Experimental closure of gunshot wounds by fibrin glue with antibiotics in pigs.

BACKGROUND/AIM: Gunshot wounds caused by the automatic rifle M70AB2 (AK-47) 7.62 mm, after the primary surgical management, were closed with delayed primary suture during the next four to seven days. This period coincides with the fibroblastic phase of wound healing. Fibrin glue is used as a local hemostatic and as a matrix for the local dosed release of antibiotics. Antibiotics addition to fibrin glue resulted in continuous diffusion into the surrounding next 4 to 7 days. The aim of this study was to create the preconditions for gunshot wounds closing without complications by the application of fibrin glue with antibiotics 24 h after primary surgical treatment. METHODS: A total of 14 pigs were wounded in the gluteofemoral region by the bullet M67, initial velocity of 720 m/s. All wounded animals were surgically treated according to the principles of the war-surgery doctrine. Seven wounds were closed with primary delayed suture four days after the primary surgical treatment (traditional approach). Fibrin glue with antibiotics was introduced in seven wounds during the primary surgical treatment and primary delayed suture was done after 24 h. The macroscopic appearance and the clinical assessment of the wound were done during the primary surgical treatment and during its revision after 24 h, as well as histopathological findings at the days 4 and 7 after wounding. RESULTS: Gunshot wounds caused by the automatic rifle M70AB2 (AK-47) 7.62 mm, and treated with fibrin glue with antibiotics after primary surgical management, were closed with primary delayed suture after 24 h. In further wound evolution there were no complications. CONCLUSION: Uncomplicated soft-tissue wounds caused by an automatic M70AB2 rifle may be closed primarily with delayed suture without the risk of developing complications if on revision, 24 h after primary surgery, there were no present necrotic tissues, hematoma, and any signs of infection when fibrin glue with antibiotics (ceftriaxone and clindamycin) was applied. The use of this method should be limited to individual and strictly controlled cases in civil practice for now.

Surface enlargement of a new arterialised venous flap by the surgical delay method.

BACKGROUND/AIM: The delay method is a surgical, pharmacological and combined method that includes two or more time separated phases, which gives bigger flap surface. In our research we explored the possibility of flap surface enlargement in a new arterialised venous flap (AVF) on an experimental rabbit ear model by the delay surgical method. The aim of this research was to establish vitality surface of our AVF and to maintain the difference in flap vital surface between AVF flaps, with or without performing the delay surgery method. METHODS: We used both ears of "Big Chinchilla" rabbits in 10 experimental male animals, divided into two groups, average weight 3-3.5 kg, and average age 8-10 months. In the first (experimental) group, a venous flap was arterialised by our method. In the second (control) group, the venous flap was arterialised 14 days after the delay surgical method. AVF surface was measured on the 1 and 14 days by the method of trapezoid rule. RESULTS: Vital surface on our AVF experimental model was bigger than 87% of elevated flap surface after the delay surgical method. Vital surface on AVF without delay on our experimental model was bigger than 30% of elevated flap surface (p < 0.001). CONCLUSION: Analysis of previous experimental models on the rabbit ear, non-delayed and delayed (to enlarge flap surface) led us to conclusion that previously created experimental models of non-delayed AVF are hemodynamically negative. Our experimental non-delay AVF model is hemodynamically more positive than previously created models of non-delay AVF and provides better conditions for AVF survival and enlargement of vital flap surface of elevated flap. On the other hand, surgical delay method significantly enlarges vital surface of AFF.

Comparative analysis of autodermal graft and polypropylene mesh use in large incisional hernia defects reconstruction.

