Bakteriologinis nudegimo žaizdų tyrimas svarbus nustatant esamus potencialius patogenus, padeda diagnozuoti infekciją, leidžia įvertinti sepsio tikimybę, nustatyti tinkamą laiką žaizdos audinių rekonstrukcijai. Tačiau iki dabar tęsiasi diskusijos, kuris mėginio paėmimo metodas yra optimalus žaizdos mikroflorai arba infekcijai nustatyti. Lietuvoje toks tyrimas iki šiol nebuvo atliktas, o kitų šalių mokslininkų skelbiami rezultatai gana prieštaringi. Atlikto darbo metu tyrėme, kuris bakteriologinio tyrimo metodas (kiekybinis bei pusiau kiekybinis tepinėliai ar biopsija) yra kliniškai vertingiausias žaizdos mikrofloros stebėjimui ligos periodu, infekcijos patvirtinimui atsižvelgiant į klinikinius žaizdos pokyčius. Vienodas bakterijų rūšis tose pačiose žaizdose dažniausiai nustatė biopsija ir pusiau kiekybinis tepinėlis. Šių metodų bendras rezultatų sutapimas buvo labai geras. Abiem metodais nustatomo bakterijų kiekio koreliacija – vidutinė. Tačiau geriausiai rezultatai sutapo žaizdoje esant nedideliam bakterijų kiekiui. Esant klinikiniams žaizdos infekcijos požymiams reikšmingai dažniau bakterijos ir didesnis jų rūšių kiekis nustatytas biopsijos tiriamojoje medžiagoje. Biopsijos metodu reikšmingai dažniau nustatytas labai gausus (>105 KFV) bakterijų kiekis. Nudegimo žaizdų užteršimui bakterijomis stebėti, kai nėra infekcijos požymių, pusiau kiekybinis tepinėlio metodas yra tinkamiausias. Kliniškai nustatytą žaizdos infekciją geriausiai atspindi biopsijos tyrimo rezultatai. / Evaluation of microorganisms in burn wound is important not only in determining potential pathogens present, but also allows diagnosing an infection, evaluating possibility of sepsis, and determining the appropriate time for wound tissue reconstruction. However, there are still many discussions about the optimal wound sample taking method to determine wound microflora or infection, and the opinions about sample taking methods for identification of microorganisms are controversial. We have compared three methods (quantitative swab, semi-quantitative swab, biopsy) and determined significant differences. Similar species of bacteria in the same wounds were most frequently identified by biopsy and the semi-quantitative swab method. The general concordance of the results of these methods was very good. There was a medium correlation of the bacterial amount identified by these methods. However, there was the best concordance of the results in presence of a small amount of bacteria in a wound.In presence of clinical wound infection signs, bacteria and larger number of their species were significantly more frequently identified in the biopsy material. The biopsy method significantly more frequently identified a very large amount (>105 CFU) of bacteria. The semi-quantitative swab method is most appropriate to monitor burn wound contamination with bacteria when there are no infection signs. A clinically determined wound infection was best reflected by the results of biopsy.

Darbų apžvalgoje nagrinėjami sergamumo skydliaukės vėžiu pokyčiai Lietuvoje 1978 – 2003 metais bei sergamumo sąsajos su diagnostika. Sergamumas skydliaukės vėžiu Lietuvoje 1978-2003 metais didėjo ir vidutinis metinis pokytis vyrams siekė 4,2% (p<0,0001), o moterims - 6,1% (p<0,0001). Standartizuotas vyrų sergamumo rodiklis padidėjo nuo 0,7 atvejo 100 000 gyventojų 1978 metais iki 2,5 atvejo 100 000 gyventojų 2003 metais, o moterų – atitinkamai nuo 1,5 iki 11,4 atvejo 100 000 gyventojų. Mirtingumas nuo skydliaukės vėžio nagrinėjamu laikotarpiu nepakito. Nustatytas papilinės skydliaukės karcinomos padidėjimas 1978 – 2003 metų laikotarpiu. Didžiausią įtaką susirgimo skaičiaus pokyčiams turėjo skydliaukės vėžio atvejai diagnozuoti ankstyvosiose stadijose. Žymų sergamumo skydliaukės vėžiu padidėjimą 2002-2003 metais Lietuvoje galima susieti su pokyčiais skydliaukės mazgų diagnostikoje, tobulesnių ultragarsinių technologijų panaudojimu bei aktyviu ultragarsu kontroliuojamų aspiracinių biopsijų plona adata pritaikymu klinikinėje praktikoje. / The aim of this study is to analyse changes in thyroid cancer incidence trends in Lithuania during the period of 1978–2003 and the relationship between incidence and diagnostic strategies. Annual percentage changes in the age-standardized rates over this period were 4.2% (p<0.0001) and 6.1% (p<0.0001) for men and women, respectively, for all carcinomas combined. During study period the age-standardized incidence rates increased in males from 0.7 to 2.5 cases per 100000 and in females from 1.5 to 11.4 per 100000. Mortality due to thyroid cancer did not change during the period of 1978–2003. By histopathology, number of papillary thyroid carcinoma cases increased in 1998-2003. Also, there was increase in the number of early stages of thyroid cancer. The increase in thyroid cancer incidence in Lithuania seems to be mainly due to the changes in the management of thyroid nodules and increased usage of ultrasound guided fine needle aspiration biopsy in clinical practice.

