Oncoplastic Surgery and the Clinical Features of Breast Cancer-Relevant Factors Associated with Reoperation in Breast Oncoplastic Surgery.

Oncoplastic breast surgery slowly becomes a part of routine breast cancer surgical management but evidence with regard to oncological safety remains limited. The aim of this study was to compare relevant factors associated with the particular type of breast carcinoma and the applied surgical techniques either with or without oncoplastic surgery. This retrospective study enrolled the breast cancer female patients who underwent breast-conserving therapy alone or with the oncoplastic surgery in the Department of Surgical Oncology at the Center of Oncology of the Lublin Region St. Jana from Dukli in the years 2008-2011. The study involves 679 breast cancer patients who underwent oncoplasty (n = 81) and the control group (n = 598). There is a significant relationship between the histological type of breast cancer (p = 0.00000) along with the expression of estrogen and/or progesterone receptors (p = 0.01285) and the usage of oncoplastic surgery in breast cancer patients. Interestingly, in the majority of cases, there was no need to conduct a reoperation. Oncoplastic surgery is an effective and safe strategy that might be favorable especially for those patients who are potential candidates for more invasive surgical methods. High-quality evidence to support the oncological safety and benefits of oncoplastic breast surgery is lacking.

Breast Cancer-Epidemiology, Risk Factors, Classification, Prognostic Markers, and Current Treatment Strategies-An Updated Review.

Breast cancer (BC) is the most frequently diagnosed cancer in women worldwide with more than 2 million new cases in 2020. Its incidence and death rates have increased over the last three decades due to the change in risk factor profiles, better cancer registration, and cancer detection. The number of risk factors of BC is significant and includes both the modifiable factors and non-modifiable factors. Currently, about 80% of patients with BC are individuals aged >50. Survival depends on both stage and molecular subtype. Invasive BCs comprise wide spectrum tumors that show a variation concerning their clinical presentation, behavior, and morphology. Based on mRNA gene expression levels, BC can be divided into molecular subtypes (Luminal A, Luminal B, HER2-enriched, and basal-like). The molecular subtypes provide insights into new treatment strategies and patient stratifications that impact the management of BC patients. The eighth edition of TNM classification outlines a new staging system for BC that, in addition to anatomical features, acknowledges biological factors. Treatment of breast cancer is complex and involves a combination of different modalities including surgery, radiotherapy, chemotherapy, hormonal therapy, or biological therapies delivered in diverse sequences.

Satisfaction with the Aesthetic Effect and Quality of Life for Women after Breast Conserving Therapy (BCT)-Preliminary Research.

All methods of breast cancer treatment may potentially lead to breast deformities, which are often associated with the reduced mental well-being of patients. Breast conserving therapy (BCT) is commonly used, and its core element is breast conserving surgery (BCS).The aim of this study was to determine the level of satisfaction with the aesthetic outcome of surgery and quality of life (QoL) of breast cancer patients undergoing BCT in a longitudinal study performed three months, six months and 12 months after surgery. This longitudinal observational study was carried out on a group of 91 women. The Breast-QTM BCT 1.0 questionnaire was used in this study. Before surgery, patients assessed their satisfaction with the appearance of their breasts (SwB) at an average level of M = 56.0. Satisfaction with the aesthetic outcome (SwO) of BCS was highest among all patients three months after surgery (M = 63.0). The mean score in the sub-scale of psychosocial well-being (Psycho-soc W-B) before surgery was M = 62.0, while in the subsequent periods of the study, it was higher. The mean score for physical well-being (Physical W-B) before surgery was M = 69.92; and in the subsequent study periods, it was lower. The level of patient satisfaction with the outcome of the surgery and the QoL related to health do not differ significantly in post-operative observation. QoL in terms of psychosocial functioning in patients undergoing BCT is significantly higher 12 months after surgery compared to the pre-operative period. Patient satisfaction with the BCS aesthetic outcome is positively related to the evaluation of QoL in terms of psychosocial functioning.

Intensity of menopausal symptoms and quality of life in climacteric women.

