Bubrežna presadba se smatra najboljim postupkom nadomještanja bubrežne funkcije u bolesnika sa završnim stupnjem kronične bubrežne bolesti. Povećanje dobi i darovatelja i primatelja dovodi do ...povećane složenosti implantacije bubrega. Dodatno, periferna žilna bolest je diljem svijeta u porastu, što dovodi do otežavanja kirurškog postupka, ali i do lošijih dugoročnih ishoda transplantacije uključujući i smanjeno preživljenje presatka
i/ili bolesnika. Unatoč tomu dijalitičko liječenje ima lošije ishode te se i u vaskularno složenijih bolesnika preporučuje učiniti bubrežnu presadbu. Neki od otežavajućih vaskularnih čimbenika jesu izrazito kalcificirane krvne žile, postojanje aortoilijačnih ili endovaskularnih proteza te višestruke transplantacije (potreba za trećom i/ili četvrtom
transplantacijom u prethodno zauzetim ilijačnim jamama). Prije same transplantacije u tih bolesnika veoma je važno učiniti prikladnu slikovnu obradu koja ponekada mora biti invazivna. Nužno je prije transplantacije odabrati mjesto implantacije, informirati bolesnika o složenosti zahvata i mogućim komplikacijama pa čak i o mogućem intraoperacijskom odustajanju od transplantacije. Moguće mjesto implantacije može biti sama žilna proteza, proksimalnije krvne žile sve do aorte i donje šuplje vene, uključujući i njih. U nekih bolesnika dobra alternativa je ortotopna bubrežna presadba. Broj komplikacija je veći nego u standardnoj transplantacijskoj populaciji. Zaključno, možemo reći kako je transplantacija u ovih bolesnika izazovan kirurški postupak s većim pobolom i većom smrtnosti te smanjenim preživljenjem presatka i bolesnika te zahtijeva iskusan kirurški tim.
Cilj: Prikazati bolesnika u kojeg je maligna neoplazma bubrega uzrok Wunderlichovog sindroma i ukazati na važnost prepoznavanja Wunderlichovog sindroma u kliničkoj praksi. Wunderlichov sindrom ...označava pojavu akutnog, netraumatskog, spontanog krvarenja u supkapsularni ili perirenalni prostor. Prikaz slučaja: Na hitni bolnički prijam primljen je muškarac s bolovima u lijevom dijelu abdomena, praćenih mučninom i vrtoglavicom te jednom tamnijom stolicom. Fizikalnim pregledom nije pronađen nikakav patološki nalaz, ali ultrazvučnim pregledom ustanovljena je veća perirenalna kolekcija. Daljnjom obradom, uključujući i kompjutoriziranu tomografiju, utvrđena je tvorba na gornjem polu lijevoga bubrega, kao i opsežniji perirenalni hematom. Pacijentu je učinjena hitna nefrektomija te evakuacija perirenalnog hematoma. Patohistološki nalaz potvrdio je kako se radi o karcinomu bubrega (svjetlostanični tip) koji je rupturirao. Dvije godine kasnije, pacijent se ponovno javio u hitni bolnički trakt radi teške parapereze. Magnetska rezonancija pokazala je koštane metastaze u području torakalne kralježnice s širenjem u spinalni kanal. Pacijentu je hitno učinjena laminektomija uz redukciju tumora u spinalnom kanalu. Imunohistokemijskim bojenjima dokazano je da se radi o metastazama karcinoma bubrega. Pacijent je upućen na daljnje onkološko liječenje. Zaključak: Wunderlichov sindrom iznimno je rijetka pojava u urološkoj praksi, ali treba biti uključen u diferencijalnu dijagnozu kod pacijenata koji se javljaju s bolovima u lumbalnoj regiji, palpabilnom tvorbom i znakovima šoka. Sindrom je etiološki najčešće vezan uz benigne neoplazme bubrega, ali može biti posljedica malignih novotvorina kao kod našeg bolesnika.
Aim: To present a case in which a malignant neoplasm of the kidney is the cause of Wunderlich syndrome and point out the importance of recognizing this syndrome in clinical practice. Case report: A male patient came to the emergency unit with pain in his left hemiabdomen, nausea, dizziness, and a darker stool. Physical examination did not reveal any pathological findings, but ultrasound examination revealed a more abundant perirenal collection. A detailed examination and CT finding revealed a mass on the upper pole of the left kidney as well as a more extensive perirenal hematoma. The urgent nephrectomy was performed and pathohistological findings confirmed that it was renal cell carcinoma (clear cell subtype). Two years later, the patient reappeared in the emergency department of the hospital due to severe paraparesis. After physical examination, the patient was sent for magnetic resonance imaging, which showed secondary pathological remodeling at several levels of the thoracic spine and the spread of the pathological process in the spinal canal. The patient then underwent laminectomy with reduction of the tumor in the spinal canal and the sample was sent for pathohistological analysis. Immunohistochemical staining confirmed renal cell carcinoma metastases. The patient was then sent for further oncological treatment. Conclusion: Wunderlich syndrome has an extremely rare occurrence in urological practice but should be included in the differential diagnosis in patients presenting with lumbar pain, palpable mass and signs of shock. This syndrome is most frequently associated with benign renal neoplasms, but, as in our patient, may be associated with malignant tumors.
