Introduction: Sentinel lymph node biopsy is a standard staging procedure in patients with early breast cancer. Aim of the study is a validation procedure of sentinel lymph node biopsy (SLNB) in our institution and comparison between two mapping techniques-isotope mapping and methylene blue dye for lymphatic mapping. Material and methods: The study comprised 75 women with breast cancer of clinical stage T1-2N0M0. We analyzed patients from June, 2010 to March, 2013. In 39 patients, (Group A) lymphatic mapping technique was performed by using the peritumoral injection of 37MBq activity isotope (99m Technetium NANOCIS),and in 36 patients (Group B) mapping technique was performed by using the periareolar injection of 2-4 ml blue dye (Methylene blue 1%). Axillary dissection was performed in both groups after SLNB. Results: Out of 75 patients, sentinel lymph node was identified in 68 (90.7%). Identification rate was similar between the groups-89.7% (Group A), 91.7% (Group B). Accuracy rate was 97% between the groups, that is, Group A 97.1% and Group B 96.9%. In relation to the Group A (90.6%), sensitivity rate was slightly higher in the Group B-91.6%,. False negative rate of SLNB was higher in the Group A (9.1%) in relation to the Group B (8.3%). The average number of sentinel nodes detected in both groups was 1.2. Conclusion: The results of the study confirmed and validated both methods of lymphatic mapping techniques in SLNB. There were no significant statistical differences (p>0.05) in accuracy, sensitivity and false negative rate between these two groups.
Introduction: Gastrectomy is one of the most common surgical methods for the treatment of gastric cancer, which basically destroys the mechanism and digestion chemistry. Reconstruction after gastrectomy attempts to optimize the antireflux and nutritive component of the postgastrectomic syndrome.Objective: To determine which reconstructive method after gastrectomy has the optimal synthesis of antireflux and nutritional components.Patients and Methods: 111 patients were treated for gastric malignancies at the Surgical Clinic of the University Clinical Center in Banja Luka, which were operated with the intention of achieving curability.Results: Based on Fisher’s exact probability test there is no statistically significant difference (p> 0.05) in mortality compared to the restoration of digestive continuity after gastrectomy. Reflux oesophagitis is the dominant modality of morbidity in omega-loop reconstruction (p <0.05). There is no statistically significant difference (p> 0.05) in late dumping syndrome in patients relative to individual gastric substitution options. In the Hunt-Lawrence-Rodino pouch reconstruction option, there is no statistically significant difference (p> 0.05) in the participation of individual modalities of meal quantity in relation to the condition before the disease or the modality of the nutritional status. .Conclusion: The results indicate the antireflux component of reconstruction Roux en Y and the advantage of the nutritive component in the loop modification (the creation of the Hunt-Lawrence-Rodino pouch).
Introduction: Until recently, gastric cancer represented the most common visceral neoplasm. In Japan, the prevalence of disease is 58.4 per 100,000 inhabitants for men and 29.9 for women. Here, the incidence is lower. Gastrectomy is the most common surgical method of treating carcinomas of the stomach. Aim of the Study: To determine which method of reconstruction after gastrectomy improves the quality of life optimally. Patients and Methods: We analyzed 221 patient operated on for gastric cancer at the Surgical Clinic of the University Clinical Center in Banja Luka, and the subject of a detailed analysis of the 111 patients who were operated with the intention of achieving curability. Results: Reflux esophagitis is dominant modality in reconstruction wth omega loop (p <0.05). Analyzing GIQLI, we found dominant modality GIQLI II in the total gastrectomy and reconstruction options RY, while predominantly GIQLI III was registered in HLR reservoir reconstruction method (p <0.01). And two hours after the ingestion of a meal labeled with a radioisotope Tc99m in artificial gastric reservoir (HLR) showed signs of radioactivity (about 10% amount). "H0 performance" (AJCC / UICC) was the most frequently recorded in subtotal gastrectomy, while there was significant appearance of "H1" and "H2" modalities with the total gastrectomy statistically. In RY reconstruction, statistically significant was participation modalities "H1", while "H1" performance (AJCC / UICC) was the dominant modality at the HLR options reconstruction with statistically significant frequency of occurrence (p <0.01). Conclusion: The results of the assessment of quality of life are comparable with the results of other statistical series. They confirm antireflux component Roux en Y reconstructions and its intestinoplications and highlight the advantage of the nutritional components loop modifications (creation pouch-a).
