Survival prognostic factors in patients with colorectal peritoneal carcinomatosis treated with cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy: a single institution experience.

PURPOSE: The aim of this research was to examine overall (OS) and disease-free survival (DFS) in patients with colorectal peritoneal carcinomatosis (CRC-PC), treated with cytoreductive surgery (CRS) and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC), as well as to analyse factors of prognostic significance. METHODS: We included 61 patients with pathological/and computerized tomography (CT) confirmation of CRC-PC, treated with CRS+HIPEC from 2005 to 2012. Peritoneal Cancer Index (PCI) score was used for quantitative assessment of the CRC-PC extent. We performed CRS following the Sugarbaker's principles in all patients with PCI ≤20 and only in 3/61 (4.92%) patients with PCI >20. HIPEC (oxaliplatin 410 mg/m(2) in 2000mL isotonic solution and 41?C) was performed using RanD Performer® HT perfusion system during 30-60 min. Cox proportional hazard regression was used to determine significant factors for OS and DFS. RESULTS: The follow-up ranged from 1 to 83 months (median 22). Median OS was 51 months (95% confidence interval/ CI 22+). Median DFS for patients without residual disease (57/61, 93.44%) was 23 months (95% CI 16+). One-, 2- and 6-year OS (DFS) were 78.6% (68.3%), 58.7% (46.7%) and 50.5% (38.1%), respectively. By the end of the study, 55.74% of the patients were still alive. Cox multivariate analysis indicated PCI score as a parameter of highly prognostic significance for patients treated with CRS+HIPEC (p<0.001). Patients with PCI (13 (vs PCI ≥13) had significantly longer OS and DFS (p<0.001), also confirmed for PCI subcategories (PCI <7 vs 7≤ PCI <13 vs PCI ≥13). All patients with PCI <7 are still alive. CONCLUSION: Our study indicates that CRS+HIPEC significantly improves the survival of CRC-PC patients. This treatment modality should be considered as the most suitable in well-selected patients with this disease.

Unilateral follicular variant of papillary thyroid carcinoma with unique KRAS mutation in struma ovarii in bilateral ovarian teratoma: a rare case report.

BACKGROUND: Struma ovarii (SO) is a rare form of ovarian mature teratoma in which thyroid tissue is the predominant element. Because of its rarity, the differential diagnosis between benign and malignant SO has not been clearly defined. It is believed that malignant transformation of SO has similar molecular features with and its prognosis corresponds to that of malignant tumors originating in the thyroid. CASE PRESENTATION: We report 35-year-old woman with bilateral ovarian cysts incidentally detected by ultrasound during the first trimester of pregnancy. Four months after delivery of a healthy child without complication she was admitted to the hospital for acute abdominal pain. Laparoscopic left adnexectomy was performed initially in a regional hospital; right cystectomy was done later in a specialized clinic. Intraoperative frozen section and a final pathology revealed that the cyst from the left ovary was composed of mature teratomatous elements, normal thyroid tissue (>50%) and a non-encapsulated focus of follicular variant of papillary thyroid carcinoma (PTC).Normal and cancerous thyroid tissues were tested for BRAF and RAS mutations by direct sequencing, and for RET/PTC rearrangements by RT-PCR/Southern blotting. A KRAS codon 12 mutation, the GGT → GTT transversion, corresponding to the Gly → Val amino acid change was identified in the absence of other genetic alterations commonly found in PTC. CONCLUSION: To the best of our knowledge, this is the first time this mutation is described in a papillary thyroid carcinoma arising in struma in the ovarii. This finding provides further evidence that even rare mutations specific for PTC may occur in such tumors. Molecular testing may be a useful adjunct to common differential diagnostic methods of thyroid malignancy in SO.

Vitamin D in the light of current knowledge.

Vitamin D, i.e., 1.25(OH)2D, is an essential factor, not only of homeostasis of calcium and phosphorus, but also of cell proliferation, differentiation and apoptosis, immune and hormonal regulation, as well as other body processes.Thus, its optimal presence in the body is of exceptional significance for health, both of children, as well as adults and elderly persons. Today, it is known that the lack of vitamin D, besides having negative effects on the skeleton and teeth, also contributes to the development of various malignancies, primarily of the large bowel, prostate and breasts, as well as of autoimmune and allergic diseases, diabetes mellitus type II, arterial hypertension and others. Considered from the biological aspect, physiological requirements in vitamin D are achieved by cutaneous synthesis from 7-dehydrocholesterol during sun exposure, while, except rarely, it is very scarce in food. Having in mind extensive evidence that sun exposure presents a high risk for the development of skin malignancies, primarily melanoma, it is clear that humans are deprived of the natural and basic source of vitamin D. In accordance, as well as based on numerous epidemiological studies showing the increase of diseases, in the basis of which vitamin D deficiency plays the important role, next led to the recommended dietary allowance of vitamin D, regardless of age. According to current attitudes, it is recommended that the daily dietary allowances of vitamin D, i.e., the quantity of oral intake that would safely cover the optimal body requirements should be 400 IU for ages 0-18 years, 600 IU for ages 19-70 years and 800 IU for persons aged over 70 years.

