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Copyright of Journal of Istanbul Faculty of Medicine / İstanbul Tıp Fakültesi Dergisi is the property of Istanbul Tip Fakultesi Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: To study the effects of routine HLA screening and the policy of avoiding donor‐dominant one‐way HLA match to prevent graft‐versus‐host disease (GVHD) after living donor liver transplantation (LDLT). Patients and Methods: The records of potential living liver donors and recipients who attended our center between 2007 and 2018 were reviewed retrospectively. Results: Of the 149 patients who underwent LDLT and survived longer than 3 months, two developed GVHD despite our strict policy. The first patient presented with grade II GVHD limited to the skin. She was treated successfully by briefly discontinuing immunosuppression and switching to everolimus. In the second case, the policy had been relaxed due to the availability of a single donor for ABO‐incompatible transplantation without any intervention to decrease anti‐A antibody levels (special case: A2 to O). Nevertheless, the patient presented with grade I GVHD limited to skin and was treated successfully by adding oral methylprednisolone to tacrolimus and mycophenolate mofetil. To the best of our information, this is the second reported case who recovered from GVHD after LDLT from a donor, homozygous at HLA A, B and DR and a recipient, heterozygous for all. Sixteen potential donors (1.2% of all candidates) of 14 recipients were disqualified solely on the basis of the HLA results; five of these patients died due to unavailability of another donor. Conclusion: The results support the policy of avoiding HLA combinations that preclude immune recognition of graft lymphocytes as foreign to decrease the risk of GVHD after LDLT. [ABSTRACT FROM AUTHOR]

Introduction: The role of esophagogastroduodenoscopy (EGD) in the preoperative period for patients scheduled for cholecystectomy due to cholelithiasis is controversial. Some studies recommend routine application, while others suggest selective application. Our study aimed to evaluate EGD findings in patients who underwent EGD before cholecystectomy. Materials and Methods: In our single-center retrospective study, patients who underwent cholecystectomy between 2020 and 2023 and had an EGD in the preoperative period were included. Patients who did not have a preoperative EGD, those who underwent cholecystectomy as part of another surgical procedure, and those with missing data were excluded from the study. Patients were evaluated based on demographic, clinical, endoscopic, and pathological findings. Results: A total of 336 patients were analyzed. The median age was 53 years (range 24-87), and 216 (64.3%) of the patients were women. Endoscopic pathology was detected in 180 (53.6%) of the patients. Histopathological abnormalities were detected in 199 (87.3%) of 228 patients. Helicobacter pylori (HP) positivity was detected in 90 patients (39.5%), atrophic gastritis in 45 patients (19.7%), and intestinal metaplasia in 41 patients (18%). Statistically, significantly more active and severe gastritis findings were observed in mucosal areas that appeared endoscopically pathological (p<0.001 and p<0.001, respectively). Conclusion: It can be concluded that the routine application of EGD before cholecystectomy may impact the clinical approach. [ABSTRACT FROM AUTHOR]

