The Role of Adjuvant Radiotherapy in the Treatment of Breast Cancer.

The role of postmastectomy radiotherapy and regional nodal irradiation after radical mastectomy is defined in high-risk patients with locally advanced tumors, positive margins, and unfavorable biology. The benefit of postmastectomy radiotherapy in intermediate-risk patients (T3N0 tumors) remains a matter of controversy. It has been demonstrated that radiotherapy after breast-conserving surgery lowers the locoregional recurrence rate compared with surgery alone and improves the overall survival rate. In patients with four or more positive lymph nodes or extracapsular extension, regional lymph node irradiation is indicated regardless of the surgery type (breast-conserving surgery or mastectomy). Despite the consensus that patients with more than three positive lymph nodes should be treated with radiotherapy, there is controversy regarding the recommendations for patients with one to three involved lymph nodes. In patients with N0 disease with negative findings on axillary surgery, there is a trend to administer regional lymph node irradiation in patients with a high risk of recurrence. In patients treated with neoadjuvant systemic therapy and mastectomy, adjuvant radiotherapy should be administered in cases of clinical stage III and/or ≥ypN1. In patients treated with neoadjuvant systemic therapy and breast-conserving surgery, postoperative radiotherapy is indicated irrespective of pathological response.

[Ulnar Carpus Translation - our Experience]. / Ulnare Karpustranslation ­ unsere Erfahrungen.

The ulnar translation (UT) of the wrist is a rare but often missed injury. We report about our experiences in the treatment of 8 patients with an imminent (5), established (1), and chronic UT (2).

The Czech version of the Utian Quality of Life Scale questionnaire assessing women's quality of life during menopause.

Introduction: Menopause is a physiological process, forming a part of a lifetime that most women go through. This period of life is briefly described by experts as a triple transformation: biological, social, and psychological. For menopausal women, health care professionals can use one of 10 specific questionnaires to assess health-related quality of life and its symptoms. The authors herein speak about the preparation of a Czech version of one such questionnaire - the Utian Quality of Life Scale (UQOL). Material and methods: A Czech version of the UQOL was created by repeated and backward translation. It was validated on a sample of 204 women after natural menopause (45-65 years old). We judged the reliability of the Czech version of UQOL using Cronbach's a. We assessed the instrument's validity by means of confirmation factor analysis. Results: The authors modified the original version of the UQOL. The Czech version has 4 new domains with 18 items. This form was created using the results of confirmation factor analysis. Conclusions: The Utian Quality of Life Scale questionnaire is completed by the women themselves, thus meeting the golden rule of all quality-of-life research stating that the primary source should be data from the client him/herself. However, this requirement raises some methodological problems.

Special Techniques of Adjuvant Breast Carcinoma Radiotherapy.

Modern radiotherapy techniques are designed to permit reduced irradiation of healthy tissue, resulting in a diminished risk of adverse effects and shortened recovery times. Several randomized studies have demonstrated the benefits of increased dosage to the tumor bed area in combination with whole breast irradiation (WBI). Conventional WBI treatment following breast-conserving procedures, which required 5-7 weeks of daily treatments, has been reduced to 3-4 weeks when using hyperfractionated regimens. The dosage administration improves local control, albeit with poorer cosmesis. The method of accelerated partial breast irradiation (APBI) shortens the treatment period whilst reducing the irradiated volume. APBI can be delivered using intraoperative radiation, brachytherapy, or external beam radiotherapy. Currently available data support the use of external beam partial breast irradiation in selected patients. Modern radiotherapy techniques make it possible to achieve favorable cosmesis in most patients undergoing immediate breast reconstruction surgery, and studies confirm that current methods of external beam radiation allow an acceptable coverage of target volumes both in the reconstructed breast and in the regional lymphatic nodes.

Case Report: Human Recombinant Growth Hormone Therapy in a DSH Cat Presented With Dwarfism.

