Characteristics and outcomes of patients with multifocal/multicentric and unifocal breast cancer.

PURPOSE: The clinical behavior and outcome of multifocal (MF) and multicentric (MC) breast tumors are not well characterized. The purpose of this study was to compare the prognosis of MF/MC tumors with unifocal (UF)tumors and its correlation with other pathological characteristics and patient outcomes. METHODS: Eighty-three patients with MC/MF breast cancer and 501 with UF breast cancer treated at the Surgical Clinic Nis were studied. We compared MC/MF and UF breast cancer patients with respect to demographics, tumor characteristics- adjuvant systemic therapy, local recurrence-free survival (LRFS) and overall survival (OS). RESULTS: There was no significant statistical difference between the two groups with respect to mean age at diagnosis, tumor grade, nodal status, estrogen receptor status, lymphovascular invasion (LVI) and adjuvant systemic therapy. The MC/MF group had more patients with modified radical mastectomy and the UF group had more patients with breast-conserving surgery. Cox multivariate regression analysis showed that the regional lymph node metastases and LVI were the most important predictors of 5-year OS rate. During this period, locoregional recurrence was registered in 29 (5.78%) patients in the UF group and in 5 (6.02%) patients in the MF/MC group (p=0.48). No statistically significant differences in the 5-year LRFS and OS between the two groups were noticed. CONCLUSION: The prognostic value of MF/MC disease is still not well known, although some studies have suggested that it is associated with a worse prognosis. This study showed no statistically significant difference in the 5-year LRFS and OS between UF and MF/MC groups.

Influence of Novel SrTiO3/MnO2 Hybrid Nanoparticles on Poly(methyl methacrylate) Thermal and Mechanical Behavior.

While dental poly methyl methacrylate(PMMA) possesses distinctive qualities such as ease of fabrication, cost-effectiveness, and favorable physical and mechanical properties, these attributes alone are inadequate to impart the necessary impact strength and hardness. Consequently, pure PMMA is less suitable for dental applications. This research focused on the incorporation of Strontium titanate (SrTiO3-STO) and hybrid filler STO/Manganese oxide (MnO2) to improve impact resistance and hardness. The potential of STO in reinforcing PMMA is poorly investigated, while hybrid filler STO/MnO2 has not been presented yet. Differential scanning calorimetry is conducted in order to investigate the agglomeration influence on the PMMA glass transition temperature (Tg), as well as the leaching of residual monomer and volatile additives that could pose a threat to human health. It has been determined that agglomeration with 1 wt% loading had no influence on Tg, while the first scan revealed differences in evaporation of small molecules, in favor of composite PMMA-STO/MnO2, which showed the trapping potential of volatiles. Investigations of mechanical properties have revealed the significant influence of hybrid STO/MnO2 filler on microhardness and total absorbed impact energy, which were increased by 89.9% and 145.4%, respectively. Results presented in this study revealed the reinforcing potential of hybrid nanoparticles that could find application in other polymers as well.

Citric Acid Cross-Linked Gelatin-Based Composites with Improved Microhardness.

The aim of this study is to investigate the influence of cross-linking and reinforcements in gelatin on the physico-mechanical properties of obtained composites. The gelatin-based composites cross-linked with citric acid (CA) were prepared: gelatin type B (GB) and ß-tricalcium phosphate (ß-TCP) and novel hybrid composite GB with ß-TCP and hydroxyapatite (HAp) particles, and their structure, thermal, and mechanical properties were compared with pure gelatin B samples. FTIR analysis revealed that no chemical interaction between the reinforcements and gelatin matrix was established during the processing of hybrid composites by the solution casting method, proving the particles had no influence on GB cross-linking. The morphological investigation of hybrid composites revealed that cross-linking with CA improved the dispersion of particles, which further led to an increase in mechanical performance. The microindentation test showed that the hardness value was increased by up to 449%, which shows the high potential of ß-TCP and HAp particle reinforcement combined with CA as a cross-linking agent. Furthermore, the reduced modulus of elasticity was increased by up to 288%. Results of the MTT assay on L929 cells have revealed that the hybrid composite GB-TCP-HA-CA was not cytotoxic. These results showed that GB cross-linked with CA and reinforced with different calcium phosphates presents a valuable novel material with potential applications in dentistry.

Acute Suppurative Thyroiditis with Thyroid Abscess and Bilateral Pneumonia: A Case Report.

Acute suppurative thyroiditis (AST) leading to thyroid abscess is a rare clinical entity. The aim of this article is to demonstrate a case of severe bilateral pneumonia which originated from a thyroid abscess. The authors report the case of a 57-year-old woman with severe bilateral pneumonia of thyroid origin. The patient had a painful throat and dysphagia for 2 or 3 days. She also had a history of mild fever and hard breathing with a discreet cough 7 days prior to hospital admission. In the past few months, the patient had frequent pneumonias. The patient was treated with a culture-appropriate antibiotic and total thyroidectomy. Primary recommendations for treatment of complicated infections of thyroid origin consider a multidisciplinary approach. Recurrent pneumonia in patients with thyroid nodules may be the result of thyroid inflammation, and, in such patients, neck ultrasound should be conducted as part of the diagnostic workup.

