An analysis of time trends in breast and prostate cancer mortality rates in Lithuania, 1986-2020.

BACKGROUND: Breast cancer (BC) and prostate cancer (PC) mortality rates in Lithuania remain comparatively high despite the ongoing BC and PC screening programmes established in 2006. The aim of this study was to investigate time trends in BC and PC mortality rates in Lithuania evaluating the effects of age, calendar period of death, and birth-cohort over a 35-year time span. METHODS: We obtained death certification data for BC in women and PC in men for Lithuania during the period 1986-2020 from the World Health Organisation database. Age-standardised mortality rates were analysed using Joinpoint regression. Age-period-cohort models were used to assess the independent age, period and cohort effects on the observed mortality trends. RESULTS: Joinpoint regression analysis indicated that BC mortality increased by 1.6% annually until 1996, and decreased by - 1.2% annually thereafter. The age-period-cohort analysis suggests that temporal trends in BC mortality rates could be attributed mainly to cohort effects. The cohort effect curvature showed the risk of BC death increased in women born prior to 1921, remained stable in cohorts born around 1921-1951 then decreased; however, trend reversed in more recent generations. The period effect curvature displayed a continuous decrease in BC mortality since 1991-1995. For PC mortality, after a sharp increase by 3.0%, rates declined from 2007 by - 1.7% annually. The period effect was predominant in PC mortality, the curvature displaying a sharp increase until 2001-2005, then decrease. CONCLUSIONS: Modestly declining recent trends in BC and PC mortality are consistent with the introduction of widespread mammography and PSA testing, respectively, lagging up to 10 years. The study did not show that screening programme introduction played a key role in BC mortality trends in Lithuania. Screening may have contributed to favourable recent changes in PC mortality rates in Lithuania, however the effect was moderate and limited to age groups < 65 years. Further improvements in early detection methods followed by timely appropriate treatment are essential for decreasing mortality from BC and PC.

Glucose and lactate metabolism in well-perfused and compromised microvascular flaps.

The success in microvascular flap transfer depends on the maintenance of optimal perfusion postoperatively. In addition to anastomosis thrombosis, other perfusion failures such as venous congestion, spasms, and kinks may appear. As perforator flaps become more frequent, it must be remembered that perforating vessels are more fragile and susceptible for trauma and mechanical compression. Sometimes, a flap is doing not well even though its anastomosis is patent. The flap perfusion can be measured using different tools in addition to clinical surveillance. We have used microdialysis in monitoring 268 microsurgical flaps and compared the metabolic data of normally perfused flaps to those that suffered from relative or absolute perfusion failure. We found that tissue glucose and lactate concentrations and especially their relation (lactate-to-glucose ratio) can show the presence of ischemia and aid in decision making, whether to reoperate or not. High lactate-to-glucose ratio may also predict total or partial flap necrosis.

Giant intermuscular lipoma of breast: A case report.

A giant intermuscular lipoma, an exceedingly rare occurrence, constitutes a non-malignant neoplasm originating from the mesodermal germ cell layer, with dimensions surpassing 10 cm. Its differentiation from liposarcoma and other malignant tumours is imperative. We present a case involving a 75-year-old woman who initially raised suspicions of liposarcoma due to pronounced enlargement and fullness in the upper quadrants of the left breast. After comprehensive imaging evaluations, the identification of a sizable BI-RADS 4a lesion positioned between the major and minor pectoral muscles of the left breast was found. The definitive diagnosis of an exceedingly rare giant intramuscular lipoma was validated solely subsequent to the surgical excision of the lipoma, through histological analysis.

Cost analysis of 109 microsurgical reconstructions and flap monitoring with microdialysis.

Few studies have examined the cost-effectiveness of microsurgery, and little is known about the cost-effectiveness of flap monitoring. We studied the costs related to microsurgery during 2004 to 2006 in Kuopio University Hospital. A total of 99 patients were reconstructed with 109 flaps. Primary success was achieved in 64% of cases. Reoperation for anastomosis was conducted in 25% and for other surgical complications in 27%. The intended result was achieved in 94% of cases. The mean total cost of hospital care was 20,000 euro in head and neck cancer surgery, 15,500 euro in defects of the lower extremities, and 9200 euro in breast reconstruction. The costs were greatly influenced by surgical complications (i.e., if the primary reconstruction failed, then the secondary microvascular flap almost doubled the expense involved; mean expenses per case 27,900 euro). Microdialysis was used in flap monitoring with an additional cost of 535 euro per patient. We found that microdialysis provided an early diagnosis of perfusion failure and helped to save the flap. It was estimated that if one or two flaps per year are saved due to more effective monitoring, then the extra costs of using microdialysis are covered.

