Razina hemoglobina u odgovoru na preoperativnu kemoiradijaciju u bolesnica s lokalno uznapredovalim rakom vrata maternice

Hemoglobin level is a very important prognostic factor in patients with gynecological carcinomas. Anemia in patients with cervical carcinoma occurs frequently and is due to the aggressive biological potential of a tumor as well as because of the poor response of patients to radiation therapy. Chemoradiation is a standard treatment followed by surgery in patients with locally advanced cervical carcinomas. Good overall results after such treatment, good quality of life, and almost no recidivism have established this method as a treatment of choice for patients with locally advanced cervical carcinomas. Sixty-four female patients with cervical carcinoma underwent neoadjuvant chemoradiation, followed by radical hysterectomy at the Department of Gynecologic Oncology, University Medical Center in Zagreb. The stages of the disease ranged from FIGO stage Ib1 to FIGO stage IIIa. Histopathological findings were squamous cell carcinoma and glandular carcinoma of the cervix. The ECOG performance status was graduated from 0 to 1. Neoadjuvant chemoradiation regimen included cisplatin (40 mg/m² once a week for 4 weeks) with concomitant radiotherapy (40 Gy total pelvic + brach therapy). Furthermore, the time interval between chemoradiation and surgery was evaluated. Response to chemoradiation therapy was observed, and the hemoglobin level and general conditions (according to the ECOG performance status) were evaluated. All the 64 patients had chemoradiation therapy prior to radical surgery. The median dosage at point A was 77.28 Gy and the median duration time of chemoradiation was 34.37 days. The time interval from chemoradiation to radical surgery was approximately 34.4 days. Hemoglobin levels decreased from 120.7 to 108.7 g/l at the end of concomitant chemoradiation. The mean tumor diameter was significantly decreased after neoadjuvant chemoradiation, and we classified the results after chemoradiation therapy as complete remission, partial remission, and stabilization of the disease, according to the WHO response criteria with respect to the size of a residual tumor. After chemoradiation and surgery, the hemoglobin level and long-term survival were evaluated. The correlation between the hemoglobin level and long-term survival after neoadjuvant chemoradiation and radical surgery in patients with different stages of cervical cancer was studied. We found that hemoglobin level could be a prognostic factor, but mostly, along with other prognostic factors, such as ECOG performance status, stage of the disease, dosage at point A, and interval between chemoradiation and surgery. However, we observed that the cellular types of tumor were of no significance.Razina hemoglobina važan je prognostički pokazatelj u odgovoru na zračenje bolesnica s ginekološkim malignomima. Anemija udružena s rakom vrata maternice česta je i pokazatelj je ne samo biološki agresivnijeg tumora već može biti i uzrokom slabijeg odgovora na zračenje. Kemoiradijacija je uobičajeni način liječenja bolesnica s lokalno uznapredovalim rakom vrata maternice s ciljem poboljšanja odgovora na liječenje i preživljenja. Operativni zahvat nakon neoadjuvantne kemoiradijacije smanjuje lokalni recidiv. U Zavodu za ginekološku onkologiju u razdoblju od 1/01 do 12/04 liječene su 64 bolesnice s rakom vrata maternice. Stadij bolesti određivao se prema FIGO-klasifikaciji (od Ib1-IIIa), patohistološki se radilo o pločastom i žljezdanom tipu raka vrata maternice, a opće stanje određivalo se prema ECOG-u (0-1). U svih bolesnica provedeno je vanjsko zračenje zdjelice u dozi od 40 Gy, a potom i unutarnje zračenje, 1 aplikacija LDR s Cezijem 137 u dozi od 35-38 Gy u točku A. Tijekom vanjskog zračenja bolesnice su primale 1x tjedno Cisplatinu u dozi od 40 mg/m2 ukupno 4x kao radiosenzibilizator. Nakon provedenog zračenja bolesnice su operirane (histerektomija s adneksektomijom uz resekciju forniksa vagine, a u nekih bolesnica učinjena je i zdjelična limfadenektomija). Za vrijeme zračenja pratili smo vrijednosti hemoglobina 1x tjedno kao i opće stanje koje smo stupnjevali prema ECOG-u. Sve bolesnice su prije operacije ozračene. Srednja doza u točku A bila je 77,2 Gy, prosječno vrijeme zračenja bilo je 34,37 dana. Vrijeme između završetka zračenja i operacije iznosilo je 34,4 dana. Razina hemoglobina i veličina tumora znatno su se smanjivali tijekom kemoiradijacije. Procjenu odgovora na kemoiradijaciju učinili smo na patohistološkom nalazu uklonjenog vrata maternice prema WHO podjeli kao potpuni odgovor (CR), djelomičan odgovor (PR) te stabilnu bolest (SD). Početna vrijednost hemoglobina te redovito praćenje razine hemoglobina tijekom kemoiradijacije pokazali su kako je veći postotak CR i PR u bolesnica s višim vrijednostima hemoglobina (>120 mg/L nasuprot <100 mg/L). Bazalne i kontrolne vrijednosti hemoglobina u bolesnica s lokalno uznapredovalim rakom vrata maternice koje su liječene kemoiradijacijom i operacijom pokazale su se kao dobar prognostički pokazatelj odgovora na primijenjeno liječenje. Ovaj pokazatelj mora se uzeti u obzir s ostalim kao što su: stupanj uznapredovalosti bolesti, histološka diferencijacija i opće stanje bolesnice

