- A young woman with breast cancer is considered to be a woman younger than 40. According to the literature, breast cancer in the population of young women usually is of a higher histologic grade, ...unfavorable hormonal status, and overall higher mortality rate when compared with breast cancer occurring in older population. We compared pathologic and immunohistochemical features of breast carcinoma in women under 40 years of age with the respective features in women over 60 years of age. The following parameters were observed in these two groups: tumor size, lymph node status, histologic grade, hormonal receptor status, Ki-67 prognostic index, Her2/neu status, and histologic type of the tumor. Early onset breast carcinoma was found to have a higher frequency of tumor grade 3 (29%
. 17%) and estrogen receptor negativity (45%
. 23%). In the group of young women, breast carcinoma was mostly multicentric (23%
. 5%), triple-negative (32%
. 10%), and was found to have higher proliferation index Ki-67 (25%
. 10%). Our results confirmed differences between the young and older groups of patients. In the group of young women, we found predominantly unfavorable prognostic parameters of the disease.
Measuring the quality of life (QoL) of women with breast cancer is an important aspect of measuring treatment success. In Croatia, no QoL studies have been carried out with a focus on patients after ...mastectomy. The aim of this study was to examine QoL 1 month and 1 year after mastectomy.
This cross-sectional single-center study of quality of life was conducted in 101 patients, 50 of whom had undergone a mastectomy 1 month prior, and 51 of whom had undergone a mastectomy 1 year prior. The study was conducted from July 2015 to June 2016. The questionnaires used in the study were developed by the European Organisation for Research and Treatment of Cancer (EORTC). The questionnaire EORTC QLQ-C30 assesses the QoL of cancer patients, and the questionnaire EORTC QLQ-BR23 is a disease-specific breast cancer module. A chi square test, Fisher's exact test, Kolmogorov-Smirnov test, Student's t-test and Mann-Whitney U test were performed in the statistical analysis using the statistical program SPSS (Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc.).
Patients who had undergone a mastectomy a year earlier placed a higher value on their health state than did those who had undergone a mastectomy a month earlier. The most affected values of functional status on the EORTC QLQ-C30 scale were emotional functioning (37.5 95% CI 33.3-61.6) and sexual functioning (16.67 95% CI 0-33.3) 1 month and 1 year after mastectomy, respectively. The most affected symptoms on the EORTC QLQ-C30 scale were hair loss 66.67 95% CI 33.3-100) and fatigue 33.33 95% CI 24-44) 1 month and 1 year after mastectomy, respectively.
In our study, both functional and symptom scales were more affected in women 1 month after mastectomy. QoL was considerably improved in women 1 year after the surgery compared to 1 month after mastectomy. The results of this study could contribute to the public awareness of the QoL of breast cancer patients.
To show our experience in treatment of patients with penetrating chest injuries sustained during the Homeland War in Croatia
It was a retrospective study based on the records of the Department of ...Surgery of the University Hospital of Osijek (Croatia). All patients surgically treated during the wartime period (1991.-1995.) were analysed with respect to death rate, causes of injuries, frequency of injuries of thoracic organs and frequency of combined injuries of thorax and abdomen. Most of our patients were treated with thoracotomy as opposed to the common protocol (thoracostomy) applied in usual treatments.
The study includes 157 patients with penetrating chest wounds, 111 (70.7%) of which were from metal fragments of bursting artillery, 37 (23.6%) of the wounded were exposed to gunshot bullets, and 9 (5.7%) had stab injuries. Lung injuries had 134 (85.4%) patients, and 15 (9.6%) had injuries of the heart. Chest injuries combined with injuries of abdominal organs happened in 30 (19%) cases. The abdominal organs in question were the liver, spleen, stomach, and colon, in eight (26.6%), seven (23.3%), four (13.3%), and three (10.0%) cases, respectively. Thoracotomy was performed in 144 (91.7%) cases, 13 (8.3%) of the patients underwent thoracostomy, and 134 (85.3%) patients stayed alive.
It points out that, in our case due to organizational problems, aggressive surgical procedure of patients with penetrating chest and multiple injuries sustained in war was the good choice.
