Cilj istraživanja: Predstaviti naše inicijalno iskustvo s laparoskopskom pijeloplastikom u djece, procijeniti sigurnost i kratkoročni ishod. Ispitanici i metode: Retrospektivno je analizirana ...medicinska dokumentacija sve djece koja su u trogodišnjem periodu od 2019. do 2022. godine laparoskopski operirana zbog opstrukcije pijeloureteričnog vrata u Kliničkom bolničkom centru Zagreb. Rezultati: Ukupno desetoro djece, dobi od 10 mjeseci do 17 godina (medijan 4,3 godine) operirano je laparoskopski. Četiri djevojčice i šest dječaka. U osmero bolesnika se radilo o lijevom bubregu, a kod dvoje o desnom. Prosječni promjer pijelona je iznosio 35 mm i prosječna separatna funkcija zahvaćenog bubrega je bila 40%. Intrizična stenoza kao uzrok opstrukcije našla se kod osmero djece, a kod dvoje se radilo o aberantnim krvnim žilama za donji pol bubrega. Prosječno vrijeme trajanja operacije bilo je 190 minuta (raspon 120 – 240 min) dok je prosječno vrijeme hospitalizacije bilo 3,2 dana (raspon 2 – 6 dana). Kod dvoje djece stavljen je abdominalni dren. Nije bilo konverzije u otvoreni zahvat, kao ni intraoperativnih i ranih postoperativnih komplikacija. Peroralni unos je započet 4 – 10 sati nakon operacije. Praćenje pacijenata je bilo od 2 do 40 mjeseca (prosječno 7,8). Prosječni postoperativni promjer pijelona u djece kod kojih je prošlo više od 6
mjeseci od operacije bio je 9,5 mm. Zaključak: Laparoskopska pijeloplastika je sigurna i učinkovita metoda u liječenju djece s opstrukcijom pijeloureteričnog vrata.
Low bone mineral density has been reported in paediatric and adult patients with different lung diseases, but limited data are available on the association between lung function and bone density in a ...healthy young population. We explored the predictors of association between bone mass and pulmonary function in healthy first-year university students, focusing on body mass index (BMI). In this cross-sectional study we measured bone density with ultrasound and lung function with spirometry in 370 university students (271 girls and 99 boys). Information on lifestyle habits, such as physical activity, smoking, and alcohol consumption were obtained with a questionnaire. All lung function and bone parameters were significantly higher in boys than in girls (P<0.001). Underweight students had a significantly lower forced vital capacity (FVC%) (P=0.001 girls; P=0.012 boys), while overweight students had a significantly higher FVC% than normal weight students (P=0.024 girls; P=0.001 boys). BMI significantly correlated with FVC% (P=0.001) and forced expiratory volume in 1 second (FEV
%) in both genders (P=0.001 girls; P=0.018 boys) and with broadband ultrasound attenuation (BUA) in boys. There were no significant associations between any of the bone and lung function parameters either in boys or girls. The most important determinant of lung function and ultrasound bone parameters in our study population was body mass index, with no direct association between bone density and lung function.
Polymorphisms of cytokine genes are an interesting focus for association studies involving atopic diseases due to their role in immune cell communications during inflammation. The aim of this study ...was to investigate associations of TNFα -308G>A, TNFα -238G>A, IL-1α -889C>T and IL-10 -1082G>A polymorphisms with atopic diseases with adjustment for confounding lifestyle and environmental factors.
This study was performed on 356 Croatian students. The diagnosis of atopic asthma, atopic rhinitis and atopic dermatitis was based on symptoms reported by the modified International Study of Asthma and Allergies in Childhood questionnaire and a positive skin prick test (SPT) to at least one common inhalatory allergen. Genetic polymorphisms were genotyped using the polymerase chain reaction-based technique. The influence of personal (gender, body mass index, parental history of atopic disease), lifestyle (cigarette smoking, pet ownership) and environmental (urban/rural residency, residency in continental/Mediterranean region) factors reported in the questionnaire was investigated by univariate and multivariate analysis.
Compared to the control subjects, univariate analysis showed a significant negative association of the TNFα -308G>A polymorphism with atopic asthma, atopic dermatitis, asthma and skin symptoms and positive SPT. These observations were confirmed in a multivariate model only for atopic dermatitis and skin symptoms (atopic dermatitis: OR = 0.27; 95% CI 0.07-1.00; p = 0.050; skin symptoms: OR = 0.29; 95% CI 0.10-0.83; p = 0.021).
