Organizational aspects of breast cancer screening in Sarajevo region.

PURPOSE: To analyze basic parameters of success and organizational aspects of screening for breast cancer implemented in the Sarajevo Canton area during the period 2000- 2006 and, based on the acquired experience, to suggest the most adequate model of screening in order to create a continuing and efficient constituent part of the population healthcare system. PATIENTS AND METHODS: Out of 30,134 women of the target age group 45-55 years, an invitation was delivered to 27,473 of them. 16,085 (53.4%) women were screened. Out of this number 33.6% came after the invitation and the remaining 66.4% were informed of the screening project from other sources, most of them after their doctor's advice. RESULTS: In 355 (2.2%) examined women mammographic findings were suspicious for malignancy, and out of this number in 187 (1.16%) women cancer was histologically proven. All diagnosed cancers were potentially curable by surgery. Even though this screening project could be considered as successful after its termination, early detection of breast cancer is not carried out as regular activity due to non existing system to refer women for examination, insufficient technical equipment and shortage of qualified and trained medical personnel. CONCLUSION: Based on the experience acquired, we believe that breast cancer screening, as an overall and continuing process, should be part of the regular healthcare system rather than a project or campaign. Screening needs to be an integral part of the primary healthcare system with family medicine as a starting point. Sufficient number of qualified and trained medical personnel, mammographers, spare parts, maintenance and service of the equipment are necessary. Good cooperation and communication of institutions included in the screening and fl ow of relevant information are of basic importance.

[Requirements for hospital emergency diagnosis in definitive treatment of injuries]. / Neophodne urgentne dijagnostike u bolnickom definitivnom zbrinjavanju povreda.

For the purpose of prompt diagnostics, next to emergency room, we have x-ray room with a possibility of chest and skeleton x-ray filming, as well as one mobile x-ray machine and ultrasound device, with a radiologist and radiographer on 24 hours shift. Subspecialists radiologists are on call, if necessary to perform special radiological procedure like angiography, CT, or MRI. We use CT like screening method for all neurological cases in emergency room. Well equipped urgent laboratory is on service 24 hours a day with a specialist biochemist and laboratory technician so all the urgent laboratory findings are available promptly and even can submit a result by phone. Blood bank has also extended department next to emergency room with full service 24 hours a day. Our experience showed that urgent diagnostic, organised in this way, provides faster definite treatment whether patient is going to Intensive Care Unit (ICU) for further reanimation or to operating room for urgent surgical procedure.

[Diagnosis of aortic coarctation using digital techniques]. / Dijagnostika coarctatiae aortae digitalnim tehnikama.

PURPOSE: In order to analyse a contribution of digital techniques in diagnostics of the aortic coarctation (CoA), a grow up of patients in whom the aforesaid disease was found, has been described. MATERIAL AND METHODS: There were examined, within 1986 and 1998, 12 patients suspected of CoA and 2 patients were subjected to medical check up of state after operation of this anomaly. There was 12 (86%) men and 2 (14%) women. Six patients were children. Average age of the patients was 25 years. The youngest was 6 and the oldest 51 years old. 12 patients underwent the intravenous digital subtraction angiography, 3 patients underwent computed tomography, and 1 patient was subjected to magnetic resonance imaging. RESULTS: There has been found CoA in 10 male patients and pseudo-coarctation of the aorta in 2 female patients advanced in years. A satisfactory diagnostics was possible by use of any of the three methods. CONCLUSION: Noninvasive methods of examination, intravenous-digital subtraction angiography (IV-DSA), computed tomography (CT), and magnetic resonance (MR) are and more alternatives to invasive angiographic examinations. Magnetic resonance is suitable especially in pediatrics since radiation could be avoided.

[Organization of radiologic services in Sarajevo during the war (1992-1995)]. / Organizacija radioloske djelatnosti u Sarajevu tokom agresije (1992.-1995.).