Menopause is a difficult period in a woman's life, associated not only with the end of menstruation, but also with symptoms such as hot flashes, sweating, dizziness, and palpitations which occur due to fluctuations in the hormones oestrogen and progesterone. The aim of this study was to evaluate the quality of life of women (aged 48-55 years) in the physical, mental and social spheres, to determine the intensity of menopause symptoms and to ascertain whether the above indicators are influenced by sociodemographic factors. The study was conducted by diagnostic survey using two tools - the WHOQOL-BREF questionnaire for the measurement of the quality of life and the Kupperman index, which measures the severity of menopause symptoms. A total of 161 women not using hormone replacement therapy were examined. In their case, the intensity of menopause symptoms was moderate. The respondents assessed their functioning in the social sphere with the highest number of points (3.65) and in the physical sphere with the lowest number of points (3.14). The intensity of menopause symptoms positively correlated with the evaluation of the quality of life by the respondents. Higher assessment of the quality of life was reported by women working in a given period of time, with good material status, sexually active. The respondents suffered from chronic diseases, most often arterial hypertension. The occurrence of chronic diseases - arterial hypertension, coronary artery disease, diabetes and osteoporosis - negatively affected the quality of life of the respondents.

The effect of pre-emptive analgesia on the level of postoperative pain in women undergoing surgery for breast neoplasm.

AIM OF THE STUDY: Dynamic development of research on pain has resulted in the formulation of the concept of pre-emptive analgesia, which involves administration of analgesics before the first pain-producing stimulus appears. It is meant to prevent increased sensitivity to pain in the postoperative period. The aim of this study was to assess the possibilities of modifying the intensity of postoperative pain evaluated with the visual analogue scale (VAS) in patients after surgical treatment for breast neoplasm offered by pre-emptive analgesia. MATERIAL AND METHODS: The intensity of postoperative pain was measured immediately after the surgery as well as 6, 12, 18, and 24 hours later in 100 women who had undergone surgery for breast tumour. The correlation between experienced pain and the type of analgesic administered pre-emptively, including metamizole, tramadol, ketoprofen, and placebo was examined. The effect of other correlates such as the extensiveness of surgery, systolic and diastolic blood pressure, and heart rate on the level of experienced pain as well as the usefulness of physiological parameters for its assessment were also analysed. RESULTS: The conducted study demonstrated the effectiveness of tramadol (p = 0.004) and ketoprofen (p = 0.039) administered half an hour before the beginning of surgery, but there was no similar effect in the case of metamizole (p = 1.0). A positive correlation was observed between the level of experienced pain and blood pressure values (p < 0.001). Heart rate does not seem to be significantly linked with the intensity of experienced pain (p = 0.157).

Retrospective study of injury rates among children and adults in the Lublin Region of Poland.

INTRODUCTION AND OBJECTIVE: In Poland and worldwide, injury rates, as well as accident rates among children and adolescents still remain a social, health and economic problem, despite an attempt to inhibit the growing tendency of this phenomenon. OBJECTIVE: An attempt to evaluate current trends in injury rates among children and adolescents based on the example of two provinces in the Lublin Region of Poland during the period 2006-2010. MATERIALS AND METHOD: The retrospective study was conducted by the method of examination of documents, using the technique of content analysis. The research material was data from the Emergency Procedures Charts and Medical Emergency Team Response Charts, while the study group were children and adolescents aged from 6 weeks - 19 years, from the counties of Krasnik and Swidnik in the Lublin Region. RESULTS: Analysis of the research material showed that during the period examined the number of injuries and accidents in the study group remained on a constant level, with a slight decrease in the number of events at home, accompanied by an increase in the number of road accidents and events which occurred in the school environment and in a public place. It was also found that the spring-autumn season, and in particular the summer months, the age group 7-13 and male gender exerted an effect on the number of injuries and accidents. The analysis did not confirm that injuries related with employment of children and adolescents in agriculture and deaths due to external causes constituted a considerable percentage of the events registered. CONCLUSION: Analysis of trends should be a basis for the planning of prophylactic actions and the promotion of safety in all environments in which the study population functions.

Myeloid-Derived Suppressor Cells Endow Stem-like Qualities to Breast Cancer Cells through IL6/STAT3 and NO/NOTCH Cross-talk Signaling.

