The aim of this study was to assess the Croatian urologists' management of non-neurogenic male lower urinary tract symptoms (LUTS) and their compliance with the European Association of Urology (EAU) ...guidelines. A cross-sectional survey included 51/179 Croatian urologists. We developed a questionnaire with questions addressing compliance with EAU guidelines. The rate of performing recommended evaluations on the initial assessment of patients with benign prostate hyperplasia (BPH)/LUTS varied from 8.0% (serum creatinine and voiding diary) to 100.0% (physical examination, prostate specific antigen and ultrasound). The international prostate symptom score was performed by 31%, analysis of urine sediment by 83%, urine culture by 53%, and serum creatinine by 8% of surveyed urologists. Only 8% of urologists regularly used bladder diary in patients with symptoms of nocturia. Our results indicated that 97% of urologists preferred alpha blockers as the first choice of treatment; 5-alpha reductase inhibitors (5ARI) were mostly prescribed (84%) in combination with an alpha-blocker, preferably as a continuous treatment, whilst 29% of urologists used to discontinue 5ARI after 1-2 years. Half of the Croatian urologists used antimuscarinics in the treatment of BPH/LUTS and recommended phytotherapeutic drugs in their practice. In conclusion, Croatian urologists do not completely comply with the guidelines available.
The aim of our study was to evaluate the impact of margin positivity in clinically and pathologically localized prostate cancer (pT2) after radical prostatectomy on biochemical recurrence and time to ...adjuvant treatment. We analyzed data from 371 patients who underwent radical prostatectomy. At the mean follow up of 36 (25-54) months, impact of margin positivity in pT2 patients on prostate specific antigen (PSA) recurrence and time to introduction of adjuvant treatment was noted. Out of 371 radical prostatectomies there were 277 (74.6%) pT2 and 94 (25.4%) pT3 (locally advanced) prostate cancers. Mean age was 67.6 years, mean Gleason score 6.78, mean preoperative PSA 11.45 ng/mL. Out of 277 pT2 pts., 233 (84%) had negative (SM-) and 44 (16%) positive surgical margins (SM+). Only 3% of SM- pts. had biochemical relapse (BCR). Among pT2 patients with SM+, 18 (41%) had BCR while 26 were free of recurrence at 3 years follow up. Positive surgical margins had an adverse impact on biochemical progression free survival (3% SM- vs. 41% SM+; p<0.001). No difference was found in age, preoperative PSA, Gleason score or follow up between BCR-SM+ and BCR+SM+ patients. Mean time to PSA recurrence in surgical margin positive pT2 patients was 15.7 months. Surgical margin status pT2 disease has an impact on biochemical progression but only 41% of margine positive patients show biochemical recurrence at 3 yr follow up. Not all SM+ patients need to receive treatment after radical prostatectomy. Longer follow up should be awaited to see the impact on overall survival in this group of patients.
In this prospective study we examined the utility of parameters obtained on prostate needle biopsy and prostate specific antigen-alpha(1)-antichymotripsine complex (PSA-ACT) to predict adverse ...pathologic findings after radical prostatectomy. 45 consecutive patients assigned for radical prostatectomy due to clinically localized prostate cancer were included in the study. Prostate biopsy parameters such as number of positive cores, the greatest percentage of tumor in the positive cores, Gleason score, perineural invasion, unilaterality or bilaterality of the tumor were recorded. PSA-ACT was determined using sandwich immunoassay chemiluminiscent method (Bayer, Tarrytown, New York). We analyzed relationship of preoperative PSA, PSA-ACTand quantitative biopsy parameters with final pathology after prostatectomy. Adverse findings were considered when extracapsular extension of cancer (pT3) was noted. Postoperatively, 29 (64.4%) patients were diagnosed with pT2 disease and 16 (35.6%) with pT3 disease. There was a significant difference in localized vs. locally advanced disease in number of positive biopsy cores (p<0.001), greatest percentage of tumor in the core (p=0.008), localization of the tumor (p=0.003) and perineural invasion (p=0.004). Logistic regression was used to develop a model on the multivariate level. It included number of positive cores and PSA-ACT and was significant on our cohort with the reliability of 82.22%. The combination of PSA-ACT and a large scale of biopsy parameters could be used in prediction of adverse pathologic findings after radical prostatectomy. Clinical decisions and patients counselling could be influenced by these predictors but further confirmation on a larger population is necessary.
