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The role of postoperative radiotherapy after radical mastectomy in treatment of early breast cancer
MladenoviJasmina,Borojevi? Nenad D.
Archive of Oncology , 2002, DOI: 10.2298/aoo0201007m
Abstract: BACKGROUND: Radical or modified radical mastectomy was considered for many years the standard therapy for operable patients. Following radical mastectomy, postoperative irradiation of the chest wall and peripheral lymphatics is indicated in selected highrisk patients. Some studies on breast cancer patients who underwent radical mastectomy and received adjuvant chemotherapy tried to find out whether the addition of irradiation treatment to the chest wall and regional lymph nodes increases survival. The hypothesis in favor of irradiation is that chemotherapy can eliminate distant micrometastases, but is less effective against local and regional diseases, which are better controlled by radiotherapy. METHODS: In one year period, 110 patients with early stage of breast cancer were treated with radical mastectomy, and postoperative radiotherapy. Forty one patients had only postoperative radiotherapy, 27 received also adjuvant chemotherapy, 40 received adjuvant hormonal therapy and 2 patients received both adjuvant chemo and hormonotherapy. Postoperative irradiation was given on the regional lymph nodes (supra and infraclavicular, axillary and internal mammary nodes) with the tumor dose 48 Gy in 22 fractions over a period of four and a half weeks. All fields were treated with Cobalt 60. RESULTS After the median follow up of 67 months, 33 patients (30 %) had some kind of failure in form of local recurrence, distant metastases or both Locoregional relapse alone or associated with distant metastases occurred in 10 patients (9.1 %). Only 1.8 % of patients had local recurrence as the first failure. Distant metastases occurred in 32 patients (29.1%). After the end of follow up, 60 % patients are alive without evidence of disease while 16.4 % patients are alive with disease. The 5 year overall survival rate was 78.19% and 5 year disease free survival rate was 67.44%. CONCLUSION: Postoperative radiotherapy after radical mastectomy has important role in adjuvant treatment of early breast cancer in combination with adjuvant chemotherapy and hormonotherapy.
Correlation between retention force of experimental plates and viscosity of experimental fluids
Mladenovi? Dragan,Stankovi? Dragutin,Stankovi? Jasmina,Stankovi? Sa?a
Srpski Arhiv za Celokupno Lekarstvo , 2011, DOI: 10.2298/sarh1110583m
Abstract: Introduction. Saliva viscosity plays a significant role in the biophysical segment of the total retention potential of total dentures. Objective. The aim of the paper was to establish the dependence of dynamic retention force of experimental plates on experimental fluid viscosity and especially time dependence of these parameters, following at the same time relative changes of the distance between the experimental plate and dentures support established by the dislocation of the experimental plate in both directions. Methods. For experimental verification we used an original device with the aim to enable in vivo simulation on the phantom made of the upper total denture prosthesis support and experimental plate. The experiment consisted of two parts. In the first part we determined the value of the dynamic retention force with plates without and with achieved ventilation effect. In the second part we determined time dependence of the dynamic retention force of experimental plates on the viscosity of experimental fluids that had been priorly determined on identical samples (8 ml of experimental fluid samples) using a rotational viscometer (Haake RV-12) with a sensor (MV, Germany). Results Under the conditions of variable viscosity rates of seven experimental fluids (from 0.02 to 1309.04 mPa s), we registered the time dependence of dynamic retention force of the experimental plate related to fluid viscosity during the action of the continual dislocating force of the separating directions. In addition, the maximal height of the dislocation of the experimental plate was registered. The dynamic retention force, manifested by the separating direction of the experimental plate dislocation, was increased concurrently with increased viscosity. Conclusion. The increase of dynamic retention force depends directly on medium viscosity. Close border values of fluid viscosity above the investigated ones, the impossibility of experimental layer thinning and the decrease of distance height probably influence the onset of separating dislocation.
Postoperative radiotherapy after conservative surgery for early breast cancer: 5-year results
MladenoviJasmina,Do?i? Marko,Borojevi? Nenad D.
