Profile for body fat percentage of Serbian working population, aged from 18 to 65, measured by multichannel bioimpedance method / Perfil del porcentaje de grasa corporal de la población activa serbia, de 18 a 65 años, medido por el método de bioimpedancia multicanal

SUMMARY: Obesity prevalence and trends of PBF related to age were defined on a sample of 8100 people among whom, 4955 were male (Age = 31.2 ± 10 yr) and 3145 were female (Age = 32.1 ± 11.3 yr). Body structure measurements were performed using a standardized method of multichannel bioimpedance analysis (BIA), using a body structure analyzer - InBody 720. The total sample was divided into two subsamples according to sex, where every subsample was divided into five different age groups.The mean PBF values of the Male total sample were 18.2 ± 8.0 % and the female total sample was 28.3 ± 9.2 %. Results of Kruskal-Wallis ANOVA with Dwass-Steel-Critchlow-Fligner post-hock showed that there are statistically significant differences (p < 0.001) between all age groups among themselves except groups 50 - 60 and 60 - 65 (p = 0.09). Analysis of obesity prevalence according to the PBF indicator in different age groups revealed the existence of statistically significant (p < 0.001) trends of increasing obesity with age, both in men and women. Based on the result of this study, it can be concluded that most of the Serbian working population are in the range of normal PBF values, excluding the male 30-39.9 yr and female 60-65 yr age categories as groups which are more prone to obesity levels.

RESUMEN: La prevalencia de obesidad y las tendencias de PBF relacionadas con la edad se determinaron en una muestra de 8100 personas, de las cuales 4955 eran hombres (Edad = 31,2 ± 10 años) y 3145 eran mujeres (Edad = 32,1 ± 11,3 años). Las mediciones de la estructura corporal se realizaron utilizando un método estandarizado de análisis de bioimpedancia multicanal (BIA), usando un analizador de estructura corporal - InBody 720. La muestra total se dividió en dos submuestras, según el sexo, donde cada muestra se dividió en cinco grupos de edad diferentes. Los valores de PBF de la muestra total masculina fueron 18,2 ± 8,0% y la muestra total femenina fue 28,3 ± 9,2%. Los resultados del ANOVA de Kruskal-Wallis con Dwass-Steel-Critchlow- Fligner post-corvejón mostraron que existían diferencias estadísticamente significativas (p <,001) entre todos los grupos de edad, excepto los grupos 50 - 60 y 60 - 65 (p = 0.09). El análisis de la prevalencia de obesidad según el indicador PBF en diferentes grupos de edad, reveló la existencia de tendencias estadísticamente significativas (p < 0,001) de un aumento de la obesidad con la edad, tanto en los hombres como en las mujeres. Con base en el resultado de este estudio, se puede concluir que la mayoría de la población activa de Serbia se encuentra en el rango de valores normales de PBF, excluyendo las categorías de edad de hombres de 30 a 39,9 años y de mujeres de 60 a 65 años, como los grupos que son más propensos a los niveles de obesidad.

PET/CT fusion in radiotherapy planning for lung cancer--Case reports.

INTRODUCTION: Application of imaging methods, namely computed tomography (CT), magnetic resonance imaging (MRI) and in recent years positron emission tomography/computed tomography (PET/CT), and the progress of computer technology have allowed the construction of effective computed systems for treatment planning (TPS) and introducing the concept of virtual simulation in 3D conformal radiotherapy planning. CASE REPORT: We hereby presented two patients with the diagnosis of non-small cell lung cancer who did PET/CT examination. Both patients had surgery earlier and local recidives are diagnosed with PET/CT. PET/CT of the first patient described the focus of intense ¹8F-fluorodeoxyglucose (¹8FDG) accumulation 2.99 x 2.9 x 2.1 cm in diameter in the projection of soft-tissue volume in the left corner, at operating clips height, corresponding to metabolically active recurrence of the tumor. Mediastinum and right lung parenchyma were without focal accumulation of ¹8FDG. Control PET/CT after 3 months was without detectable focus of intense pathological ¹8FDG accumulation--good therapeutic response, (metabolic disease remission). On the other hand, in the second case PET/CT showed a focus of intense ¹8FDG accumulation screening in the scar tissue of the apical part of the right lung, 20 x 16 mm, corresponding to metabolically active tumor recurrence. In the lung parenchyma on the left and in the mediastinum no visible focus of intense ¹8FDG accumulation was descrbed. Radiography included using 3D conformal radiotherapy with fusion PET/CT scan and CT simulations. CONCLUSION: PET/CT provides important information for planning conformal radiotherapy, especially in dose escalation, sparing of organ at risk and better locoregional control of the disease.

