Cilj: Ispitati učestalost, kliničku evaluaciju i kirurško liječenje pacijenata s karcinomom bubrega (KB). Pacijenti i metode: Retrospektivnim istraživanjem bili su obuhvaćeni svi pacijenti u ...Kliničkom bolničkom centru Rijeka koji su između 1. siječnja 1972. i 31. prosinca 2012. godine operirani zbog KB-a. Rezultati: U promatranom razdoblju u našem centru zbog KB-a bilo je operirano 1045 pacijenata. Broj pacijenata se tijekom vremena povećao, s 5 pacijenata godišnje početkom 70-ih godina na preko 50 posljednjih nekoliko godina. Broj asimptomatskih pacijenata povećao se s 6 % na 75 %. Prosječna dob pacijenata bila je 63 godine (raspon 21 – 86 godina). Nefrektomija je učinjena u 95,3 % pacijenata, u 2,6 % parcijalna nefrektomija, a u 2,1 % eksplorativna lumbotomija. U promatranom razdoblju 5-godišnje preživljenje bilo je u 64 %, a 10-godišnje preživljenje 47 %. Zaključak: Učestalost KB-a se tijekom posljednja četiri desetljeća višestruko povećala. Novije dijagnostičke metode omogućuju njegovo otkrivanje u ranijoj fazi, a samim time se omogućuje poštednije kirurško liječenje, ne umanjujući onkološki učinak.
Cilj: Prikazati učestalost uroloških komplikacija nakon transplantacije bubrega u našem transplantacijskom centru. Ispitanici i metode: Retrospektivnim istraživanjem bili su obuhvaćeni svi pacijenti ...u Kliničkom bolničkom centru Rijeka u kojih je između 30. siječnja 1971. godine i 31. prosinca 2018. godine učinjena transplantacija bubrega. Rezultati: U promatranom razdoblju u našem transplantacijskom centru učinjeno je 1160 transplantacija bubrega. Urološke komplikacije imala su ukupno 154 pacijenta (13,3 %). Najčešće komplikacije su bile stenoza uretera u 52 pacijenta (4,5 %), urinarna fistula u 50 pacijenata (4,3 %), retencija urina u 23 pacijenta (1,9 %) te urolitijaza u 8 pacijenata (0,7 %). U većine pacijenata je provedeno kirurško liječenje. U posljednje vrijeme značajno se povećalo rješavanje uroloških komplikacija korištenjem minimalno-invazivnih metoda. U dvoje pacijenata (0,17 %) je zbog uroloških komplikacija došlo do gubitka grafta, a u troje pacijenata (0,25 %) su one dovele do smrtnog ishoda. Zaključak: Urološke komplikacije u našoj transplantacijskoj populaciji nisu česte. U pacijenata u kojih je potrebno kirurško liječenje endourološke metode predstavljaju danas inicijalnu metodu liječenja.
Aim: To evaluate the incidence of urological complications after kidney transplantation in our transplant center. Patients and Methods: We retrospectively analyzed all patients with kidney transplantation operated in University Hospital Rijeka from January 30st 1971 to December 31st 2018. Results: In the observed period 1160 kidney transplantations were performed in our transplant center. Urological complications were noticed in the 154 patients (13.3%). The most frequent complications were ureteral stenosis in 52 patients (4.5%), urinary fistula in 50 patients (4.3%), urinary retention in 23 patients (1.9%) and urolithiasis in the 8 patients (0.7%). The majority of the patients underwent surgical treatment. Recently, minimally invasive surgery was the method of choice for treatment of urological complications. In two patients (0,17%) urological complications caused graft loss and in the three patients (0,25%) this complications lead to death. Conclusion: Urological complications are not frequent in our transplant population. In the group of patients that required surgical treatment endourology methods are currently the initial treatment modality.
