70 research outputs found
The history of kidney transplantation in the SuŔak hospital
Transplantacija bubrega najuÄinkovitija je metoda nadomjeÅ”tanja bubrežne funkcije.
Iako prvi poÄeci transplantacije datiraju iz druge polovice 19. stoljeÄa, razvoj transplantacije
seže u drugu polovicu 20. stoljeÄa. U bolnici na SuÅ”aku prvi eksperimentalni kirurÅ”ki postupci
koji su prethodili zahvatima na ljudima poÄeli su 1966. godine. Razvoj transplantacije bubrega
omoguÄilo je uvoÄenje dviju drugih metoda nadomjeÅ”tanja bubrežne funkcije ā hemodijalize i
peritonejske dijalize. Time su steÄeni uvjeti za razvoj svih metoda nadomjeÅ”tanja bubrežne
funkcije do danas. Prva transplantacija bubrega sa živog davatelja u bolnici na SuŔaku izvrŔena
je 31. sijeÄnja 1971., a godinu dana kasnije i prva transplantacija bubrega s umrlog davatelja.
Posljednjih 40 godina napredak transplantacijske medicine u Rijeci i Hrvatskoj rezultirao je Äinjenicom
da je Rijeka i danas jedan od vodeÄih transplantacijskih centara u Hrvatskoj, a od
2003. godine Klinika za urologiju je Referentni centar Ministarstva zdravstva za transplantaciju
bubrega. Daljnji razvoj transplantacije bubrega ali i dijalize u Rijeci neupitan je, temelji se na
velikom iskustvu, struÄnosti, znanstvenom radu brojnih naraÅ”taja lijeÄnika i medicinskih sestara,
a osigurava se trajnom edukacijom mladih kroz brojne nastavne sadržaje na Medicinskom
fakultetu SveuÄiliÅ”ta u Rijeci.Kidney transplantation is the most efficient method of renal replacement therapy
(RRT). Although first surgical activities were performed in the 19th century, real development
of the kidney transplantation occured in the second part of 20th century. In the SuŔak hospital,
first experimental surgical acts on the animal models started in year 1966. Development
of kidney transplantation was possible after the introduction of two other methods for RRT
ā hemodialysis and peritoneal dialysis. The first kidney transplantation from living related
donor in the SuŔak hospital was performed on January 31st 1971, one year after first transplantation
from cadaveric donor. In the last 40 years, development of transplantation medicine
in Rijeka and Croatia was succesful and Rijeka is one of the top transplantation centers
in Croatia today. From year 2003, Clinic for urology developed the Referrent center for kidney
transplantation under auspicies of the national Ministry of Health. Development of
both kidney transplantation and dialysis became possible on the base of the great experience,
knowledge and scientific work of generations of doctors and nurses. Permanent education
in the field of RRT of the young generation is a continuous process at the Faculty of
Medicine, University of Rijeka
Development of urology in SuÅ”ak ā historical view
Razvitak urologije na SuÅ”aku povijesno se ne može izdvojit iz ukupnog razvitka nkirurÅ”kih disciplina u Hrvatskoj. Kako je Zagreb slijedio zasade beÄke kirurÅ”ke Å”kole, dolaskom vrhunskih lijeÄnika iz Zagreba na SuÅ”aku se zapoÄela razvijati kirurÅ”ko-uroloÅ”ka struka. Izgradnjom āOpÄe javne banovinske bolniceā 1935. godine otvara se i Odjel za kirurgiju, a prim. dr. Janko KomljenoviÄ imenovan je proÄelnikom odjela. On osuvremenjuje, razvija i primjenjuje niz kirurÅ”kih disciplina, izmeÄu ostalog i urologiju. ZaÄetnik je i endoskopske urologije. Nakon Drugog svjetskog rata, na istom odjelu, nastavlja se razvoj urologije uvoÄenjem veÄih operacijskih zahvata (urolitjaza i adenomektomija prostate). Kao samostalna jedinica UroloÅ”ki odjel je osnovan 1950. godine, osnivaÄ i voditelj bio je doc. dr. Zlatko Å estiÄ, a odjel je imao 30 postelja. Godine 1959. u Rijeci je osnovana UroloÅ”ka sekcija Zbora lijeÄnika Hrvatske Äiji je prvi predsjednik bio upravo doc. dr. Å estiÄ. Nakon dolaska prof. dr. Vinka FranÄiÅ”koviÄa na mjesto Å”efa Odjela za kirurgiju dolazi do znaÄajnog razvoja urologije kao zasebne kirurÅ”ke discipline. On zapoÄinje eksperimentalni program transplantacijske kirurgije, a 30. sijeÄnja 1971. godine predvodi tim koji je uÄinio prvu transplantaciju bubrega u bivÅ”oj Jugoslaviji. U to vrijeme urologiju vodi prof. dr. Tomislav TiÄac, a uz transplantacijski program razvija se i lijeÄenje hemodijalizom, zamjene urinarnih