<p>Karcinom dojke predstavlja najče&scaron;ću malignu neoplazmu među ženskom populacijom, a po&scaron;tedna terapija dojke, preferirani je model lečenja bolesnica u ranom stadijumu bolesti. Smatra se da je optimalna hirur&scaron;ka resekciona margina 2 mm. Opisano je mnogo metoda koje služe za intraoperativnu proveru suficijentnosti resekcione hirur&scaron;ke margine i sve one imaju svoje prednosti i mane. Ciljevi ove studije bili su da se utvrdi, da li postoji statistički značajna razlika u određivanju &scaron;irine negativne resekcione hirur&scaron;ke margine izražene u milimetrima pri operacijama karcinoma dojke upotrebom palpatorne metode i intraoperativne mobilne radiografije, poređenjem nalaza merenja hiruga sa većim i manjim iskustvom u hirurgiji karcinoma dojke kao i nalaza radiologa u odnosu na patohistolo&scaron;ku ex tempore analizu. Istraživanje je sprovedeno kao retrospektivno&ndash;prospektivna studija na Klinici za operativnu onkologiju, Instituta za onkologiju Vojvodine i obuhvatilo je 150 bolesnica kod kojih je preoperativno dijagnostikovan karcinom dojke. Kriterijum za uključenje u studiju bilo je izvođenje po&scaron;tedne operacije dojke sa ili bez disekcije ipsilaterale aksile, dok su iz studije isključene bolesnice kod kojih nije bilo moguće izvesti po&scaron;tednu operaciju dojke, one sa radiolo&scaron;ki potvrđenom diseminovanom bole&scaron;ću, kao i bolesnice koje su ranije operisane zbog karcinoma iste dojke. Kod svih 150 ekstirpiranih karcinoma dojke urađena je procena &scaron;irine resekcione hirur&scaron;ke margine intraoperativno palpatornom metodom, zatim na aparatu za mobilnu digitalnu radiografiju, te radiogram analiziran od strane iskusnog i manje iskusnog hiruga u hirurgiji karcinoma dojke, kao i radiologa te upoređen sa nalazom ex tempore patohistolo&scaron;ke analize. Definitivna &scaron;irina resekcione hirur&scaron;ke margine potvrđena je na parafinskim patohistolo&scaron;kim preparatima. Srednja vrednost praćenja bolesnica, postoperativno, iznosila je 100,97 nedelja. Najveći broj bolesnica pripadao je starijoj životnoj dobi (56,67%). Preoperativna lokalizacija klinički nepalpabilnih tumora u dojci urađena je kod 52 (34,67%) bolesnice. Najče&scaron;će se tumor prezentovao kao solitarni fokus sa okolnim ognji&scaron;tima in situ karcinoma (72, 48%), dok je najče&scaron;ći histolo&scaron;ki subtip bio duktalni invazivni karcinom dojke (112 (74,67%)). Najveći broj operacija dojke okarakterisan je kao kvadrantektomija (85 (56,67)), dok je najučestalija operacija aksile bilo određivanje limfnog čvora stražara (119 (79,33%). Analizom rada aparata za mobilnu digitalnu radiografiju do&scaron;li smo do saznanja da nema statistički značajne razlike u oceni kvaliteta radiograma i &scaron;irine resekcione hirur&scaron;ke margine merene na aparatu za mobilnu digitalnu radiografiju između iskusnog hirurga i radiologa. Statistički značajna razlika nije uočena ni pri merenju &scaron;irine resekcione hirur&scaron;ke margine izražene u milimetrima na aparatu za mobilnu digitalnu radiografiju od strane iskusnog hirurga i radiologa u odnosu na ex tempore patohistolo&scaron;ku analizu, dok je ista uočena nakon definitivne patohistolo&scaron;ke analize. &Scaron;ansa doresekcije tkiva dojke nakon merenja na aparatu za mobilnu digitalnu radiografiju je 1,4 puta veća nego nakon patohistolo&scaron;ke ex tempore analize. Lokalni recidiv javio se kod jedne pacijentkinje tokom perioda praćenja. Ne postoji statistički značajna razlika u određivanju &scaron;irine resekcione hirur&scaron;ke margine izražene u milimetrima upotrebom aparata za mobilnu digitalnu radiografiju od strane iskusnog hirurga i radiologa u odnosu na patohistolo&scaron;ku ex tempore analizu, dok ista postoji nakon analize radiograma od strane manje iskusnog hirurga. Palpatorna metoda se ne može smatrati sigurnom metodom u određivanju &scaron;irine hirur&scaron;ke resekcione margine. Ne postoji statistički značajna razlika u broju doresekcije tkiva dojke između hirurga sa različitim hirur&scaron;kim iskustvom.</p> / <p>Breast cancer is the most common malignant neoplasm in the female population, and conservative breast therapy is the preferred treatment model for patients in early stages of the disease. The optimal surgical resection margin, from healthy breast tissue around the primary tumor is 2 mm. Many methods have been described that serve to check the resection margin during breast conservative surgery and all of them have their advantages and disadvantages. The aim of this study was to determine whether there was a statistically significant difference in the determination of the width of the negative resection margin expressed in millimeters in breast cancer surgery using palpatory method and intraoperative mobile specimen radiography, comparing the findings of measuring of surgeons with greater and lesser experience in breast cancer surgery as well as the findings of the radiologist in relation to histopathological ex tempore and definitive histopathological analysis. The study was conducted as a retrospective - prospective study at the Clinic for Operative Oncology, Oncology Institute of Vojvodina and included 150 patients who were preoperatively diagnosed with breast cancer. The criterion for inclusion in the study was the opportunity to perform breast conservative surgery with or without complete axillary lymph node dissection. Patients that were treated with breast amputation, those with radiological confirmed disseminated disease, as well as patients previously operated from cancer were excluded from the study. For all 150 extirpated breast cancers, an estimate of the width of the resection surgical margin was performed intraoperatively with a palpatory method, followed by measuring on device for mobile specimen digital radiography, and a radiogram was analyzed by an experienced and less experienced surgeon in breast cancer surgery, as well as by a radiologist and compared with an ex tempore histopathological analysis. The definitive width of the resection surgical margin was confirmed on histopathological preparations. The mean follow-up, postoperatively, was 100.97 weeks. The majority of patients belonged to the elderly age (56.67%). Preoperative localization of clinically impalpable breast tumors was performed in 52 (34.67%) patients. Most often the