A 6-month-old kitten, male, domestic shorthair cat was presented with dwarfism, ocular and nasal discharge, and Ascaris infestation. Congenital hyposomatotropism was diagnosed on the basis of serum level of insulin-like growth factor-1 (IGF-I). The cat was treated with human recombinant growth hormone for 9 weeks. After that, his liver enzymes became elevated, and the therapy was discontinued. His IGF-I levels were normal at the end of the therapy. Normal IGF-I was present 3 months after discontinuation of therapy with human recombinant growth hormone and even half a year after the discontinuation. All other comorbidities were addressed with the therapy. The cat is now the size of normal cats, living with the first author.

Controversies of radiotherapy in human epidermal growth factor receptor (HER)-2 positive breast cancer patients.

Tumor biology plays a crucial role in the systemic treatment, specifically in HER2-positive tumors. Distinct biological behavior of breast cancer subtypes is associated with different rates of locoregional recurrence (LRR). HER2- positive breast cancer patients treated with surgery in combination with radiation, without trastuzumab have poor outcome, including high LRR. The efficacy of radiotherapy in HER-2-positive breast cancer appears to be associated with the expression of estrogen receptors. In patients with HER-2-positive breast cancer, studies conducted before the introduction of trastuzumab indicated higher benefit of adjuvant radiation in patients with hormone receptor-positive tumors compared to patients with tumors not expressing hormone receptors. The introduction of agents targeting HER-2 has transformed the management of these patients, resulting in improved outcomes. The data of clinical studies show that the administration of trastuzumab as part of a multimodality approach (with radiation based on standard guidelines) results in improved outcomes, including lower locoregional recurrence. The risk of cardiac toxicity associated with radiation to the heart and administration of potential cardiotoxic trastuzumab is not clear. In patients treated concomitantly with regional lymph node irradiation and anti-HER-2 agents after prior anthracycline-based chemotherapy minimizing the dose to the myocardium, e.g. respiratory gating or proton beam radiotherapy, have been suggested.

Consequences of holocaust on physical health of survivors: bibliography review.

OBJECTIVE: Period of elderly age preordains the occurrence of many health issues. People deported during World War II to concentration camps suffered from malnutrition, lack of sleep, physical and mental exhaustion. Recently, the health condition of Holocaust survivors is often complicated as a result of physical punishments and different torture methods as well as mental hardships which they had suffered during deportation. The consequences often have psychosomatic nature thus the survivors are often receivers of health care. The topic of bibliography review is based on the need to objectivize and systematically evaluate subjective health issues of Holocaust survivors in connection with trauma related to the stay in a concentration camp. The aim is to offer a review of effects of the Holocaust on health of different body systems for survivors in concentration camps and Jewish ghettos in the course of World War II. METHODS: To map the subjective problems of Holocaust survivors, evidence-based medicine (EBM) method has been used with the help of scientific database PubMed, CINAHL Plus with full text, ProQuest and other sources with specific key words and Boole operators. Prognostic type of clinical/review questions has been selected for the bibliography review, which is trying to predict the probability of relation or output of illness/condition and based on diseases or symptoms seriousness to find out expectancy for treatment/improvement of care. RESULTS: 175 studies have been found in basic search with the use of key words both in English and in Czech language. The search has not been time-limited. The advanced search has focused on different body systems and health damage due to Nazi experiments. Fourteen studies have been used to complete the study. The research results have confirmed the significant effect of Holocaust trauma on body condition of the survivors. The reasons of this condition were insufficient nutrition, unsuitable and harmful hygienic, living and working conditions and brutality of the guards. According to the research, these factors have impacted all organ systems, mainly locomotion and cardiovascular ones. The results have shown a more frequent occurrence of osteoporosis, fractures of long bones and corresponding chronical pain of people of Jewish origin who had gone through different forms of torture during World War II. Other present symptoms include gastrointestinal problems, tumors mainly in the area of colorectum and lungs. Moreover, the stay in concentration camps had influence on women's menstrual cycle. CONCLUSION: The studies of Holocaust effects are an example of the influence of an extreme mental and physical burden on the body condition of the survivors' health. The results of the studies have shown a wide range of the effects also in mental and social areas.

Paediatrics in Theresienstadt ghetto.

