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Diabetic foot ulcers are an extremely urgent medical and social problem throughout the world. The purpose of this study was to analyse the histological and immunohistochemical features of tissues and cells of different sections of wounds taken during the primary surgical treatment of chronic wounds in patients with diabetic foot syndrome with favourable and unfavourable outcomes. Material and methods. A clinical prospective observational study of the treatment outcomes of fifty-three patients with diabetic foot ulcers hospitalized twice in one specialized centre over the course of the year was conducted. The analysis of histological and immunohistochemical data of the tissues of the edges and the centre of the ulcer taken during the primary surgical treatment was performed. While performing histological analyses of wound tissues, special attention was given to the determination of cellular characteristics of leukocyte-necrotic masses, granulation tissue, and loose and dense connective tissue. Immunohistochemistry was performed using a set of monoclonal antibodies, allowing verification of neutrophilic leukocytes, fibroblasts, and endothelial cells. Results. Unfavourable outcomes (amputation, reamputation, death from cardiovascular diseases, nonhealing ulcer within a year) were registered in 52.8% of cases. Uniform distribution of neutrophils and endothelial cell fibroblasts in all parts of the wound was recorded in patients with a favourable outcome. An unfavourable outcome was predetermined by the uneven content of these cells with a significant increase in neutrophilic leukocytosis in the bottom of the wounds, as well as a significant decrease in the number of fibroblasts and endotheliocytes in the centre of the wounds. Conclusions: The datasets obtained during primary surgical treatment are extremely informative to predict the outcome of the treatment of diabetic foot ulcers and indicate more active surgical strategies with the potential to reduce the treatment time, increase its effectiveness, and eventually make the treatment cost-effective. [ABSTRACT FROM AUTHOR]

Background: The role and effectiveness of primary surgical treatment for sporadic chiasmatic–hypothalamic glioma (CHG) are not clear. The present study was to describe sporadic CHG visual acuity (VA) outcomes after surgery and to analyze the relevant factors affecting VA improvement.Methods: Forty-five pediatric sporadic CHG patients who met the inclusion criteria were included in a retrospective study. All patients received primary intratumor partial resection. Disease characteristics, treatment strategies, complications, and VA outcome were analyzed. Univariate and multivariate analyses were performed to identify relevant factors of VA improvement. Receiver operating characteristic (ROC) analysis was performed to evaluate the predictive accuracy of measurement indexes.Results: There were 77 eyes of 45 children suffering from various levels of VA impairment before surgical treatment, and only 13 eyes had normal vision. Patients with resection extents >70, 50–70, and

Aim. To analyze options for treatment tactics for open fractures of bones, implemented in a regional trauma system in theKrasnodar Territory.Materials and methods. Retrospective analysis includes the results of treatment of 82 patients with polytrauma and severe open fractures of the shin bones aged from 18 to 60 years, of whom 23 in unstable or critical condition, hospitalized in 2016-2017 in the Scientific Research Institution – S.V. Ochapovsky Regional Clinical Hospital № 1.Results. Treatment tactics for patients with severe polytrauma and open fractures type IIIA and B according to the classification of Gustilo-Andersen adopted in trauma center of level I, reduces the total number of infectious complications to 9,09% for fractures of type III A and 53,84% of IIIB fractures compared to option treatment strategies adopted in trauma centres II, III where the level of infection reaches 58,06% fractures type III A and 93,75% of IIIB fractures. The typical mistakes made in primary surgical treatment in patients with polytrauma and severe open fractures were revealed: incomplete revision of the wound with leaving foreign bodies, non-viable soft tissues, unstable fixation of the fracture with the help of a skeletal traction system, incomplete external fixation of the fracture with a device or plaster bandage, suturing of the wound with relaxing skin incisions during soft tissue swelling, absence of drains or passive drainage of the open fracture.Conclusion. The usage of primary surgical treatment in a reduced volume, with the application of VAC-dressings, in patients with polytrauma and severe open fractures of the limb bones can reduce the overall incidence of infectious complications.

