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The aim of the prospective clinical study was to evaluate the reasons for refusing kidney transplantation among chronic dialysis patients. A total of 164 adult chronic dialysis patients participated in the study. They were asked to complete a detailed questionnaire on specific issues regarding transplantation. The mean age was 60.9 ± 16.0 (20-89) years, 61.6% were male, 11.6% had had a previous transplant. The majority, that is, 72.0%, of the patients believed that transplantation improved the quality of life, and 55.5% believed that transplantation prolonged life. Nevertheless, 45.0% of the patients wanted to be transplanted, 35.0% refused transplantation, and 20.0% were undecided. Patients refusing transplantation were significantly older compared to the patients wanting to be transplanted (67 ± 16 vs. 57 ± 16 years; P < 0.001). The main reasons for refusing transplantation (57 patients) were the side-effects of immunosuppressive therapy (31.6%), unpredictability of transplant outcome (29.8%), and unfavorable outcomes in fellow patients (28.1%). The side-effects of immunosuppressive therapy that patients were most concerned about included mobility problems (29.8%), new-onset diabetes (26.3%), increased risk of severe infections (26.3%), problems with vision (22.8%), and increased risk of cancer (21.1%). Many patients did not want to accept organs from expanded criteria donors (ECD) (44.6% of the patients wanting and 64.9% of those refusing transplantation). The majority believed that patients should be informed if an organ from an ECD donor is being offered (64.9% of patients wanting and 63.2% of those refusing transplantation). The main reasons for refusing kidney transplantation were the side-effects of immunosuppressive therapy, unpredictability of transplant outcome, and unfavorable outcomes in fellow patients.

According to our results, LED significantly improves healing of chronic diabetic wounds and prepares the wound bed for further coverage options.

Intraosseous lipomas are rare benign bone neoplasms with an incidence of less than 0.1%; origin in the calcaneus has been reported in only a few patients. First-line treatment remains conservative, but several surgical techniques have also been described. We describe a 44-year-old woman with increasing pain in her left heel for a year and a half, who noticed swelling on the lateral side of the calcaneus. The patient underwent radiography, magnetic resonance imaging, and computed tomography of her left foot, which was suspicious for an intraosseous lipoma with a threatening calcaneal fracture. We performed a surgical procedure, curettage of the tumor, spongioplastics (by autologous bone transplant and β-tricalcium phosphate), and internal stabilization with a calcaneal plate considering the goal of immediate postoperative weightbearing. Histologic examination confirmed an intraosseous lipoma of the calcaneus. The patient's pain was relieved immediately after surgery. Internal stabilization of the calcaneus allowed the patient to immediately fully weightbear and to return to usual daily activities. Although a benign bone tumor, intraosseous lipoma can cause many complications, such as persistent pain, decreased function, or even pathologic fracture as a result of calcaneal bone weakening. Choosing an appropriate treatment is still controversial. Conservative treatment is the first option, but for patients with severe problems and threatening fracture, surgery is necessary. Internal fixation for stabilization enables immediate postoperative weightbearing and shortens recovery time.

Introduction. A ganglion cyst is a common benign tumor, mainly found in the wrist and ankle. The ones originating from a tendon, such as in our case, are the most rare. The ganglion cyst presents with a variety of symptoms, offering a wide range of possible differential diagnoses. Physical examination is crucial to make an accurate diagnosis, but magnetic resonance imaging (MRI) can help in identifying the ganglion cyst. The treatment is mostly conservative, but in cases when the ganglion cyst disables the patient's ability for normal life functioning, due to pain and decreased mobility, surgery is necessary. Case report. A 38-year-old female with persistent ankle pain and edema was clinically diagnosed with luxation of peroneal tendons. Further investigation with MRI showed tenosynovitis of peroneal tendons and rupture of the superior peroneal retinaculum with an intratendinous ganglion cyst of peroneus brevis tendon. Surgical treatment with the reconstruction of peroneus brevis and peroneal retinaculum was performed with semitendinosus graft and anchor sutures. Histology confirmed the diagnosis of the intratendinous ganglion. After four months of rehabilitation, the patient returned to normal daily and sports activities and was pain-free on the follow-up. No recurrence of the ganglion cyst was acknowledged. Conclusion. Surgery is crucial for patients with intratendinous ganglion cyst and symptomatic instability of the peroneal tendons with chronic subluxation.

