Važnost rekonstrukcijske kirurgije kod bolesnica s rakom dojke

Breast cancer is the most common cancer in women in Croatia. Thanks to modern diagnostics and national program of early detection of breast cancer, tumors today are diagnosed in earlier stage, which has favorable effect on the prognosis of disease, but also on the possibilities of surgical treatment. Surgical treatment of breast cancer is progressing rapidly, from breast conserving surgical procedures to skin sparing mastectomies and primary reconstruction of removed breast which became the standard of modern surgical treatment. Apart from the primary reconstruction, patients are offered the opportunity of secondary reconstruction. In patients with early breast cancer (T1 and T2 stage), skin sparing mastectomy followed with breast reconstruction is a safe method from oncologic viewpoint and from the aspect of patient, it reduces psychological trauma that is associated with removal of the entire breast (feeling of mutilation, depression, decreased sexuality). This method also gives plastic surgeons ability to achieve excellent aesthetic appearance of new breast.Rak dojke najčešći je rak u žena u Hrvatskoj. Zahvaljujući suvremenoj dijagnostici i nacionalnom probiru u mogućnosti smo otkrivati rak dojke u ranijoj fazi. Važnost rane dijagnostike povoljno utječe ne samo na prognozu bolesti, već i na mogućnost odabira optimalnog kirurškog zahvata s kojim i počinje liječenje u žena s rakom dojke. Od kirurških zahvata u obzir dolaze poštedni zahvati na dojci, od mastektomije s poštedom kože i primarnom rekonstrukcijom do sekundarnih rekonstrukcija. U svih bolesnica s T1 i T2 tumorom, mastektomija s poštedom kože i primarnom rekonstrukcijom kirurški je postupak koji nudi jednaku onkološku sigurnost kao i standardna mastektomija, a nakon primarne rekonstrukcije u bolesnica se umanjuje psihološka trauma, koje tim zahvatom ne gube osjećaj ženstvenosti. ženama se također vraća povjerenje u vlastito tijelo, a samim time i odnos prema partneru te drugima u zajednici

Važnost ranog otkrivanja raka dojke u očuvanju psihičkog i tjelesnog integriteta žene

Breast cancer remains a major public health problem in the entire developed world. The first and the biggest reason is an ever increasing number of breast cancer diagnoses and consistently high mortality from this disease. Due to the continuous improvement of standard methods and introduction of new diagnostic tests breast cancer can be detected at an early stage, when a high percentage of cases are likely to be successfully treated and/or cured. One of many different types of surgery is usually the first step in treating breast cancer. Each in their own way affects woman’s quality of life. Efforts should be made to detect breast cancer as early as possible to entirely avoid some of the treatment modalities and thus significantly improve woman’s quality of life in all its aspects.Rak dojke i dalje ostaje velik javnozdravstveni problem u cijelom razvijenom svijetu. Prvi i najveći razlog svakako je sve veći broj oboljelih žena i konstantno visoka smrtnost od ove bolesti. Zahvaljujući stalnom usavršavanju standardnih te uvo|enju novih dijagnostičkih metoda rak dojke moguće je otkriti u najranijoj fazi kada je bolest u visokom postotku uspješno liječiva i/ili izlječiva. Prvi korak u liječenju raka dojke najčešće je jedan od više tipova operativnih zahvata. Svaki od njih na svoj način utječe na kvalitetu života žene. Rak dojke treba nastojati što ranije otkriti kako bi se neki od modaliteta liječenja u cijelosti izbjegli što značajno podiže kvalitetu života žene u svim njegovim aspektima

Važnost rekonstrukcijske kirurgije kod bolesnica s rakom dojke

Breast cancer is the most common cancer in women in Croatia. Thanks to modern diagnostics and national program of early detection of breast cancer, tumors today are diagnosed in earlier stage, which has favorable effect on the prognosis of disease, but also on the possibilities of surgical treatment. Surgical treatment of breast cancer is progressing rapidly, from breast conserving surgical procedures to skin sparing mastectomies and primary reconstruction of removed breast which became the standard of modern surgical treatment. Apart from the primary reconstruction, patients are offered the opportunity of secondary reconstruction. In patients with early breast cancer (T1 and T2 stage), skin sparing mastectomy followed with breast reconstruction is a safe method from oncologic viewpoint and from the aspect of patient, it reduces psychological trauma that is associated with removal of the entire breast (feeling of mutilation, depression, decreased sexuality). This method also gives plastic surgeons ability to achieve excellent aesthetic appearance of new breast.Rak dojke najčešći je rak u žena u Hrvatskoj. Zahvaljujući suvremenoj dijagnostici i nacionalnom probiru u mogućnosti smo otkrivati rak dojke u ranijoj fazi. Važnost rane dijagnostike povoljno utječe ne samo na prognozu bolesti, već i na mogućnost odabira optimalnog kirurškog zahvata s kojim i počinje liječenje u žena s rakom dojke. Od kirurških zahvata u obzir dolaze poštedni zahvati na dojci, od mastektomije s poštedom kože i primarnom rekonstrukcijom do sekundarnih rekonstrukcija. U svih bolesnica s T1 i T2 tumorom, mastektomija s poštedom kože i primarnom rekonstrukcijom kirurški je postupak koji nudi jednaku onkološku sigurnost kao i standardna mastektomija, a nakon primarne rekonstrukcije u bolesnica se umanjuje psihološka trauma, koje tim zahvatom ne gube osjećaj ženstvenosti. ženama se također vraća povjerenje u vlastito tijelo, a samim time i odnos prema partneru te drugima u zajednici

