Treatment of the rectal cancer in casuistic Clinic for Abdominal Surgery, Clinical Centre of the University of Sarajevo (2006.-2010.).

Malignant disease of the colon and rectum is the most often human neoplasm which comprises about 30% of all digestive tumours. Thereat, cancer of the lower end the colon (rectum) comprises 45 to 48% of all CRC (colorectal cancers). According to "American Society Cancer", only lung and prostate cancer in men and breast and cervix cancer in women are more frequent than CRC. The incidence of colorectal cancer is 20 to 30/100.000 citizens. Rectal cancer is the result of interection of disturbed genetic factors with external factors. The first surgical treatments began with Faget, who did the first rectal extraperitoneal excision (1739). It was improved by Ernest Milles in 1908, and in 1923, Hartman did the resection without anamnesis. In the middle of 20th century, Dixon defined the resective interventions and in Litre did a colostomy. The aim of this study is point out the necessity of early diagnosis and protocolar chirurgical end oncological approach to the treatment of this malignant disease which must be done before choosing any operative procedure in order to prevent postoperative morbidity. On the material of the Clinic for Abdominal Surgery at the Clinical centre University of Sarajevo, during the four-year period (from 2006 to 2010), out of the 406 patients with CRC, 261 of them (64.3%) had cancer of the final part of the colon and rectum. In this case, all the time of the treatment, protocol was strictly applied. Primary surgery was performed on the early stages of the disease. Radiochemotherapy (RCT) followed by operation after 6 to 8 week is applied in the progressive state of the disease with the penetration of the meso rectal fascia with positive lymph-gland assessment (NMR-nuclear magnete resonance). Out of 261 operated patients, 5 of them (1.9%) underwent transanal resections where the tumour was up to 2 cm; 104 patients (39.8%) underwent rectal resection with TME (II and III tumour states of recto-sigma); 24 (9.2%) patients uderwent amputation; 156 (22.4%) underwent left chemicolectomy with rectal resection and 29 (11%) underwent intersphincteric colo-trans-versal-anal anastomosis. The operation by Hartman was performed on 44 (16.8%) patients and colostomy on 10 (3.8%) patients in emergency service. In the tumours with low localisation we do low colo-transversal-rectal or ultra-low intersphincer colo-anal anastomosis. Total meso rectal excision and lymhadenectomy is our priority. We fully respect the oncologic approach, i.e. complete removement of the affected organ with the lymphovascular arcade. Operative lethality up to 30 days was 2.5% (comorbidity, thromboembolism). Owing to combined protocolar approach of surgical and radiochemotherapy, extirpational interventions are not so frequent any more compared with resections with low and ultra-low anastomosis. Team work and close cooperation of oncologic team of physicians (surgeons, gastroenterologists, pathologists, oncologists, radiotherapeutists) as well as respect for the protocol of the treatment are the most important factors of a successful oncologic surgery.

[Infections of the breast]. / Infekcija dojke.

The authors present their experiences of 45 female patients under the treatment of an acute purulent mastitis in five years period. From 45 treated female patients 8 (17.7%) were treated clinically, and 37 (82.2%) in the outpatient department. At the age to 35 years old, there were 87% of female patients from which 79.2% who bore the first child, and 21.7% of those who bore more than one child. From an acute lactic mastitis were treated 39 (86.6%) from which 2 (4.4%) were young girls, and 4 (8.8%) patients with already finished period of reproduction. Right-side localization of the pathological process was in 22 (48.8%) cases, left-side in 19 (42.2%) cases, and both-sides in 4 (8.8%) cases. In 15 (33.3%) female patients we have followed an immunological status. It is characteristic an immunological disbalance in acute phase. Following the immunological status, it can be useful for estimating and prognosis in treatment. In literature, there are quotation details of purulent diseases, among which breast infection takes a considerable place from 1.6 to 18%, and the death-rate is described in high percentage from 9.6 to 1.7%. Our attitude in the treatment of breast infection, especially when purulent process is present, as first we have to evacuate the suppuration, then to make good breast drainage, and separately to infiltrate the tissue because there are small abscesses in it, which bring to dissemination of pus within the breast. According to all mentioned above, we also give an antibiotic therapy.