European Journal of Medicine

100-109

Authors: Ibrahim Albalawi

Purpose: to compare primary surgery and surgery after neoadjuvant chemotherapy (NCT) in locally advanced breast cancer (LABC) patients for whom loco-regional& systemic treatment in the form of chemotherapy and radiotherapy were performed. Patients and methods: Between 2008 & 2011, 112 patients with LABC were treated at KAAH & OC-Jeddah-KSA. Of whom 42 were treated by NCT followed by surgery either mastectomy or conservative surgery, then adjuvant chemotherapy and radiotherapy. The rest patients (70) were treated by primary surgery (mastectomy or conservative resection) followed by adjuvant chemotherapy and radiotherapy. All patients received adjuvant antiestrogen. Patients were followed for a median duration of 33 months. Disease- free survival (DFS) and overall survival (OAS) were studied for all patients, compared between both groups and related to extent of surgery and menopausal status. Results: median age was 46.5 years for all patients. 48 years, and 46 years for NCT and primary surgery groups respectively. Median DFS was 15 months for all patients, 16 & 15 months for NCT and primary surgery groups. Median OAS was 24 months for all patients, 22 & 24 months for NCT and primary surgery groups. Difference in DFS& OAS were highly significant in favor of postmenopausal patients (p = 0.05 for DFS & p = 0.03 for OAS) while in primary surgery group the differences between pre and postmenopausal patients in DFS & OAS were statistically insignificant (p = 0.4). NCT followed by surgery group patients showed significant improvement in DFS & OAS in patients performed conservative surgery while in primary surgery group the difference was insignificant. The results of neoadjuvant chemotherapy showed (14.3%) complete clinical remission (33.3%) showed more than 50% primary tumor regression, while the rest of patients (52.4%) showed less than 50% reduction of the primary tumor. The incidence of metastases was 56.5% for all patients, 49.4% for NCT group and 61.1% for primary surgery group. Freedom of disease was seen in 28.6% in NCT group and 37.1% for primary surgery group and local recurrence was noticed in 23.8% in NCT group Vs 2.9% in the primary surgery group. Conclusion: Surgery post-neoadjuvant chemotherapy neither prolongs DFS nor OAS in comparison with primary surgery followed by adjuvant chemotherapy. However, it permits more conservative surgery to be performed in LABC patients, but many of these patients could not achieve complete pathological remission leading to increased incidence of local failure. Postmenopausal patients fared much better than premenopausal patients regarding DFS & OAS. Earlier surgical interference with modified radical mastectomy for those who showed minimal response to NCT (after 2 courses) is highly recommended. Alternatively, aggressive treatment with newer chemotherapeutic drugs or increasing dose intensity plus growth factor support may be warranted for younger patients to improve the outcome of conservative surgery.

73-80

Authors: Isaac Acheampong Sarfo, Victoria A. Acquaye, Jacob Owusu Sarfo

This study examines the role of orthodox and traditional health systems on the health seeking behaviour among people in the Eastern Region of Ghana. Data from a sample of 600 respondents indicate that, the efficacy of both Traditional and Orthodox Health Systems were significant predictors of health seeking behaviour. Thus, respondents’ perception and belief in a particular health system influenced their patronage to those health facilities. This calls for the provision of a more balanced and ‘culturally congruent’ health services that tend to serve the needs of patients. This will go a long way to enhance patients’ decision in seeking help from the appropriate health facility on time.

50-53

Authors: E. Dusseux, V. Richez, A. Appert-Flory, F. Fischer, M. Dodoi, L. A. Vido, Legros, O. Moranne

Heparin like Syndrome is an entity discovered in 1980s. Although uncommon in clinical practice, this syndrome can lead to death in many cases because of severe bleeding. We report the fourth clinical case of a heparin like Syndrome associated to multiple Myeloma and acute kidney injury with a favourable outcome. We describe the evolution of clinical bleeding as activated partial thromboplastin time (APTT) and CD138 (transmembrane heparin sulphate on tumor cells surface) dosage over time.

12-18

Authors: Oksana G. Cherniukh

Our works consider the investigation of possible manifestation of hyperbilirubinemia in infants against the ground of genetic incompatibilities of the fetus according to АВ0 system and Rh-factor (D) concerning the maternal organism. From this point of view we deal with jaundice of mixed genesis against erythroblastosis domination as a primary antenatal factor of pathological process formation. The present study presents the results of distribution of the group and rhesus determinants (Rh D) of infants born to mothers with negative Rh-factor in 2014. Analytical review and comparison with the previous investigations in this direction have been made. New trends of further work with the elements of chronobiological characteristics concerning possible signs of hemolytic diseases of newborns (HDN), neonatal isoerythrolysis, in Bukovyna region are outlined. The values of umbilical bilirubin concentration are taken as a biochemical criterion of HDN development which is the main diagnostic sign of pathological jaundice of newborns. The signs of HDN of various degree were observed in 24 infants out of 333 neonates born to mothers with negative Rh-factor during the period of 2014.

25-33

Authors: Adriana Repková, Anna Bútorová, Hana Padyšaková, Nina Sládeková, Elena Žiaková, Jaroslav Kresánek, Eva Balogová, Hana Padyšáková

Background: The aim of this study was to determine the impact of symptoms of urinary incontinence by individuals, with the help of pelvic floor muscle's activation using Cantienica® and the subsequent effect on the quality of women's life. Patients and methods: The selected sample consists of two groups - experimental and control. The experimental group consisted of 31 female patients with incontinence, who completed therapeutic exercises using features of Cantienica® method. Control group consisted of 31 female patients with incontinence, which had taken a different way of conservative therapy. Results: The research has found that in the group of female patients who completed the therapeutic exercise by Benita Cantieni method, came in both phases to significantly greater change in the quality of life and greater alleviation of incontinence among the women who completed the other conservative treatments of incontinence. Conclusion: It can be alleged by the observed results, that the evaluated method has an effect on improving the quality of life and alleviating the symptoms of urinary incontinence in women.