Prikaz slučaja bolesnice s pojavom lokalnog recidiva na prsnom košu pet uzastopnih godina nakon radikalne mastektomije

Breast cancer is most common cancer in women. After surgical treatment and adjuvant therapy, locoregional recurrences do occur in certain number of patients. Herein we report a breast cancer patient who developed isolated chest wall local recurrence 3 years after mastectomy which was reappearing in next fi ve consecutive years. Multimodal treatment which includes surgical excision and adjuvant chemoradiotherapy can achieve a signifi cant degree of palliation when locoregional recurrences are diagnosed. In our case, inclusion of adjuvant treatment did not provide satisfactory local control of disease therefore repetitive surgical excision was the only modality which off ered our patient 7 years of overall survival after fi rst excision of local recurrence.Rak dojke je najčešći rak u žena. Unatoč kirurškom liječenju i adjuvantnoj terapiji, lokalni recidivi se javljaju u određenom broju pacijenata. Prikazan je slučaj bolesnice s pojavama lokalnog recidiva na prsnom košu u razdoblju od pet uzastopnih godina nakon radikalne mastektomije. Koristeći se multimodalnim tretmanom koji uključuje kirurški zahvat i kemoradioterapiju, načelno se postižu dobri rezultati u liječenju lokoregionalnog recidiva. Unatoč danoj terapiji, uzastopne kirurške ekscizije su se pokazale kao jedini modalitet liječenja koji je bolesnici omogućio sedmogodišnje preživljenje nakon pojave prvog lokalnog recidiva

Prikaz slučaja bolesnice s pojavom lokalnog recidiva na prsnom košu pet uzastopnih godina nakon radikalne mastektomije

Breast cancer is most common cancer in women. After surgical treatment and adjuvant therapy, locoregional recurrences do occur in certain number of patients. Herein we report a breast cancer patient who developed isolated chest wall local recurrence 3 years after mastectomy which was reappearing in next fi ve consecutive years. Multimodal treatment which includes surgical excision and adjuvant chemoradiotherapy can achieve a signifi cant degree of palliation when locoregional recurrences are diagnosed. In our case, inclusion of adjuvant treatment did not provide satisfactory local control of disease therefore repetitive surgical excision was the only modality which off ered our patient 7 years of overall survival after fi rst excision of local recurrence.Rak dojke je najčešći rak u žena. Unatoč kirurškom liječenju i adjuvantnoj terapiji, lokalni recidivi se javljaju u određenom broju pacijenata. Prikazan je slučaj bolesnice s pojavama lokalnog recidiva na prsnom košu u razdoblju od pet uzastopnih godina nakon radikalne mastektomije. Koristeći se multimodalnim tretmanom koji uključuje kirurški zahvat i kemoradioterapiju, načelno se postižu dobri rezultati u liječenju lokoregionalnog recidiva. Unatoč danoj terapiji, uzastopne kirurške ekscizije su se pokazale kao jedini modalitet liječenja koji je bolesnici omogućio sedmogodišnje preživljenje nakon pojave prvog lokalnog recidiva

