Radiation-Induced Breast Angiosarcoma-A Single-Institution Experience.

Introduction: Radiation-induced breast angiosarcoma (RIBAS) is a rare adverse event associated with postoperative breast irradiation. The data from the literature indicate that RIBAS occurs in less than 0.3% of patients treated with adjuvant radiotherapy for breast cancer. Given the rarity, diverse clinical presentation, poor prognosis, and lack of consensus on the management, this study aimed to present experiences of our specialized cancer center with RIBAS, in terms of the incidence, presentation, management, and outcomes. Methods: We reviewed the medical records of 10,834 breast cancer patients treated at the Institute for Oncology and Radiology of Serbia between January 2013 and June 2024 to detect patients that had breast-conserving surgery, followed by postoperative irradiation, and developed angiosarcoma in the irradiated area at least 3 years after radiotherapy, without distant metastases. The incidence, latency period, management, and treatment outcomes were analyzed. Results: A total of nine female patients with RIBAS were identified and included in this study. The median age at RIBAS diagnosis was 64 years (range: 36-68), with a median latency of 64 months (95% CI > 57) from irradiation to diagnosis. The mean tumor size was 55 mm (SD 32.78). Patients were followed for a median of 30 months (range: 7-40) after initial RIBAS surgery. Local recurrence occurred in seven patients (77.8%), with five undergoing re-do surgery with curative intent. Three patients developed distant metastases during follow-up. The median overall survival (OS) was 31 months (95% CI > 30), with a 3-year survival rate of 15.2% (95% CI 2.5-91.6%). The median local recurrence-free interval was 10 months (95% CI > 3). Median OS after RIBAS local recurrence and after breast cancer treatment was 17 months (95% CI > 15) and 108 months (95% CI > 88), respectively. Conclusions: RIBAS is a rare but increasingly prevalent adverse event associated with BC irradiation, marked by an aggressive disease course and high relapse rates. Awareness, prompt diagnosis, and a radical surgical approach with wide clear margins are critical for improving patients' outcomes.

Course and rate of post-fracture bone healing in correlation with bone-specific alkaline phosphatase and bone callus formation.

Alkaline phosphatase (ALP) and bone-specific alkaline phosphatase (S-bone ALP) activities may serve as markers of the course and rate of bone healing after sustained fractures. The aim of this study was to examine whether the assessment of S-bone ALP as a biochemical parameter in the early posttraumatic phase may indicate the course of fracture healing. To date, the methods used to monitor the bone healing process have been based on the patients' assessment and the radiographic findings. In view of the fact that patient opinion is highly subjective, that the radiographic findings depend on the radiologist's experience and that the monitoring of bone healing is a long-lasting process, measurements of biochemical parameters appear to be the only objective evidence of the changes occurring during bone regeneration. In this study, the activity of bone-specific alkaline phosphatase was measured in the serum of 41 patients who had sustained long bone fractures. The participants included 26 males and 15 females, aged 15 to 80 years. All patients were treated surgically. The activity of S-bone ALP was assessed every seven days over a period of 4 weeks. The study patients were followed up radiologically for several months. Our research showed that the increase of alkaline phosphatase correlated with an increase of S-bone ALP levels. In addition, changes in ALP levels on days 7 and 14 as compared to those on day 1 post injury were associated with changes in S-bone ALP levels on the same day. Likewise, the callus volume correlated with the decrease, no change or increase in the levels of ALP and S-bone ALP in the same way. Based on these results, it may be concluded that monitoring changes in the biochemical parameters alkaline phosphatase and bone-specific alkaline phosphatase allows early detection of fracture healing rates. A minor increase in the activity or no change in the level of the biochemical parameters ALP and S-bone ALP in the period of the first two weeks indicates successful fracture fixation, rapid bone healing and the formation of a minimal or insignificant callus. A major increase in the activity of the biochemical parameters ALP and S-bone ALP in the period of the first two weeks indicates inadequate fracture fixation, delayed bone healing and the formation of a visible and significant callus.

Mutational and clinico-pathological analysis of papillary thyroid carcinoma in Serbia.

