Assessment of efficiency of delayed breast reconstruction after mastectomy by modified suspension technique

UVOD: Odložene, sekundarne, rekonstrukcije su operativni zahvati u periodu posle mastektomije. Tehnike su razne, ali se najčešće se izvode korišćenjem ekspander proteza, a potom zamenom trajnim u drugom aktu ili korišćenjem mišićno-kožnih režnjeva. Rekonstrukcija ekspander protezama je retko korišćena u našoj zemlji jer je značajno skuplja procedura, a tehnike sopstvenim tkivom zahtevaju dobru kondiciju pacijenata i duži oporavak posle operacije kao i moguće komplikacije donorne regije. Tehnika suspenzorne metode u kojoj se koristi lokalni klizajući režanj omogućava sekundarnu rekonstrukciju dojke u kombinaciji sa trajnom protezom. Ova tehnika prvi put bila je opisana 1979. godine (Lewis i sar.), a kasnije i modifikovana korišćenjem neresorptivne mrežice (Riejtens i sar., 2005.) koji su koristili istu tehniku u kombinaciji sa trajnom protezom da bi obezbedili najoptimalniji estetski rezultat. CILJ: Ispitati prednosti modifikovane suspenzorne tehnike za odloženu rekonstrukciju kroz analizu postoperativnog oporavka pacijenata i procenta postoperativnih komplikacija. Istovremeno prikazati mogućnosti modifikovane suspenzorne tehnike u odloženoj rekonstrukciji u odnosu na veličinu i oblik endoproteze i istovremenu simetralizaciju suprotne dojke. Cilj je bio i procena kozmetskog efekta nakon modifikovane suspenzorne tehnike rekonstruktivnog hirurga i pacijentkinja neposredno posle operacije i 2 godine kasnije. MATERIJAL I METODE: Ova klinička kohortna studija uključila je 139 pacijentkinja sa primarnim karcinomom dojke koje su imali unilateralnu odloženu rekonstrukciju dojke modifikovanom suspenzornom tehnikom nakon mastektomije. Sve pacijentkinje su operisane u Institutu za onkologiju i radiologiju Srbije, u periodu od 1996. do 2010. godine. Pacijentkinje su inicijalno imale operabilni karcinom dojke, bez udaljenih metastaza. Hirurško lečenje je podrazumevalo modifikovanu radikalnu mastektomiju i adjuvantnu terapiju (hemioterapija, hormonoterapija) koja je bila primenjena shodno indikacijama. U ovom istraživanju ispitan je uticaj 4 grupe parametara: karakteristike pacijenata, karakteristike bolesti, karakteristike adjuvantne terapije i karakteristike rekonstrukcije na pojavu neželjenih ishoda rekonstrukcije (ranih, kasnih komplikacija i lokalnih recidiva) i kozmetski ishod rekonstrukcije neposredno nakon zahvata i dve godine posle, a shodno subjektivnim procenama pacijentkinja i ocenama rekonstruktivnog hirurga...INTRODUCTION: Delayed breast reconstruction after mastectomy is mainly performed using expander prostheses that are later replaced by permanent ones, or using pedicle or free musculocutaneous flaps. Insufficient amount of skin in this area represents the main problem. Expander technique is rarely available in our country due to financial implications of this method. Flap procedures are performed in several instances which increase treatment costs and prolong the patient’s recovery due to many expected complications. Besides these two techniques, it is possible to use AAF technique to increase the skin envelope for permanent prosthesis. This surgical technique was first described by Lewis in 1979. Later, in 2005 it was modified by Riejtens combined AAF with non-absorbable mesh. This technique reduces the number of operational stages, as well as donor-site complications, whilst providing more optimal aesthetical results. PURPOSE: To evaluate the adverse outcomes after delayed breast reconstruction (DBR) by abdominal advancement flap (AAF) and permanent prosthesis in patients treated with mastectomy due to unilateral breast carcinoma, as well as to determine which factors are predictive for their occurrence. In the same time, purpose was to evaluate cosmetic results after surgery and two years later. MATERIALS AND METHODS: This clinical cohort study included 139 patients with primary breast carcinoma who were subjected to unilateral delayed breast reconstruction using modified suspension technique upon mastectomy. All patients were operated at the Institute for Oncology and Radiology of Serbia from 1996 to 2010. Patients initially had operable breast carcinoma with no distant metastases. Surgical treatment consisted of modified radical mastectoimy followed by adjuvant treatment (chemotherapy, radiotherapy, hormonotherapy) applied accordingly. This research examines four groups of parameters: characteristics of the patients, of the disease, of adjuvant therapy and of the reconstructions, and their influence on appearance of adverse outcomes of reconstruction (early and late complications and local relapses) and on cosmetic outcome of reconstruction immediately after the procedure as well as two years later, taking into account subjective assessment of patients and evaluations of reconstructive surgeons..