BACKGROUND: Large defects of the abdominal wall caused by incisional hernia still represent a challenging problem in plastic, reconstructive, and abdominal surgery. For their successful tension-free repair a proper selection of reconstructive material is essential. In the last decades, the use of synthetic meshes was dominant while biological autodermal grafts were rarely used. The aim of the study was to comparatively analyse efficacy and safety of autodermal graft and polypropylene mesh in surgical treatment of large abdominal wall defects. METHODS: This prospective comparative clinical study enroled 40 patients surgically treated for large incisional hernia repair in a 10-year period. The patients were divided into two equal groups consisting of 20 subjects and treated either by biological autodermal graft or by synthetic polypropylene mesh. The surgical techniques of reconstruction, duration of surgery, the occurrence of early, minor, and major (severe) and delyed complications and hospital stay were analysed. The average follow-up took 2 years. RESULTS: Statistically significant differences in demographic characteristics of patients and in size of defects were not found. The surgical technique of reconstruction with an autodermal graft was more complicated. The duration of surgery in patients treated with autodermal grafts was significantly longer. There was no statistically significant difference regarding occurrence of early, minor postoperative complications and hospital stay in our study. Two severe complications were registered in the synthetic mesh group: intestinal obstruction and enterocutaneous fistula. The recurrence rate was 10% in the autodermal graft group and 15% in the group with a synthetic mesh. CONCLUSION: Tension-free repair of large incisional hernia with autodermal grafts was unjustly neglected despite the fact that it is safe and effective. It can be applied in all cases where synthetic mesh are not indicated (presence of infection, immunodeficient patients, after radiotherapy). They are especially important in war surgery and in lack of funds when commercial grafts cannot be purchased.

A unique case of hereditary bilateral segmental neurofibromatosis on the face.

Segmental neurofibromatosis is a rare clinical finding generally with no family history and facial involvement. There are four subtypes of segmental neurofibromatosis: true segmental, localized cases with deep involvement, hereditary segmental and bilateral segmental neurofibromatosis. Here we report three patients from the same family (father, son and granddaughter) with segmental bilateral neurofibromatosis on the face. This form has not been noticed in the literature.

A unique case of hereditary bilateral segmental neurofibromatosis on the face / Neurofibromatose segmentar bilateral hereditária da face: caso único

Segmental neurofibromatosis is a rare clinical finding generally with no family history and facial involvement. There are four subtypes of segmental neurofibromatosis: true segmental, localized cases with deep involvement, hereditary segmental and bilateral segmental neurofibromatosis. Here we report three patients from the same family (father, son and granddaughter) with segmental bilateral neurofibromatosis on the face. This form hasn't noticed in the literature.

A neurofibromatose segmentar é um achado clínico raro, geralmente com história familiar negativa e raro envolvimento facial. Existem quatro subtipos de neurofibromatose segmentar: segmentar verdadeira, segmentar com envolvimento visceral profundo, segmentar com história familiar e segmentar cutânea bilateral. Aqui nós reportamos três pacientes de uma mesma família (pai, filho e neta) com neurofibromatose segmentar bilateral na face. Esta forma ainda não foi relatada na literatura.

Viral infection in renal transplant recipients.

Viruses are among the most common causes of opportunistic infection after transplantation. The risk for viral infection is a function of the specific virus encountered, the intensity of immune suppression used to prevent graft rejection, and other host factors governing susceptibility. Although cytomegalovirus is the most common opportunistic pathogen seen in transplant recipients, numerous other viruses have also affected outcomes. In some cases, preventive measures such as pretransplant screening, prophylactic antiviral therapy, or posttransplant viral monitoring may limit the impact of these infections. Recent advances in laboratory monitoring and antiviral therapy have improved outcomes. Studies of viral latency, reactivation, and the cellular effects of viral infection will provide clues for future strategies in prevention and treatment of viral infections. This paper will summarize the major viral infections seen following transplant and discuss strategies for prevention and management of these potential pathogens.

[Unusual case of successful hand replantation with bad functional outcome: a case report].