tumor was presented as a solitary focus with surrounding foci of in situ cancer (72, 48%), while the most common histological subtype was invasive ductal breast cancer (112 (74.67%)). The majority of breast operations were characterized like quadrantectomy (85 (56.67)), while the most frequent axillary surgery was the determination of the sentinel lymph node (119 (79.33%). No significant difference was observed in the evaluation of radiography quality and the width of the resection surgical margin measured on the mobile digital radiography device between the experienced surgeon and the radiologist. No statistically significant difference was observed in the measurement of the width of the resection surgical margin expressed in millimeters on the mobile digital radiography device by the experienced surgeon and radiologist versus ex tempore histopathological analysis, while the statistical difference was observed after definite histopathological analysis. The chance of breast tissue reexcision after measurement on a mobile digital radiography device is 1.4 times higher than after histopathological ex tempore analysis. Local relapse occurred in one patient during the follow-up period. There is no statistically significant difference in the determination of the width of the resection surgical margin expressed in millimeters using a mobile digital radiography device by an experienced surgeon in breast cancer surgery and radiologist with respect to histopathological ex tempore analysis. However, the statistical difference exists after radiogram analysis by a less experienced surgeon. The palpatory method cannot be considered as a safe method in determining the width of a surgical resection margin. There is no statistically significant difference in the number of breast tissue additional resections between surgeons with different surgical experience.</p>

<p>Receptor epidermalnog faktora rasta (EGFR) pripada porodici receptora protein-tirozin kinaze čija je aktivacija povezana sa proliferacijom malignih, invazijom, inhibicijom apoptoze, tumorskom angiogenezom i metastatskim &scaron;irenjem stoga ima važnu ulogu u karcinogenezi i tumorskoj progresiji. Aktivirane mutacije se odvijaju oko katalitičkog tirozin kinaza domena. Biopsijski, citolo&scaron;ki i hirur&scaron;ki uzorci se koriste u detekciji EGFR mutacija u momentu postavljanja dijagnoze adenokarcinoma ili karcinoma sa komponentom adenokarcinoma, najpouzdanije lančanom reakcijom polimeraze. Činjenica da primena ciljane molekularne terapije tirozin kinaza inhibitorima kod obolelih sa EGFR mutiranim adenokarcinomom pluća pobolj&scaron;ava prognozu bolesti, postoji rezistencija kod pojedinih tipova EGFR mutacija i povezanost histopatolo&scaron;kim i imunohistohemijskim karakteristikama tumora, da je bronholo&scaron;ki uzorak često jedini uzorak u kome je potrebno odrediti i molekularni profil tumora osnovni cilj ove disertacije bio je da se odredi učestalost i tip EGFR mutacija i povezanost sa karakteristikama adenokarcinoma. Da bi se taj cilj realizovao postavljeni su sekundarni ciljevi odnosno da se: izvr&scaron;i histopatolo&scaron;ka reklasifikacija adenokarcinoma pluća na osnovu kriterijuma koje je postavila internacionalna asocijacija za proučavanje carcinoma pluća, američko torakalno dru&scaron;tvo i evropsko respiratorno dru&scaron;tvo; odredi ekspresija TTF-1 u adenokarcinomu pluća i povezanost sa EGFR mutacionim statusom; odredi učestalost, tip i povezanost EGFR mutacija sa predominantnim tipom adenokarcinoma i utvrdi da li bronhoskopska biopsija može da bude reprezentativni uzorak za određivanje EGFR mutacionog statusa. Histopatolo&scaron;ka građa adenokarcinoma pluća u hirur&scaron;kim uzorcima je heterogenija u odnosu na biopsijske uzorke i ta razlika je statistički značajna (p&lt;0,001). Acinarno predominantni tip je najzastupljeniji u hirur&scaron;kim i biopsijskim uzorcima bez statistički značajne razlike u raspodeli predominantnih tipova u njima (p=0,65883). Predominantni tip u primarnom tumoru određuje predominantni tip u limfogenim metastazama. EGFR mutacije tipa insercija na egzonu 21 i L858R mutacija na egzonu 20 su detektovane kod tri od 60 (5%) bolesnika u pet od 120 uzoraka (tri hirur&scaron;ka i dva biopsijska uzorka), če&scaron;će kod žena, starijih od 60 godina, pu&scaron;ača i u solidno predominantnom tipu. Ne postoji statistički značajna razlika u koncentraciji izolovane DNK između EGFR mutiranih i wt EGFR adenokarcinoma u biopsijskim (p=0,132) i hirur&scaron;kim uzorcima (p=0,641). Procenat invalidnih rezultata prilikom određivanja EGFR mutacionog statusa u je veći u biopsijskim uzorcima u odnosu na hirur&scaron;ke uzorke. Postoji statistički značajna razlika izmeĐu broja TTF-1 pozitivnih i TTF-1 negativnih adenokarcinoma (p&lt;0,001), ali ne i u raspodeli ovih bolesnika prema polovima (p=0,1231), prosečnoj starosti, pu&scaron;ačkim navikama (p=0,6488) i prosečnoj veličini tumora (p=0,21). Postoji pozitivna korelacija između TTF-1 pozitivne ekspresije i EGFR mutacionog statusa stoga TTF-1 pozitivna ekspresija može da bude prediktor pozitivnog EGFR mutacionog statusa. Bronhoskopska biopsija je reprezentativni uzorak za određivanje EGFR mutacionog statusa zato &scaron;to: većina dijagnostičkih biopsijskih uzoraka ima vi&scaron;e od 100 očuvanih tumorskih ćelija, nema razlike u raspodeli predominantnih tipova u odnosu na hirur&scaron;ke uzorke, EGFR mutacije se detektuju u uzorcima sa manje od 100 tumorskih ćelija i manje od 20% volumenske gustine tumorskog tkiva, razlika između koncentracije izolovane DNK u EGFR mutiranim i wt EGFR adenokarcinomima u biopsijskim i hirur&scaron;kim uzorcima nije statistički značajna (p=0,132 i p=0,641).