The organization and functioning of radiological diagnostic services in Sarajevo during the three and a half years of aggression are presented. The sudden and brutal aggression, all kinds of blockage, and total unreadiness of the services caused many problems regarding the number, age structure and qualification of the staff, expended and technically defective equipment lacking spare parts and shortage of electric power, water, heating, of X-ray films, chemicals, contrast agents, sanitary, and all other kinds of material. In spite of all these problems and the necessary narrowing of indications, from April 1992 till September 1995, 340,079 radiological examinations were performed at the Institute of Radiology and 82,924 in the State Hospital, respectively. The majority of examinations was done on the muscular-skeletal system and the thorax. All radiological techniques like classic roentgenology, ultrasound examinations, computerised tomography and digital methods were used. The organisation employed in both institutions proved justified, rational and effective. It can be concluded that in this difficult period the radiological diagnostic services in Sarajevo fulfilled what was demanded of them. Regarding the extremely difficult circumstances, their contribution could also be deemed unexpected.

[Digital angiography of pulmonary vein anomalies]. / Digitalna angiografija anomalija plucnih vena.

In this study, the authors made the analysis of five patients who had striped tortuous pulmonary density or wide hilus at the standard radiography examination. By the pulmonary intravenous digital subtraction angiography method, a pulmonary varix was discovered in two cases and in one case a wide common mouth of the right pulmonary veins in the left atrium. Mild variation of the dilatation of the pulmonary veins was present in two cases out of which one was with an aberrant draining into the left atrium. Digital angiography, as a simple screening method, give us a possibility of the ambulatory check up of the large number of patients and therefore a more frequent discovery of these, in the most cases asymptomatic anomalies, what eliminates an unnecessary surgical treatment.

[Diagnosis of post-traumatic aortic pseudoaneurysm]. / Dijagnostika posttraumatske pseudoaneurizme aorte.

We can say that with the traffic's development, more and more, we become faced with aorta's posttraumatic pseudoaneurysm. We diagnosed it, accidentally, in the medical findings, with five patient, by computed tomography, and intravenous digital subtraction angiography, within the thirteen years period. These methods are presented as complementary ones in the matters of diagnose. Diagnose is of the great importance for this disease, considering its unpredictable evolution and a possibility of death outcome.

[Diagnosis of duplicate superior vena cava]. / Dijagnostika dvostruke vene kave superior.

Anomalies of the system vein entrance into the right atrium are rarity, particularly in the double superior vena cava. As an isolated anomaly it is asymptomatic. Throughout eight years period we have been making computed tomography checks of 4045 patients, and with five of them, meaning 1.2 promil we have discovered double superior vena cava as a random finding. The diagnosis was confirmed by means of a bi-cubital intravenous digital subtraction angiography. The diagnosis of these anomaly is significant for the differential diagnostics from tumor syndrome, as well as for prevention of surprises in studies of the mediastinum.

[95 years' of radiology in Sarajevo]. / Devedesetpet godina radiologije u Sarajevu.

The development of the radiology in Sarajevo from its beginning in "Zemaljska bolnica", 3-4 years after Rontgen's epochal finding of X-rays, till now has been reviewed in this paper. Equal and parallel development of the diagnostic radiology, as well as radiotherapy is given chronologically, regarding the stuff, equipment and premises. This is referred to the period before and after The Second World War till 1973, when--after stagnation--radiology started developing relatively quickly. With the integration of the service within the Sarajevo Region, building the annex, modernizing the equipment, especially by providing digital radiological techniques, current organisation of the work and necessary, adequately educated medical stuff, the development of radiology in Sarajevo was on its way up, in professional, educational and scientific aspect. At the end, present condition and the needs of premise, equipment and stuff, as well as some points of the possible further development of the radiology in Sarajevo have been summarized in this paper.

[Radiologic diagnosis of bronchogenic carcinoma]. / Radioloska dijagnostika bronhogenog karcinoma.

The staging classifications and basic characteristics of five cell types of bronchogenic carcinoma, as well as the sensitivity and specificity of plain radiography, CT and MRI in the staging of central and peripheral bronchogenic carcinoma have been presented. In conclusion, it was emphasized that CT, US and MRI have considerably improved diagnostics of bronchogenic carcinoma, although there are still difficulties regarding their sensitivity and specificity in the assessment of malignant mediastinal and hilar adenopathy, pleural and chest wall infiltration and tissue categorisation of the solitary pulmonary nodule. Finally, two schemes for evaluation of the patients with central bronchogenic carcinoma and solitary pulmonary nodule have been recommended.

[CT aspects of brain metastases in bronchial carcinoma]. / CT aspekti metastatskog karcinoma bronha u mozgu.

