Comparison of Results of Surgical Treatments of Primary Inguinal Hernia with Flat Polypropylene Mesh and Three-Dimensional Prolene (Phs) Mesh – One Year Follow Up

The aim of this study was to compare the results of the surgery of inguinal hernias using flat polypropylene mesh and three-dimensional prolene (PHS) mesh. The study included two groups of 40 male patients, aged 18–50 years, with the diagnosis of inguinal hernia. One group was operated with a flat polypropylene mesh, while the second group was operated with three-dimensional prolene (PHS) mesh. The study has shown that the operation with three-dimensional prolene mesh lasted 15 minutes longer and that the patients had stronger inflammatory response. Statistically, there was no significant difference in post-operative pain intensity, post-operative use of analgesics, length of hospitalization, return to daily activities, early and late post-operative complications. No recurrence was registered in any of the groups. The analysis of results indicates that there is no difference in treatment of inguinal hernia with flat polypropylene and three-dimensional prolene (PHS) mesh

ATTITUDES OF STUDENTS OF MEDICINE, UNIVERSITY OF MOSTAR ACCORDING TO INDUCED ABORTION

Background: Aim of this study was to establish attitudes of medical students on induced abortion and connection of those attitudes with religiousness, length of their studies, sex and various circumstances of pregnancy. Subjects and methods: In total, 148 students of the first, second, fifth and sixth year of medical faculty participated in the research. The study was conducted at the Medical Faculty of the University in Mostar. While collecting the data, we used a survey taken over from literature. The data were tested with adequate statistical methods afterwards. Results: 81.1% of students would perform an abortion under certain circumstances (χ2=57.189; P<0.001). Most students answered that they would perform an abortion in case that a fetus had malformations (χ2=3.892; P=0.49) or if the mother’s life were endangered (χ2=47.676; P<0.001). By comparison of students’ readiness to perform an abortion under various circumstances of pregnancy depending on length of medical education, statistically significant difference was proved in the following circumstances: rape (χ2=6.097; P=0.014) and if the pregnancy would endanger mother’s mental health (χ2=4.488; P=0.034). Students with shorter medical education expressed more liberal attitudes in the above stated circumstances. By comparison of students’ readiness to perform an abortion under various circumstances of pregnancy depending on religiousness statistically significant difference was proved in the following circumstances: in case of ‘abortion on demand’, no matter the reason (χ2=11.908; P=0.012), teenage pregnancy (χ2=33.308; P<0.001) and if the pregnancy would interfere with mother’s career (χ2=35.897; P<0.001). Unreligious students expressed more liberal attitudes. Conclusion: Influence of length of medical education and sex on attitudes on abortion was not proved statistically. Impact of religiousness on that attitude cannot be commented due to very small share of unreligious students in the sample

ATTITUDES OF STUDENTS OF MEDICINE, UNIVERSITY OF MOSTAR ACCORDING TO INDUCED ABORTION

Background: Aim of this study was to establish attitudes of medical students on induced abortion and connection of those attitudes with religiousness, length of their studies, sex and various circumstances of pregnancy. Subjects and methods: In total, 148 students of the first, second, fifth and sixth year of medical faculty participated in the research. The study was conducted at the Medical Faculty of the University in Mostar. While collecting the data, we used a survey taken over from literature. The data were tested with adequate statistical methods afterwards. Results: 81.1% of students would perform an abortion under certain circumstances (χ2=57.189; P<0.001). Most students answered that they would perform an abortion in case that a fetus had malformations (χ2=3.892; P=0.49) or if the mother’s life were endangered (χ2=47.676; P<0.001). By comparison of students’ readiness to perform an abortion under various circumstances of pregnancy depending on length of medical education, statistically significant difference was proved in the following circumstances: rape (χ2=6.097; P=0.014) and if the pregnancy would endanger mother’s mental health (χ2=4.488; P=0.034). Students with shorter medical education expressed more liberal attitudes in the above stated circumstances. By comparison of students’ readiness to perform an abortion under various circumstances of pregnancy depending on religiousness statistically significant difference was proved in the following circumstances: in case of ‘abortion on demand’, no matter the reason (χ2=11.908; P=0.012), teenage pregnancy (χ2=33.308; P<0.001) and if the pregnancy would interfere with mother’s career (χ2=35.897; P<0.001). Unreligious students expressed more liberal attitudes. Conclusion: Influence of length of medical education and sex on attitudes on abortion was not proved statistically. Impact of religiousness on that attitude cannot be commented due to very small share of unreligious students in the sample