Myeloid-derived suppressor cells (MDSC) contribute to immune suppression in cancer, but the mechanisms through which they drive metastatic progression are not fully understood. In this study, we show how MDSC convey stem-like qualities to breast cancer cells that coordinately help enable immune suppression and escape. We found that MDSC promoted tumor formation by enhancing breast cancer cell stem-like properties as well as by suppressing T-cell activation. Mechanistic investigations indicated that these effects relied upon cross-talk between the STAT3 and NOTCH pathways in cancer cells, with MDSC inducing IL6-dependent phosphorylation of STAT3 and activating NOTCH through nitric oxide leading to prolonged STAT3 activation. In clinical specimens of breast cancer, the presence of MDSC correlated with the presence of cancer stem-like cells (CSC) and independently predicted poor survival outcomes. Collectively, our work revealed an immune-associated mechanism that extrinsically confers cancer cell stemness properties and affects patient outcome. We suggest that targeting STAT3-NOTCH cross-talk between MDSC and CSC could offer a unique locus to improve cancer treatment, by coordinately targeting a coupled mechanism that enables cancer stemness and immune escape. Cancer Res; 76(11); 3156-65. ©2016 AACR.

Selected breast cancer risk factors and early detection of the neoplasm in women from Lublin region attending screening program in St. John's Cancer Center, years 2005-2006.

INTRODUCTION AND OBJECTIVE: In Poland, consulting is offered to women about risk factors of breast cancer, breast symptoms and early cancer detection. Study aims were to evaluate the correlation between some risk factors and women's attendance to breast checkups, and to assess links between risk factors and detection of early breast cancer. MATERIALS AND METHODS: The study involved 8014 women aged 50-69 years, participating in breast cancer screening program. The frequency of breast checkups (mammography, CBE and BSE) and occurrence of breast cancer risk factors in studied women were evaluated as well as clinical stage of detected tumors. Odds ratios were used to compare relative odds of breast cancer with exposure to risk factors. RESULTS: 47.11% studied women had regularly undergone MMG, 30.82% had CBE within the previous year, 14.26% regularly performed BSE. The incidence of risk factors varied from 2.94% (menarche at ≤11 years) to 12.38% (current use of HRT). In 47.82% women, no evidence of studied risk factors was found. Women with history of breast biopsies and current users of HRT had MMG, CBE and BSE significantly more often (p<0.0001). 29.27% early breast cancers (pTis, pT1abN0) were found among 82 detected tumors. Relative odds of breast cancer occurrence in women without the risk factors were significantly lower (OR=0.55, 95% CI [0.35; 0.86]). Only nulliparous women had significantly higher odds of early breast cancer (OR=7.37, 95% CI [1.32; 41.17]). CONCLUSIONS: Women using HRT and women after breast biopsy were significantly more likely to attend breast checkups. There were no significant links between most risk factors and odds of early stages of breast cancer. Women should have preventive checkups irrespective of their breast cancer risk factors.

Causes of late diagnosis of the reproductive organs' cancer in the opinion of suffering women from urban and rural areas of Lublin as an indicator of the condition of the early cancer detection system: a preliminary report.

INTRODUCTION: Tumours as well as the cardiovascular diseases are the leading causes of deaths in Poland. This article contains excerpts from research on complex causes of late diagnosis of cancer among the region's residents. AIM OF THE STUDY: One of the specific aims of the research undertaken was to learn about subjective assessment of women suffering from cancer taking into account its late diagnosis. MATERIAL AND METHODS: The research was conducted on 130 women with diagnosed cancer of reproductive organs in the late stage of the disease, who were in oncological care. The method of diagnostic survey in the form of a questionnaire was developed for the study. RESULTS: The research reveals that the place of living has an impact on the opinions of suffering women as for the causes of late diagnosis of cancer and, secondly, that their oncological awareness is low. CONCLUSIONS: In the examined group, cancer awareness of women already having cancers - irrespective of the environment of settling, was low and did not constitute the grounds for taking pro-health decisions in the area of the early diagnostic testing of cancer. This fully confirms the need for the research on effective tools to increase the awareness, particularly in the population of healthy persons, including menopausal and postmenopausal women.The opinions indirectly indicate a weaker organization and effectiveness of the activities of the cancer prevention programs in the country than those organized in the city.

T-tube duodenocholangiostomy for the management of duodenal fistulae.