A novel Wolbachia ftsZ genotype in 'Candidatus Phytoplasma solani' planthopper vector Hyalesthes obsoletus (Hemiptera: Fulgoromorpha: Cixiidae) associated with Convolvulus arvensis

Hyalesthes obsoletus (Hemiptera: Fulgoromorpha: Cixiidae) is a pan-European polyphagous planthopper known as a significant vector of the plant pathogenic bacterium 'Candidatus Phytoplasma solani' (stolbur phytoplasma), which poses threats to various agricultural crops. A population of H. obsoletus associated with Convolvulus arvensis in Serbia was studied to investigate the presence and genetic diversity of Wolbachia, an endosymbiotic bacterium known for its promising biological control applications. Both insect-associated microorganisms, 'Ca. P. solani' and Wolbachia, were found in the assessed H. obsoletus population. The analyzed vector population had a 'Ca. P. solani' infection rate of 50%, while Wolbachia showed a high infection rate of 80%. Wolbachia presence displayed minimal variation across genders and was independent of individuals' phytoplasma-infection status. Genotyping of the identified 'Ca. P. solani' strains revealed four previously described stamp genotypes (Rqg50/St1, Rqg31/St2, STOL/St4 and M5/St28). Notably, a single novel Wolbachia ftsZ genotype, designated WHo1, was found in the assessed H. obsoletus population, providing a valuable insight into the genetic diversity of Wolbachia endosymbionts within the Cixiidae family. Phylogenetic analysis demonstrated intricate relationships between WHo1 and other Wolbachia strains infecting hosts from diverse hemipteran suborders. Although Wolbachia-based strategies show promise for phytoplasma vector control, further research is needed to elucidate its potential interactions with 'Ca. P. solani' and its effects on vector reproduction and fitness

Field trial evaluation to RTD susceptibility/tolerance to RTD in Serbia: Is there a tolerance to RTD in current varieties?

Sugar beet is the second most important source for the sugar industry, particularly important in temperate climate zones of Central, West, and East Europe. However, its production has declined recently due to various factors of which the most important are subsidy cuts and the spread of various plant diseases. In the Pannonian Plain (Slovakia, Hungary, Romania, and Serbia), a disease called rubbery taproot disease (RTD) has been observed for along time. The variability in RTD symptoms and the extent of damage it causes have made its detection quite challenging, often leading to misdiagnoses as other diseases. However, the identification of Candidatus Phytoplasma solani as the cause of RTD has resolved the issue of its diagnosis. The latest outbreak in Serbia has had a significant economic impact on sugar beet production, prompting an urgent response to aid the industry and growers. In our study, conducted during the 2022 and 2023 seasons, we assessed the susceptibility/tolerance of thirty registered sugar beet hybrids in Serbia, evaluating their impact on root yield and quality in naturally infected experimental fields

Actual contamination of the Danube and Sava Rivers at Belgrade (2013)

This study was focussed on a comprehensive investigation on the state of pollution of the Danube and Sava Rivers in the region of Belgrade. Different complementary analytical approaches were employed covering both i) organic contaminants in the river water by target analyses of hormones and neonicotinoids as well as non-target screening analyses and ii) heavy metals in the sediments. Finally, some common water quality parameters were analysed. The overall state of pollution is on a moderate level. Bulk parameters did not reveal any unusual observations. Moreover, quantification of preselected organic contaminants did not indicate to elevated pollution. More significant contaminations were registered for chromium, nickel, zinc and partially copper in sediments with values above the target values according to Serbian regulations. Lastly, non-target screening analysis revealed a wider spectrum of organic contaminants comprising pharmaceuticals, technical additives, personal care products and pesticides. The study presented a comprehensive view on the state of pollution of the Sava and Danube Rivers and is the base for setting up further monitoring programs. As a superior outcome, it was illustrated how different chemical analyses can result in different assessments of the river quality. A comparison of target and non-target analyses pointed to potential misinterpretation of the real state of pollution

Clinical, Dermatoscopical and Laboratory Essentials of Fish Tank Granuloma

In immunocompetent individuals Mycobacterium marinum (M. marinum) infection usually presents with localized skin lesions, better known as “swimming pool granuloma” or “fish tank granuloma” (FTG). When establishing the diagnosis of FTG, doctors encounter several problems in the clinical practice: granulomas are detected in less than two thirds of biopsies and acid-fast bacilli are identified only in a minority of cases. Majority of disseminated and aggressive FTG forms are unrecognized at the beginning, and occur in immunosuppressed patients, including organ transplant patients. Functional impairment or even amputation of the extremity, visceral involvement and lethal outcome have been reported. Although more than one thousand cases of FTG have been reported worldwide, dermatoscopy of FTG, as a diagnostic aid, has not been reported yet. Presenting the case of FTG of recent onset where, guided by dermatoscopy, microorganisms were isolated and identified from the biopsy material, we summarize the essentials of clinical and laboratory diagnostics of M. marinum infection