[Neurosurgical treatment of spontaneous and traumatic intracerebral hematomas].

In the period from 01.01.2000 until 31.12.2002 34 patients with spontaneous intracerebral hematoma (ICH) and with deeply disturbed state of consciousness were operated in the Department of neurosurgery of the Urgent Center, Clinical Center of Serbia. In all operated patients the indication for surgery was given on the basis of CT scan of the brain, state of consciousness, defined Glasgow coma score (GCS) and neurological status, but due to existing or threatening incarceration not even one patient was submitted to angiography of the blood vessels at the cerebral base, thus preoperatively we did not know the cause of the hemorrhage. Of 34 operated patients 22 or 64.7% died, and 12 or 35.3% survived. 14 patients were in the deepest phase of coma, where the preoperative GCS is from 3 to 5 points, and in the postoperative course only one survived, aged 25. The other survivors had somewhat less disturbed state of consciousness, they also were younger, CT scan of the brain was without blood in the chamber system. In the same period, in the Department of Neurosurgery of the Urgent Center, Clinical Center of Serbia 43 patients with traumatic intracerebral hematoma (TIH) were operated; 9 patients survived, 34 died. Only 4 patients had acute TIH. All of them were in the terminal stage of incarceration, and despite being immediately submitted to surgery all of them died. The remaining 39 patients had, the so called delayed TIH where the secondary CT scan of the brain showed development of the traumatic intracerebral haematoma that was not verified on the incipient scanner. Indication for a repeated CT scan was given in 19 patients due to focal or general neurological deterioration. However in 20 patients subsequent neurological disturbances were not registered. Those that survived were younger patients, and they were not in the deepest stage of coma, most often they had a temporal localization of hematoma.

[Neurosurgical treatment of patients with supratentorial cavernoma].

The aim of this study is to present the principal clinical manifestations and neurosurgical results of the treatment of patients with supratentorial cavernoma and epilepsy. The retrospective study included 14 patients with supratentorial lesion on MRI and CT scan of the brain that manifested with epileptic seizures. All patients were surgically treated and pathophysiologic evaluation in all patients confirmed that cavernoma was in question. Results were analyzed and compared with data from the literature. Epileptic seizures are the most frequent clinical manifestation found in supratentorial cavernoma and neurosurgical treatment gives excellent result as regards the control of epilepsy, with a very low incidence of morbidity and mortality. A complete resection of all cavernomas in this study was confirmed by postoperative neurosurgical diagnosing. 12 patients did not have any more epi seizures in the postoperative period, and in 2 patients we found decrease in the occurrence of epilepsy seizures.

Application of boron-entrapped stealth liposomes to inhibition of growth of tumour cells in the in vivo boron neutron-capture therapy model.

Tumour cell destruction in boron neutron-capture therapy (BNCT) is due to the nuclear reaction between (10)B and thermal neutrons. It is necessary for effective BNCT therapy to accumulate (10)B atoms in the tumour cells. The delivery system consisted of polyethylene-glycol (PEG) binding liposomes (DPPC/cholesterol/DSPC-PEG2000) with an entrapped (10)B-compound and we evaluated the cytotoxic effects of intravenously injected (10)B-PEG-liposomes on human pancreatic carcinoma xenografts in nude mice with thermal neutron irradiation. After thermal neutron irradiation of mice injected with (10)B-PEG-liposomes, growth of AsPC-1 tumours was suppressed relative to controls. Injection of (10)B-PEG-liposomes caused the greatest tumour suppression with thermal neutron irradiation in vivo. These results suggest that intravenous injection of (10)B-PEG-liposomes can increase the retention of (10)B atoms by tumour cells, causing suppression of tumour growth in vivo, after thermal neutron irradiation.

Cytological grading of breast carcinoma with histological correlation.

PURPOSE: A grading system based on cytology would be helpful in the selection of patients for appropriate therapy. The aim of this study was to devise such a system for grading breast carcinoma based on cytological features alone. MATERIALS AND METHODS: Diagnostic fine needle aspiration (FNA) smears taken from 100 patients with invasive breast carcinoma were studied without knowledge of the subsequent grade and type of the tumors. The technique of aspiration employed a 10 ml syringe and 23 gauge needle. The aspirates were spread onto slides and half of the smears were rapidly air-dried and stained by May-Grunwald-Giemsa, while the rest were alcohol-fixed and stained by Papanicolaou technique. The features assessed were: nuclear pleomorphism, nucleoli, mitoses, nuclear/cytoplasmic ratio, apoptosis, necrosis, cell clustering, cel-lularity and tubular formation. Cytological features were compared to the histological grade of breast carcinomas following excision, and the results were analyzed by the x(2) test (the significance level was set to p<0.05), as well as by the correlation coefficients (ri). Multivariate analysis was carried out by multiple correlation coefficients (Rij) for each pair of significant parameters. RESULTS: Significant association between worsening cytological features and increasing histological grade were found with nuclear pleomorphism, nucleoli, mitoses, apoptosis, cellularity and tubular formation. A scoring system based on these 6 parameters enabled the classification of tumors into low and high cytological grades which showed a close correlation with histological grade with 81% concordance. The best multiple correlations were found for the following pairs of cytological parameters: mitoses-apoptosis (0.603), mitoses-tubular formation (0.572), apoptosis-nuclear pleomorphism (0.550) and mitoses-nuclear pleomorphism (0.545). CONCLUSION: On the basis of this study we conclude that the proposed system of grading breast carcinoma is possible from FNA cytology and it shows a good correlation with histological grade.