Fusarium vrste i njihovi mikotoksini u zrnu pšenice

Incidence of fungi and concentration of mycotoxin deoxynivalenol (DON), zearalenone (ZON) and fumonisin (FB1) were studied in the grain of the winter wheat collected subsequently after harvesting in 2010. In the analyzed samples the highest incidence was determined for the species of Fusarium (84.7%) genus, significantly lower incidence was determined for the species of genus Alternaria (12.35%), and especially for species of genera Acremoniella (2.05%), Acremonium (0.65%) and Penicillium (0.25%). F. graminearum (99.05%) was the most present species of Fusarium genus, whereas the following species F. sporotrichioides (0.4%), F. subglutinans (0.4%), F. poae (0.05%), F. proliferatum (0.05%) and F. verticillioides (0.05%) were only sporadic. The presence of DON, ZON and FB1 mycotoxins was established in all studied wheat samples. DON was detected in concentrations from 123 to 393 μg kg-1 (average 214 μg kg-1), ZON from 157.144 to 471.055 μg kg-1 (average 299.934 μg kg-1), and FB1 from 2.715 to 16.488 μg kg-1 (average 6.286 μg kg-1).Učestalost gljiva i koncentracija mikotoksina deoksinivalenola (DON), zearalenona (ZON) i fumonizina (FB1) proučavana je u zrnu ozime pšenice prikupljene neposredno nakon žetve u 2010. godini. U ispitivanim uzorcima najveću zastupljenost imaju vrste iz roda Fusarium (84,7%), a znatno manje vrste iz roda Alternaria (12,35%), a posebno iz rodova Acremoniella (2,05%), Acremonium (0,65%) i Penicillium (0,25%). Od vrsta roda Fusarium najzastupljenija je vrsta F. graminearum (99,05%), dok su sporadične vrste F. sporotrichioides (0,4%), F. subglutinans (0,4%), F. poae (0,05%), F. proliferatum (0,05%) i F. verticillioides (0,05%). Prisustvo mikotoksina DON, ZON i FB1 ustanovljeno je u svim ispitivanim uzorcima zrna pšenice. DON je bio detektovan u koncentracijama od 123 do 393 μg kg-1 (prosek 214 μg kg-1), ZON od 157,144 do 471,055 μg kg-1 (prosek 299,934 μg kg-1) i FB1 od 2,715 do 16,488 μg kg-1 (prosek 6,286 μg kg-1)

Hernijacija kroz drenažni otvor kao rijetka rana -komplikacija laparoskopije

Port site hernia is very rare but serious complication after laparoscopic procedures. In clinical practice drain is often placed in 10 mm or larger trocar port sites. We report a case of 61-year-old woman who underwent laparoscopy and developed small bowel herniation and incarceration in a 12 mm port site in which 24 Fr drain was inserted leaving real free space of approximately 4 mm. There are only a few case reports with the similar pathology. Priority should always be on the adequate fascial closure of port sites. Smaller trocar insertion sites (<10 mm) should be used as insertion sites for drains.U kliničkoj praksi abdominalni dren se često postavlja na mjesta insercije troakara promjera većih od 10 mm, te je pojava hernije, kao vrlo rijetke ali ozbiljne komplikacije ovih zahvata moguća. U prikazanom slučaju, na mjestu insercije troakara promjera 12 mm lijevo postavljen je dren veličine 24 Fr koji je dodatno reducirao prostor dostupan za hernijaciju na oko 4 mm. Kroz ovaj otvor ipak je došlo do hernijacije i inkarceracije tankog crijeva, što je opisano u svega nekoliko slučaja. Smatramo kako je važno odgovarajuće zatvaranje defekata fascije na mjestu postavljanja troakara i postavljanje abdominalnog drena na mjesta insercije troakara promjera manjih od 10 mm

