Efficacy and safety of TC dose-dense chemotherapy as first-line treatment of epithelial ovarian cancer: a single-institution retrospective cohort study.

BACKGROUND: The optimal first-line therapy of advanced ovarian cancer still remains questionable: standard paclitaxel-carboplatin (TC), dose-dense TC, intraperitoneal chemotherapy or TC plus bevacizumab. In this study, we present the real-life results of dose-dense treatment of the single-institution on Caucasian population. METHODS: A retrospective cohort study was used on consecutive samples of 74 patients treated with the conventional 3-weekly TC protocol (2008-11) and on 70 treated with TC dose-dense protocol (2012-16). The primary endpoint of this study was overall survival (OS). Secondary endpoints were progression free-survival (PFS) and toxicity. We made adjustments for age, pathohistological type, tumor grade, stage and postoperative residual disease by Cox regression. RESULTS: After adjustment for pre-planned clinical and sociodemographic factors, patients treated with dose-dense protocol showed a significantly lower hazard for dying from any cause, than patients treated with conventional protocol (HR = 0.50; 95% CI 0.26-0.98; P = 0.042). Median OS, at 60 months follow-up had not been reached in the dose-dense group, while in the standard treatment group was 48 months (95% CI 33-62). Unadjusted PFS was significantly longer in the dose-dense group (HR = 0.58; 95% CI 0.38-0.88; P = 0.011), but not after the adjustment (P = 0.096). Generally, the level of toxicity was similar in both groups of patients. The need for blood transfusions and usage of filgrastim was significantly higher in the TC dd group. The incidence of neutropenia and thrombocytopenia Grade 3 or 4 were not significantly different in both regimens. CONCLUSIONS: Our retrospective study has shown the superior efficacy and comparable toxicity of dose-dense chemotherapy regimen over the conventional regimen in treatment of ovarian cancer on Caucasian population at a single-institution.

Ultrasound screening of the neonatal hip: cost-benefit analysis.

AIM: To explore the economic justification for introducing ultrasound screening for developmental dysplasia of the hip in Croatia. METHODS: The analysis was based on the two formulas: that cost-benefit equals benefit/cost, and that net benefit equals benefit minus cost. Screening costs were expressed as a sum of training costs and fee for ultrasound screening of neonates. The neonatologists' working hours and utilization of ultrasound instruments were expressed by multiplying the number of infants born per year in Croatia (N = 47,792) with the standard time needed for one examination and then dividing the product by the number of employed neonatologists (N = 54) and number of ultrasound instruments (N = 58). The benefit was expressed as a late case treatment costs and screening costs ratio. Savings, which would have resulted from the reduction in expected treatment costs of patients with hip problems at later age, represent the indirect benefit. RESULTS: Total hip screening costs would have amounted to US$329,537.80, including the training costs of US$31,035.90. On the average, a neonatologist would spend 71.4 hours screening per year, whereas the instrument utilization would be 64.7 hours. An ultrasound-screening program would save annually US$195,336.50, compared with the existing diagnostic approach. The treatment costs without ultrasound screening were 1.6 times higher than the screening costs. Hospital treatment costs for 165 patients needing endoprosthesis would cover the total screening program in the whole country. CONCLUSION: It is economically justified to introduce ultrasound screening for developmental dysplasia of the hip in neonates in Croatia, a country with transitional and developing economy.

Algorithm for establishing the indication for knee arthroscopy in children: a comparison of adolescent and preadolescent children.

The aim of this study was to select children with pathological lesions of the intra-articular structures from children with identical complaints but with no pathological intra-articular changes. The younger the child, the more difficult it is to make the diagnosis, and the expected distribution of pathology changes increasingly. This is particularly stressed in children aged younger than 13 years. Synovial inflammatory alterations are more frequent, and osteochondral and chondral fractures appear to be more problematic than meniscal and cruciate ligament lesions. Before establishing the indication for knee arthroscopy it is mandatory to implement the algorithm of diagnostic and conservative therapeutic procedures. The indication for knee arthroscopy is considered in cases when complaints persist after conservative treatment, a lesion of intra-articular segments is suspected, and the pathological condition is deemed arthroscopically treatable. Arthroscopy before conservative treatment is justified only in acute cases.

Synovial osteochondromatosis of the sternoclavicular joint.

A 9-year-old boy with a rare localisation of synovial osteochondromatosis at the left sternoclavicular joint is presented. Synovial osteochondromatosis at this site and at this age has not been previously reported. Joint loose bodies were removed surgically and partial synovectomy was performed. Follow-up showed no evidence of recurrence over a period of 8 years.

Development of acetabulum after closed reduction in developmental hip dysplasia.