Archive of Oncology , 2004, DOI: 10.2298/aoo0401029m
Abstract: BACKGROUND: Breast conserving surgery followed by postoperative radiotherapy, as alternative to radical mastectomy, has been accepted as an optimal method for loco- regional treatment of the majority of women with early stage of breast carcinoma. The aim of the study was to evaluate the results of postoperative radiotherapy after breast conserving surgery in the Institute for oncology and radiology of Serbia. METHODS: During the 3-year period, 109 breast cancer patients with stage I and II were treated with postoperative radiotherapy after breast conserving surgery. Ninety- four patients underwent quadrantectomy with axillary node dissection, and 15 patients underwent only tumorectomy. After surgery all patients received postoperative radiotherapy to the whole breast with tumor dose 50 Gy in 15 fractions every second day. In 52 patients radiotherapy was given to the regional lymphatics with tumor dose 45 Gy in 15 fractions every second day. Twenty-eight patients received a booster dose (10 Gy) to the tumor bed. Adjuvant systemic therapy was administered depending on the nodal involvement and steroid receptors content: 17 patients received adjuvant chemotherapy (CMF or FAC), 18 received adjuvant hormonal therapy (tamoxifen or ovarian ablation), and 6 patients received both chemo- and hormonotherapy. RESULTS: After median follow-up period of 62 months, there was no evidence of loco- regional recurrence in anyone of patients. Distant metastases occurred in 7 patients (6.4%) with median disease free interval of 27.6 months. At last follow-up 91 patients (83.4%) were alive, 4 patients (3.7%) were dead of disease, and the same number was dead of other causes. The 5-year overall survival rate was 92.9% and disease-free survival rate was 92.7%. CONCLUSION: According to our results the combined surgery and radiotherapy approach provides good local control of early breast cancer patients. Postoperative radiotherapy after breast conserving surgery with or without adjuvant systemic therapy has important role in adjuvant treatment of early breast cancer.
The role of radiotherapy in combined treatment for locally advanced breast cancer with ipsilateral supraclavicular metastases
MladenoviJasmina,Zoranovi? Slavica,?a?i? Jelena,Do?i? Marko
Archive of Oncology , 2003, DOI: 10.2298/aoo0303148m
Abstract: Background: Locally advanced breast cancer (LABC) includes a heterogeneous group of breast neoplasms classified from stage IIB, IIIA to IIIB. LABC with ipsilateral supraclavicular adenopathy without evidence of distant disease is included in the stage IV (but regional stage IV). Purpose of this study was to assess the role of radiotherapy (RT) in combined treatment with systemic therapy (chemotherapy and hormonotherapy) in LABC with ipsilateral supraclavicular adenopathy. Methods: In 5-year period 45 patients with LABC and ipsilateral supraclavicular metastases were treated with radiotherapy and chemo- or hormonotherapy depending on the physical condition, age and steroid receptors (ER, PGR) content. Twenty patients received TD 30 Gy in 10 fractions on breast and regional lymph nodes and 25 patients received TD 51 Gy in 15 fractions on the breast and TD 45 Gy in 15 fractions on regional lymph nodes. Twenty-three patients received chemotherapy (CMF or FAC), 10 received hormonotherapy, and 12 received both chemo- and hormonotherapy. Results: After finishing complete treatment the overall response rate was 93.3%. Complete response was 20% and partial response was 73.3%. Locoregional relapse occurred in 5 patients and distant metastases occurred in 10 patients. Conclusion: Treatment of LABC with ipsilateral supraclavicular lymph node involvement should be aggressive, what means combined radiotherapy and systemic chemo-hormonotherapy. Such treatment provides for these patients maximum chance of long-term disease - free and overall survival.