Biomehanička svojstva kostiju štakora tretiranih sevelamerom

Sevelamer hydrochloride is used for ten years in patients on dialysis as a phosphate binder. We have previously shown that oral application of sevelamer prevents the bone loss and increases the bone volume in ovariectomized rats. In this study we further analysed the biomechanical properties of bones from rats treated with sevelamer utilizing a threepoint bending test to determine the mechanical properties of the cortical bone of the mid-shaft femur, while the indentation test was used to determine the mechanical properties of cancellous bone in the marrow cavity of the distal femoral metaphysis. Parameters analyzed included: maximum load (F(u)), stiffness (S), energy absorbed (W), toughness (T) and ultimate strength (sigma). The intrinsic properties, stress, elastic modulus and toughness were determined from measured maximum load, strains, stiffness, energy absorbed, outer and inner diameters, and calculated bone cross-sectional moment of inertia. Sevelamer was given to rats for 25 weeks with a content of 3% of sevelamer in a standard diet, starting immediately following ovariectomy (OVX). Animals were divided to the following groups: (1) Sham; (2) Sham + sevelamer 3%; (3) OVX; (4) OVX + sevelamer 3%. Our results showed that sevelamer particularly influenced the rat trabecular bone by increasing the maximum load for 26.2%, energy absorbed for 24.2% and the ultimate strength for 26.2% in sham animals treated with sevelamer 3%, as compared to sham rats. Sevelamer 3% in OVX rats also increased the maximum load for 71.4%, stiffness for 70.7%, energy absorbed for 55.9% and the ultimate strength for 71.3% as compared to OVX controls. In the three bending test sevelamer had a very little effect on preventing loss of bone strenght in the cortical bone. These results collectively suggest that sevelamer improves bone biomechanical properties, mainly affecting trabecular bone quality in both normal and ovariectomized rats.Sevelamer hidroklorid koristi se već 10 godina u pacijenata na dijalizi kao fosfatni vezač. Naša prethodna istraživanja pokazala su da oralna primjena sevelamera sprečava gubitak koštane mase i povećava koštani volumen u ovarijektomiranih štakora(1). U ovom ispitivanju analizirali smo biomehaničke karakteristike kostiju štakora tretiranih sevelamerom pomoću »threepoint bending» testa kako bi se odredila biomehanička svojstva kortikalne kosti središnjeg dijela femura, dok se za mehaničke karakteristike trabekularne kosti distalne femoralne metafize koristio test indentacije. Analizirani parametru su bili: maksimalno opterećenje (F(u)), rigidnost (S), apsorbirana energija (W), čvrstoća (T) i maksimalna jakost (sigma). Endogene karakteristike, stres, elastični modul i čvrstoća kostiju dobivene su pomoću izmjerenog maksimalnog opterećenja, rigidnosti, apsorbirane energije, vanjskih i unutarnjih dijametara kosti te izračunatog inercijskog momenta koštanog presjeka. Štakori su dobivali sevelamer 25 tjedana sa standardnom prehranom, počevši odmah nakon ovarijektomije (OVX). Životinje su podijeljene u slijedeće grupe : (1) Sham (lažno operirane životinje); (2) Sham + sevelamer 3%; (3) OVX; (4) OVX + sevelamer 3%. Naši rezultati su pokazali da je sevelamer osobito utjecao na trabekularnu kost povećavajući maksimalno opterećenje za 26,2%, apsorbiranu energiju za 24,2% i maksimalnu jakost za 26,2% u životinja koje su dobivale 3% sevelamera u usporedbi sa životinjama koje su dobivale standardnu prehranu. Sevelamer 3% u ovarijektomiranim štakorima je također povećao maksimalno opterećenje za 71,4%, rigidnost za 70,7%, apsorbiranu energiju za 55,9% i maksimalnu jakost za 71,3% u usporedbi sa OVX kontrolama. U »threepoint bending« testu sevelamer je imao mali utjecaj na sprečavanje gubitka jakosti kortikalne kosti. Ovi rezultati pokazuju da sevelamer poboljšava biomehanička svojstva kosti, prvenstveno djelujući na trabekularnu kost u normalnih i ovarijektomiranih štakora

Prikaz slučaja rijetkog unutarparenhimnog leiomioma dojke – dijagnostičke i patohistološke značajke

Leiomyomas are one of the rarest neoplasms of the breast. Intraparenchymal leiomyomas can present a diagnostic challenge, as they can resemble other benign, and more importantly, malignant lesions - especially leiomyosarcomas. Here we report a case of a 28-year old female patient with a palpable mass in the right upper quadrant of the right breast and present diagnostic and histopathological features, with special reference to magnetic resonance imaging.Leiomiomi su izrazito rijetki tumori dojke. Unutarparenhimni leiomiomi predstavljaju dijagnostički izazov, jer mogu nalikovati na druge dobroćudne i zloćudne tvorevine, posebice na leiomiosarkom. U radu je prikazan slučaj 28-godišnje žene s opipljivom masom u desnoj gornjoj četvrtini desne dojke. Opisane su dijagnostičke i patohistološke značajke nađenog tumora, s posebnim osvrtom na magnetsku rezonanciju

A sporadic case of myositis ossificans of the forearm presenting clinically as mesenchimal tumor

