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Sternal cleft is a rare congenital malformation resulting from a fusion failure of the sternum and often patients have no clinical signs at birth. The defect is usually divided into partial or complete forms and is often accompanied by other anomalies. We herein report a case of upper sternal cleft that was repaired in the neonatal period by primary closure after partial thymectomy. The patient was discharged 9 days after the operation with good condition and normal respiratory movements. Sternal cleft is a rare case, with little more than 100 cases published worldwide.

Although symptomatic Mickel's Diverticulum (MD) in infants is rare, we report a case of perforated (MD) at birth in a full term male with signs of peritoneal irritation. Because of the rareness of perforated (MD) in infants, predicting the preoperative diagnosis is so difficult, but it doesn't affect the prognosis.

هدف البحث: تقييم دور اختبار قياس الضغوط في تشخيص داء هيرشبرونغ لأنقاص الاعتماد على خزعة المستقيم. المرضى وطرائق البحث: خلال عامي 2019-2020 م تم إجراء دراسة على (49) طفلاً يعانون من الإمساك المزمن ولديهم واحد أو أكثر من المرافقات التالية (تمدد بطني، قصة تأخر عقي، التبرّز بالمساعدة، قوام براز صلب، ألم أثناء التبرّز) خضع هؤلاء الأطفال لاختبار قياس الضغوط وتبعاً لوجود أو غياب المنعكس الشرجي المستقيمي إما خضعوا لإجراء خزعة مستقيم أو علاج محافظ لمدة (3-4) أشهر لتشخيص داء هيرشبرونغ. النتائج: المنعكس كان طبيعياً لدى (40) طفلاً، (9) أطفال ممن كان لديهم المنعكس سلبي أجري لهم خزع مستقيم، (3) منهم كانت نتيجة خزعتهم وجود خلايا عقدية عصبية، (6) منهم أبدى الفحص النسيجي لخزعهم غياباً للخلايا العقدية العصبية وتأكيد داء هيرشبرونغ لديهم، وبالتالي تكون حساسية الاختبار ونوعيته والقيمة التنبؤية الإيجابية والسلبية كما يلي على التوالي (100%،93%،66.7%،100%). الاستنتاج: مما سبق نجد أن اختبار قياس الضغوط فعال وآمن، فمع حساسيّة وقيمة تنبؤية سلبية عالية لا داعي لإجراء خزعة مستقيم في حالي المنعكس طبيعي.

هدف البحث إلى تعرف آثار جائحة الكورونا "كوفيد19" وعلاقتها بمستوى التوافق الأكاديمي مع الحياة الجامعية لدى طلبة جامعة زاخو, وتحديد الفروق الدالة إحصائياً بين متوسط درجات العينة على مقياس آثار جائحة الكورونا " كوفيد19" ومقياس التوافق الأكاديمي مع الحياة الجامعية وفقاً لمتغيرات الجنس والتخصص. اتبع الباحث المنهج الوصفي التحليلي, مستخدماً مقياس آثار جائحة الكورونا من إعداد الباحث نفسه, ومقياس التوافق مع الحياة الجامعية (ATCS) لروبرت بيكر وبوهدن سيرك (Robert Baker, Bohdon Siryk) والذي تم تعريبه واعداده من قبل علي عبد السلام علي. طبق الباحث المقياسين على عينة من طلبة جامعة زاخو بلغ عددها (230) طالب وطالبة. وتوصل الباحث الى عدة نتائج من أهمها: توجد علاقة ارتباطية عكسية سلبية قوية بين آثار جائحة الكورونا والتوافق الأكاديمي مع الحياة الجامعية لدى طلبة الجامعة بالدرجة الكلية ووفقاً لكل مجال من مجالات البحث. وجود آثار سلبية كثيرة وقوية لجائحة الكورونا على الجانب التعليمي والنفسي للطالب الجامعي. لا يوجد فرق ذو دلالة احصائية بين متوسطي درجات طلبة جامعة زاخو على مقياس آثار جائحة الكورونا "كوفيد19" ومقياس التوافق الاكاديمي وفقاً لمتغير الجنس. يوجد فرق ذو دلالة احصائية بين متوسطي درجات طلبة جامعة زاخو على مقياس آثار جائحة الكورونا " كوفيد19" وعلى مقياس التوافق الأكاديمي وفقاً لمتغير التخصص بالدرجة الكلية.