Twenty patients of 210 with the brain metastases with diagnosed bronchogenic carcinoma were analysed, according to existing morphological criteria of computed tomography (CT), in correlation with pathohistologically findings (PHD) of primary tumor. Multiple lesions and perifocal edema as the main CT features of metastatic disease of the brain were confirmed. Some details like increased frequence of the solitary forms and uncharacteristic perifocal edema were emphasized. Also, some differential diagnostic possibilities with the brain metastases were considered.

[Frequency of abdominal metastases in bronchogenic carcinoma]. / Ucestalost abdominalnih metastaza kod bronhogenog karcinoma.

In the retrospective study, 210 patients with diagnosed bronchogenic carcinoma have been managed during four years period. In this group there were 23 patients with abdominal metastases; 21 with liver metastases and 2 with adrenal metastases. Abdominal metastatic lesions were diagnosed by ultrasonography and CT. With the patients with liver metastases, 4 of them had solitary lesion, and remaining 17 patients had multiple metastases. In the same group, 8 patients had planocellulary cancer, 5 microcellulary cancer, 3 had confirmed anaplastic cancer, and 5 patients were without pathohistologically confirmed findings. In one case of adrenal metastases planocellulary cancer was found, and in another case of adrenal metastases pathohistological diagnosis was unknown. The authors concluded that ultrasonography and CT were the methods of choice in diagnostics liver and adrenal glands metastases with the patients with bronchogenic carcinoma.

[Frequency of bone metastases in bronchogenic carcinoma]. / Ucestalost kostanih metastaza bronhogenog karcinoma.

Medical findings of 210 patients with bronchogenic cancer in the four years period of time were elaborated retrospectively. Bone metastases were found with 27 (13.8%) patients. Diagnostic radiologic procedure were plain radiography and CT. The frequency, the localization and the distribution of bone metastases depending on pathohistological diagnosis were presented. The bone metastases were the most frequent (27 patients or 13.8%) compared to metastases of abdomen (23 patients or 10.9%) and brain (20 patients or 9.5%). Out of the total number of 27 (100%) patients with bone metastases, 9 (33.3%) of them have got solitary metastases, and 18 (66.7%) patients have got multiple metastases. Large number of bone metastases were located at spine, and very rarely at radius, ulna and scapula. It was shown that the small cell carcinoma with the most malignant potential was found with 3 (11.1%) patients only. It can be explained by the fact that a large number of patients hadn't got pathohistological diagnosis (13 patients or 48.2%). As a conclusion, the high percentage of patients without final diagnosis is a result of insufficient diagnostic procedures, the radiological ones due to a lack of technical means and not performing biopsy and autopsy.

[Multiple neoplasms]. / Multiple neoplazme.

This paper describes observation on multiple carcinomas, with emphasis on double carcinomas of the lungs and other organs. The paper presents four cases of multiple neoplasmas and goes on to discuss eventual etiopathogenesis of multiple malignancies. Of the four cases presented in this paper, three cover double carcinoma of the throat and lungs, and in the fourth, double carcinoma of the lung and bladder. Three of the cases covered relate to metachronous carcinoma and the fourth case to synchronous carcinoma.

[Evaluation of findings in computerized tomography and other diagnostic methods in pulmonology]. / Evaluacija nalaza kompjuterizirane tomografije i drugih dijagnostickih metoda u pulmologiji.

The work has presented a retrospective study of 123 clinica patients, who underwent the chest computerized tomography (CT). With the aim to evaluate the possibilities and importance of CT in diagnosis and therapy of the different pathologic processes, CT results were analysed in relation to other diagnostic methods results. The superiority over conventional radiography (including fluoroscopy and conventional tomography) and importance in evaluation of mediastinal anomalies and pulmonary nodules were confirmed in defining the stages of neoplasms according to TNM system the planning and follow-up of therapy results. CT is not a tissue specific method; the invasive methods are necessary for the definitive histologic diagnosis.

[Analysis of the results of bronchoalveolar lavage (BALF) in patients with pulmonary sarcoidosis]. / Analiza rezultata bronhoalveolarnog ispirka (BALF) kod pacijenata sa sarkoidozom pluca.

