Background: Breast carcinoma recurrence appears in 5%-30% of cases, after the completion of breast cancer treatment. Recurrence appears on thoracic wall (chest wall), on the skin, on the breast tissue remaining after the surgery, equal sided axillary lymph nodes, supraclavicular lymph nodes or on the internal mammary lymph nodes. Recurrence often stays undetected by clinical examination, while it can be detected by ultrasound and punctured under ultrasound control. Cytological confirmation of malignant cells represents a signal to commence a specific recurrence treatment. Methods: Aspiration puncture under ultrasound control has been performed within 128 patients. Only 38 patients, out of 128, did not have distant metastasis at the moment of recurrence detection, so the recurrence was surgically removed and was subjected to the histopathological analysis. The results of definite histopathological analysis were compared to the clinical results and cytological results, which had been obtained preoperatively. Results: 31 patients, out of above mentioned 38 patients, have had breast carcinoma recurrence, while 7 patients have had benign tumor lesion. Clinical diagnoses were correct in 47.4% of cases, and incorrect for 52.6%. False positive finding result happened in 7.89% cases and false negative finding result happened in 39.47% cases. Ultrasound diagnoses were correct for 86.84% of patients and incorrect for 13.16% of patients. Cytological analysis of material obtained by aspiration puncture under ultrasound control produced correct diagnoses for 86.84% of patients. 13.16% of patients had inconsistent cytological and histopathological findings result. Cytological analysis has detected malignant cells for 5.26%, but the recurrence was not histopathologically confirmed, which points that the results were falsely positive. Falsely negative results were confirmed for 7.89%. Conclusion: Clinical examination was reliable for 52.6% of patients examined. Cytological analysis of material obtained by ultrasound-controlled puncture was reliable for 86.84% of patients examined. Aspiration puncture followed by cytological analysis gave falsely negative result for 7.89% of patients examined, while clinical examination gave falsely negative result for 39.47% of patients examined. Aspiration puncture gave falsely positive result for 5.26%, and clinical examination gave falsely positive result for 7.89%. Aspiration puncture is simple, easy to perform, without damaging effect for the patient or the medical personnel, it is not expensive and it is significantly more reliable than clinical examination itself for detection of breast carcinoma recurrence.
Introduction/Objective. The purpose of this study was to assess the effectiveness of different approaches in the treatment of metastatic melanoma in daily clinical practice in a situation with limited and late availability of new drugs in a resource-limited country and to compare these parameters with those reported in clinical studies and from other real-world data. Methods. Main methods included assessment of overall survival (OS) and progression-free survival (PFS). Patients were included in the study if they were treated with first or second-line systemic therapy for radiologically/pathologically confirmed metastatic melanoma. Patients were divided into four groups based on the type of therapy they received: chemotherapy (dacarbazin), BRAF inhibitor (vemurafenib), BRAF/MEK inhibitors (vemurafenib/cobimetinib and trametinib/dabrafenib) and anti PD-1 therapy with pembrolizumab. Results. Regardless of the line of therapy, the calculated median OS in chemotherapy and vemurafenib group was nine months. The median OS in the BRAF/MEK inhibitor group was 14 months and 15 months in the pembrolizumab group. Median PFS in the chemotherapy group was four months, seven months for vemurafenib, in the BRAF/MEK inhibitor group nine months and in the pembrolizumab group six months. There was a statistically significant difference in survival between first and second-line therapy in the pembrolizumab group. Conclusion. Our results showed lower median OS and PFS in comparison to reported data from clinical trials. Compared to other real-world data from countries with similar problems related to the late reimbursement of new drugs, our research has shown similar results.
The municipal solid waste (MSW) landfill is recognized as an anthropogenic source of air pollutants that can have a negative impact on human health and the environment. Workers who work at the MSW landfill may be exposed to risk due to the inhalation of substances such as volatile organic compounds (VOCs). Although VOCs account for 1% in landfill gas, they are important because of the high level of toxicity associated with them. Regular monitoring of air quality and risk assessment provides important information in protecting the health of workers at the landfill. This study focuses on a health risk assessment related to VOCs (benzene, toluene and xylene) exposure via inhalation for workers at a landfill Banja Luka, Republic of Srpska, Bosnia and Herzegovina. Additionally, cancer risk and non-cancer risk of benzene, toluene and xylene of workers indicated that occupational exposures were above recommended standard. This implies that landfill workers are exposed to a significant health risk associated with inhalation exposure to VOCs
Hip arthroplasty or hip replacement is a surgical procedure by which damaged cartilage and bone are removed from the joint and replaced by implants. Hip replacement is performed in order to achive painless and normal movements. Obesity is characterized by excessive accumulation of fat inside an organism and it affects occurance of arthrosis. Obese people make up to 30% of the population in developed countries. A vast majority of recent research publications talk about obesity and its impact on the outcome of orthopedic surgical procedures.
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