ObjectiveIn early 2020, the spread of coronavirus disease-2019 (COVID-19) led the World Health Organization to declare this disease a pandemic. Initial epidemiological data showed that patients with cancer were at high risk of developing severe forms of COVID-19. National scientific societies published recommendations modifying the patients' breast cancer (BC) management to preserve, in theory, quality oncologic care, avoiding the increased risk of contamination. The Senology International Society (SIS) decided to take an inventory of the actions taken worldwide. This study investigates COVID-19-related changes concerning BC management and analyzes the will to maintain them after the pandemic, evaluating their oncological safety consequences.Materials and MethodsSIS network members participated in an online survey using a questionnaire (Microsoft® Forms) from June 15th to July 31st, 2020.ResultsForty-five responses from 24 countries showed that screening programs had been suspended (68%); magnetic resonance imagines were postponed (73%); telemedicine was preferred when possible (71%). Surgeries were postponed: reconstructive (77%), for benign diseases (84%), and in patients with significant comorbidities (66%). Chemotherapy and radiotherapy protocols had been adapted in 28% of patients in both. Exception for telemedicine (34%), these changes in practice should not be continued.ConclusionThe SIS survey showed significant changes in BC's diagnosis and treatment during the first wave of the COVID-19 pandemic, but most of these changes should not be maintained. Indeed, women have fewer severe forms of COVID-19 and are less likely to die than men. The risk of dying from COVID-19 is more related to the presence of comorbidities and age than to BC. Stopping screening and delaying treatment leads to more advanced stages of BC. Only women aged over 65 with BC under treatment and comorbidities require adaptation of their cancer management.

Au tor za ko res pon den ci ju/Corresponding aut hor: Marko Margaritoni, MD, Ph.D., Associate proffesor, Department for Surgery, General Hospital Dubrovnik, Roka Mišetića 2, 20000 Dubrovnik, Croatia • Tel: +385 22 431 613 • GSM: +385 98 2445 75 • E-mail: marko.margaritoni@du.htnet.hr; markom@bolnica-du.hr Received 18th May 2014; Accepted October 16th 2014; Antropometrijske karakteristike šake – pregledni članak

Cilj/svrha: Cilj je istraživanja trostruki, i to: ad 1] uporabom antropoloških metoda mjerenja utvrditii postojanje tzv.antropološkog "fenomena akceleracije" šake; ad 2] usporedba vrijednosti četiriju osnovnih čimbenika mjerenja šake; ad 3] povezanost dimenzija šake u odnosu na vrstu zanimanja, spol, mjesto boravka u dvije populacije različite starosne dobi, i to od 20 do 30 godina u odnosu na populaciju starosne dobi od 50 do 60 godina u Dubrovačko-neretvanskoj županiji [DNŽ].Metoda i ispitanici: U istraživanje je uključeno 117 ispitanika, i to 52 ispitanika [30 muškaraca] starosne dobi od 20 do 30 godina, te 65 ispitanika starosne dobi od 50 do 60 godina [33 muškarca].Svi uključeni ispitanici liječeni su u Općoj bolnici [OB] Dubrovnik tijekom 6 mjeseci [od 1. studenoga 2012.do 1.svibnja 2013.].Kriteriji za uključivanje bili su ispitanici prosječnog osteomuskularnog statusa, bez neuroloških poremećaja, tjelesne visine od 160 do 170 cm za žensku, te od 180 do 190 cm za mušku populaciju, nepostojanje degenerativnih i kongenitalnih bolesti šake.Kriterij za isključivanje bila je tjelesna težina veća od 75 kg za žensku te veća od 100 kg za mušku populaciju.U uporabi su 4 standardne antropometrijske metode mjerenja šake, i to: dužina šake, dužina dlana, širina dlana u projekciji metakarpofalangealnih zglobova, opseg cirkumferencije ručnog zglo-