Objectives: To investigate the effects of syringaldehyde (SA) on the antioxidant and oxidant system in spinal cord ischemia (SCI)., Methods: These study and experiments were conducted at Medical Research Center, Çanakkale Onsekiz Mart University, Çanakkale, Turkey, between 2014-2018. Eighteen New Zealand White adult male rabbits were randomly divided into 3 groups (n=6). Superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), myeloperoxidase (MPO) activities, and malondialdehyde (MDA) levels were measured in the spinal cord tissues. Degenerated neurons, hemorrhage and in ammatory cell migration in the spinal cord were investigated histopathologically. Expressions of neuronal nitric oxide synthase (nNOS), caspase-3, and nuclear factor-κB (NF-κB) were evaluated immunohistochemically. Clinically, it was evaluated with modified Tarlov score., Results: Biochemically, there was an expected decrease in SOD, CAT, and GPx enzyme activities in ischemia groups, there was also an increase in MPO activity at the same time. When the enzyme activities spinal cord ischemia/ reperfusion (SCI/R)+SA, control and SCI/R groups were compared, the difference was found to be statistically significant (p less than 0.05). Glutathione peroxidase enzyme activity levels were very low in ischemia group compared to the significant increase in the SA group (p less than 0.05). Histopathologically, when SCI/R and SCI/R+SA groups were compared, there were statistically significant differences in the number of degenerative neurons and amount of hemorrhage; this comparison shows the significance of treatment in terms of inflammatory cell migration (p less than 0.05). The expressions of nNOS, caspase-3, and NF-κB were found significantly increased in SCI/R group compared to the control group (p less than 0.05). Syringaldehyde treatment decreased nNOS, caspase-3, and NF-κB expressions immunohistochemically. Clinical evaluation showed improvement in the SA-treated group., Conclusion: Syringaldehyde therapy administered for protective purposes may reduce oxidative stress, degenerative changes and in ammatory cell migration in the ischemic spinal cord.Saudi Med J 2020; Vol. 41 (4): 341-350doi: 10.15537/smj.2020.4.24993 How to cite this article:Malçok UA,  Aras AB, Şehitoğlu MH, Akman T, Yüksel Y. Therapeutic effects of syringaldehyde on spinal cord ischemia in rabbits. Saudi Med J 2020; Vol. 41: 341-350. doi: 10.15537/smj.2020.4.24993.

Objectives: The objective of the study is to understand the impact of adjuvant radiotherapy (RT) and prognostic factors for patients diagnosed with uterine carcinosarcoma., Materials and Methods: The records of 31 patients receiving adjuvant RT between the dates of September 2003-January 2013 in our clinic were evaluated retrospectively. Surgery was performed in 27 (87%) patients as staging laparotomy, for 4 patients as total abdominal hysterectomy and bilateral salpingo-oophorectomy. Pelvic external beam radiotherapy (EBRT) was 4500-5040 cGy in 25-28 fractions. In addition, 23 patients received brachytherapy following EBRT, 12 patients received adjuvant, and 1 patient received neoadjuvant chemotherapy (CT)., Results: The median age was 63 (between 30 and 78). The stage distribution of the patients was as follows: Stage I, 20 (64%); Stage II, 7 (23%), and Stage III, 4 (13%) patients. Five-year locoregional control (LRC) rate was 100%, disease-free survival (DFS) and overall survival (OS) rates were 65.5% and 66.2%, respectively. Stage I or II patients have a tendency for better 5-year OS and DFS rates than Stage III patients (73.1% vs. 42.9% and 72.7% vs. 42.9%; P = 0.065 and 0.051). Regarding lymph node dissection was performed or not, 5-year OS (64.7% vs. 75.0%) was not statistically different between groups (P = 0.77). Five-year OS and DFS rates were 69.2% and 61.5% for patients receiving CT (adjuvant or neoadjuvant) versus 63.7% and 68.8% for patients not receiving CT; P = 0.63 and P = 0.89, respectively. Based on the analysis of peritoneal washings, 5-year OS was 0% for patients with malignant or suspicious cytology whereas 89% for patients with benign cytology (P = 0.000). A negative correlation was observed between mitotic count of sarcomatous component and DFS time (rs = -0.812 and P = 0.05)., Conclusions: Surgery and adjuvant RT seem beneficial for excellent LRC rate. However, survival rates are low due to distant metastases. Thus, there is a great need for better systemic therapies., Competing Interests: None