Scrotal reconstruction using thigh pedicle flaps after scrotal skin avulsion.

Major scrotal and penile skin loss is uncommon and management of such an injury is a challenging problem for genitourinary reconstruction surgeons. Less than 50% scrotal skin loss can often be closed without difficulties immediately after trauma with surrounding tissue. In cases of more significant skin loss, the testes may be preserved by placing them in thigh pouches or dressed with wet dressings until reconstruction, or split thickness skin grafting can be performed. The surgeon's decision depends on the cause of skin loss - trauma, Fournier's gangrene or others. We describe a case of massive scrotal and penile skin loss due to an incident with an agricultural machine. The scrotal reconstruction, performed in three steps, was chosen because of its simplicity, early closure of the wound, excellent cosmetic appearance and maintenance of sexual functions. In the first step the penis was covered with remnant scrotal and preputium skin, and the testes were placed in thigh pouches. Incision of thigh flaps was planned to perform the second step and finally scrotal reconstruction with thigh pedicle flaps was done. Results were satisfactory from an esthetical and functional point of view.

Diagnosis, treatment, and outcomes of encapsulated papillary carcinoma: a single institution experience.

BACKGROUND: Encapsulated papillary carcinoma (EPC) is a rare entity of breast cancer accounting for approximately 1-2% of all breast tumours. There are no evidence-based guidelines for the treatment of EPC. MATERIALS AND METHODS: From the database of the National Centre of Pathology (NCP), we obtained pathology reports of 19 patients with histologically confirmed EPC, who were treated at the National Cancer Institute (NCI) in Vilnius, Lithuania, between July 2009 and July 2015. Demographic, diagnostic and treatment data were collected from medical records retrospectively. RESULTS: During the indicated period, 19 patients with EPC were treated at the NCI. Three of them had pure EPC, they were 74 to 81 years of age at the time of diagnosis (mean 76.7 years, median 75 years); all of them are still alive and no disease progression has been observed. Seven patients had EPC associated with carcinoma in situ. Nine patients had EPC associated with invasive breast ductal carcinoma. All patients underwent surgery, in most cases - wide local excision. Only one patient died. CONCLUSIONS: EPC is a rare form of breast cancer and usually presents with an invasive breast carcinoma or carcinoma in situ in postmenopausal women. Tumours have an excellent prognosis in the cases of pure EPC and in both EPC associated with carcinoma in situ (CIS) and invasive carcinoma.

The effectiveness of caloric value of enteral nutrition in patients with major burns.

UNLABELLED: Enteral nutrition as an important component of modern treatment is mandatory for patients suffering from major burns. Regardless of the initial estimation of caloric requirements, actual daily volume of energy consumption may vary depending on the general condition of the patient and the side effects of enteral nutrition. The aim of our study was to investigate the relation between caloric value of enteral nutrition and treatment course. METHODS: The prospective study involved 103 adult patients treated in the Hospital of Kaunas University of Medicine for 2 degrees -3 degrees burns of 10-80% body surface area from 1 January 2001 till 31 December 2003. All patients received enteral nutrition during the acute phase. After the completion of the treatment, caloric value of enteral nutrition was estimated, and patients were divided into two groups: group A received more than 30 kcal/(kg 24 h); and group B, received less than 30 kcal/(kg 24 h). We compared patients' mortality, complication rate, and hospital stay time. RESULTS: The mortality of patients, who enterally received less than 30 kcal/(kg 24 h), was 32.6%, comparing to 5.3% mortality in patients who received 30 or more kcal/(kg 24 h) (p < 0.01). The caloric value of less than 30 kcal/(kg 24 h) increased the frequency of pneumonia by 2.0 times, and the frequency of sepsis by 1.8 times (p < 0.05). The duration of the treatment of survivors in this group was by 12.6 days longer (p = 0.01). CONCLUSIONS: The caloric value of enteral nutrition seems to be associated with patient mortality, complication rate, and treatment duration. The results of the treatment of patients who received more or 30 kcal/(kg 24 h) were much better. Because determined relationship may not be directly causal, further study is needed to determine whether active intervention to improve nutrition could improve outcomes.