The Foundation is indebted to the following colleagues for their voluntary contributions between January 1, 2013 and June 30, 2013. Ahmad H. Alhazmi, Saudi Arabia Mumtaz Khidder Hanna Alnasir, Iraq Abdullah S.A. Al, Zahrani, Saudi Arabia Ovidiu Eugen Bala, Romania Marcelo Alberto Beltran, Chile Kathleen M. Casey, United States of America Henry Chua, Philippines José Emidio Craveiro Rocha, Portugal Nicolae Danila, Romania Fernando Docobo Durantez, Spain Hector A. Duque Rendon, Canada Antonio Elias, Peru Alberto R. Ferreres, Argentina Toshihiko Fukushima, Japan Rudolf A. Garcia-Gallont, Guatemala Peter E. Goretzki, Germany Roald Jarl Guleng, Norway Brian R. Gwynn, United Kingdom Yatsuka Hibi, Japan Piotr Juszkiewicz, Canada Kyotaro Kanazawa, Japan George Z. Kapellakis, Greece Paulo Kassab, Brazil Hisashi Kasugai, Japan Neill Kenneth Kling, Australia Paul Eduardo Lada, Argentina Alvaro Larrad Jimenez, Spain Oladejo O. Lawal, Nigeria Enrique A. Lopez Arvizu, Mexico Ronald V. Maier, United States of America Marko M. Margaritoni, Croatia Morito Maruta, Japan Carlos Alberto G. Mesquita, Portugal Kazuhito Miyachi, Japan Masaki Morise, Japan Peter John Morris, United Kingdom Michael B. Mortensen, Denmark Doru Munteanu, Romania Yoshinori Murao, Japan Patricia Numann, United States of America Pericles Paleomylitis, Greece Amyn Pardhan, Pakistan Gerson A. Pereira Junior, Brazil Norman M. Rich, United States of America Tetsuo Shibuya, Japan Yotaro Shinozawa, Japan Dietmar Simon, Germany Elmin Steyn, South Africa Kate Melissa Stringer, Australia Michael J. Thalhammer, Austria Gerardo Rodas Thonet, Chile Jan Erik Varhaug, Norway George Velimezis, Greece Tatsuo Yamakawa, Japan Gustus HC Yeung, Hong Kong/SAR Jorge Alfredo Zendejas Vazquez, Mexico

Breast cancer is the most common malignancy in women. Early diagnosis and more effective treatment of invasive breast cancer resulted in significant mortality reduction, improvement of survival and the quality of life of the patients. The management od non-invasive breast cancer, on the contrary, is still controversial and the problem of overdiagnosis and overtreatment of patients come to evidence. In the following text a multidisciplinary team of experts brings the first consensus guidelines aimed to standardize and optimize the criteria and management in diagnosis, treatment and monitoring of non-invasive breast cancer patients in the Republic of Croatia.

Ahmad Alhazmi, Saudi Arabia Aurel Andercou, Romania Keishiro Aoyagi, Japan M. Walid Baker, Sweden Yusuf Bükey, Turkey Geoffrey Chiam, Singapore Sebastian O. Ekenze, Nigeria Issam El Nakadi, Belgium Antonio Manuel Estima-Martins, Portugal Masayuki Fukumitsu, Japan Yatsuka Hibi, Japan Rüdiger Horstmann, Germany Toshiki Kamano, Japan Paulo Kassab, Brazil Carlos Jesse Leon, Chile Ken-ichi Mafune, Japan Ronald V. Maier, USA Marko M. Margaritoni, Croatia Shuichi Miyakawa, Japan Michael B. Mortensen, Denmark Yoshinori Murao, Japan Henning Overgard Nielsen, Denmark Amyn Pardhan, Pakistan Jose Oswaldo Rojas Rincon, Colombia Tetsuo Shibuya, Japan Dietmar Simon, Germany Eduardo Antonio Souchon, USA Seiichi Takenoshita, Japan Gerardo Rodas Thonet, Chile Pierre Verhaeghe, France Eric Joseph Voiglio, France Jung Han Yoon, South Korea

Objectives: Few studies have examined the psychosocial impact of breast cancer and its treatment on African women who come from a poverty‐stricken, uneducated background in a developing country. The purpose of this study was to describe the specific psychosocial effects of breast cancer on married African women in order to help physicians educate and counsel future women and their families in Northwestern Nigeria.