Objective: Despite the advances, reconstruction of the sacral region remains a challenge due to the nature of this area. Parasacral perforator flaps can be useful for small to moderate defects of the sacral area, and with the standard design, their skin paddle can overlap with the skin paddle of the superior gluteal artery perforator (SGAP) flap, forcing us to sacrifice one flap in order to use the other. In this retrospective study, we aim to present our experience with superiorly designed parasacral perforators as a single unit and their combined use with SGAP flaps. Methods: A retrospective review of 25 patients with sacral area defects reconstructed with a parasacral perforator flap or a parasacral perforator flap combined with a SGAP flap was presented in this study, and the results are discussed. Results: In our series, all flaps survived uneventfully except one. In 21 cases, a single superiorly designed parasacral perforator flap was used for coverage of a small to moderate sacral defect. In 2 cases, a combination of a parasacral flap and a SGAP flap was used simultaneously, and in 2 cases, a multi-stage approach was used with a SGAP flap in the initial stage and a parasacral flap in the second stage. We did not encounter any end resultaltering major complications, and all patients were functionally satisfied. Conclusion: With its quick learning curve and simplicity, the parasacral flap should be an essential tool in sacral reconstruction. When designed superiorly, their skin paddle would not overlap with the SGAP flap's skin paddle, and a combination of these 2 flaps can be utilized. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Sump syndrome is one of the rare long-term complications of side-to-side choledochoduodenostomy (CD) leading to attacks of cholangitis due to accumulation of food and debris in the common bile duct distal to the anastomosis is one of the rare long-term complications after CD. Methods: Fifteen patients treated with the Sump syndrome in our institution between 1996 and 2023 were retrospectively evaluated for long-term outcome. Results: Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and bile duct clearance was done in 11 patients, while four were subjected to revisional surgery in the form of a Roux-en-Y hepaticojejunostomy. No complications were recorded. There were 5 (38%) recurrences in a median follow-up period of 8 years (10 months–23 years). Of those, 3 patients were treated surgically and two with repeat ERCP. None of the patients developed any cholangiocarcinoma during follow-up. Conclusion: We conclude that although a high recurrence rate was observed, endoscopic treatment may be a valid approach in the treatment of Sump syndrome, with revisional surgery in the form of a Roux-en-Y hepaticojejunostomy as salvage therapy in recurrences. [ABSTRACT FROM AUTHOR]

Objective: Planning and marking are vital stages of breast reduction, and a significant step in this process is deciding the new location of the nipple. Many intricate measurements have been described to guide this decision, but there has not been a consensus on the best method. Most of these methods involve vertical repositioning of the nipple, and horizontal repositioning is neglected to some extent. Common marking techniques are not suitable for all breast types, especially breasts with laterally placed nipples. We propose a simple method for preventing mispositioning of the nipple– areola complex (NAC) on the horizontal axis. Methods: The suprasternal notch to nipple (SNN) axis was used to relocate the NAC in selected patients with laterally located nipples. During marking, both SNN axis and midclavicular point to nipple (breast meridian) axis were drawn. New potential nipple locations were reflected on both axes, and the distance in between was measured. Patients were asked to evaluate their post-op results regarding both shape and NAC positioning. Results: Seventeen patients with laterally placed nipples were operated on by the primary surgeon. The SNN axis was used to relocate NAC. The mean distance between two projected nipple locations was 2.1 cm. No major complications were encountered, and all the patients were satisfied with their appearance. Conclusion: The horizontal repositioning of the nipple during breast reduction is not given enough significance. While performing breast reduction, using the traditional breast meridian for patients with laterally placed nipples can lead to lateralized nipples after surgery. Our simple plan modification can prevent this minor complication. [ABSTRACT FROM AUTHOR]

Breast lesions are mainly classified as benign and malignant. When breast cancer is diagnosed, the patient is evaluated and a treatment plan is prepared. For benign lesions, follow-up or surgery may be performed. Imaging and biopsy results are essential when deciding on surgery. In particular, when there is a discrepancy between radiologic imaging and pathology results, excision may be useful for definitive diagnosis. We planned to present an approach to suspicious breast lesions with radiology pathology discordance through the presentation of three patients diagnosed with malignancy. Between February 2018 and March 2023, patients who underwent wire marking and excision for suspicious breast lesions were analyzed. Three patients diagnosed with malignancy after total excision were analyzed in detail. Of 33 patients, 2 (6.06%) patients had ductal carcinoma in situ and 1 (3.03%) patient had invasive tubular carcinoma. Preoperative and postoperative pathological findings were consistent with benign changes in all three cases. After total excision, a definitive diagnosis was made, and follow-up and treatment were planned. In cases of radiology-pathology discordance, total excision may be effective in detecting atypia, carcinoma in situ, or invasive carcinoma not detected on pathologic examination. Therefore, even if the biopsy result is not malignant, wire-guided total excision of radiologically suspicious lesions should be considered as a diagnosis and treatment method. [ABSTRACT FROM AUTHOR]