Cilj: Osificirajući miozitis je benigna, solitarna, samoograničavajuća lezija koja je karakterizirana ekstraskeletnim tvorbama fokalne heterotopične kosti i hrskavice u mekim tkivima. Uglavnom zahvaća mišiće, ligamente i fascije. Osificirajući miozitis pretežno se javlja u mlađih osoba nakon lokalizirane traume u području prednje skupine mišića natkoljenica i ruku. Cilj ovog prikaza slučaja je opisati rijedak slučaj osificirajućeg miozitisa podlaktice koji se prezentirao izbočinom u području podlaktice te slabošću ruke. Klinički znakovi i slikovni prikazi često se mogu poistovjetiti s malignim lezijama, kao što je bio slučaj i kod naše pacijentice. Prikaz slučaja: 48-godišnja žena dolazi zbog tvorbe u distalnom i volarnom dijelu desne podlaktice. U anamnezi navodi da je nekoliko tjedana osjećala slabost podlaktice, ali bez ikakve prethodne akutne ozljede ili traume podlaktice. Preoperativna snimka magnetske rezonancije pokazala je tvorbu nalik malignom fibroznom histiocitomu. Završna dijagnoza postavljena patohistološkim pregledom preparata govorila je u prilog rijetkoj bolesti, osificirajućem miozitisu. Nakon operacije pacijentica je imala parestezije te manje razgibane prste. Nakon šest mjeseci pacijentica je pokazala značajno poboljšanje na fizikalnoj terapiji te su nalazi magnetske rezonancije bili bez osobitosti. Zaključak: Osificirajući miozitis valja uzeti u obzir kao moguću dijagnozu za mekotkivne tvorbe u području podlaktice dokazane slikovnim metodama. S obzirom na rijetku lokaciju lezije, postoperativna patohistološka analiza nužna je za dobivanje točne dijagnoze.Aim: Myositis ossificans is a benign, solitary, self-limiting lesion characterized by extraskeletal formation of focal heterotopic bone and cartilage in soft-tissue. It generally affects the muscles, ligaments, and fascia. Myositis ossificans usually occurs in young adults mostly after localized trauma, with predilection in the anterior muscle groups of the thighs and arms. The aim of this case report was to present a rare case of myositis ossificans in the forearm, which presented as a bump on the forearm and weakness of the hand. The clinical signs and imaging appearance can be easily confused with malignant lesions, as was the case in our patient. Case report: A 48-year old woman was presented with a palpable formation in the distal and volar part of the right forearm. She had suffered from weakness of the forearm for a while, and had no history of acute injury or trauma of the forearm. Preoperative magnetic resonance imaging demonstrated malignant fibrous histiocytoma-like tumor, but final pathohistological examination revealed rare disease, myositis ossificans. Postoperatively, the patient had some minor neurological deficits, such as paresthesia, and less flexible fingers. After six months, the patient showed a major improvement in physical therapy, and the MRI findings were unremarkable. Conclusion: Myositis ossificans should be considered as a possible diagnosis for a soft-tissue mass in the forearm shown on the imaging findings. Due to the rare location of the lesion, the postoperative histopathological examination is necessary for making an ultimate diagnosis

Minimalno invazivno liječenje raka dojke

The development of diagnostic methods and screening leads to early detection of breast cancer, which is why aspirations are moving towards more conservative local treatment methods. New, non invasive and minimally invasive methods, should att ain same local control, with less cosmetic defects, side eff ects and complications compared to standard surgery. Five methods are being researched in clinical trials: cryoablation, radiofrequency ablation, laser ablation, microwave ablation and ablation by focused high intensity ultrasound waves. Although some results are promising, these methods need further technical development and prospective comparison with today’s golden standard - oncoplastic breast surgery.Razvojem dijagnostičkih mogućnosti, i probira karcinom dojke se otkriva u sve ranijem stadiju, zbog čega se teži sve poštednijim metodama lokalnog liječenja tumora. Nove, neinvazivne i minimalno invazivne metode trebale bi pružiti jednaku lokalnu kontrolu, ali uz manje kozmetske defekte, nuspojave i komplikacije u odnosu na kirurške zahvate. Trenutno je u istraživanju pet metoda: krioablacija, radiofrekvencijska ablacija, laserska ablacija, mikrovalna ablacija i ablacija fokusiranim ultrazvučnim valovima. Neke od navedenih metoda pokazuju ohrabrujuće rezultate, ali zahtijevaju dodatno tehničko usavršavanje i prospektivnu usporedbu s današnjim zlatnim standardom - onkoplastičnim kirurškim zahvatima