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Glavas Tahtler J, Djapic D, Neferanovic M, Miletic J, Milosevic M, Kralik K, Neskovic N, Tomas I, Mesaric D, Marjanovic K, Rajc J, Orkic Z, Cicvaric A, Kvolik S. Long-Term Outcomes of Breast Cancer Patients Receiving Levobupivacaine Wound Infiltration or Diclofenac for Postoperative Pain Relief. Pharmaceutics 2023; 15:2183. [PMID: 37765154 PMCID: PMC10534840 DOI: 10.3390/pharmaceutics15092183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Breast cancer is the most common malignant disease in women. Preclinical studies have confirmed that the local anesthetic levobupivacaine has a cytotoxic effect on breast cancer cells. We examined whether postoperative wound infiltration with levobupivacaine influences survival in 120 patients who were operated on for breast cancer and underwent quadrantectomy or mastectomy with axillary lymph node dissection. Groups with continuous levobupivacaine wound infiltration, bolus wound infiltration, and diclofenac analgesia were compared. Long-term outcomes examined were quality of life, shoulder disability, and hand grip strength (HGS) after one year and survival after 5 and 10 years. Groups that had infiltration analgesia had better shoulder function compared to diclofenac after one year. The levobupivacaine PCA group had the best-preserved HGS after 1 year (P = 0.022). The most significant predictor of the 5-year outcome was HGS (P = 0.03). Survival at 10 years was 85%, 92%, and 77% in the diclofenac, levobupivacaine bolus, and levobupivacaine PCA groups (ns. P = 0.36). The extent of the disease at the time of surgery is the most important predictor of long-term survival (P = 0.03). A larger prospective clinical study could better confirm the effect of levobupivacaine wound infiltration on outcomes after breast cancer surgery observed in this pilot study-trial number NCT05829707.
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Affiliation(s)
- Josipa Glavas Tahtler
- Department of Anesthesiology, Resuscitation and Intensive Care, Osijek University Hospital, 31000 Osijek, Croatia; (J.G.T.); (A.C.)
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Dajana Djapic
- Department of Anesthesiology, Resuscitation and Intensive Care, Osijek University Hospital, 31000 Osijek, Croatia; (J.G.T.); (A.C.)
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Marina Neferanovic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Jelena Miletic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Marta Milosevic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Kristina Kralik
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Nenad Neskovic
- Department of Anesthesiology, Resuscitation and Intensive Care, Osijek University Hospital, 31000 Osijek, Croatia; (J.G.T.); (A.C.)
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Ilijan Tomas
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
- Department of Oncology and Radiotherapy, Osijek University Hospital, 31000 Osijek, Croatia
| | - Dora Mesaric
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
- Department of Oncology and Radiotherapy, Osijek University Hospital, 31000 Osijek, Croatia
| | - Ksenija Marjanovic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
- Department of Pathology and Forensic Medicine, Osijek University Hospital, 31000 Osijek, Croatia
| | - Jasmina Rajc
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
- Department of Pathology and Forensic Medicine, Osijek University Hospital, 31000 Osijek, Croatia
| | - Zelimir Orkic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
- Department of Surgery, Osijek University Hospital, 31000 Osijek, Croatia
| | - Ana Cicvaric
- Department of Anesthesiology, Resuscitation and Intensive Care, Osijek University Hospital, 31000 Osijek, Croatia; (J.G.T.); (A.C.)
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Slavica Kvolik
- Department of Anesthesiology, Resuscitation and Intensive Care, Osijek University Hospital, 31000 Osijek, Croatia; (J.G.T.); (A.C.)
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
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Krajina Kmoniček I, Kvolik S, Pinotić K, Ištvanić T, Mraovic B, Marjanovic K. Epidural analgesia for acute ischemic pain after intra-arterial zolpidem injection in opioid-addicted patient-A case report. Clin Case Rep 2020; 8:3445-3449. [PMID: 33363949 PMCID: PMC7752646 DOI: 10.1002/ccr3.3445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 08/13/2020] [Accepted: 10/07/2020] [Indexed: 01/08/2023] Open
Abstract
A patient taking opioid maintenance therapy unintentionally injected dissolved zolpidem pills into the femoral artery and suffered acute limb ischemia. High amounts of opioids with supplemental therapies were inefficient for intractable ischemic pain, suggesting the presence of opioid‐induced hyperalgesia (OIH). Epidural analgesia efficiently relieved pain and symptoms of OIH.
