Factors influencing time to seeking medical advice and onset of treatment in women who are diagnosed with breast cancer in Serbia.

OBJECTIVE: Streamlining the diagnosis is a key factor in improving the treatment outcomes for breast cancer. The aim of this study was to determine factors influencing time to seeking medical advice and treatment onset in women who are diagnosed with breast cancer in Serbia. METHODS: The study was a multicenter, cross-sectional national survey, performed at 10 oncology centers in Serbia. Time intervals spent throughout the complex diagnostic pathway were evaluated using a validated questionnaire administered to women with breast cancer (n = 800). Total interval (TI) was determined using predefined time scales, including one referring to patient interval (PI), and several related to health care system interval (SI). RESULTS: Mean PI, SI, and TI were 4.5, 9.2, and 12.9 weeks, respectively; 20% of patients had a PI>12 weeks. Based on the multivariate regression model, longer PI was associated with perceived lack of time and personal disregard or trivialization of detected symptoms and signs. Women who were supported by family members or friends and had at least a secondary level education tended to have a shorter PI. Longer PI was correlated with a longer SI, while regular self-examination, having been diagnosed by an oncologist, and living in a major city were associated with shorter SI. CONCLUSIONS: Several factors, related to psychological, demographic, behavioral, and health system characteristics, determined both the time to seeking medical advice and treatment onset for breast cancer. These findings support review and refining of national strategies and policies to promote early detection, diagnosis, and treatment of breast cancer.

Potential Influence of Selenium, Copper, Zinc and Cadmium on L-Thyroxine Substitution in Patients with Hashimoto Thyroiditis and Hypothyroidism.

Background: Besides genetic factors, it is known that some trace elements, as Selenium, Copper, and Zinc are essential for thyroid gland fuction and thyroid hormone metabolism. Moreover, there were some metals effect that suggested patterns associated with overt thyroid disease. Aim of study: Hashimoto thyroiditis (HT), chronic autoimune inflamation of thyroid gland with cosequtive hipothyroidism, is common disease in Serbia, and we thought it is worthwile to explore potential effects of essential and toxic metals and metalloides on thyroid function and ability to restore euthyroid status of them. Results: This cross-sectional, case-control, study investigated the status of essential elements (Selenium,Copper,and Zinc) and toxic metals and metalloides (Al, Cr, Mn, Co, As, Cd, Sb, Ba, Be, Pb and Ni) from the blood of 22 female, patients with Hashimoto thyroiditis and overt hypothyroidism, and compared it with those of 55 female healthy persons. We tried to establish the presence of any correlation between previous mentioned elements and thyroid function in hypothyroid patients and healthy participants. Conclusions: The results of our study suggested that the blood concentration of essential trace elements, especially the ratio of Copper, and Selenium may influence directly thyroid function in patients with HT and overt hypothyroidism.Thus, our findings may have implication to life-long substitution therapy in terms of l-thyroxine dose reduction. Furthermore, for the first time, our study shown potential toxic effect of Cadmium on thyroid function in HT patients, which may implicate the dose of l-thyroxine substitution.

Anticardiolipin antibodies are not an independent risk factor for stroke: an incident case-referent study nested within the MONICA and Västerbotten cohort project.

BACKGROUND AND PURPOSE: Anticardiolipin antibodies (aCL) have been proposed to be an independent risk factor for stroke. To test this hypothesis, a nested case-control study was performed to compare aCL with the other known risk factors for stroke. METHODS: Within the framework of the World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) project and the Västerbotten Intervention Program (VIP) health survey, 44 725 men and women were enrolled and followed up from January 1, 1985, through August 31, 1996. Individuals free from cardiovascular events were followed up, and 123 developed stroke (on average, 34.1 months after blood sampling; 21 cerebral hemorrhage and 102 cerebral infarction); they were compared with 241 age- and sex-matched control subjects from the same population. ELISA was used for the analysis of IgG, IgM, and IgA aCL. RESULTS: IgM-aCL were present in 11.4% of patients (14/123) who developed stroke and in 4. 1% of individuals (10/241) who remained healthy (P=0.013, OR 2.97, 95% CI 1.28 to 6.89). The OR for the levels of IgM-aCL was 1.34 (P=0. 01, 95% CI 1.07 to 1.68) without adjustment for other risk factors and 1.24 when adjusted for hypertension, diabetes mellitus, cigarette smoking, and use of smokeless tobacco (P=0.077, 95% CI 0. 98 to 1.56). There was no difference between patients and controls for the prevalence or level of IgG-aCL and IgA-aCL and also no difference between patients with cerebral hemorrhage and cerebral infarction for the prevalence of all 3 isotypes of aCL. CONCLUSIONS: We conclude that aCL are associated with future stroke but do not constitute an independent risk factor.

Autoantibodies against oxidatively modified LDL do not constitute a risk factor for stroke: a nested case-control study.

BACKGROUND AND PURPOSE: Autoantibodies against oxidatively modified LDL have been shown to be associated with atherosclerosis. Their possible pathogenic role is not yet fully understood, and earlier published data are inconsistent. In this prospective study, we have investigated the association of these antibodies with future stroke. METHODS: A prospective case-control study in which 44 725 men and women from the World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) project and the Västerbotten Intervention Program (VIP) were enrolled and followed from January 1, 1985, to August 31, 1996. One hundred nineteen cases of stroke (male 75, female 44) were noted and compared with 233 age- and sex-matched controls from the same population. Antibodies against oxidatively modified LDL (copper-oxidized LDL and malonaldehyde [MDA]-LDL) were analyzed by ELISA. RESULTS: There was no difference in the levels or in the prevalence of IgG, IgA, and IgM autoantibodies against copper-oxidized LDL or MDA-LDL between patients and controls. Risk ratios for these antibodies, when adjusted for diabetes mellitus, hypertension, and smoking habits, did not confer a risk of stroke. Serum triglycerides (1.7 versus 1.4 mmol/L, P=0.01), fasting blood sugar, and systolic and diastolic blood pressures were significantly higher in the patient group than in the control group, as was the prevalence of hypertension (51.8% versus 27.4%, P<0.0001) and diabetes mellitus (9.6% versus 0.8%, P<0.001). CONCLUSIONS: Autoantibodies against oxidatively modified LDL do not constitute a risk factor for stroke in an adult population.