</p> / <p>Epidermal growth factor receptor (EGFR) belongs to the family of protein-tyrosin kinase family, whose activation is associated with the proliferation of malignant cells, invasion, inhibition of apoptosis, tumor angiogenesis and metastatic spread and thus plays an important role in carcinogenesis and tumor progression. Activated mutations take place around the catalytic tyrosine kinase domain. Biopsy, cytological and surgical specimens are used for the detection of EGFR mutations at the time of diagnosis of adenocarcinoma or carcinoma with an adenocarcinoma component, most reliably using a polymerase chain reaction. The fact that the application of molecular tyrosin kinase inhibitor therapy to patients with EGFR mutated lung adenocarcinoma improves the prognosis of the disease, there is resistance in certain types of EGFR mutations and connection with histopathological and immunohistochemical characteristics of tumor, that the bronchoscopic specimen is often the only specimen in which it is necessary to determine the molecular profile of the tumor, the primary objective of this thesis is to determine the frequency and type of EGFR mutations and their connection with the characteristics of adenocarcinoma. In order to realize this objective, the following secondary objectives have been set: to execute histopathological reclassification of lung adenocarcinoma based on the criteria set by the International Association for the Study of Lung Cancer, the American Thoracic Society and European Respiratory Society; determine the expression of TTF-1 in lung adenocarcinoma and connection with EGFR mutation status; determine the frequency, type and connection of EGFR mutations with predominant type of adenocarcinoma and confirm whether bronchoscopic biopsy may be a representative specimen for the determination of EGFR mutation status. Histopathological material of lung adenocarcinoma in surgical specimens is more heterogeneous in relation to biopsy specimens and such difference is statistically significant (p&lt;0,001). Acinar predominant type is the most common in surgical and biopsy specimens with no statistically significant differences in the distribution of predominant type among them (p=0,65883). The predominant type in the primary tumor determines the predominant type in lymphatic metastases. EGFR mutations in the type of insertions on exon 21 and L858R mutations on exon 20 have been detected in three out of 60 (5%) of patients in five out of 120 specimens (three surgical and two biopsy samples), more often in women older than 60, smokers and in a solid predominant type. There are no statistically significant differences in the concentration of isolated DNA between EGFR mutated and wt EGFR adenocarcinoma in biopsy (p=0,132) and surgical specimens (p=0,641). The percentage of invalid results in determining the EGFR mutation status is higher in biopsy specimens compared to the surgical specimens. There is a statistically significant difference between the number of TTF-1 positive and TTF-1 negative adenocarcinoma (p&lt;0,001), but not in the distribution of these patients according to gender (p=0,1231), average age, smoking habits (p=0,6488) and average tumor size (p-0,21). There is a positive correlation between TTF-1 positive expression and EGFR mutation status and therefore TTF-1 positive expression can be a predictor of positive EGFR mutation status. Bronchoscopic biopsy is a representative sample for the determination of EGFR mutation status because: most diagnostic biopsy specimens have more than 100 preserved tumor cells, there is no difference in the distribution of predominant types in relation to surgical specimens, EGFR mutations are detected in samples with less than 100 tumor cells and less than 20% of volume density of tumor tissue, the difference between the concentration of isolated DNA in EGFR mutated and wt EGFR adenocarcinoma in biopsy and surgical specimens is not statistically significant (p=0,132 and p=0,641).</p>

<p>Uvod: Implementacija brojnih neuroradiolo&scaron;kih modaliteta je značajno uticala na način i efikasnost sprovođenja dijagnostike tumora mozga. Na osnovu neinvazivno dobijenih podataka može se postaviti diferencijalna dijagnoza, ali do sada nije potvrđena nijedna neuroradiolo&scaron;ka metoda koja može samostalno i konačno da postavi definitivnu patohistolo&scaron;ku (PH) dijagnozu. Stereotaksična biopsija je neurohirur&scaron;ka procedura kojom se, bez bitnog naru&scaron;avanja integriteta i funkcije moždanog tkiva, može obezbediti reprezentativni uzorak intrakranijalne tumorske promene radi sprovođenja PH i drugih specifičnih analiza, u cilju postavljanja tačne dijagnoze i potom primene adekvatnog lečenja. Cilj: Cilj ove studije je da se utvrditi mogućnost uzorkovanja reprezentativnog tkiva za postavljanje PH dijagnoze uz pomoć stereotaksične biopsije kod pacijenata sa tumorom mozga, kao i da se utvrdi vrsta i učestalost eventualnih komplikacija same procedure i postojanje korelacije između PH nalaza dobijenog stereotaksičnom biopsijom i rezultata sprovedenih neuroradiolo&scaron;kih ispitivanja. Materijal i metode: Sprovedeno istraživanje je bilo kliničko, prospektivno, a uzorak je činilo ukupno 50 pacijenata koji su bili hospitalizovani na Klinici za neurohirurgiju KCV zbog dijagnostikovane tumorske promene mozga i postavljene indikacije za stereotaksičnu biopsiju, u periodu od septembra 2016. godine do januara 2018. godine. Svi pacijenti koji su uključeni u studiju su u sklopu sprovedene dijagnostičke obrade imali načinjen magnetno rezonanantni (MRI) pregled glave na osnovu kojeg su se određivale morfolo&scaron;ke karakteristike tumora i vr&scaron;ila procena prirode tumorske promene mozga, a kod ukupno 25 pacijenata je dodatno načinjena MR spektroskopija (MRS) dijagnostikovane tumorske promene sa ciljem određivanja biohemijskog profila i dodatne procene i karakterizacije tkiva. Nakon sprovedene detaljne onkolo&scaron;ke obrade i adekvatne pripreme, se sprovodila kompjuterizovanom tomografijom (CT) navođena stereotaksična biopsija sa ramom u cilju uzorkovanja adekvatnog tkiva za PH analizu. U toku istraživanja procena uspe&scaron;nosti uzorkovanja reprezentativnog tkiva se vr&scaron;ila pregledom bioptata od strane patologa, a nakon procedure se kliničkim pregledom i kontrolnim CT pregledom glave utvrđivao stepen komplikacija. Rezultati: Dobijeni rezultati su pokazali da su fokalni neurolo&scaron;ki deficit i moždani sindrom bili najče&scaron;ći klinički simptomi i znaci kod pacijenata kod kojih je indikovana stereotaksična biopsija tumora mozga. Prema MRI nalazu najzastupljenije su bile difuzne tumorske promene sa 36% udela u uzorku, zatim solitarne sa 34% i multifokalne sa 20%, a potom multicentrične tumorske promene koje su predstavljale 10% uzorka. Takođe, na osnovu MRI i MRS nalaza je oko 80% tumora procenjeno kao najverovatnije glijalnog porekla. U 95,9% slučaja je postavljena precizna PH dijagnoza. Nepromenjeno stanje svesti i