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Affiliation(s)
| | - Slavica Kvolik
- Department of Anesthesiology Osijek University Hospital Osijek Croatia.,Faculty of Medicine Josip Juraj Strossmayer University of Osijek Osijek Croatia
| | - Kresimir Pinotić
- Faculty of Medicine Josip Juraj Strossmayer University of Osijek Osijek Croatia.,Department of Surgery Osijek University Hospital Osijek Croatia
| | - Tomislav Ištvanić
- Faculty of Medicine Josip Juraj Strossmayer University of Osijek Osijek Croatia.,Department of Surgery Osijek University Hospital Osijek Croatia
| | - Boris Mraovic
- Department of Anesthesiology & Perioperative Medicine School of Medicine University of Missouri Columbia MO USA
| | - Ksenija Marjanovic
- Faculty of Medicine Josip Juraj Strossmayer University of Osijek Osijek Croatia.,Department of Pathology Osijek University Hospital Osijek Croatia
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Prakatur I, Miskulin M, Pavic M, Marjanovic K, Blazicevic V, Miskulin I, Domacinovic M. Intestinal Morphology in Broiler Chickens Supplemented with Propolis and Bee Pollen. Animals (Basel) 2019; 9:ani9060301. [PMID: 31151310 PMCID: PMC6617278 DOI: 10.3390/ani9060301] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 05/26/2019] [Accepted: 05/27/2019] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to determine the influence of dietary supplementation with propolis and bee pollen on the intestinal morphology and absorptive surface areas of chickens. Two hundred day-old Ross 308 chickens (100 male and 100 female) were equally allocated into five groups. Throughout the whole study, the control group of chickens was fed with a basal diet, while the experimental groups of chickens were fed with the same diet supplemented with propolis and bee pollen: P1 = 0.25 g of propolis/kg + 20 g of bee pollen/kg; P2 = 0.5 g of propolis/kg; P3 = 1.0 g of propolis/kg; P4 = 20 g of bee pollen/kg. The duodenal villi of chickens from all experimental groups were significantly higher and wider (p < 0.001), while their duodenal villi crypts were significantly deeper (p < 0.001) in comparison with these parameters in chickens from the control group. The villus height to crypt depth ratio, as well as the absorptive surface areas of broiler chickens, were significantly increased (p < 0.001) in experimental groups of chickens in comparison with the control group. These findings suggest that dietary supplementation with propolis and bee pollen has a beneficial effect on broilers chickens' intestinal morphophysiology.
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Affiliation(s)
- Ivana Prakatur
- Faculty of Agrobiotechnical Sciences Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia.
| | - Maja Miskulin
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia.
| | - Mirela Pavic
- Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia.
| | - Ksenija Marjanovic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia.
| | - Valerija Blazicevic
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia.
| | - Ivan Miskulin
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia.
| | - Matija Domacinovic
- Faculty of Agrobiotechnical Sciences Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia.
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Kurbel S, Dmitrovic B, Marjanovic K. Differences in immunohistochemical features between invasive breast cancers and DCIS lesions from a single population, based on a consecutive case series of 1,248 patients. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e22084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Leovic D, Sabol M, Ozretic P, Musani V, Car D, Marjanovic K, Zubcic V, Sabol I, Sikora M, Grce M, Glavas-Obrovac L, Levanat S. Hh-Gli signaling pathway activity in oral and oropharyngeal squamous cell carcinoma. Head Neck 2012; 34:104-12. [PMID: 21484923 DOI: 10.1002/hed.21696] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2010] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of this study was to examine the role of Hh-Gli signaling in oral and oropharyngeal squamous cell carcinoma (SCC). The role of this signaling pathway in SCC formation has not yet been elucidated. METHODS Sixty-four tissue and blood samples were collected from 60 patients with SCC, all tobacco and alcohol users. An additional six buccal mucosa tissue samples were collected from nonsmokers and nondrinkers as control tissue. RESULTS Hedgehog-Gli pathway components were associated with clinical and pathologic features. Broders' grade and N stage were associated with higher Ptch1 and lower Gli1 expression. Tumor stage was negatively associated with Smo expression, and tumor size was positively associated with p16 expression. Ptch1 and Shh were frequently detected in the surrounding stroma. Ptch1 was found to be correlated with p16 expression, as well as with survivin expression. CONCLUSIONS The signaling pathway is activated in SCC and inducible in vitro by Shh protein.