Dural injury during spinal surgery can subsequently give rise to a remote cerebellar hemorrhage (RCH). Although the incidence of such injury is low, the resulting hemorrhage can be life threatening. The mechanism underlying the formation of the hemorrhage is not known, but it is mostly thought to develop after venous infarction. Cerebellar mutism (CM) is a frequent complication of posterior fossa operations in children, but it is rarely seen in adults. The development of CM after an RCH has not been described. We describe the case of a 65-year old female who lost cerebrospinal fluid after inadvertent opening of the dura during surgery. Computerized tomography performed when the patient became unable to speak revealed a bilateral cerebellar hemorrhage.

Aim: In the relevant literature, there is no experimental study that investigated the axon protective effects of syringic acid- a polyphenol compound- with an anti-oxidant capacity on ischemia/reperfusion injury., Material and Methods: The rats were randomly divided into four groups: Control group (no medication or surgical procedure), Sham group, Syringic acid group, and Methyprednisolone (MP) Group. Ischemia was achieved by abdominal aorta clamping and all animals were sacrificed 24 hours after ischemia. Harvested sciatic nerve segments were investigated histopathologically and for tissue biochemistry., Results: Ischemic fiber degeneration scores were found significantly lower in syringic acid and MP groups than sham group. Additionally, apoptosis-related cysteine peptidase caspase-3 immunostaining scores were lower in syringic acid and MP groups. Biochemically, superoxide dismutase and nuclear respiratory factor 1 values were significantly higher in syringic acid group compared to those of control and sham groups while malondialdehyde levels were significantly lower in the syringic acid group., Conclusion: Syringic acid reduces oxidative stress and axonal degeneration in rat sciatic nerve after ischemia/reperfusion injury. Therefore, syringic acid may play a role in the treatment of peripheral nerve injuries due to ischemia/reperfusion.

Aim: The objective of this study was to investigate the effect of using 2 different surgical techniques (curette or high-speed drill) in anterior cervical discectomy surgery on the healing of cases., Material and Methods: Fifty-four operated cervical disc hernia cases were retrospectively examined in 2 groups. Discectomy and osteophytectomy were carried out in Group A by using a high-speed drill, while a curette was used for group B. Preoperative and postoperative computerized tomography and direct radiography were performed. Cervical disc height, cervical and segmental lordotic angles were calculated. The visual analogue scale and Odom's criteria were used in the assessment of pain and clinical healing. The fusion ratio of both groups was compared. The Mann-Whitney U test was used to compare data from the groups., Results: Satisfactory results were obtained in the groups where high-speed drill and curette were used. Independently from the surgical technique, pain scores were significantly reduced in both groups after surgery. No radiologically significant differences were identified between the two groups within the postoperative period., Conclusion: Either high-speed drill or curette can be chosen for the osteophytectomy and discectomy stages of anterior cervical discectomy operations.