neurolo&scaron;ki nalaz su imali 92% pacijenata nakon biopsije, a kod 3 pacijenta (6%) je do&scaron;lo do razvoja prolaznog neurolo&scaron;kog deficita, dok je jedan pacijent (2%) razvio trajan neurolo&scaron;ki deficit. Ukupan morbiditet vezan za proceduru je stoga 2%, a nije zabeležen ni jedan smrtni slučaj (mortalitet 0%) tokom sprovođenja studije. Zaključak: Stereotaksična biopsija je dokazana i veoma pouzdana procedura sa malim brojem komplikacija i niskom stopom morbiditeta i mortaliteta, kojom se omogućava dobijanje reprezentativnog uzorka tumorskog tkiva za postavljanje sigurne patohistolo&scaron;ke dijagnoze. Intraoperativna PH analiza dela uzorka tkiva dodatno pobolj&scaron;ava uspe&scaron;nost pri uzorkovanju i postavljanju definitivne PH dijagnoze. Savremene neuroradiolo&scaron;ke metode imaju visoku specifičnost u razlikovanju biolo&scaron;ke prirode tumorskih promena, ali se ne mogu koristi nezavisno od PH analize uzorka tkiva</p> / <p><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> 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5.4pt;mso-para-margin-top:0in;mso-para-margin-right:0in;mso-para-margin-bottom:10.0pt;mso-para-margin-left:0in;line-height:115%;mso-pagination:widow-orphan;font-size:11.0pt;font-family:"Calibri","sans-serif";mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-font-family:"Times New Roman";mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;}</style><![endif]-->Introduction: The implementation of numerous neuroradiological techniques has significantly influenced the way and the efficiency in which the diagnosis of brain tumor is established. Based on non-invasive imaging data, a differential diagnosis can be made, but no neuroradiological method has been established so far, which can finally make a definitive diagnosis. Stereotactic biopsy is a neurosurgical procedure that can provide a representative sample of any intracranial tumor in order to performe histopathological and other specific examinations, and to set the exact diagnosis and then apply adequate treatment, but without significantly impairing the integrity and function of brain tissue. Objective: The aim of this study is to determine the diagnostic value of stereotactic biopsy and ability of providing the representative tissue in order to establish a pathohistological diagnosis in patients with brain tumors. Also, the aim is to determine the type and frequency of possible complications of the procedure itself and the correlation between the pathohistological findings obtained and the results of the conducted neuroradiological examinations. Materials and methods: This research was clinical, prospective and included a total of 50 patients who were hospitalized at the Clinical Center of Vojvodina, from September 2016 to January 2018, due to diagnosed brain tumor for which the stereotactic biopsy is indicated. In all patients magnetic resonance (MRI) examination of the head was used to determine morphological characteristics and assesse the nature of the brain tumor tissue, and in a total of 25 patients MR spectroscopy was additionally made with the goal of determining the biochemical profile and additional tissue assessment and characterization. After detailed oncological assessment, completed laboratory and radiological diagnostics, a CT guided framebased stereotactic biopsy was performed for the purpose of sampling tumor tissue for pathohistological analysis. During the research, the success rate of biopsy in providing the representative tissue and establishing the diagnosis was performed by a pathologist, and after the procedure, a clinical and a control head CT examination was used to review the rate of complications. Results: The results obtained showed that focal neurological deficit and psychoorganic syndrome were the most common clinical symptoms and signs in this study. According to MRI, the most common were diffuse brain tumors with 36% of the sample, then solitary with 34% and multifocal with 20%, followed by multicentric tumors representing 10% of the study sample. Also, based on MRI and MRS findings, approximately 80% of tumors are estimated to be most likely of glial origin. In 95.9% of cases, a complete pathohistological (PH) diagnosis was established. The unchanged neurological status was observed in 92% of patients after biopsy, and 3 patients (6%) developed a transient neurological deficit, while only one patient (2%) developed a permanent neurological deficit. The total morbidity associated with the procedure is therefore 2%, and no deaths (mortality 0%) related to the procedure during the study is recorded. Conclusion: Stereotactic biopsy is highly reliable procedure with a small number of complications and a low morbidity and mortality rate, which allows us to acquire the representative sample of brain tumor tissue and to establish a pathohistological diagnosis. Intraoperative PH analysis of acquired tissue samples further enhances the sampling performance and the setting of definitive PH diagnosis. Modern neuroradiological modalities have a high specificity in distinguishing the biological nature of brain tumors, but they still can not be used independently of the pathohistological analysis of the tissue sample.</p>

Prostatos vėžys yra dažniausia vyrų onkologinė liga JAV, Vakarų Europoje bei Lietuvoje. Dėl senstančios visuomenės ateityje bus nustatoma dar daugiau naujų prostatos vėžio atvejų. Lietuvos vėžio registro duomenimis 1995 – 2005 metais vidutinis metinis prostatos vėžio sergamumo didėjimas - 14,5 proc. per metus. Vyrų sergamumas prostatos vėžiu Lietuvoje 2005 metais siekė 125,9/100000 atvejų, o mirtingumas nuo šios ligos siekė 31/100000 atvejų. Vyrų mirtingumas nuo prostatos vėžio antras pagal dažnį po plaučių vėžio su vėžiu susijusio mirtingumo grupėje. Todėl daugelis tyrėjų pabrėžia, kad norint mažinti mirtingumą, reikia ankstinti prostatos vėžio nustatymo laiką. Pradėta Lietuvos vyrų ankstyvosios prostatos vėžio diagnostikos programa ir dažnas prostatos specifinio antigeno nustatymas lėmė padidėjusį apsilankymų pas urologus skaičių ir padidino prostatos biopsijų kiekį. Norint efektyviai ir optimaliai ištirti šiuos pacientus, reikia daug materialinių išteklių ir laiko.