Postoperative craniospinal radiotherapy of medulloblastoma in children and young adults
Golubi?i? Ivana V.,Bokun Jelena,Nikitovi? Marina R.,MladenoviJasmina
Srpski Arhiv za Celokupno Lekarstvo , 2003, DOI: 10.2298/sarh0306226g
Abstract: PURPOSE The aim of this study was: 1. to evaluate treatment results of combined therapy (surgery, postoperative craniospinal radiotherapy with or without chemotherapy) and 2. to assess factors affecting prognosis (extend of tumor removal, involvement of the brain stem, extent of disease postoperative meningitis, shunt placement, age, sex and time interval from surgery to start of postoperative radiotherapy). PATIENTS AND METHODS During the period 1986-1996, 78 patients with medulloblastoma, aged 1-22 years (median 8.6 years), were treated with combined modality therapy and 72 of them were evaluable for the study end-points. Entry criteria were histologically proven diagnosis, age under 22 years, and no history of previous malignant disease. The main characteristics of the group are shown in Table 1. Twenty-nine patients (37.2%) have total, 8 (10.3%) near total and 41 (52.5%) partial removal. Seventy-two of 78 patients were treated with curative intent and received postoperative craniospinal irradiation. Radiotherapy started 13-285 days after surgery (median 36 days). Only 13 patients started radiotherapy after 60 days following surgery. Adjuvant chemotherapy was applied in 63 (80.7%) patients. The majority of them (46 73%) received chemotherapy with CCNU and Vincristine. The survival rates were calculated with the Kaplan-Meier method and the differences in survival were analyzed using the Wilcoxon test and log-rank test. RESULTS The follow-up period ranged from 1-12 years (median 3 years). Five-year overall survival (OS) was 51% and disease-free survival (DFS) 47% (Graph 1). During follow-up 32 relapses occurred. Patients having no brain stem infiltration had significantly better survival (p=0.0023) (Graph 2). Patients with positive myelographic findings had significantly poorer survival compared to dose with negative myelographic findings (p=0.0116). Significantly poorer survival was found in patients with meningitis developing in the postoperative period, with no patient living longer than two years (p=0.0134) (Graph 3). By analysis of OS and DFS in relation to presence of the malignant cells in liquor, statistically significant difference, i. e. positive CSF cytology was not obtained, which was of statistical importance for survival (p=0.8207). Neither shunt placement nor shunt type showed any impact on survival (p=0.5307 and 0.7119, respectively). Children younger than three years had significantly poorer survival compared to those older than 16 years (p=0.0473). Although there was a better survival rate in females than in males this was not statist
The influence of plasma TGF-beta1 levels on development of postradiotherapy fibrosis in breast cancer patients
MladenoviJasmina,Borojevi? Nenad D.,Todorovi?-Rakovi? Nata?a,Ne?kovi?-Konstantinovi? Zora
Archive of Oncology , 2002, DOI: 10.2298/aoo0203171m
Estimation of the value-at-risk parameter: Econometric analysis and the extreme value theory approach
Mladenovi? Zorica,Mladenovi? Pavle
Economic Annals , 2006, DOI: 10.2298/eka0671032m
Abstract: In this paper different aspects of value-at-risk estimation are considered. Daily returns of CISCO, INTEL and NASDAQ stock indices are analyzed for period: September 1996 - September 2006. Methods that incorporate time varying variability and heavy tails of the empirical distributions of returns are implemented. The main finding of the paper is that standard econometric methods underestimate the value-at-risk parameter if heavy tails of the empirical distribution are not explicitly taken into account. .
Lipid Peroxidative Damage on Cisplatin Exposure and Alterations in Antioxidant Defense System in Rat Kidneys: A Possible Protective Effect of Selenium
Branka I. Ognjanovi?,Nata?a Z. Djordjevi?,Milo? M. Mati?,Jasmina M. Obradovi?,Jelena M. Mladenovi,Andra? ?. ?tajn,Zorica S. Sai?i?