Background: The role and effectiveness of primary surgical treatment for sporadic chiasmatic–hypothalamic glioma (CHG) are not clear. The present study was to describe sporadic CHG visual acuity (VA) outcomes after surgery and to analyze the relevant factors affecting VA improvement. Methods: Forty-five pediatric sporadic CHG patients who met the inclusion criteria were included in a retrospective study. All patients received primary intratumor partial resection. Disease characteristics, treatment strategies, complications, and VA outcome were analyzed. Univariate and multivariate analyses were performed to identify relevant factors of VA improvement. Receiver operating characteristic (ROC) analysis was performed to evaluate the predictive accuracy of measurement indexes. Results: There were 77 eyes of 45 children suffering from various levels of VA impairment before surgical treatment, and only 13 eyes had normal vision. Patients with resection extents >70, 50–70, and <50% accounted for 26.67, 24.44, and 48.89%, respectively. The percentages of VA maintained and deteriorated in normal vision eyes were 61.54 and 38.46%. The percentages of VA improved, maintained, and deteriorated in visually impaired eyes after surgery were 29.87, 45.45, and 24.68%, respectively. There was a positive correlation between the IVA level and VA improvement. There was no significant difference in VA improvement between the different resection extents. Blindness occurred in ~4.4%. Approximately 11.1% of the children had complications that affected quality of life, which correlated with resection extent. IVA and tumor size were correlated with VA improvement. The AUC for IVA + tumor size predicting VA improvement was 0.831. The cutoff points for IVA level and tumor volume were 4.5 and 43.50 cm3, respectively. Conclusions: IVA and tumor size were correlated with VA improvement after primary intratumor partial resection. Children with IVA ≥ level 5 were more likely to achieve visual improvement after decompression surgery, but decompression had limited effectiveness on vision improvement in patients with tumor volumes ≥ 43.50 cm3. Performing resections < 50% was safe and did not reduce the effect of decompression to improve VA. [ABSTRACT FROM AUTHOR]

We present a 71-year old patient admitted to Plastic and Reconstructive Surgery Clinic, Clinical Center Niš for the right leg conquasation. The patient was injured accidentally by a petrol tiller. On admission, both thigh and lower leg conquasation was observed with large wound on anteromedial thigh and one on medial side of the lower leg. Soft tissue and bones were covered with dirt and pieces of clothing. The wounds were thoroughly rinsed and dirt was removed followed by detailed debridement. After primary surgical treatment of the wound, open proximal lower leg fracture was stabilized with external skeletal fixation using two nails in the proximal and two nails in the distal fragment. Soft tissue defect was treated by plastic surgeon. The patient was administered anti-tetanus protection, antibiotic treatment and anticoagulant prophylaxis of deep vein thrombosis and pulmonary thromboembolism. Physical therapy was initiated subsequent to successful healing of the soft tissue wounds. External skeletal fixation was removed after three months for infection around the proximal nails and the treatment was contuinued using functional Sarmiento’s plaster imobilization leading to full recovery of open lower leg fracture.

Introduction Breast cancer treatment in elderly patients is controversial. This single-centre study was conducted to review the treatment and outcomes for octogenarian women treated for breast cancer. Methods Data from all patients aged 80 years or more with primary breast cancer treated at our institution between 1995 and 2012 were included. Patients with carcinoma in-situ (stage 0) and advanced breast cancer (stage IV) were excluded. Results The study population consisted of 369 patients (median age 84 years). A total of 277 (75%) patients underwent surgical treatment (PST) and 92 (25%) received primary endocrine treatment (PET). Prognostic factors (HER-2, tumour grade, lymphovascular invasion and subsequent adjuvant therapy) were homogeneously distributed in both groups. PST and PET were stratified according to stage: 273 (66%) patients with early stage disease (I, IIA, IIB) and 96 (34%) with locally advanced disease (IIIA, IIIB, IIIC). Patients were followed-up for a median of 63 months. In patients with early stage disease, the mean breast cancer-specific survival (BCSS) was 109 months (95% CI = 101–115) in PST patients, and 50 months (95% CI = 40–60) in PET patients (P < 0.01). Conversely, for patients with locally advanced breast cancer, there was no significant difference in BCSS between the surgical and non-surgical groups. In the PST group, BCSS and disease-free survival were significantly better among patients who underwent standard surgical treatment than among those who received suboptimal treatment. There were no differences in the Charlson comorbidity index scores between the PST and PET groups. Conclusion In women ≥80 years with early-stage breast cancer, standard surgical treatment was associated with a better BCSS when compared with PET. [ABSTRACT FROM AUTHOR]