Aim: The aim of this study is to compare the different types of fusion materials known as PEEK cages used during anterior cervical discectomy (ACD) surgery., Material and Methods: A total of 67 patients were operated and evaluated retrospectively under two groups (group A: 35 PEEK cage patients, group B: 32 bladed PEEK cage patients) between 2009 and 2013. Preoperative and postoperative (postoperative first day, postoperative 1st, 3rd and 12-24th mo) images were obtained. The cervical disc heights, cervical and segmental lordotic angles of the operated levels were calculated. Pain assessment was performed and fusion rates were also compared. Mann-Whitney U test was applied to compare the outcomes., Results: The pain scores (especially for arm pain) were decreased significantly in both groups after surgery regardless of the type of operation technique (P < 0.05). There were no significant differences between both groups at the disc height measurements of operated levels in postoperative periods (P > 0.05). In addition to these; there was no significant difference between both groups of segmental and cervical lordodic angles in postoperative periods (P > 0.05). There was no statistically significant difference between the fusion rates and pain scores of both groups (P > 0.05)., Conclusion: The PEEK cage and bladed PEEK cages can be used safely to obtain fusion after ACD.

Aim: The intervertebral disc starts to degenerate when a human being begins to stand and learn to walk. It is known that many extrinsic, intrinsic and genetic factors play a role in disc degeneration. In this study, we examined whether the matrix metalloproteinase 11 might be associated with intervertebral disc degeneration., Material and Methods: Fifty-six patients with lumbar disc herniations who were operated at Göztepe Education and Research Hospital, Neurosurgery Clinic between September 2008 and December 2009 were prospectively reviewed. History and complaints were obtained from the case reports. Neuroradiological evaluation was performed with magnetic resonance imaging. Surgical findings of cases were reported in the operation notes. Microscopic posterior hemipartial laminectomy and discectomy were performed in all cases. Degenerated herniated disc material of all cases extracted during surgery was evaluated with immunohistochemical staining in Marmara University, Institute of Neurological Sciences, Pathology Laboratory., Results: Comparing the immunohistochemical staining of cases who were 50 years or younger and cases who were over 50 years old, statistical significance was determined., Conclusion: Matrix metalloproteinase 11 has a role in degenerating intervertebral disc disease, but it is not the only factor. Matrix metalloproteinase 11 might be a genetic factor in young-middle aged patients.

Background: In recent years, white blood cells (WBCs) and their subtypes have been studied in relation to inflammation. The aim of our study was to assess the relationship between neutrophil-lymphocyte ratio (NLR) and ankylosing spondylitis (AS)., Materials and Methods: We enrolled a total of 177 patients, 96 AS and 81 healthy controls. Complete blood count, WBC, neutrophil and lymphocyte levels were measured, and the NLR was calculated. In the assessment of AS, we used the erythrocyte sedimentation rate, C-reactive protein (CRP), the Bath Ankylosing Spondylitis Disease Activity Index, and the Bath Ankylosing Spondylitis Functional Index., Results: In the present study, 96 AS and 81 healthy individuals were enrolled. The mean age was 43.8 ± 12.9 and 46.5 ± 11.2 years, respectively. Mean disease duration of AS patients was 6.9 ± 5.6 years (median = 5, min-max = 1-25). The patients with AS had a higher NLR than the control individuals (mean NLR, 2.24 ± 1.23 and 1.73 ± 0.70, respectively, P < 0.001). A statistically significant positive correlation was observed between NLR and CRP (r = 0.322, P = 0.01). The patients receiving antitumor necrosis factor α therapy had a lower NLR than the patients receiving nonsteroidal anti-inflammatory drug therapy (mean NLR, 1.71 ± 0.62 and 2.41 ± 1.33, respectively, P = 0.02)., Conclusion: NLR may be seen as a useful marker for demonstrating inflammation together with acute phase reactants such as CRP and in evaluating the effectiveness of anti-TNF-α therapy., (© 2014 Wiley Periodicals, Inc.)

[Purpose] The aim this study was to assess the relation between bone mineral density (BMD) and mean platelet volume (MPV) in ankylosing spondylitis (AS) patients, and evaluate the diagnostic role of the diffusion-weighted magnetic resonance imaging (MRI). [Subjects and Methods] Fifty patients diagnosed with AS were divided into two groups on the basis of BMD, a normal group (n=30) and an osteopenic (n=20) group. [Results] Duration of disease in the group with a normal BMD was 10.3±7.0 years, while it was 16.7±12.2 years in the osteopenia group. MPV was high in the osteopenia group, while no significant differences were observed between the groups in terms of apparent diffusion coefficient (ADC) and platelet distribution width (PDW). There was a positive correlation between MPV and duration of disease. Correlations between ADC value and the lumbar T score, femoral neck T score, and duration of disease were insignificant. A negative correlation was observed between BMD and disease duration. [Conclusion] Diffusion-weighted imaging provides valuable results in osteoporosis but is not a suitable technique for evaluating BMD in patients with AS because of the local and systemic inflammatory effects in the musculoskeletal system. The common pathophysiology of atherosclerosis and osteoporosis plays an important role in the negative correlation observed between MPV and BMD in patients with AS.