The perception of obesity among people has not changed significantly regardless numerous public educational programs. Reasons for obesity pandemics are numerous and complex, but can be mostly resumed ...to life-style changes. The aim of this research was to determine connection between socioeconomic factors and obesity with children of our region. Study included pupils aged 7-8 from 19 first grades in 8 primary schools in Osijek-Baranya County. Body height and weight were measured and socioeconomic data status were collected. Socioeconomic status included data on marital status, educational level, employment, number of children in the family, kindergarten attendance and urban/rural location and also smoking habits of parents. BMI was calculated as a parameter for obesity assessment according to Croatian reference values. Total of 372 children were measured. There were 6.5% of overweight children (BMI between 90th and 97th percentile) and 2.4% of obese children (BMI above 97th percentile). The prevalence of obese children in our research was 8.9%. Obesity is not influenced by rural/urban residence, marital status of parents, number of children in the family, mother's education, or by parents' smoking habits. Positive correlation between obesity and father's education and parents' unemployment was found. Available literature data, same as our study, did not show consistent association between socioeconomic factors and obesity with children. Contradictory results of different studies can be a result of a small sample, difference in study design and different criteria for defining categories within investigated socioeconomic factor.
There are 961 new cases and approximately 366 deaths from urothelial carcinoma registered annually in Croatia. Exfoliative urinary cytology has important role in detection of high grade urinary ...tumors, invasive and in situ lesions respectively. In contrast to cystoscopy and biopsy, cytology is a noninvasive method which is easily repeated. The aim of this retrospective study was to assess value of urinary cytology in our institution. For this purpose only patients with histological diagnosis and clinical follow up were considered. There were 138 urine specimens with cytological diagnosis of dyskaryosis, suspicious for malignancy or malignant and histology and follow up data examined at our Department of Clinical Cytology between 2004 and 2011. Cytological diagnosis suspicious for malignancy and malignant were considered positive and the results were correlated with histological diagnosis according to the WHO histological classification of tumors of the urinary tract. Patients with negative histological findings were followed for the next two years. The positive predictive value of cytological detection of malignant urothelial lesions was 91.8%. In 10 cases cytological diagnosis of malignancy was not confirmed histologically or clinically which makes the total of 8.2% of false positive reports. Of the total of detected malignant urothelial lesions 90.9% are high grade lesions and only 9.1% low-grade lesions; 67.3% are invasive lesions and 32.7% non-invasive lesions. Cytological findings of dyskariotyc cells requires further urological investigation because such findings in further processing prove the presence of tumor in 93.8% of cases. In conclusion: cytology is very good diagnostic tool for detection of high grade invasive and noninvasive carcinomas of the urinary tract. In order to make it more efficient we need to study its limits carefully, define diagnostic criteria and reach consensus in nomenclature.
Ameloblastoma is a benign, slow growing but locally aggressive tumor that is clinically manifested as swelling in a jaws. Prone to relapse (30%) even 30 years after inadequate primary operation. The ...most important cytological features of this tumor are small bazaloid cells in clusters, and single spindle and stellate shaped cells. We report on a case of 79-year-old patient, who was hospitalized due to tumor formation in the buccal region. FNA was performed and liquid material that contained only fagocites was collected. The conclusion was--cyst, while biopsy finding--adenoma baseo-cellulare, pointed to the salivary gland tumor. Patient refused the proposed surgical treatment. Four years later, the patient was urgently hospitalized due heavy bleeding from the tumor in the same region. It affected the crest portion of the upper jaw and a section of hard palate, and was bleeding on palpation. In second FNA we found phagocytes and a few small clusters of basaloid cells with palisade arrangement at the edges. Because of uniform and benign cytomorphological features it was concluded that it was a cystic tumor. On biopsy pattern the diagnose of ameloblastoma was determinated. The patient underwent surgery, however due to postoperative complications he died. Preoperative diagnosis is usually set on the basis of clinical and often nonspecific radiological findings. As it is very important to get the correct diagnose before planning an adequate surgical procedure, we would like to point out the potential value and disadvantages of FNA cytology in the diagnosis of ameloblastoma.
