Rak jajnika, jajovoda i potrbušnice: kirurško liječenje

Surgery is the cornerstone of eff ective management of the ovarian, tubal and peritoneal cancer. In 2014 the International Federation of Gynecology and Obstetrics (FIGO) published a new classifi cation collectively covering cancer of ovary, fallopian tube and peritoneum as well as malignant ovarian germ cell tumors and malignant sex-cord stromal tumors. Comprehensive surgical staging according to the 2014 FIGO classifi cation system plays an important role in management of apparently early stage of ovarian, tubal and peritoneal cancer. Primary debulking (cytoreductive) surgery followed by paclitaxel and platinum based combination chemotherapy is the cornerstone of the advanced-stage disease treatment. In cases of suboptimal primary cytoreduction, interval debulking surgery performed after two to four cycles of chemotherapy based on the clinical judgment of the gynecologic oncologist is second att empt to achieve optimal cytoreduction. Secondary cytoreductive surgery can be considered in patients with platinum-sensitive locally recurrent ovarian cancer. The volume of residual tumor remaining after these surgical approaches is one of the most important independent prognostic factors for survival.Kirurško liječenje je temelj uspješnog liječenja raka jajnika, jajovoda i potrbušnice. Međunarodno federacija ginekologa i opstetričara (FIGO) u 2014. godini objavila je novu klasifi kaciju koja zajedno obuhvaća rak jajnika, jajovoda, potrbušnice, zloćudne tumore zametnih stanica i zloćudne tumore specijalizirane strome jajnika. Kirurško stupnjevanje bolesti prema FIGO 2014 klasifi kaciji je ključno u liječenju raka jajnika, jajovoda i potrbušnice naizgled ranog stadija bolesti. Primarna citoredukcijska kirurgija i dodatno liječenje kemoterapijom je standardni pristup uznapredovaloj bolesti. Prilikom suboptimalne citoredukcije tijekom primarnog kirurškog zahvata “interval debulking surgery” nakon drugog do četvrtog ciklusa kemoterapije, ovisno o procjeni ginekološkog onkologa, drugi je pokušaj postizanja optimalne ciotredukcije. Sekundarna citoredukcijska kirurgija dolazi u obzir kod pacijentica koje su osjetljive na kemoterapiju, a imaju lokalni povrat bolesti. Veličina rezidualnog tumorskog tkiva nakon kirurških zahvata je najznačajniji prognostički čimbenik na koji se može utjecati tijekom liječenja

Regional development assessment using parametric and non-parametric ranking methods: A comparative analysis of Slovenia and Croatia

In this paper we describe several regional development-assessment methods and subsequently apply them in a comparative development level analysis of the Slovenian and Croatian municipalities. The aim is to compare performance and suitability of several parametric and non-parametric ranking methods and to develop a suitable multivariate methodological framework for distinguishing development level of particular territorial units. However, the usefulness and appropriateness of various multivariate techniques for regional development assessment is generally questionable and there is no clear consensus about how to carry out such analysis. Two main methodological approaches are based on parametric and non-parametric methods, where in the former an explicit econometric model containing theory-implied causal and possibly simultaneous relationships is estimated using likelihood-based methods and formally assessed in terms of the goodness of fit and other test statistics, subsequently allowing for estimation of the development level on a metric scale, while in the later, territorial units or regions are essentially classified into clusters or groups differing in the development level, but no formal inferential methods are applied to confirm the validity of the model, or to establish the difference in the development level on a metric scale. The possible advantages of the first approach are in the existence of formal testing and evaluation procedures, as well as in producing interval ranks of the analysed units, while its disadvantages are in the lack of robustness; often unrealistic distributional assumptions; and possible invalidity of the theoretically implied causal relationships. In this paper we consider a parametric, inferential approach based on maximum likelihood estimation of the linear structural equation model with latent variables for metric-scale development ranking, and a non-parametric approach based on cluster analysis for development grouping. Our analysis is based on ten regional development variables such as income per capita, population density, age index, etc. which are similarly collected and generally compatible for both analysed countries. Within the parametric approach, a simultaneous equation econometric model is estimated and latent scores are computed for each underlying latent development variable, where three latent constructs are postulated corresponding to economic, structural and demographic development dimensions. In the non-parametric approach, a combination of Ward?s hierarchical method and K-means clustering procedure is applied to classify the territorial units. We apply both methodological frameworks to Slovenian and Croatian municipality data and assess their regional development level. We further compare the performance of both methods and show to which degree their results are compatible. Finally, we propose a unified framework based on both parametric and non-parametric methods, where clustering techniques are performed both on the original development indicators and on the computed latent scores from the structural equation model, and compare these results with the results from each of the two methods applied separately. We show that a combined parametric/non-parametric approach is superior to each approach applied individually and propose a methodological framework capable of estimating the development level of territorial units or regions on a metric scale, while in the same time preserving the robustness of the non-parametric techniques.