Bacteremias in patients with severe burn trauma.

UNLABELLED: The aim of the study was to investigate the causative agents of bacteremia in burned patients during 1999-2003. MATERIAL AND METHODS: All case records of 82 burned patients with bacteremia treated at the Department of Plastic Surgery and Burns of Kaunas University of Medicine Hospital were analyzed during 1999-2003. RESULTS: Mean body surface area burned in bacteremic patients was 29%. Bacteremia was diagnosed, on an average, on the 15th day after hospitalization and the 16th day after the burn. The causative agent of bacteremia in 71% of cases was methicillin-resistant Staphylococcus aureus; 11% of bacteremias were caused by Pseudomonas aeruginosa, and in 78% of cases Pseudomonas was sensitive to gentamicin. In all years, methicillin-resistant Staphylococcus aureus was the most common agent of bacteremia. Altogether, 55 patients out of 82 recovered. The mean duration of inpatient treatment was 48 days. CONCLUSIONS: Bacteremia was diagnosed at the beginning of the third week of hospital stay. More than half of bacteremic patients (67%) survived. The most common causative agents of bacteriemia were methicillin-resistant Staphylococcus aureus and gentamicin-sensitive strains of Pseudomonas aeruginosa.

Rare types of breast carcinoma.

Breast cancer (BC) is a heterogeneous disease that encompasses several distinct entities with remarkably different characteristics. Histological type is one of important BC characteristics. Histological type is associated with differences in epidemiology, diagnostic issues, clinical course, prognosis. When we talk about BC, ductal and lobular carcinoma is usually what we have in mind. However, the other types that comprise less than 10% of BC are also very important. The rarity of many of these neoplasms does not allow large or randomized studies to define the optimal treatment. Many of the descriptions are from case reports and small series. The aim of this retrospective study was to analyze the data on rare breast cancers, to describe their main characteristics, and to calculate survival rates. We believe that the experience of our institution will contribute to the available data about these rare breast cancers and help in better understanding of this subgroup.

[Efficiency of new treatment methods in burned patients]. / Nudegusiu ligoniu nauju gydymo metodu efektyvumas.

UNLABELLED: The aim of study was to investigate if new treatment methods reduced mortality and diminished hospital stay time for survivors. MATERIAL AND METHODS: We assessed patients, treated in Kaunas University of Medicine Hospital with 10-80% 2B-3 degrees body surface area burned. Group A, which was assessed prospectively, included 89 patients, treated during 2001-2003. All patients in Group A received sufficient enteral nutrition, in 21 patient early escharectomy and skin-grafting were done. This group was compared with Group B, assessed retrospectively and included 89 patients, treated in 1997-1998. They did not receive enteral nutrition and were treated without early escharectomy and skin grafting. RESULTS: Groups were homogeneous by age, extent of general and deep burn, and burn indexes. For 24% patients in Group A early escharectomy and skin-grafting was done, they were operated on the average at 3.6 day after admission (standard deviation - 1.32). In Group A mortality was 5.6%. Average hospital stay time for survivors was 35.7 days (standard deviation--20.4) or 0.9 day/% body surface area burned, standard deviation--0.6. In Group B no early escharectomies and skin grafting were done. Mortality in Group B was 23.6%, hospital stay time for survivors--40.6 days (standard deviation--23.6), or 1.9 day/% body surface area burned. These indicators were statistically significantly different compared to Group A (p<0.05). The significant influence of new treatment methods in major burns was established. CONCLUSION: New methods, early escharectomy and skin grafting and enteral nutrition, introduced in Kaunas University of Medicine Hospital in the last 5-7 years significantly reduced mortality and hospital stay time for survivors (p<0.05).