Breast cancer is a leading cause of mortality and morbidity in women, mostly due to high metastatic capacity of mammary carcinoma cells. It has been revealed recently that metastases of breast cancer comprise a fraction of specific stem-like cells, denoted as cancer stem cells (CSCs). Breast CSCs, expressing specific surface markers CD44(+)CD24(-/low)ESA(+) usually disseminate in the bone marrow, being able to spread further and cause late metastases. The fundamental factor influencing the growth of CSCs is the microenvironment, especially the interaction of CSCs with extracellular matrix (ECM). The structure and function of ECM proteins, such as the dominating ECM protein collagen, is influenced not only by cancer cells but also by various cancer treatments. Since surgery, radio and chemotherapy are associated with oxidative stress we analyzed the growth of breast cancer CD44(+)CD24(-/low)ESA(+) cell line SUM159 cultured on collagen matrix in vitro, using either native collagen or the one modified by hydroxyl radical. While native collagen supported the growth of CSCs, oxidatively modified one was not supportive. The SUM159 cell cultures were further exposed to a supraphysiological (35 microM) dose of the major bioactive lipid peroxidation product 4-hydroxynonenal (HNE), a well known as 'second messenger of free radicals', which has a strong affinity to bind to proteins and acts as a cytotoxic or as growth regulating signaling molecule. Native collagen, but not oxidised, abolished cytotoxicity of HNE, while oxidized collagen did not reduce cytotoxicity of HNE at all. These preliminary findings indicate that beside direct cytotoxic effects of anticancer therapies consequential oxidative stress and lipid peroxidation modify the microenvironment of CSCs influencing oxidative homeostasis that could additionally act against cancer.

Background Breast cancer is the commonest cancer of women the world over, and its incidence is rising, especially in developing countries, where the disease poses a major health care challenge. This growing incidence in developing countries reflects the advanced stage at diagnosis, low levels of public awareness of the risk for the disease, and poor medical infrastructure and expertise, with the resultant poor treatment outcomes. Methods This article provides a collective edited summary of the presentations at the symposium titled “Breast Cancer Care in Developing Countries,” held as part of the Breast Surgery International program at the International Surgical week 2007, Montreal, Canada, August 2007. The aim of the presentations was to bring out the diverse clinical pathological and outcomes-related facts of breast cancer care available to women in several countries. As the incidence of breast cancer continues to rise steadily in the developing world, the lack of awareness of this disease and the absence of breast cancer screening programs make it almost certain that the majority of breast cancers are diagnosed at an advanced stage. In addition, the quality of care available for breast cancer patients varies widely according to where the patient is treated. Results Though there are some centers of excellence providing multimodality protocol-based treatment on a par with the best anywhere in the world, most breast cancer patients receive inadequate and inappropriate treatment because of a lack of high-quality infrastructure—and sometimes skills—and, above all, because of limited financial resources. Conclusions In countries where these limitations are present, there is a need to emphasize public health education, promoting early diagnosis. In addition, resources must be directed toward the creation of more public facilities for cancer treatment. As these goals are met, it is likely that there will be a much-needed improvement in breast cancer care in developing countries.

Oncoplastic surgery is the seamless joining of the extirpative and reconstructive aspects of breast surgery that is performed by a single surgeon. A symposium was held at ISW 2007 in Montreal with a prearranged aim to publish an article on the current and historical record of the developing specialty of oncoplastic breast surgery. The presenters and authors are well-known breast surgeons from Australia, Croatia, India, Sweden, and South Africa.