Fuzariotoksini u zrnu pšenice u Srbiji

Samples of wheat grain (41), collected during the 2010 harvest from seven localities in Serbia, were analyzed for the presence of zearalenone (ZEA), T-2 toxin, deoxynivalenol (DON) and fumonisine B1 (FB1). Results of Enzyme-Linked Immunosorbent Assay (ELISA) showed that all analysed samples were positive for the presence of at least one of four observed fusariotoxins. The most distributed mycotoxins were ZEA (90.2%, with the average concentration of 442.6μg kg-1) and T-2 (90.2%, with the average concentration of 24.2 μg kg-1). DON (73.2%) and FB1 (84.4%) were detected in a somewhat smaller number of samples, but their average concentrations were higher (1988.1 μg DON kg-1 and 882.7 μg FB1 kg-1). The established correlations between concentrations of DON and FB1 (r = 0.32) or DON and ZEA (r = 0.22) were not statistically significant. A negative correlation was established between concentrations of T-2 and FB1 (r= -0.24), as well as, between T-2 and DON (r = -0.36). Detected concentrations of ZEA and T-2 were bellow the level prescribed by the World Health Organisation (WHO), while concentrations of FB1 and DON detected in five that is, 17 samples, respectively, were above the permissible limit for human consumption.Uzorci zrna pšenice (41), sakupljeni tokom žetve 2010. godine iz 7 različitih lokaliteta na teritoriji Srbije, analizirani su na prisustvo ZEA, T-2 toksina, deoksinivalenola (DON) i FB1. Primenom ELISA metode utvrđeno je da su svi analizirani uzorci bili pozitivni na prisustvo bar jednog od četiri ispitivana fuzariotoksina. Najzastupljeniji mikotoksini su bili ZEA (90,2%, prosečne koncentracije 442,6 μg kg-1) i T-2 (90,2%, prosečna koncentracija 24,2 kg-1). U nešto manjem broju uzoraka utvrđeni su DON (73,2%) i FB1 (84,4%), ali u većoj prosečnoj koncentraciji (1988,1 μg DON kg-1 i 882,7 μg FB1 kg-1). Nije utvrđena statistički značajna korelacija između koncentracije DON i FB1 (r = 0,32) ili DON i ZEA (r = 0,22). Negativna korelacija je utvrđena između koncentracije T-2 i FB1 (r = -0,24), kao i između T-2 i DON (r = -0,36). Detektovane koncentracije ZEA i T-2 bile su niže od nivoa koji propisuje Svetska zdravstvena organizacija, dok su FB1 i DON detektovani kod 5, odnosno 17 uzoraka u koncentraciji većoj od dozvoljenih u ljudskoj hrani

Ovarian Cancer: PCD and Brain Metastases

Paraneoplastic cerebellar degeneration (PCD), the one of the most common paraneoplastic syndromes, refer to clinical disorders associated mostly with lung, ovarian and breast cancer, but not directly caused by the cancer or its metastases. Pathologic finding is an extensive loss of Purkinje cells in the cerebellum. Immunohistocemicaly, the auto-antibodies on the Purkinje cells had been detected. Clinically, PCD is characterized by sub-acutely evolving pancerebellar symptoms. Neurological dysfunction may appear before the detection of the underlying cancer. Therefore, the surgical exploration is necessary for the final diagnosis. The patient undergoes specific therapy. Soon, neurological status of the patient gets irreparable worse. Death come usually 2–3 years after the first symptoms of the PCD occurs. Case of a 63-years old woman with PCD as the first evidence of her cancer is reported. The patient developed brain metastases and died almost 3 years after the first symptoms of PCD occur