PAIN INTENSITY SCALES COMPARISON IN PATIENT WITH ABDOMINAL PAIN

Background: The aim of study was to explore efficiency of the pain rating scales on patients experiencing abdominal pain, determine correlation between the scales and their applicability to general population and determine the minimal clinical important difference in mm on the VAS as discriminatory for difference in pain intensity. Subjects and methods: The study was performed at the Emergency Department of the University Clinical Hospital of Mostar on patients with abdominal pain which started less than 24 hours before, excluding patients under 16 years old, uncooperative patients and those with altered state of consciousness. The sample data were collected from February to May 2010. Hundred patients completed the questionnaire. Two patients, admitted to the Abdominal Surgery Department, were excluded. The patients were asked to sign the informed consent form and assess the level of pain on three scales (VAS, NRS, VRS). Results: The NRS showed a significant difference in assessing the pain intensity in the observed time. By lapse of time, the patients were reporting lower pain intensity (P=0.017). VAS and NRS had high correlation coefficient values, indicating strong correlation and credibility. The NRS showed strong results correlation (r=0.784; P<0.001). Inter-scale correlation was growing over time. Correlation between VAS and NRS was very strong, the strongest in the last measurement (r=0.950; P<0.001). The NRS correlation with VRS (r=0.430; P<0.001) was slightly better than with VAS (r=0.402; P<0.001). The NRS proved to be the most sensitive to changes in pain intensity (SRM=0.305), whereas the VRS showed extremely low responsiveness (SRM=0.185). Conclusion: Having proved as the most useful, reliable and efficient pain assessment instrument, the NRS is hereby recommended as method of pain objectification and determining changes in pain intensity

PAIN INTENSITY SCALES COMPARISON IN PATIENT WITH ABDOMINAL PAIN

Background: The aim of study was to explore efficiency of the pain rating scales on patients experiencing abdominal pain, determine correlation between the scales and their applicability to general population and determine the minimal clinical important difference in mm on the VAS as discriminatory for difference in pain intensity. Subjects and methods: The study was performed at the Emergency Department of the University Clinical Hospital of Mostar on patients with abdominal pain which started less than 24 hours before, excluding patients under 16 years old, uncooperative patients and those with altered state of consciousness. The sample data were collected from February to May 2010. Hundred patients completed the questionnaire. Two patients, admitted to the Abdominal Surgery Department, were excluded. The patients were asked to sign the informed consent form and assess the level of pain on three scales (VAS, NRS, VRS). Results: The NRS showed a significant difference in assessing the pain intensity in the observed time. By lapse of time, the patients were reporting lower pain intensity (P=0.017). VAS and NRS had high correlation coefficient values, indicating strong correlation and credibility. The NRS showed strong results correlation (r=0.784; P<0.001). Inter-scale correlation was growing over time. Correlation between VAS and NRS was very strong, the strongest in the last measurement (r=0.950; P<0.001). The NRS correlation with VRS (r=0.430; P<0.001) was slightly better than with VAS (r=0.402; P<0.001). The NRS proved to be the most sensitive to changes in pain intensity (SRM=0.305), whereas the VRS showed extremely low responsiveness (SRM=0.185). Conclusion: Having proved as the most useful, reliable and efficient pain assessment instrument, the NRS is hereby recommended as method of pain objectification and determining changes in pain intensity