Šio darbo tikslas buvo optimizuoti pacientų su padidėjusia prostatos vėžio rizika ištyrimą ir stebėjimą bei nustatyti ryšį tarp prostatos vėžio rizikos veiksnių ir prostatos vėžio diagnozavimo padidėjusios rizikos grupėje. Darbo uždaviniai: 1. Išanalizuoti prostatos vėžio nustatymo dažnį pirmąja ir kartotinėmis lateralinėmis sekstantinėmis prostatos biopsijomis ir įvertinti jų efektyvumą. 2. Nustatyti amžiaus, rūkymo, alkoholio vartojimo, prostatos vėžio šeiminės anamnezės, viršsvorio ir padidėjusio cholesterolio... [toliau žr. visą tekstą] / Prostate cancer is the most frequent malignant disease in men in United States, Western Europe and in Lithuania. Due to ageing population incidence of prostate cancer will rise even more in the future. Since the year 2003 prostate cancer became the most common form of cancer diagnosed in men in Lithuania (more than 1500 new prostate cancer cases a year). There were 2005 of new prostate cancer cases diagnosed in the year 2005. According to Lithuanian Cancer Registry data during the years 1995-2005 the prevalence of prostate cancer was increasing 14.5 percent annually. Prostate cancer was detected in 24.3 percent of all cancer cases in men in the year 2005 in Lithuania and in 48.3 percent of them disease was detected in the stages I and II. In the year 2005 the prevalence of prostate cancer in Lithuanian men was 125.9 per 100000 population and mortality was 31 per 100000 population. Prostate cancer is a second common form of death after lung cancer in cancer-associated mortality group in Lithuania. Prostate cancer mortality ranged between 19 and 55 per 100000 in Europe and it was 23.2 per 100000 populations in the year 2006 in European Union. Many authors stress that it is important to diagnose prostate cancer in the early stages in order to reduce prostate cancer mortality rate. The aim of the study was to optimize investigation and follow-up of the high prostate cancer risk patients, and to define the relation between prostate cancer risk factors and prostate cancer... [to full text]

<p>Oralni karcinom je po učestalosti &scaron;esta najče&scaron;ća maligna bolest u svetu čija incidenca varira u različitim geografskim područjima. Predstavlja 5% svih novootkrivenih malignih tumora godi&scaron;nje i čini 14% svih malignih tumora glave i vrata. Pod oralnim karcinom podrazumevamo planocelularni karcinom obzirom na činjenicu da on čini preko 90% malignih tumora oralne lokalizacije, dok se u manjem procentu javljaju drugi tumori (maligni tumori malih pljuvačnih žlezda, limfomi, mezenhimni tumori). Oralni karcinom podrazumeva karcinome koji se javljaju u sledećim anatomskim regijama: sluznici prednje 2/3 jezika, poda usta, obraza, gingivi gornje i donje vilice, retromolarnom trouglu, kao i sluznici mekog i tvrdog nepca. Najče&scaron;ća lokalizacija oralnog planocelularnog karcinoma je sluznica pokretnog dela jezika i poda usta. Oralni karcinom se če&scaron;će javlja kod mu&scaron;karaca (odnos mu&scaron;karci:žene je 3:1) verovatno zbog većeg procenta rizičnog pona&scaron;anja kod mu&scaron;karaca. Najče&scaron;će se javlja u &scaron;estoj i sedmoj deceniji života (medijana je 62 godine) iako se poslednjih godina sve če&scaron;će javlja kod mlađih od 45 godina. Faktori rizika za oboljevanje su dobro poznati. Na prvom mestu se izdvaja pu&scaron;enje duvana (značajna je dužina pu&scaron;enja, da li pacijent pu&scaron;i lulu ili cigaretu, da li žvaće duvan, kao i dužina trajanja apstinencije). Smatra se da je smrtnost kod oralnog karcinoma direktno povezana sa brojem popu&scaron;enih cigareta na dan. Preko 75% pacijenata sa oralnim karcinomom anamnestički daje podatak o prekomernoj upotrebi alkohola. Postoji sinergističko dejstvo alkohola i cigareta, dugotrajna ekspozicija ovim faktorima rizika dovodi do pojave &ldquo;polja kancerizacije&ldquo;, pojave genetske nestabilnosti i razvoja tumora. Kod oralnog planocelulranog karcinoma primećene su hromozomske abnormalnosti koje su rezultat o&scaron;tećenja DNK i uključuju promene genetskog materijala na hromozomima.Jedna od najče&scaron;ćih genetskih abnormalnosti kod oralnog planocelularnog karcinoma je mutacija r53 gena koji se nalazi na kratkom kraku hromozoma 17 i predstavlja tumor supresor gen. Planocelularni karcinom nije te&scaron;ko dijagnostikovati kada postane simptomatski. Pacijent se žali na bol, krvavljenje, otalgiju, otežano gutanje, smanjenje pokretljivosti jezika. Neretko je prvi simptom metastatski uvećan limfni čvor na vratu jer bolesnici ne primećuju ili ignori&scaron;u oralnu patologiju. Dijagnoza oralnog karcinoma se postavlja na osnovu detaljno uzete anamneze, kliničkog pregleda i patohistolo&scaron;ke verifikacije. Oralni planocelularni karcinom se javlja u tri klinike forme: egzofitična, endofitična i infiltrativna. Zlatni standard za dijagnozu oralnog karcinoma je biopsija i patohistolo&scaron;ka verifikacija, pri čemu se može primeniti &bdquo;punch&ldquo; biopsija, inciziona biopsija ili eksciziona biopsija kod manjih promena. TNM &bdquo;staging&ldquo; sistem AJCC (American Joint Committee on Cancer) se danas standardno koristi za klinički &bdquo;staging&ldquo; oralnog karcinoma i bazira se na podacima dobijenim kliničkim pregledom i &bdquo;imaging&ldquo; metodama. Sam &bdquo;staging&ldquo; je bitan kako zbog komunikacije među lekarima koji učestvuju u lečenju bolesnika tako i zbog standardizacije prognoze. T stadijum označava veličinu primarnog tumora, N stadijum označava regionalnu nodalnu zahvaćenost dok M stadijum prikazuje prisustvo udaljenih metastaza. Terapija patohistolo&scaron;ki dokazanog oralnog karcinoma zahteva multidisciplinarni pristup. Osnova terapije oralnog planocelularnog karcinoma je hirur&scaron;ko lečenje koje podrazumeva ablativno i rekonstruktivno hirur&scaron;ko lečenje. Osnovni princip ablativne hirurgije kod oralnog karcinoma je resekcija primarnog tumora sa najmanje 1cm negativnim hirur&scaron;kim marginama. Pored ablacije tumora hirur&scaron;ko lečenje podrazumeva i uklanjanje regionalnih limfnih čvorova vrata. Cilj disekcije vrata je da se kod klinički evidentnih metastaza iste uklone (terapijska disekcija) ili da se uklone okultne metastaze koje su klinički neevidentne (elektivna disekcija). Oralni planocelularni karcinom spada u tumore sa visokom stopom smrtnosti, većom nego &scaron;to je kod limfoma, laringealnog karcinoma, karcinoma testisa i endokrinih karcinoma. Stopa petogodi&scaron;njeg preživljavanja je direktno povezana sa veličinom