putova tankim i debelim crijevom, longitudinalne nefrolitotomije, razliÄite resekcije bubrega, kirurgija nadbubrežne žlijezde. Prim. dr. Vjerislav PeterkoviÄ postao je Å”ef Odjela 1986. godine. Tada se uvode nove operacijske metode: transuretralni zahvat na donjim urinarnim putovima, ureterorenoskopija, perkutani zahvat na bubregu, radikalne operacije karcinoma prostate i mjehura, a razvija se i andrologija. Na Äelo urologije 2000. godine dolazi prof. dr. Željko FuÄkar koji je bio ujedno i predstojnik Klinike za kirurgiju. Odjel urologije se obnavlja kadrovski i prostorno, a nabavljen je i aparat za izvantjelesno mrvljenje kamenaca. Godine 2005. osniva se Klinika za urologiju, a njezin prvi predstojnik postaje prof. dr. FuÄkar. Na Medicinskom fakultetu se kao zasebna katedra odvaja i Katedra za urologiju (2006. godine). Klinika za urologiju postaje 2006. godine Referentni centar za transplantaciju bubrega u Republici Hrvatskoj. Na Klinici se nastavlja i unaprjeÄuje struÄna, znanstvena i nastavna aktvnost te obnavlja program eksperimentalne urologije. Prim. dr. Maksim ValenÄiÄ obnaÅ”ao je dužnost predstojnika do 2013. godine, a nakon njega prof. dr. Antun MariÄiÄ te naposljetku doc. dr. Josip Å panjol. Posljednjih godina bilježi se znaÄajan napredak u transplantacijskoj kirurgiji ali i u primjeni minimalno invazivnih metoda lijeÄenja.In the past the development of urology was as the part of the development of surgery. In the beginning the well known specialist come from Zagreb medical school to SuÅ”ak and the era of surgery and urology started. The new hospital āOpÄa javno banovinska bolnicaā was open in 1935 with Prim. dr. Janko KomljenoviÄ as first chief of Department of Surgery. He applied new surgical techniques and also new surgery specialites as was urology. He was a founder of endoscopic urology. Afer the Second World War, in the same department, urology started to grow with more complicated operations such as those for urolithiasis and prostate adenomectomy. As independent ward urology was established in 1950, with doc. dr. Zlatko Å estiÄ as first chief. The ward has 30 beds. In the 1959, the Urological secton of Croatian Medical Associaton was established in Rijeka with doc. dr. Å estiÄ as frst president. In the 60-ties, prof. dr. Vinko FranÄiÅ”koviÄ became a new chief of Surgery and the urology become an independent surgical speciality. He started with the experimental programme of transplantaton surgery and on January 30th 1971 the first kidney transplantation was performed in former Yugoslavia. In that time the chief of urology was prof. dr. Tomislav TiÄac. Except the transplantation programme urologists developed hemodialysis programme, use intestinal segments as substituton or urinary diversion, performed longitudinal nephrolithotomy, different resections of the kidney and surgery of the adrenal gland. Prim. dr. Vjerislav PeterkoviÄ become chief of urology in 1986 with special emphesasis on transurethral resections, ureterorenoscopy, percutaneous treatment, radical treatment for prostate and bladder cancer and development of andrology. In 2000 the chief of urology, and also surgery, become prof. dr. Željko FuÄkar. The ward was renovated, the new urologist was coming and also the extracorporeal shock wave lithotripsy was introduced. In 2005 ward become a Clinic of Urology with prof. FuÄkar as first chief. The next year urology become an independent department in the Rijeka Medical School. Also in 2006 Urology Clinic become Referral center for kidney transplantaton in Croata. The Clinic improved professional, scientific and educational activites and re-established programme of experimental urology. Prim. dr. Maksim ValenÄiÄ was chief to 2013, after him prof. dr. Anton MariÄiÄ and finally doc. dr. Josip Å panjol. In the last years the Clinic made a substantal improvement of transplantation programme and in performing minimally invasive procedures
A contribution to the ultrasound diagnostics of ascites