The main objective of this study is to describe the most common childhood diseases occurring in the Theresienstadt ghetto during the Second World War as well as applied anti-epidemic measures. A partial objective is to describe medical and nursing care of sick child prisoners. The data was obtained by the method of synthesis of primary and secondary data with the highest importance after adequate external source criticism using selected monographs, memoirs, survivor diaries, Orders of the day by the Council of the Elders and Reports of the Jewish self-government of the Theresienstadt ghetto from 1941 to 1945, the Archives of the Jewish Museum in Prague, the Ghetto Museum, the Museum of the History of Polish Jews in Warsaw, Post Bellum online electronic collection of oral historical interviews, and witness accounts. The validity of the presented conclusions is ensured by comparing data from several sources. The most common infections in Theresienstadt children were enteritis, scarlet fever, infectious jaundice, measles, mumps, rubella, varicella, black cough, pneumonia, otitis media, and typhoid fever. Most of these infections had entirely atypical symptomatology or complications. Children were hospitalized in children's hospitals, in children's rooms of hospitals for adults and infirmaries in children's homes. Albeit diagnostic methods had a high standard, options of treatment were very limited. The most common treatments included bed rest, diet and cold compress. Occasionally, chemotherapeutic agents (e.g. a sulphonamide drug Prontosil) and Aspirin were available. The anti-epidemic measures in the ghetto focused on hygiene, enhancing children's immunity, vaccination and pest control.

Selective Carpus Denervation - One of Treatment Options of Madelung Deformity. / Selektive Carpusdenervation als Behandlungsmöglichkeit einer Handgelenksarthrose bei Madelung-Deformität.

Case presentation of 7 years follow up of female patient with wrist arthritis caused by Madelung deformity. As causal treatment remains unknown, the pain reduction by means of selective wrist denervation is one possible option.

Prevalence of late-life depression and gap in mental health service use across European regions.

Background We aimed to determine the prevalence and gap in use of mental health services for late-life depression in four European regions (Western Europe, Scandinavia, Southern Europe and Central and Eastern Europe) and explore socio-demographic, social and health-related factors associated with it. Methods We conducted a cross-sectional study based on data from the Survey on Health, Ageing and Retirement in Europe. Participants were a population-based sample of 28 796 persons (53% women, mean age 74 years old) residing in Europe. Mental health service use was estimated using information about the diagnosis or treatment for depression. Results The prevalence of late-life depression was 29% in the whole sample and was highest in Southern Europe (35%), followed by Central and Eastern Europe (32%), Western Europe (26%) and lowest in Scandinavia (17%). Factors that had the strongest association with depression were total number of chronic diseases, pain, limitations in instrumental activities of daily living, grip strength and cognitive impairment. The gap in mental health service use was 79%. Conclusions We suggest that interventions to decrease the burden of late-life depression should be targeted at individuals that are affected by chronic somatic comorbidities and are limited in mental and physical functioning. Promotion of help-seeking of older adults, de-stigmatization of mental illness and education of general practitioners could help decrease the gap in mental health service utilization.

Active pharmaceutical ingredients available as substances for extemporaneous preparation in veterinary medicine in the Czech Republic.

UNLABELLED: In veterinary medicine, extemporaneously prepared drugs can be also used in therapy. In the recent four years the selection of suitable compounds for extemporaneous (magistral) preparation has been expanded and new possibilities for the creation of formulas have appeared. The paper reports on the substances available for compounding that can be used in veterinary medicine, in the pharmacotherapeutic classes antibiotics, antimycotics, antiseptics, corticosteroids, emollients and epithelizing agents, anti-inflammatory drugs, local anesthetics, decongestives, beta-blockers and calcium channel blockers, antiemetics and prokinetics, sedatives and hypnotics. The emphasis has been placed on newly available substances. Examples of suitable magistral formulas are presented that can replace mass-produced drug products which are not readily obtainable. The aim of the paper is to inform pharmacists and veterinarians about new possibilities of drug compounding. KEYWORDS: compounded preparations extemporaneous preparation compounding of drugs possibilities magistral formulas in veterinary medicine.

Compounded preparations with nystatin for oral and oromucosal administration.