[Sonographic imaging in the diagnosis of tumors of the pancreas]. / Sonografski imidzing u dijagnostici tumora pankreasa.

BACKGROUND: Pancreatic cancer is generally in its advanced stage when symptoms of the disease develop and the diagnosis is established. Although an increase of the disease has been evident, an early diagnosis has still remained a problem. Ultrasonographic diagnostics in patients with abdominal troubles can classify abdominal changes as unechogenic-hypoechogenic and-iso-hyperechogenic circumscribed lesions. Of course, it cannot immediately differentiate between benign and malignant ones. It is by directed aspiration biopsy that either of them can be confirmed or excluded. MATERIAL AND METHODS: In our series we examined 58 patients with a pancreas disorder. Ultrasonography verified a focal change in one part of the pancreas suspected of a tumor in 52 patients who were all submitted to a directed ultrasound guided aspiration biopsy. RESULTS: Out of 58 examined patients tumor mass in the region of pancreas was found in 52 patients. Thirty-three patients were diagnosed with cancer, while 19 patients were with benign lesions--pancreatitis or cysts. Positive cytologic findings were confirmed in case of 41 patients. Method sensitivity was 88%. Moreover, we have achieved a great accuracy in suspecting a malignancy of the pancreas on the basis of additional, indirect symptoms, even when a tumorous lesion of the pancreas was not observed by ultrasonography. Method accuracy was 89%. DISCUSSION: A fine-needle ultrasound guided biopsy is an efficient, relatively inexpensive technique which facilitates the diagnosis of cancer and contributes to a faster differential diagnosis of focal pancreatic lesions. Authors report diverse results and efficiency of the method. False-negative findings, i.e. a finding is negative despite the presence of cancer, are obtained in a diverse but a small percentage and due to different reasons. Nevertheless, this method is exceptionally safe. CONCLUSION: Ultrasonographic diagnostics has been recognised as a valuable method in diagnosing lesions of the biliary tract and organs and blood vessels in the vicinity of the pancreas involved by a carcinoma. In a high percentage of the examined patients the intervention was successfully performed and a malignant or benign etiology of the change seen on ultrasonography was confirmed.

Genetic association of Ctla-4 to myasthenia gravis with thymoma.

Cytotoxic T lymphocyte associated antigen-4 (CTLA-4) plays a pivotal role in downregulating both the cellular and the humoral response by suppressing ongoing responses of activated T cells. Our earlier study showed that genetic variations in interleukin-1 genes confer susceptibility to myasthenia gravis, especially in patients having the lowest risk from major histocompatibility complex genes. Here we describe an association of Ctla-4 gene to the disease with thymoma and a higher prevalence of CTLA-4 gene polymorphism allele 104 in patients positive for IL-1beta TaqI allele 2, an IL-1beta 'high secretor' phenotype. There was no association in patients with hyperplasia and normal thymic histology. These results further advocate that MG is a polygenetic disease and suggest that co-stimulators such as CTLA-4 and CD28 might have an important role in the pathogenesis of the disease.

The germinal center kinase gene and a novel CDC25-like gene are located in the vicinity of the PYGM gene on 11q13.

Multiple endocrine neoplasia type 1 (MEN1) is tightly linked to the muscle-type glycogen phosphorylase (PYGM) gene in 11q13. This region of the human genome contains additional disease-related loci implicated in the development of insulin-dependent diabetes mellitus, familial paraganglioma type 2, spinocerebellar ataxia type 5, Bardet-Biedl syndrome and translocation t(11;17) described in B-cell non-Hodgkin's lymphoma. We approached cloning of candidate disease genes from 11q13 by large-scale genomic sequencing. We obtained > 106 kb of sequence around the PYGM gene and established a transcriptional map that includes: (i) two genes previously localized to 11q13, PYGM and a zinc-finger protein (ZFM1) gene; (ii) the germinal center kinase (GCK, human B-lymphocyte serine/threonine protein kinase) gene; (iii) a novel human CDC25-like (HCDC25L) gene; (iv) a dystrophia myotonica protein kinase-like (DMPKL) gene; and (v) a novel ubiquitously expressed gene of unknown function (germinal center kinase- neighboring gene, GCKNG).

[Possibilities of interventional ultrasonography in the differential diagnosis of pancreatic malignancy]. / Mogucnosti interventne ultrasonografije u diferencijalnoj dijagnozi maligniteta pankreasa.

Pancreatic carcinoma is one of the most aggressive visceral malignancies with lethal ending in 99% of cases. Although diagnostic methods make a great progress, the world epidemiologists consider this disease to be increasing. The main reason for this is probably the problem of making early diagnosis. Various diagnostic techniques including ultrasonography often make no difference between benign and malignant changes. The aim of this paper is to consider values of pancreatic functions under the control of ultrasound in a group of patients. The examination included patients with evident pancreatic changes. By cytopathologic analysis of the gathered material clear diagnosis was made. In most cases malignancy was established. The aim of diagnostic examination is to make diagnosis as early as possible, using minimal number of tests which should be the least invasive and traumatic for patients. As a diagnostic method ultrasonography is fast and simple which provides better chances for patients with pancreatic carcinoma.