Zadnjih pet godina pregledano je 427 bolesnika upuÄenih na pregled zbog sumnje na ascites. Ultrazvukom je ascites otkriven u 127 oboljelih, a toÄnu etioloÅ”ku dijagnozu postavili smo u 36 pregledanih (28,3%). U svih bolesnika s ascitesom, ultrazvukom smo ustanovili slobodnu tekuÄinu u abdominalnoj Å”upljini u ranoj ili razvijenoj fazi bolesti. Smatramo da je ultrazvuÄna pretraga inicijalna dijagnostiÄka metoda u otkrivanju ascitesa, a dobri rezultaii ovise o iskustvu lijeÄnika, tehnici pregleda i kvaliteti aparata.During the past five year period 427 patients with suspect ascites were ultrasonically examined. In 127 patients the ascites was found by means of ultrasound with correct ethyological diagnosis in 36 patients (28.3%). All patients with ascites in early or developed forms have been examined in various positions, and ascites in all patients has been demonstrated by sonolaminograms. We consider that the ultrasonic examination is an initial diagnostic method in diagnosis of ascites and correct results depend on experience of the examiner, the technique of examination and the quality of the unit
Derivations and substitutions of urinary tract
U 19. stoljeÄu uÄinjen je prvi pokuÅ”aj supstitucije mokraÄnog mjehura kada je kapacitet mokraÄnog mjehura poveÄan uporabom rektuma. Nakon toga je bio niz pokuÅ”aja uporabe i tankog i debelog crijeva u istu svrhu, a najbolji rezultati dobiveni su uporabom ileuma. U osnovi se koriÅ”tenje crijevnog segmenta unutar uropoetskog sustava može podijeliti na derivacije (ili diverzije) i supstitucije. Derivacije podrazumijevaju napuÅ”tanje dijela uropoetskog sustava uz njegovo zavrÅ”avanje na nefizioloÅ”kim otvorima. Dijele se na privremene i trajne. Supstitucije oznaÄavaju zamjenu dijela uropoetskog sustava s crijevnim segmentom. U ovom preglednom radu prikazat Äemo najznaÄajnije Äinjenice u vezi s urinarnim derivacijama i supstitucijama.The first attempt to made substitution of the one part of urinary system was made in the 19th century when the rectum was used to increase capacity of urinary bladder. After that a numerous procedures using a part of colon and small bowel was used in the urinary system and the best result was made with using ileum. The using a part of intestinum in the urinary system can be divided on urinary diversion and substitution. Urinary diversion was characterized with abandoning of part of urinary system and its finishing in the unnatural orificies. It can be divided as temporary and permanent diversion. Substitution mean replacement of part of urinary system with part of intestinum. In this review article we will present the most important facts about urinary derivations and substitutions
Prostate Volume and Urinary Discomforts in Elderly
Occasional doubts about the real effect of the prostate volume on the urinary discomforts that elderly have been experiencing
required additional assessment of these parameters. The aim of this study was to re-evaluate relationship between
the urinary discomforts of the elderly and the prostate volume in comparison with age. Results of the group of 79 patients
observed within one-year period were analyzed. In assessing their urinary discomforts the International Prostate Symptom
Score (IPSS) was calculated, the ultrasound prostate volumetry was performed, and both of these parameters where
compared with age. Statistical analysis of the results confi rmed signifi cant positive correlation between the prostate volume
and age, positive correlation between IPSS and age, as well as between prostate volume and IPSS
Diagnostic Accuracy of Ultrasound T-staging of the Urinary Bladder Cancer in Comparison with Histology in Elderly Patients
Urinary bladder cancer (UBC) is dominantly the cancer of the elderly occurring primarily in the 6th, 7th and 8th decade
of life. The aim of this study was to evaluate diagnostic accuracy of ultrasound T-staging (UTS) of UBC in the group of
elderly patients. In 152 elderly patients referred to transabdominal ultrasound examination in two different facilities (76
each) due to various symptoms (primarily painless gross or microscopic haematuria) UBC was diagnosed. Initial UTS
at the moment of detection was performed and compared with fi nal histological T-staging (HTS). A high level of conformity
between UTS and HTS was detected. In a total of 152 patients with UBC there were 115 (75.66%) patients with complete
match between the UTS and HTS, 24 (15.79%) patients with minimal variation within one stage, and 13 (8.55%) patients
