IMMUNOHISTOCHEMICAL DIFFERENTIATION OF TRIPLE NEGATIVE BREAST CANCER.

Based on immunohistochemical staining for the basal markers cytokeratin 5/6 (CK 5/6), cytokeratin 14 (CK 14) and P-cadherin, triple negative tumors (TNT) are divided into two groups: 1) basal-like (BL) positive for one or all three markers; and 2) non basal-like (NBL) negative for all three markers. Even though the different origin of the cells of these two types of tumors implies different biological properties, they had been treated as one entity until recently. This paper analyzes TNT collected from 150 patients and distributed into two groups according to the results of immunohistochemical analysis, i.e. BL 116 (77.3%) and NBL 34 (22.67%). In this study, CK 5/6, CK 14 and P-cadherin were used as markers for identifying BL tumors. The immunohistochemical reaction was positive for CK 5/6 in 37%, for CK 14 in 50.86% and for P-cadherin in 68.34% of cases. The subclassification of triple negative breast cancer using the basal markers CK 5/6, CK 14 and P-cadherin has enabled identification of BL and NBL breast cancers in a proportion that is in line with the only accurate analysis of TNT gene expression. Using the mentioned combination of markers in daily practice is easy to perform and economically affordable.

Influence of hormonal status on thermography findings in breast cancer.

The aim of this study was to investigate the association of infrared imaging findings and hormone receptor (estrogen and progesterone) status in breast cancers. The study was carried out at Department of Surgical Oncology and Department of Pathology, Sestre milosrdnice University Hospital Center, in collaboration with licensed infrared thermography experts. The study involved 75 female patients with invasive breast tumors. Thermography findings were compared with different immunohistochemical findings (hormone status positive or negative). Seventy-five female patients aged 36 to 86 years, mean age 64 +/- 11.36 years, were examined. The tumor itself and the breast containing the tumor were statistically significantly warmer (p < 0.001) than the healthy breast in all study patients. There was no statistically significant difference (p > 0.05) between patients with positive and those with negative estrogen receptors. Unlike all previously published results of various thermographic studies, results obtained in this study on the hormone receptor status analyzed and its impact on thermographic findings indicated that estrogen negative tumors had a higher maximum and average temperature than estrogen positive tumors. It was also observed that estrogen negative tumors had lower impact on warming of the entire breast, and that maximum and average temperature of the affected breast was higher in estrogen positive tumors. Arithmetic means of maximum and average tumor temperatures were statistically significantly higher for progesterone negative tumors compared with progesterone positive tumors (p < 0.05). Thermographic findings correlated with the specific hormonal status of breast invasive tumors, which reflects the biological behavior of tumors as well as their clinical variables.

A new approach for transversalis fascia reinforcement in Lichtenstein's inguinal hernia repair.

Operations undertaken for inguinal hernia repair are the most common elective surgical procedures. According to the current guidelines, Lichtenstein's tension-free method is the gold standard for elective hernia operations. The most common types of implanted mesh are polypropylene and composite mesh. We herein present Lichtenstein's operation using a biological hemostatic mesh (Tachosil) used for transversalis fascia reinforcement, and our results after a 3-year follow-up period for 52 patients implanted with Tachosil mesh are reported. According to our results, the biological mesh can be safely implanted during hernia repair with the same recurrence rate and lower postoperative pain and complications compared to hernia repair with polypropylene mesh implantation.

Assessing Health-Related Quality of Life with Antimicrobial Photodynamic Therapy (APDT) and Low Level Laser Therapy (LLLT) after Third Molar Removal.

INTRODUCTION: The purpose of this study was to evaluate the antimicrobial photodynamic therapy (APDT) and low level laser therapy (LLLT) on wound healing, pain intensity, swelling problems, halitosis and the postoperative usage of analgesics after surgical removal of lower third molars. METHODS: One hundred and fifty patients, randomly divided into three groups were selected (50 per each group). The P1 group received the APDT after a third molar surgery, the P2 group received the LLLT and the C group (control group) was without any additional therapy after surgery. A photoactive substance was applied in the APDT study group before suturing. After 60 seconds the photosensitive substance was thoroughly washed with saline water and the laser light was applied in two intervals (30 seconds each). The irradiation power was 50 mW while the wavelength was 660 nm. The laser therapy in P2 group was performed before suturing and the laser light was applied also in two intervals (90 seconds each), the irradiation power was 90 mW while the wavelength was the same as in the first group - 660 nm. Postoperative follow-ups were scheduled on the third and the seventh day in patients who received laser therapy. RESULTS: The results of the postoperative evaluation showed that there was a statistically significant difference in the postoperative wound healing, pain intensity, swelling problems, halitosis and analgesics intake between patients in all three groups (p<0.001). The patients that were subjected to APDT (P1) had the least postoperative problems. After the laser therapy (P1 and P2) wound healing was without any complications, opposite from the patients from the C group (p<0.001). Postoperative application of a laser therapy significantly reduced patient's use of analgesics over the observed period of time (p<0.001). CONCLUSION: Both modalities of laser therapy significantly reduced postoperative problems after surgical removal of third lower molars with the best results in both laser groups.