INTRODUCTION: Traumatic hand amputation is a very severe and rare injury. Replantation and revascularization surgery requires the existence of specialized centres and well-educated teams of microsurgeons. In places where there are no such specialized centres for this kind of surgery, traumatic hand amputation is a major concern and quite a challenge, and a successfully performed replantation is a great accomplishment. CASE OUTLINE: We report a case of a successfully survived replanted hand in a 35-year-old male patient with unfortunately bad end result of the treatment. The patient with the amputated left hand (disarticulation) had a surgery 4 hours after injury. The urgent surgical procedure required a debridement, the excision of the first row of the carpal bones, external fixation of the wrist, vascular anastomoses, nerve repair, tenorrhaphy, skin sutures and decompression skin incisions.The successful operation did not have a successful post-operative course due to the patient's psychiatric problems and lack of rehabilitation at the psychiatric institution where the treatment was continued. CONCLUSION: Successful surgical performance can unfortunately be ruined due to inadequate further treatment course or the wrong selection for such a demanding surgery. The survival of the amputated hand can be achieved surgically, but achieving refunctioning does not always depend on surgery. It also depends on the very patient, his motivation, rehabilitation, as well as on the proper selection for such a demanding and complex surgical procedure.

Application of sentinel lymph node biopsy in cutaneous basosquamous carcinoma.

Basosquamous carcinoma of the skin is a relatively rare cutaneous neoplasm that has significant metastatic potential and a metastatic rate greater than that of basal cell and squamous cell carcinoma. We describe the use of lymphatic mapping and sentinel lymph node biopsy in a 63-year-old man after identification of basosquamous carcinoma. Sentinel lymph node biopsy, which is a standard tool to detect regional lymphatic metastasis in cutaneous melanoma, has been rarely employed to detect lymphatic metastasis of basosquamous carcinoma. The approach was successful in detecting a regional lymphatic metastasis of two nodal basins with minor morbidity. Sentinel lymph node biopsy may be useful for certain high-risk lesions of basosquamous carcinoma.

Expression of regulatory proteins and proliferative activity in relation to phenotypic characteristics of upper urothelial carcinoma.

BACKGROUND/AIM: Deregulation of the normal cell cycle is common in upper urothelial carcinoma (UUC). The aim of this study was to investigate the expression of regulatory proteins of the cell cycle (p53, p16, cyclin D1, HER-2) and proliferative Ki-67 activity in UUC, and to determine their interaction and influence on the phenotypic characteristics of UUC. METHODS: In 44 patients with UUC, histopathological and immunohistochemical analyses (p53, p16, cyclin D1, HER-2, and Ki-67) of tumors were done. RESULTS: Overexpression/altered expression of p53, p16, cyclin D1 or HER-2 was detected in 20%, 57%, 64%, and 57% of tumors, respectively. Eleven (25%) UUC had a high proliferative Ki-67 index. Forty patients (91%) had at least one marker altered, while four (9%) tumors had a wild-type status. Analysis of relationship between expressions of molecular markers showed that only high expression of p53 was significantly associated with altered p16 activity (p < 0.05). High Ki-67 index was associated with the high stage (p < 0.005), solid growth (p < 0.01), high grade (p < 0.05), and multifocality p < 0.05) of UUC, while high expression of p53 was associated with the solid growth (p < 0.05). In regression models that included all molecular markers and phenotypic characteristics, only Ki-67 correlated with the growth (p < 0.0001), stage (p < 0.01), grade (p < 0.05) and multifocality (p < 0.05) of UCC; (Ki-67 and HER-2 expression correlated with the lymphovascular invasion (p < 0.05). CONCLUSIONS: This investigation showed that only negative regulatory proteins of the cell cycle, p53 and p16, were significantly associated in UUC, while proliferative marker Ki-67 was in relation to the key phenotypic characteristics of UUC in the best way.

Collet Sicard syndrome as atypical presentation of neck fibrosarcoma: a case report.