tumora, prisustvom metastaza u regionalnim limfnim čvorovima i prisutvom udaljenih metastaza. Prosečno trogodi&scaron;nje preživljavanje bolesnika sa oralnim karcinomom je 52% dok je prosečno petogodi&scaron;nje preživljavanje oko 39% i ove stope se nisu mnogo menjale tokom godina bez obzira na nova saznanja i nove pristupe lečenju oralnog planocelulanog karcinoma. Ciljevi istraživanja su da se utvrdi da li postoji korelacija debljine OPK izmerene kompjuterizovanom tomografijom i svetlosnim mikroskopom, da li dubina invazije OPK i volume tumora mogu biti prediktivni faktor za razvoj regionalnih cervikalnih metastaza kod oralnog planocelularnog karcinoma. Istraživanje je uključilo 65 konsekutivnih bolesnika oba pola lečenih od oralnog karcinoma na Klinici za maksilofacijalnu hirurgiju Kliničkog centra Vojvodine. Dijagnoza oralnog karcinoma je postavljena na osnovu anamneze, kliničkog pregleda i biopsije. U sklopu TNM &bdquo;staging&ldquo;-a bolesnika načinjen je pregled glave i vrata i grudnog ko&scaron;a kompjuterizovanom tomografijom (CT) na osnovu kog smo dobili podatak o dimenzijama tumora. Na osnovu kliničkog nalaza i analize CT nalaza planiralo se operativno lečenje u skladu sa bolesnikovim TNM statusom. Postoperatativni patohisto&scaron;ki preparati je pregledan od strane istog patologa. Parametri koji će su određivani su sledeći: 1. Veličina tumora (2 dimenzije) izmerene na osnovu CT pregleda izražene u cm 2. Debljina tumora izmerena na osnovu CT pregleda izražena u cm 3. Veličina tumora (2 dijametra) na makroskopskom preparatu izražena u cm 4. Debljina tumora na mikroskopskom preparatu izmerena svetlosnim mikroskopom izražena u cm 5. Dubina invazije tumora na mikroskopskom preparatu izmerena svetlosnim mikroskopom izražena u mm 6. Volumen tumora koji se izračunavao prema formuli: VT=&pi;/6 x maksimalni dijametar tumora A x minimalni dijametar tumora B x dubina invazije tumora i izražava se u cm&sup3; 7. Broj metastatski izmenjenih limfnih čvorova u disekatu vrata 8. Ukupan broj patohistolo&scaron;ki ispitanih limfnih čvorova u disekatu vrata Nakon prikupljanja planiranog materijala urađena je statistička obrada podataka. Statistička analiza podataka je uključila metode deskriptivne statistike (srednja vrednost, standardna devijacija, učestalost), kao i standardne parametrijske i neparametrijske testove za komparacije dve grupe (Studentov T test, Mann&ndash;Whitney U test, hikvadrat test). U fazi statističke analize međusobnih uticaja i povezanosti prikupljenih podataka kori&scaron;ćen je Pearsonov test korelacije. Sva testiranja sprovedena su na nivou statističke značajnosti p&lt;0,05. REZULTATI: Istraživanje je obuhvatilo 65 bolesnika, od kojih je 82% bilo mu&scaron;kog pola prosečne starosti 59 godina. 83% bolesnika su se izja&scaron;njavali kao pu&scaron;ači, dok je 69% bolesnika navelo da redovno koristi alkohol. Svim pacijentima je tokom hirur&scaron;kog lečenja OPK rađena disekcija vrata i to najče&scaron;čće selektivna disekcija vrata (91%). Kod 30 bolesnika je utvrđeno postojanje cervikalnih regionalnih metastaza na operativnom preparatu te su bolesnici podeljeni u dve grupe: sa prisustvom i bez prisustva metastaza u limfnim čvorovima vrata. Utvrđeno je da se ove dve grupe statistički značajno razlikuju u dubini invazije tumora i volumenu tumora. Utvrđeno je takođe da postoji statistički značajna korelacija između debljine tumora izmerene CT pregledom i debljine tumora izmerene svetlosnim mikroskopom. Dokazano je da dubina invazije tumora veća od 7mm i zapremina tumora veća od 4cm&sup3; predstavljaju prediktivni faktor za pojavu regionalnih cervikalnih metastaza. ZAKLjUČAK: Na osnovu istraživanja izvedeni su zaključci koji ukazuju na to da postoji statistički značajna korelacija između debljine tumora OPK izmerene CTpregledom i svetlosnim mikroskopom te se debljina tumora izmerena CT pregledom može koristiti za planiranje operativnog zahvata prilikom lečenja OPK. Dubina invazije tumora veća od 7mm i volumen tumora veći od 4 cm&sup3; predstavljaju prediktivni faktor za pojavu nodalnih cervikalnih metastaza te su značajni za određivanje stadijuma bolesti.</p> / <p>Oral cancer is the sixth most common malignant disease in the world which incidence varies based on geographic area. It represents 5% of all newly discovered malignant tumors annually and constitutes 14 % of all malignant tumors of head and neck. Squamous cell carcinoma is considered to be a type of oral cancer because more than 90 % of malignant tumors that occur in oral cavity are squamous cell carcinomas while other tumors (malignant tumor of minor salivary gland, lymphoma, sarcoma) rarely occur. Oral cancer is the cancer found in the following anatomic regions: mucosa of front two-thirds of the tongue, the floor of the mouth, cheeks, upper and lower gingiva, retromolar trigone as well as&nbsp; mucosa of soft and hard palates. Oral squamous cell carcinoma is most commonly localized in mucous membrane of the movable part of the tongue and floor of the mouth. Men are more affected than women (male to female ratio is 3:1) probably because of men&rsquo;s riskier behavior. It is most commonly diagnosed in the sixth and seventh decade of life (the median is 62 years old) although it has been diagnosed in patents younger than 45 in recent years. Risk factors of oral squamous cell carcinoma are well known. The major factor is tobacco smoking (the period of smoking is significant, it is also important to consider whether a patient smokes a pipe or cigarette, whether he/she chews tobacco as well as the period of abstinence). The mortality rate is believed to be directly related to the number of cigarettes smoked a day. An excessive use of alcohol has been reported in over 75% of patients with oral cancer. There is a synergistic effect of alcohol and cigarette consumption and long-term exposure to these risk factors results in &lsquo;field of cancerization&rsquo;, genetic instability and tumor development. Chromosome abnormalities, which are caused by DNA damage and include the change in genetic material of chromosomes, have been reported in patients with oral squamous cell carcinoma. One of the most common genetic abnormalities in patients with oral squamous cell carcinoma is a mutation of р53 gene which is located on a short arm of chromosome 17 and represents a tumor suppressor