Cilj: Adultna policistična bolest bubrega je najčešća nasljedna bolest bubrega.Tijekom godina dolazi do povećanja cisti, smanjenja funkcionalne nefronske mase i kompresije uvećanih bubrega na okolne ...strukture. U ovom radu prikazujemo pacijenticu s policističnom bolesti bubrega, kod koje se nakon presađivanja bubrega razvila tromboza donje šuplje vene. Prikaz pacijenta: Tri mjeseca nakon transplantacije kadaveričnoga bubrega u lijevu ilijačnu jamu 67-godišnja pacijentica hospitalizirana je zbog otoka desne noge. Kliničkim i ultrazvučnim pregledom ustanovljena je duboka venska tromboza desne noge i uvedena je terapija heparinom. S obzirom na to da nije dolazilo do poboljšanja, učinjen je pregled kompjutoriziranom tomografijom kojim je potvrđena duboka venska tromboza desne noge, ilijačnih vena desno i parcijalna tromboza distalnog dijela donje šuplje vene. Nalazi radiološke obrade ukazali su na pritisak desnog policističnog bubrega na donju šuplju venu te smo, zbog sprječavanja kompletnog venskog zastoja na razini donje šuplje vene, učinili nefrektomiju policističnog bubrega. Poslijeoperacijski tijek bio je uredan, otok noge se smanjio i funkcija bubrežnog presatka je ostala stabilna. Rasprava i zaključak: U pacijenata s velikim policističnim bubrezima kompresija donje šuplje vene može dovesti i do njezine tromboze. Indicirana je pravovremena nefrektomija.
The aim of the present study was to evaluate the prognostic value of the local NK cell count in patients with recurrent non-muscle-invasive bladder cancer.
The archival paraffin-embedded primary ...tumor specimens were derived from retrospectively-selected patients, who were treated between 1996 and 2001 for bladder cancer. The study group consisted of 46 patients who developed recurrent disease during their first two post-operative years. The control group consisted of 27 patients who did not develop recurrent disease during their first two post-operative years. Specimens were assessed immunohistochemically with standard "ABC" technique. The frequency of NK cells was expressed as total number, estimated for each tumor by counting the positive NK cells in 10 high-power representative fields. Statistical analysis was done using Kruskal-Wallis test.
Patients with recurrent non-muscle invasive bladder cancer in general have significantly higher values of stromal NK cell count than the control group. Patients with single tumor and smaller tumors show a statistically significant difference in NK cell count between study and control group. There also exists a statistically significant difference in stromal NK cell count in patients with clinical stage Ta tumor.
Our results confirm an association of the bladder wall NK cell count in bladder cancer patients with the natural history of disease. Further well-performed, reproducible, large, prospective investigation stratified by clinical parameters, such as tumor number and diameter, is needed to display the true value of this marker in the clinical work-up of bladder cancer patients.
Autonomic dysreflexia (AD) is a syndrome that occurs in patients with high spinal cord lesion. It is caused by activation of sympathetic nervous system by a noxious stimulus below the level of ...injury, usually consisting of distention and/or irritation of the bladder or constipation. Sympathetic system activation leads to blood pressure elevation because compensatory mechanisms cannot properly regulate blood pressure due to the spinal cord lesions. The most important manifestation of AD is arterial hypertension because of the possible cerebrovascular and cardiovascular complications, including death. Initial treatment consists of recognition of the symptoms and resolution of the cause. In patients with high blood pressure antihypertensive therapy is initiated (with nifedipine, captopril and nitroglycerin). Prevention is also a very important task, with the goal of influencing all possible triggers of this condition, specially micturition and colon disorders. One of the most important tasks is educating patients, their caregivers and health professionals about AD.
Voiding dysfunction is frequently seen in the early posttransplant period. Among other causes, this condition can arise due to bladder outlet obstruction. Primary bladder neck obstruction (PBNO) is a ...possible but very rare cause of bladder outlet obstruction. We present the case of a 52-year-old woman who, after kidney transplantation, presented with PBNO. The diagnosis was established based on symptoms, uroflowmetry, and multichannel urodynamics with electromyography. The transurethral incision of the bladder neck was made at the 5- and 7-o’clock position. After the operation, the maximal flow rate was significantly increased, and postvoid residual urine was decreased compared to the preoperative findings. The patient was followed for 5 years, and her voiding improvement is persistent. This is the first reported case of PBNO treated with a transurethral incision of the bladder neck in a posttransplantation female patient.
