Background: Efforts have been made to improve minimally invasive breast surgery techniques, resulting in less tissue damage and much better cosmetic results. We evaluated the therapeutic value of a new scarless operation, endoscopic papillomectomy (EP), in patients with pathologic nipple discharge (PND). Methods: Breast ductoscopy was performed on 126 women with PND. These patients underwent a variety of appropriate ductoscopy-assisted (DA) endosurgical interventions, combined with cytologic examinations. Success was determined by recurrence of PND and by standard radiological examinations. Results: Ductoscopy was successfully performed in 102 patients. Of these 102 patients, 26 had solitary papillomas (SP), 5 had multiple papillomas (MP), 11 had intraductal debris, and 1 had a ductal epithelial surface abnormality with positive cytology. Of the 26 polypoid lesions (cytology negative), 22 were excised endoscopically (endoscopic papillomectomy). Patients with MP underwent DA-microdochectomy. Except in one patient, all discharges disappeared. After a mean ± SD follow-up time of 11.5 ± 5.8 months (range 2–22 months), there were no recurrences of nipple discharge and no radiological results suggestive of malignancy. Thus, the therapeutic efficacy of EP in our study was 95.4% (21/22). Conclusions: Ductoscopy is not only a diagnostic procedure, but is also therapeutic for breast papillomas. EP is a new scarless treatment option for patients with PND.

Since there is an increased risk of malignancy, surgical excision is recommended for multiple, larger papillomas and for papillomas with atypia and in addition for papillomas where diagnostic tools produce suspicious findings. On the other hand DP is a minimally invasive intervention and can aid in the follow-up of lesions proven to have no atypia.

We believe that, as the technology quickly improves, ductoscopy will become more widely accepted and applied for breast disorders, not only as a diagnostic tool but also as a privileged therapeutic option for certain pathologies.

Laparoscopic splenectomy (LS) is a preferred choice, especially for hematologic diseases. We present the advantages of the use of LigaSure (energy-based equipment that works by applying a precise amount of bipolar energy and pressure to the tissue, achieving a permanent seal) for achieving a precise hemostasis, thus making the LS easier. We have performed LS using LigaSure on 10 patients (4 female, 6 male; mean age, 36 years [range, 16-58]) between December 2002 and August 2003. All patients had ITP. There were no conversion to open surgery. Mean dimensions of spleens were 99 x 49 mm (range, 85 x 36-118 x 60). Intraoperative blood loss was no more than 100 mL in any patients (range, 20-100; mean, 60). The average operative time was 93 minutes (range, 60-155). There were no complications in the postoperative period. The average postoperative stay was 4.3 days (range, 3-7). LS using LigaSure is a safe and time-sparing procedure with almost no complications in this small initial series.

AMAÇPenetran kalp yaralanmaları nadirdir ancak yüksek mortalite gösterir. Yaralanmalarda erken tanı ve hızlı müdahale gereklidir. Penetran kalp yaralanması ile görülen hastaların karakteristikleri ve bir eğitim hastanesinde acil hizmeti veren genel cerrahların bireysel tecrübeleri dahil bu hastalarda sağkalımı etkileyen faktörler irdelendi. GEREÇ VE YÖNTEM 1995-2009 yılları arasında İstanbul Okmeydanı Eğitim veAraştırma Hastanesi Genel Cerrahi Kliniği'nde penetran kalp yaralanması nedeni ile tedavi edilen 23 hasta retrospektif kohort olarak analiz edildi. Hastaneye ulaştığında hayat belirtisi olmayan hastalar çalışma dışında tutuldu. BULGULARHastaların tamamı erkekti. Median yaş 25 yıl olarak saptandı. On beş hastada sol 4 hastada sağ ventriküler yaralanma saptandı, 4 hastada sağ atriyal yaralanma görülürken, 2 hastada karın içi yaralanma da eşlik etmekteydi. Hiçbir hastada koroner vasküler yaralanma saptanmadı. Yirmi üç hasta arasından 10 hasta kaybedildi, bu hastalardan altısının bu tip yaralanmalarda ilk tecrübesini yaşayan cerrahlar tarafından müdahale gördüğü ön plana çıkmıştır. Ayrıca kardiyak tamponad sağ kalımda anlamlı fark oluşturmamıştır. SONUÇKurumumuza görülen penetran kardiyak yaralanma özel-likleri literatür ile uyumludur. Bu tip yaralanma oranının nispeten az görüldüğü göz önüne alındığında travma cerrahisi eğitimi almış cerrahların ve kapsamlı travma referans merkezlerinin gerekliliği kaçınılmaz olarak gereklidir.Anahtar Sözcükler: Tecrübe; genel cerrah; penetran kalp yaralanması.