Preoperative Diagnosis of Fallopian Tube Malignancy with Transvaginal Color Doppler Ultrasonography and Magnetic Resonance Imaging after Negative Hysteroscopy for Postmenopausal Bleedin

Primary Fallopian tube carcinoma is a rare malignancy and is not often diagnosed preoperatively. We present a case of a 67-year old woman who complained of postmenopausal vaginal bleeding. After a negative hysteroscopy, transvaginal ultrasound showed a well vascularized solid-cystic tumor in the adnexal region separate from the ovary. The presence of an adnexal mass was confirmed by MR imaging. Total abdominal hysterectomy with bilateral salpingoophorectomy, omentectomy and appendectomy, as well as pelvic and para-aortic lymphadenectomy was performed. The pathohistological diagnosis was poorly differentiated serous adenocarcinoma of the Fallopian tube, FIGO stage IA. The patient was subsequently treated with platinum based adjuvant chemotherapy

Kirurško zdravljenje akutnega izpaha pogačice s kostnim odlomkom pri otrocih

Purpose: The management of acute patellar dislocation in children and adolescents is controversial. Traditionally,most first time traumatic patellar dislocations have been treated nonoperatively. However, due to new knowledge about medial patellar stabilizers some authors have advocated for surgical repair. The present report describes the midterm subjective and functional results of operative treatment of acute patellar dislocation in children less than eighteen years of age with concomitant osteochondral fracture. Methods: Data on a cohort of sixteen patients (eight girls and eight boys) aged 14.9 years (mean, range12-17 years) with acute patellar dislocation were retrospectively collected. Intraarticular fragments were detected in all patients in conventional radiographs. Operative treatment consisted of arthroscopic removal (12cases) or refixation (4 cases) of the osteochondral fragments and direct repair of the damaged medial patellofemoral ligament (MPFL) if that was still feasible (13 cases). All patients were seen at six months, and a telephone interview with twelve patients (75%) was conductedat four years (mean, range 27 years). Results: Of the sixteen patients, two (12.5%) had a recurrent patellar luxation. The subjective IKDC score at the time of the most recent follow up was 86 (mean, range 63-100), and the Marx Activity Rating Scale score was 9.2 (mean, range 216).Conclusions: Direct surgical repair of the injured MPFLmay be considered an option to prevent subsequent dislocation and subluxation in first time traumatic dislocation of the patella in children and adolescents with osteochondral fractures and substantial disruption of medial patellar stabilizers.Namen: O zdravljenju akutnega izpaha pogačice pri otrocih in mladostnikih še ni jasnega konsenza. Tradicionalno zdravljenje prvega poškodbenega izpaha pogačice je bilo konzervativno, zaradi novih spoznanj o medialnih stabilizatorjih pogačice pa nekateri avtorji v zadnjem času priporočajo operacijsko zdravljenje. Pričujoča raziskava opisuje srednjeročne subjektivne in funkcionalne rezultate operacijskega zdravljenja akutnega izpaha pogačice s pridruženim osteohondralnim odlomkom pri otrocih in mladostnikih, mlajših od osemnajst let. Metode: Retrospektivno smo zbrali podatke 16 bolnikov (osmih deklic in osmih dečkov), povprečno starih 14,9 (12-17) let z akutnim izpahom pogačice. Pri vseh bolnikih smo na rentgenskih posnetkih ugotovili prisotnost znotrajsklepnih odlomkov. Bolnike smo operacijsko zdravili z artroskopsko odstranitvijo (12 primerov) ali refiksacijo (4 primeri) osteohondralnih odlomkov in neposrednim popravilom medialne patelofemoralne vezi, kjer je bilo to še mogoče (13 primerov). Bolnike smo pregledali po šestih mesecih in z dvanajstimi (75 %) opravili telefonski pogovor po povprečno štirih (2-7) letih. Rezultati: Dva izmed 16 bolnikov (12,5 %) sta imela ponovni izpah pogačice. Povprečno doseženo število točk po subjektivnem IKDC točkovniku ob zadnjem sledenju je bilo 86 (63-100), po Marx Activity Rating Scale pa 9,2 (216). Zaključki: Neposredna kirurška rekonstrukcija medialne patelofemoralne vezi predstavlja možnost preprečitve ponovne dislokacije in subluksacije pogačice. Posebej primerna je lahko ob prvem travmatskem izpahu pogačice pri otrocih in mladostnikih z osteohondralnimi zlomi in obsežnejšo okvaro medialnih stabilizatorjev pogačice

Prognostic significance of some clinical, histopathological and biological parameters for survival of node-negative breast cancer patients treated in University Medical Centre Maribor in the period 2000–2009

