The impact of ultrasound-guided erector spinae plane block on hemodynamic stability and postoperative pain in patients undergoing modified radical mastectomy for breast cancer.

OBJECTIVE: Breast cancer, a prevalent global malignancy in women, necessitates a comprehensive treatment approach, with surgery playing a crucial role. Severe acute pain is common post-radical breast cancer surgery, emphasizing the significance of hemodynamic stability and postoperative pain control for optimal outcomes. This study evaluates the impact of ultrasound-guided erector spinae plane block (ESPB) on these parameters in ASA scores 1-2 patients undergoing modified radical breast cancer surgery with general anesthesia. PATIENTS AND METHODS: Forty-eight patients were divided into two groups: a general anesthesia group, with erector spinae plane block (GA+ESPB), and a control group receiving only general anesthesia (GA). Hemodynamic parameters were continuously monitored, and postoperative pain was assessed using the visual analog scale (VAS) at various time points. RESULTS: Ultrasound-guided ESPB effectively maintained hemodynamic stability and reduced postoperative pain in breast cancer surgery patients. Statistically significant differences were observed in heart rate, systolic and diastolic blood pressure, and mean arterial pressure between the GA and GA+ESPB groups at multiple time points (p < 0.05). VAS scores showed a significant interaction time*group (p < 0.001), with consistent differences between the groups at all time points (p ≤ 0.001). CONCLUSIONS: Ultrasound-guided ESPB application proved effective in preserving hemodynamic stability and managing postoperative pain in modified radical breast cancer surgery. The technique demonstrates promise in minimizing complications related to hemodynamic variations and postoperative pain, contributing to a comprehensive approach to breast cancer surgical treatment.

Late recurrence of malignant melanoma mimicking ovarian malignancy.

BACKGROUND: Malignant melanoma (MM) is an extremely malignant tumor with an unpredictable profile of spread and variable periods of remission. CASE: We describe an unusual case of malignant melanoma metastatic to the omentum occurring seven years after diagnosis and treatment of cutaneous malignant melanoma in the patient's arm. She received surgery and chemoimmunotherapy. To date, nine months after detection of malignant melanoma metastatic to the omentum, the patient is alive with no clinical and radiological metastatic disease. CONCLUSIONS: The diagnosis of omentum malignant melanoma in a living patient is uncommon, thus very few individuals and referral centers can build up an adequate experience of handling this disease. Optimal management has been a challenge and a subject of debate and has not yet been established.

[Lead point as a poor prognostic factor in the therapy of invagination in children].

UNLABELLED: Invagination is specific form of bowel opstruction that is seen in 1-4 children per 1000 births, usually in the period from 3 to 12 months of age. In 90-95 % reason for invagination in unknown so we called this forms idiopathic. In 5-10% invagination is caused by specific leading point. THE AIM of this retrospective study was to determinate prognostic valye of used biochemical tests (hemograms, glucosa, electrolites ( levels of Na+, K+, Ca+ and Cl-) and to prove bad influence of existing "leading point" in therapy of invagination (weather it will be surgical or hydrostatic desinvagination). METHODS: We analised 65 patients with invagination. We devided all our patients into 2 groups: first group consisted patients with idiopathic forms of invagination, and the other one were patients with invagination coused by specific leading point. RESULTS proved that leading point in invagination has great implications on clinical presentation, laboratory results, diagnostic and therapeutic procedure, and finaly in prognosis.

Axillary recurrence after modified radical mastectomy.

Optimal management for axillary recurrence is poorly understood. The aim of this study was to evaluate the risk factors for overall survival in the patients with axillary recurrence. Data of 1098 patients were collected from breast cancer registers from Clinic for Oncology Nis between 1990-1995. All patients underwent modified radical mastectomy. Axillary recurence was diganosed in 43 (3.92%) patients. Most patients were presented with a localized, palpable axillary mass 30 (69.77%). Cox multivariate analysis of prognostic factors for breast cancer-specific survival showed that node status HR 4.69 (1.50 to 14.72), tumor size HR 3.18 (0.90 to 11.26) and axillary radiotherapy HR 1.99 (0.69 to 5.75) had statistically significant effect on breast cancer mortality. Log-rank (54.21 p < 0.001) analysis showed significant difference for overall survival among women with a axillary recurrence based on different cancer stages. Tumor size and node status were the most important prognostic factors in women with axillary recurrence.

[D-dimer in the early detection of deep vein thrombosis in the lower extremity]. / D-dimer u ranom otkrivanju tromboze dubokih vena donjih ekstremiteta.

Deep vein thrombosis is important social and health care problem for its high incidence, pulmonary embolism-related mortality, and long-term sequelae which may be disabling (post-thrombotic syndrome and ulceration). The aim of our work was to determine the diagnostic potential and importance of D dimer in the early detection of deep vein thrombosis of lower extremities. Prospectively we have analyzed a group of 47 patients who were admitted to vascular department of Surgical Clinic in Nis during the period from 1.8.2001. to 31.3.2003. with echosonographically verified deep vein thrombosis of no more than 48 hours of duration. D dimer was measured before anticoagulant treatment started using commercial Nycomed test. The activation of coagulation process was detected with increase in D dimer values in 44 out of 47 examined patients (93.61%). D dimer is highly sensitive diagnostic tool that should be routinely used in the patients with suspected deep vein thrombosis of leg.