The impact of human epidermal growth factor receptor-2 status of invasive breast tumors on thermography findings.

OBJECTIVE: To analyze the impact of prognostic human epidermal growth factor receptor-2 (HER-2) in invasive breast cancers on the findings of thermography tests. METHODS: The study was carried out at the Department of Surgical Oncology and the Department of Pathology, University Clinical Hospital Center, Sisters of Mercy, Zagreb, Croatia, in collaboration with licensed infrared (IR) thermography experts. The study involved 75 female patients diagnosed with invasive breast cancer from May to July 2011. Thermography findings were compared between different immune-histochemical (IHC) findings (HER-2 status: positive or negative). RESULTS: Significantly higher temperatures were recorded in invasive cancer breasts than in healthy breasts. The cancer sites and the entire cancer breasts were significantly warmer (p less than 0.001) than the healthy breasts and opposite tumors mirror sites. Considering the HER-2 status, HER-2 positive invasive cancers were significantly warmer in comparison with the HER-2 negative cancers (p=0.035). CONCLUSION: The trend of increased temperature in HER-2+ tumors was noted. The findings clearly indicate that HER-2+ status has a higher impact on the increased thermographic temperature findings.

[Epidemiology of invasive breast cancer according to histopathologic and immunohistochemistry prognostic factors]. / Epidemiologija invazivnih tumora dojke s obzirom na patohistoloske i imunohistokemijske prognosticke cimbenike.

The aim of this study was to analyze the TNM classification factors of invasive breast cancer that can be affected by the national program for early detection of breast cancer in the Republic of Croatia. The other analyzed factors related to histology and immunohistochemistry have no such impact as they are related to biological behavior and aggressiveness of malignant breast tumors, thus providing useful predictive and prognostic information. The study was performed at Department of Oncologic Surgery, Sestre milosrdnice University Hospital Center, and included 75 patients surgically treated for invasive breast cancer during the period of one month in 2011, mean age 64 +/- 11.36 (range 36-86) years. Most of the patients (68%) with malignant breast disease were diagnosed in a localized stage, which is consistent with the reports from developed European countries. The size of the newly discovered tumors showed continuation of a trend of detecting tumors of ever less size and a lower percentage of pT3 pT4 tumors. This result proved superior to those reported from many European countries. The results of correlation analysis, tumor size, estrogen and progesterone receptor, HER-2 protein, Ki-67, and histologic tumor grade, tumor size did not show significant correlation with any of these parameters. Concordant expression of phenotype (ER+, PR+) receptor pairs and negative HER-2 was recorded in most study patients. The second most frequent group had tumors with so-called 'triple-negative' immunohistochemistry negative phenotype (ER-, PR-, HER-2). In conclusion, the program of early detection of breast cancer in the Republic of Croatia and at the University Hospital for Tumors justifies its existence for revealing malignant breast tumors at an earlier stage of the disease considering the size local stage of newly diagnosed tumors.

Surgical treatment of pathologic fractures in patients with metastatic tumors.

The study presents results in treatment of pathologic fractures of long bones of all patients who underwent surgery in the last 10 years in our hospital. The study cohort comprised 133 consecutive patients divided in two groups who underwent surgery of long bone fractures caused by metastatic tumor or trauma. We used resection, open reduction and plating with bone cement application for pathologic fracture and some cases of femoral shaft fractures were stabilized with intramedullary nailing. Proximal femoral fractures were treated with hip arthroplasty or dynamic hip screw. There were 2 amputations performed: one case of pathologic fracture of tibia and one case of humeral fracture. The present study compares results between two group of patients. We noted: age, gender, fracture site, choice of the surgical procedure, hospital stay, need for analgesia after surgery, postoperative complications, and reached level of physical activity after surgery. The mean survival rate was 8.1 months. Seventeen patients experienced postoperative complications. We also found statistically significant improvement in functional scores (MSTS and TESS) in surgically treated patients with pathologic fractures. There are many different techniques of surgical treatment of pathologic fractures caused by skeletal metastases including arthroplasty or a combination of internal fixation combined with polymethyl methacrylate (PMMA) that provides immediate fixation and stability. The present study showed that surgical treatment of pathologic fractures caused by skeletal metastases in vast majority of cases provides bone healing after pathologic fracture, with significant improvement of physical activity and rehabilitation in the investigated group.