Cilj: Ispitati upućenost studenata o tumorima testisa, poznavanju samopregleda i motiviranosti da steknu dodatna znanja o ovoj bolesti. Ispitanici i metode: U istraživanje je bilo uključeno 116 ...studenata Sveučilišta u Rijeci. Prvu grupu (42 studenta) sačinjavali su studenti prve godine Odjela za informatiku, drugu su grupu sačinjavala 44 studenata druge godine Odjela za informatiku, a 30 mladića ostale studentske populacije sačinjavalo je treću grupu. Za istraživanje se koristio anonimni anketni upitnik s 18 pitanja. Rezultati: Medijan dobi u prvoj i trećoj grupi bio je 19 godina, a u drugoj grupi 20 godina. Najveći broj studenata dolazio je iz Primorsko-goranske županije. O tumorima testisa čulo je 71,4 % studenata iz prve grupe, 93,2 % studenata iz druge grupe i 90 % studenata iz treće grupe. Najvažniji izvor informacija za sve tri grupe su Internet i televizija. Samopregled testisa učinilo je 57,8 % ispitanika, a samo njih 45,7 % zna kako ga ispravno učiniti. Zaključci: Studenti su putem Interneta i televizije upoznati s tumorima testisa i imaju želju da budu još bolje informirani. Samopregled testisa, kojim se ova bolest može otkriti, provodi samo oko 50 % studenata, a manje od 50 % ih zna kako ga i učiniti, što je nezadovoljavajuće. Podatci dobiveni našom studijom pokazuju kako je neophodno provesti edukaciju studenata o ovom zdravstvenom problemu.
Aim: The aim of the study was to examine students’ awareness of testicular tumors, their knowledge of self-examination, and motivation to learn more about the disease. Subjects and Methods: The survey was conducted among 116 students of the University of Rijeka. The first group (42 students) consisted of first year students of the Department of Informatics, the second group consisted of 44 students of the second year of the Department of Informatics and the third group consisted of 30 young men of other student population. The survey used an anonymous survey questionnaire with 18 questions. Results: The median age of the participants in the first and third group was 19 years and 20 years in the second group. The largest number of students came from Primorje-Gorski Kotar County. The information about testicular tumor was known in 71.4% of students in the first group, 93.2% of students in the second group and 90% of students in the third group. The most important source of information for all three groups is the Internet and television. The testicular self-examination was done by 57.8% of the participants, and only 45.7% knew how to do it properly. Conclusions: Students are familiar with testicular tumors via the Internet and television and are eager to be better informed. Testicular self-examination, the method that can detect this disease, is conducted by only 50% of students, and less than 50% know how to do it, which is unsatisfactory. The data of our study show that it is necessary to educate students about this health problem.
Extracorporeal shockwave lithotripsy is not a novel therapeutic method in the treatment of urolithiasis. It uses shock waves (SW) created in the generator outside of the body that are then focused ...and directed on the calculus in the patient's body. It is the method of choice for the treatment of kidney stones smaller than 20 mm, and those in the proximal part of the ureter (up to 10 mm). Complications are relatively rare and most often clinically insignificant. SW can reversibly damage all parts of the renal parenchyma. The degree of damage depends on the number of SW and the energy level delivered to a particular tissue. Such changes are most often asymptomatic. Microhaematuria is present in virtually all patients, and macrohaematuria occurs in about 1/3 of patients. A rare but serious complication is a kidney rupture that requires surgical care that can sometimes lead to a nephrectomy. The occurrence of perinephric or subcapsular hematoma is rare and usually requires only conservative therapy. Despite the aforementioned negative impact of SW on the renal parenchyma (primarily around the calculus), studies have not shown that treatment with this method leads to significant renal function impairment in either the adult or paediatric population. Key words: Extracorporeal shockwave lithotripsy; Nephrolithiasis; Renal injury; Renal function
Context/Objective Autonomic dysreflexia is a clinical syndrome affecting persons with spinal cord lesions. The aim of the study was to detect the level of knowledge among students about autonomic ...dysreflexia in persons with spinal cord lesions.
Design: Single centre questionnaire study.
Setting: Faculty of Health Studies, Rijeka, Croatia.
Participants Nursing (n = 43) and physiotherapy (n = 48) students.
