The Gail model is a statistical tool, which assesses breast cancer probability, based on nonmodifiable risk factors. In contrast, the evaluation of mammographic breast density is an independent and dynamic risk factor influenced by interventions modifying breast cancer risk incidence. The aim of the present study is to compare the possibilities for risk factor integration and analysis and to search for a correlation between mammographic density and the Gail model for breast cancer risk evaluation. The subject of this prospective study is a cohort of 107 women at ages from 37 to 71 years, who have had benign breast diseases, digital mammograms, and Gail model risk evaluation. Mammographic density is evaluated in craniocaudal projection subjectively visually and objectively using the computer imaging software. (Image J software) The Gail risk evaluation is completed using the standardized NCI questionnaire (Breast Cancer Risk Assessment Tool). In concordance with the Breast Imaging Reporting and Data System (BI-RAD) by ACR, mammographic density is evaluated using a four-grade scale. Low density D1 (less than 25%) was determined in 24 cases, D2 (25-50%) in 36 cases, D3 (51-75%) in 31 cases and high density D4 (greater than 75%) in 16 cases. According to the Gail model, 80 (74,8%) of the examined patients did not have an increased risk (less than 1,67% for a five-year period), whereas the remaining 27 (25,2%) had a statistically significant increase in risk (greater than 1,67% for a term of five years). Women with increased risk more often present with denser breast (34% with D3, D4 versus 18,3% for D1, D2). The Gail model does not fully explain the correlation between breast density and statistically calculated risk. The development of more detailed tools, which take into consideration breast density, as well as other risk factors, may be helpful for a more accurate evaluation of the individual risk for breast cancer.
Introduction Torsion or twisting of the left lower lobe following left upper lobe lobectomy is a rare, but severe complication. According to the literature, the outcome of this complication is necrotic pneumonitis, most often followed by pneumonectomy. According to different authors its frequency ranges between 0,1% and 0,4% from all operated patients. We treated a patient with pulmonary torsion with a favorable outcome. Case report: A 56 years-old patient with peripheral carcinoma of the left upper lobe of the lung underwent a typical upper left lobectomy. On the third postoperative day, there was a sudden deterioration in patient's condition, which led to the diagnosis of torsion of the lower pulmonary lobe. Using the video-thoracoscopic approach we were able to restore the proper position of the remaining lobe without any ischemic parenchymal alterations. The condition of the patient stabilized, and she discharged without any further complications. Discussion: The described clinical case is significant in several aspects. Firstly the emergency invasive diagnosis is essential when similar complications are suspected and is crucial for preserving the vitality of the lung parenchyma. Secondly the minimally invasive video-thoracoscopic approach is a safer procedure and it should, therefore, precede the thoracotomy. Conclusion: The rarity of this complication is the most likely reason for the lack of reports in the literature. In our case, we were able to avoid pneumonectomy and the patient recovered well. When there are more such cases described, then we will have a functional standard algorithm to follow.
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