[Variations in the concentration of total human milk proteins in the first month of lactation].

INTRODUCTION: Human milk proteins are maximally adapted to physiological needs of a neonate. Thus, depending on the speed of the neonatal growth and development, the content of milk proteins changes, both in quantity and quality. OBJECTIVE: The study was conducted in order to determine variations of total protein concentrations in milk in the first and third lactation week in lactating mothers of term and preterm neonates. Also, we analyzed the influence of the mode of delivery, neonatal Apgar score and parity on the concentration of human milk proteins in both lactation phases. METHOD: The study aims were evaluated on the sample of 48 women, of whom 33 were mothers of term neonates and 15 of neonates born between the 34th to 37th gestational weeks. Total protein level of the lactation milk from the middle phase was determined using the standard laboratory method (Lowry et al., 1951), and the obtained differences were analyzed by t-test. RESULTS: Total protein concentration in term colostrum was 17.60-45.17 g/l (X = 24.71 +/- 5.19), while in preterm colostrum it was 28.39-73.30 g/l (X = 39.17 +/- 11.08). The total protein level of mature milk in women who had term delivery was 11.90-22.11 g/l (X = 16.39 +/- 2.96), while in women who had preterm delivery it was 14.50-44.19 g/l (X = 23.25 +/-8.96). The obtained results indicated that total protein concentration in women who had preterm delivery was significantly higher than that of women who had term delivery, both in the colostral and mature phase of lactation. (p < 0.01). Also, the difference in the protein concentration was statistically highly significant (p < 0.01) in the colostral and mature phase of lactation, both in women who had term and preterm delivery. Variations in the total protein level of human milk were not significant, depending on the prematurity stage, the mode and severity of delivery and parity, both in the first and third week of lactation. CONCLUSION: Our results show that total protein concentration in human milk was significantly higher in the first than the third week of lactation. In both lactation phases, milk protein content was higher in women who had preterm delivery than those having had term delivery. The influence of prematurity stage, the mode and severity of delivery and parity on the total milk protein level was not significant.

[Arias icterus--prolonged unconjugated hyperbilirubinemia caused by breast milk].

INTRODUCTION: Breast milk jaundice occurs in 1-2% of healthy breast-fed newborns and young infants. It develops as the result of liver immaturity and the inhibitory effect of mother's milk to the clearance of unconjugated bilirubin. OBJECTIVE: The paper analyzes variations in the level and length of unconjugated hyperbilirubinemia in breast-fed infants. METHOD: The study was conducted on a sample of 29 young infants (19 male) with breast milk jaundice. All infants were born on time, by natural delivery and without complications. All were on breast-feeding only and developed optimally. None of the infants had either haemolysis or any other disease associated with unconjugated hyperbilirubinemia. RESULTS: All infants had physiological jaundice in the first week after birth, with unconjugated bilirubin level of 166-260 micromol (201.50 +/- 36.37 micromol). In the postneonatal period the highest bilirubin level was recorded in the fifth week of life and was 87-273 micromol (166.82 +/- 45.06 micromol), which then spontaneously, without interruption of breast-feeding, gradually declined. The decrease of the unconjugated fraction of serum bilirubin between the fourth and fifth week was significant, and after that highly significant. The normalization of serum bilirubin occurred in the seventh and thirteenth week (10.41 +/- 1.68 micromol). Negative consequences of hyperbilirubinemia were not noted in any of the infants. CONCLUSION: Breast milk jaundice presents a harmless and transitory disorder of bilirubin metabolism. It occurs in healthy breast-fed neonates and young infants. Jaundice is most marked in early neonatal period, and then it gradually declines and disappears between the seventh and thirteenth week.

[Rotavirus gastroenteritis].