Objectives: Stroke poses a crucial risk for mortality and morbidity. Our study aimed to investigate the effect of p-coumaric acid on focal cerebral ischemia in rats., Material and Methods: Rats were randomly divided into four groups, namely Group I (control rats), Group II (ischemia rats), Group III (6 hr ischemia + p-coumaric acid rats) and Group IV (24 hr ischemia + p-coumaric acid rats). Cerebral ischemia was induced via intraluminal monofilament occlusion model. In all groups, the brain was removed after the procedure and rats were sacrificed. Malondialdehyde, superoxide dismutase and nuclear respiratory factor-1 were measured in the ischemic hemisphere. The histopathological changes were observed in the right hemisphere within the samples. Functional assessment was performed for neurological deficit scores., Results: Following the treatment, biochemical factors changed significantly. Histopathologically, it was shown that p-coumaric acid decreased the oxidative damage. The neurological deficit scores of p-coumaric acid-treated rats were significantly improved after cerebral ischemia., Conclusion: Our results showed that p-coumaric acid is a neuroprotective agent on account of its strong anti-oxidant and anti-apoptotic features. Moreover, p-coumaric acid decreased the focal ischemia. Extra effort should be made to introduce p-coumaric acid as a promising therapeutic agent to be utilized for treatment of human cerebral ischemia in the future.

Purpose: To assess the relation between ankylosing spondylitis (AS) and degenerative disc disease emerging in association with various intrinsic and extrinsic factors and to evaluate the correlation between degree of degeneration in intervertebral discs and apparent diffusion coefficient (ADC) values., Methods: Thirty-five patients with AS and a control group of 35 patients were included in the study. Three hundred fifty intervertebral discs were assessed in terms of degeneration by analyzing signal intensities and morphologies on T2 weighted series of a 1.5 Tesla magnetic resonance scanner. ADC values were determined in diffusion weighted images (DWI) using a "b value of 500 s/mm(2)". Patients in the AS and control groups were compared in terms of intervertebral disc degeneration, and association between degree of degeneration and ADC values was analyzed., Results: The mean of total degeneration degrees for five lumbar intervertebral discs was significantly higher in the patients with AS compared to the control group (16.77±4.67 vs 13.00±4.08, respectively; P=0.001). When intervertebral discs were analyzed separately, disc degeneration was again significantly higher in patients with AS compared to the control group, with the exception of L5-S1. Age, cholesterol level, triglyceride level, duration of disease and BASFI index were significantly associated with degree of degeneration in patients with AS. A negative correlation was determined between disc degeneration and ADC value., Conclusion: AS is a risk factor for degenerative disc disease due to its systemic effects, the fact it leads to posture impairment and its inflammatory effects on the vertebrae. A decrease in ADC values is observed as degeneration worsens in degenerative disc disease.

Diagnosis, treatment, and surgery for lumbar disc herniations have existed for over a century. However, during the last three decades, there have been many new developments in imaging techniques, surgical procedures, physical medicine, and rehabilitation. In light of this, the most effective and appropriate treatment is controversial. Spontaneous regression of sequestrated, extruded, or protruded disc herniation has often been reported in the literature, although it is still a rare phenomenon. After a thorough review of the literature, we did not find any case report about this phenomenon after weight loss. In this report, though, we present a recent case about spontaneous regression of extruded disc herniation following weight loss.