Obesity is one of the leading public health issues in the world whose significance lies, not only in its prevalence, but also in its consequences i.e. diseases that gradually develop in obese people. ...The aim of the study was to determine obesity prevalence among school children and the influence of health education on its prevalence. Study included pupils of 19 first grades in 8 primary schools of Osijek-Baranja County, Croatia. Body weight and height, waist and hip circumference were measured. Parameters for assessing obesity: body mass index (BMI, according to Croatian referral values), waist circumference (WC), waist and hip circumference ratio (WHR) and waist circumference and height ratio (WHtR) were measured. In order to determine whether the health education of pupils and their parents influences children's anthropometric indexes, health education regarding correct diet, obesity and its consequences and the need for life style changes in terms of daily physical activity was conducted in four primary schools. Pupils of other four primary schools were measured as a control group. Prevalence of overweight children according to BMI before education was 8.9% (6.5% of overweight and 2.4% of obese children). In intervention group of children, according to BMI, there was no decrease in proportion of obese after the health education was conducted and prevalence was 2% before and after the education. On the second measurement, pupils in control group showed increase in proportion of obese from 2.9% to 3.5%. According to weight circumference and height ratio before education there were 10.2% of obese children. After six months, there was an increase in proportion of obese to 11.3%. According to this index there was an increase in proportion of obese in all groups of pupils regardless of gender and conducted education. This study shows that in school-based obesity programs it is necessary to apply more intense interventions with another type of methodology; program should be conducted continuously during longer period, otherwise this condition will continue to rise.
Small cell carcinoma of the lung (SCLC) together with the large cell neuroendocrine carcinoma (LCNEC), typical carcinoid (TC), and atypical carcinoid (AC) make a group of morphologically identifiable ...neuroendocrine tumors. The differential diagnosis of SCLC includes, first of all, other neuroendocrine tumors, and primary or metastatic non-small cell carcinomas. Although the criteria for the morphologic separation from other tumors of the lung are defined, in everyday practice it can be a problem, both in cytology and with histological samples. Accurate and early differentiation of the SCLC is important because it exhibits aggressive behavior, rapid growth, early spread to distant sites, but also exquisite sensitivity to chemotherapy and radiation. The study included 127 patients who underwent bronchoscopic examination or percutaneous transthoracic fine-needle aspiration (PTTFNA) during the period from early 2003 to 2007 in University Hospital Center Osijek whose cytological diagnosis was SCLC. The value of cytological diagnosis was determined by comparing it with histological findings obtained from a biopsy sample during bronchoscopy or on a resection specimen in 50 patients. In the remaining 77 patients, histological verification of cytological diagnosis was not made and the patients were treated based on cytological diagnosis of small cell carcinoma. In 76% of cases (38/50) cytological diagnosis of small cell lung carcinoma was also confirmed histologically. In 8% of cases (4/50) adenocarcinoma was histologically confirmed, in 10% (5/50) of the cases the squamous carcinoma was confirmed, and there was one case of urothelial carcinoma, one case of sarcoma and one undifferentiated carcinoma. Cytological diagnosis of SCLC was made in all cases in a brush smear while the catheter aspirate was positive in only 32 cases (25.8%). Median survival in the group of patients with histologically confirmed small cell cancer was 238 days, for women 250 days, and for men 237 days. Cumulative survival was 63.2% for 6 months, 26.3% for 12 months, 13.2% for 18 months and 7.9% for two years. In conclusion, cytology is a reliable and relatively non-invasive method for patients. Our results confirm that there is a good correlation between cytology and histology diagnoses, especially when it comes to malignant lesions. In determining the type of tumor cytology must be supported with additional methods, especially in cases when it is not possible to take samples for histological verification.
