Tumour Size Distribution of Invasive Breast Cancer in a One-Year Period: Case Study Herzegovina.

BACKGROUND: To analyse the early stage breast cancer tumour size distribution as an important prognostic factor among the female patients within our local geographic region of Herzegovina. SUBJECTS AND METHODS: This cross-sectional retrospective study included 379 patients who were treated in 2017 at the Oncology Clinic, University Clinical Hospital Mostar. The patients were divided into two groups based on their primary tumour size: early (≤2 cm) and late (>2 cm) stage groups. RESULTS: The number of patients tested for advanced stage tumours surpassing 2 cm was statistically higher (χ2=106,325; p<0.001). 39.32% (N=149) of the patients presented with tumours ≤2 cm (T1) and 52.24% (N=198) of the total number of the patients presented with tumours >2 cm but ≤5 cm in greatest dimension (T2). The patients' knowledge about breast cancer, availability and adherence of mammography did not show any statistically significant difference with regard to tumour size, while the number of patients with smaller tumours who indicated that they underwent regular mammography was statistically significantly higher (χ2=13,629; p<0.003). CONCLUSIONS: Our data shows that in our region, more women with a diagnosis of breast cancer presented with a larger tumor size. Although there was no statistically significant difference with regard to prior knowledge about breast cancer and availability to mammography, this may be due to a small sample size. Our region does not have a screening mammogram program and this data suggests that the implementation of such a program may improve adherence to existing mammography guidelines which might capture tumors at a smaller size and hence an earlier stage.

The Incidence and Frequency of Various Causes of Angioedema in Emergency Medicine.

OBJECTIVE: Angioedema (AE) is a potentially life-threatening event. We investigated the etiology of AE, with the emphasis on bradykinininduced angioedema treatment in emergency medicine. METHODS: The retrospective study included 237 patients with AE, who were examined and treated in two hospitals (group A and B) in Croatia from 2009 to 2016. The location and duration of AE, data about chronic diseases and treatment, potential causative agents (food, drugs, insect bites and chemicals), physical examination data and the subsequent treatment were analyzed. RESULTS: There was no statistical difference regarding age or comorbidities but there was a statistically significant difference in etiology between the groups (Chi-square, P=0.03). Renin-angiotensin-aldosterone system (RAAS) blocker induced AE was the main cause of emergency attendance in group A (37.5%) and among the leading causes in group B (18.8%). Bradykinin-induced AE (hereditary angioedema (HAE) and RAAS-AE) were the leading causes in a total of 75 (31.5%) patients. RAAS-AE was treated with glucocorticoids and antihistamines. HAE attacks in both groups (2/7 patients, 1.5/6%) were treated with specific therapy. Other causes of AE in groups A/B were insect bites (15/23 patients, 13.5/20%), use of antibiotics/analgetics (11/17 patients, 9/15%), gastroesophageal reflux disease (10/11 patients, 8/9%), neoplasms (5/6 patients, 4/5%) and idiopatic (32/31 patients, 26.5/26%). 21% of patients were hospitalized. CONCLUSION: Bradykinin-mediated AE was the main cause of emergency attendance associated with AE. Advances in the treatment of HAE, with case reports of patients with RAAS-AE treated with C1 esterase inhibitor concentrate or bradykinin receptor antagonist, may prove to be a new, reliable and efficacious therapy option.