ABSTRACT
The HERe2Cure project, which involved a group of breast cancer experts, members of multidisciplinary tumor boards from healthcare institutions in Bosnia and Herzegovina, was initiated with the aim of defining an optimal approach to the diagnosis and treatment of HER2 positive breast cancer. After individual multidisciplinary consensus meetings were held in all oncology centers in Bosnia and Herzegovina, a final consensus meeting was held in order to reconcile the final conclusions discussed in individual meetings. Guidelines were adopted by consensus, based on the presentations and suggestions of experts, which were first discussed in a panel discussion and then agreed electronically between all the authors mentioned. The conclusions of the panel discussion represent the consensus of experts in the field of breast cancer diagnosis and treatment in Bosnia and Herzegovina. The objectives of the guidelines include the standardization, harmonization and optimization of the procedures for the diagnosis, treatment and monitoring of patients with HER2-positive breast cancer, all of which should lead to an improvement in the quality of health care of mentioned patients. The initial treatment plan for patients with HER2-positive breast cancer must be made by a multidisciplinary tumor board comprised of at least: a medical oncologist, a pathologist, a radiologist, a surgeon, and a radiation oncologist/radiotherapist.
Subject(s)
Breast Neoplasms/diagnosis , Breast Neoplasms/therapy , Receptor, ErbB-2/metabolism , Bosnia and Herzegovina , Combined Modality Therapy , Female , Humans , Mammography , MastectomyABSTRACT
Because of the unannounced war state in Bosnia and Herzegovina in the period 1992-1995, there were overlapping of war and peaceful doctrine of taking care of all injuries. Many extraperitoneal and intraperitoneal injuries of colon and rectum were treated in the Cantonal Hospital Zenica and in the other war hospitals where the staff of Cantonal Hospital Zenica worked. According to the war doctrine all injuries of colon and rectum are treated operatively with obligatory making colostoma. This presentation includes 7 cases of extraperitoneal rectum injuries from great number of intra- end extraperitoneal injuries of rectum and injuries of colon, which were not treated by principles of war doctrine. We emphasize that surgical teams were experienced, had diagnostic equipment and operation hall with staff and equipment in the case of reintervention. THE AIM: Of this presentation is to point out the size of lesion and the association with the other injuries in order to decide about operative or conservative way of treatment as alternative method. It was necessary to define the patients in which we would avoid colostoma with adequate drainage procedures, first of all looking at the size of lesion and the association with the other injuries. THE MAIN DIAGNOSTIC PROCEDURE: Was rectoscopic verification of all 7 injuries with the presentation of size of lesion. THE MAIN METHOD OF TREATMENT: Was high grade quality, continuous and adequate toilette and drainage of canal of injury and perirectal area following with antibiotics (metronidasol) and stool regulation. In comparison with doctrinal treatment by making colostoma there was no significant more complications and lethal outcome by this alternative method of treatment. CONCLUSION: Six of seven cases of extraperitoneal rectum injuries with lesion not bigger than 30 mm and with small pelvis mutilation were solved using conservative method (not making colostoma).
