The history of kidney transplantation in the Sušak hospital

Transplantacija bubrega najučinkovitija je metoda nadomještanja bubrežne funkcije. Iako prvi počeci transplantacije datiraju iz druge polovice 19. stoljeća, razvoj transplantacije seže u drugu polovicu 20. stoljeća. U bolnici na Sušaku prvi eksperimentalni kirurški postupci koji su prethodili zahvatima na ljudima počeli su 1966. godine. Razvoj transplantacije bubrega omogućilo je uvođenje dviju drugih metoda nadomještanja bubrežne funkcije – hemodijalize i peritonejske dijalize. Time su stečeni uvjeti za razvoj svih metoda nadomještanja bubrežne funkcije do danas. Prva transplantacija bubrega sa živog davatelja u bolnici na Sušaku izvršena je 31. siječnja 1971., a godinu dana kasnije i prva transplantacija bubrega s umrlog davatelja. Posljednjih 40 godina napredak transplantacijske medicine u Rijeci i Hrvatskoj rezultirao je činjenicom da je Rijeka i danas jedan od vodećih 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, stručnosti, znanstvenom radu brojnih naraštaja liječnika i medicinskih sestara, a osigurava se trajnom edukacijom mladih kroz brojne nastavne sadržaje na Medicinskom fakultetu Sveučilišta 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 Sušak 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 – hemodialysis and peritoneal dialysis. The first kidney transplantation from living related donor in the Sušak 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 Sušak – historical view

Razvitak urologije na Sušaku povijesno se ne može izdvojit iz ukupnog razvitka nkirurških disciplina u Hrvatskoj. Kako je Zagreb slijedio zasade bečke kirurške škole, dolaskom vrhunskih liječnika iz Zagreba na Sušaku se započela razvijati kirurško-urološka struka. Izgradnjom „Opće javne banovinske bolnice” 1935. godine otvara se i Odjel za kirurgiju, a prim. dr. Janko Komljenović imenovan je pročelnikom odjela. On osuvremenjuje, razvija i primjenjuje niz kirurških disciplina, između ostalog i urologiju. Začetnik je i endoskopske urologije. Nakon Drugog svjetskog rata, na istom odjelu, nastavlja se razvoj urologije uvođenjem većih operacijskih zahvata (urolitjaza i adenomektomija prostate). Kao samostalna jedinica Urološki odjel je osnovan 1950. godine, osnivač i voditelj bio je doc. dr. Zlatko Šestić, a odjel je imao 30 postelja. Godine 1959. u Rijeci je osnovana Urološka sekcija Zbora liječnika Hrvatske čiji je prvi predsjednik bio upravo doc. dr. Šestić. Nakon dolaska prof. dr. Vinka Frančiškovića na mjesto šefa Odjela za kirurgiju dolazi do značajnog razvoja urologije kao zasebne kirurške discipline. On započinje eksperimentalni program transplantacijske kirurgije, a 30. siječnja 1971. godine predvodi tim koji je učinio prvu transplantaciju bubrega u bivšoj Jugoslaviji. U to vrijeme urologiju vodi prof. dr. Tomislav Tićac, a uz transplantacijski program razvija se i liječenje hemodijalizom, zamjene urinarnih putova tankim i debelim crijevom, longitudinalne nefrolitotomije, različite resekcije bubrega, kirurgija nadbubrežne žlijezde. Prim. dr. Vjerislav Peterković postao je šef 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 čelo urologije 2000. godine dolazi prof. dr. Željko Fučkar 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. Fučkar. 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 unaprjeđuje stručna, znanstvena i nastavna aktvnost te obnavlja program eksperimentalne urologije. Prim. dr. Maksim Valenčić obnašao je dužnost predstojnika do 2013. godine, a nakon njega prof. dr. Antun Maričić te naposljetku doc. dr. Josip Španjol. Posljednjih godina bilježi se značajan napredak u transplantacijskoj kirurgiji ali i u primjeni minimalno invazivnih metoda liječenja.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 Sušak and the era of surgery and urology started. The new hospital “Opća javno banovinska bolnica” was open in 1935 with Prim. dr. Janko Komljenović 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 Šestić 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. Šestić as frst president. In the 60-ties, prof. dr. Vinko Frančišković 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 Tićac. 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 Peterković 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 Fučkar. 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. Fučkar 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 Valenčić was chief to 2013, after him prof. dr. Anton Maričić and finally doc. dr. Josip Španjol. 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 upućenih na pregled zbog sumnje na ascites. Ultrazvukom je ascites otkriven u 127 oboljelih, a točnu etiološku dijagnozu postavili smo u 36 pregledanih (28,3%). U svih bolesnika s ascitesom, ultrazvukom smo ustanovili slobodnu tekućinu u abdominalnoj šupljini u ranoj ili razvijenoj fazi bolesti. Smatramo da je ultrazvučna pretraga inicijalna dijagnostička metoda u otkrivanju ascitesa, a dobri rezultaii ovise o iskustvu liječnika, 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. stoljeću učinjen je prvi pokušaj supstitucije mokraćnog mjehura kada je kapacitet mokraćnog mjehura povećan uporabom rektuma. Nakon toga je bio niz pokušaja uporabe i tankog i debelog crijeva u istu svrhu, a najbolji rezultati dobiveni su uporabom ileuma. U osnovi se korištenje crijevnog segmenta unutar uropoetskog sustava može podijeliti na derivacije (ili diverzije) i supstitucije. Derivacije podrazumijevaju napuštanje dijela uropoetskog sustava uz njegovo završavanje na nefiziološkim otvorima. Dijele se na privremene i trajne. Supstitucije označavaju zamjenu dijela uropoetskog sustava s crijevnim segmentom. U ovom preglednom radu prikazat ćemo najznačajnije činjenice 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 Youden’s 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

Our Experiences in Treatment of Prostate Carcinoma in Patients over the Age of 70

The goal of our study was to present our long-standing experience of the treatment of prostate carcinoma in patients over the age of 70. During the 20 years period (from 1991 to 2010) we diagnosed the prostate carcinoma in 1998 patients. More than 58% of the patients were over 70 years old. The most frequent symptoms of the prostate carcinoma were frequent urination and backache. At the first examination 36% of the patients had both prostate lobes involved, and 27% of them had metastases. The most frequent ones (26%) were those in the bone system (pelvis and spine), while in only 1% metastases were found in solid organs (lungs and liver). According to the TNM classification, T1 and T2 were diagnosed in 818 (71%) patients. Histopathological examination discovered Gleason score 2 in 70% of patients and Gleason score 3 in 24% of them. Most often the combination of castration and antiandrogen therapy (in 68% of the patients) and the combination of castration and Estracyt therapy (in 19% of the patients) were applied. In conclusion, intensified efforts should be made in promoting preventive urological examinations because of the great number of patients (27%) with metastases at the first examination

Expression of Bone Morphogenetic Protein-7, It´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)1–5. 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

Neuobičajeni slučaj akutnog zadržavanja mokraće

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.Muškarac u dobi od 47 godina upućen je na hitni odjel naše bolnice zbog akutnog zadržavanja mokraće. Fizikalnim pregledom otkriven je električni kabel koji je dijelom bio uvučen u uretru. Radiografski pregled trbuha pokazao je metalni predmet u zdjelici, pa je bolesnik podvrgnut operacijskom zahvatu. Primijenili smo pristup suprapubičnom 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