We report a 57 years old female patient with neck fibrosarcoma. Her main complaints consisted of hoarseness, difficulty swallowing, pain in the left side of her neck and left shoulder region, which all indicated the Collet Sicard syndrome, so the working diagnosis was glomus tumor. Diagnostic MSCT was used, and the characteristics of the radiologic finding did not indicate any of the paraganglioma types, although the tumor was localized in the area of the carotid bifurcation, demonstrating the signs of extension into the jugular foramen. The patient has been treated surgically in general anesthesia and pathologic diagnosis was fibrosarcoma.

Does incomplete excision of basal cell carcinoma of the eyelid mean tumor recurrence? / A excisão incompleta de carcinoma basocelular da pálpebra implica

INTRODUCTION: Basal cell carcinoma is the most common tumor of the eyelid. In this region, reconstruction is complex and damage to healthy tissue should be minimal. Objective: To define the relationship between margin clearance at excision and the recurrence rate of basal cell carcinoma of the eyelid. METHODS: This prospective study was conducted with 111 patients submitted to surgery for basal cell carcinoma of the eyelid between 2001 and 2003 and followed up for a period of five years. The patients were evaluated according to age, tumor site, recurrence rate and margin clearance at excision. RESULTS: No significant association was found between incomplete tumor excision and recurrence except in patients under 56 years of age, female patients and in the case of tumors of the medial canthus. CONCLUSION: A risk of recurrence in incompletely excised basal cell carcinomas of the eyelid was only confirmed in younger patients, females and for tumors of the medial canthus.

INTRODUÇÃO: O carcinoma basocelular é o tumor mais comum entre os tumores das pálpebras. Nesta região, a reconstrução é complexa e recomenda-se que haja perda mínima de tecido saudável. OBJETIVO: Para definir a relação entre margem livre de tumor na excisão e taxa de recidiva do carcinoma basocelular das pálpebras. MÉTODOS: Este estudo prospectivo incluiu 111 pacientes operados para remoção de carcinoma basocelular das pálpebras no período de 2001 a 2003, com acompanhamento subsequente de 5 anos. Os pacientes foram avaliados de acordo com a idade, localização do tumor, taxa de recidiva, e margem livre de tumor na excisão. RESULTADOS: Não se encontrou associação significativa entre a excisão incompleta do tumor e casos de recidiva, exceto em pacientes com idade inferior a 56 anos, pacientes do sexo feminino e em tumores do canto medial. CONCLUSÃO: Um risco maior de recidiva de carcinoma basocelular das pálpebras com excisão incompleta foi confirmado estatisticamente apenas em pacientes mais jovens, em mulheres, e nos tumores do canto interno.

Urothelial cancer stem cells.

There is mounting evidence supporting the idea that tumors, similar to normal adult tissues, arise from a specific stem-like cell population, the cancer stem cells (CSCs), which are considered as the real driving force behind tumor growth, the ability to metastasize, as well as resistance to conventional antitumor therapy. The concept that cancer growth recapitulates normal proliferative and/or regenerative processes, even though in very dysfunctional ways, has tremendous implications for cancer therapy. The rapid development of the CSC field, shoulder to shoulder with powerful genome-wide screening techniques, has provided cause for optimism for the development of more reliable therapies in the future. However, several important issues still lie ahead. Recent identification of a highly tumorigenic stem-like compartment and existence of urothelial differentiation programs in urothelial cell carcinomas (UCCs) raised important questions about UCC initiation and development. This review examines the present knowledge on CSCs in UCCs regarding the similarities between CSCs and the adult urothelial stem cells, potential origin of urothelial CSCs, main regulatory pathways, surface markers expression, and the current state of CSC-targeting therapeutic strategies.

Does incomplete excision of basal cell carcinoma of the eyelid mean tumor recurrence?