Published reports on the prognosis of pregnancy-associated breast cancer are controversial. This study aims to determine the histopathological features of pregnancy-associated breast carcinoma (PABC) and the outcomes of patients with breast cancer during pregnancy and lactation among Turkish women. The study retrospectively analyzed 29 patients diagnosed with pregnancy-associated breast malignancies who underwent surgery between January 1989 and March 2021. Demographic and pathological data were obtained to evaluate the clinicopathological and prognostic characteristics of the patients. The median age was 36 years (range: 26--42 years). Of the 29 patients with breast cancer, 13 (44.8%) were diagnosed during pregnancy, and the remaining 16 (55.2%) were diagnosed during lactation. Most patients had clinical tumor stage (cT) cT2--3 (n = 20, 69%) disease, and 15 patients had clinically node (cN)-positive disease (N1 and N2, 51.7%). The majority (n = 19, 65.5%) had invasive ductal carcinoma with high Ki-67 scores (>20%). Patients with lactation-associated breast cancer were more likely to have a family history of breast cancer (44% vs. 8%, p = 0.04) than those with pregnancy-associated breast cancer. Notably, symptom duration ≥6 months and presenting with cT3--4 or cN(+) disease were associated with poor disease-free and disease-specific survival. However, no difference could be found in outcome among patients with pregnancy- and lactation-associated breast cancer. PABC mostly presents with aggressive tumor molecular subtypes with high Ki-67 scores and more advanced stages associated with poor outcome, possibly due to delayed diagnosis. Therefore, prompt early diagnosis and awareness of this disease might improve survival. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Istanbul Faculty of Medicine / İstanbul Tıp Fakültesi Dergisi is the property of Istanbul Tip Fakultesi Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Istanbul Faculty of Medicine / İstanbul Tıp Fakültesi Dergisi is the property of Istanbul Tip Fakultesi Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: It is known fact that locoregional relapse is a significant risk factor for distant metastases. In breast cancer, local or regional relapses are seen between %1-10 in all patients. To search the relationship between the distinct factors in cases with regional relapses (relapse zone, relapse time, pathological features of the tumor etc.) and prognosis of the disease. Materials and Methods: The data of the 30 breast cancer patients, who had a surgery for the disease in our center between 1994-2015 and had a regional lymph node relapse in the follow-up period were included in the study. Clinicopathological features and long term survival data were assessed retrospectively. Results: The median age was 43 (29-74), %37 of the patients were younger than 40 age (n=11), and 19 patients (63%) were premenopausal (n=19). As pathologic stage, 90% of the tumors were TI-II and 10% was TIII-IV, whereas 43% was N0 (n=13), 30% was N1 (n=9), 20% was N2 (n=6) and %7 was N3 (n=2). The most common histological type was invasive ductal ca in 24 patients (n=30), whereas 19 patients had hormor receptor (HR) positivity (70%, n=27), and 5 patients had HER2 positivity (25%, n=20). At a median follow-up of 102 months (17-228), 19 patients had axillary relapse (%63), 7 patients had supraclavicullary relapse (24%) and remaining 4 had relapses in the other regions (13%). Of those, 70% had axillary lymph node dissection (n=21) and %22 had sentinel lymph node biopsy (n=9). Adjuvant radiotheraphy was given to 83% of the patients (n=25). The majority of locoregional recurrences (70%, n=21) were seen with local recurrences following mastectomy or breast conservation, whereas 9 patients had isolated locoregional recuurence. Of 8 patients with axillary recurrences, 5 had SLNB and 3 had axillary lymph node dissection, and almost all of them received radiaiton. The regional relapses were accompanied by distant metastases in 30% of cases. Median relapse time was 33.5 months (6-192). Of the relapses, 43% was seen in the first 24 months (n=13), 27% was seen between 25-60 months (n=8) and 30% was seen after 60 months (n=9). Hormone receptor-negative patients (n=6) were more likely to recur within the first 24 months compared to HR+ patients (n=5) (%75 vs %26%, p=0.033). Of those, 11 patients (38%) had distant organ metastases after the local relapse with a 5-year disease specific survival of 82%, whereas the 5-year disease specific survival after an axillary relapse was 93%. Conclusion: Our results suggest that patients with isolated local regional relapses have excellent prognosis, and the relapses in the HR-patients were usually seen in the first 24 months. Since the majority of patients with isolated locoregional recurrences already received radiation and had a negative pathology for lymph nodes, there may be other biological factors for future investigation. [ABSTRACT FROM AUTHOR]

