Introduction: Secondary lymphedema is one of the major important long-term complications of breast cancer treatment. The aim of this study is to determine patient-and treatment-related risk factors of lymphedema in breast cancer patients. Patients and Methods: Patients, who had been operated on for primary breast cancer at Akdeniz University Hospital and followed regularly between August 1984 and December 2009 were included in the study. In order to evaluate the arm swelling objectively, measurements were performed with a flexible tape measure for both arms, and limb volume was calculated using a truncated cone volume formula. Participants, whose volume difference between the two arms was ‡5%, were considered as lymphedema-positive patients. The SPSS program (SPSS inc. Chicago, IL) was used for statistical analysis. Results: The mean age of 455 patients was 50.6 years and the median follow-up time was 53 months. Lymphedema was found in 124 (27%) patients. Most of the patients with a history of postoperative wound infection (52%) and lymphangitis (57%) had lymphedema ( p = 0.003 and p = 0.002, respectively). Addition of radiation therapy increased lymphedema risk 1.83 times ( p = 0.007). The mean duration of the axillary drainage and number of the removed lymph nodes were 7.8 days and 19, respectively. The rate of lymphedema in patients with early stage breast cancer was less than patients with advanced breast cancer (24% and 35.3%, respectively, p = 0.018). Most of the patients (92%) with lymphedema had a high body mass index (BMI ‡25 kg/m 2 ), and obesity was another important factor for lymphedema ( p < 0.001). Conclusions:The most important treatment and patient-related risk factors for breast cancer-related lymphedema were obesity ( ‡ 25 kg/m 2 ), axillary lymph node dissection, postoperative radiotherapy, wound infection, history of lymphangitis, and duration of axillary drainage. Elimination or prevention of these risk factors may reduce the incidence of lymphedema.

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Topical or intravitreal administration of tacrolimus seems to be systemically safe whereas parenteral administration can cause some systemic haematological changes such as dose-dependent decreased serum cholesterol concentrations. Dose reduction may prevent such adverse effects.

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Objective  Patients undergoing laparoscopic procedures may experience postoperative pain. We evaluated the effectiveness of intraperitoneal local anaesthetic instillation after laparoscopic gynaecological procedures. Design  Randomized, double‐blinded, placebo‐controlled trial. Methods  Patients were randomly assigned to one of three groups of 20 patients each. Those in group A received ropivacaine, 20 ml 0.75%, and those in group B received bupivacaine, 20 ml 0.5% intraperitoneally. Those in group C (the control group) received 20 ml 0.9% saline. Pain was assessed, using a visual analogue scale (VAS) and a verbal rating scale (VRS), at 30 min, 60 min, 2 h and 4 h after surgery. Total analgesic consumption and the time to first need for analgesia were also noted. Results  VAS and VRS pain scores were significantly lower in the ropivacaine and bupivacaine groups compared with the placebo group. Patients in group A (ropivacaine) experienced less pain than those in group B (bupivacaine) for all measurements. The time to first need for analgesia was significantly later for the ropivacaine and bupivacaine groups compared with the placebo group. The total analgesic consumption was also significantly lower in those groups than in the placebo group. Conclusion  The results indicated that both ropivacaine and bupivacaine were effective at preventing pain and the need for postoperative analgesic when intraperitoneally instilled. However, ropivacaine is the better choice because of its higher efficacy.