INTRODUCTION: Basal cell carcinoma is the most common tumor of the eyelid. In this region, reconstruction is complex and damage to healthy tissue should be minimal. OBJECTIVE: To define the relationship between margin clearance at excision and the recurrence rate of basal cell carcinoma of the eyelid. METHODS: This prospective study was conducted with 111 patients submitted to surgery for basal cell carcinoma of the eyelid between 2001 and 2003 and followed up for a period of five years. The patients were evaluated according to age, tumor site, recurrence rate and margin clearance at excision. RESULTS: No significant association was found between incomplete tumor excision and recurrence except in patients under 56 years of age, female patients and in the case of tumors of the medial canthus. CONCLUSION: A risk of recurrence in incompletely excised basal cell carcinomas of the eyelid was only confirmed in younger patients, females and for tumors of the medial canthus.

Characteristics of upper urothelial carcinoma in an area of Balkan endemic nephropathy in south Serbia. A fifty-year retrospective study.

AIMS AND BACKGROUND: Upper urinary tract transitional cell carcinoma, a relatively rare tumor, is up to 100 times more frequent in regions with Balkan endemic nephropathy. Characteristics of transitional cell carcinoma in the endemic South Morava Region in Serbia in the previous 50 years were evaluated. PATIENTS: We analyzed 477 cases with pathologically confirmed transitional cell carcinoma who underwent surgery from 1957 to 2006: 91 from endemic, 106 from adjacent and 280 from control settlements. Cases in the study came from 10 endemic villages, 46 adjacent villages, 51 control villages and the city of Nis. RESULTS: The increase in number of transitional cell carcinoma from 1957 was followed by a peak between 1967 and 1978 (yearly incidence 21.9 per 100,000) and a slow decrease thereafter to 7.4 (1997-2006). In the control settlements, the increase was steady. Reduced kidney function at surgery was found in 58% of patients from endemic and in 20% from control settlements. Age at surgery has significantly increased from 52.3 and 51.5 (1957-1966) to 70.9 and 66.1 (1997-2006) for endemic and control settlements, respectively. The female sex was predominant in endemic and adjacent settlements and the male sex in control settlements. Transitional cell carcinoma from endemic settlements was of a lower grade in the period from 1957-1986, but in the period from 1987-2006 they were predominantly high grade. Low tumor stage (pTa-pT1) predominated in transitional cell carcinoma from the endemic and adjacent but not the control settlements in the period from 1957 to 1986. However, in the last 20 years, upper urinary tract transitional cell carcinoma stage increased, the highest in the period from 1997 to 2006 in all settlements studied. Conservative surgery was advocated for transitional cell carcinoma in Balkan endemic nephropathy areas up to 1996. Transitional cell carcinoma are now more malignant and more advanced than before, and a less aggressive approach is used only for absolute indications. CONCLUSIONS: An increased number of transitional cell carcinoma in endemic settlements was observed, markedly decreasing in the last decade. An increasing age and a shorter survival were recorded in patients both from Balkan endemic nephropathy and control settlements. Sporadic cases upper urinary tract transitional cell carcinoma in settlements adjacent to endemic settlements were demonstrated.

Extended orbital exenteration in the treatment of advanced periocular skin cancer with primary reconstruction with a galeacutaneous flap.

Extended orbital exenteration includes the removal of orbital contents together with the surrounding orbital wall(s). Skin cancers (basal cell cancer and squamous cell skin cancer) arising in the periorbital region could present as invasive tumours infiltrating the orbit and orbital walls. We describe the treatment of advanced invasive skin cancers of the periorbital region by extended orbital exenteration. A retrospective consecutive series over a nine-year period, included 21 extended orbital exenterations treated in a tertiary referral centre. The margins of excision were clear in 18. Twenty postoperative defects were reconstructed using galea-skin flaps, and one defect was left to heal by secondary intention. Two patients died of their disease during the three-year follow up. The reconstruction with frontal or frontoparietal galea-skin flap is a suitable option. The technique is versatile and simple, and gives acceptable aesthetic results. The operating time is shorter than that required for microvascular reconstructions, and the complication rate is low. The secondary defect can be closed primarily or by skin grafting. Extended orbital exenteration offers the best chances of cure in the treatment of non-melanotic skin cancers that have infiltrated the orbit and orbital walls.

