[Reminiscence on the municipal out-of-hospital maternity unit and the motherhood home in Novi Sad].

INTRODUCTION: In the mid-twentieth century, the health care of women and children was inadequate in the post-war Yugoslavia, including the city of Novi Sad, due to the severe post-war reality: poverty in the devastated country, shortage of all commodities and services and especially of medical supplies, equipment and educated staff. OUT-OF-HOSPITAL MATERNITY UNIT: One of the serious problems was parturition at home and morbidity and mortality of the newborns and women. Soon after the World War II the action programme of improving the women's health was realized on the state level by establishing out-of-hospital maternity units but under the expert supervision. The Maternity unit at 30 Ljudevita Gaja Street in Novi Sad played a great role in providing skilled birth attendance at mainly normal deliveries. With a minimal number of medical staff and modest medical equipment, about 2000 healthy babies were born in this house. MOTHERHOOD HOME: After 5 years of functioning in that way, this unit was transformed into the Motherhood Home and became a social and medical institution for pregnant women and new mothers. Regardless of the redefined organization concept the curative and preventive health care as well as women and children social protection programmes were provided successfully for the next 12 years. Although the Motherhood Home was moved into the Women Health Centre of Novi Sad and later into the former Maternity Hospital in Sremski Karlovci, its great importance for women and children's health care remained unchanged. In 1979 the overall social situation and mostly economic issues led to its closing. EPILOGUE: The house in Gajeva Street is now used as the municipality office. However, this house with its story recommends itself to become a house for a special social function, such as a museum of medical history of Novi Sad. A small investment could make it possible to collect, preserve and display the valuable records of our past, which is something we do owe to the generations to come.

Rectal cancer: possibilities of MRI in detection of local recurrence.

Treatment of rectal cancer, which includes periodic evaluations, may lead to earlier identification of recurrent local infiltration. Differentiation between local recurrence and other post radiation changes is frequently rather difficult. Pelvic MR examination was performed in 30 patients (20 men, 10 women) at the Institute of oncology, Sremska Kamenica. All patients underwent surgical resection of rectal cancer at the same institution. Preoperative or postoperative radiation therapy was administrated in 29 patients (93%). Criteria for detection of local recurrent tumours were based on morphologic changes, such as the presence of tumour inflltration, size increase of the mass and the change of the mass shape. Recurrent tumor inflitration was detected in 50% patients. Tumours of low differentiation histological type was predominantly found within 10 months after surgery, while moderately differentiated and high differentiated types were detected within 20 months and after 20 months after resection, respectively. Pelvic MR examination represents important diagnostic modality for recurrent rectal cancer identification.

[The value of endorectal ultrasonography in rectal cancer staging].

INTRODUCTION: Preoperative staging of rectal cancer is considered essential to select patients adequately for different therapeutic regimes. The aim of the present study was to evaluate the accuracy of endorectal ultrasonography in preoperative staging of rectal cancer. MATERIALS AND METHODS: Fifty rectal cancer patients (31 men, 19 women) underwent endorectal ultrasonography with a 7.5-MHz probe. Thirty-eight of these patients had preoperative chemoradiation and in these patients examination was done before and after the radiotherapy treatment. The results of examinations were compared with the histological findings of the resected specimens. RESULTS: Histopathology showed 4 stage TO, 3 stage T1, 12 stage T2, 30 stage T3, and one stage T4 tumor. Nodal metastases were seen in 17 patients. The overall accuracy of endorectal ultrasonography for determining the depth of invasion (T stage) was 66% (33/50). The accuracy rate of T1 was 100% (1/1), T2 was 45% (9/20), T3 was 79% (22/28), and T4 was 100% (1/1). Overstaging was 18% (9/50) and understaging 16% (8/50). In staging lymph node metastasis, the overall accuracy rate was 70% (18/25) with 18% (9/50) overstaged and 12% (6/50) understaged With regard to nodal involvement, sensitivity was 65% and specificity 73%. Regarding penetration of the rectal wall (stages T1 and T2 vs stages T3 and T4/Dukes' classification A versus B), endorectal sonography showed sensitivity, specificity, and accuracy of 74%, 68%, and 72%, respectively. CONCLUSION: Endorectal ultrasonography is a valuable diagnostic modality for rectal cancer staging. It is fast, safe, accurate, well tolerated by the patient and cheap procedure and therefore should be used as a diagnostic modality of the first choice in rectal cancer staging although one must take into consideration possible limitations in cases of preoperative chemoradiation.