Correlation of steroid hormone receptor status with histological and nuclear grading in breast carcinoma.

PURPOSE: The present study was performed to evaluate the immunohistochemical analysis of estrogen receptor (ER) and progesterone receptor (PR) in invasive breast carcinomas of various histological subtypes and grades. In this paper an attempt was made to establish a correlation between hormone receptor status and histological and nuclear grading of breast carcinoma. MATERIALS AND METHODS: Immunohistochemistry was performed on paraffin sections of 80 invasive breast carcinomas (38 ductal, 18 lobular, 18 ducto-lobular, 2 medullary, 2 mucinous, 1 tubular and 1 papillary). The same scoring system was used for immunohistochemically stained ER and PR. The results were compared with the histological and nuclear grade and analyzed by the chisquare test. RESULTS: Positive immunoreactivity for ER and PR were seen in 71.25% and 60.00% cases, respectively. Both ER and PR positive immunostaining was observed in all (100%) well-differentiated (grade I) breast carcinomas, while in grade II tumors ER and PR-positive cancer cells were 76.36% and 61.62%, respectively. The corresponding figures for grade III carcinomas were 41.18% and 35.29%. A significant association (p <0.05) between different histological grades of breast carcinomas and ER and PR immunoreactivity was found. No significant association was found between nuclear grade of breast carcinoma and ER and PR immunoreactivity. CONCLUSION: The results presented herein suggest that histological grade of invasive breast carcinoma was significantly associated with ER and PR immunoreactivity, while nuclear grade alone showed no correlation. Moreover, our findings showed that ER and PR positivity declined with increasing tumor grade.

[Successful surgical removal of a cardiac myxoma from the left ventricular outflow tract]. / Uspesno hirurski odstranjen miksom srca u izlaznom trakty leve komore.

The precondition for successful, exclusively surgical treatment in the extracorporeal circulation, is the precise diagnosis of heart myxoma, particularly in rare locations such as the left ventricle. We present a case of myxoma in the outflow tract of the left ventricle as the exceptionally rare location, successfully diagnosed and surgically treated at the Clinic for Cardiac and Thoracic Surgery of the Military Medical Academy. A female patient, aged 46 years, was sent from another hospital with misdiagnosis of idiopathic hypertrophic subaortic stenosis. The patient was successfully operated after transthoracic and transesophageal echocardiography as the main diagnostic procedures. Myxoma that completely obstructed the aortic opening if pulled, was completely removed through aortic valve in the extracorporeal circulation. Its pedicle was arising from the ventricular side of the great mitral cusp. Postoperative course was uneventful and the patient was released from the hospital on the tenth postoperative day.

[Successful surgical treatment of a massive pulmonary embolism in the organized thromboembolic phase]. / Masivna plucna embolija uspesno operisana u fazi orgnizovanog tromboembolusa.

A patient, male, aged 36, clinically presented as an unstable angina pectoris following myocardial infarction, who came from general hospital of Banja Luka for further examination is presented. According to the medical report, he was treated for acute myocardial infarction in 1994 at Banja Luka's general hospital, when he was resusciated due to of cardiac arrest. The anginous pain was still present regardless of prescribed therapy. Following the clinical examination at the Military Medical Academy we have established a diagnosis of thromboembolism of the main pulmonary artery with a high pressure in the right ventricle. He underwent surgery under the extracorporeal circulation, when an organized old thrombus the main pulmonary artery and partially in arterial branches. The main pulmonary artery was almost completely obliterated. Thrombectomy was done. Following the operation, the patient was in a good condition and the repeated echocardiographic examinations showed no signs of recurrent thrombosis while the pressure in the right ventricle was significantly decreased. Afterwards, he was treated by heparine and oral anticoagulants and then by antiagregants. This case is very instructive because the massive pulmonary thromboembolism which was wrongly recognized and treated as an acute myocardial infarction.

[Coronarography in the diagnosis of left atrial thrombosis]. / Koronarografija u dijagnostici tromboze leve pretkomore.