Radiotherapy treatment planning: benefits of CT-MR image registration and fusion in tumor volume delineation.

BACKGROUND/AIM: Development of imaging techniques, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), made great impact on radiotherapy treatment planning by improving the localization of target volumes. Improved localization allows better local control of tumor volumes, but also minimizes geographical misses. Mutual information is obtained by registration and fusion of images achieved manually or automatically. The aim of this study was to validate the CT-MRI image fusion method and compare delineation obtained by CT versus CT-MRI image fusion. METHODS: The image fusion software (XIO CMS 4.50.0) was applied to delineate 16 patients. The patients were scanned on CT and MRI in the treatment position within an immobilization device before the initial treatment. The gross tumor volume (GTV) and clinical target volume (CTV) were delineated on CT alone and on CT+MRI images consecutively and image fusion was obtained. RESULTS: Image fusion showed that CTV delineated on a CT image study set is mainly inadequate for treatment planning, in comparison with CTV delineated on CT-MRI fused image study set. Fusion of different modalities enables the most accurate target volume delineation. CONCLUSION: This study shows that registration and image fusion allows precise target localization in terms of GTV and CTV and local disease control.

[Optimal postoperative radiotherapy treatment of orbital rhabdomyosarcoma].

INTRODUCTION: Rhabdomyosarcoma (RMS) is the most common sarcoma of the soft tissue, mostly affecting the region of head and neck (orbit, paranasal sinus). Histological types include embryonal (66-70%) with better prognosis, and alveolar type (20%) with poorer prognosis. There are also diffuse anaplastic and undifferentiated sarcomas (10%). Due to multimodal therapy approach (surgery, chemotherapy and radiotherapy), RMS survival rate is considerably improving. Nevertheless, early diagnosis of RMS is of crucial importance for the outcome of treatment. Standard conformal radiation therapy is very complex due to closeness of many critical structures of head and neck, thus limiting optimal tumor dose coverage. CASE OUTLINE: Patient aged 59 years, surgically treated for RMS of nasal cavity several times before radiation therapy treatment. Due to relapse, patient was re-operated, when subtotal re-resection of the maxilla with exenteration of the right orbit was done. The patient received IV cycles of polychemotherapy postoperatively. Standard procedure and planning for conformal radiation therapy did not lead to acceptable irradiation plan, and hence modification in the patient's preparation was done, resulting in optimal therapeutic plan according to internationally recognized recommendations. CONCLUSION: The reported case shows a rare pediatric tumor, which often occurs in children but extremely rare in adults. The problem of inadequate isodose distribution obtained by standard conformal plan was solved by placing bolus material into the orbital cavity.The outcome of the treatment plan showed much better isodose distribution and tumor bed coverage.

Importance of positron emission tomography-computed tomography (PET-CT) examination in rectal cancer staging--initial clinical experience.

AIM: Accurate preoperative staging is essential in determining optimal therapeutic procedures and planning for individual patients. Advances in imaging technology have raised interest in the potential role of positron emission tomography-computed tomography (PET-CT) examination for staging of rectal cancer. The primary end point of the study was the correct classification of the tumor node-metastases (TNM) tumor stage using whole-body PET-CT examination. METHODS: This prospective study was performed from October 2011 to October 2012. Patients with histopathological diagnosis of rectal cancer after biopsy underwent PET-CT before surgical treatment and TNM staging. Twenty patients who fulfilled inclusion criteria were included in the study. All of the patients were operated and histopathology served as the standard of reference. RESULTS: There was no statistical significance in T staging comparing PET-CT and histopathological staging, according to the Monte Carlo simulation (p=.066). Also, there was no statistical significance between two methods in mesorectal fascia involvement analysis (p=1). There was statistical difference between PET-CT and histopathological staging. Sensitivity of the PET-CT for N staging was 86.7% and it was higher than for the histopathology. Two patients showed liver metastases. CONCLUSION: Positron emission tomography-computed tomography examination could play an important role in the initial staging for the rectal cancer. Good patient selection for preoperative chemoradiotherapy ensures survival benefit. Avoidance of unnecessary therapeutic procedures allows an acceptable quality of patient's life.