Clinical significance of sentinel lymph node detection in early vulvar cancer

UVOD. Cilj istraživanja bio je ustanoviti limfni čvor čuvar kod raka stidnice, najpogodniji način njegove detekcije, te koliko odsustvo metastaza u sentinel limfnom čvoru korelira s proširenošću bolesti. ----- ISPITANICE I METODE. Na uzorku od 28 bolesnica s početnim stadijem raka stidnice, liječenih u Zavodu za ginekološku onkologiju Klinike za ženske bolesti i porode KBC-a Zagreb i MF-a Sveučilišta u Zagrebu, od 01. siječnja 2004. do 31. prosinca 2010, određivali smo sentinel limfni čvor kombinirajući limfoscintigrafsko obilježavanje radioaktivnim tehnecijem, patohistološku te imunohistokemijsku analizu preparata. Sve su bolesnice operirane kirurškom metodom „3 u 1”. Podaci su statistički obrađeni. ----- REZULTATI. U 28 ispitanica određivan je sentinel limfni čvor. Ukupno je odstranjeno 346 limfnih čvorova, od toga je 57 bio SLN. Točno su prepoznati svi pozitivni limfni čvorovi (kappa koeficijent podudarnosti od 1,000 i razina značajnosti P<0,001). Kod lateralnog sijela primarnog tumora SLN je dokazan ipsilateralno, kod centralnih i multifokalnih bilateralno. χ2-testom uz Yatesovu korekciju i, alternativno Fisherovim egzaktnim testom dokazali smo kako je recidiv češći u bolesnica s pozitivnim SLN (P=0,001; P=0,002). Ispitanice koje su imale negativne sentinel limfne čvorove imale su medijan vremena do pojave recidiva od 12 (5,0 – 12,0) mjeseci naprama ispitanicama koje su imale pozitivan sentinel limfni čvor u kojih je medijan vremena bio 1 mjesec (1,0 – 1,0) (Mann-Whitneyjev U-test, P=0,001). Regresijskim modelom je kao značajan prediktor rizika za nastanak recidiva bolesti izdvojeno prisustvo barem jednog pozitivnog limfnog čvora čuvara s omjerom šansi od 4,11 (P=0,049, 95% CI 1,21-13,89). ----- ZAKLJUČAK. Kombinirajući limfoscintigrafsko obilježavanje sentinel limfnog čvora radioaktivnim tehnecijem, Tc-99m, patohistološku analizu preparata na standardni način (H&E) i imunohistokemijsku analizu (AE1/AE3), točnost prepoznavanja pozitivnog sentinel limfnog čvora je 100%. Analizirajući sve parametre ukupno utvrdili smo kako je nalaz limfnog čvora značajan prediktor pojave recidiva bolesti, odnosno najvažniji nezavisni prognostički čimbenik.OBJECTIVES. To investigate the real sentinel lymph node (SLN) in vulvar cancer, the best method of detection, and the significance of the absence of metastases in SLN for spread of disease. ----- MATERIALS AND METHODS. Twenty-eight patients with early vulvar cancer (FIGO I and II) were treated in the Department of Gynecologic Oncology, University Clinic Zagreb, from January, 1st, 2004 to December, 31st, 2010. Detection of SLN was done by using technetium-99m radioisotope, standard sectioning with haematoxylin and eosin staining (H&E) and immunostaining by cytokeratin cocktail, AE1/AE3. All patients underwent “triple separate incision” surgical procedure. Data were statistically analyzed. ----- RESULTS. In all 28 patients, the detection of SLNs was performed. A total of 346 were removed, and 57 of those were SLNs. All positive SLNs were detected (kappa coefficient 1.000, P<0.001). When the primary lesion was situated laterally, the SLN was detected among the ipsilateral inguinofemoral lymph nodes. When the primary lesion was situated in the midline and bilaterally, the SLNs were detected among bilateral inguinofemoral lymph nodes. Chi-square-test with Yates-correction and, alternatively Fisher’s test proved that the reoccurrence of disease is more often when the SLNs are positive (P=0.001; P=0.002). Patients with negative SLNs had a median time interval to reoccurrence of disease of 12 months (5.0-12.0 months) in contrast with patients with positive SLNs who had a median time interval to reoccurrence of disease of 1 month (1.0-1.0 months) (Mann-Whitney U-test, P=0.001). With Cox regression analysis, at least one positive SLN was marked as a very important factor for reoccurrence of disease with odds chance of 4.11 (P=0049, 95% CI 1.21 – 13.89). ----- CONCLUSION. By using technetium-99m radioisotope, H&E staining, and immunostaining with AE1/AE3, recognition accuracy of positive SLN is 100%. Analyzing parameters all together, the status of SLNs is the most important prognostic factor