OVARIAN CANCER – SCREENING AND DIAGNOSIS

Usprkos razvoju ginekološke onkologije karcinom jajnika se i dalje otkriva vrlo kasno, odnosno u uznapredovalim stadijima, što uzrokuje nepovoljan ishod ove bolesti. Patogeneza kao i svi čimbenici rizika za razvoj bolesti nisu do kraja poznati, a često nespecifična klinička slika onemogućava pravodobnu dijagnozu u ranijim stadijima pri čemu važnu ulogu u prepoznavanju bolesti imaju liječnici, ali i pacijenti. Cilj ovoga rada je prikazati dosadašnje spoznaje o probiru i dijagnozi karcinoma jajnika s posebnim naglaskom na ulogu ultrazvuka u prepoznavanju ove bolesti te posljedičnom usmjeravanju pacijentica u odgovarajuće ustanove radi daljnjeg liječenja.Despite advances in gynecologic oncology, ovarian cancer is still mostly diagnosed very late or in advanced stages, which leads to adverse outcome of the disease. The pathogenesis of this disease as well as the risk factors for its development are not completely understood, while symptoms in the early stage of disease are sometimes nonspecific and delay earlier diagnosis. The aim is to present recent knowledge about the screening and diagnosis of ovarian cancer, with special reference to the role of ultrasound in recognizing the disease and referring patients for further consultation

Utjecaj trajanja hlađenja Δt8/5 na svojstva zavarenog spoja kod toplinskih simuliranih uzoraka od čelika TStE 420

In this paper the influence of cooling time in temperature interval from 800 to 500 °C (Δt8/5) on hardness and impact strength of thermal cycle simulated specimens from high strength fine grained steel TStE 420 is explained. Also a research on scanning electron microscope and fractography analysis of characteristic fractures on simulated specimens is performed.U radu se obrazlaže utjecaj trajanja hlađenja u intervalu od 800 do 500 °C (Δt8/5) na tvrdoću i udarnu radnju loma kod toplinski simuliranih uzoraka od mikrolegiranog čelika povišene čvrstoće TStE 420. Napravljeno je i ispitivanje na elektronskom scanning mikroskopu, te fraktografska analiza karakterističnih prijeloma simuliranih uzoraka

Levels of LDL-cholesterol, Triglyceride and Urate in Patients With Type 2 Diabetes Mellitus

Aim: The study aimed to examine LDL cholesterol, triglyceride and urate levels in patients of both sexes with type 2 diabetes mellitus (DM2T) in family medicine offices and to examine whether there is a difference in these parameters between obese patients and patients with normal body weight with DM2T, and between patients with and without manifest cardiovascular diseases. Participants and methods: The study was organized as a cross-sectional study. It included 136 participants of both sexes diagnosed with DM2T, who were divided into groups of patients with or without adiposity and into groups of patients with or without experience of cardiovascular event. General and demographic data were collected, as well as data on experiencing cardiovascular events and levels of LDL cholesterol, triglycerides and urates. Results: The average LDL cholesterol level was 2.93 mmol/L, the average triglyceride level was 1.65 mmol/L and the average urate level was 326.36 µmol/L. Only 12.5% of participants reached target LDL cholesterol levels, while levels of triglycerides and urates were within recommended limits. 24.3% of participants had experienced cardiovascular events and 39.7% of participants were obese. There was no significant difference in levels of LDL cholesterol, triglycerides and urates in participants who had experienced a cardiovascular event and those who had not. There was a significantly higher concentration of triglycerides in obese patients than in patients with normal body weight (p = 0.005). Conclusion: In addition to regulation of glycaemia in patients with DM2T, statin doses should be increased in order to reach the target levels of LDL cholesterol. When it comes to obese patients, education courses on physical activity and diet should be conducted more often and, if necessary, fibrates should be included in therapy in order to reduce additional cardiovascular risks. (Šojat* D, Pirić M, Klarić M, Šapina M, Popović Z, Bačun T. Levels of LDL Cholesterol, Triglyceride and Urate in Patients With Type 2 Diabetes Mellitus. SEEMEDJ 2020; 4(1); 32-39