[Conformal radiotherapy of prostate carcinoma--procedure description].

INTRODUCTION: Today, three-dimensional conformal radiotherapy is a standard way in the radical treatment of localized prostate cancer, and it is an alternative to the radical prostatectomy. This method of radiotherapy treatment is widely accepted in the treatment of prostate cancer patients, and provides irradiation of targeted volume (prostate, seminal vesicles) with dose escalation sparing the surrounding healthy tissues (rectum, bladder) at the same time. That is not possible with the conventional two dimension technique. PROCEDURE DESCRIPTION: Three-dimensional conformal radiotherapy is a volumetric, visual simulation according to the computed tomography slices; it defines the tumour and organ at risk individually in each patient. Results of several studies have shown that there is a significant decrease in the development of acute toxicity when prostate cancer patients are treated with conformal radiotherapy. High dose irradiation gives excellent results in treatment of localized prostate carcinoma and improves treatment results in the patients with locally advanced carcinoma of prostate. DISCUSSION: Prostate carcinoma irradiation techniques have been changed dramatically during recent years. Data obtained by computed tomography are important since the size and shapes of the prostate as well as its anatomic relations towards the rectum and bladder are considerably different in individual patients. The three-dimension plan of irradiation can be designed for each patient individually by performing computed tomography technique when planning radiotherapy. CONCLUSION: The advanced planning systems for conformal radiotherapy can reconstruct the anatomic structures of pelvis in three-dimension technique on the basis of computed tomography scans, which provides better conformality between the irradiation beam and geometrical shape of the tumour with minimal irradiation of the surrounding healthy tissue.

Prevalence and underdiagnosis of chronic obstructive pulmonary disease among patients at risk in primary care.

BACKGROUND: People with known risk factors for chronic obstructive pulmonary disease (COPD) are important targets for screening and early intervention. We sought to measure the prevalence of COPD among such individuals visiting a primary care practitioner for any reason. We also evaluated the accuracy of prior diagnosis or nondiagnosis of COPD and identified associated clinical characteristics. METHODS: We recruited patients from three primary care sites who were 40 years or older and had a smoking history of at least 20 pack-years. Participants were asked about respiratory symptoms and underwent postbronchodilator spirometry. COPD was defined as a ratio of forced expiratory volume in the first second of expiration to forced vital capacity (FEV(1)/FVC) of less than 0.7 and an FEV(1) of less than 80% predicted. RESULTS: Of the 1459 patients who met the study criteria, 1003 (68.7%) completed spirometry testing. Of these, 208 were found to have COPD, for a prevalence of 20.7% (95% confidence interval 18.3%-23.4%). Of the 205 participants with COPD who completed the interview about respiratory symptoms before spirometry, only 67 (32.7%) were aware of their diagnosis before the study. Compared with patients in whom COPD had been correctly diagnosed before the study, those in whom COPD had been over-diagnosed or undiagnosed were similar in terms of age, sex, current smoking status and number of visits to a primary care practitioner because of a respiratory problem. INTERPRETATION: Among adult patients visiting a primary care practitioner, as many as one in five with known risk factors met spirometric criteria for COPD. Underdiagnosis of COPD was frequent, which suggests a need for greater screening of at-risk individuals. Knowledge of the prevalence of COPD will help plan strategies for disease management.

[Importance of electromiographic examination in diagnostification and monitoring of chronic inflammatory demyelinating polyneuropathy].

