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Surgical treatment of irradiation induced sarcomas after treatment for breast cancer: our experience of 4 cases
No full textNa Odjelu za plastičnu kirurgiju Klinike za kirurgiju KB »Dubrava« od 1993. do 1999, liječene su 4 bolesnice sa sarkomom induciranim radioterapijski. Sve su bolesnice operirane i zračene zbog karcinoma dojke. Prosječeno vrijeme nastanka sarkoma od radioterapije bilo je 4,75 godina. Bolesnice su liječene širokom ekscizijom i rekonstrukcijom lokalnim režnjevima. Patohistološki nalaz pokazao je u jedne bolesnice fibrosarkom, kod dvije bolesnice limfangiosarkom, a kod jedne osteosarkom. Dvije bolesnice su umrle unutar 2 godine. Radijacijski inducirani sarkomi rezistentni su na liječenje, literaturnim pregledom ne nalaze se velika istraživanja koja bi uputila na optimalno liječenje. Gotovo u svim slučajevima postradijacijskih sarkoma dolazi do brze progresije bolesti.In the Department of Plastic Surgery of »Dubrava« University Hospital from 1993 to 1999 four patients were treated for radiation induced sarcoma. All of the patients were formerly operated for breast cancer and irradiated postoperatively. The mean time span between radiotherapy and development of sarcoma was 4.75 years. Four patients were treated with wide excision and immediate reconstruction with local flaps. One of the patients had fibrosarcoma, two patients had Iymphangiosarcoma, and one patient had osteosarcoma. Two patients died within two years. Radiation induced sarcomas are therapy resistant, and the review of literature did not show large controlled investigations which would offer the most optimal treatment. Most frequently a rapid progression of the disease is seen
Depressive Disorder as Possible Risk Factor of Osteoporosis
No full textHipothalamo-pituitary-adrenal (HPA) axis is a very complicated control system playing an important role in stress reaction, where glucocorticoids suppress the autonomic (vegetative), endocrine, immunologic and psychic responses to stressful stimuli.
We described the marked clinical, physiological, and biochemical connection between osteoporosis and major depressive disorder (MDD). Both conditions are associated with a hyperactive HPA axis and LC/NE system, and hence with increased CRH, cortisol, and catecholamine secretion. There are numerous states or diseases associated with osteoporosis and we were looking for a hypercorticism value as a one of these. Some recent studies demonstrated that earlier history of MDD was associated with marked osteoporosis. In MDD there are two well-documented biochemical abnormalities: hypercortisolism and its resistance to dexamethasone suppression. The present study included 31 MDD patients (19 males and 12 females, mean age 37 1.3, age range 29–41 years), and 17 healthy male volunteers (mean age 39 1.6, age range 34–45 years). In each of our patients
24-hour urinary free cortisol, serum cortisol level at 8 a.m. and 5 p.m., cortisol in dexamethasone suppression test and bone mineral density were measured. We have, therefore, analyzed a group of young men and women with normal menstrual cycles,
who were without signs of osteoporosis in the beginning, and who received anti-depressive therapy for many years. Analysis showed that increased levels of cortisol and the occurrence of osteoporosis, that developed as the result of elevated cortisol level. For our workshop we used nonparametric rang-correlation with Spearman’s ro = –0.805, with statistic significant at the 0.01 level (2-tailed). Patients under long-term history of depression could develop a very stronger type of osteoporosis i.e. it is before known that the patients with untreated Cushing syndrome developed hard osteoporosis
Mogući utjecaji rata u Hrvatskoj (1990.-1995.) na epidemiologiju raka štitne žlijezde