BACKGROUND: The tube decompression of the duodenum through an additional point of access of the duodenal wall or occasionally via the leak site decreases morbidity and mortality in patients with duodenal fistula. The objective of this paper is to present the detailed technique and clinical benefits of simplified duodenal and biliary decompression achieved by transampullary insertion of a T-tube with one-step duodenal closure for the prevention and/or treatment of duodenal leak. METHODS: The duodenocholangiostomy using T-tube with laterally perforated long duodenal limb was performed preventively in 4 patients and as a secondary procedure for septic duodenal leak in another selected 12. The mean output from the fistula, length of hospital stay, incidence of pancreatitis, as well as any postoperative septic events was recorded. The nutritional schedule during the in early postoperative period also was analyzed. RESULTS: The outcome was favorable for all patients. The mean length of hospital stay was 19 days. Septic events, such as wound or urinary tract infections, were observed in 30% of patients. Serum amylase and lipase activity was increased in two patients without a clinical picture of pancreatitis. Mean volume of T-tube duodenocholangiostomy drainage was approximately 500 ml per day during the first postoperative week. Enteral feeding was commenced 10-52 (mean, 21) hours after surgery and was followed by the initiation of normal diet on average 5 days postoperatively. CONCLUSIONS: Duodenocholangiostomy performed for duodenal decompression may be a promising alternative to classical tube duodenostomy for selected patients; however, further studies should be made to evaluate fully its practical value.

Breast self-examination among Polish women of procreative age and the attached significance.

The aim of the study was to check whether and how frequently Polish women of procreative age examine their breasts, what this is conditioned by, and whether such self-examination has diagnostic significance. In this study, survey by questionnaire of 492 women of procreative age was conducted. Breast self-examination (BSE) was conducted by 82.9% of the respondents, out of which 33.7% conducted regular monthly examinations. The demographic variables assumed in this study proved to be statistically significant (P < .05) for younger single women with medical education and living under conditions of higher economic standard. The diagnostic significance attached to BSE was closely connected with the professional background of the respondents and the actual conducting of BSE. An opinion that BSE has diagnostic value was expressed in the group of medical professionals significantly more frequently than in the group of women representing other professions (P = .0000009). Such an opinion was also held significantly more often in the group of women performing BSE than in the group of women who had no such habit (P < .0000001). A majority of women of procreative age perform BSE; however, only a third perform that regularly, every month. Factors determining the conduction of BSE include age, profession, marital status, and standard of living conditions. The diagnostic significance attached to BSE is closely connected with the professional background of the respondents and actual conducting of BSE. Breast self-examination has not been satisfactorily popularized among Polish women. Greater involvement in educational activities of medical personnel may improve the present situation.

[Knowledge of the term and methods of alternative medicine in the example of the patients of one bioresonance practice]. / Znajomosc pojecia i metod medycyny alternatywnej na przykladzie populacji korzystajacej z uslug jednego z gabinetów biorezonansu.

UNLABELLED: The growing number of patients of various kinds of unconventional medicine poses a question as to the reason of taking up such treatments. Do such people know whether the methods of treatment they opt for are scientifically proven? Aim of the study was to test the knowledge among patients of bioresonance practice on methods of alternative medicine and to determine the break down of those patients based on their sex, age and the level of education. MATERIAL AND METHODS: 152 patients of bioresonance practice were asked to fill in an anonymous questionnaire. The respondents were to choose unconventional methods of treatment from the list of ten. Afterwards they were asked to answer 4 questions that referred to the opinion on and experience with alternative medicine. Chi square test and t-Student test were used to find statistical significance. RESULTS: The level of education is the only factor which determines the knowledge of the methods of alternative medicine. What is more, a mere third of patients realized that they used such a method. For one in four respondents it did not matter whether the method was properly tested and scientifically proven. Some 7.5% did not understand the meaning of the term 'alternative medicine' and did not differentiate such methods from conventional ones. CONCLUSIONS: There is quite a high percentage of people who do not know that the methods of treatment selected are unconventional. The second alarming fact is that the people who decide on treatment in an unconventional way are not concerned with any scientific evidence. The knowledge of the term and methods of alternative medicine increases with the education level.

Prognostic value of p27 kip1 expression in adenocarcinoma of the pancreatic head region.

