ABSTRACT
PURPOSE: To assess differences between patients with breast cancer before, during and after the 1991-1995 war in Croatia. MATERIAL AND METHODS: We analyzed 660 patients of Pozesko-Slavonska County, during the three periods. Relative predictive values of patient's characteristics and stage of tumor were assessed using the X2-test, and survival with Kaplan-Meier analysis. RESULTS: Tumors were significantly more often of higher stages (IIA and IIB) and with axillary lymph node metastases (N1) during the war, than in pre-war and post-war period.Breast cancer was significantly more frequent in patients who previously experienced death in the family (35,3%). The Kaplan-Meier analysis showed correlation between survival, T and N stages of tumor and clinical stage of tumor. CONCLUSION: The war aggression towards Croatia with its impact on our patients, contributed to modification of characteristics of breast cancer in the analyzed period.
Subject(s)
Breast Neoplasms, Male/pathology , Breast Neoplasms/pathology , Stress, Psychological/psychology , Warfare , Axilla , Breast Neoplasms/psychology , Breast Neoplasms, Male/psychology , Croatia , Death , Female , Humans , Life Change Events , Lymphatic Metastasis/pathology , Male , Neoplasm Staging , Retrospective Studies , Survival Rate , Time Factors , Treatment OutcomeABSTRACT
PURPOSE: In spite of the general consensus on the issue, to point to major dilemmas which appear in this matter of multidisciplinary interest, and to review current concepts on how to achieve optimal diagnostic and therapeutic outcome. RESULTS: Recent literature data show that the rate of gestational breast cancer, according to most protocols, range from 0.2% to 3.8%. By definition, the clinical manifestation of this type of carcinoma is expected to occur during pregnancy or within one year after delivery. The mode of treatment and prognosis is identical to those of women with breast carcinoma beyond pregnancy, except for radiotherapy that is not indicated during pregnancy and selective use of cytostatics in polychemotherapy during the first trimester. The only exceptions to this practice are women with any advanced stage of the disease due to delayed diagnosis. Results of large studies indicate that the therapy for breast cancer has no adversarial effect on the prognosis of subsequent pregnancy. CONCLUSION: The evaluation and management of women with gestational breast cancer requires a multidisciplinary approach. A chemotherapeutic regimen should be individualised to a maximum reduction of risk, if applied in the second and third trimester. Surgical therapy may include mastectomy and sparing operative procedures. Sentinel node biopsy should be considered in node negative patients. Radiotherapy should be postponed to the postpartum period.
Subject(s)
Breast Neoplasms/diagnosis , Breast Neoplasms/therapy , Pregnancy Complications, Neoplastic/diagnosis , Pregnancy Complications, Neoplastic/therapy , Female , Humans , PregnancyABSTRACT
Fournier's gangrene is a rare infection characterized with fast-progressing myonecrosis, that affect regions of perineum, genitalia and perianal area. This retrospective study presents authors' experiences and their principles in early diagnosis and treatment of Fournier's gangrene. The goal of this paper is to point out numerous diagnostically and therapeutic difficulties that lead to a high mortality if not recognized in time. We here describe seven male patients with myonecrosis and necrotising fasciitis in scrotal, perianal and perineal regions. Average age was 61 years (form 57 to 66 years of age), and average length of treatment was 25.8 days (from 14 to 36 days), with lethality of 14% (one case). We have recognised diabetes mellitus as risk factor, together with urethrostenosis, and other diseases of the perianal region (hemorrhoids, anal fissure, abscesses). Our hypothesis is that the key of the successful treatment is to treat as soon as symptoms onset, early and aggressive necrectomy under broad antibiotic protection. We also emphasize the possibility of recurrence of this disease even several years after treatment.
Subject(s)
Fournier Gangrene/therapy , Aged , Anti-Bacterial Agents/therapeutic use , Anus Diseases/diagnosis , Anus Diseases/etiology , Anus Diseases/therapy , Combined Modality Therapy , Diabetes Complications/diagnosis , Diabetes Complications/etiology , Diabetes Complications/therapy , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/etiology , Fasciitis, Necrotizing/therapy , Fournier Gangrene/diagnosis , Fournier Gangrene/etiology , Humans , Male , Middle Aged , Perineum , Retrospective Studies , Scrotum , Treatment Outcome , Ureteral Obstruction/complicationsABSTRACT
Radial scar is a confusing lesion of the breast which represent a premalignant lesion. It looks like a tubular carcinoma but histologically we can see two rows of cells in tubules. Mammographically there are some typical but not specific signs: (1) the presence of the central radiolucency, (2) the presence of radial long thin spicules, (3) varying appearance in different projection, (4) radiolucent linear structures parallel to spicules, and (5) abscence of palpable lesion or skin changes. All these signs make the "black star" appearance. Authors reanalyzed 21 from 26 woman with the radial scar diagnosis. Aim of our study was to investigate the different morphologic changes in view of differential diagnosis, frequency and potential prognostic importance of the different lesions. According to our findings we can conclude that the radial scar is unpalpable, subclinical lesion which can be seen on mammography but the final diagnosis is histological.
Subject(s)
Breast Neoplasms/diagnosis , Carcinoma/diagnosis , Cicatrix/diagnosis , Adult , Aged , Breast/pathology , Breast Diseases/diagnosis , Breast Diseases/pathology , Breast Neoplasms/pathology , Carcinoma/pathology , Cell Proliferation , Cicatrix/pathology , Female , Humans , Mammography/methods , Middle Aged , Precancerous Conditions , Radiography/methods , Retrospective StudiesABSTRACT
The work of the Pozega Medical Center Surgical Unit during the two war years (from July 16, 1991, to October 1, 1993) in Croatia is described. Since the war operations did not affect the town directly, the work was mostly characterized by treatment of wounds inflicted by explosive devices (51.2%) and localized mostly on the extremities (62.9%). Apart from these wounds, there were 0.7% burns, 26.6% gunshot wounds, and 19.6% injuries caused by blunt and hard objects. Of the total of 959 treated wounded persons, only 18 (1.9%) died, illustrating the success of the therapy administered according to the war surgery doctrine criteria.