International Journal of Molecular Sciences , 2012, DOI: 10.3390/ijms13021790
Abstract: Cisplatin ( Cis-diamminedichloroplatinum II, CP) is an important chemotherapeutic agent, useful in the treatment of several cancers, but with several side effects such as nephrotoxicity. The present study investigated the possible protective effect of selenium (Se) against CP-induced oxidative stress in the rat kidneys. Male Wistar albino rats were injected with a single dose of cisplatin (7 mg CP/kg b.m., i.p.) and selenium (6 mg Se/kg b.m, as Na 2SeO 3, i.p.), alone or in combination. The obtained results showed that CP increased lipid peroxidation (LPO) and decreased reduced glutathione (GSH) concentrations, suggesting the CP-induced oxidative stress, while Se treatment reversed this change to control values. Acute intoxication of rats with CP was followed by statistically significant decreased activity of antioxidant defense enzymes: superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), glutathione reductase (GR) and glutathione- S-transferase (GST). Treatment with Se reversed CP-induced alterations of antioxidant defense enzyme activities and significantly prevented the CP-induced kidney damage.
Importance of Digital Dental Photography in the Practice of Dentistry
Dragan Mladenovi,Lidija Mladenovi,Sanja Mladenovi
Acta Facultatis Medicae Naissensis , 2010,
Abstract: Digital photography has today, quite sure, penetrated into all segments of life, providing new facts and perceptions in the field of science, medicine, industry, fashion design, communications and arts. The aim of this paperwork was to, based of the observations from litera-ture and clinical experience, inform and assist the physician-practitioner in having insight into the overall importance from the domain of digital dental photography and make in this way the everyday practice easier, more comprehensive and of better quality. Numerous statements in technical literature and reports in everyday practice point to its great significance in contemporary dentistry, both from the aspect of its role in documenting dental treatment, communication in the relation dentist-patient-dental technician, self-checking (control) of one’s own results, illustration of lectures and publications, and the aspect of conceptualizing efficient marketing and accomplishing electronic teledental system of connections. Digital photography has multilevel significance and represents the synonym of contemporary dentistry. It’s application in dental practice is simple, fast and utterly useful in documenting procedures of work, effectuating the education of patients and pursuing clinical investigations, thus securing many benefits to dentists and patients.
Clinical Comparasion of the Quality of Fissure Sealing With FISURAL and IONOSIT -Seal in the Observation Period of up to Two Years
Lidija Mladenovi,Dragan Mladenovi,Sanja Mladenovi
Acta Facultatis Medicae Naissensis , 2010,
Abstract: There is nearly a unanimous standpoint that fissure system is the "region sensitive to caries". These difficulties imposed the consideration of efficient protection of the fissure system from caries. For final realization of this method, both adequate selection and comprehensive planned application of contemporary materials is necessary (composite light-initiated sealants as well as latest glass-ionomers resin fortified) as well as adequately performed technique of their application. The aim of the paper was to estimate the clinical successfulness of application of the two types of sealants, Fissural -Galenika-composite sealant, representative of Ш generation and Ionosit -seal-DMG Hamburg, glass-ionomer resin fortified, on the basis of determined clinical criteria as per Cvar and Ryge in the function of time from one week to two years. Clinical investigations were carried out on 72 teeth of transcanine sector with 36 patients of both genders aged 18-25 years, by the method of invasive technique. Upon sealing fissures, teeth were monitored by clinical method - probing of edge attachment of the sealant, as per Cvar and Ryge criteria (retention of the sealant, marginal adaptation, change of surface structure, edge coloring and secondary caries). The results of analysis of all adopted criteria did not show аnу changes after the observation period of 7 days for both preparations. There was evident continued declining trend of the quality of Fissural after two years, which confirmed the declining values of all adopted criteria: full retention of preparations (77.77%), full marginal adaptation (77.77%), edge coloring (11.12%), change of surface structure (88.88%) and appearance of secondary caries (11.12%). With Ionosit seal, high relative values of all adopted criteria weге retained, with a slight decline. The results confirmed that Ionosit-seal , a hybrid glass-ionomer sealant showed better qualities than Fissural , a composite sealant of III generation, in all analyzed criteria after observation period of two years.
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