The radiographic study of acetabulum development after closed reduction of 87 congenitally dislocated hips in 64 patients who were treated between 1980 and 1990 was conducted retrospectively. An average patient's age at the moment of closed hip reduction was 16 months (range between 6 to 24 months). On the average, patients were 16 months old (range between 6 to 24 months) at the moment of closed hip reduction. Development of bony acetabulum was followed for 8 years by measuring the AC angle. According to the age at the moment of closed reduction patients were sorted into three groups, the first group from 6 months to 12 months old (39 hips), the second group from 12 to 24 months old (28 hips) and the third group from 24 to 36 months old (20 hips). At the beginning of the treatment mean values of the AC angle in the first group were 37.2 degrees +/- 3.31 degrees; in the second group 39.7 degrees +/- 3.2 degrees; and in the third group 43.8 degrees +/- 2.7 degrees. The final values of the AC angle in the first group were 14.7 degrees +/- 3.21 degrees, in the second group 21 degrees +/- 3.02 degrees; and in the third group 24 degrees +/- 3.76 degrees. Normally and mildly dysplastic hips were achieved in 80.5% treated hips, while in 19.5% treated hips medium and serious dysplasia retarded. The acetabulum development in dysplastic hip after retained stable concentric reduction was the same as in the normal hip. The operative reconstruction of acetabulum should not be done before the third year of life.

Development of bony acetabulum in newborns with developmental hip dysplasia.

Trend in the development of bony acetabulum in newborns with developmental hip dysplasia was examined during the first year of life. The study comprised 120 newborns with developmental hip dysplasia. The degree of dysplasia was determined by measuring the acetabular angle (AC) on X-rays of the hips in the anteroposterior projection. The experimental trend curve was most adequate for both the whole group and each subject. The coefficient of trend was assessed by specially designed iterative method. The exhibited trend form allows the extrapolation and prognosis of treatment outcome already after 3-5 measurements of the AC angle. The applied iterative method for the determination of the coefficient of exponential trend iterated rather quickly. The chosen form of the trend curve proved to be adequate for manifestations in which a constant value is expected after a longer period of time. The exponential curve represents a mathematical model of the acetabular development dynamics, with allometric exponents and coefficients of the equation being numerical parameters that define developmental changes. As the AC angle reaches the constant value with the closure of triradiate cartilage, this parameter is an objective measure of the development of bony acetabulum. When assessing the acetabular growth in developmental dysplasia it is necessary to bear in mind that duration, specific position and quantity of newly formed and remodelled bone are determined genetically, and that external factors have a significant influence on the definitive formation.

Echosonogrametric diagnosis of developmental dysplasia of the hip.

In view of adding to ultrasonographic scanning of the neonatal hip through various projections and in order to improve the measurement and quantification base of the normal and dysplastic neonatal hip, the research was conducted on anatomic hip preparation of full-term still-born baby. The research on a clinical sample covered 600 ultrasonically examined normal and dysplastic hips. Ultrasonographic serial scanning was performed on various planes using linear transducer with 5 and 7.5 MHz and with or without a water pillow. On the clinical sample of the particular group various projections were applied and results compared with projections obtained on anatomic preparation. Concluded was that with several projections frontal sonographic projections tomographic examination of the hip joint could be performed. Better insight of the position of the femoral head at rest in neutral and flexed positions, the relative stability of the hip with motion and stress and the depth and configuration of the bony and cartilaginous portions of the acetabulum could be obtained if, besides frontal sections, cross sections of the hip were used. Sufficient measurement data echosonogrametric parameters were indispensable for an adequate definition of all hip joint structures.

Development and growth of immature hips.

The authors investigated the development of the bony acetabulum in type IIa+ immature hips using ultrasound follow-up evaluation of the alpha and beta angle. The study comprised 900 hips in one-month old infants. In the initial ultrasound examination the alpha angle measured less than 60 degrees and the beta angle more than 55 degrees. In the second ultrasound examination at the age of two months a discrepancy between the bony and cartilaginous acetabular component was found in 15% of the hips, which means that the type IIa+ hips were transformed into the type IIa-. The infants with type IIa- hips had more than two risk factors for developmental dysplasia of the hip. The statistical relative risk was 17. These hips were treated with the Pavlik harness during two months on average. After treatment all hips had normal values the alpha and beta angles (more than 60 degrees and less than 55 degrees respectively). This study showed that each newborn and infant with a sonographically confirmed hip development disorder has to be included in the follow-up evaluation of acetabular development, which makes it possible to choose the most adequate therapeutic and prophylactic measures.

[War injuries in children]. / Ratne ozljede kod djece.

The pathology of the wartime injuries in children, the ways of injuring, primary and secondary surgical treatment, and principles of war surgery applied in children age are analysed. Some typical patients admitted to the Clinical Hospital for Pediatric Surgery of the Institute for Mother and Child Health in Zagreb are presented.