Role of Bone Morphogenetic Proteins in Human Prostate Cancer Pathogenesis and Development of Bone Metastases: Immunohistochemical Study

Bone morphogenetic proteins (BMP) have the ability to induce ectopic bone formation1–10. The findings of their expression in prostate cancers have been linked with specifically tumor progression to bone and development of osteosclerotic metastases7–15. We investigated the expression pattern of BMP-2/4, -6 and -7 and the receptors BMPR-IA,-IB and -II in normal human prostate, organ-localized and metastatic prostate cancers. The expression we also examined in skeletal metastases caused by prostate cancer. In localized prostate cancers we found increased expression of BMP-6 and decreased expression of BMP-2/4 and -7. In metastatic prostate cancers the expression of examined BMPs decreased. The expression of BMPRs showed the tendency to be lower with progression of prostate cancer but the expression of BMPR-II was completely absent in metastatic prostate cancers. In bone metastases caused by prostate cancer we found high expression of BMP-2/4, -6 and -7. Decreased expression of BMPs and lose of BMPR-II expression, could suggest that the influence of BMPs on prostate cancer cells is inhibited and plays an important role in prostate cancer pathogenesis. High expression of osteogenic BMPs in prostate cancer bone metastases could explain their osteosclerotic properties

Are Lipoprotein Disturbances in Chronic Hemodialyzed Patients only Renal Failure Related?

Chronically hemodialyzed (HD) patients frequently suffer from quantitative and even more often qualitative serum lipids disorders. Mostly they have increased triglycerides and VLDL-cholesterol, slightly increased or normal total and LDL-cholesterol and decreased HDL-cholesterol concentrations. The study compared lipid profile between two groups of chronic HD patients coming from regionally distinct areas, the continental and the maritime one. The aim was to examine the hypothetic influence of their different dietary habits on lipid profile. The study included 72 patients from continental region (39 men) and 50 from maritime part of the country (30 men). Patients suffering from diabetes mellitus, hypothyroidism, liver disease, alcoholics as well as sevelamer treated patients were not included. Prior to a HD session the patients were determined fasting total cholesterol, triglycerides, HDL- and LDL-cholesterol, total proteins, albumins and C-reactive protein serum concentrations. All patients were undergoing bicarbonate hemodialysis with polysulphone dialysers of low permeability. The continental group of patients were somewhat older, undergoing HD for longer period of time, of lower height, greater weight, greater body mass index, higher total (4.70±0.91: 4.42±1.02 mmol/L), and LDL-cholesterol (2.78±0.74:2.66±0.75 mmol/L) concentrations, while lower triglycerides (1.72±0.84:1.81±0.83 mmol/L) and HDL-cholesterol (1.13±0.42:1.16±0.54 mmol/L). However, all the differences were without statistical significance. Chi-square test showed that the continental group of patients consumed more often pork, bacon, smoked and cured meats, margarine, butter, walnuts, almonds, garlic, cream and full-fat cheese than fish. They prepare food more often with lard and sunflower oil. Almost every fourth continental patient received statins, while only every 25th in the maritime group of patients. There were not any statistically significant Chi-square values for differences in frequencies of patients with total cholesterol greater than 5.2 mmol/L, triglycerides above 1.6 mmol/L, HDL-cholesterol less than 1.1 mmol/L, LDL-cholesterol greater than 2.6 mmol/L, obesity and malnutrition between the two groups. Based on the results of this study we have concluded that diet has significant influence on lipid profile of HD patients. Even though the continental and the maritime groups of patients differed significantly in diet, they were similar in plasmatic lipoprotein concentrations. However, this similarity was ascribed only to statin treatment, which was more frequent in the continental group of patients. The influence of ESRD and HD as a method of renal replacement therapy on lipid profile was not more dominant than diet