The results indicate a protective role of TNFα -308G>A genetic polymorphisms regarding atopic dermatitis and skin symptoms even after controlling for personal, lifestyle and environmental factors. Further studies are needed to elucidate the molecular patterns of this association in atopic dermatitis and other chronic inflammatory skin disorders.
The use of renal cortical slices in vitro and the data obtained in these studies have been subjects of controversy, largely due to uncertain viability, e.g., structural and functional integrity of ...the proximal and other tubules. However, detailed studies of tubule integrity have not been reported. To correlate functional and structural viability of the hand-cut rat renal cortical slices, incubated in optimally conditioned media for up to 25 h, we studied the time course of p-aminohippurate (PAH) uptake, the immunocytochemical distribution of several proteins that reside in the proximal tubule basolateral Na/K-ATPase, organic anion transporters (OAT)1 and OAT3, or brush border megalin, sodium-proton exchanger (NHE)3 membrane, as well as the general integrity of the tubule epithelium and its cytoskeleton (actin filaments, microtubules). PAH uptake in slices was proportional to time within 1 h of incubation and gradually declined thereafter. The immunostaining experiments indicated a fast, time-dependent loss of basolateral transporters, at a rate of OAT1 > Na/K-ATPase > OAT3. In the brush border membrane, the loss of megalin was faster than that of NHE3, and a partial redistribution of NHE3 into the basolateral domain indicated the loss of cell polarity. The loss of intracellular actin and tubulin cytoskeleton in the proximal tubule was already visible after 15 min of incubation and gradually increased with time, whereas a partial redistribution of actin to the basolateral domain indicated a compromised polarity of the cells. The data also revealed very early (after 15 min) necrotic events in the proximal tubule epithelium, with sloughing of brush border and cell debris into the tubule lumen, detachment of cells from the basal membrane, and opening and widening of the tubule lumen. We conclude that the loss of cellular structure, cytoskeleton, and cell membrane transporters in the nephron epithelium is a very early event in the incubated rat renal cortical slices.
A significant increase in the occurrence of allergic respiratory diseases has been perceived in the world in the last several decades. One of the presumed causes of this phenomenon is the ...contemporary altered dietary pattern. Many studies investigated the possible inflammatory or anti-inflammatory effects of various nutrients in the pathophysiology of respiratory allergies. Recent epidemiological studies reported an association between a high intake
of w-6 and a low intake of w-3 polyunsaturated fatty acids (PUFA-s) with the elevated prevalence of respiratory allergies. w-6 PUFA-s are precursors of strong inflammatory mediators which promote allergic inflammation, whereas metabolites of w-3 PUFA-s are weak inflammatory mediators. However clinical trials of w-3 supplementation failed to show substantial beneficial results. A high dietary intake of salt could have a bronchoconstrictive
effect in the pathogenesis of asthma, whereas magnesium is considered to act bronchodilatatively, yet most research in asthmatic patients has not proven these proposed impacts. Antioxidants, such as vitamin C, E, A, flavonoides, isoflavones and some trace elements (selenium, zinc, manganese, copper) are relevant in diminishing oxidative stress. Despite epidemiological and some clinical evidence of a protective antioxidant effect against the development of respiratory allergies, interventional studies mainly have
not confirmed significant benefit of antioxidant supplementation therapy. Due to a large amount of controversial scientific evidence regarding the possibility of preventing and treating respiratory allergies with a modified diet, there is a need for further research in this field.
Wood processing is usually performed in environments with large amounts of endotoxin-rich bioaerosols that are associated with a variety of health effects. The aim of this preliminary study was to ...assess the relation between endotoxin levels in settled and airborne dust in wood-processing industry. Ten pairs of airborne and settled dust samples were collected in a sawmill and parquet manufacture of two wood-processing plants in Croatia. Endotoxin was assayed with a chromogenic end-point LAL (Limulus amebocyte lysate) method. The results showed that endotoxin levels in airborne respirable dust were above the proposed occupational exposure limit of 125 EU m-3 and could be considered hazardous for the respiratory system. In settled dust they ranged between 229.7 EU mg-1 and 604.3 EU mg-1 and in airborne dust between 166.8 EU mg-1 and 671.6 EU m-3, but there was no significant correlation between them (Spearman's rho=0.358, P=0.310). This study points to sawmill settled dust as endotoxin reservoir and suggests that it may add to already high exposure to airborne endotoxins associated with wood processing. Investigations of the relation between settled and airborne endotoxin levels should be continued to better understand the sources and sites of endotoxin contamination in wood-processing industry.