Bronchoalveolar lavage is a relatively new method in pulmonology. Treatment of broncho-alveolar fluid-washing/BALF/obtained after the procedure of broncho-alveolar lavage/BAL/enables obtaining of samples for investigation of inflammatory and immune cells, so-called alveolar, which, treated by different laboratory procedures, represent the source for different informations at many lung diseases. Analysis of BALF is significant in the differential diagnosis of interstitial lung changes, in the estimate of process activity as well in analysis of therapy with glucocorticosteroids, as well as in the estimate of immune cells state, particularly T abd B lymphocyte subpopulations. We have analysed BALF in 161 patients with lung sarcoidosis with the purpose of analysing the process activity and according to activity of lymphocyte alveolitis in relation to total lymphocyte number in BALF cytogram and by identification of T and B lymphocytes and their subpopulations/CD4, CD8, CD11/as well as by the index CD4/CD8. We have determined the CD4, CD8, CD11 values as well as B lymphocytes by monoclonal antibodies, manufactured by ORTHO-mune/USA/, signed by the manufacturer as OKT4, OKT8, OKT11, OKT22, conjugated by gost antimice IgG antibodies. The working procedure we have done according to instructions of the manufacturer by immunofluorescent technic.

[Aspiration biopsy of thoracic lesions using the Chiba needle under CT guidance]. / Aspiraciona biopsija torakalnih lezija chiba iglom pod kontrolom CT-a.

Percutaneous transthoracic aspiration biopsy (PTAB) is an interventional radiologic procedure for histologic confirmation or elimination of malignant nature of the lesion. The development of digital techniques (introduction of CT and US) and small gauge needles increased the interest for this method. CT scanner enables the accurate determination of the entry point of the puncture guide, precise visualisation of the needle tip and reliable analyses of complications. The type of the puncture needle is very important for establishment of the correct diagnosis. Of 163 Chiba needle punctures the cytologically representative samples were obtained in 84.7% and pathohistologically representative samples in 56%. Of complications the most common was pneumothorax found in 9.7% and alveolar hemorrhage in 9.1% cases. In this paper the method and contribution of the Chiba needles are analysed compared to the results of other authors obtained by other types of needles. Our results are satisfying with small number of complications.

[Significance of two-dimensional echocardiography in the diagnosis of mitral valve calcification--sensitivity and specificity]. / Znacaj dvodimenzionalne ehokardiografije u dijagnostici kalcifikacija mitralnog zaliska--senzitivnost i specificnost metode.

The effect of two-dimensional echocardiography in assessment mitral valve calcifications was compared to computed tomography (CT) in 50 patients with pure rheumatic mitral stenosis (MS). Echocardiography revealed no mitral calcifications in 23 patients, respectively 46 per cent (grade 0). Twelve patients (24 per cent) had calcifications smaller than 2.5 mm (grade 1). Eleven (22 per cent) had moderate calcifications, smaller than one half of length of the anterior mitral leaflet (grade 2) and four (8 per cent) had calcifications larger than one half of the length of the anterior mitral leaflet (grade 3). The last two groups were thought to have clinically important calcifications. Specificity and sensitivity were examined in comparison to CT. By echocardiography, five (ten per cent) false positive findings were found in the group 2. There were neither false positive nor false negative findings in the last two group. The first group when compared with other three groups showed sensitivity of 100, specificity of 85, and predictive accuracy of 81 per cent. But the first two groups together compared with the last two groups showed sensitivity, specificity and predictive accuracy of 100 per cent.

[Percutaneous transthoracic aspiration biopsy guided by computer tomography]. / Perkutana transtorakalna aspiraciona biopsija pod kontrolom kompjuterizirane tomografije (CT).

CT-guided percutaneous transthoracic aspiration biopsy presenting one of interventional radiologic procedures, has enabled the sample providing for cytologic analysis. It has been frequently used with the aim of confirmation or elimination of malignant neoplastic process. The main advantages of CT over fluoroscopy are precise needle visualization, documentation of needle tip in the lesion, puncture of small, for fluoroscopy unreachable lesions, as well as the adequate presentation of eventual complications. The authors have analysed, retrospectively, 195 findings of patients, who underwent CT-guided Chiba needle percutaneous transthoracic aspiration biopsy. The finding was cytologically representative in 85.64% of cases, unrepresentative in 14.36%. Out of all complications, pneumothorax (9.74%) and perifocal hematom (9.23%) were most frequent. Contraindications, complications and safety of this very useful method in definitive diagnosing and planning of the adequate therapy have been discussed.