Factors Predicting Microinvasion in Ductal Carcinoma in situ

Background: Whether sentinel lymph node biopsy (SLNB) should be performed in patients with pure ductal carcinoma in situ (DCIS) of the breast has been a question of debate over the last decade. The aim of this study was to identify factors associated with microinvasive disease and determine the criteria for performing SLNB in patients with DCIS. Materials and Methods: 125 patients with DCIS who underwent surgery between January 2000 and December 2008 were reviewed to identify factors associated with DCIS and DCIS with microinvasion (DCISM). Results: 88 patients (70.4%) had pure DCIS and 37 (29.6%) had DCISM. Among 33 DCIS patients who underwent SLNB, one patient (3.3%) was found to have isolated tumor cells in her biopsy, whereas 1 of 14 (37.8%) patients with DCISM had micrometastasis (7.1%). Similarly, of 16 patients (18.2%) with pure DCIS and axillary lymph node dissection (ALND) without SLNB, none had lymph node metastasis. Furthermore, of 20 patients with DCISM and ALND, only one (5%) had metastasis. In multivariate analysis, the presence of comedo necrosis [relative risk (RR)=4.1, 95% confidence interval (CI)=1.6-10.6, P=0.004], and hormone receptor (ER or PR) negativity (RR=4.0, 95% CI=1.5-11, P=0.007), were found to be significantly associated with microinvasion. Conclusions: Our findings suggest patients presenting with a preoperative diagnosis of DCIS associated with comedo necrosis or hormone receptor negativity are more likely to have a microinvasive component in definitive pathology following surgery, and should be considered for SLNB procedure along with patients who will undergo mastectomy due to DCIS

Factors That Affect the False-Negative Outcomes of Fine-Needle Aspiration Biopsy in Thyroid Nodules

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

SINGLE CENTER AND SINGLE SURGEON EXPERIENCE AND THE RESULTS OF THE SURGICAL TREATMENT OF PILONIDAL SINUS

Aim: Pilonidal sinus is a disease deriving from hair follicules in the sacrococcygeal region. The aim of this study is to evaluate the results of patients with pilonidal sinus disease who underwent primary excision by single surgeon at single center. Material and methods: Between June 2007 and June 2010, 82 patients were enrolled in this study who operated at Ergani State Hospital. The age, sex, surgical techniques, anesthesia techniques, the time to return work, and the time of wound healing, complications and recurrences data were collected retrospectively. All patients underwent primary excision and left with open wound. Results: Between June 2007 and June 2010, 82 patients underwent primary excision and left with open wound at the same center by single surgeon. Twenty-three of patients were women (28%) and 59 were men (72%), the mean age was 23.5 (1438) years. Acute, chronic and recurrent diseases were detected in 17 (20.7%), 58 (70.8%) and 7 (8.5%) patients, respectively. Mean time to return work was 7 days (1-10), 4 patients were readmitted to hospital due to bleeding. Mean time of healing was 3 weeks (2-8). Conclusion: Primary excision with open wound is the most commonly used surgical technique in pilonidal sinus disease. It is contraversal which technique was the best in pilonidal sinus. As a result of the author experience, primary excision is safe and has the low recurrence risk

Medical academic staff selection and academic staff organisation's criteria

World Federation for Medical Education's global standards are used widely in the medical education all over the world. The purpose of this study was to analyze the diversity of existing academic staffs in one of the medical faculties in Turkey (Istanbul Medical Faculty, ITF) and in the world and also to compare and analyze the staffs' characteristics. In this study, according to the Shanghai classification 2012 the most popular six universities' web pages were examined and evaluated in detail. These universities were Harvard University, University of California San Francisco (UCSF), Johns Hopkins University, University of California at Los Angeles (UCLA), Stanford University and Cambridge university. Of the academic personnel in departments provided in the websites of the faculty of medicines in these six universities, educational variety and the number at Bachelor's degree and academic titles were reviewed. Some of the non-medical basic science academic staff were found to be over 50%. Some clinical branches like anesthesia, general surgery, cardiovascular surgery and transplantation, all the academic personnel both in ITF and the other six universities were medical doctor and had special training on these clinical branches. In the Department of Psychiatry, the range of people from different areas of expertise with PhD degree ranged from 8-56%, it was found to be lowest in ITF and Stanford University. Only in Public Health Department of ITF, the non-medical graduates and medical graduates ratios were similar to the leading universities in the world. All of these results showed that, one of the leading universities in the world provide clinical, educational and research activities in mosaic concept. In our country, in clinical sciences branches there were multidisciplinary people from different areas of expertise, however it is understood that PhD's were not provided enough in academic staff

Necrotizing pancreatitis after transcatheter arterial chemoembolization for hepatocellular carcinoma

A patient who developed necrotizing pancreatitis after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) is presented. A 55-year-old man had been followed for chronic hepatitis B infection for 10 years at another institution. He presented with multiple masses in the right lobe of the liver and a metastasis in the left adrenal gland. He was referred after a percutaneous liver biopsy which revealed a moderately differentiated HCC. He was,treated by TACE. At the third session of TACE, the right hepatic artery was found to be thrombosed; however, angiography also demonstrated collateral feeder vessels (arising from the pancreaticoduodenal artery) which were used for treatment. He developed necrotizing pancreatitis, possibly due to regurgitation of the chemotherapeutic agents to the pancreas. He recovered without complications with imipenem-cilastatin prophylaxis. Acute pancreatitis is a rare but severe complication of TACE. Selective catheterization of the tumor vessels is the established standard in TACE. A careful risk-benefit analysis is mandatory in patients with abnormal collateral vessels. Treatment of acute necrotizing pancreatitis (ANP) after TACE is the same as the accepted approach to ANP due to other causes

Appendix Inflamation with Varicella Zoster Infection

Acute appendicitis with varicella zoster infection is a very rare event. We report the case of an 18-year-old immunocompetent adult with acute varicella zoster infection and abdominal pain at the right lower quadrant. He had tenderness on the right lower quadrant with defense and rebound. He had no leukocytosis, and abdominal ultrasonography showed an inflammation of the appendix (6.4 mm in diameter) with free fluid of about 25x21x20 mm. We observed the patient with antiviral therapy. On the second day, there was no increment in his physical signs, and on the tenth day of the acute onset of varicella zoster infection, he had no pain; the abdominal ultrasonography revealed no inflammation of the appendix

Comparison of Limberg and Dufourmentel flap in surgical treatment of pilonidal sinus disease

Purpose: Pilonidal sinus is a common chronic disease relating sacrococcygeal region. Although several surgical treatment methods were determined relating pilonidal sinus, no optimal treatment method is available because of its high recurrence rates. This study was designed to compare Limberg and Dufourmentel flap methods that are currently used