Prospective randomized study comparing sentinel lymph node evaluation with standard pathologic evaluation for the staging of colon carcinoma: results from the United States Military Cancer Institute Clinical Trials Group Study GI-01.

BACKGROUND: The principal role of sentinel lymph node (SLN) sampling and ultrastaging in colon cancer is enhanced staging accuracy. The utility of this technique for patients with colon cancer remains controversial. PURPOSE: This multicenter randomized trial was conducted to determine if focused assessment of the SLN with step sectioning and immunohistochemistry (IHC) enhances the ability to stage the regional nodal basin over conventional histopathology in patients with resectable colon cancer. PATIENTS AND METHODS: Between August 2002 and April 2006 we randomly assigned 161 patients with stage I-III colon cancer to standard histopathologic evaluation or SLN mapping (ex vivo, subserosal, peritumoral, 1% isosulfan blue dye) and ultrastaging with pan-cytokeratin IHC in conjunction with standard histopathology. SLN-positive disease was defined as individual tumor cells or cell aggregates identified by hematoxylin and eosin (H&E) and/or IHC. Primary end point was the rate of nodal upstaging. RESULTS: Significant nodal upstaging was identified with SLN ultrastaging (Control vs. SLN: 38.7% vs. 57.3%, P = 0.019). When SLNs with cell aggregates < or =0.2 mm in size were excluded, no statistically significant difference in node-positive rate was apparent between the control and SLN arms (38.7% vs. 39.0%, P = 0.97). However, a 10.7% (6/56) nodal upstaging was identified by evaluation of H&E stained step sections of SLNs among study arm patients who would have otherwise been staged node-negative (N0) by conventional pathologic assessment alone. CONCLUSION: SLN mapping, step sectioning, and immunohistochemistry (IHC) identifies small volume nodal disease and improves staging in patients with resectable colon cancer. A prospective trial is ongoing to determine the clinical significance of colon cancer micrometastasis in sentinel lymph nodes.

Elevated plasma TGF-beta1 levels correlate with decreased survival of metastatic breast cancer patients.

BACKGROUND: The role of circulating TGF-beta(1) in prognosis of breast cancer (BC) was investigated with an intention to define TGF-beta(1)-dependent high risk and low risk subsets of patients. METHODS: Fifty three BC patients of all clinical stages and 37 healthy donors (HD) were analyzed for plasma TGF-beta(1) by the TbetaRII receptor-based Quantikine TGF-beta(1) ELISA kit. RESULTS: The plasma TGF-beta(1) level of Stage I/II disease (median: 0.94 ng/ml; n=10)) remained close to HD (median: 1.30 ng/ml; n=37; p>0.1). In contrast, Stage III/IV disease (median: 2.34 ng/ml; n=43) exhibited highly significant TGF-beta(1) elevation (p<0.001) relative to HD. Further analysis revealed that TGF-beta(1) increase was predominantly attributed to Stage IV, metastatic disease patients (Q3=4.23 ng/ml) rather than to the group Stage III/IV (Q3=3.58 ng/ml). Using the plasma TGF-beta(1) concentration of 3.00 ng/ml as the cut-off value, two subgroups of patients were formed. Overall 2-year survival of the first subgroup, having elevated plasma TGF-beta(1) (>3.00 ng/ml; n=10), was 10%. This was significantly decreased (p<0.05) compared to 52% survival observed for the second subgroup of patients with plasma TGFbeta(1) values close to HD (<3.00 ng/ml, n=19). CONCLUSION: We have performed a pilot study to determine the relationship between overall survival and TGF-beta(1) concentration in the blood of metastatic breast cancer patients. The survival was significantly reduced in the patients with elevated plasma TGF-beta(1) levels compared to that of the patients with plasma TGF-beta(1) levels close to normal. We propose that plasma TGF-beta(1) concentration may be a new tumour marker attributed to the presence of metastatic BC cells that may be used in selection of metastatic BC patients with poor prognosis.