SURGICAL TREATMENT FOR BREAST CANCER AND AXILLARY METASTASES: HISTORICAL PERSPECTIVE

Breast cancer (BC) is the most common malignancy to affect females. The first suggestions of BC and its treatment date back to Ancient Egypt, 1500-1600 B.C. Throughout history, the management of BC has evolved from extensive radical mastectomy towards less invasive treatments. Radical mastectomy was introduced by W.S. Halsted in 1894, involving the resection of the breast, regional lymph nodes, pectoralis major and minor. Despite its mutilating effect, it had been the main surgical approach to BC patients until 1948, when Patey and Dyson proposed its modified form that conserved pectoralis major and minor and the level III of axillary lymph nodes. The latter was associated with less postoperative morbidity and improved quality of life. The idea of limited breast tissue resection was introduced in the 1970s by Umberto Veronesi and led to further minimizations of surgery in BC patients until breast conservation became the standard of care for early-stage disease. In the 1990s, intraoperative lymphatic mapping and the concept of sentinel lymph node (SLN) biopsy (SLNB) have been developed. SLNB has replaced axillary lymph node dissection (ALND) to be the standard procedure for axillary staging in patients with clinically node-negative BC. Many women have since been spared ALND, including those with negative SLNB or with SLNs involved with micrometastases (0.2-2 mm in size). In the last decade, evidence gathered from new clinical trials suggests that ALND may be safely omitted even in BC patients with 1 or 2 positive SLNs if adjuvant radiotherapy is delivered.

Outcome evaluation of 10,317 laparoscopic cholecystectomies: a 17-year experience at a single center.

BACKGROUND/AIMS: This study is an analysis of the large series of laparoscopic cholecystectomies and compare our results with those reported in the literature concerning complications. METHODOLOGY: From December 1993 to September 2010, 10,317 patients with gallstone disease underwent laparoscopic cholecystectomy. Previously operated patients were also included in the study. We analyzed the successfulness of the results, intraoperative and postoperative complications, conversions in open cholecystectomy, mortality and reoperation rate. RESULTS: We registered 23.28% complications. Intraoperative complications were bleeding in 9.84%, gallbladder perforation in 8.63%, stone loss in 1.37%, common bile duct injury in 0.24% and injury of intraabdominal organs in 0.07% of cases. Postoperative complications were bleeding in 1.12%, wound infection in 0.59%, bile leakage in 0.5%, incisional umbilical hernias in 0.37%, subhepatal collection in 0.33%, residual gallstones in choledocus in 0.09%, urine retention in 0.08% and biliary peritonitis in 0.01% of patients. Conversion to open cholecystectomy was necessary in 2.13%. Reoperation was performed in 0.27%. The mortality rate was 0.019%. CONCLUSIONS: Our results on large number of patients are similar to other series in the newer literature but the rate of complications should be decreased. The incidence of complications decreases with growing laparoscopic experience.

Severe traumatic brain injury after the assault with an axe handle.

Traumatic brain injuries represent a major cause of death and disability. We present a case of a 47-year-old patient who sustained a severe brain injury after being assaulted with a handle of an axe. The patient underwent numerous surgeries by various specialists during several months. Following a few failed attempts to cover the skull defects, the vacuum-assisted closure system had been utilized with great success in healing of her complex head wound. Traumatic brain injury requires great effort and collaboration in order to rehabilitate people to the most independent level of functioning possible.

[Burn injuries: what have we learned from history]. / Opeklinska bolest: sto smo naucili iz povijesti

Severe burn injuries present a significant public health risk and are often associated with a life-threatening systemic inflammatory response. With the traditional approach, patients often stay in hospital longer and are more prone to problems like joint contractures, hypertrophic scars and infections due to delayed healing. The approach to burn injuries has been improving through and has been adopting new technologies and materials. Today, burn injuries are treated by general practitioners and surgeons. Unfortunately, this does not always ensure faster healing improvement of the quality of life.

Pathological pulmonary hernia in a patient with metastatic breast cancer.

INTRODUCTION: Pathological pulmonary hernia is a rare clinical entity which can be caused by malignancies. CLINICAL PICTURE: A 72-year-old female presented with a painful bulge in the left 4th intercostal space. Chest radiography and computed tomography demonstrated a left pulmonary hernia, pleural effusion and destruction of ribs. TREATMENT: The hernia sac was excised and a part of the chest wall was resected with reconstruction of residual defect. OUTCOME: The patient died 2 years after the treatment. CONCLUSIONS: A multidisciplinary approach involving various medical specialists may offer patients with pathological pulmonary hernia remarkable palliation and better quality of life.