INTRODUCTION: Polyneuropathies or peripheral neuropathies present a dysfunction or disease of larger number of peripheral nerves or their dysfunction. Considering their morbidity - mortality characteristics they present an important aspect in daily clinical practice. One particular polyneuropathy that deserves special review is chronic inflammatory demyelinating polyneuropathy, which, due to its clinical-laboratory presentation, does not include the group of "simple" neuropathies, thus requiring further examinations. Neurophysiological testing should be performed using the protocol for neuropathy examinations. Neurophysiological examination, during the electroneurographic examination, shows neurographic parameters referring to polyneuropatic demyelinating type of lesion, while the electromyographic finding records the presence of neuropathic lesions (denervation activity, great action potentials with a reduced sample). CASE REPORT: A 54-year-old patient was diagnosed to have a "complicated" demyelinating polyneuropathy according to the clinical-laboratory findings and electromyographic examination. Exclusion criteria, targeted diagnostic examinations, considering the mentioned peripheral neuropathies, pointed to acute inflammatory demyelinating polyneuropathy. However, the chronic inflammatory demyelinating polyneuropathy was finally differentiated during the clinical and electromyographic monitoring.

Metastatic differentiated thyroid carcinoma: clinical management and outcome of disease in patients with initial and late distant metastases.

OBJECTIVE: Our objective was to analyze the clinical management and the outcome of disease in differentiated thyroid carcinoma with initial and late distant metastases (M1). PATIENTS AND METHODS: Radioiodine (131I) therapy was applied in 77 differentiated thyroid carcinoma patients with M1 (31 patients with M1-initial and 46 patients with M1-late). The median follow-up of patients was 72.7 months. Probability of disease-specific survival (DSS) was analyzed by the Kaplan-Meier method and the log rank test, while the significance of differences between groups was calculated by the t-test of proportions. RESULTS: Follicular carcinomas were more frequent in patients with M1-late (P<0.05). During the follow-up, 58% of the patients died: 39% of cases had disease related deaths, while 42% had complete remission of disease. Stable disease and progressive disease were significantly influenced by age only (P = 0.0122), while 131I uptake, histological type, and sex had no influence (P = 0.1235; P = 0.340; P = 0.8540, respectively). Remission of disease (complete and partial) was not significantly influenced by age, sex, histological type, and 131I accumulation (P = 0.0644; P = 0.8452; P = 0.6308; P = 0.7675, respectively). DSS in patients with M1-initial and M1-late at 5 years was 71 and 50%, respectively and 62 and 41% at 10 years, respectively, without significant difference (P = 0.2582). Disease related deaths appeared more frequent in patients at 45 years of age or older, significantly caused by distant metastases (P<0.001). CONCLUSION: Distant metastases occur late more often in patients with follicular carcinoma while M1-initial is detected more often in patients with papillary carcinoma. DSS was not significantly different among patients with M1-initial and M1-late. The risk of death from M1 increased after the age of 45 years.

[Treatment protocol for cervical carcinoma]. / Protokol lecenja karcinoma grlica materice.

INTRODUCTION: Cervical cancer is the second most common cancer in women worldwide and the second cause of cancer death among women. About 95% (90% in developed countries) of invasive carcinomas are of squamous types, and 5% (10% in developed countries) are adenocarcinomas. FIGO classification of cervical carcinomas, based on clinical staging and prognostic factor dictate therapeutic procedures and help in designing treatment protocols. THERAPEUTIC MODALITIES: Surgical therapy includes conization, radical hysterectomy with pelvic lymphadenectomy and palliative operation--urinary diversion and colostomy. Radiotherapy, brachytherapy and teletherapy are most recently combined with chemotherapy as concurrent chemoradiation. DISCUSSION AND CONCLUSION: No change in therapeutic modalities will ever decrease mortality rate of cervical carcinoma as much as education, prevention and early screening. The 5-year survival for locally advanced disease has not improved during the last 40 years as a result of failure to deliver therapy to the paraaortic region. Paraaortic lymph nodes should be evaluated before therapy planning by different imaging procedures, or more exactly by surgical staging: laparoscopy or laparotomy. Radical operations of cervical carcinoma should be performed by experienced surgeons, educated for this type of operation, with sufficient number of cases.