Erectile Dysfunction

Erektilna je disfunkcija (ED) nemogućnost postizanja i održavanja erekcije dostatne za zadovoljavajući odnošaj. Zbog starenja populacije i komorbiditeta ED postaje sve važniji zdravstveni problem, koji smanjuje kvalitetu života i narušava odnose među partnerima. Smatra se da od ED-a boluje više od polovice muškaraca u dobi od 40 do 70 godina. Danas se smatra da ED nije bolest nego jedan od najranijih simptoma endotelne disfunkcije i bolesti krvnih žila te jedan od najvažnijih prediktora razvoja teže KV bolesti. S napretkom peroralne terapije i slabim rezultatima rekonstruktivne kirurgije danas se pacijenti sve brže i ranije podvrgavaju terapiji, a komplicirana, invazivna dijagnostika provodi se samo u rijetkim slučajevima. Terapija prvog izbora u liječenju ED-a, neovisno o etiologiji, jesu inhibitori fosfodiesteraze 5. Članak prikazuje etiologiju, patogenezu, dijagnostiku i aktualne preporuke za terapiju ED-a.Erectile dysfunction (ED) has been defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. Although ED is a benign disorder, it affects physical and psychosocial health and has a significant impact on the quality of life of sufferers and their partners. Recent epidemiological data have shown a high prevalence and incidence of ED worldwide and it is assumed that ED is bothering more than half of men aged 40-70 years. Today, ED is not considered a disease but one of the very early symptoms of cardiovascular disease, and it is in most cases caused by organic changes. New oral therapies have completely changed the diagnostic and therapeutic approach to ED. Phosphodiesterase-5 inhibitors are considered to be the first line treatment for all types of ED, regardless of its cause. The article presents the etiology, pathogenesis, diagnosis, and current recommendations for ED treatment

The Role of Inflammation in Prostate Cancer Pathogenesis

Karcinom prostate je u novije vrijeme prepoznat kao vodeći uzrok mortaliteta i morbiditeta muškaraca druge i treće životne dobi. U recentnim publikacijama sve je više dokaza o direktnoj ili indirektnoj povezanosti kronične upale i/ili infekcije i karcinoma prostate. Smatra se da kronična, supklinička upala inducira karcinogenezu oksidativnim oštećenjem stanica i genoma, stvaranjem miljea koji stimulira replikaciju stanica, angiogenezu i reparaciju tkiva. Za molekularnu patogenezu karcinoma prostate vezane su i somatske alteracije gena koji su angažirani u obrani protiv upalnog oštećenja stanica te u procesu regeneracije stanica. U prilog ovoj pretpostavci, epidemiološki podaci i populacijske studije dokazali su da postoji povišen relativni rizik od razvoja karcinoma prostate u muškaraca s preboljelim spolno prenosivim bolestima ili prostatitisom. Novija saznanja genetičkih i molekularnih studija također podupiru pretpostavku da upala i/ili infekcija mogu uzrokovati karcinom prostate. Buduće strategije u kemoprevenciji koje proistječu iz ovih saznanja uključuju: 1/ antioksidanse; 2/ konzumiranje hrane bogate antioksidansima; 3/ protuupalne lijekove (antiflogistike); 4/ sprečavanje, otkrivanje i liječenje spolno prenosivih bolesti. Kritički je prikazana recentna literatura.Prostate cancer continues to be a source of considerable morbidity and mortality for aging men. In recent publications there is emerging evidence that prostate inflammation and/or infection may contribute to prostatic carcinogenesis. Chronic subclinical inflammation is thought to incite carcinogenesis by causing oxidative cell and genome damage, promoting cellular turnover, and creating a tissue microenvironment that can enhance cell replication, angiogenesis and tissue repair. The molecular pathogenesis of prostate cancer has been characterized by somatic alterations of genes involved in defences against inflammatory damage and in tissue recovery. In support of this hypothesis, epidemiological data and population studies have found an increased relative risk of prostate cancer in men with a prior history of certain sexually transmitted infections or prostatitis. Evidence from genetic and molecular studies also support the hypothesis that prostate inflammation and/or infection may be a cause of prostate cancer. These emerging insights into chronic inflammation in the aetiology of prostate carcinogenesis hold the promise of spawning new preventive strategies for prostate cancer. The novel strategies in prostate cancer chemoprevention include: 1/ antioxidants; 2/dietary antioxidants; 3/ anti-inflammatory drugs; 4/ prevention, detection and therapy of sexually transmitted diseases. Recent literature on the topic is reviewed and discussed

Posttraumatski prijapizam: prikaz slučaja, terapijske opcije i pregled literature