The aim of the study was to evaluate the justification of Croatian modification of Bethesda classification after thirteen years of its application, answering the question if the subclassification of ...high-grade squamous intraepithelial lesion (HSIL) into cervical intraepithelial lesion (CIN) grade 2 (CIN2) and grade 3 (CIN3) is cytologically real and clinically justified. The retrospective study included 3110 women to whom cervical intraepithelial lesion of different grade was diagnosed by cytological examination of vaginal-cervical-endocervical (VCE) smear at Department of Clinical Cytology, Clinical hospital Osijek in period from 1993 to 2005. 57.1% of women were monitored cytologically and colposcopically, while 42.9% of them had also pathohistological examination. The spontaneous regression of cytological finding was noted in 66.3% of the cases. Moderate dysplasia regressed more often (50.98%) than severe dysplasia (31.3%) and more rarely than mild dysplasia (70.1%), which was statistically significant (p < 0.05). Comparing the first and the most serious cytological diagnosis during monitoring, it was found that mild dysplasia was also the most serious diagnosis in 80.1% of the cases, while in 19.9% of patients the initial diagnosis progressed into more severe lesion. Moderate dysplasia was also the most serious cytological diagnosis in 65.35% of the cases, while it progressed in severe dysplasia in 34.1% of the cases. Moderate dysplasia progressed more often into severe dysplasia than mild dysplasia (34.1% vs. 12.7%), which was statistically significant (p < 0.05). Positive predictive value of differential cytological diagnoses mild (23.7%), moderate (40.3%) and severe (90.1%) dysplasia calculated in relation to histological CIN3+ statistically significantly increases for every single diagnosis. Moderate dysplasia and severe dysplasia differ statistically (p > 0.05) in their biological behaviour and histological finding. In fact, 50.9% of moderate dysplasia spontaneously regressed, 14.4% persisted during follow-up, and 59.7% had a histological finding milder than CIN3. Therefore, in almost 65% of moderate dysplasia lesions it is not justified to apply the same diagnostic therapeutic procedures as for severe lesions, which means that cytological subclassification of HSIL into moderate dysplasia and severe dysplasia lesions is clinically justified. Positive predictive value of differential cytological diagnoses mild, moderate and severe dysplasia calculated in relation to histological CIN3+ statistically significantly increases for every single diagnosis, which also confirms that moderate dysplasia can be individual diagnostic category, thus the subclassification of HSIL is cytologically possible.
Endometrial cancer is the most common gynecological cancer but there is no economically justified screening method. Although we can detect endometrial cells in the sample using PAP test, many studies ...show low sensitivity and positive predictive value of PAP test for the diagnosis of endometrial cancer. The goal of this research was to determine significance of PAP test for the diagnostics of endometrial carcinoma. Sensitivity and specificity were analyzed with statistical parameters. VCE (vaginal, cervical, endocervical) smears of patients with histologically proven endometrial carcinoma were re-examined in order to determine the proportion of false negative results for endometrial cancer cells in the VCE samples. Study group consisted of all consecutive patients with PAP test performed at the Department of Clinical Cytology of the University Hospital Center Osijek from 2002 until the end of 2014. There was one inclusion criteria: subsequent hysterectomy or curettage within the six month after the PAP test, regardless of histological finding. From a total of 263 patients with previous PAP test and histologically proven endometrial cancer, endometrial cancer was cytologicaly diagnosed in 24.7% (including suspicious and positive findings), while 66.2% patients had normal cytological findings. The diagnostic value of PAP test in detection of endometrial cancer was statistically revealed with 25% sensitivity and 99% specificity. To determine false negative rate VCE samples were reviewed for patients with histologically proven endometrial cancer and negative VCE findings. There were a total of five negative results. In one case revision did not changed the original negative diagnosis, but benign endometrial cells, a lot of blood and inadequate cytohormonal status were found. In three out of four reviewed samples there were missed cells of endometrial adenocarcinoma. Review of remaining VCE sample upgraded the diagnosis from negative to suspicious for endometrial cancer. Proportion of error in the detection of endometrial cancer using cytological findings was 3.4% (true false negatives). Negative rate of the cytological findings in the detection of endometrial cancer was 66.2%. PAP test is not a suitable method for detection of endometrial carcinoma due to low sensitivity (25%). The main cause of negative findings in PAP test was lack of diagnostic cells in the sample.