BACKGROUND: p27(kip1) is a tumour suppressor gene, functioning as a cyclin-dependent kinase inhibitor, and an independent prognostic factor in breast, colon, and prostate adenocarcinomas. Conflicting data are reported for adenocarcinoma of the pancreas. The aim of this study was to establish the prognostic value of p27(kip1) expression in adenocarcinoma of the pancreatic head region. PATIENTS AND METHODS: The study included 45 patients (male/female ratio 2:1; mean age 59, range 38-82 years) with adenocarcinomas of the pancreatic head region: 24 - pancreatic head, 18 - periampullary and 3 - uncinate process. The patients underwent the Kausch-Whipple pancreatoduodenectomy (n=39), pylorus-preserving pancreatoduodenectomy (n=5), or nearly total pancreatectomy (n=1). Eight patients received adjuvant chemotherapy postoperatively. Follow-up time ranged from 3 to 60 months. Tumours were staged according to the pTNM classification (UICC 1997). Immunohistochemistry was done on paraffin-embedded blocks from tumour sections. Quantitative determination of p27(kip1) expression was based on the proportion of p27(kip1) -positive cells (< 5% = negative). Survival analysis was carried out using the Kaplan-Meier method and Cox regression model. RESULTS: Positive p27(kip1) expression was detected in 22 tumours (49%), whereas 23 tumours (51%) were p27(kip1)-negative. There were no significant correlations between p27(kip1) index and stage or lymph node involvement. Median survival time in patients with p27(kip1)-positive tumours was 19 months, whereas in patients with p27(kip1)-negative tumours it was 18 months (p=0.53). A significant relationship was found between p27(kip1)-negative tumours and radical resection (p=0.04). Multivariate survival analysis revealed that the localization of the tumour (pancreatic head/uncinate process vs periampullary) was the only significant and independent prognosticator (p = 0.01, Cox regression model). Resection margins involvement and grade remained nearly significant prognostic factors (p=0.07 and p=0.09, respectively). CONCLUSION: We conclude that p27(kip1) has limited overall prognostic utility in resected carcinoma of the pancreatic head region, but its potential role as a marker of residual disease needs to be further assessed.

Self-examination of breasts as an element of breast cancer prophylaxis.

Increased mortality, morbidity and incidence of neoplastic diseases, malignancy especially, has been observed in Poland for over 20 years. Death rate has increased from 19.34% to 22.13% in male population and from 16.68% to 18.48% in females in 1987-1996. The prognosis for 2010 estimates ca 70,000 deaths in males and ca 40,0000 in females. In the male population, among malignancies, lung cancer accounts for the biggest number of deaths. In the female population the first place is taken by breast cancer. Breast cancer is likely to develop in any age, however it increases significantly with age. Among the causes is the lack of knowledge about self-detection of alarming signs and symptoms within breasts that should arouse their concern. The purpose of the study was to answer the following questions: 1. Do young women know the technique of self-examination of the breasts? 2. Where did they learn about the necessity of breast self-examination? 3. Do they self-examine breasts?

Communication with patients and their families, who undergo bone marrow transplantation.

Bone marrow transplantation (BMT) is a widely accepted treatment for malignant and nonmalignant diseases. With advances such as autologous and allogenic stem cell transplant, umbilical cord blood transplant, and improved biomedical support therapies, the need to evaluate the impact technology on the patient and the family continues to be an important aspect of medical and nursing research. BMT has been described as a procedure associated with isolation of the patient, prolonged hospitalizations, rapid fluctuations in medical conditions, frequent and often life-threatening infections, and graft-versus-host disease (GVHD). Although some patients encounter such difficult experiences during recovery and a significant mortality rate is associated with the procedure, other patients experience rapid recovery with minimum risk of serious complications and a shortened hospital length of stay. Issues related to the caregiver availability and caregiver burden become more important in theses aggressive outpatient settings. The paper discusses the psychosocial impact of BMT on the patient as well as on the family. The psychosocial nursing care during BMT is discussed. The cultural influence is recognized and stressed. Quality-of-life dimensions and the impact of BMT as well as implications for nursing are stressed. Also, the experience of donating bone marrow to a relative will be discussed and the implications for a nursing practice will be described.