A rare case of posttraumatic high-flow priapism is presented. A 20-year-old man underwent diagnostic procedure with color Doppler sonography and angiography. On color Doppler sonography and selective and supraselective angiographic images, arteriocavernosal fistula and pseudoaneurysm were detected in the proximal part of the right cavernous body. Complete detumescence of the penis was achieved by selective embolization with microcoil. No recurrence was observed and postoperative erectile function was incompletely restored. The clinical, diagnostic and therapeutic peculiarities of this rare condition are presented, along with review of the literature on the topic.Prikazuje se rijedak slučaj bolesnika s posttraumatskim arterijskim (neishemičnim) prijapizmom. U 20-godišnjeg muškarca provedena je dijagnostička obrada obojenim Doppler ultrazvukom i angiografija. Na obojenom Doppler ultrazvuku, te na selektivnim i supraselektivnim angiografskim snimkama potvrđeno je postojanje arteriokavernozne fistule i pseudoaneurizme. Nakon selektivne embolizacije postignuta je potpuna detumescencija penisa. Poslijeoperacijski nije bilo povrata prijapizma i došlo je do nepotpunog oporavka erektilne funkcije. Prikazane su kliničke, dijagnostičke i terapijske osobitosti ovoga rijetkog slučaja, uz pregled relevantne literature

Liječenje Fournierove gangrene : prikaz slučaja i pregled literature

A 65-year-old man was referred to our department with clinical signs of septic shock and necrotizing soft tissue infection of the scrotal, perianal and right inguinal region. Initial presentation was a typical Fournier’s gangrene. Because of the life-threatening condition, the initial treatment was extensive removal of necrotic tissue. Antibiotic therapy was administered and several debridements of the wound were done afterwards. Three weeks after the initial treatment, wide wound defects of the perianal, scrotal and inguinal regions were closed secondarily and the patient was discharged from the hospital. Fournier’s gangrene is a surgical emergency. Although rare, it remains a life-threatening disease. Rapid and accurate diagnosis remains the key component in achieving successful outcome. Early aggressive surgical intervention together with fluid, hemodynamic and nutritional support and broad-spectrum antibiotics is the essential management to reduce mortality.Šezdesetpetogodišnji muškarac je primljen u našu ustanovu s kliničkom slikom septičkog šoka i nekroze u skrotalnom, perianalnom i desnostranom ingvinalnom području. Postavljena je dijagnoza Fournierove gangrene. Zbog lošeg općeg stanja bolesnik je odmah kirurški zbrinut, učinjena je opsežna nekrektomja. Antibiotska terapija je ordinirana, a nakon prve operacije je učinjeno nekoliko debridmana rane. Sedamnaest dana nakon operacije su postavljeni sekundarni šavi, a 23. dana bolesnik je otpušten na kućnu njegu. Fournierova gangrena je hitno kirurško stanje te, iako je rijetka, predstavlja tešku i za život opasnu bolest. Brza i točna dijagnostika uz agresivnu kiruršku terapiju i opetovane debridmane te antibiotici širokog spektra i dalje su ključ uspješnog liječenja

The application of ultrasound in neuroendoscopic procedures: first results with the new tool »NECUP-2« [Upotreba ultrazvuka u neuroendoskopskim procedurama: prvi rezultati s novim uređajem »NECUP-2«]

In this paper, our experience with originally constructed Neurosurgical Endoscopic Contact Ultrasound Probe »NECUP-2« in neuroendoscopy is reported. Between June 1997 and June 2007, 132 neuroendoscopic procedures have been performed: 102 endoscopic thrid ventriculostomies (ETV), 15 arachnoid cysts and 5 intraventricular tumours operations. The »NECUP-2« was applied effectively in all cases in which blunt perforation was not possible: 38/102 ETV, 10/10 septostomies, 15/15 arachnoid cysts. In five cases of intraventricular tumours, neuroendoscopic procedure was combined with open microsurgery for tumour removal with preservation of vascular structures. There were no »NECUP-2« related complications. Of postoperative complications, we had liquorrhea (9 patients), and symptoms of meningitis (6 patients). In the follow-up period (6 months to 6 years), we had a patency rate of 80% (50/63 patients). All patients improved in clinical status. According to the first results, it seems that ultrasonic contact probe NECUP-2 presents a new device in neurosurgical armamentarium that can be used in various fields of neurosurgery. With minimal and controlled lesion that is produced at the tip of the probe, it can be used in highly demanding operations such as third ventriculostomy and tumour resection