A giant exulcerated phyllodes breast tumor a case report

© 2020, University of Kragujevac, Faculty of Science. All rights reserved. Phyllodes tumors of the breast can be benign, malignant, or borderline. Benign and borderline tumors are rare tumor types that have a positive outlook and high survival rate, while the risk of recurrence is typical for malignant breast tumors. Giant phyllodes tumors are larger than 10 cm in diameter and demand a serious diagnostic and treatment approach. In this study we present a case of a female patient treated for an exulcerated breast carcinoma-a giant borderline phyllodes tumor of the breast. The patient presented to the department for the right breast lump with ulcerated skin and nipple abnormalities. The core biopsy was performed and the patient was diagnosed with a benign tumor. Simple mastectomy was performed and final histopathological report revealed a borderline phyllodes tumor. Diagnosis and treatment of a giant phyllodes tumor remain a great challenge for the surgeons. Establishing the preoperative diagnosis based on histopathological findings is imperative to disease management. Surgery is the mainstay of treatment and mastectomy has been the traditional procedure; in cases where suspicious findings in the axilla are revealed, radical mastectomy is performed and the axilla is to be dissected

Promotor hypermethyation of BRCA1, p16, MGMT, RASSF1 and CDH-1 genes in correlation with clinical course of disease in estrogen receptor, progesterone receptor and her-2 receptor negative breast cancer

Trostruko-negativni karcinom dojke (engl. triple-negative breast cancer –TNBC) predstavlja subtip karcinoma dojke koji zauzima 15-20% od svih karcinoma dojke, karakteriše se odsustvom receptora za ER i PR, kao i odsustvom povećane ekspresije Her-2 receptora. Kao posledica agresivnog tumorskog fenotipa, nemogućnosti sprovođenja ciljane antitumorske terapije zbog odsustva pomenutih receptora, kao i parcijalnog odgovora na hemioterapije koje se primenjuju za karcinom dojke, ovaj subtip ima lošu prognozu. Intenzivno se izučavaju molekulske mete za praćenje kliničkog toka bolesti i efekata antitumorke terapije. Epigenetičke promene igraju isto tako značajnu ulogu u nastanku kancera kao i promene koje se odvijaju u nivou gena. Cilj ovog rada je bio da se utvrdi da li metilacioni status promotora ispitivanih BRCA1, p16, O6MGMT, RASSF1 i CDH-1 gena kod bolesnica sa trostruko negativnim karcinomom dojke, kao prognostički najlošijom grupom karcinoma dojke sa agresivnim fenotipom, može da se poveže sa kliničkim tokom bolesti i da posluži kao eventualni pokazatelj prognoze bolesti. Materijal i metode: U rad je uključena 131 bolesnica sa karcinomom dojke koje su na početku lečenja bile podvrgnute hirurškom lečenju (61 sa trostruko negativnim karcinomom dojke, a drugu grupu čini 70 bolesnica koje spadaju u najbolju prognostičku grupu karcinoma dojke (ER+, PR+, Her2-). Bolesnice su praćene između 1 i 87 meseci (medijana 78 meseci). Hipermetilacioni status promotorskog regiona BRCA1, p16, O6MGMT, RASSSF1 i CDH-1 gena je određivan u tumorskom tkivu, obzirom da je metilacija tkivno i tumor specifična. DNK iz uzoraka sveže smrznutog tumorskog tkiva je izolovana metodom isoljavanja. Određivanje