[Analysis of burn-related deaths in Kaunas University of Medicine Hospital during 1993-2002]. / Mirstamumo nuo nudegimu Kauno medicinos universiteto klinikose 1993-2002 m. analize.

UNLABELLED: Objective of this study was to investigate mortality of burned patients, treated in Kaunas University of Medicine Hospital during 1993-2002, changes of mortality, causes of death, to assess patients' age, gender, burn agent, and adjacent diseases. MATERIAL AND METHODS: Retrospective analysis of case-records of 283 burned patients deceased during 1993-2002 was done. RESULTS: During 1993-2002, 1876 burned adult patients were hospitalized in Kaunas University of Medicine Hospital. The mortality rate of burned patients was between 9 and 22% (average--13.3%, standard deviation--3.8). Age of deceased patients was on average 56 years (standard deviation--8); actually 21.6% were older that 80 years. There were 62% men among deceased burned patients. Common body surface area burned was 32% (standard deviation--28.6%), deep burn area was at average 22% (standard deviation--19.8%). Seventy two percent of burns were caused by fire, and 10% of patients were scalded. In 35% case-records adjacent diseases were not mentioned, in 57% atherosclerosis and ischemic heart disease were diagnosed, 5% of patients had respiratory diseases, 7% had central nervous system troubles, mental disorders were diagnosed in 2%. Eight percent were cachectic at admission, 6%--with chronic alcohol dependence. In 70% of patients pneumonia was diagnosed, in 13%--pulmonary edema, and in 39%--sepsis. Deceased patients were treated until death on average 14 days (standard deviation--6); during first two weeks 50% died. CONCLUSIONS: At higher mortality risk are elder burned patient with major burns, especially with serious adjacent diseases. Common death causes in burned patients are pneumonia, pulmonary edema and sepsis.

Influence of enteral nutrition on the frequency of complications in case of major burns.

UNLABELLED: The objective of the study was to assess if enteral nutrition reduces the rate of severe complications and complication-related mortality in case of major burns. MATERIAL AND METHODS: Two groups were included in the study. Group A was assessed prospectively and included 67 patients treated in Kaunas University of Medicine Hospital in 2000-2003. These patients received 30-40 kcal/kg/day in enteral way over the period of wound surgery. Group A was compared with Group B, which was assessed retrospectively and included 71 patients without enteral nutrition treated in 1997-1998. Groups were homogeneous by patients' age; extent of general and deep burn area; Baux and Burn indexes. RESULTS: 10 patients (15%) in Group A had pneumonia, 3 (30%) of them died; 11 (16%) had lung edema, 3 (27%) of them died; 24 (36%) had sepsis, 3 (12.5%) of them died; renal insufficiency was diagnosed to 4 patients (6%) in Group A, 2 (50%) of them died. In Group B (without enteral nutrition) pneumonia was diagnosed to 27 patients (38%) of 71, 18 (63%) of them died; lung edema--to 20 (28%), 18 (90%) of them died, 19 patients (27%) had sepsis, 12 (63%) of them died; renal insufficiency was diagnosed to 10 patients (14%), all of them (100%) died. CONCLUSIONS: Enteral nutrition statistically significantly diminished frequency of pneumonia and lung edema for burned patients. Pneumonia, lung edema, sepsis and renal insufficiency were less hazardous for life of patients with enteral nutrition (p<0.05).

Nutrition of burned patients.

Burns form 5-12% of all traumas. About 2,200 of patients are annually hospitalized in Lithuania. In most cases people of the employable age get burned. The treatment is often long-lasting, and afterwards recovered patients often have invalidity from burn sequels. The mortality of hospitalized burned patients is about 10%. The most common causes of death are pulmonary edema, pneumonia, sepsis and multiorgan failure. All these complications are related with insufficient nutrition. These complications are extremely frequent and dangerous for patients with more than 20% of body burned. The nutritional support of burned patient gives a possibility to increase the survival probability, to decrease complication rate and hospitalization time. Currently in Lithuania there are no standards for burned patient nutrition. More attention is given to strategy of surgical strategy and techniques, as well as antibiotic therapy. This article is the review of the different aspects of artificial nutrition of burned patient: indications, modes of nutrition, mixtures and terms of nutritional support.