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    Association of knowledge and cultural perceptions of women with delay in breast cancer diagnosis: A single center experience
    (2019) Altintas, Yasemin; Bayrak, Mehmet
    Aim: Breast cancer is the most common cause of cancer-related death among women worldwide and is the highest case mortality rate in low-income countries. The purpose of the current study is to investigate whether awareness, knowledge and socio-culturaleconomic factors are effective in the stages of patients diagnosed with breast cancer. Material and Methods: This study was conducted retrospectively at Ortadogu Private Hospital, breast outpatient clinic between January 2016 and January 2018 in Adana, Turkey. Two hundred - three females diagnosed as breast carcinoma were included. Females with recurrent, previous breast carcinoma and those who refused to participate were excluded from this study. Data was collected using demographic status, self-administered questionnaire consisted of knowledge about breast cancer and awareness of mammography. Results: A statistically significant difference was found between age and stage. There was no significant relationship between marital status, family history, income, body mass index, and stage of breast cancer at diagnosis. When we compare the stages with education, we see that the stages are higher as the education rate decreases. There was a significant relationship between location, occupation, routine screening, self-breast examination, awareness, knowledge, and stage. The independent variables that enable the diagnosis of patients at an early stage were routine screening, awareness, and knowledge. Conclusion: Our research showed that awareness, education, knowledge of breast cancer, self-breast examination, and routine screening were the most important factors in early detection of breast cancer.
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    Diagnostic utility of tru-cut biopsy in the assesment of breast lesions
    (2019) Altintas, Yasemin; Bayrak, Mehmet
    Aim: This report aims to assess the diagnostic utility of Tru-Cut biopsy in the diagnosis of breast mass in patients admitted to our breast unit in our clinic.Material and Methods: Between March 2013 and June 2018, In Ortadogu Private Hospital, Adana, 13.660 participants visited the breast unit and 472 participants of them aged 22-91 years experienced Tru-Cut biopsy(TCB) because of clinical doubt and/ or BI-RADS ( Breast Imaging Reporting and Data System ) III– V categorization. TCB specimens were compared with the histopathological reports of follow-up procedures including surgical procedures. When the pathology document was not compatible with clinical / image uncertainties, a biopsy was performed as a diagnostic method to exclude carcinoma.Results: The histopathological diagnosis of the TCB specimens showed that 237 cases (50.2%) were benign lesions, 219 (46.4%) were malignant lesions and 16 (3.4%) of them were disconcordance. Of the patients who underwent Tru-Cut biopsy, 256 (54.2%) had palpable and 216(45.8%) had nonpalpable lesions. Pathological results were not compatible with clinical / imaging suspicion in 3.4% of cases. TCB exhibited a sensitivity of 95.4%, 100% specificity, PPV of 100%, NPV of 96.1%, and diagnostic accuracy of 97.8%. There were no cases with false positivity.Conclusion: This study shows that Tru-Cut biopsy can safely be applied as a component of triple evaluation of suspected breast lesions. Multidisciplinary teamwork is crucial to implement the Tru-Cut biopsy, which replaces the present surgical approach to treat breast lesion and prevent from diagnostic inaccuracies.Keywords: Tru-Cut Biopsy; Breast Carcinoma; Disconcordance.
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    Laparoscopic cholecystectomy under spinal anesthesia in high risk patients: A single center experience
    (2019) Bayrak, Mehmet; Altintas, Yasemin
    Aim: Laparoscopic cholecystectomy is routinely done with general anesthesia except for patients that are considered too sick for general anesthesia. The goal of this study was to investigate the availability, safety, and side effects of spinal anesthesia in laparoscopic cholecystectomy. Material and Methods: Patients with high risk for general anesthesia who admitted for laparoscopic cholecystectomy were given the choice of spinal anesthesia instead of general anesthesia. In Ortadogu Private Hospital, Adana, Turkey; 371 subjects were prospectively admitted for laparoscopic cholecystectomy under spinal anesthesia between January 2015 and January 2018. All volunteers provided informed consent. The spinal anesthesia procedure was done similar to the general anesthesia protocol with no modifications. Intra-abdominal pressure was sustained within the 8-10 mmHg range. A 3.5mL bupivacaine (0.5%)/fentanyl (20 μg) mixture was used for spinal anesthesia. Data collected for demographics, ASA scores, surgery duration, comorbidities, and sedation medication/dosage were reviewed. Results: A total of 232 women (62.6%) and 139 men (37.4%) comprised the study. The subjects averaged 51 years of age (range: 37-89). Patients were classified into the following ASA categories: ASA II: 48 subjects (12.9%), ASA III: 197 subjects (53.1%), ASA IV: 126 subjects (34.0%). Surgery was performed successfully in 371 patients. Spinal anesthesia was adapted to general anesthesia for 2 (0.5%) subjects. The average operation time was 38.1 minutes (range: 16-74 minutes). O2 saturation was 97.8% on average for all patients. Right shoulder pain was documented in 14.5% of the patients, and a shoulder massage alleviated the discomfort in most subjects. Conclusions: Spinal anesthesia should be the anesthesia of choice dues to its numerous advantages in high-risk patients related to general anesthesia.
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    Pre-operative work-up before bariatric surgery: Should ultrasonography and upper gastrointestinal endoscopy be done routinely?