with one stage difference between the UTS and HTS. The best result was established for the stage T1, where the accuracy
was 94.5%. In other stages the accuracy was between 84.9% and 91.8%. The Youdenās index for all the stages was over
0.6. UTS has a high diagnostic accuracy, especially for stages T1 and T2. It is extremely useful tool in differentiating the
superfi cial UBC from the muscle-invasive one, being of signifi cant importance in planning the further treatment of elderly
patients and having important role in choosing appropriate surgical approach
Expression of Bone Morphogenetic Protein-7, ItĀ“s Receptors and Smad1/5/8 in Normal Human Kidney and Renal Cell Cancer
Bone morphogenetic proteins (BMPs) are cytokines which are important for kidney homeostasis but also have role in the some renal diseases and renal cell carcinoma (RCC)1ā5. In the last three decades incidence of RCC was constantly increased and the role of different molecular biomarkers in RCC is explored1. We analyzed expression of BMP-7, their receptors (BMPR-IA, BMPR-IB, BMPR-II) and proteins of their signaling pathway (pSmad1/5/8) in sixteen renal cancer samples and paired normal tissue. Tissue samples were analyzed by immunohistochemistry and Western blot. BMP-7, BMP receptors and pSmad1/5/8 were expressed in all structures of normal kidney but dominantly in the proximal tubular cells. In the cancer samples their expression was also noticed. Comparison of BMPs between different tissue showed increased expression of BMPR-IB and pSmad 1/5/8 and decreased expression of BMP-7 and BMPR-II in RCC compared to normal kidney. BMPR-IA was detected with immunohistochemistry but with Western blot attenuated signal was presented. BMP-7, BMP receptors and pSmad1/5/8 were showed in normal kidney and RCC. Detected alterations of BMP-7, BMP receptors and pSmad expression in RCC suggested their possible role in tumorigenesis of kidney cancer
NeuobiÄajeni sluÄaj akutnog zadržavanja mokraÄe
A 47-year-old male was referred to Emergency Department of our hospital for acute urinary retention. Physical examination showed electrical cable with proximal part introduced into the urethra. Plain abdominal radiograph demonstrated a metallic object in the pelvis and the patient underwent an operation. We used suprapubic cystostomy approach, and the wire was removed from the bladder and urethra.MuÅ”karac u dobi od 47 godina upuÄen je na hitni odjel naÅ”e bolnice zbog akutnog zadržavanja mokraÄe. Fizikalnim pregledom otkriven je elektriÄni kabel koji je dijelom bio uvuÄen u uretru. Radiografski pregled trbuha pokazao je metalni predmet u zdjelici, pa je bolesnik podvrgnut operacijskom zahvatu. Primijenili smo pristup suprapubiÄnom cistostomom i uklonili žicu iz mjehura i uretre
The Role of Negative Pressure Wound Therapy in Patients with Kidney Transplantation
Kidney transplantation is the best treatment modality for patients with end-stage renal disease. Wound healing is
impaired in these patients, and factors such as immunosuppression, older age and comorbidities have a negative impact
on wound healing. Recently, negative pressure wound therapy has become an important wound management technique.
We present two patients with wound healing issues in the early posttransplant period. In both patients, an immunosuppressive
treatment was administered, which included tacrolimus, mycophenolate mophetil and high-dose corticosteroids
with anti-IL-2 induction therapy. Postoperatively, the wounds became infl amed with dehiscence. Negative pressure wound
therapy was successfully applied to aid the wound healing. The treatment duration period was two weeks for one patient
and three weeks for the other. After the treatment period, the wounds were signifi cantly improved and were closed. After
the secondary wound closures, the posttransplant course was uneventful in both patients. Presently, one and three years
after the transplantations, both patients have well functioning kidneys. According to our limited experience, negative
pressure wound therapy is a feasible and effective dehiscence wound treatment following kidney transplantation
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