Optimisation of breast cancer patients' follow-up - potential way to improve cancer care in transitional countries.

The aim of this analysis was to evaluate adherence of Croatian oncologists to follow-up criteria as suggested by the current national and international guidelines for women with breast cancer receiving adjuvant endocrine therapy. The use of clinical and diagnostic methods was documented in this prospective, non-interventional, multicenter study. A total of 438 post-menopausal patients receiving adjuvant endocrine treatment with non-steroidal aromatase inhibitors were included. Average annual frequency for each clinical and diagnostic method was calculated. Median adjuvant endocrine treatment duration before study recruitment was 10.5 months (interquartile 4.7-26.6). Patients were followed up for an average 23.5 ± 4.9 months. Average number of oncological visits was 5.3. Mammograms were performed at mean annual frequency of 0.7, chest radiographs at 0.5, abdominal ultrasounds at 0.9, breast ultrasounds at 1.2, complete blood counts and chemistry panels at 1.7, carcinoembryonic antigen at 0.8, cancer antigen 15-3 at 1.6, gynaecological examination at 0.3, and densitometry at mean annual frequency of 0.3. In conclusion, among post-menopausal women with breast cancer receiving adjuvant endocrine therapy in this study, more unnecessary and unproven follow-up procedures were done compared to the guidelines' recommendations.

"V"-technique as a method of breast conserving surgery in multifocal and T2 invasive breast cancers situated in the upper outer quadrant / La técnica "V" como método quirúrgico para conservar las mamas en cánceres de mama invasivos T2 y multifocales situados en el cuadrante superior externo

OBJECTIVE: To assess the oncologic and cosmetic outcomes in women with multifocal breast cancers or T2 tumours with diameters larger than 3 cm situated in the upper outer quadrant who were treated with "V"-technique. METHODS: From July 1999 till June 2003, 44 conserving surgeries with "V"-technique using a local rotational flap were performed. Localization of tumours was in the upper outer quadrant. All solid tumours were larger than 3 cm in diameter. In all patients, axillary lymph node dissection was performed. All the patients received postoperative radiotherapy. Mean follow-up was 58 months. RESULTS: Out of 44 conserving surgeries with "V"-technique, an adequate distance of tumour from the margins was obtained in 84.1% (37/44). Out of 37patients who underwent conserving surgery with this technique, the cosmetic result was favourable in 83.78% (31/37). None of these patients had a corrective surgery such as reduction mammaplasty or mastopexy. Mean weight of excised tissue was 215 g. The 5-year local recurrence rate was 10.8%. The 5-year metastasis-free survival rate was 81,1%. The 5-year overall survival rate was 86.5 %. CONCLUSIONS: Surgical treatment of multifocal and T2 breast cancers larger than 3 cm in diameter situated in the upper outer quadrant and performed with "V"-technique gives a good aesthetic result and enables a wide resection of breast tissue around the tumour.

OBJETIVO: Evaluar los resultados oncológicos y cosméticos en las mujeres con cánceres multifocales de mama o tumores T2 de diámetro mayor de 3 cm, situados en el cuadrante superior externo, en pacientes tratadas con la técnica "V". MÉTODOS: De julio 1999 hasta junio de 2003, se realizaron 44 cirugías conservadoras usando la técnica "V" con colgajo local de rotación. Los tumores se hallaban localizados en el cuadrante superior. Todos los tumores sólidos tenían más de 3 centímetros de diámetro. A todas las pacientes se les practicó la disección del ganglio linfático axilar. Todas las pacientes recibieron radioterapia postoperatoria. El seguimiento promedio fue de 58 meses. RESULTADOS: De las 44 cirugías conservadoras con la técnica "V", se obtuvo una distancia adecuada del tumor en 84.1% (37/44) desde los márgenes. De 37 pacientes que tuvieron cirugía conservadora con esta técnica, el resultado cosmético fue favorable en 83.78% (31/37). A ninguna de estas pacientes se les realizó cirugías correctivas tales como mamoplastia de reducción, o mastopexia. El peso promedio del tejido extirpado fue 215 g. La tasa de recurrencia local quinquenal fue de 10.8%. La tasa de supervivencia quinquenal libre de metástasis fue 81, 1%. La tasa general de supervivencia fue de 86.5%. CONCLUSIONES: El tratamiento quirúrgico de los cánceres de mama T2 y multifocales mayores de 3 cm. de diámetro situados en el cuadrante superior externo y realizado con la técnica "V" produce un buen resultado estético y permite una resección amplia del tejido mamario alrededor del tumor.

"V"-technique as a method of breast conserving surgery in multifocal and T2 invasive breast cancers situated in the upper outer quadrant.