Objective: Thoracic wall recurrences following mastectomy are seen relatively rare in breast cancer. Local and regional recurrences are seen about %5-10 in breast cancer. Of those, 20% to 30% of recurrences are seen with regional recurrences. The aim of this study is to investigate the clinical, pathological features and long-term survival of patients with local recurrence after mastectomy. Materials and Methods: Between 1993 and 2015, 27 patients who were operated with a diagnosis of breast cancer at the Istanbul Medical Faculty Breast Surgery Clinic, developed recurrence in the thorax wall. Clinicopathologic and long-term survival data was obtained for 27 patients. Results: Median age was 47 (25-79) and 63% of patients (n=17) were premenopausal. The majority of patients were found to have stage III disease (30%), whereas 30% had stage 1, and %26 had stage 2 disease. Furthermore, the majority of patients were found to have invasive ductal carcinoma as histological tumor type. Hormone receptor positivity (estrogen and/or progesterone receptor positivity) was detected in 16 patients (67%, n=24), whereas 2 patients were found to have HER-2 positivity (15%, n=13). One patient (6.7%, n=15) with hormone receptor positivity upfront was turned to be hormone receptor negative (ER/PR negative) in recurrence. At a median follow-up of 87 month (12-261), 21 patients (78%) had isolated thoracic wall recurrence, whereas 6 patients (22%) had synchronous thoracic®ional recurrence. The median recurrence time was 44 months (6-260), and 37% (n=10) of recurrences were detected in the first 2 years, whereas 22% of them (n=6) were seen between 2 and 5 years, and 41% (n=11) of them developed after 5 years. Twenty patients (74%) underwent a surgical procedure as recurrent mass excision+/- axillary dissection, and 7 patients (26%) underwent systemic treatment after tissue biopsy (core / FNAB). Hormone-positive patients (median recurrence month=89.5) were less likely to be found a recurrence compared to the hormone receptor-negative patients (median recurrence month, 89.5 vs 14.5; p=0.002). Four patients (15%) developed distant metastasis after recurrence. There were 3 deaths due to breast cancer during the follow-up period and the overall 10-year survival rate was 86.8%. Conclusion: Our findings suggest that the majority of patients who developed local/regional relapse after mastectomy relapsed within the first five years, and HR-positive patients were less likely to recur than HR-negative patients. Therefore, triple negative patients may require more aggressive local and systemic therapies. [ABSTRACT FROM AUTHOR]

Background: Adrenal gland injury (AGI) associated with trauma is an uncommon and often overlooked condition. This study aimed to evaluate the frequency of AGI in individuals with severe trauma injuries and investigate the outcomes of patients with AGI., Methods: All patients admitted to a tertiary trauma referral center under the trauma protocol who had a computed tomography (CT) scan between January 2012 and January 2023 were analyzed retrospectively. Patients who were dead on arrival and patients with incomplete data were excluded. They were classified into two main groups, adult and pediatric, and further subcategorized by the presence or absence of radiologically evident AGI. Demographic data, mechanism of injury, injury severity scores (ISS), presence of concurrent abdominal injury, and 30-day mortality rates were compared. A separate analysis was performed for factors affecting mortality rates., Results: A total of 1,253 patients were included: 950 adults and 303 pediatric patients. In the adult group, AGI was detected in 45 (4.7%) patients and was more commonly associated with the following mechanisms of injury: motor vehicle accidents (26.7% vs. 14.3%) and pedestrian accidents (37.8% vs. 15.5%). Injury to the right side was more common (55.6%). Patients with AGI had higher rates of concurrent liver (17.8% vs. 3.9%), spleen (11.1% vs. 3.6%), and kidney injuries (15.6% vs. 1.3%). In the pediatric population, AGI was detected in 30 patients (14.8%), a significantly higher rate compared to the adult group. Similar to the adult group, AGI was more commonly associated with concurrent abdominal injuries and had a right-sided dominance (60%), but the rate of concurrent abdominal injuries was higher in the pediatric group (80% vs. 46%). The 30-day mortality was significantly higher in both adult and pediatric AGI groups compared to patients without AGI (adult: 15.6% vs. 2.9%, pediatric: 10% vs. 1.8%). In patients with AGI, major head and neck injuries and chest injuries were associated with mortality., Conclusion: Adrenal gland injuries due to trauma are not uncommon. They are usually associated with blunt trauma and other concurrent abdominal organ injuries. The major contributors to mortality in patients with AGI were major head and neck injuries and chest injuries.