Rotavirus is the main etiological agent that causes severe diarrheal diseases in newborns and young children up to two years. Every year, about one million children around the globe die of dehydration caused by Rotaviruses. The problem is even bigger in underdeveloped and developing countries. The results of our 18-month research, in the town Kragujevac and its surrounding area from December 1998 to May 2000 indicate that viruses are an important factor in the etiology of the acute diarrheal diseases in our population. In 124 children, aged 0 to 5, with the acute diarrheal diseases treated at the Pediatric clinic HMC "Kragujevac", viruses were the causes in 27% of the time. The Rotavirus belongs to the family Reoviridae. The infections caused by rotaviruses may be detected around the world. The incidence rate is higher in developed countries. The infection is transmitted orally. The entry of the Rotavirus infection is the upper part of the small intestine. The clinical picture is specific. The disease usually lasts four to seven days. The fastest diagnostic method is direct detection of viruses using the electronic microscope. The agglutination tests ELISA and LATEX are used for the examination of numerous samples. Only symptomatic treatment is required. High morbidity and mortality rates in developing countries are the reason to prevent the Rotavirus disease by active immunization.

[Molecular epidemiology of rotaviruses in preschool children].

Numerous epidemiological studies, conducted in both developed and developing countries, have shown that the rotavirus is an important aetiological agent in severe diarrhoeal diseases among preschool children. In recent years, different biochemical techniques for the genetic and phenotypic analysis of rotaviruses have been developed. The aim of this study was to define the biological and genetic differences among rotaviruses isolated from the faeces of affected children, by using the Polyacrylamide Gel Electrophoresis technique, as well as to type the viruses and establish the number of strains circulating within our population. In total, 124 faeces samples from children up to 5 years of age were analysed. With the use of the ELISA test, rotaviruses were isolated in 10.3% of cases. The extraction of viral RNA was carried out directly from the faeces samples, which was followed by electrophoresis, and finally observation using a UV lamp, and documentation with a photo camera. The analysis of viral RNA, using Polyacrylamide Gel Electrophoresis (PAGE), revealed equal mobility in all segments of the genome. The results of our analysis demonstrated that the same strains of rotaviruses do circulate within our population. Such a result can be explained as a consequence of our years-long isolation as well as of the decreased mobility of our population. However, the results do not signify that the rotavirus genome in this region will not be susceptible to variations and that, consequently, new strains will not be created.

[Clinical manifestations of cow milk protein intolerance in infants].

INTRODUCTION: The disorder of cow milk protein intolerance is characterised by a wide spectrum of clinical manifestations caused by hypersensitivity of type I, II, or IV, and occurs in 2-3% of children, mostly infants. OBJECTIVE: The aim of this study was to present our experiences and observations of clinical signs and symptoms of cow milk protein intolerance in infants aged below 12 months. METHOD: The investigation was carried out on a sample of 55 infants, aged between 1.5-9 months (X = 4.21 +/- 1.25), who had cow milk protein intolerance. Diagnosis of illness was based on characteristic anamnestic, clinical, and laboratory parameters, as well as on an adequate patient's response to antigen elimination. RESULTS: The clinical presentation of cow milk protein intolerance was dominated by cutaneous problems, found in 40/55 (72.73%) infants, followed by digestive disorders, found in 31 (56.36%), while respiratory tract disorders were observed least frequently (14.55%). None of the patients developed anaphylactic shock. Changes involving only one system were found in 35 (63.64%) patients; of these 20 (36.36%) were cutaneous and 15 (27.27%) digestive. Twenty (36.36%) infants displayed multisystemic changes; of these 12 were cutaneus with digestive, 4 were cutaneus with respiratory, while 4 infants had cutaneous, digestive, and respiratory disorders. Of the 55 infants with cow milk protein intolerance, 26 (47.27%) had urticaria, 22 (40.00%) perioral erythema, 21 (38.18%) diarrhoea (15 haemorrhagic, 6 non-haemorrhagic), 13 (23.64%) vomiting, 12 (21.82%) Quincke's oedema, 12 (21.82%) eczema, 5 (9.09%) obstructive bronchitis, while 3 (5.45%) infants had laryngitis. In 5 (9.09%) patients we found a significant body weight deficit and in 3 (5.45%), sideropenic anaemia, while longitudinal growth retardation was not registered in any of the patients. CONCLUSION: Our study showed that the disorder of cow milk protein intolerance predominantly involved cutaneous disorders as well as combinations of cutaneous and digestive disorders, while respiratory system disorders proved to be relatively rare.