Molecular pathogenesis of papillary thyroid carcinoma (PTC) is largely associated with mutational changes in the BRAF, RAS family and RET genes. Our aim was to assess clinico-pathological and prognostic correlations of these PTC-specific gene alterations, with a particular emphasis on the BRAF mutation, in a group of 266 Serbian PTC patients, for the first time. The reference center-based retrospective cohort included 201 (75.6%) females and 65 (24.4%) males aged 48.0±16.1 years (8-83 years old, range) diagnosed and treated for PTC during 1993-2008. Follow-up period was 53.1±41.6 months (7-187 months, range). BRAF and RAS mutations were determined by direct sequencing of genomic DNA. RET/PTC rearrangements were analyzed by RT-PCR/Southern blotting. Genetic alterations were detected in 150/266 tumors (56.4%). One tumor displayed two genetic alterations. The BRAF(V600E) was found in 84/266 (31.6%) cases, RAS mutations in 11/266 (4.1%) and RET/PTC in 55/266 (20.7%; 42/266 (15.8%) RET/PTC1 and 13/266 (4.9%) RET/PTC3). On multivariate analysis BRAF(V600E) was associated with the classical papillary morphology (P = 0.05), the higher pT category (P = 0.05) and advanced clinical stage (P = 0.03). In a proportional hazard model, BRAF(V600E) did not appear to be an independent risk factor for the faster recurrence (P = 0.784). We conclude that under the extensive thyroid surgery and limited application of radioiodine ablation BRAF(V600E) may not be an indicator of poorer disease-free survival during the short to middle follow-up period. However, it has a potential to contribute to patients stratification into high- and low-risk groups.

Our experience with modified osteomyoplasty for reamputation of war-related transtibial amputees.

The aim of this study was to examine the efficacy of the operative method of modified osteomyoplasty in relation to primary "guillotine" amputation in Croatian war amputees. From 1995 to 2000 a total of 425 patients underwent transtibial amputation for their war-related injuries. From these group, 52 patients were selected that were unable to tolerate prosthetic wear. Following primary amputation, these 52 patients underwent reamputation surgery using the technique of modified osteomyoplasty. The efficacy of the operative method was assessed in relation to age, presence of complications before amputation, the level of amputation, the number of amputations, motivation for social integration, and the normalization of physical activity and the patient's level of satisfaction (graded from 1, unsatisfactory to 5, completely satisfactory). The results of the analysis showed that the application of modified osteomyoplasty as the method of choice for transtibial residual limb reconstruction creates the basic prerequisite for functional prosthetic fitting. The level of satisfaction significantly increased from the mean value of 1.21 before the surgery to the mean of 2.96 one year after the surgery (Z = -6.270, p < 0.001, Wilcoxon signed rank test).

Prognostic significance of BsALP in healing of long bone fractures.

The aim of this work was to assess the relationship of both total alkaline phosphatase (ALP) and bone-specific alkaline phosphatase (BsALP) with the course and outcome of operatively treated long-bone fractures. The activity of total ALP and BsALP was measured in 41 patients with a long bone fracture, comprising 26 men and 15 women. All patients were treated operatively. Total ALP and BsALP levels were measured in sera on day 1, 7, 14 and 21 after sustaining injury. Patient monitoring included X-rays. According to the outcome, patients were divided into two groups: the fast healing group and the slow healing group. The levels of total ALP and BsALP showed parallel trends in the course of this study. Depending on the healing outcome, on day 7 an increase in the case of slow healing, or a decrease in the case of fast healing, for both BsALP and total ALP was observed. No difference was found between various sites of bone fracture. This is an important result indicating the prognostic significance of total ALP and BsALP measurement in the monitoring of long bone fracture healing. In addition, an early change in the level of these enzymes was associated with the efficiency of the performed surgery.

Denture repairs in different regions of Croatia in relation to prosthodontic teams.

The purpose of this paper is to evaluate the incidence of denture repairs in different districts of Croatia through the year of 2002. and to analyse the percentage of different repairs (relinings, simple repairs up to 2 elements and complicated repairs-more than 2 elements) in relation to prosthodontic teams. Data on the number of dentures, and the number and types of denture repairs delivered in the Croatian regions of Zagreb, Rijeka, Split and Karlovac were obtained from the Croatian Institute for Health Insurance for the whole of the year 2002. Information of the number of prosthodontic teams operating in those regions was also obtained. Proportionally more denture repairs were carried out in Karlovac (18%) than Split (5%). The smallest percantage of dentures that required relining was registered in Split and the highest in Rijeka (chi2 = 36.7, p < 0.01). The smallest percentage of simple repairs was registered in Rijeka and the highest in Split (chi2 = 24.3, p < 0.01). The smallest percentage of complicated repairs was registered in Split and the highest in Karlovac. In each region the proportion of denture repairs and types of repairs were correlated with a number of prosthodontic teams in that region. Karlovac had the smallest percentage of specialistic prosthodontic teams and the highest rate of denture repairs.