Background: To prove the frequency of thrombocytosis in patients with cancer, and the importance of anticoagulant therapy. Thrombocytosis represents an elevated platelet count of more than 350,000/mm3 which is one of the risk factors for venous thromboembolism.Methods: This study has analyzed 146 patients who were hospitalized at the Oncology Clinic of the University Clinical Centre, Banja Luka and the Day Oncology Hospital “S.tetik”, Banja Luka in the period between 2009 and 2014. These were patients with breast tumor, gastrointestinal or gynecological malignancies. Thrombocytosis was detected in 38 patients in the moment of diagnosing. All examinees were analyzed by sex, age, primary site of tumor, presence of comorbidity, relevant laboratory analyses, clinical stage of the disease (metastatic or localized disease).Results: In the observed sample of 146 patients, thrombocytosis was detected in 38 patients in the moment of diagnosing the disease (26%). Through the follow-up, DVT (deep venous thrombosis) was found in 13 patients (34.2%) and anticoagulant therapy was administered. Out of patients who were not on anticoagulant therapy because they had no thrombotic manifestations (25 patients, 65.8%), 2 ended up experiencing the development of a clinical presentation of massive pulmonary embolism with fatal outcome.Conclusions: The occurrence of thromboembolism significantly increases morbidity and mortality, as well as the total cost of treating cancer patients. Regardless of the fact that cancer patients are at a high risk of thromboembolic events, thromboembolic prophylaxis has not been adopted as a standard therapeutic modality because of potential bleeding.
Sažetak. Cilj rada bio je da se analiziraju rani rezultati operativnog liječenja bolesnika sa metastazama kolorektalnog karcinoma u jetri. Studijom su obuhvaćena 453 bolesnika operisana na Klinici za opštu i abdominalnu hirurgiju Kliničkog centra u Banjoj Luci u periodu od 01. aprila 2004. do 31. marta 2009. Metastaze u jetri imalo je 108 (23,84%) bolesnika. Kod 49 (45,37%) bolesnika one su bile sinhrone, a kod 59 (54,63%) metahrone. Kod 39 (36,11%) bolesnika postavljena je indikacija za hirurško liječenje, a kod 27 (25%) urađena je uspješna resekcija jetre. U grupi uspješno operisanih bilo je 14 (51,85%) žena, prosječne starosti 60,4 (46-75) godine i 13 (48,15%) muškaraca, prosječne starosti 66,8 (57-75) godina. Kod 16 (59,26%) bolesnika korišćena je desna subkostalna laparotomijska incizija, a kod 11 (40,74%) pristup po Makuchiju. Kod 6 (22,22%) bolesnika je urađena segmentektomija, kod 3 (11,11%) bisegmentektomija, kod 4 (14,81%) lijeva hepatektomija, kod 2 (7,41%) desna hepatektomija i kod 12 (44,44%) atipična resekcija jetre. Prosječno je operacija trajala 138 (75-265) minuta. Kod 15 (55,56%) opsežnih resekcija korišćena je tehnika hepatične vaskularne izolacije (kod 6 selektivno klemovanje portne trijade za resektovani lobus i kod 9 bolesnika intermitentno klemovanje hepatoduodenalnog ligamenta po Pringleu). Prosječno vrijeme hepatične vaskularne izolacije iznosilo je 30 minuta. Od ukupnog broja operisanih 16 (59,26%) bolesnika dobili su transfuziju krvi (u prosjeku 450 mL). Prosječna hospitalizacija je trajala 9,3 dana. Komplikacije su se javile kod 5 (18,52%) bolesnika, a nijedan bolesnik nije podlegao intraoperativno i postoperativno. Anatomske resekcije jetre sa selektivnom vaskularnom hepatičnom ekskluzijom i uz upotrebu harmoničnog skalpela ili uređaja za tkivno spajanje jesu uspješne i pouzdane metode sa minimalnim intra-i postoperativnim komplikacijama.
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