomy. In 4 patients (28%) with BCS decision, the surgical ap proach was changed to mastectomy. In one patient, the border and extansion of the primary cancer was detected more clearly by MRI and the decision of BCS was changed to mastectomy. Conclusion: We found that MRI findings accurately guided the CBS planning. Preoperative contrast-enhanced breast MRI plays an important role in detec tion, staging and surgical planning in invasive and noninvasive cancers

Radiologic findings of screen-detected cancers in an organized population-based screening mammography program in Turkey

PURPOSE:Bahçeşehir Breast Cancer Screening Program is a population based organized screening program in Turkey, where asymptomatic women aged 40–69 years are screened biannually. In this prospective study, we aimed to determine the mammographic findings of screen-detected cancers and discuss the efficacy of breast cancer screening in a developing country.METHODS:A total of 6912 women were screened in three rounds. The radiologic findings were grouped as mass, focal asymmetry, calcification, and architectural distortion. Masses were classified according to shape, border, and density. Calcifications were grouped according to morphology and distribution. Cancers were grouped according to the clinical stage.RESULTS:Seventy cancers were detected with an incidence of 4.8/1000. Two cancers were detected in other centers and three were not visualized mammographically. Mammographic presentations of the remaining 65 cancers were mass (47.7%, n=31), calcification (30.8%, n=20), focal asymmetry (16.9%, n=11), architectural distortion (3.1%, n=2), and skin thickening (1.5%, n=1). The numbers of stage 0, 1, 2, 3, and 4 cancers were 13 (20.0%), 34 (52.3%), 14 (21.5%), 3 (4.6%), and 1 (1.5%), respectively. The numbers of interval and missed cancers were 5 (7.4%) and 7 (10.3%), respectively.CONCLUSION:A high incidence of early breast cancer has been detected. The incidence of missed and interval cancers did not show major differences from western screening trials. We believe that this study will pioneer implementation of efficient population-based mammographic screenings in developing countries

Onion growth, yield and quality as influenced by different drip lateral depths and irrigation levels

This research aimed to evaluate the different lateral depths and irrigation water applied with subsurface drip irrigation on onion production traits during the spring growing seasons of 2009 and 2010 in Tekirdag conditions. Three different lateral depths as 0 (surface drip), 10 and 20 cm (subsurface drip) and four different irrigation (50, 75, 100 and 125 % of Class A pan evaporation). The seasonal evapotranspiration ranged from 337.1 and 715.4 mm depending on irrigation water applied. The highest onion yield obtained in the treatment which lateral was buried in 20 cm depth and the amount of irrigation water was applied based on 125 % of Class A pan evaporation. It can be said that the total marketable onion yield increases as the amount of lateral depth and applied irrigation water increases. The irrigation water use efficiency (IWUE) changed from 4.03 to 18.30 kg m-3 while the water use efficiency (WUE) changed from 2.61 to 6.86 kg m-3. The highest IWUE and WUE obtained in the treatment which lateral was buried in 20 cm depth and the amount of irrigation water was applied based on 50% of Class A pan evaporation. © 2019, Horticulture Society of India. All rights reserved.The authors would like to thank the Namık Kemal University for its financial support to the project ofThe authors would like to thank the Nam?k Kemal University for its financial support to the project of NKUBAP.00.24.YL.09.08

Supine or Prone Percutaneous Nephrolithotomy: Do Anatomical Changes Make it Worse?

Purpose: To evaluate the different anatomical properties and determine the risk of visceral organ injury in supine, prone, and prone-flex positions. Materials and Methods: A total of 30 patients with renal stones >2cm were included. A dose reduced abdominopelvic tomography in a supine, prone, and 30 degrees prone-flex position was performed. The access tract length, subcutaneous tissue length, nearest organ distance, maximum access angle, access field, and the degree of renal displacement were measured in axial and coronal images. The parameters were analyzed by the paired t-test and Wilcoxon signed test according to normalcy analysis. Results: The mean tract lengths and the subcutaneous fat tissue lengths in the lower, middle, and upper poles of kidney were significantly longer in the supine position. The significance of access tract lengths had disappeared when we subtracted the subcutaneous fat tissue length from the whole tract length, exhibiting that the main determinant of tract length was subcutaneous tissue thickness. The maximum access angles were 96.722.0 degrees, 94.2 +/- 23.6 degrees, and 89.1 +/- 23.9 degrees in the supine, prone, and prone-flex position, respectively (p>0.05). The access field was shorter in the supine (80.8 +/- 13.3mm) than prone (86.3 +/- 15.0mm) and prone-flex (86.7 +/- 18.4mm) position (p<0.001). The nearest organ distance to access tract was similar between the supine and prone position in every pole of kidney. Conclusions: The anatomical changes related to supine positioning does not increase the risk of percutaneous nephrolithotomy (PCNL) complications. Although supine PCNL may have some benefits over prone PCNL, there will also be some technical difficulties related to the surgeon's manipulations, which are related with the longer access tract and more limited access field

Multi-parametric MR imaging of transition zone prostate cancer: Imaging features, detection and staging

Magnetic resonance (MR) imaging has been increasingly used in the evaluation of prostate cancer. As studies have suggested that the majority of cancers arise from the peripheral zone (PZ), MR imaging has focused on the PZ of the prostate gland thus far. However, a considerable number of cancers (up to 30%) originate in the transition zone (TZ), substantially contributing to morbidity and mortality. Therefore, research is needed on the TZ of the prostate gland. Recently, MR imaging and advanced MR techniques have been gaining acceptance in evaluation of the TZ. In this article, the MR imaging features of TZ prostate cancers, the role of MR imaging in TZ cancer detection and staging, and recent advanced MR techniques will be discussed in light of the literature