[Clinical recommendations for diagnosing, treatment and monitoring of patients with ovarian cancer -- Croatian Oncology Society and Croatian Society for Gynecology and Obstetrics as Croatian Medical Association units and Croatian Society of Gynecological Oncology]. / Klinicke upute za dijagnostiku, lijecenje i pracenje bolesnica oboljelih od raka jajnika hrvatskoga onkoloskog drustva i hrvatskog drustva za ginekologiju i opstetriciju hrvatskoga lijetnickog zbora te hrvatskoga ginekoloskoonkoloskog drustva.

Ovarian cancer together with fallopian tube represents the fifth most common female cancer in the Republic of Croatia. Epithelial ovarian cancer, serous subtype, encompasses most of malignant ovarian neoplasms. Less common are various non-epithelial ovarian malignancies. A special group consists of epithelial carcinomas of low malignant potential with clinically indolent flow, good prognosis and no invasion, and primary cancer of the peritoneum and fallopian tube cancer. Clinically, these malignant tumors are generally asymptomatic in early stages, and usually diagnosed in advanced stages. The diagnosis is confirmed by pathological examination, and occasionally, cytological findings after completing diagnostic procedures. Multidisciplinary team makes treatment decisions, taking into account age, general condition and comorbidities of the patient and characteristics of the tumor itself, including disease stage, histological type and grade of the tumor. The principles of treatment of primary peritoneal and fallopian tube cancer are based on the principles of treatment of epithelial ovarian cancer involving surgery, chemotherapy, immune and hormone therapy, and symptomatic-supportive care throughout the treatment. Less common histological types have a different treatment approach being more frequently diagnosed in the early stages of the disease, have more indolent flow, so in these patients conservative surgeries with the goal of preserving fertility are more often employed. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, management, treatment and monitoring of patients with ovarian carcinoma, fallopian tube and primary peritoneal cancer in the Republic of Croatia.

[Clinical recommendations for diagnosing, treatment and monitoring of patients with uterine cervical cancer -- Croatian Oncology Society and Croatian Society for Gynecology and Obstetrics as Croatian Medical Association units and Croatian Society of Gynecological Oncology]. / Klinicke upute za dijagnostiku, lijecenje i pracenje bolesnica oboljelih od raka vrata maternice hrvatskoga onkoloskog drustva i hrvatskog drustva za ginekologiju i opstetriciju hrvatskoga lije nickog zbora te hrvatskoga ginekoloskoonkoloskog drustva.

Cervical cancer, in comparison with other gynecological malignancies, mainly affects younger women. It can be prevented trough educational programs, screening and early detection. It also can be efficiently treated when it appears. Treatment modalities include surgery, chemotherapy and radiotherapy, according to the stage of the disease and patient condition. Treatment decisions should be made after multidisciplinary team discussion. Due to the significance of this disease it is important to define and implement standardized approach for diagnostic, treatment and monitoring algorithm as well. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, management, treatment and monitoring of patients with uterine cervical cancer in the Republic of Croatia.

Frequency and distribution of lymph node metastases in epithelial ovarian cancer.

BACKGROUND: The aim of this retrospective study was to evaluate the incidence and distribution of nodal metastases in relation to the serous versus nonserous histological subtypes of epithelial ovarian cancer. METHODS: Patients were treated primarily with upfront surgery, including pelvic and paraaortic systematic lymphadenectomy, up to the level of the left renal vein, before any kind of chemotherapy administration. Patients were classified according the tumor histology into 2 groups: serous (including the cases of mixed histology with a serous component) and nonserous group. RESULTS: A total of 173 patients fulfilled the inclusion criteria; 76 and 97 patients had serous and nonserous ovarian carcinoma, respectively. Positive lymph nodes were found in 59.3% (45/76) and 14.4% (14/97) of patients in the serous and nonserous histology groups,respectively. There was no difference in positive node distribution in 3 regions (pelvic and para-aortic regions, below and above the inferior mesenteric artery) between these 2 groups. Early spread including 1 or 2 positive lymph nodes was predominantly found in the para-aortic region in both groups, serous and nonserous, whereas distribution of positive nodes in patients with 3 or more lymph nodes shows equal presence in pelvic and para-aortic regions. CONCLUSIONS: Serous ovarian carcinomas are much more prone to metastasize to lymph nodes than nonserous histological types. However, the pattern of lymph node distribution did not differ between these 2 groups and was similar in the pelvic and para-aortic regions.