OBJECTIVE: To assess the oncologic and cosmetic outcomes in women with multifocal breast cancers or T2 tumours with diameters larger than 3 cm situated in the upper outer quadrant who were treated with "V"-technique. METHODS: From July 1999 till June 2003, 44 conserving surgeries with "V"-technique using a local rotational flap were performed. Localization of tumours was in the upper outer quadrant. All solid tumours were larger than 3 cm in diameter In all patients, axillary lymph node dissection was performed. All the patients received postoperative radiotherapy. Mean follow-up was 58 months. RESULTS: Out of 44 conserving surgeries with "V"-technique, an adequate distance of tumour from the margins was obtained in 84.1% (37/44). Out of 37 patients who underwent conserving surgery with this technique, the cosmetic result was favourable in 83.78% (31/37). None of these patients had a corrective surgery such as reduction mammaplasty or mastopexy. Mean weight of excised tissue was 215 g. The 5-year local recurrence rate was 10.8%. The 5-year metastasis-free survival rate was 81.1%. The 5-year overall survival rate was 86.5%. CONCLUSIONS: Surgical treatment of multifocal and T2 breast cancers larger than 3 cm in diameter situated in the upper outer quadrant and performed with "V"-technique gives a good aesthetic result and enables a wide resection of breast tissue around the tumour

Osteometric dimensions of metacarpal bones with respect to the professional exposure to vibration.

The comparative analysis of the osteometric dimensions of metacarpal bones in three groups of males (aged from 23 to 63 years) differing with respect to the presence of the professionally connected long-term exposure to the vibration is performed. The sample encompasses forest workers employed in wood industry (exposed to heavy physical work and to the daily use of hand-held vibrating tools) from two regions of Croatia: Podravina (n = 192) and Gorski Kotar (n = 115). The control group is formed using the random sample (selected according to age criterion) of phenotypically healthy male inhabitants of rural communities of Eastern Adriatic islands and peninsula (n = 200). Additionally, the influence of the level of calcium in diet, as a regional nutritional characteristic of particular regions of Croatia, is also considered. The regression of the percent cortical area (PCA) of the second left metacarpal bone and age showed that significant decrease of PCA in older age can be observed only in males from Eastern Adriatic (the control group), while that is not so in either group of males professionally exposed to vibration. Authors conclude that the analysis of the osteometric dimensions performed on males professionally daily exposed to vibration missed to provide evidence to support the hypothesis of long-term exposure to vibration as a risk for accelerated osteoporosis of metacarpal bones.

Morphometric dimensions of metacarpal bones in the population structure analysis (island of Krk, Croatia).

The population structure analysis by means of the osteometric dimensions of metacarpal bones in the population groups of the northern Adriatic island of Krk, Croatia was performed. The sample consisted of randomly sampled adult islanders (94 males and 79 females) aged from 18 to 85 years from six villages of the island of Krk. "Biological distances" were estimated by the Mahalanobis D2 analysis for bone length (L), total diaphysis width (T) and medullary canal width (M) dimensions of the second left metacarpal bone. Analysis of the osteometric dimensions of metacarpal bones as a measure of biological distance between population groups of the island of Krk indicated bio-cultural and socio-cultural events, rather than geographical distances, to be the primary determinants of anthropogenetic structure of today's population groups of the island.

Unilateral renal agenesia in the angiographic material and renovascular hypertension.

Analysis of 1216 abdominal aortographies and selective renovasographies undertaken at the Institute of Radiology, Clinical Hospital Centre Rijeka during the period 1979-1985, was performed 39 (3.2%) unilateral renal agenesias were established, a percentage that is significantly higher than reported by other authors. Analysis of all angiographic parameters of a single kidney was also worked out. A significantly high percentage (66.7%) of hypertension was diagnosed in this group. Congenital renal failures make their appearance in the early embryological development and are discovered, if compatible with life, most frequently at an advanced age. Statistical data on the frequency during a lifetime are less reliable because a great number of anomalies are never discovered during a person's life. The etiology of variations and congenital failure of renal arteries is unknown in 90% of the cases, and most of the malformations are without characteristic symptomatology. Since the anatomic relations in anomalous kidney are disturbed, the sign of the disease can develop atypical forms causing frequent errors in diagnosis. The kidney is supplied by numerous lateral branches of the medial sacral artery, i.e. the aorta, during embryological development. Later, some of them degenerate or mutually connect themselves, and the definitive kidney has been usually penetrated by only one artery and one vein on the same side.(ABSTRACT TRUNCATED AT 250 WORDS)

Vascular complications of the transplanted kidney--angiographic study.

The applied angiographic examination technique of the renal homotransplants performed during a 14-year period has been reported. 101 patients underwent 132 angiographic examinations in the course of 1971-1985. Thirty-two various vascular complications were diagnosed. Arterial stenoses during anastomoses were most frequent. Thromboembolic complications were second (4 arterial, 2 venous). One thrombosis of the iliac artery as a consequence of a wound infection following renal transplantation is described. In addition there were a few other single pseudoaneurysms of the arterial anastomoses and arteriovenous fistulas subsequent to renal biopsies. The importance of this examination technique and the diagnostic use of angiographic investigation of the transplanted kidney is pointed out.