Reproducibility of histological subtyping of malignant pleural mesothelioma

Malignant pleural mesothelioma (MPM) has a very poor prognosis. Although clinical stage is currently the only reliable prognostic factor, histologic subtyping reportedly also affects prognosis. Some studies propose reclassification of pleomorphic epithelioid as biphasic or sarcomatoid MPM. This study assessed prognostic significance and interobserver agreement in MPM subtyping of small biopsy specimens. We analyzed biopsy specimens, and clinical and survival data from records of 108 patients who were diagnosed between 2000 and 2010 at the Institute of Pathology University of Zagreb School of Medicine, of whom 98 had epithelioid MPM, six biphasic MPM, and four sarcomatoid MPM. Among epithelioid subtypes, 44 (44.9 %) were solid, 19 (19.4 %) tubulopapillary, 18 (18.4 %) acinar, six (6.1 %) adenomatoid, five (5.1 %) pleomorphic, four (4.1 %) trabecular, and two (2.0 %) micropapillary subtype. Interobserver reliability for histological diagnosis was found to be κ = 0.72 (P < 0.001). Median overall survival for epithelioid MPM was 10.5 months with an interquartile range (IQR) of 5.8-28.0 months but significantly shorter for the pleomorphic subtype (3 [IQR 3.0-8.0] months; P = 0.034), but not significantly different from biphasic (6.5 [IQR 3.5-15.3] months) and sarcomatoid mesothelioma (4.0 [IQR 1.3-6.8] months; P = 0.270). We found strong reproducibility of MPM subtyping with good interobserver agreement. Furthermore, our results indicate that pleomorphic subtype to be a predictor of poor prognosis and support classifying it with sarcomatoid or biphasic MPM, as patients with the pleomorphic, biphasic, or sarcomatoid subtype show similarly poor overall survival

Medical termination of unplanned pregnancy

Medicinski pobačaj se definira kao prekid trudnoće pomoću lijekova. Mifepriston u kombinaciji s mizoprostolom najčešći je oblik medikamentoznog prekida trudnoće. Cilj je ovoga rada predstaviti primjenjivost i učinkovitost medikamentoznog prekida neželjene trudnoće u Kliničkom bolničkom centru Rijeka gdje se primjenjuje od sredine 2015. godine. Medicinski pobačaj u KBC Rijeka vrši se prema protokolu Svjetske zdravstvene organizacije za medikamentozni prekid trudnoće od 9. do 12. tjedna trudnoće, a sastoji se od jednokratne peroralne primjene mifepristona u dozi od 200 mg i nakon 36–48 sati vaginalne ili bukalne primjene mizoprostola u dozi od 800 mcg. Nakon 6 sati od primjene prve doze mizoprostola učini se procjena stanja ginekološkim i ultrazvučnim pregledom te u slučajevima nedovršenog pobačaja nastavlja se svaka 3 sata s primjenom mizoprostola bukalnim putem u dozi od 400 mcg do najviše 4 dodatne primjene (2400 mcg kumulativne doze mizoprostola). Kombinacijom navedenih lijekova u 860 slučajeva postignuta je uspješnost od 99% (N=851) prekida trudnoće, a u 9 (1,0%) neuspjelih slučajeva prekid trudnoće dovršen je sljedećeg dana kirurškim putem. Ukupna stopa ostatnog tkiva trofoblasta (tzv. rezidua) u navedenoj studiji iznosila je 1,9%. Medikamentozni pobačaj predstavlja sigurnu i učinkovitu metodu prekida neželjenih trudnoća.Medical termination is defined as a termination of pregnancy by medications. Mifepristone in combination with misoprostol is the most common protocol of use for medical termination of pregnancy. The aim of this paper is to present the applicability and efficiency of medical termination of unplanned pregnancies at Clinical Hospital Center (CHC) Rijeka, where it has been practiced since the mid-2015. In CHC Rijeka we follow the protocol of the World Health Organization for medical termination of pregnancy from nine up to 12 weeks of gestation. It consists of a single dose of mifepristone 200 mg administered orally, followed by vaginal or buccal administration of misoprostol 800 mcg after 36–48 hours. After six hours of the first dose of misoprostol, gynecological and ultrasound examination determines whether the termination has occurred. In cases of uncompleted termination, the treatment is continued every three hours with the use of buccal misoprostol in a dose of 400 mcg to a maximum of four additional doses (2400 mcg of cumulative dose of misoprostol). Following the above procedure in 860 cases a success rate of 99% was achieved in the termination of pregnancies. Unresolved nine (0.1%) women underwent surgical removal of pregnancy. Total rate of residual tissue of the trophoblast (so-called residua) in this study was 1.9%. Medical termination of unwanted pregnancy represents a safe and effective method of abortion