Sentinel node biopsy for skin melanoma.

BACKGROUND/AIM: Skin melanoma is one of the most malignant diseases with increasing incidence rate. Sentinel node biopsy (SNB) is very important for early detection of metastatic spread. The aim of the study was to analyze the first 40 patients with skin melanoma of 1 to 4 mm Breslow thickness when SNB was indicated. METHODS: The patient characteristics, localization of the primary melanoma as well as histology grade were analyzed. SNB with intraoperative radiocolloid and methylene blue dye detection was performed. RESULTS: Complication rate after SNB was analyzed and seroma was found in 5% of the patients. The therapeutic node dissection was performed in 10 patients with positive sentinel biopsy. The follow-up lasted two years. In five patients the false negative SNB was defined after the mean time of 11 months and the therapeutic dissection was performed. CONCLUSION: SNB in melanoma patients is a useful diagnostic procedure. It is advised for melanoma of 1 to 4 mm Breslow thickness.

[Breast reconstruction following amputation for cancer].

BACKGROUND/AIM: Today, breast reconstruction is a widely accepted method in the treatment of breast cancer after modified radical mastectomy. Reconstruction methods are associated with an acceptable number of complications and reconstruction favourably impacts quality of life. The aim of the study was to present our experience in breast reconstruction. METHODS: We presented here a four-year experience with 84 patients with breast reconstruction after modified radical mastectomy. RESULTS: Implant reconstructions were most common, 44 (52.3%), with primary reconstruction in 31 (70.4%) and secondary in 13 (29.5%) women. Lattisimus dorsi flap (LDF) and implant were utilized in 32 (38%) of the patients, with primary reconstruction in 24 (75%) and secondary in 8 (25%) women. Transversal rectus abdominis myocutaneous (TRAM) flap was rarely used -- just in 8 (9.5%) patients and only for secondary breast reconstruction. Postoperatively, some early complications such as hematoma, seroma, infections and partial flap necrosis were observed in 10 (11.9%) patients. Late complications, such as implant rejection, hypertrophic scarring and hernias at the flap elevation site, were noted in 10 (11.9%) cases. Implant loss occurred in 5 (5.9%) cases. All the complications were successfully managed, and patients rated their reconstruction as follows: excellent, 49 (59%) cases; very good, 20 (24%), and good, 14 (16.8%). In one case, disease progression was observed 6 months after the primary breast reconstruction. CONCLUSION: Breast reconstruction is an acceptable method in the treatment of breast cancer in patients in the need for or with already performed mastectomy. The choice of reconstruction approach depends on the breast volume, patient's wish and experience of surgical team. Our results suggest the advantage of breast reconstruction with LDF with implant, since the technique is safe, complications relatively rare and easily manageable, and the results are excellent or very good in each woman.

E-cadherin expression in upper urothelial carcinoma in Balkan Endemic Nephropathy and non-endemic regions.

There is a high incidence of upper urothelial carcinoma (UUC) in regions affected by Balkan Endemic Nephropathy (BEN). The aim of this study was to compare E-cadherin expression in UUC, in regions affected by BEN, and in control rural and city populations free of BEN. Another aim was to determine the influence of some morphological parameters on the E-cadherin status. In the samples of 85 UUC patients, of whom 40 lived in BEN settlements and 45 served as control subjects, immunoreactions were performed using monoclonal anti-human E-cadherin antibody. Aberrant expression of E-cadherin was more frequent in BEN tumors than in control tumors (p<0.01). Decreased E-cadherin expression was linked to high grade and solid growth in control and BEN tumors (p<0.0001 and <0.05 versus p<0.05 and <0.05, respectively), and to the stage in control tumors (p<0.01). However, BEN low grade and low stage tumors showed aberrant expression more often than did control tumors (p<0.05 and <0.005, respectively). In control tumors, using univariate analysis, E-cadherin status was found to be influenced by grade, stage, and tumor growth (p=0.001, 0.017, 0.015, respectively). In the same group, only the grade was significant according to multistep logistic regression analysis (Wald=6.429 and p=0.011). The growth pattern had a predominant influence on E-cadherin expression in BEN tumors (p=0.005). A significant influence on normal membranous or abnormal cytoplasmic expression of E-cadherin in UUC is exerted by tumor grade, stage, growth, and metaplastic change (p=0.002, 0.048, 0.019, 0.011, respectively), but only by tumor grade in the multistep logistic regression model. These results suggest that decreased expression of E-cadherin in BEN tumors may be linked to tumor growth, while expression of E-cadherin in control tumors may be associated with tumor grade.