Colon examination with colon capsule

Endoskopija videokapsulom, VCE (prema engl. Video Capsule Endoscopy), postala je prva slikovna metoda za pregled cjelokupnog tankog crijeva. Prvi službeni pregled kapsulom učinjen je 2001. godine. Kapsula za pregled debelog crijeva najnovije je tehnološko dostignuće koje omogućava pregled tog dijela crijeva bez bolnosti i neugode. Najznačajnija indikacija za pregled je probir za kolorektalni karcinom. Prema do sada objavljenim studijama videokapsulska endoskopija za pregled debelog crijeva pruža zadovoljavajuću razinu pouzdanosti za otkrivanje polipa debelog crijeva, poglavito onih iznad 6 mm veličine. Ograničavajući čimbenici su još uvijek relativno visoka cijena te ovisnost o idealnoj očišćenosti crijeva.Video Capsule Endoscopy (VCE) has become the first imaging method for the complete examination of small bowel. The first official capsule examination was done in 2001. Colon capsule is the latest advance in capsule technology which provides painless examination of the colon. The main indication for this method is colorectal screening. According to the current published data colon capsule is a reliable tool for detecting colon polyps, especially those larger than 6 mm. Limiting factors are relatively high price and dependence on ideal colon preparation

Colon examination with colon capsule

Endoskopija videokapsulom, VCE (prema engl. Video Capsule Endoscopy), postala je prva slikovna metoda za pregled cjelokupnog tankog crijeva. Prvi službeni pregled kapsulom učinjen je 2001. godine. Kapsula za pregled debelog crijeva najnovije je tehnološko dostignuće koje omogućava pregled tog dijela crijeva bez bolnosti i neugode. Najznačajnija indikacija za pregled je probir za kolorektalni karcinom. Prema do sada objavljenim studijama videokapsulska endoskopija za pregled debelog crijeva pruža zadovoljavajuću razinu pouzdanosti za otkrivanje polipa debelog crijeva, poglavito onih iznad 6 mm veličine. Ograničavajući čimbenici su još uvijek relativno visoka cijena te ovisnost o idealnoj očišćenosti crijeva.Video Capsule Endoscopy (VCE) has become the first imaging method for the complete examination of small bowel. The first official capsule examination was done in 2001. Colon capsule is the latest advance in capsule technology which provides painless examination of the colon. The main indication for this method is colorectal screening. According to the current published data colon capsule is a reliable tool for detecting colon polyps, especially those larger than 6 mm. Limiting factors are relatively high price and dependence on ideal colon preparation

Cochrane group from Rijeka – review of activities and results

Dugogodišnja suradnja riječkih gastroenterologa sa specifičnim grupama u sklopu Cochrane kolaboracije rezultirala je značajnim napretkom na polju znanstveno-istraživačke djelatnosti i brojnim publikacijama. Spoznaje i zaključci dosegnuti u Cochrane sustavnim pregledima predstavljaju pouzdane stručne dokaze u raznim područjima gastroenterologije, posebno kronične hepatitis C infekcije, kolestatskih bolesti jetre i akutnog pankreatitisa. Navedene publikacije visoko su citirani radovi, koji su implementirani i u nekim međunarodnim smjernicama, odnosno preporukama liječenja. Doprinosom riječke Cochrane grupe otvorena su vrata suradnje s brojnim inozemnim stručnjacima i suradnicima, pokrenuto je organiziranje tečajeva medicine temeljene na dokazima i unaprijeđena je suradnja s Hrvatskim Cochrane centrom te drugim domaćim znanstvenicima. Ovaj pregledni članak predstavlja pregled dosadašnjih postignuća riječkih autora u sklopu Cochrane kolaboracije uz sažeti prikaz najznačajnijih rezultata i zaključaka u objavljenim Cochrane sustavnim pregledima s ciljem upoznavanja javnosti s mogućnostima rada u Cochrane kolaboraciji i vrstom znanstveno-istraživačke djelatnosti koja se u sklopu iste provodi te promocije i popularizacije medicine temeljene na dokazima u široj znanstvenoj i stručnoj zajednici.The long-term cooperation of gastroenterologists from Rijeka with specific groups within the Cochrane Collaboration has resulted in significant progress in the field of scientific research and numerous publications. The findings and conclusions reached in the published Cochrane systematic reviews represent reliable evidence in various gastroenterology fields, particularly chronic hepatitis C infection, cholestatic liver disease and acute pancreatitis. The aforementioned publications are highly quoted papers, which are cited in different international guidelines and treatment recommendations. With the contribution of authors from Rijeka, a door to cooperation with several foreign experts and associates has been opened, courses in evidence-based medicine have been organized, and the collaboration with the Croatian Cochrane Center and other domestic scientists has been enhanced. This review article presents an overiew of the achievements of authors from Rijeka within the Cochrane Collaboration with a summary of the most important results and conclusions from the systematic reviews aiming to inform the public of the opportunities given by the Cochrane Collaboration and the type of scientific research implemented by it, as well as, to promote and popularize evidence-based medicine in a broad scientific and professional community