Outcome Measures: AD knowledge test.
Results: More of the half of the students (57%) had contact with persons with spinal cord lesions during work, especially nursing students. The self-estimated knowledge of autonomic dysreflexia was judged as poor or none in 73.6% of students. On the autonomic dysreflexia knowledge test, nursing students collected mean of 5.6 points and physiotherapy students 4.9 points (P = 0.173). There was no difference in the autonomic dysreflexia test results regardless of work experience or group affiliation.
Conclusion: The level of knowledge about autonomic dysreflexia among students was low. Our results suggest the need for more education of students and health care professionals to apply adequate treatment to persons with episodes of autonomic dysreflexia.
Chronic kidney disease (CKD) is among the most significant health problems, with the associated cardiovascular disease and bone metabolism disorders being the leading cause of morbidity and mortality ...in these patients. The aim of the study was to determine markers of bone turnover in patient sera (phosphates, calcium, alkaline phosphatase, parathyroid hormone and osteoprotegerin (OPG)) in all stages of kidney failure including kidney transplant recipients. We also wanted to determine whether dialysis vintage affects recovery of bone markers one year after transplantation. There were 164 study patients, whereas 30 healthy individuals served as a control group. Serum OPG progressively increased with decline of the glomerular filtration rate. The highest OPG concentration was recorded in dialysis group. We observed a statistically significant OPG increase in stage 2 CKD. In kidney transplant group, there was positive correlation between OPG and dialysis vintage. We also found that serum OPG was lower in patients treated with dialysis for less than 4 years prior to transplantation. We confirmed that CKD-mineral and bone disorder began in stage 3 CKD with parathyroid hormone and OPG elevation, and a statistically significant OPG increase in stage 2 CKD might be an early sign of CKD-mineral and bone disorder. Dialysis vintage longer than 4 years is associated with more significant disturbances in mineral and bone metabolism.Chronic kidney disease (CKD) is among the most significant health problems, with the associated cardiovascular disease and bone metabolism disorders being the leading cause of morbidity and mortality in these patients. The aim of the study was to determine markers of bone turnover in patient sera (phosphates, calcium, alkaline phosphatase, parathyroid hormone and osteoprotegerin (OPG)) in all stages of kidney failure including kidney transplant recipients. We also wanted to determine whether dialysis vintage affects recovery of bone markers one year after transplantation. There were 164 study patients, whereas 30 healthy individuals served as a control group. Serum OPG progressively increased with decline of the glomerular filtration rate. The highest OPG concentration was recorded in dialysis group. We observed a statistically significant OPG increase in stage 2 CKD. In kidney transplant group, there was positive correlation between OPG and dialysis vintage. We also found that serum OPG was lower in patients treated with dialysis for less than 4 years prior to transplantation. We confirmed that CKD-mineral and bone disorder began in stage 3 CKD with parathyroid hormone and OPG elevation, and a statistically significant OPG increase in stage 2 CKD might be an early sign of CKD-mineral and bone disorder. Dialysis vintage longer than 4 years is associated with more significant disturbances in mineral and bone metabolism.
Studies show insufficient sensitivity of virtual non-contrast (VNC) reconstructions for stone detection in dual-energy CT urography (DE-CTU). The aim of this study was to investigate if ...side-by-side-evaluation of both VNC and post-contrast images could increase the sensitivity of single-phase split bolus DE-CTU.
Consecutive patients with haematuria who underwent split bolus DE-CTU on the same dual-source DE-CT scanner were retrospectively enrolled in the study. Intravenous furosemide and oral hydration were employed. Two readers, independently and then jointly in two separate sessions, recorded the location and the longest axial stone diameter on three randomised sets of images: separate VNC and post-contrast images, and side-by-side-reconstructions. True non-contrast (TNC) images served as the standard of reference.
A total of 83 urinary stones were detected on TNC images. Independent reader side-by-side-evaluation of VNC and post-contrast images yielded higher stone detection sensitivity (76 and 84%, respectively) compared to evaluation of only VNC (71 and 81%, respectively) or post-contrast images (64 and 80%, respectively). The sensitivity of joint reader evaluation of side-by-side-images reached almost 86% and was not significantly different from TNC images (
= 0.77). All stones larger than 3 mm were correctly detected by side-by-side-evaluation. Dose reduction of 55% could be achieved by omitting TNC scans.
Side-by-side-VNC and post-contrast image evaluation enable detection of clinically significant urolithiasis on single-phase split bolus DE-CTU with significant dose reduction.
This study shows that single-phase DE-CTU is feasible if VNC imaging is simultaneously utilised with post-contrast images.
