Zoran Radovanovic

Highly aggressive Buschke-löwenstein tumor of the perineal region with fatal outcome

Indian Journal of Dermatology, Venereology, and Leprology | September-October 2012 | Vol 78 | Issue 5 648 shows fibroblastic proliferation with variable vascularity and lack of inflammatory infiltrate, as seen in this patient. Whether the proliferation is spontaneous or reactive is not clear. Among the imaging techniques, ultrasonography (USG) and magnetic resonance imaging (MRI) are both useful for diagnosis. Delineation of the soft-tissue and local invasion is better seen with MRI than USG, but USG is preferred because of widespread availability and low cost. However, it did not reveal any significant softtissue thickening in this case.

The results of the surgical treatment of rectal cancer

Methods: From 2006 to 2008, we included 100 rectal cancer patients in the study, 46 women and 54 men aged form 29 to 80 years. They were all surgically treated at the Oncology Institute of Vojvodina, Clinic for surgical oncology and their medical reports served as our data source. Results: We found locally advanced carcinoma T3 in 62% of patients and T2 in 24% of patients. Lymph nodes were positive in 74% of patients and distant metastases were found in 16% of diseased. Stage III was the most common (31%). The most frequently performed surgical treatment was low anterior resection of the rectum (52%) and Miles’ operation. Palliative surgery was done in 13% of patients. Survival rate after radical operations was the highest in patients with stage I of the disease (100%) and the lowest in patients with stage IV of the disease (31.25%).

Knowledge of HPV infection and Pap testing among young women in Serbia.

⁎ Corresponding author. Clinic of Oncological Surgery, Oncology Institute of Vojvodina, Institutski put 4, 21204 Sremska Kamenica, Serbia. Tel.: +381 214805548; fax: +381 21613741. E-mail address: aljosa.m@eunet.rs (A. Mandic). The high incidence rate of cervical cancer in Serbia highlights the need for a more detailed overview of this issue than has already been undertaken nationally [1]. National screening programs for the early detection of cervical carcinoma have not been implemented in the Serbian health system, so additional effort should be made within the healthcare and education systems to inform the population about the importance of regular gynecologic examinations and the risk factors that can lead to the development of cervical cancer. The principal aim of the present study was to assess the extent to which young women in the province of Vojvodina, Serbia, were informed about human papillomavirus (HPV) infection as a risk factor for the development of precancerous/cancerous lesions of the cervix and about the importance of the Papanicolaou (Pap) test and gynecologic examinations in identifying such lesions. The present study was performed between November 1 and December 20, 2009. It involved 361 women aged 17–27 years, who were divided into 3 groups: group A, comprising 117 final-year secondary school students from the grammar and medical schools in Sombor, Serbia (aged 17–19 years [mean, 17.9 years]); group B, comprising 128 students from the Faculty of Medicine at the University of Novi Sad, Novi Sad, Serbia (aged 19–27 years [mean, 22.8 years]); and group C, comprising 116 students from other faculties at the university (aged 19–27 years [mean, 20.8 years]). All participants completed an anonymous survey of 15 questions, includingquestions about age, sexual activity, knowledge of the Pap test, and knowledge of HPV infection as a risk factor for the development of precancerous/cancerous lesions of the cervix (Table 1). Ethics approval was not required, and informed consent was not needed because of the anonymous nature of the survey. Statistical analysis (Fisher exact test) was performed using STATISTICA version 9.0 (University of Novi Sad, Novi Sad, Serbia). Pb0.05 was considered to be statistically significant. The results of the survey indicated that 46 (39.3%) women in group A, 15 (11.7%) women in group B, and 23 (19.8%) women in group C had not engaged in sexual intercourse, and that 35 (29.9%) women in group A, 19 (14.8%) women in group B, and 15 (12.9%) women in group C had first engaged in sexual intercourse between the ages of 15 and 16 years. Of thewomenwhowere sexually active, themajority (56/71 [78.9%] in groupA, 88/113 [77.9%] in groupB, and78/93 [83.9%] in groupC)used condoms for protection against sexually transmitted diseases. Correct answers about the area from which smears are taken for cytopathologic analysis were given by 103 (88.0%) women in group A, 126 (98.4%)women in groupB, and101(87.1%)women in groupC.All of the women in group A, 127 (99.2%) women in group B, and 111 (95.7%) women in group C agreed that the Pap test is an important diagnostic tool in the prevention of cervical cancer. Of the 121 women in groups B and C who were older than 21 years of age, 44/69 (63.8%) in group B and 24/52 (46.2%) in group C had undergoneaPap test; this differencewas statistically significant (Pb0.05). Young sexually active womens knowledge of the necessity for regular Pap testing was high in all 3 groups in the present study; however, there was a significant difference between the women in groups A/B and those in group C in terms of knowledge of HPV (Pb0.001). University medical students (group B) knew much more about HPV as a sexually transmitted infection than did secondaryschool students (group A) and university students from other faculties (group C) (P=0.001). Compared with group B, a lower proportion of women in groups A and C knew about men being significant transmitters of the HPV infection and about the HPV vaccine. In the present study, knowledge of HPV as a risk factor for the development of precancerous/cancerous lesions of the cervix was similar to results obtained in other studies [2–4]. The implementation of a healthcare and education program in Serbia is an ideal basis from which to raise awareness among the general population of the need for a national screening program for the early detection of cervical carcinoma. The need for academically educated women to be further educated about HPV (as indicated by the present study) indirectly suggests a requirement for better medical education among the general population. This would significantly raise the efficiency of screening programs, which must be implemented in the Serbian national health system as soon as possible.

Thoracic Epidural Versus Intravenous Patient-Controlled Analgesia after Open Colorectal Cancer Surgery

The aim of the study was to compare thoracic epidural analgesia (TEA) and intravenous patient-controlled analgesia (IV-PCA) after open colorectal cancer surgery. This prospective study included sixty patients scheduled for elective open colorectal surgery and randomized to either postoperative IV-PCA with morphine (n=30) or TEA with a mixture of levobupivacaine, fentanyl and adrenaline (n=30). Th e primary outcome was return of bowel function. The secondary outcome was quality of postoperative analgesia at rest, on coughing and during mobilization. Intermediate outcomes included patient satisfaction, time out of bed, rate of side effects and postoperative complications, and time of discharge. Recovery of postoperative ileus occurred sooner (p<0.001) and resumption of dietary intake was achieved earlier (p<0.001) in TEA group. Intensity of pain during the first 3 postoperative days was significantly lower at rest, on coughing and during mobilization (p<0.001), and mobilization was much more effi cient (p<0.005) in TEA than in IV-PCA group. Satisfaction scores were better in TEA group (p<0.001). Nausea, sedation and postoperative delirium occurred less frequently in TEA group (p<0.05, p<0.001 and p<0.05, respectively). TEA demonstrated significantly better effectiveness than IV-PCA after open colorectal cancer surgery and had a positive impact on bowel function, dietary intake, patient satisfaction and early mobilization. The results of this study demonstrated the importance of implementation of TEA as a preferred method for postoperative pain control after major open colorectal surgery.