No full textA Thyroid Cancer Registry containing data of patients treated at our department during a 20-year period (1980-1999) has been established. The aim of the study was to analyze the possible effects of the 1990-1995 war in Croatia on the prevalence, type, and age and sex distribution of thyroid carcinoma. Three different 2-year periods were analyzed: distant prewar (1980-1981), immediate prewar (1989-1990) and postwar (1998-1999) period. There was no statistically significant difference in age at diagnosis and sex ratio among the three study periods. The incidence of follicular cancer was at the upper limit for countries with normal iodine uptake when the 20-year period was analyzed, however, in the 1980-1981 period follicular cancer accounted for 34.9%, and in 1998-99 for only 2.8% of all cases. Papillary cancer was diagnosed in less advanced stages than others. Five-year survival for papillary, follicular and anaplastic cancer was 100%, 100% and 0%, respectively. Analysis of the 2-year periods for all cancer types except anaplastic cancer showed the mean age at onset to be on a decrease. In the 1998-1999 period, papillary cancer was diagnosed in a more advanced stage. The number of follicular cancer cases decreased from 22 in 1980-1981 to 3 in 19891990 and 2 in 1998-1999. Analysis of the epidemiology of thyroid cancer in the pre- and post-Chernobyl period did not reveal any increase in the number of papillary cancer in younger patients. It was concluded that in the postwar period, patients presented in more advanced stages of the disease. However, the effects of war on the epidemiology of thyroid carcinoma and other malignant tumors should be further investigated.Na našoj Klinici uspostavljeni Registar raka štitne žlijezde sadrži podatke o svim bolesnicima obrađenim u Klinici u 20godišnjem razdoblju (1980.-1999.). Cilj ovoga istraživanja bio je utvrditi moguće učinke rata u Hrvatskoj na učestalost, histološki tip te spolnu i dobnu raspodjelu bolesnika sa zloćudnim tumorom štitne žlijezde. Analizom su obuhvaćena 3 dvogodišnja razdoblja uključujući vrijeme znatno prije rata (1980.-1981.), neposredno prije rata (1989.-1990.) i nakon rata(1998.-1999.). Nije utvrđena statistički značajna razlika u starosti i spolnoj raspodjeli tumora između tri navedena razdoblja. Učestalost folikularnog raka bila je na gornjoj granici učestalosti za zemlje bez gušavosti, s tim da je u razdoblju 1980.-1981. bilo ukupno 34,9%, a u razdoblju 1998.-1999. samo 2,8% folikularnog karcinoma. Petogodišnje preživljenje bilo je 100%, 100% odnosno 0% za papilarni, folikularni i anaplastični rak. U uspoređivanim razdobljima prosječna starost bolesnika se snižavala, ali se rak dijagnosticirao u sve uznapredovalijem stadiju. Analiza populacije prije i nakon Černobila nije pokazala povećan broj mladih bolesnika s papilarnim karcinomom. Na temelju rezultata ovoga istraživanja zaključeno je da nije bilo povećanja učestalosti karcinoma štitnjače u poratnom razdoblju, međutim, bolesnici su se javljali s uznapredovalijim stadijima tumora. Ovaj i moguće druge učinke rata na karcinom štitnjače, kao i na druge zloćudne tumore, valja dalje istraživati
The Value of Ascitic Fluid Polymorphonuclear Cell Count Determination During Therapy of Spontaneous Bacterial Peritonitis in Patients with Liver Cirrhosis
No full textBackground/Aims: Spontaneous bacterial peritonitis is one of the most common complications attending the onset of ascites in patients with liver cirrhosis. The aim of this study was to demonstrate whether it is possible, on the basis of ascitic fluid polymorphonuclear cell count in patients with liver cirrhosis and spontaneous bacterial peritonitis, to determine the optimal duration of cefotaxime therapy, as the most frequently applied empirical therapy, and possibly anticipate the disease recurrence.
Methodology: In 16 patients with alcoholic liver cirrhosis and confirmed diagnosis of spontaneous bacterial peritonitis, cefotaxime therapy was administered 2g t.i.d. during 5 days. Before the therapy, at 48 hours, 5 days and 15-20 days after the cefotaxime therapy was started, in all patients with spontaneous bacterial peritonitis diagnostic abdominal paracentesis was performed, each time determining the ascitic fluid polymorphonuclear cell count together with microbiological analysis.