e13536 Background: Different CHEK2 germline pathogenic variants/likely pathogenic variants (PV/LPV) are associated with distinct immunophenotypic molecular subtypes of breast cancer (BC). The aim of our study was to explore the characteristics of Slovenian BC patients with CHEK2 c.444+1G > A variant. Methods: Germline CHEK2 pathogenic PV/LPV were identified in 76 individuals from 50 families who underwent genetic counseling and testing using a multigene panel at our institution from year 2014 to 2019. The data on 41 Slovenian BC patients with CHEK2 PV/LPV were retrospectively collected and analyzed, with an emphasis on c.444+1G > A variant carriers. Results: BC in our CHEK2 positive patients was diagnosed in 40 females and one male. Mean age at BC diagnosis was 42.8 years (range 21-63). Four recurrent CHEK2 PV/LPV were found in 80% (33/41) of our BC patients: c.444+1G > A (12/41; 29%; 11 females, one male), c.349A > G (9/41; 22%). deletion of exons 9-10 (7/41; 17%) and c.1100delC (5/41; 12%). There was a trend for c.444+1G > A carriers to develop BC at younger age in comparison to patients with other CHEK2 PV/LPV (mean age 39.3 vs. 44.2 years; p = 0.089). None of the patients with the c.444+1G > A variant had invasive lobular carcinoma. Median tumor size in patients with c.444+1G > A variant was 34 mm and median number of positive lymph nodes was 2.67 (range 1-8). Patients with c.444+1G > A variant had a luminal A subtype in 2 cases, luminal B in 7 cases, HER2+ subtype in 3 cases, while none of patients had a triple negative BC. Mastectomy, tumorectomy and axillary lymphadenectomy was performed in 8, 4 and 12 patients, respectively. All c.444+1G > A carriers had to be treated with chemotherapy and external beam irradiation. Patients with the c.444+1G > A variant were more often treated with chemotherapy (p = 0.038) and/or external beam irradiation (p = 0.014) in comparison to patients with other PV/LPV. Distant metastases were diagnosed in two patients at age 45 and 47. Conclusions: Mutation c.444+1G > A was detected in 29% of Slovenian patients with CHEK2 PV/LPV. Distant dissemination was diagnosed despite aggressive treatment at a young age in 16% of these patients.

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Bolnik: Pri 42-letnem bolniku z novo odkritim metastatskim karcinomom descendentnega kolona s številnimi zapleti ob diagnostiki smo odkrili klinične in laboratorijske znake TMA. Šlo je za sekundarno, z rakom povzročeno trombotič-no trombocitopenično purpuro (TTP), ki se na zdravljenje s plazmaferezo ni odzvala. V nadaljevanju je bolnik prejel krog kemoterapije, a je kmalu za tem umrl. Obdukcija ni dala dodatnih podatkov, kostni mozeg ni bil maligno spremenjen.Zaključek: Diagnoza sekundarne TTP kot zapleta maligne bolezni je težka. Pri bolnikih z rakom povzročeno TTP je zdravljenje s plazmaferezo neučinkovito in pogosto odloži zdravljenje s kemoterapijo, ki v takem primeru edino lahko pomaga. AbstractBackground: Thrombotic microangiopathy (TMA) is a rare syndrome that leads to excessive formation of blood clots, microthrombosis and is accompanied by non-autoimune haemolytic anemia and thrombocytopenia. Only few cases describing secondary TMA, thrombotic thrombocytopenic purpura (TTP) caused by cancer have been reported in the literature.