Aim Preoperative comorbidity may significantly influence theconduction of anesthesia and patients’ outcome. The aim of thisstudy was to compare a number of anesthetic interventions and theuse of ...non-anesthetic drugs in hypertensive and non-hypertensivepatients during general anesthesia for moderately invasive surgery.Methods A total number of 88 elective hypertensive (n = 44) andnon-hypertensive (n = 44) breast cancer patients were enrolled inthe prospective study. Midazolam and infusion of normal salinewere given before anesthesia. Etomidate, rocuronium, fentanyl,and sevoflurane up to the 1 MAC were used for the maintenanceof anesthesia. Mean arterial pressure (MAP), pulse, core temperatureand intraoperative use of all drugs were recorded. MAPwas maintained by sevoflurane and infusion replacement. Urapidiland ethylephrine were given if MAP differed > or <30% ofbaseline, and atropine if heart rate <50 beats min-1. A statisticalanalysis was made using chi-square and Mann-Whitney tests.Results The highest MAP was 133±19.3 in hypertensive and 122±16.5mmHg in the non-hypertensive patients (p<0.05). Hypertensive patientsrequired more anesthetic balancing (42 vs. 23 interventions),more urapidil for intraoperative hypertension (13/44 vs. 2/44, p<0.05) and had more intraoperative hypotensive episodes (23 vs. 12;ns, p> 0.05). Intraoperative bradycardia (11/44 vs.7/44) and atropineapplications (16 vs. 9, ns, p> 0.05) were similar in two groups.Conclusion Hypertensive patients required more anesthetic interventionsand had higher consumption of vasoactive drugs duringanesthesia for breast cancer surgery, suggesting their hemodynamicinstability possibly related to the hypertension.
Proximal femoral fractures, especially in elderly persons with osteoporosis, present a challenge for the traumatologist. While the dynamic hip screw (DHS) became the implant of choice for the ...treatment of stable fractures, the ideal implant for the treatment of unstable fractures remains an issue. In our experience, Proximal Femoral Nail Antirotation (PFNA) is an excellent device for osteosynthesis as it can be easily inserted, it provides angular and rotational stability and allows early weight bearing on the affected limb. Between February 2007 and August 2009, 76 patients underwent the PFNA fixation for proximal femoral fractures (15 men and 61 women). Forty seven fractures were pertrochanteric, 14 subtrochanteric, 2 pathological and 5 ipsilateral trochanteric and diaphyseal fractures whereas in 8 cases the PFNA was used in reosteosynthesis. The mean age of patients was 73.4 years (range 22-91 years). The fractures were reduced on a traction table and the implant was inserted using minimally invasive technique. Four patients developed superficial postoperative wound infection. No cases of implant breakage have been recorded; there was one cut-out; delayed union was noted in three patients. The majority of patients regained their pre-injury mobility status. The PFNA is an excellent implant for stabilisation of both trochanteric and complex combination fractures as well as an exceptional device for reosteosynthesis. It is easily inserted with few intra- and postoperative complications and allows early weight bearing on the affected limb as well as quicker rehabilitation of patients.
Pleomorphic adenomas, also known as benign mixed tumors, are the most common tumors of glandular origin in the head and neck and although they are generally benign they can undergo malignant ...transformation. Primary pleomorphic adenomas of the lung are extremely rare tumors with less than 40 cases reported in the literature by now. This is the first case in the literature describing overlapping with a traumatic event and also one of the rare cases describing primary adenoma of the lung reaching this impressive size.
We report a rare case of a giant primary pleomorphic adenoma of the lung presenting as a post-traumatic pulmonary hematoma. A 38-year-old Caucasian male patient came to the Urgent Trauma Center after being hit in the chest by a bull and, after a number of tests, was diagnosed with primary pleomorphic adenoma of the lung. Operative treatment was performed and the surgical excision was successfully done.
Our conclusion is that the surgical excision is the main treatment for pleomorphic adenoma of the lungs and we recommend lifelong follow-up and regular check-ups. Furthermore, we consider our case an interesting one due to its concurrence with the chest trauma and the dilemma about the optimal approach considering the entity could have been a large interlobular hematoma.
Diagnostic value of available tumor markers, such as cancer antigen CA 15-3 and carcinoembryonic antigen (CEA) in breast cancer is limited. There is an ongoing search for additional, potentially ...better diagnostic blood markers with improved clinical utility. The aim of this study is to evaluate performance of the approach based on routine blood tests accompanied by a statistical learning tool to the diagnosis of breast cancer.
Blood was collected from total of 104 subjects which were divided into two groups: breast cancer patients and a control group that consisted of asymptomatic volunteers and patients who had benign breast lesions at the time of blood collection. Random forest statistical learning method and the external method validation have been applied to evaluate diagnostic performance of 31 routine blood tests.
The applied statistical learning approach assigned the highest diagnostic importance to the anemia panel among all analyzed blood tests that also included CA 15-3. External validation has shown utility of selected statistical approach – we were able to select tests that provide a diagnostic accuracy comparable to some diagnostic tools described in literature and based on more demanding laboratory techniques, such as gene expression microarrays.
Inclusion of tests for anemia significantly improves diagnostic accuracy for the breast cancer in comparison to the diagnostic accuracy of the CA 15-3 alone. Application of the random forests also enables the reduction of number of laboratory tests needed for the establishment of diagnosis. Differences in relevant test values between the cancer and control group are small but application of multiparametric statistical learning ensured diagnostic accuracy of 72.0% associated by a sensitivity of 64.7% and specificity of 84.9%.
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