Appendectomies constitute 55 % of all urgent operations. Appendiceal neoplasms are found in 0.5-1.1 % of all appendectomy specimens, of which 0.2-0.4 % are benign and 0.5-0.8% are malignant tumors. Carcinoid tumors, the most common of appendiceal tumors, are seen in 0.5 %, mucoceles in 0.2-0.5 % and adenocarcinomas 0.03- 0.1 % of all neoplasms. Although neoplastic lesions of the appendix vermiformis are found in about 1% of such cases, unexpected histopathologic anomalies are increased to about 5% due to unexamined or missed lesions. The majority of appendix tumors are incidentally found in appendiceal specimens and preoperative diagnosis is rare. Simple appendectomy usually suffices in the management of these appendix neoplasms, but right hemicolectomy is sometimes required. After reviewing the published literature, we discuss epidemiology, classification, histopathological features and treatment of appendiceal neoplasms.
To report the clinical and pathological features and surgical treatment outcomes of patients with granulomatous mastitis.Case series.Ankara Oncology Training and Research Hospital, between 1999-2003.Data of 16 patients with granulomatous mastitis treated surgically by total excision with disease-free margins were reviewed. Patients given additional medical therapy or treated with mastectomy because of the size and extent of the disease were excluded.The mean age of patients at the time of diagnosis was 31.8 (range: 22-45 years). All patients were diagnosed from the pathological tissue specimens obtained by surgery. Clinical and radiological examinations suggested breast carcinoma in 82.1% patients. Except one patient who developed a fistula from the incision which was treated again with surgery, no other complications were noted, including recurrence of disease during a median follow-up period of 12.8 months (range: 4-30 months).Although granulomatous mastitis is a rare benign breast disease, it usually mimics breast carcinoma both clinically and radiologically, making the diagnosis difficult and challenging. As long as good cosmetic results can be achieved, surgical excision is quick, safe and effective treatment method for idiopathic granulomatous mastitis.
Introduction: The excellent results of harmonic scalpel (HS) for closure of blood vessels encouraged surgeons to use these instruments for cystic ducts. The use of HS on tissues other than blood vessels was started with little data about its efficacy or safety. Therefore, this study was designed to verify the safety and efficacy of HS for achieving safe closure of the cystic ducts after laparoscopic cholecystectomy. Materials and Methods: Sixty patients with symptomatic gallstone disease were enrolled in this prospective case control study. The patients were operated with laparoscopic technic and divided into two groups (n = 30). After the dissection of Calot's triangle, proximal cystic ducts on common bile ducts were sealed with single surgical clips (SC) in both groups. In the first group, distal of the cystic ducts was sealed with single SC and the gallbladders were removed with SC. In the second group, distal of the cystic ducts was sealed with HS and the gallbladders were removed as sealed cystic ducts with HS. Twenty-gauge catheters were inserted into the fundus of gallbladders in vitro and connected to the arterial line transducer set. A gradually increasing pressure was applied through a sphygmomanometer. The bursting pressures of the gallbladders were measured, and differences between HS and single SC groups were calculated with independent samples t-test. The value of P < 0.05 was accepted as significant. Results: The mean cystic duct bursting pressures in single SC and HS groups were 332.46 ± 4.62 and 343.06 ±4.28 mmHg, respectively. The mean values between the groups were found significant and indicated the superior results of HS. Conclusions: HS sealer could be an alternative method for cystic duct closure, especially for avoiding the clip displacement and migration of the clip. Results of this study indicated that HS sealer was as reliable as single SC and it could be accepted as a standard closure technic.