Professional information, education and counselling as prerequisites for quality cancer care.

The importance of psychosocial factors in the cancer journey for both patients and their careers has been recognized, yet, there is still a great gap between the theory and the practice. The majority of cancer patients express universal need and stress the importance of having good relationships with health-care professionals and receiving good-quality information. There is still much to do when it comes to informing cancer patients. Many patients do not receive enough information about the prognosis, the alternatives of treatment and the effects of cancer treatment. Most people want information because it has a positive impact on their feelings and attitudes and it helps them to cope with their situation. Health-care professionals must target interventions toward the greatest needs. Interventions must be developed and evaluated to assist patients and their families in dealing with the increased stress they experience as they progress the illness trajectory. By recognizing the importance of social support to patients with cancer and by helping patients maintain this support, health-care professionals, especially nurses, can be the best facilitators in helping them to understand that they are not alone in fighting their disease. Health-care professionals must target interventions toward the greatest needs. Interventions must be developed and evaluated to assist patients and their families in dealing with the increased stress they experience as they progress the illness trajectory.

Care of a patient with acute leukemia based on a Dutch specialized model of oncology nursing.

Within the University Hospital Vrije Universiteit autologous and allogenic SCT are practiced. The hematology ward has 18 beds 3 of which are isolation rooms with laminar airflow and six day-care beds. In a year about 20 allogeneic and some 50 autologous SCT take place. In this paper a presentation of the various responsibilities of the hemato-oncology nurse with the help of a case study of a patient with AML is done. The structure of this article is based on The Dutch professional profile of an oncology nurse. The responsibilities of the nurse with regard to the treatment and care of the patient consist of the following activities: - information and prevention, - planning and executing the care, diagnostic and therapeutic role, coordination and organization of the care, evaluation and recording, supporting role. Two specialized types of nurses are involved in the care; those are the transplant co-coordinator and the apheresis nurse.

Complementary and alternative care within cancer care.

In this paper the authors will describe the emergence of CAM within cancer care by summarizing developments in research, practice and delivery, and outline the context within supportive and palliative care and highlight the parallels within the emergence of this specialty. It will be illustrated how the users, patients and their families are increasingly shaping service, provision and describe initiatives, both regional and national, which put the patients' perspective at the heart of decision making for the future CAM research and service delivery. The paper makes an attempt to identify and discuss briefly integrative medicine and describe the variety of forms and venues in which integrative medicine can be practiced by oncologists to treat cancer patients.

Information needs of the patients undergoing bone marrow transplantation.

The number of allogenic and autologous bone marrow transplantation (BMT) and the number of centers which perform these procedures have increased dramatically over the last 10 years. This increase can be attributed to the progress in supportive care which caused a significant decrease of transplant related mortality. Hematopoietic stem cell transplantation (HSCT) is now established therapy for many hematological malignancies, solid tumors and autoimmune disease. In spite of the great progress made, BMT is still a drastic procedure that may make patients suffer very much and can be even fatal. Careful exploration of the social and psychological situation of the patient is a very important factor which may prevent future difficulties. Many patients suffer psychological difficulties related to bone marrow transplantation from inadequate psycho-social preparation and support. It is important to prepare an information document about the newly diagnosed hematological malignancies. It must be a clear language and must answer the initial questions the patient will ask after diagnosis is made. The information leaflet distributed to the patients suffering from hematological malignancies can play an important role in the recovery of the immune system, thereby promoting a return to health.

Palliative care--transiting old tradition and values into the modern health care practice.

Care of the dying patient is care for the patient who is still living, it is helping that patient to live his or her life to the fullest whether at home or hospice, or in hospital. It is care that is not just centered on the individual but includes members of the family. It is focused on improving the quality of patients' life, by incorporating into the professional care most of unique human values, such as respect, empathy, compassion and tender loving care. Palliative care is a broad band of care of indeterminate length, and does not necessarily end with the death of the patient. Until life begins to glow again, some surviving relatives may need support during the bereavement period. Thanks to Dr Elisabeth Kübler-Ross and Dame Cicely Saunders, two great women visionaries and leaders of the emergence of Palliative Care, one of the best things that has happened to medicine in the 20th century, the development of care for dying patients and their families was possible.