Treatment and outcome of stage Ia1 squamous cell carcinoma of the uterine cervix.

OBJECTIVE: To evaluate the treatment and clinical outcome of patients with FIGO stage IA1 cervical squamous cell carcinoma (SCC). METHODS: Medical records, including 5-year follow-up, were reviewed for 276 patients with stage IA1 SCC. RESULTS: As definitive surgery, 152 (55.1%), 72 (26.1%), 40 (14.5%), and 12 (4.3%) patients underwent conization, hysterectomy, hysterectomy with pelvic lymphadenectomy (PL), and radical hysterectomy with PL, respectively. Among these groups, the 5-year recurrence-free rate was 94.1%, 98.6%, 95%, and 100%, respectively, and the survival rate was 98.7%, 98.6%, 100%, and 100%, respectively. Recurrent disease was identified among 12 (4.3%) patients, and was related to the depth of invasion (P<0.001). Eleven (4.0%) of 276 patients were found to have lymph vascular space invasion (LVSI). There were no positive lymph nodes among 52 patients who underwent PL, including those with LVSI. Conization was followed by hysterectomy in 49 patients. In these patients, residual intraepithelial neoplasia was found in 18 women, 3 of whom had no involved margins on previous conization. In the group of patients treated by conization, recurrence correlated with the status of the endocervical and lateral cone margin (P<0.001). CONCLUSION: As a conservative approach, conization is an effective and reasonable treatment option for stage IA1 SCC, especially in actively reproductive women.

Treatment of invasive cervical cancer: Rijeka experience.

The aim of this retrospective analysis was to evaluate the survival rate in 661 patients with cervical cancer regarding two time periods 1990-1996 and 1997-2003 and the specific stage related risk factors. The respective five-year survival was 71.7% and 80.0%. Analyzing the risk factors in the univariate and multivariate regression modalities ultimately only two parameters, the two time periods and FIGO staging were found to be independent prognostic factors. The observed total improvement in the survival rate of the second time period is followed by an increase in conservative surgery in stage TIA1, a reduction in the use of adjuvant radiotherapy among operable stages Tlbl, Tlb2 and T2A, while the treatment of locally advanced cervical cancer did not differ significantly.

[Recent findings regarding physiological characteristics and effects of renal dopamine]. / Novije spoznaje o fizioloskim svojstvima i ucincima bubreznog dopamina.

During the past decade, it has become evident that dopamine acts not only as a classical neurotransmitter in the central and peripheral nervous system but also as an autocrine, paracrine and/or endocrine substance in peripheral, non-neuronal tissues. This work is aimed to review some of the recent aspects related to the physiological features and effects of renal origin dopamine. Renal dopamine is synthesized in the proximal tubule epithelial cells. Newly formed dopamine leaves the cellular compartment by crossing the apical cell border and the basolateral membrane side. Dopamine exerts its intrarenal action via specific cell surface receptors, differentially expressed along the nephron and other structural components of renal tissue. These receptors have been classified into five types. D1 and D5 receptors are linked to stimulation, while D2, D3 and D4 receptors are linked to inhibition of adenylyl cyclase. Renal dopamine affects electrolyte and fluid balance by regulation of renal excretion of electrolytes and water through actions on renal hemodynamics and tubular, epithelial transport. The importance of intrarenally produced dopamine as a natriuretic hormone is reflected by its capacity to inhibit the majority of sodium transporters (Na+K+ATPase, Na+/H+-exchanger) in the entire nephron. Numerous clinical and animal, experimental observations suggest that dopamine coordinates the effects of antinatriuretic and natriuretic factors and indicate that the intact renal dopamine system is of major importance for maintenence of sodium homeostasis and systemic blood pressure. Sodium retention leads to an increase in renal dopamine tonus. This function is, due to deficient renal dopamine production and/or a D1 receptor G-protein coupling defect, lost in human essential hypertension and in some animal models of genetic hypertension. A better knowledge of molecular bases of these changes may contribute to the development of specific diagnostic and therapeutic approaches in essential as well as secondary forms of hypertension.