Daidzein, a plant extract, has antioxidant activity. It is hypothesized, in this study, that daidzein exhibits neuroprotective effects on cerebral ischemia. Rat models of middle cerebral artery occlusion were intraperitoneally administered daidzein. Biochemical and immunohistochemical tests showed that superoxide dismutase and nuclear respiratory factor 1 expression levels in the brain tissue decreased after ischemia and they increased obviously after daidzein administration; malondialdehyde level and apoptosis-related cysteine peptidase caspase-3 and caspase-9 immunoreactivity in the brain tissue increased after ischemia and they decreased obviously after daidzein administration. Hematoxylin-eosin staining and luxol fast blue staining results showed that intraperitoneal administration of daidzein markedly alleviated neuronal damage in the ischemic brain tissue. These findings suggest that daidzein exhibits neuroprotective effects on ischemic brain tissue by decreasing oxygen free radical production, which validates the aforementioned hypothesis.

Aim: Anterior transodontoid screw fixation technique is generally chosen for the management of type II odontoid fractures. The nonunion of type II odontoid fractures is still a major problem especially in elderly and osteoporotic patients. Eleven osteoporotic type II odontoid fracured patients were presented in this article., Material and Methods: We have divided 11 patients in two groups as classical and Ozer's technique. We have also compared (radiologically and clinically) the classical anterior transodontoid screw fixation (group II: 6 cases) and Ozer's transodontoid screw fixation technique (group I: 5 cases) retrospectively., Results: There was no difference regaring the clinical features of the groups. However, the radiological results showed 100% fusion for Ozer's screw fixation technique and 83% fusion for the classical screw fixation technique., Conclusion: In conclusion, we suggest that Ozer's technique may help to increase the fusion capacity for osteoporotic type II odontoid fractures.

Background/aim: Brain ischemia and treatment are important topics in neurological science. Free oxygen radicals and inflammation formed after ischemia are accepted as the most significant causes of damage. Currently there are studies on many chemopreventive agents to prevent cerebral ischemia damage. Our aim is to research the preventive effect of the active ingredient in syringic acid, previously unstudied, on oxidative damage in cerebral ischemia., Materials and Methods: The rats were randomly divided into 4 groups: control group (no medication or surgical procedure), sham group (artery occlusion), artery occlusion + syringic acid group sacrificed at 6 h, and artery occlusion + syringic acid group sacrificed at 24 h. Obtained brain tissue from the right hemisphere was investigated histopathologically and for tissue biochemistry., Results: Superoxide dismutase and nuclear respiratory factor 1 values decreased after ischemia and they increased after syringic acid treatment, while increased malondialdehyde levels after ischemia were reduced after treatment. Caspase-3 and caspase-9 values increased after ischemia and decreased after treatment; this reduction was more pronounced at 24 h., Conclusion: Our study revealed that syringic acid treatment in cerebral ischemia reduced oxidative stress and neuronal degeneration. In the light of the biochemical and histopathologic results of the present study, we think that syringic acid treatment may be an alternative treatment method.

Purpose: To investigate the neuroprotective effects of Sulindac on the hippocampal complex after global cerebral ischemia/reperfusion (I/R) injury in rats., Methods: Thirty one Sprague-Dawley rats were used, distributed into group I (sham) n:7 were used as control. For group II (n:8), III (n:8) and IV (n:8) rats, cerebral ischemia was performed via the occlusion of bilateral internal carotid artery for 45 minutes and continued with reperfusion process. 0.3 mL/kg/h 0.9 % sodium chloride was infused intraperitoneally to the Group II rats before ischemia, 5μg/kg/h/0.3 ml sulindac was infused intraperitoneally to the Group III rats before ischemia and 5μg/kg/h/0.3 ml sulindac was infused intraperitoneally to the Group IV rats after ischemia and before reperfusion process. The levels of MDA, GSH and MPO activity were measured in the left hippocampus tissue. The hippocampal tissue of all group members were taken for histopathological study., Results: The MDA and MPO levels increased from group I (control) to group II (I/R) (P<0.05) and decreased from group II (I/R) to group III (presulindac + I/R) and IV (postsulindac + I/R) (P<0.05). Beside these, the GSH levels decreased from group I (control) to group II (I/R) (P<0.05) and increased from group II (I/R) to group III (presulindac + I/R) and IV (postsulindac + I/R) (P<0.05).The number of apoptotic neurons increased from group I (control) to group II (I/R) (P<0.05) and decreased from group II (I/R) to group III (presulindac + I/R) and IV (postsulindac + I/R) (P<0.05)., Conclusion: The Sulindac may have neuroprotective effects on ischemic neural tissue to prevent the reperfusion injury after ischemia.