Background: Previous research has shown that levobupivacaine is as effective as bupivacaine but carries a lower risk of cardiac and central nervous system toxicity. This study explores whether levobupivacaine and bupivacaine are preferable for all patients, includ-ing those with comorbidities, particularly focusing on their effects on colonic anastomosis. The primary objective is to examine the influence of levobupivacaine and bupivacaine on colonic anastomosis. Additionally, the study will assess their impact on wound healing and their anti-adhesive properties., Methods: Conducted between July 28, 2022, to August 4, 2022, at the Hamidiye Animal Experiments Laboratory, this study was approved by the University Science Health, Hamidiye Animal Experiments Local Ethics Committee. This study was conducted using 21 male Sprague rats aged 16-20 weeks. The rats were allocated into three equal groups of seven each: Group C: pre-incisional isotonic; Group B: pre-incisional bupivacaine; and Group L: pre-incisional levobupivacaine. Macroscopic adhesion scores (MAS) were recorded during laparotomy and tissue samples were taken for histopathological examination and hydroxyproline levels measurement. Wound tensile strength along the middle incision line and anastomotic burst pressure were also assessed., Results: MAS was statistically significantly lower in Groups B and L compared to Group C (p<0.001). The wound histopathology score (WHS) was significantly higher in Group L than in Group B (p=0.021). Colon histopathology scores (CHSs) were also signifi-cantly higher in Group L compared to Group C (p=0.011)., Conclusion: TThe study found that bupivacaine and levobupivacaine did not significantly enhance wound healing, although le-vobupivacaine significantly improved WHS relative to bupivacaine. According to the findings of this study, levobupivacaine can enhance clinical practice by being used in patients undergoing colon anastomosis. It contributes significantly to the durability of colon anasto-mosis, has a more positive effect on wound healing compared to bupivacaine, and exhibits anti-adhesive properties. Additional clinical trials are necessary to validate these results further.

The most important and serious complication of thyroid surgery is recurrent laryngeal nerve (RLN) injury, and it has been noted that this risk increases considerably in the presence of anatomical variations. Double recurrent laryngeal nerve (DRLN) is very rare among RLN anatomical variations. There are only a few case reports on DRLN in the literature It is crucial to possess surgical expertise and ensure complete visualization of the nerve to minimize the likelihood of RLN injury. Intraoperative nerve monitoring (IONM) is particularly useful in identifying anatomical variations. In a 54-year-old woman undergoing diagnostic left lobectomy+isthmectomy, a left DRLN was identified during intraoperative exploration and meticulous nerve exploration with the assistance of IONM monitoring verified that the impulse conduction in both branches was identical. The surgical procedure was successfully performed without causing any harm to the nerve. Based on the case reports in the literature and our experience with this patient, we believe that surgical expertise and the utilization of IONM can decrease RLN nerve damage and reveal its anatomical variations during thyroid surgery.

A spontaneous intramural duodenal hematoma is a rare complication in patients receiving anticoagulation therapy. Presently described is a case of intramural duodenal hematoma in a patient with a cadaveric renal transplant who was under oral anticoagulant treatment due to paroxysmal atrial fibrillation. The patient was admitted with intense abdominal pain, nausea, vomiting, and a total obstruction of duodenum. After a diagnosis of intramural hematoma, a good prognosis was achieved with conservative care.