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Affiliation(s)
- Dinko Leovic
- Department of Maxillofacial Surgery, University Hospital Osijek, Croatia
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Kvolik S, Jukic M, Matijevic M, Marjanovic K, Glavas-Obrovac L. An overview of coagulation disorders in cancer patients. Surg Oncol 2009; 19:e33-46. [PMID: 19394816 DOI: 10.1016/j.suronc.2009.03.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Revised: 03/19/2009] [Accepted: 03/22/2009] [Indexed: 12/12/2022]
Abstract
A diversity of coagulation disorders in cancer patients arise from tumor-specific growth characteristics, neoangiogenesis with impaired endothelial lining, defective myelopoiesis, hypoproteinemia or metastatic lesions growth with organ dysfunction. Recent investigations have found a clinically relevant correlation of coagulation disorders and tumor growth. These prompted new therapeutic strategies focused on growth factors with the aim to control tumor metastasis, particularly if used for the treatment of micrometastatic disease. However, such treatment may lead to the life threatening coagulation imbalance. A coagulation homeostasis may become further impaired after nonsurgical cancer therapy, especially after preoperative irradiation, which produces lesions precipitating both bleeding and thrombosis. Anticancer chemotherapy may affect liver function and decrease the synthesis of both procoagulation and anticoagulation factors. The most of chemotherapeutic protocols affect platelet synthesis, which arises as a principal dose-limiting side effect. It was observed both during combined systemic chemotherapy and local antitumor therapy. Although the side effects produced by chemotherapy are reversible, endothelial lesions may persist for many years after the anticancer treatment. Instead of cancer patients, there's a growing cohort of patients with nonmalignant diseases who use cytostatics in the perioperative period, and are candidates for surgical procedures not related to their malignant disease, i.e. hernia repair. In this patient population a special attention must be paid to the preoperative evaluation of coagulation status and thromboprophylaxis. This overview reminds the most common coagulation disorders in cancer patients in the perioperative period. It emphasizes the need for proper patient monitoring which may facilitate the diagnostics and treatment of cancer-related coagulation disorders in the perioperative setting.
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Affiliation(s)
- Slavica Kvolik
- Department of Anesthesiology and ICU, University Hospital Osijek, J. Huttlera 4, 31000 Osijek, Croatia.
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Abstract
We present an extremely rare case of a successfully operated giant (6700 g) paraovarian myxoma and uterus myomatosus in a 49-year-old woman. Preoperative examination (biochemical investigations, ultrasound and computed tomography scan) and perioperative findings did not identify a malignant tumor so that total abdominal hysterectomy/bilateral salpingo-oophorectomy and tumorectomy was chosen to treat the patient. Histologically, the tumor was clearly differentiated from the surrounding tissue. In solid regions there were spindle-shaped cells arranged in sheaves and within the profuse, well-vascularized myxomatous stroma there were star-shaped cells. Immunohistochemical analysis showed that tumor cells were positive to vimentin and smooth muscle actin. Electron microscopic analysis showed that tumor cells had ultrastructural characteristics that corresponded to cells in fibroma and thecoma in a profuse intercellular matrix, which confirmed the result of light microscopy.
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Affiliation(s)
- Dubravko Habek
- Department of Obstetrics and Gynecology, School of Medicine, Zagreb University, Sveti Duh Hospital Zagreb, Zagreb, Croatia.
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