[Sentinel lymph node biopsy in breast neoplasms].

BACKGROUND/AIM: Sentinel node (SN) is the first draining node from the malignant tumor site. In the last decade, sentinel node biopsy (SNB) has been introduced as an alternative to axillary dissection in breast cancer. I n patients with negative SNB (sentinel node uninvolved with malignancy) axillary dissection is not recommended. The aim of this stady was defining the indications for SNB, and SNB principles, as well as the survey of our first experiences. METHODS: In the period from 2004 to 2008, we performed 78 SNBs in 75 patients (72 females, 3 males) with breast cancer. Indications for SNB were T1-2 and N0 lesions according to TNM classification (Tumor, Nodus Methastasis). In all cases, lymphoscintigraphy was done first, and then SNB with double contrast (methylen blue and technetium - Tc-99). In 57 (73%) cases, one SN was confirmed, and in 21 (26.9%) 2 nodes. RESULTS: In 58 (74.3%) SNB, SN pathohistology was negative, ie. there were no cancer metastases. In this group of patients, axillary dissection was not done in 47 (81%) SNB. In the remaining 11 (18.9%), lymphonodal dissection level I and II was done after SNB, regardless of the presence or no presence of metastases within SN. All the cases were monitored from six months to one year of the operation and disease progression was not observed. CONCLUSION: Sentinel node biopsy is an acceptable method of breast cancer diagnosis and a good alternative to lymphonodal dissection if there are no metastases within SN. The technique is relatively simple, but requires team work of experienced specialists: surgeons, nuclear medicine specialists and anesthesiologists. Our first experiences suggest a high degree of reliability of the method in selected patients and with well trained team of doctors.

Upper urothelial carcinoma in Balkan endemic nephropathy and non-endemic regions: a comparative study of pathological features.

Upper urothelial carcinoma (UUC), a rare neoplasm, occurs more frequently in some regions of Balkan countries than in other areas in the world. The aim of this study is to compare phenotypic morphological characteristics of UUC in Balkan endemic nephropathy (BEN) region and control rural and city populations free of BEN, and to determine the characteristic(s) that could discriminate tumors in endemic and non-endemic regions. The authors analyzed biopsies from 88 patients with UUC, 40 patients who live in Balkan endemic (BEN) settlements and 48 control subjects. The histological sections were used to assess morphological variables: histologic grade, pathologic stage (pT), growth pattern, pattern of invasion, lympho-vascular invasion (LVI), presence of necrosis and metaplastic changes (squamous or glandular) within the tumor. Statistically significant differences between the groups were found concerning tumor grade, pattern of invasion, growth pattern and metaplastic changes. High-grade tumors and trabecular/infiltrative patterns of invasion were more frequent in the group of BEN tumors (chi(2)=4.583, p<0.05; chi(2)=8.064, p<0.05). Moreover, solid growth and metaplastic changes are significant in BEN tumor, chi(2)=9.696, p<0.01; chi(2)=9.35, p<0.01, respectively. Discriminant analysis of morphological variables had indicated that BEN and control tumors are significantly different (Wilks' lambda=0.833, chi(2)=15.044 and p<0.05). The best characteristic that differentiated them was growth pattern; i.e., solid growth for BEN tumors and papillary for control tumors.