Therapy of oral, esophageal and gastrointestinal candidiasis is still a common problem that can be solved by an administration of antimycotics. Major disadvantage of registered commercial antifungal medicinal products is their price, so the health care system and its payers may profit from extemporaneous compounding. An appropriate drug therapy for candidiasis (trush) is nystatin, which is a substance available in the Czech Republic for the magistral preparation relatively recently, since 2010. Making formulas for extemporaneous compounding is quite simple and preparations particularly useful for dentists, pediatricians, otolaryngologists, oncologists and gastroenterologists. The authors formulated composition of viscous oromucosal suspension, oral/oromucosal hydrogel and oromucosal gelatine globule which may be present as compounded products containing nystatin for oromucosal and/or oral administration. The preparation is practically verified and magistral products have been already used in clinical practice.

InPouch™ TF-Feline medium is not specific for Tritrichomonas foetus.

Trichomonads are a group of anaerobic flagellates. Two species of intestinal trichomonads have been described in cats - pathogenic Tritrichomonas foetus and probably harmless Pentatrichomonas hominis. InPouch™ TF-Feline medium (Bio-Med Diagnostics, White City, Oregon, USA) is considered the gold standard for diagnosis of T. foetus infection in cats. It is commercially available, relatively cheap and easy-to-use. The medium is intended to be highly specific to T. foetus as morphologically similar Pentatrichomonas hominis and Giardia sp. do not survive here longer than 24h. In this study we successfully cultivated P. hominis in InPouch™ TF-Feline medium for 3 days after inoculation with cat faeces. The identity of the organism was assessed by sequencing of SSU rDNA and ITS region. Possible coinfection with T. foetus was ruled out using Tritrichomonas-specific PCR. Our results suggest possible misdiagnosis of tritrichomonosis in cats using InPouch™ TF-Feline medium. PCR-based verification of culture-positive samples prior the potentially neurotoxic ronidazole treatment is recommended.

[Magistral prepared lidocaine-gel for topical aplication on skin]. / Lidokainový gel pro pouzití na kuzi magistraliter pripravený.

Due to a limited availability of industrially manufactured products containing local anesthetics for skin application and an increased demand for lidocaine-containing gel applicable prior to a product containing capsaicin for neuropathic pain treatment, it is necessary to prepare a topical semi-solid preparation containing the local anesthetic in pharmacies. Our aim was to create a mixed system of a hydrophilic gel with the emulsified drug, using excipients to decrease the lidocaine melting point, thereby creating a eutectic mixture with a high concentration of lidocaine in the oil phase. Based on bibliographic data, thymol creating a binary eutectic system containing lidocaine has been chosen. After addition of other excipients, an emulsion system was prepared and the drug was stabilized in the oil phase by a mixed nonionic emulsifier and carbomera. For the optimal anesthetic effects, the pH value should be adjusted; trometamol has been chosen as a suitable basic reacting excipient. Based on the addition of different amounts of trometamol, pH values of individual emulgels have been measured and the final composition of lidocaine emulgel has been created. A recipe for a 5 % lidocaine emulgel with the pH value of 9.1 has been created, based on the gel-forming substance carbomera with an emulsion of the oil phase containing a eutectic mixture of lidocaine and thymol, with an addition of ethanol and propylenglycol, stabilized by a mixed nonionic emulsifier. The advantage is the absence of other local anesthetics.

[The possibilities of innovation of extemporaneous preparation in pharmacies in the Czech Republic]. / Moznosti inovace individuální prípravy lecivých prípravku v lékárnách v Ceské republice.

Extemporaneously prepared products still have an irreplaceable role in therapy. In order to boost the magistral preparation, the availability of appropriate substances for the pharmacies must be ensured. This is due to the fact that many commercial pharmaceutical products containing these active ingredients do not comply with the individual requirements of a particular patient. Based on the practice requirements, the most requested substances have been chosen and within two years 16 pure substances with quality certificates have been provided for magistral preparation in pharmacies, and there are other chemicals coming. The increased availability of these chemicals should in particular eliminate the inappropriate and sometimes unlawful use of commercial medicinal products in extemporaneously prepared products. The paper presents 16 substances and formulations created by the authors, some of which are based on foreign formulations; however, they have been adapted to meet the requirements of the domestic environment. These products should create the basis of standardized formulations for preparation in pharmacies in the Czech Republic.