We present a 71-year old patient admitted to Plastic and Reconstructive Surgery Clinic, Clinical Center Niš for the right leg conquasation. The patient was injured accidentally by a petrol tiller. On admission, both thigh and lower leg conquasation was observed with large wound on anteromedial thigh and one on medial side of the lower leg. Soft tissue and bones were covered with dirt and pieces of clothing. The wounds were thoroughly rinsed and dirt was removed followed by detailed debridement. After primary surgical treatment of the wound, open proximal lower leg fracture was stabilized with external skeletal fixation using two nails in the proximal and two nails in the distal fragment. Soft tissue defect was treated by plastic surgeon. The patient was administered anti-tetanus protection, antibiotic treatment and anticoagulant prophylaxis of deep vein thrombosis and pulmonary thromboembolism. Physical therapy was initiated subsequent to successful healing of the soft tissue wounds. External skeletal fixation was removed after three months for infection around the proximal nails and the treatment was contuinued using functional Sarmiento's plaster imobilization leading to full recovery of open lower leg fracture. [ABSTRACT FROM AUTHOR]

Cervical cancer is currently the first or second leading cause of cancer-related mortality among women in developing countries. This study was conducted in order to determine whether neoadjuvant cisplatin and 5-flourouracil (NAPF) prior to surgery is superior to primary surgical treatment (PST) as a treatment option for patients with International Federation of Gynaecology and Obstetrics (FIGO) stage IB2/IIA2 cervical cancer. A retrospective review of 195 patients with early-stage bulky cervical cancer was performed. The patients were divided into two groups, according to whether they received NAPF prior to surgery. The surgical profiles and complications, risk factors of recurrence and survival were compared between the groups. The response rate to NAPF was found to be 61.2%. There were no differences in operative time and intra-operative complications between the two groups, whereas the estimated blood loss in the NAPF and PST groups were 620.1±394.9 and 434.8±233.7 ml, respectively (P=0.000). When compared with PST, NAPF remarkably reduced tumor size (22.5 vs. 93.3%, P=0.000). Furthemore, the ratio of deep stromal invasion was significantly lower in responders to NAPF compared with that in non-responders (46.7 vs. 76.3%, respectively; P=0.004) and in the PST group (46.7 vs. 70.0%, respectively; P=0.004). No reduction of high-risk factors (HRFs) was observed. The NAPF group, even the responder subgroup, exhibited no significant improvement in progression-free survival (PFS) and overall survival (OS) compared to the PST group. In conclusion, despite the reduction of intermediate-risk factors (IRFs), neoadjuvant chemotherapy (NAC) with the NAPF regimen prior to radical surgery (RS) did not improve the prognosis in patients with FIGO stage IB2/IIA2 cervical cancer. [ABSTRACT FROM AUTHOR]