We present a case of necrotizing vasculitis with the testicle as the isolated affected organ. A 25-year-old man, pretreated for epididymo-orchitis, presented with a presumed testicular neoplasm. ...Radical orchiectomy was performed and diagnosis of necrotizing vasculitis was established. In the absence of any other sign of systemic disease, the diagnosis of isolated necrotizing vasculitis of the testis was confirmed. Two years after the operation, the patient showed no symptoms of systemic disease.
Bone morphogenetic proteins (BMP) have the ability to induce ectopic bone formation. The findings of their expression in prostate cancers have been linked with specifically tumor progression to bone ...and development of osteosclerotic metastases. We investigated the expression pattern of BMP-2/4, -6 and -7 and the receptors BMPR-IA,-IB and -II in normal human prostate, organ-localized and metastatic prostate cancers. The expression we also examined in skeletal metastases caused by prostate cancer. In localized prostate cancers we found increased expression of BMP-6 and decreased expression of BMP-2/4 and -7. In metastatic prostate cancers the expression of examined BMPs decreased. The expression of BMPRs showed the tendency to be lower with progression of prostate cancer but the expression of BMPR-II was completely absent in metastatic prostate cancers. In bone metastases caused by prostate cancer we found high expression of BMP-2/4, -6 and -7. Decreased expression of BMPs and lose of BMPR-II expression, could suggest that the influence of BMPs on prostate cancer cells is inhibited and plays an important role in prostate cancer pathogenesis. High expression of osteogenic BMPs in prostate cancer bone metastases could explain their osteosclerotic properties.
Today successful kidney transplantation procedures, techniques and immunosuppression protocols are a consequence of extensive research on animal models. During every transplantation surgery there are ...two crucial points for the success of the entire procedure: vascular (arterial end venous) and ureteral or ureterovesical anastomosis. Renal artery and vein of the donor kidney can be anastomosed end-to-side to the abdominal aorta and vena cava of the recipient (heterotopic transplantation), or end-to-end to the remains of renal artery and vain of the recipient (orthotopic transplantation) after nephrectomy. The ureter can be anastomosed also end-to-end or we can connect it directly to the urinary bladder (ureterocystoneostomy). The aim of this study was to elucidate which technique has better results according to: animal survival, reperfusion and perfusion of the transplanted kidney, elimination of the urine from the transplanted kidney and procedure costs. The study included 240 (120 donors and 120 recipients) male Wistar rats (3 months old; weight 250-300 g Our results are clearly showing that the end-to-end vascular anastomosis, and Paquins ureterovesical anastomosis have better results in transplanted rat kidneys survival and urine drainage compared to end-to-side vascular anastomosis and end-to-end ureteral anastomosis. Based on our experience we can conclude that described methods of end-to-end vascular anastomosis and Paquins ureterovesical anastomosis are less technically demanding and have a shorter learning curve. Therefore, we can recommend the use of described methods in kidney transplantation related researches.
Renal cell carcinoma (RCC) is the most common malignant tumor of the kidney. The major goal of imaging techniques is to correctly differentiate between benign and malignant renal lesions. We present ...the cases of six patients with renal masses that were interpreted completely differently based on ultrasound (US) and computerized tomography (CT) findings.From January 1st, 2008 to March 1st, 2014, 307 patients from our center underwent nephrectomy for RCC. In all patients US and CT were performed before the operation.In six patients, the US indicated a focal, solid renal lesion that was interpreted by CT as a cystic lesion (Bosniak II-III). Because discrepancies were evident, renal biopsies were performed. The biopsies revealed RCC in the six patients, all of whom underwent subsequent nephrectomy. All of the patients were confirmed to have macroscopically solid RCC without any cystic components.In most cases, CT is the most accurate diagnostic technique for the clinical diagnostic classification of renal masses. In cases where US characterizes a renal lesion as solid, despite CT findings of a cystic lesion, kidney biopsies are recommended. The 6 cases reported here support our belief that, in diagnostic processes of RCC, these techniques should be complementary used.
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