Because of complex pathophysiology and severe consequences, traumatic brain injuries (TBI) are an important medical problem. Pathophysiology of TBI includes local and systemic stress response, in which interleukin-8 (IL-8) is considered as a key mediator of neuroinflammation. However, prognostic relevance of IL-8 measurement in adult patients with severe TBI is not certain. Therefore, IL-8 was determined in blood samples from central venous and jugular bulb catheter and in cerebrospinal fluid of twenty patients with isolated TBI at admission to Intensive Care Unit. None of the patients had history of stroke, dementia, autoimmune diseases, acute infection or medication with anti-inflammatory drugs. Ten patients died due to traumatic brain injury, while the other ten recovered well. While there was no significant difference of IL-8 levels in cerebrospinal fluid between survivors and nonsurvivors, central venous plasma level of IL-8 was significantly lower in survivors (71.00 +/- 14.17 pg/ml), than in nonsurvivors (111.26 +/- 16.9 pg/ml). Receiver Operating Characteristic (ROC) analysis revealed significant prognostic value for IL-8 in the blood as well as for the age of patients, Glasgow Coma Scale (GCS) and Acute Physiologic and Chronic Health Evaluation (APACHE II). These findings suggest that the central venous plasma values of IL-8 at admission might be an early predictive marker in patients with severe TBI, comparative to standard clinical prognostic markers such as APACHE II and GCS.

Radiation-induced osteosarcoma is a rare complication of radiation therapy for breast cancer. The authors present a 60-year-old patient in whom osteosarcoma of the chest wall developed 5 years after modified radical mastectomy and radiation therapy for breast cancer. One year after resection of the chest osteosarcoma, metastasis to the contralateral axillary lymph nodes developed and these were removed. Radiation-induced osteosarcoma is difficult to treat and has a poor prognosis, thus early diagnosis is necessary for optimal treatment.

In the Department of Plastic Surgery of "Dubrava" University Hospital from 1993 to 1999 four patients were treated for radiation induced sarcoma. All of the patients were formerly operated for breast cancer and irradiated postoperatively. The mean time span between radiotherapy and development of sarcoma was 4.75 years. Four patients were treated with wide excision and immediate reconstruction with local flaps. One of the patients had fibrosarcoma, two patients had lymphangiosarcoma, and one patient had osteosarcoma. Two patients died within two years. Radiation induced sarcomas are therapy resistant, and the review of literature did not show large controlled investigations which would offer the most optimal treatment. Most frequently a rapid progression of the disease is seen.

Dubrovnik General Hospital teas target of brutal agression during the war in Croatia (1991 to 1992) and so were the other hospitals in Croatia. In the beginning of the war, the whole Dubrovnik Medical Care Service was located in (so called) Old hospital (built in 1888) nearby historical city center. Because of inadequate architecture for urgent medicine, lack of shelters and lack of self-resources of electricity and running water, during third day of the war the whole surgical service had to be transferred into the new building. The authors stress that the organisation of the War hospital St. Blasius was done under general and air-raid alerts, within only eight hours and without the interruption of work. During this time, the hospital has worked without any support and communications with greater clinical centers. Recent postoperative treatment and rehabilitation was organised under control of physicians in a few hotels which were also damaged by violent attacks of the Yugoslav Federal Army. During the first year of the war (October 1991 to September 1992), 1408 wounded persons were treated in the War hospital "St. Blasius" with very good results in treatment, and lour morality rate of only 1,9 percent.

The incidence of melanoma is among the five most common malignancies. The aim of the research was to determine the incidence of melanoma in the general population of Dubrovnik-neretvanska County [DNC], and in particular the relationship between disease by sex, age, thickness of skin involvement, clinical stage of disease and degree of survival. We described the methods and procedures of treatment in relation to clinical stages of the disease. We represented results of diagnostic and therapeutic procedures and methods / procedures of treating melanoma in a population of patients treated at the General Hospital [GH] Dubrovnik, in a five-year period from January 1 st 2006 until Decembre 31 st 2010.