Epidemiological study on removable denture deliveries in different districts of Croatia, 1996-2001 and 2002.

Aim of this study was to determine the prevalence of removable denture (complete and partial) deliveries through Croatian Public Health Service (covered by insurance) in different districts of Croatia and to compare the two periods: 1996 to 2001 and 2002. Number of dentures delivered was obtained from Croatian Institute for Health Insurance for the district of Zagreb, Rijeka, Split and Karlovac. Information of the population living in the same districts was obtained from the National Institute for Statistics. The percentage of fully edentulous inhabitants varied from more than 13% to more than 20%, dependent on the district, while the percentage of partial edentulism reconstructed with removable partial dentures varied from more than 13% to more than 30%. The highest percentage (average for living population) of complete and removable partial dentures was delivered in Zagreb in the both observed periods. In all districts, the number of complete denture wearers increased in 2002, except in Split. The percentage of removable partial denture deliveries increased significantly in all examined districts. Partial and complete denture deliveries increased in higher percentage in population younger than 70 years than in older population. The percentage of metal framework removable partial dentures increased significantly in all districts. The prevalence of removable denture deliveries increased, especially in patients younger than 70 years. This was attributed not only to the consequences of the 1991-1995 war, the migrations from rural to urban areas, decrease of economic status, but also to the new rules of the Croatian Insurance System.

The amputees and quality of life.

The application of highly sophisticated computer technology and high technology materials allows production of quality prosthetic replacements both in the functional and esthetic sense. The basic prerequisite for successful use of prostheses is an adequately shaped stump, which can be achieved using new operative technique used for extremity amputation. In this way, the possibilities of prosthetic device usage are enlarged to fulfill not only basic daily needs but also highly active work-related, sports-related or recreational needs of the modern man. However, the adequate and successfully performed operative procedure and the implementation of a quality prosthetic device do not guarantee that all patient requirements for improved quality of life are fulfilled. The aim of this study was to examine therapeutic effects of the applied method of surgical and prosthetic treatment, with a special focus on the improvement of patient's quality of life. The research was conducted in a sample of healthy and active patients with trauma-related lower extremity amputation. Following a positive objective evaluation by the physician, who stated that surgical and prosthetic treatment was satisfactory, the subjective evaluation was performed by the patient using a specially designed questionnaire. The factors possibly influencing the overall satisfaction of the patient with therapy were analyzed. The satisfaction with prosthesis function was evaluated as very good by 63.5% of the patients, excellent by 9.6% and good by 26.9% of the patients.

Patients' satisfaction with prosthetic devices.

The purpose of the paper was to ascertain the factors which affect the satisfaction of patients with the prosthetic therapy. The purpose of the paper was also to ascertain if there are common factors characteristic for patients dissatisfied with the prosthetic therapy although the specialist appraises it as objectively successful. 52 patients of the Clinical Institute for Rehabilitation and Orthopedic Devices were participating in the research, to which, after unsuccessful surgical-prosthetic rehabilitation, reamputation and prosthetic provision was carried out, which was appraised successful by the doctor. It was endeavored to appraise to what extent the appraisal by the doctor corresponds to patient's satisfaction. On the basis of the questionnaire elaborated specifically for this research and the statistical processing, it was concluded that where the doctor appraised the prosthetic therapy as successful, the same opinion was shared by the majority of the patients (92.3%). Patients are similarly satisfied with the function and the esthetic quality of the prosthesis (73%). The reason why 7.7% of patients are dissatisfied in cases when the doctor considers that there are no objective reasons for that should be sought in non-medical factors. The age, the education, the marital status, the income state, the size of the residence and the regional affiliation do not have a significant influence on the satisfaction of patients with the prosthesis (p > 0.05). Patients with a minor handicap achieve satisfaction with the prosthetic therapy faster, as well as the right-handed persons if the prosthesis on the right-hand extremity is in question (p < 0.05). This investigation showed that the responsibility of not wearing prosthetic aids, both orthopedic, and dental prostheses, couldn't be only neuroticism by prosthetic patients, because that connection is not statistically significant (p < 0.09).