Presentation of pericardial hydatid cyst as acute cardiac tamponade.

We report a case of a 47-year-old man with isolated pericardial hydatid cyst (without myocardial involvement) that presented as acute pericardial tamponade. After initial investigation and transthoracic echocardiography, emergent pericardial drainage was performed for downgrading the urgency of a definitive treatment for a hydatid cyst. A computed tomography examination after the pericardial drainage showed a pericardial cyst without heart muscle involvement, making the treatment possible through anterior thoracotomy and without performing cardiopulmonary bypass. Complete surgical removal of the cyst was performed. The postoperative course was uneventful. The patient received postoperative albendazole treatment. He remained asymptomatic and no recurrence was observed during a 1-year follow-up period.

Correlation between the season, temperature and atmospheric pressure with incidence and pathogenesis of acute appendicitis.

Introduction: There is very little literature data on the correlation between the seasons, temperature and atmospheric pressure, and pathogenesis of acute appendicitis (AA). Objective: The aim of this research is to investigate the association between the seasons, changes in atmospheric temperature and pressure, and patients' age and severity of the clinical form of AA in the city of Nis Methods: This study included 395 patients diagnosed with AA, who, during the two-year period, from July 1st 2011 to June 30th 2013, were hospitalized and operated on at the Department of General Surgery, Clinical Center in Nis, Serbia. Results: The increased average daily values of barometric pressure by 1 millibar on the day when the event took place was associated (p < 0.05) with the decrease of total risk of the occurrence of appendicitis by 2.2% (0.2­4.1%). In all observed patients, each increase of the mean daily temperature by 1°C three days before the event took place (Lag 3) was associated (p < 0.05) with the increase of total risk of the occurrence of appendicitis by 1.3% (0.1­2.5%). Conclusion: According to the results of this research, we can conclude that patients' sex, age and severity of the clinical form of AA are not in connection with the seasons, while there are certain connections between appendicitis occurrence and atmospheric temperature and pressure.

Incarcerated inguinal hernias surgical treatment specifics in elderly patients.

BACKGROUND/AIM: Incarcerated inguinal hernias surgical treatment represents one of the most frequent surgical treatments in elderly patients. The percentage of incarcerated inguinal hernias urgent surgical treatments is growing exponentially with the age in patients over 50. The aim of the study was to investigate some of the factors that may have impact on the incarcerated inguinal hernias surgical treatment outcome in elderly patients. METHODS: The study included 180 patients classified in two groups: the study group (> 65 years of age) and the control group (< or = 65), managed in the period from January 2005 till March 2009 at the General Surgery Clinic, Clinical Center Nis. RESULTS: Most of the patients had right inguinal hernia (52.6%, the study group; 59.1%, the control group). All the study group patients suffered from some of accompanying chronic diseases (100%), opposite to 39 (59%) patients of the control group. Synthetic material was implanted in 124 (68.90%) patients, while the tension technique was performed in 65 (31.1%) patients. The duration of incarceration more than 24 h (p = 0.015), previous abdominal surgery (p = 0.001), the American Society of Anesthesiologists physical status classification system (ASA classification) (p = 0.033) and the presence of chronic diseases (p = 0.01) appeared to be statistically significant risk factors for performing intestinal resection in the study group, while in the control group they represented risk factors, but not at the level of statistical significance (p < 0.05), except for the duration of incarceration (p = 0.007). A higher ASA stage (p = 0.001) and the presence of bowel resection (p <0.001) are the most important risk factors for lethal outcome in both groups of patients. CONCLUSION: Incarcerated inguinal hernia in elderly patients is a serious problem. A higher ASA score and the presence of bowel resection are the most important factors related to unfavorable outcome.

Ileocolic intussusception as a presenting sign of primary lymphoma of the colon.

INTRODUCTION: Intussusception is a rare phenomenon in adults. It is caused mainly by malignant neoplasm. Primary lymphoma of the colon is a rare malignancy of the large intestine. The association of intussusception in adult and primary colorectal lymphoma is a diagnostic challenge, since they occur with a variety of atypical symptoms. CASE OUTLINE: We report a case of ileocolic intussusception in a 26-year-old man induced by primary lymphoma of the cecum. He was admitted to our hospital for incomplete intestinal obstruction. After thorough diagnostic work-up (plain abdominal radiography, abdominal ultrasonography, multi-slice computerized tomography, colonoscopy with biopsy), the patient underwent surgery. Intraoperative findings confirmed lymphoma as the cause of intussusception. The right hemicolectomy was carried out with end-to-side ileo-transverse anastomosis. CONCLUSION: Primary colorectal lymphomas should be considered in differential diagnosis of intussusceptions in adults. The treatment of choice is a radical resection where all oncological standards must be fulfilled.