Urolithiasis is a rare urologic complication after kidney transplantation, and its diagnosis and treatment can be challenging for clinicians. In our 52-year-old male patient, graft hydronephrosis was ...found six months after transplantation. The patient had recurrent urinary tract infections followed by macrohematuria and an increase in creatinine levels. Computerized tomography revealed a 13-mm diameter stone in the ureter of the transplanted kidney as the cause of obstruction. Percutaneous nephrostomy was placed in the graft to solve the obstruction. Initial endoscopic treatment with a retrograde approach failed. An antegrade approach through a previously placed nephrostomy was not successful either. By a repeated retrograde approach, laser lithotripsy was performed successfully. The patient has been monitored for six months and has stable graft function without hydronephrosis or stones. As in our patient's case, the diagnosis and treatment of urolithiasis in kidney transplant patients is challenging, and minimally invasive procedures are the treatment of choice.Urolithiasis is a rare urologic complication after kidney transplantation, and its diagnosis and treatment can be challenging for clinicians. In our 52-year-old male patient, graft hydronephrosis was found six months after transplantation. The patient had recurrent urinary tract infections followed by macrohematuria and an increase in creatinine levels. Computerized tomography revealed a 13-mm diameter stone in the ureter of the transplanted kidney as the cause of obstruction. Percutaneous nephrostomy was placed in the graft to solve the obstruction. Initial endoscopic treatment with a retrograde approach failed. An antegrade approach through a previously placed nephrostomy was not successful either. By a repeated retrograde approach, laser lithotripsy was performed successfully. The patient has been monitored for six months and has stable graft function without hydronephrosis or stones. As in our patient's case, the diagnosis and treatment of urolithiasis in kidney transplant patients is challenging, and minimally invasive procedures are the treatment of choice.
Urinary bladder cancer is one of the most common cancers of the urinary tract. This cancer is characterized by its high metastatic potential and recurrence rate. Due to the high metastatic potential ...and recurrence rate, correct and timely diagnosis is crucial for successful treatment and care. With the aim of increasing diagnosis accuracy, artificial intelligence algorithms are introduced to clinical decision making and diagnostics. One of the standard procedures for bladder cancer diagnosis is computer tomography (CT) scanning. In this research, a transfer learning approach to the semantic segmentation of urinary bladder cancer masses from CT images is presented. The initial data set is divided into three sub-sets according to image planes: frontal (4413 images), axial (4993 images), and sagittal (996 images). First, AlexNet is utilized for the design of a plane recognition system, and it achieved high classification and generalization performances with an AUCmicro¯ of 0.9999 and σ(AUCmicro) of 0.0006. Furthermore, by applying the transfer learning approach, significant improvements in both semantic segmentation and generalization performances were achieved. For the case of the frontal plane, the highest performances were achieved if pre-trained ResNet101 architecture was used as a backbone for U-net with DSC¯ up to 0.9587 and σ(DSC) of 0.0059. When U-net was used for the semantic segmentation of urinary bladder cancer masses from images in the axial plane, the best results were achieved if pre-trained ResNet50 was used as a backbone, with a DSC¯ up to 0.9372 and σ(DSC) of 0.0147. Finally, in the case of images in the sagittal plane, the highest results were achieved with VGG-16 as a backbone. In this case, DSC¯ values up to 0.9660 with a σ(DSC) of 0.0486 were achieved. From the listed results, the proposed semantic segmentation system worked with high performance both from the semantic segmentation and generalization standpoints. The presented results indicate that there is the possibility for the utilization of the semantic segmentation system in clinical practice.
Computerized tomography (CT) is the most accurate method for evaluating pelvic calcifications, which are of utmost importance for planning kidney transplantation (KT). The aim of our study was to ...evaluate the incidence and distribution of iliac artery calcifications and correlate the novel pelvic calcification score (PCS) with cardiovascular risk factors and graft and overall survival in KT patients.
We retrospectively included 118 KT patients operated at our institution with pretransplant pelvic CT. Calcification morphology, circumference and length of both common and external iliac arteries were independently scored by two uroradiologists. PCS was calculated as the total score sum of all three calcification features in all vessels. PCS correlation with graft and patient survival was performed.
Calcification in at least one vascular segment was found in 79% of patients. PCS was significantly higher in male patients (
= 0.006), patients over 55 years (
< 0.001), and patients on haemodialysis (
= 0.016). Patients with a PCS >3 had significantly shorter graft and overall survival rates (
= 0.041 and
= 0.039, respectively).
The extent of iliac artery calcification in KT recipients quantified by PCS on pretransplant CT correlates with graft and overall patient survival. A PCS over three was associated with worse clinical outcomes and could become a possible prognostic factor.
Our novel PCS is a robust method for quantifying iliac artery calcification burden. Since higher a PCS correlates with worse patient and graft survival, PCS has the potential to become a prognostic factor in kidney transplant patients.
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