Relapsed ovarian high-grade serous carcinoma with long-term survival associated with synchronous primary squamous cell carcinoma of the colon

High-grade serous ovarian cancer (HGSOC) is the most common and also the most aggressive subtype of ovarian cancer while squamous cell carcinoma (SCC) of the colon is an extremely rare histologic subtype of all colonic malignancies with poor prognosis. Here we report a unique case of synchronous primary SCC of the colon and second recurrence of HGSOC in a patient with 15-years survival. Our patient developed two recurrent HGSOCs with disease-free survival time of five and nine years, respectively. The second recurrence of HGSOC was associated with the synchronous primary SCC of the ascending colon and was further complicated with the patient′s development of platinum resistance. Awareness of this unusual occurrence should emphasize the need for adequate sampling of tumor tissue in patients with relapsing ovarian cancer. Reports of more cases of SCC of the colon would possibly help to establish appropriate management modality and strategies for treatment

Vaginal Delivery and Continuous Epidural Analgesia: Should We Change Our Clinical Approach?

The aim of the study was to investigate the effects of continuous epidural analgesia (EA) on the course of vaginal delivery with an emphasis on duration of labor and instrumental interventions. In a prospective 2-year trial, the study group included singleton vaginal births between 35 and 41 gestational weeks with a vertex fetus, in which continuous EA with bupivacaine or chirocaine in concentration of 0.125% combined with 2–4 mg of fentanyl or 0.5 mg of sufenta was used. The control group was created randomly from laboring patients with singleton pregnancies but without EA. The groups were adjusted for epidemiological characteristics and compared regarding the obstetric data and perinatal outcome. Student t-test and Mann-Whitney U-test were performed for normally and non-normally distributed results, respectively. Out of 1284 patients, 551 pregnant women were included in the study group and 733 in the control group. The statistically significant differences between the groups related to duration of the first and second stage of labor, frequency of premature rupture of membranes, intrapartal complications, and incidence of operative deliveries were found. Both stages of labor were significantly protracted and the incidence of operative deliveries was higher in the study group of patients compared with controls. There is a need for an active obstetric approach and management of vaginal deliveries of women who receive continuous EA, particularly if it is medically indicated

ABO and RhD Blood Groups in Nasal Polyposis

Objective:The aim of this study was to determine ABO and RhD blood group distribution in nasal polyposis (NP) patients and whether there is a specific ABO or RhD blood phenotype associated with susceptibility to or protection with respect to development of NP.Methods: The study group comprised 126 consecutive patients with chronic rhinosinusitis and bilateral NP. The control group comprised 126 healthy blood donors. All participants were from the same geographical region. Distribution of ABO and RhD phenotypes in all participants was studied.Results: There were no significant differences between patients and controls in the distribution of the A (p=0.520), B (p=0.306), AB (p=0.673), O (p=0.894), and RhD (p=0.742) phenotypes.Conclusion: According to the present results, the ABO and RhD blood group systems are not associated with development of NP