hipermetilacije promotora specifičnih gena je urađeno metilaciono-specifičnim PCR metodom. Rezultati: Poređenje hipermetilacije promotora BRCA1, p16, O6MGMT, RASSF1 i CDH-1 gena pokazalo je da se ove dve grupe statistički značajno razlikuju samo u odnosu na učestalost hipermetilacije promotora p16 gena – statistički značajno veći broj hipermeilacija promotora gena pronađen je u grupi trostruko negativnog karcinoma dojke, 33 (54.1%) vs. 20 (28.6%), p=0.00298. Iako nije pokazana statistički značajna razlika u učestalosti hipermetilacije promotora BRCA1 gena između ispitivanih grupa bolesnica, uočen je trend ka većem broju hipermetilacija u trostruko negativnom karcinomu dojke grupi bolesnica: 33 (54.1%) prema 27 (38.6%), χ2 test, p=0.0752...riple-negative breast cancer, present with frequency of about 15-20% of all breast cancers, is characterized with the lack of estrogen, progesterone and Her-2 receptors and aggressive form of disease. As the consequence of aggressive tumor phenotype, lack of targeted anticancer therapy due to the absence of biological markers, as well as poor response to conventional chemotherapy, triple-negative breast cancer is associated with poor prognosis. Molecular targets that can serve as prognostic as well as predictive markers are intensively studied. It has been proposed that epigenetic changes in the cancer development are as significant as genetic changes. Aim: This work was done in order to evaluate if methylation status of BRCA1, p16, MGMT, RASSF1 and CDH-1 genes in triple-negative brast cancer as prognostically the worst subtype of breast cancer, can be correlated with clinical course and can serve as prognostic markers of disease. Material and Methods: 131 breast cancer patients with surgery as primary treatment were included: 61with triple-negative breast cancer (TNBC) and 70 with estrogen, progesterone positive and Her2 negative (ER+, PR+, Her2- ) breast cancer that represents prognostically the best subtype of breast cancer. The pateints were followed up between 1 and 87 months (median 78 months). Status of promotor hypermethylation of BRCA1, p16, O6MGMT, RASSSF1 i CDH-1 genes was determined in the tumor tissue since methylation is tissue and tumor specific. DNA was isolated from fresh frozen tissues by salting out procedure. Status of promotor hypermethylation was determined by methylation-specific PCR. Results: There was statistically significant difference only in p16 hypermethylated breast cancer cases when TNBC was compared with ER+PR+Her2- group, 33 (54.1%) vs. 20 (28.6%), p=0.00298. Although the difference between the incidences of BRCA1 hypermethylation between the examined groups of patients did not reach statistical significance, we observed a tendency towards higher occurrence of BRCA1 hypermethylation in TNBC compared to ER+PR+Her2- cases: 33 (54.1%) vs. 27 (38.6%), p=0.0752. When the frequencies of co-methylated (combined hypermethylation of the examined genes) p16 and RASSF1A genes (p16+RASSF1A+) were compared between the breast cancer patients with TNBC and ER+PR+Her2- characteristics, we found that the number of patients with both hypermethylated genes was significantly higher in the TNBC than in ER+PR+Her2- group: 20 (32.8%) vs. 10 (14.3%), p=0.0225..