Drvoprerađivačka industrija radna je sredina s izloženošću velikim količinama bioaerosola bogatog endotoksinom, što je povezano s učincima na zdravlje izložene radne populacije. Cilj ove studije bio je procijeniti odnos između razina endotoksina u sedimentiranoj prašini i zraku (aerosoliziranoj prašini) drvoprerađivačkih radnih prostora. Deset parova uzoraka zraka i sedimentirane prašine skupljeno je u dvije tvornice za preradu drva (pilanama i pogonima za proizvodnju parketa) u Hrvatskoj. Endotoksin je izmjeren kromogenom "end-point" LAL (Limulus amebocitni lizat) metodom. Rezultati su pokazali da razine endotoksina u aerosoliziranoj respirabilnoj prašini drvoprerađivačkih pogona prelaze preporučene granice izloženosti za radne prostore od 125 EU m-3, pa se mogu smatrati štetnima za dišni sustav izloženih radnika. Razine endotoksina izmjerene u sedimentiranoj i aerosoliziranoj prašini kretale su se u sličnu rasponu (229.7 do 604.3) EU mg-1 i (166.8 do 671.6) EU m-3, ali nije utvrđena značajna korelacija razina endotoksina između parova uzoraka sedimentirane i aerosolizirane prašine (Spearman rho=0.358, P=0.310). Ovi rezultati upućuju na to da uz velike količine proizvedene i aerosolizirane drvne prašine u sklopu radnih operacija u pilanama, razini endotoksina u aerosoliziranoj respirabilnoj prašini može pridonijeti i uskovitlana sedimentirana prašina koja je dodatni rezervoar endotoksina. Istraživanje odnosa između razina endotoksina u sedimentiranoj i aerosoliziranoj prašini treba nastaviti kako bi se bolje definirali izvori i mjesta kontaminirana endotoksinom u pilanama.
SAŽETAK
Ciljprikazati metodu i rane ishode prvih 20 dječaka i adolescenata kod kojih je učinjena mikrokirurška varikokelektomija na Zavodu za dječju kirurgiju Kliničkoga bolničkog centra Zagreb. Ova ...metoda prema literaturnim podatcima ima najmanju učestalost recidiva i komplikacija.
Ispitanici i metodeIndikacije za mikrokiruršku operaciju jesu simptomatska varikokela, hipotrofija testisa (zahvaćeni testis volumno manji od zdravog za >20%), te poremećaj spermiograma kod adolescenata u završnom (Tanner 5) stadiju spolnog razvoja. Varikokela i hipotrofija testisa utvrđeni su kliničkim pregledom, ultrazvučnom volumetrijom i dopplerskim pregledom. Operacija se izvodi kroz rez duljine 3 – 4 cm u razini vanjskoga ingvinalnog otvora. Pacijenti su praćeni prospektivno nakon operacije, a prosječno vrijeme praćenja bilo je deset mjeseci (raspon 6 – 12 mjeseci).
RezultatiProsječno trajanje operacije bilo je 65 minuta. Svi pacijenti su otpušteni kući unutar 24 sata od operacije, a vratili su se svim aktivnostima unutar dva tjedna nakon operacije. Tijekom kontrolnih pregleda nije zabilježen recidiv varikokele, kod svih pacijenata koji su operirani zbog simptoma došlo je do nestanka tegoba, dok je kod onih koji su operirani zbog lošeg spermiograma došlo do oporavka ejakulata. Od komplikacija, jedan pacijent je imao prolaznu nelagodu kod ejakulacije. Kod jednog pacijenta je intraoperativno neželjeno podvezana testikularna arterija koja je odmah rekonstruirana termino-terminalnom anastomozom uz uredne protoke na kontrolnim dopplerskim pregledima sjemenskog snopa, bez znakova atrofije testisa.
ZaključakMikrokirurška varikokelektomija je sigurna metoda za liječenje varikokele sa visokom uspješnošću i malim brojem komplikacija.
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