gene. Oral squamous cell carcinoma is not difficult to diagnose when it becomes symptomatic. The patient complains of pain, bleeding, otalgia, swallowing difficulties, decreased tongue mobility. The first symptom is rarely metastatic lymph node on the neck because patients either do not notice or ignore oral pathology. The oral cancer is diagnosed based on the detailed anamnesis, physical examination and pathohistological verification. The oral squamous cell carcinoma occurs in three clinical forms: exophytic, endophytic and infiltrative form. The gold standard for diagnosis of oral cancer is biopsy and pathohistological verification. However, in case of smaller changes, punch biopsy, incisional and excisional biopsies can also be applied. ТNМ staging system of AJCC (American Joint Committee on Cancer) is nowadays used for clinical staging of oral cancer and it is based on the data acquired by clinical examination and imaging methods. Not only is the staging itself important for communication between the doctors involved in treatment, but it is also important for standardization of prognosis. Т describes the size of primary tumor, N describes regional nodal spread and М describes distant metastasis. The treatment of histopathologically proven oral cancer requires multidisciplinary approach. The main treatment of oral squamous cell carcinoma is surgical treatment which involves ablative and reconstructive surgical treatment. The basic principle of ablative surgery for oral cancer is the resection of primary tumor with at least 1 cm negative surgical margins. Apart from tumor ablation surgical treatment also involves removal of regional lymph nodes on the neck. The aim of neck dissection is to remove clinically evident metastasis (therapeutic dissection) or to remove occult metastasis that are not clinically evident (elective dissection). The oral squamous cell carcinoma is the cancer with high mortality rate. The mortality rate is higher than the mortality rate for lymphoma, laryngeal cancer, testicular cancer and endocrine cancer. The five-year survival rate is directly related to the size of the tumor, presence of metastasis in regional lymph nodes and distant metastasis. The average three-year survival rate of the patients with oral cancer is 52% and the average five-year survival rate is 39%. These rates have not changed a lot over the years regardless of new knowledge and approaches in treatment of oral squamous cell carcinoma. The aims of the study are to determine whether there is a correlation between the depth of invasion of oral squamous cell carcinoma determined by computed tomography and light microscope and whether the invasion depth of OSCC and tumor volume can be predictive factors of development of regional cervical metastases in case of oral squamous cell carcinoma. The study covered 65 consecutive patients of both sexes who received treatment for oral cancer at the Clinic for Maxillofacial Surgery of the Clinical Center of Vojvodina. The diagnosis of oral cancer was established based on the anamnesis, physical examination and biopsies. The TNM &lsquo;staging&rsquo; of the cancer involved the examination of the patient&rsquo;s head and thorax by computed tomography (CT) which enabled us to obtain reliable data about the tumor size. After obtaining clinical findings and CT results, the patients&rsquo; treatment was planned based on their TNM status. A postoperative histopathological examination was performed by the same pathologist and the following parameters were determined: 1. Tumor size (2 dimensions) measured by CT and expressed in cm 2. Tumor thickness measured by CT and expressed in cm 3. Tumor size (2 diameters) on microscopic device and expressed in cm 4. Tumor thickness on microscopic device measured by light microscope and expressed in cm 5. Depth of tumor invasion on microscopic device measured by light microscope and expressed in cm 6. Tumor volume calculated based on the following formula: VT=&pi;/6 x maximum tumor diameter А x minimum tumor diameter B x depth of tumor invasion and expressed in cm&sup3; 7. The number of metastatic lymph nodes in the neck dissection 8. Total number of pathohistologically tested lymph nodes in the neck dissection. Upon collecting the planned material, statistical analysis of all data was carried out. The statistical analysis included the methods of descriptive statistics (mean value, standard deviation, frequency) and standard parametric and nonparametric tests for comparison of two groups (Student&rsquo;s T test, Whitney U test, chi-square test). The Pearson&rsquo;s Test of Correlation was used in the phase of statistical analysis of interaction effects and correlation of obtained data. All tests were performed at the level of statistical significance of p&lt;0.05. RESULTS: The study covered 65 patients, out of which 82% were male patients aged 59. 83% of patients said they smoked and 69% of patients stated that they consumed alcohol regularly. A neck dissection was performed in all patients during surgical treatment of OSCC and it was selective neck dissection (91%). Cervical regional metastasis was found in 30 patients so they were divided into two groups: the group of patients who had metastasis in the lymph nodes and the group of patients with no metastasis in lymph nodes of the neck. It was determined that there was a statistically significant difference in depth of invasion and tumor volume between these two groups. The statistically significant difference was also determined between the thickness of tumor measured by CT and thickness of tumor measured by light microscope. Moreover, the depth of invasion of tumor greater than 7mm and volume of tumor greater than 4cm&sup3; were proven to represent a predictive factor of development of regional cervical metastasis. The study results show that there is a statistically significant correlation between the thickness of OSCC tumor measured by CT and the thickness measured by light microscope, so the thickness of tumor measured by CT can be used for planning the surgery during the treatment of OSCC. The depth of tumor invasion greater than 7 mm and tumor volume greater than 4 cm&sup3; represent a predictive factor of development of cervical metastasis, which means that they are significant for determining the stage of disease.</p>