Results: In the course of the "primary" spontaneous bacterial peritonitis attack, 3 patients died (18.8%). In 4 patients the recurrence of spontaneous bacterial peritonitis was observed within 15-20 days after therapy was discontinued. Two patients died during the therapy of spontaneous bacterial peritonitis recurrence. After 48 hours of therapy, 11 patients with the "primary" spontaneous bacterial peritonitis attack were without any symptoms (68.8%). Out these 11, 10 patients (62.5%) had the ascitic fluid polymorphonuclear cell count lower than 250/mm3. After 5 days of therapy, 12 patients (75%) were free of symptoms, and the number of ascitic fluid polymorphonuclear cell count 250/mm3, 48 hours after the the therapy was started.
Conclusions: By monitoring the ascitic fluid PMN cell count it seems to be possible to determine efficacy and optimal duration of cefotaxime therapy in patients with spontaneous bacterial peritonitis when it is of most importance that the number of asctic fluid PMN cell count should decrease below 250/mm3 during the therapy
Laser biomodulation: application of the gallium - arsenide laser in cell growth modulation and in the treatment of ulcus cruris
No full textThe aim of this study was to test the hypothesis that exposure to low-power laser energy can modulate cell growth and differentiation under certain physiological conditions. Specifically, this hypothesis predicts that in conditions of rapid cycling (e.g. in vitro cell proliferation and in vivo wound healing in mice), laser treatment will have little or no stimulating effect on the rate of cell proliferation and might even inhibit cell growth. However, in conditions of slow cycling (e.g. healing of ulcus cruris) laser treatment will stimulate cell proliferation. To test the hypothesis, we evaluated the effect of exposure to a pulsed GaAs semi-conductor laser (50 W peak power, 904 nm wavelength at energy density of 1.05 J/cm®) on the proliferation of L.929 fibroblasts cell cultures, the healing of murine skin wounds and on the healing of human leg ulcers. Lasing did not stimulate the growth of cultured fibroblasts, nor the healing of skin wounds in mice. It did, however, promote healing of skin ulcers in 34 out of 40 patients evaluated. These data support the principle of cellular modulation by laser treatment and indicate that such biomodulation may have a therapeutic application in the treatment of ulcus cruris
Celiac artery and superior mesenteric artery blood flow in patients with chronic pancreatitis : ultrasonic duplex-doppler analysis
No full textEven though a considerable amount of information about the pathogenesis of chronic pancreatitis has been accumulated, our present knowledge, particularly about possible alterations in arterial circulation, is still incomplete. This study was intended to evaluate the celiac and superior mesenteric artery blood flow in patients with chronic pancreatitis. The study included 15 patients with proven chronic pancreatitis and 15 healthy controls. All patients underwent ultrasonic echo-duplex evaluation (Hitachi EUB 565). The hemodynamic parameters evaluated included peak systolic flow velocity, ratio between end-diastolic and peak systolic flow velocity, resistance index and pulsatility index. In patients with chronic pancreatitis, peak systolic flow velocity and ratio between end-diastolic and peak systolic flow velocity for both celiac and superior mesenteric artery were significantly higher than those in healthy controls (p<0.001 and p=0.0435 for celiac artery; and p<0.001 and P<0.001 for superior mesenteric artery, respectively). The calculated resistance index and pulsatility index for both celiac and superior mesenteric artery were significantly lower in patients with chronic pancreatitis compared with controls (p<0.0015 and p=0.0376 for celiac artery; and p<0.0073 and p<0.0052 for superior mesenteric artery, respectively). The study demonstrated the blood flow increase and vascular resistance decrease at the level of both celiac artery and superior mesenteric artery in patients with chronic pancreatitis, as assessed by duplex-Doppler ultrasonography