Thrombosis of left atrium is frequent in the patients with mitral defect. Systemic embolism that generates by separated thrombus parts is a possible complication during the disease. Echocardiography is routinely used in the diagnosis of left atrial thrombosis. On the basis of angiographic experience, we have set the hypothesis: coronary angiography has a great sensitivity, but small specificity in the diagnosis of left atrial thrombosis. The presence of thrombus in left atrium was analyzed in 60 operated patients with mitral valve disease. During the surgery, thrombus was found in 13, and not found in 47 patients. Coronary angiography was preoperatively performed in all patients. In 9 out of 13 patients with intraoperatively observed left atrial thrombus, thrombus was also found by angiography. In 47 patients thrombus was found neither intraoperatively, and in 45 nor by angiography. The sensitivity of angiography in the diagnosis of left atrial thrombosis is 69%, specificity is 97%, and the accuracy is 90%. Positive index of anticipation is 81%, and negative index of anticipation is 91%.

Nucleolar volume in breast carcinomas.

The prognostic value of histopathological typing of breast carcinomas is relatively good. The determination of cell size has been a common and useful parameter in the diagnosis of various malignancies. With modern stereologic methods it is possible to obtain unbiased estimates of nucleolar volume. The aim of this study was to present our data regarding the nucleolar size in breast carcinoma. Patients treated for breast carcinoma (n = 39) were retrieved and randomly selected from the files of the University Institute of Pathology, Nis. Histological sections (4 microns) were cut from each of the routinely processed, paraffin-embedded tissue blocks and stained with hematoxylin and eosin. A Carl Zeiss NU-1 microscope equipped with a x 100 oil-immersion lens (N.A. = 1.25) and eyepiece graticule was used for stereological measurements. A total magnification of x 1600 was used. A simple grid was used for point sampling of nucleolar intercepts, which were measured in one arbitrary direction. By multiplying the averaged, cubed intercept length by pi/3, an unbiased estimate of volume-weighted nucleolar volume was obtained. The nucleolar volume was significantly larger in invasive ductal carcinoma (12.34 +/- 3.48 microns3) than invasive lobular carcinoma (5.6 +/- 2.73 microns 3) and mucinous (colloid) adenocarcinoma (0.88 +/- 0.42 micron 3). Various histological types of breast cancer exhibit differences with regard to nucleolar volume.

[Immediate results of surgical treatment of intracardiac myxomas in 45 patients]. / Neposredni rezultati hirurskog lecenja intrakardijalnih miksoma u 45 bolesnika.

Between 1961 and 1992, 45 patients with intracardiac myxomas localised in the left ventricle--40 (89%) and in the right ventricle--5 (11%) were operated on. There were 27 women and 18 men, aged 15-63, mean age, 46.5 years. Three patients were asymptomatic while in other dominated different degree of malfunction of the corresponding atrioventricular valve, mainly with dominant symptoms and signs of stenosis. In 5 patients (11%) myxoma of the left atrium was in question together with systemic embolization. The diagnosis was established both by invasive and noninvasive methods and the method of choice, very reliable and easy, has proved to be echocardiography. All patients were operated on with the use of the total cardiopulmonary bypass and induced heart arrest. The histologic verification of all excised myxomas was performed. Three early deaths occurred (6.6%), while in other patients no postoperative complications developed. It has been concluded that echocardiography is very safe diagnostic procedure and results of surgical treatment are very good.

[Infections of the sternum after cardiac surgery]. / Infekcije sternuma posle kardiohirurskih operacija.

Methods of treatment of suppurative mediastinitis in cardiosurgical operations applied at the clinic are analysed. These methods are: debridment with closure of the sternum with irrigation of the substernal space, debridment with bandage of open wound and healing per secundam, debridment with bandage of open wound and its closure by myocutaneous layers. It has been concluded that these infections are very complex etiopathogenetically because of which it is very important to know all relevant risk factors aiming to prevent development of this complication in cardiosurgical operations. Its early recognition is necessary.

[Significance of the the tumor markers, Ca-125 and tumor-associated trypsin inhibitor in patients with carcinoma of the cervix and uterus]. / Znacaj merenja tumorskih markera CA-125 i "C-tumorom-udruzeni-inhibitor-tripsina" kod obolelih od karcinoma grlica i tela materice.

Quantitative contents of tumour markers in 51 patient suffering from carcinomas of the cervix and corpus uteri, are analysed. CA-125 and tumor-associated-trypsin-inhibitor (TATI) were determined in the serum of these patients before and after surgical treatment. After careful and detailed analysis and statistical testing of the results, we observed insignificant changes of CA-125 in both localisations of carcinoma. The great importance of preoperative determination of TATI markers in carcinomas of the corpus uteri is emphasized. However, the testing of these markers should be performed with great attention and in correlation with other indexes of pathobiological nature of cancers of the cervix and corpus uteri.