Search

Surgical treatments of advanced tumors have expanded in the last two decades as a result of ad-vances in surgical techniques, advanced interventional radiology methods, improved intensive care unit settings and increased overall life expectancy. Advanced liver tumors represent a broad category from various malignancies such as liver metastasis or native liver tumors. Not uncom-monly these tumors are not amenable to curative treatment and require down-staging, or local control at the initial diagnosis. Herein we discuss the portal vein embolization (PVE), transarterial radioembolization (TARE) with Yttrium-90 (Y-90), and surgical options namely, two-staged hepatectomy (TSH), and associating liver partition and portal vein ligation for staged hepatecto-my (ALPPS) as bridging strategies for definitive surgical treatment., (Celsius.)

Mesh contraction is a threat for hernia repair. Our aim is to analyze the effects of fixation techniques on mesh contraction. Forty-eight rats with abdominal wall defects were equally divided into four groups (G): G1 (control) with no repair, G2 defects were repaired with free polypropylene mesh, and G3 and G4 defects were reinforced with prolene mesh fixed by running and interrupted sutures, respectively. The corners of the defect and prolene mesh were marked with silver clips. The contraction rate was calculated by radiological measurement of distances between corner clips and by measuring the mesh areas after harvesting abdominal wall containing the patch. Host reaction was histhopathologically and biochemically examined by inflammation score, fibroblast count, thickness of the granulation tissue, and tissue hydroxyproline level. Distances between corner clips and mesh area have decreased by 31.5% and 26.4% respectively in G2, while in G3 the decrease was 24.4% (p = .008) and 22% (p = .01), respectively. Granulation tissue thickness was highest in the group with mesh fixed by running suture. The tissue hydroxyproline levels were similar in mesh repair groups. Our study suggests that mesh contraction, which reduces mesh surface, occurs during the wound healing process. In order to decrease the contraction rate, it is important to keep the mesh in place until its incorporation into the surrounding tissue. Our results suggest that mesh contraction is minimized by suture fixation, and running fixation suture, which provides more balanced tension around the mesh, seems more beneficial for decreasing contraction rate.

Colonic complications of Behcet's disease due to intestinal involvement are rarely reported in the literature. Ulcers are the most frequently seen intestinal complications that cause bleeding and perforation predominantly in the ileocecal region. In this article, we report a patient with Behcet's disease who presented with multiple perforations along the entire colon. Postoperative histopathological examination revealed multiple ulcers containing lymphocytic infiltrations in the small peripheral and submucosal venules. Intimal thickening and fresh intraluminal fibrin thrombosis were also seen in these venules.

Objective: To determine the accuracy of SLN biopsy for the assessment of axillary status, and prognostic markers leading to lymphatic metastasis in patients with early (T1) breast cancer., Design: Cross-sectional study., Place and Duration of Study: Department of Surgery, Teaching and Research Hospital. Between January 2000 and August 2004., Patients and Methods: SLN mapping by blue dye method was performed on 39 patients with T1 breast carcinoma. SLNs, level 1 and 2 axillary nodes were dissected and excised. The size, pathologic features of the primary tumor, SLNs and other axillary nodes, and hormone receptors were evaluated by histopathologic examination. The rate of SLNs and non-SLNs involvement, and demographic, clinical and pathologic risk factors leading to nodal metastasis were established. The diagnostic accuracy of SLN for axillary status was calculated., Results: SLNs were identified in 37 (95%) patients. The axilla had metastasis in 11 (28%) patients. Malignant cells involved SLNs in 8 patients. Non-SLNs had metastasis in 3 patients without SLN involvement. The sensitivity, specificity and accuracy of SLN biopsy for predicting axillary status was calculated as 73%, 100% and 92% respectively. Four of 5 patients with non-SLN metastasis were pre-menopausal (p=0.03), and hormone receptor negative (p=0.04). All 5 patients had T1c tumors (p=0.14) and lymphovascular invasion (p=0.0004)., Conclusion: SLN biopsy with high diagnostic accuracy may prevent unnecessary dissection of the axilla in the majority of patients with early (T1) breast carcinoma. Some risk factors as pre-menopausal status, absence of hormone receptors, and presence of lymphovascular invasion must be taken into account as important determinant of non-SLNs metastasis.