Učinak Tamoxifen na ženski reproduktivni sustav

Tamoxifen, a triphenylethyleneestrogen receptor modulator, is an eff ective treatment for estrogen receptor positive breast cancer patients. It acts as an estrogen antagonist in breast tissue and a week estrogen agonist in the female genital tract. Its estrogenagonist properties refl ects on increased risk of gynaecologic pathologies and includes the development of endometrial cancer, endometrial hyperplasia, endometrial polyps, adenomyosis, leiomyomas, uterine sarcomas, cervical polyps and ovarian cysts. Breast cancer patients during tamoxifen treatment should be under close gynaecological and ultrasonographic surveillance.Tamoxifen, trifeniletilenski modulator estrogesnih receptora, se koristi u liječenju raka dojke s pozitvnim estrogenskim receptorima. U tkivu dojke i tumorskim stanica ima estrogen-antagonistički učinak, a u ženskom spolnom sustavu blagi agonistički učinak što se očituje povećanim rizikom od ginekoloških bolesti koje uključuju rak endometrija, hiperplaziju endometrija, polipe endometrija, adenomiozu, miome, sarkome, polipe vrata maternice i ciste jajnika. Bolesnice s rakom dojke koje se liječe tamoxifenom trebaju biti redovito ginekološki i ultrazvučno pregledavane

Predictors of Nonalcoholic Steatohepatitis in Patients with Elevated Alanine Aminotransferase Activity

Incidence of obesity and hepatic steatosis is increasing worldwide. Almost one quarter of western countries population suffer from non alcoholic fatty liver disease (NAFLD). The aim of this study was to investigate the frequency and predictors of nonalcoholic steatohepatitis (NASH) in patients with unexplained alanine aminotransferase activity elevation (ALT), and therefore avoid unnecessary biopsies in cases of simple steatosis. Earlier studies provided different results and have not answered the question how to distinguish NASH from simple steatosis. Ultrasound (US), computed tomography (CT) and magnetic resonance (MRI) can detect steatosis with great sensitivity level, but not NASH. This study included 50 patients (18 women and 32 men) with mean age 43±9 years, and with defined selected biochemical, anthropometric and hormone biomarkers. The average BMI was 27.1±3.81 (kg/m2), insulin resistance HOMA IR 3.89± 3.81. All patients underwent liver biopsy and NASH was staged by NASH activity score (NAS) from 1 to 8. Results are compared to pathohistological finding as relevant method. The results show that 90% of patients (n=45) had NAFLD (minimal stage at least), and 15 (30%) had nonalcoholic steatohepatitis (NASH). High triglyceride, low HDL and high ferritin serum levels correspond with NASH. As in earlier studies, insulin resistance as basic mechanism of NAFLD and NASH was confirmed

Izražajnost proteina HER-2 i njegova prognostička vrijednost u karcinomu dojke

Immunohistochemical analysis of the HER-2 protein expression in ductal invasive breast cancer was done on archival paraffin-embedded breast cancer tissue using specific monoclonal antibodies. All of the 190 analyzed patients were treated at the University Hospital for Tumors, Zagreb, Croatia, from September 2002 to September 2003. Year of birth, tumor size, histological type of tumor, histological grade, lymph-node status, steroid receptors, HER-2 expression, nuclear grade and vascular invasion were determined for each patient. HER-2 overexpression was found in 24% of the patients. HER-2 overexpression was not associated with age, but it was associated significantly with tumor size, worse histological and nuclear grades, lack of steroid receptors, lymph node involvement and positive vascular invasion. Steroid receptors expression was associated significantly with better nuclear grade and negative vascular invasion.Izražajnost HER-2 proteina te steroidnih receptora u duktalnom invazivnom karcinomu dojke određena je imunohistokemijski, uporabom monoklonskih protutijela. Korišten je arhivski bioptički materijal uklopljen u parafinske blokove. Svih 190 analiziranih bolesnica liječeno je u Klinici za tumore, Zagreb, Hrvatska, u razdoblju od rujna 2002. do rujna 2003. godine. Svakoj bolesnici utvrđena je godina rođenja, veličina tumora, histološka slika tumora, histološki gradus tumora, zahvaćenost pazušnih limfnih čvorova metastazama, nalaz steroidnih receptora, nalaz HER-2 proteina, nuklearni gradus te vaskularna invazija. Analizom imunohistokemijskih rezultata utvrđena je izražajnost HER-2 proteina kod 24% bolesnica. Nije utvrđena statistički značajna razlika u izražajnosti HER-2 proteina s obzirom na dob bolesnica, a utvrđena je povezanost HER-2 proteina s nepovoljnijim prognostičkim čimbenicima: većom veličinom tumora, nepovoljnijim stupnjem diferenciranosti tumora, većom zahvaćenosti pazušnih limfnih čvorova metastazama, negativnim nalazom steroidnih receptora, pozitivnom vaskularnom invazijom te nepovoljnijim nuklearnim gradusom. Statistički je utvrđena i povezanost steroidnih receptora s povoljnijim prognostičkim čimbenicima: povoljnijim nuklearnim gradusom i negativnom vaskularnom invazijom

Recidivirajuća pupčana endometrioza: prikaz slučaja i pregled literature

Umbilical primary endometriosis is a rare localization of the functional endometrial tissue outside of uterine cavity and it represents 0.5-1% of ectopical endometriosis. We are reporting a case in which recurrence of umbilical endometriosis has occurred 5 months after excision of umbilical endometriotic lesion and 19 years after the surgery of endometriotic cyst of the right ovary. It caused periodical bleeding from the umbilicus, associated with severe abdominal pain. Endometriosis was suspected and treated by wide surgical excision. Pathohistological analysis confirmed the diagnosis of endometriosis.Primarna endometrioza funkcionalnog endometrijskog tkiva izvan maternice s lokalizacijom u pupku je rijetkost sa zabilježenom pojavnoš}u 0,5-1% među ektopičnim endomteriozama. Opisujemo bolesnicu u koje je recidiv pupčane endomterioze nastupio 5 mjeseci nakon ekscizije pupčane endometriotičke lezije i 19 godina nakon operacije endometriotičke ciste u desnom jajniku. Endometrioza je uzrokovala povremeno krvarenje iz pupka, povezano s jakom boli u trbuhu. Zbog sumnje na endometriozu primijenjena je široka kirurška ekscizija. Patohistološka analiza potvrdila je dijagnozu endometrioze