    (2019) Altintas, Yasemin; Bayrak, Mehmet
    Aim: The objective of this research was to clarify whether routine upper gastrointestinal endoscopy and abdominal ultrasound examination before bariatric surgery affect the surgical plan in our bariatric center. Material and Methods: Bariatric surgery was performed in 320 patients between January 2015 and February 2018 in our bariatric center. The files of 185 patients who underwent upper abdominal ultrasonography and upper endoscopy in the preoperative workup period were assessed retrospectively. Collected data; age, gender, BMI before operation, sonographic findings, endoscopic findings, and subsequent follow-up plan. The patients were seperated into four groups regarding sonographic and upper endoscopy findings. Results: The mean age of the participants was 41.01, 65 (35.1%) were female and 120 (63.9%) were male. The mean BMI was 42.2 kg/m2 . Ultrasound was found normal in 75 participants (40.5%) and one or multipl abnormal findings were detected in 110 patients (59.5%). The procedure was delayed or canceled for patients (2.1%) according to the sonographic findings which required workup and treatment before surgery. Normal endoscopy without findings appeared in 47 participants (25.4%) while one or more abnormal findings was appeared in 138 patients (74.6%). Patients who had serious esophagitis, gastroesophageal reflux disease, grade D esophagitis or wide hiatus hernias were treated on regime change and proton pump inhibitor drugs but these circumstances were contemplated to be an evaluation for gastric bypass and a inappropriate for sleeve gastrectomy. Conclusions: Ultrasound findings affected the offered surgical timing in 3 (2.1%) of 185 patients reviewed and should be reserved for symptomatic patients only. Depending on the abnormal abnormalities in the gastroscopy, the procedure was canceled, altered or deferred at 48.4%. We suggest that endoscopy should be performed routinely in light of these results.
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    Prognostic factors affecting survival in stage 3 colorectal cancers
    (2019) Bayrak, Mehmet; Altintas, Yasemin
    Keywords: key. In this study, we consider the clinical and pathologic factors that affect survival in stage 3 colorectal cancer.br /Material and Methods: We analyzed patients who underwent radical surgery for stage 3 colorectal cancer between January 2012 and March 2018 at the Ortadogu Hospital, Adana, Turkey. The age and gender of the patients, the length of the colectomy specimen, the location and size of the tumors, TNM stage and the number of retrieved lymph nodes were evaluated. The lymphovascular and perineural invasion was examined.br /Results: In the group, 73 were men and 52 were women, ranging in age from 22 to 88 years (mean age, 58 years). There were 29 cases of right colon cancer, 30 cases of left colon cancer and 66 cases of rectal cancer. Lymphovascular and perineural invasion were present in 78 patients (62.4%) and 30 patients (24.0%) respectively. Twenty-one patients received preoperative adjuvant therapy. No significant difference was found between tumor size and invasion and mortality. However, we found a statistically significant difference between age, metastatic lymph node, total lymph node number, and mortality. According to the Log-Rank test, we found that lymphovascular and perineural invasion were significant for survival.br /Conclusions: The number of metastatic lymph nodes had a poor prognosis on the survival, we found that the high total number of retrieved lymph nodes affected prognosis in a good way. We conducted that perineural and lymphovascular invasion is a factor affecting the survival adversely in stage 3 colorectal cancers.br / Retrieval Of Pericolorectal Lymph Nodes, Stage 3 Colorectal Carcinoma, T-Classification, N-Classification, Neoadjuvant Therapy, Understaging.
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    Unplanned readmission and outpatient workup 90-days after cholecystectomy in adults
    (2019) Altintas, Yasemin; Bayrak, Mehmet
    Aim: The majority of patients with persistent postoperative pain are caused by a change in the indications and timing of cholecystectomy due to a lack of evidence and different views among surgeons. We purposed to identify the relation of preoperative patients’ characteristics and postoperative readmission after laparascopic cholecystectomy Material and Methods: Between June 2015 and June 2018, 710 consecutive patients who were admitted for laparoscopic cholecystectomy were included in the study. Based on database the following factors were analysed: gender, age, American Society of Anesthesiologists classification, body mass index, Visual Analog Scale (VAS)-scale prior to operation (intensity of abdominal pain, scored on a visual score of 0–10), duration of symptoms and existence of abdominal pain. Results: There were 472 men (66.5%) and 238 women (33.5%). The median age was 51.0 (range 18-79) years. Indications for laparoscopic cholecystectomy were as follows: choleystolithiasis 452 (63.7%), acute cholecystitis 140 (19.8%), chronic cholecystitis 105 (14.7%) and sludge 13 (1.8%). The following preoperative incidence of dispeptic and colonic symptoms were as: abdominal pain n=137 (19.3%), nousea n=119 (16.8%), vomiting n=86 (12.1%), heartburn n=79 (11.1%), early satiety 80 (11.3%), bloating n=151 (21.3%), food intolerance n=62 (8.7%), constipation n=73 (10.3%), diarrhea 60 (8.5%), back pain n=307 (43.2%). Readmission was present in 108 (15.2%) of the 710 patients due to added examination for persistent abdominal pain after laparascopic cholecystectomy. The cause of readmission were gallstone related (n=16, 2.2%), surgery related (n=7, 1.0%), other diagnosis (n=30, 12.0%), nonspesific abdominal pain (n=55, 7.7%) respectively. Number of readmission were as follows: 1 (n=59, 54.6%), 2 (n=39, 36.1%), 3 (n=10, 9.3%). Conclusions: The main causes of readmission were associated with gastrointestinal symptoms other than gallstone or surgery related. Before accepting patients for cholecystectomy, doctors should discover and help realistic expectations.