Vascular complications after lumbar discectomy are rarely seen. We present a unique and potentially life-threatening postoperative complication from this procedure. A 27-year-old man was admitted to our emergency vascular unit 1 day after a lumbar discectomy, during which a scalpel blade fragmented and a part was lost. Radiological images of the patient were performed and a broken scalpel blade was located anterior to the sacrum. An anterior laparotomy was performed which identified a mass within the left iliac vein that migrated suddenly to the inferior vena cava. An emergency angiography was performed, by which time the scalpel blade had ascended to the right-sided inferior pulmonary artery. It was subsequently removed via a right lateral thoracotomy.

Purpose: To test the validity and reliability of The European Organization for Research and Treatment of Cancer (EORTC) core (QLQ-C30) and breast cancer module (QLQ-BR23) for Turkish breast cancer patients., Patients and Methods: A total of 127 patients treated with radiotherapy (RT) enrolled to this prospective study. EORTC QLQ-C30 and QLQ-BR23 modules applied to patients before initiation of RT and at follow-up period. Statistical analyses were performed by SPSS 13.0., Results: Questionnaires' were found reliable and valid for Turkish breast cancer patients. Six of the 8 multi-item scales of QLQ-C30 had a high reliability (Cronbach's ? >0.7); where physical functioning and pain scores were less reliable (Cronbach's ? of 0.66 and 0.68 respectively). In the QLQ-BR23, 3 of 5 multi-item scales were reliable; less reliable were breast and arm symptoms scale (Cronbach's ? of 0.65 and 0.61 respectively). In our analysis the most determinative subscales of QLQ-C30 on global health was emotional functioning followed by fatigue, role functioning and appetite loss (respectively p=0.002, p=0.01; p=0.03 and p=0.08). Among QLQ-BR23 scales systemic therapy SIDE effects, future perspective and upset by hair loss subscales had high impact on global health status (respectively p=0.006; p=0.01 and p=0.03)., Conclusions: The Turkish version of EORTC QLQ-C30 and QLQ-BR23 modules are reliable and valid tools to assess quality of life of Turkish breast cancer patients.

Purpose: To evaluate the necessity and direct cost effectiveness of screening and staging procedures in breast cancer patients having ≥4 positive axillary lymph nodes and to identify further possible biopathological risk factors associated with increased risk of metastasis., Methods: We reviewed the demographic and clinicopathological data from the medical records of 1897 newly diagnosed breast cancer patients. Patients having ≥4 positive axillary lymph nodes after primary surgery for breast cancer and who had staging examinations for metastasis were eligible. The impact of staging procedures (thoracoabdominal CT, bone scan etc.) for detecting metastasis, decision of adjuvant treatment and direct costs were analyzed in 329 patients with operable breast cancer., Results: Thirty-five (10.6%) patients were found with metastasis at diagnosis. Seven (20.0%) among them had multiple metastases. Eighteen (51.4%) had lung, 17 (48.6%) bone, and 7 (20.0%) liver metastasis. Twenty-one (60.0%) patients needed further radiological investigation for metastasis confirmation. Treatment decision was changed in 27 (77.1%) patients. No statistically significant risk factor was identified among the metastatic patients by means of conventional demographic and biopathological parameters. The cost of screening was lower when compared to the cost of treatment without any screening procedure., Conclusion: Since the conventional clinicopathological data seems not sufficient to define the risk of developing metastasis in breast cancer patients with ≥4 axillary lymph node involvement, all of them should undergo full staging examinations until new parameters based on genomic level are defined. Staging procedures need modification for high risk breast cancer patients.