Promotor hypermethyation of BRCA1, p16, MGMT, RASSF1 and CDH-1 genes in correlation with clinical course of disease in estrogen receptor, progesterone receptor and her-2 receptor negative breast cancer

Trostruko-negativni karcinom dojke (engl. triple-negative breast cancer –TNBC) predstavlja subtip karcinoma dojke koji zauzima 15-20% od svih karcinoma dojke, karakteriše se odsustvom receptora za ER i PR, kao i odsustvom povećane ekspresije Her-2 receptora. Kao posledica agresivnog tumorskog fenotipa, nemogućnosti sprovođenja ciljane antitumorske terapije zbog odsustva pomenutih receptora, kao i parcijalnog odgovora na hemioterapije koje se primenjuju za karcinom dojke, ovaj subtip ima lošu prognozu. Intenzivno se izučavaju molekulske mete za praćenje kliničkog toka bolesti i efekata antitumorke terapije. Epigenetičke promene igraju isto tako značajnu ulogu u nastanku kancera kao i promene koje se odvijaju u nivou gena. Cilj ovog rada je bio da se utvrdi da li metilacioni status promotora ispitivanih BRCA1, p16, O6MGMT, RASSF1 i CDH-1 gena kod bolesnica sa trostruko negativnim karcinomom dojke, kao prognostički najlošijom grupom karcinoma dojke sa agresivnim fenotipom, može da se poveže sa kliničkim tokom bolesti i da posluži kao eventualni pokazatelj prognoze bolesti. Materijal i metode: U rad je uključena 131 bolesnica sa karcinomom dojke koje su na početku lečenja bile podvrgnute hirurškom lečenju (61 sa trostruko negativnim karcinomom dojke, a drugu grupu čini 70 bolesnica koje spadaju u najbolju prognostičku grupu karcinoma dojke (ER+, PR+, Her2-). Bolesnice su praćene između 1 i 87 meseci (medijana 78 meseci). Hipermetilacioni status promotorskog regiona BRCA1, p16, O6MGMT, RASSSF1 i CDH-1 gena je određivan u tumorskom tkivu, obzirom da je metilacija tkivno i tumor specifična. DNK iz uzoraka sveže smrznutog tumorskog tkiva je izolovana metodom isoljavanja. Određivanje hipermetilacije promotora specifičnih gena je urađeno metilaciono-specifičnim PCR metodom. Rezultati: Poređenje hipermetilacije promotora BRCA1, p16, O6MGMT, RASSF1 i CDH-1 gena pokazalo je da se ove dve grupe statistički značajno razlikuju samo u odnosu na učestalost hipermetilacije promotora p16 gena – statistički značajno veći broj hipermeilacija promotora gena pronađen je u grupi trostruko negativnog karcinoma dojke, 33 (54.1%) vs. 20 (28.6%), p=0.00298. Iako nije pokazana statistički značajna razlika u učestalosti hipermetilacije promotora BRCA1 gena između ispitivanih grupa bolesnica, uočen je trend ka većem broju hipermetilacija u trostruko negativnom karcinomu dojke grupi bolesnica: 33 (54.1%) prema 27 (38.6%), χ2 test, p=0.0752...riple-negative breast cancer, present with frequency of about 15-20% of all breast cancers, is characterized with the lack of estrogen, progesterone and Her-2 receptors and aggressive form of disease. As the consequence of aggressive tumor phenotype, lack of targeted anticancer therapy due to the absence of biological markers, as well as poor response to conventional chemotherapy, triple-negative breast cancer is associated with poor prognosis. Molecular targets that can serve as prognostic as well as predictive markers are intensively studied. It has been proposed that epigenetic changes in the cancer development are as significant as genetic changes. Aim: This work was done in order to evaluate if methylation status of BRCA1, p16, MGMT, RASSF1 and CDH-1 genes in triple-negative brast cancer as prognostically the worst subtype of breast cancer, can be correlated with clinical course and can serve as prognostic markers of disease. Material and Methods: 131 breast cancer patients with surgery as primary treatment were included: 61with triple-negative breast cancer (TNBC) and 70 with estrogen, progesterone positive and Her2 negative (ER+, PR+, Her2- ) breast cancer that represents prognostically the best subtype of breast cancer. The pateints were followed up between 1 and 87 months (median 78 months). Status of promotor hypermethylation of BRCA1, p16, O6MGMT, RASSSF1 i CDH-1 genes was determined in the tumor tissue since methylation is tissue and tumor specific. DNA was isolated from fresh frozen tissues by salting out procedure. Status of promotor hypermethylation was determined by methylation-specific PCR. Results: There was statistically significant difference only in p16 hypermethylated breast cancer cases when TNBC was compared with ER+PR+Her2- group, 33 (54.1%) vs. 20 (28.6%), p=0.00298. Although the difference between the incidences of BRCA1 hypermethylation between the examined groups of patients did not reach statistical significance, we observed a tendency towards higher occurrence of BRCA1 hypermethylation in TNBC compared to ER+PR+Her2- cases: 33 (54.1%) vs. 27 (38.6%), p=0.0752. When the frequencies of co-methylated (combined hypermethylation of the examined genes) p16 and RASSF1A genes (p16+RASSF1A+) were compared between the breast cancer patients with TNBC and ER+PR+Her2- characteristics, we found that the number of patients with both hypermethylated genes was significantly higher in the TNBC than in ER+PR+Her2- group: 20 (32.8%) vs. 10 (14.3%), p=0.0225..