Abstract: Objective.: The objective of this study was to compare the significance of numbers of metastatic (MLN) and removed lymph nodes (RLN) between primary surgical treatment (PST) and neoadjuvant chemotherapy followed by surgery (NCS) in patients with FIGO stage IB1 to IIA cervical cancer. Methods.: Among 1124 patients with cervical cancer, PST (n =451) and NCS (n =73) groups were enrolled for evaluating the association between numbers of MLN and RLN, and clinical outcomes including the pattern of recurrence and survival according to the 2 treatments. Results.: Mean values of progression-free survival (PFS) were 100.8 vs. 87.6 vs. 57.7months in 0 vs. 1–2 vs. ≥3 MLN, suggesting that ≥3 MLN was associated with poor PFS (adjusted HR, 2.71; 95% CI, 1.02 to 7.21). However, there was no association between the number of MLN and survival in NCS group. The increased number of MLN was also associated with the increase of distant metastasis in PST group (44.0% vs. 72.7% vs. 78.6%; p =0.02), whereas there was no association between the number of MLN and the pattern of recurrence in NCS group. Moreover, mean values of PFS were 57.2 (<20 RLN) vs. 77.9months (≥20 RLN) in PST group with lymph node metastasis (p =0.04), demonstrating that ≥20 RLN improved PFS in PST group (adjusted HR, 0.48; 95% CI, 0.25 to 0.95). Conclusions.: The increased number of MLN may be more significant for predicting poor survival and distant metastasis, and the increased number of RLN may be associated with better survival in the patients treated with PST than those treated with NCS. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate whether neoadjuvant chemotherapy before surgery (NCS) is more efficient than primary surgical treatment (PST) for improving clinical outcomes in FIGO stage IB1-IIA cervical cancer. Methods: We conducted a matched-case comparison where 61 patients treated with NCS were matched to 183 treated with PST. We compared intermediate- and high-risk factors, the need of adjuvant radiotherapy, disease recurrence and survivals between NCS and PST. Patients with ≥2 intermediate- or ≥1 high-risk factors received adjuvant concurrent chemoradiation using cisplatin-based chemotherapy. Results: NCS reduced more definitely intermediate- and high-risk factors than PST in stage IIA disease in spite of little difference of them in stage IB disease (large tumor size, 25% vs. 52.4%; deep stromal invasion, 57.1% vs. 82.1%; lymphovascular space invasion, 35.7% vs. 65.5%; parametrial invasion, 17.9% vs. 41.7%; p <0.05). Moreover, ≥2 intermediate-risk factors were less common in NCS than PST despite no difference of the number of high-risk factors between the 2 treatments, which decreased the need of adjuvant radiotherapy in patients with stage IIA disease who received NCS (46.4% vs. 84.5%, p <0.01). Although there were no differences in progression-free survival and disease recurrence between the 2 treatments, NCS led to poorer overall survival than PST in stage IIA disease with no difference of it in stage IB disease. Conclusions: The efficacy between NCS and PST may be similar in FIGO stage IB cervical cancer. However, NCS can lead to poor prognosis despite the reduction of intermediate-risk factors and the need of adjuvant radiotherapy in FIGO stage IIA disease. [ABSTRACT FROM AUTHOR]

Cervical cancer is currently the first or second leading cause of cancer-related mortality among women in developing countries. This study was conducted in order to determine whether neoadjuvant cisplatin and 5-flourouracil (NAPF) prior to surgery is superior to primary surgical treatment (PST) as a treatment option for patients with International Federation of Gynaecology and Obstetrics (FIGO) stage IB2/IIA2 cervical cancer. A retrospective review of 195 patients with early-stage bulky cervical cancer was performed. The patients were divided into two groups, according to whether they received NAPF prior to surgery. The surgical profiles and complications, risk factors of recurrence and survival were compared between the groups. The response rate to NAPF was found to be 61.2%. There were no differences in operative time and intra-operative complications between the two groups, whereas the estimated blood loss in the NAPF and PST groups were 620.1±394.9 and 434.8±233.7 ml, respectively (P=0.000). When compared with PST, NAPF remarkably reduced tumor size (22.5 vs. 93.3%, P=0.000). Furthemore, the ratio of deep stromal invasion was significantly lower in responders to NAPF compared with that in non-responders (46.7 vs. 76.3%, respectively; P=0.004) and in the PST group (46.7 vs. 70.0%, respectively; P=0.004). No reduction of high-risk factors (HRFs) was observed. The NAPF group, even the responder subgroup, exhibited no significant improvement in progression-free survival (PFS) and overall survival (OS) compared to the PST group. In conclusion, despite the reduction of intermediate-risk factors (IRFs), neoadjuvant chemotherapy (NAC) with the NAPF regimen prior to radical surgery (RS) did not improve the prognosis in patients with FIGO stage IB2/IIA2 cervical cancer.