Izhodišča. Enega izmed največjih izzivov pri zdravljenju raka dojk v zgodnjem stadiju predstavlja izbor bolnic s predvidenim agresivnejšim potekom bolezni, ki potrebujejo dopolnilno sistemsko zdravljenje. O tem se odločamo na podlagi različnih napovednih dejavnikov, kot so status pazdušnih bezgavk, velikost tumorja, stopnja diferenciacije, limfovaskularna invazija, starost bolnic, status hormonskih receptorjev, status HER2, v zadnjem času pa v ta namen ponekod uporabljajo tudi urokinazni aktivator plazminogena (uPA) in inhibitor aktivatorja plazminogena 1 (PAI-1). Vloga novejših napovednih dejavnikov v primerjavi s tradicionalnimi še ni povsem razjasnjena. Namen raziskave je bil ugotoviti vpliv posameznih dejavnikov na preživetje bolnic z rakom dojk brez zasevkov v bezgavkah, zdravljenih v Univerzitetnem kliničnem centru (UKC) Maribor. Hkrati sem želela tudi primerjati preživetje bolnic, zdravljenih v UKC Maribor, s slovenskim povprečjem. Bolnice in metode. Opravila sem retrospektivno analizo bolnic z invazivnim rakom dojk brez zasevkov v bezgavkah, ki so bile primarno zdravljene v UKC Maribor v letih 2000–2009. Podatke sem pridobila iz medicinske dokumentacije in jih dopolnila s podatki iz Registra raka Republike Slovenije, od koder sem pridobila tudi podatke o vseh primerljivih slovenskih bolnicah, zdravljenih v istem obdobju. Analizirala sem korelacije med napovednimi dejavniki in s pomočjo Coxove regresije in Coxovega modela sorazmernih tveganj opravila univariatne in multivariatne analize preživetja brez bolezni, celokupnega in specifičnega preživetja. Rezultati. Študijsko skupino je sestavljalo 858 bolnic s srednjim časom sledenja 101 mesec. Med bolnicami, zdravljenimi v UKC Maribor, in vsemi slovenskimi bolnicami ni bilo razlik v celokupnem (HR 1,0795 % CI 0,91–1,27p = 0,413) in specifičnem preživetju (HR 0,8595 % CI 0,66–1,11p = 0,234). Preživetje brez bolezni (HR 0,6795 % CI 0,50–0,91p = 0,010) in specifično preživetje (HR 0,5395 % CI 0,30–0,94p = 0,031) je bilo statistično značilno boljše v obdobju 2005–2009 v primerjavi z 2000–2004, pri celokupnem preživetju pa se je kazal enako usmerjen statistično neznačilen trend (HR 0,7395 % CI 0,51–1,05p = 0,087). Med napovednimi dejavniki so bile prisotne številne korelacije. V multivariatnih analizah so na preživetje brez bolezni najbolj vplivali starost ob diagnozi, vrednost uPA/PAI-1 in status estrogenskih receptorjev, na celokupno preživetje starost, stopnja diferenciacije in vrednost uPA/PAI-1, na specifično preživetje pa stopnja diferenciacije. Zaključki. Preživetje bolnic z rakom dojk brez zasevkov v bezgavkah, primarno zdravljenih v UKC Maribor v letih 2000–2009, je zelo visoko in enakovredno preživetju vseh primerljivih bolnic na ravni Slovenije. Kot najpomembnejša napovedna dejavnika sta se pri tej skupini bolnic izkazala vrednost uPA/PAI-1 in stopnja diferenciacije, ki sta klinično pomembno vplivala na preživetje brez bolezni, celokupno in specifično preživetje.Introduction. The choice of patients with an expected aggressive course of the disease who need adjuvant systemic treatment represents one of the main challenges of early stage breast cancer treatment. Prognostic factors, such as lymph node status, tumour size, grade, lymphovascular invasion, patient age, hormone receptor status, HER2 status, and more recently urokinase plasminogen activator (uPA) and plasminogen activator inhibitor 1 (PAI-1), can be used to guide this decision. The significance of some novel prognostic factors in comparison with traditional factors is not yet completely understood. The purpose of this study was to determine the effect of different prognostic factors on survival in node-negative breast cancer patients treated in University Medical Centre Maribor. In addition, I wished to compare the survival of patients treated in Maribor with that of all Slovenian patients. Patients and methods. A retrospective analysis of lymph node-negative invasive breast cancer patients treated in University Medical Centre Maribor in the years 2000–2009 was performed. Data were obtained from patient medical records and from the Cancer Registry of Republic of Slovenia whence I also obtained information on all comparable Slovenian patients diagnosed in the same period. Correlations between different prognostic factors were analysed. Univariate and multivariate analyses of disease-free (DFS), overall (OS), and breast cancer specific survival (BCSS) were performed using the Cox regression and the Cox proportional hazards model. Results. The study group consisted of 858 patients with a median follow-up of 101 months. No differences were observed between the Maribor and Slovenian patients in terms of OS (HR 1.0795% CI, 0.91–1.27p=0.413) and BCSS (HR 0.8595% CI, 0.66–1.11p=0.234). DFS (HR 0.6795% CI, 0.50–0.91p=0.010) and BCSS (HR 0.5395% CI, 0.30–0.94p=0.031) were significantly better for patients diagnosed in the period 2005–2009 compared to 2000–2004 and a similar though unsignificant trend was observed for OS as well (HR 0.7395% CI, 0.51–1.05p=0.087). Many correlations existed between different prognostic factors. In multivariate analyses, DFS was particularly influenced by patient age at diagnosis, uPA/PAI-1 level and oestrogen receptor status, OS by age, grade and uPA/PAI-1 level, and BCSS by tumour grade. Conclusions. Survival of node-negative breast cancer patients treated in University Medical Centre Maribor in the period 2000–2009 was very good and not inferior to the survival of comparable patients at the national level. The most important prognostic factors in node-negative patients were uPA/PAI-1 level and tumour grade because they had a clinically important influence on DFS, OS and BCSS