Validation of Epstein biopsy criteria for insignificant prostate cancer in contemporary cohort of Croatian patients [Patohistološki nalazi bolesnika s rakom prostate liječenih radikalnom prostatektomijom koji su bili podobni za aktivni nadzor]

Only few reports validated contemporary Epstein criteria for insignificant prostate cancer, and only one being from Europe. Patients with insignificant prostate cancer should be offered active surveillance and spared radical treatment. In our study we tested Epstein biopsy criteria for predicting unfavorable final pathology and biochemical relapse in low risk prostate cancer patients, who were eligible for active surveillance but where treated with radical prostatectomy. Between January 2003 and January 2008, 586 patients were subjected to radical prostatectomy in our institution. Among them, 106 where eligible for active surveillance according to Epstein biopsy criteria for insignificant prostate cancer. We analyzed the presence of adverse pathological findings in the final pathohistological specimen after radical prostatectomy which excludes low risk disease. Adverse pathohistological findings were noted in 41 (38.6%) patients, who could have been offered active surveillance. During the follow up of 48 (12-72) months, biochemical relapse was noted in 6 (5.6%) patients. Although active surveillance is becoming more popular because of the long natural course of prostate cancer and fear of overtreatment of patients with indolent course of disease, both doctors and patients must be aware of potentially significant disease in this group and limitations of current preoperative criteria defining low risk patients

Validation of Epstein Biopsy Criteria for Insignificant Prostate Cancer in Contemporary Cohort of Croatian Patients

Only few reports validated contemporary Epstein criteria for insignificant prostate cancer, and only one being from Europe. Patients with insignificant prostate cancer should be offered active surveillance and spared radical treatment. In our study we tested Epstein biopsy criteria for predicting unfavorable final pathology and biochemical relapse in low risk prostate cancer patients, who were eligible for active surveillance but where treated with radical prostatectomy. Between January 2003 and January 2008, 586 patients were subjected to radical prostatectomy in our institution. Among them, 106 where eligible for active surveillance according to Epstein biopsy criteria for insignificant prostate cancer. We analyzed the presence of adverse pathological findings in the final pathohistological specimen after radical prostatectomy which excludes low risk disease. Adverse pathohistological findings were noted in 41 (38.6 %) patients, who could have been offered active surveillance. During the follow up of 48 (12 – 72) months, biochemical relapse was noted in 6 (5.6%) patients. Although active surveillance is becoming more popular because of the long natural course of prostate cancer and fear of overtreatment of patients with indolent course of disease, both doctors and patients must be aware of potentially significant disease in this group and limitations of current preoperative criteria defining low risk patients

Validation of Epstein Biopsy Criteria for Insignificant Prostate Cancer in Contemporary Cohort of Croatian Patients

Only few reports validated contemporary Epstein criteria for insignificant prostate cancer, and only one being from Europe. Patients with insignificant prostate cancer should be offered active surveillance and spared radical treatment. In our study we tested Epstein biopsy criteria for predicting unfavorable final pathology and biochemical relapse in low risk prostate cancer patients, who were eligible for active surveillance but where treated with radical prostatectomy. Between January 2003 and January 2008, 586 patients were subjected to radical prostatectomy in our institution. Among them, 106 where eligible for active surveillance according to Epstein biopsy criteria for insignificant prostate cancer. We analyzed the presence of adverse pathological findings in the final pathohistological specimen after radical prostatectomy which excludes low risk disease. Adverse pathohistological findings were noted in 41 (38.6 %) patients, who could have been offered active surveillance. During the follow up of 48 (12 – 72) months, biochemical relapse was noted in 6 (5.6%) patients. Although active surveillance is becoming more popular because of the long natural course of prostate cancer and fear of overtreatment of patients with indolent course of disease, both doctors and patients must be aware of potentially significant disease in this group and limitations of current preoperative criteria defining low risk patients

Advanced Clinical and Radiological Features of Ankylosing Spondylitis: Relation to Gender, Onset of First Symptoms and Disease Duration

To determine the frequency of advanced clinical and radiological features of AS with reference to gender, onset of symptoms and disease duration. Fifty-seven patients diagnosed with AS were included in this study. Functional evaluation of the musculoskeletal system detected advanced clinical features: rubber-ball phenomenon, flattening of the chest anterior wall, diastasis of rectus abdominis muscle, steel back phenomenon, umbilical extrusion, skiing posture. Conventional radiographs of sacroiliac joints, pelvis and axial skeleton were obtained in order to analyze signs of sacroiliitis, syndesmophytes, vertebral squaring and ligamentous ossification. Statistical significance is found in the distribution of particular advanced clinical and radiological features of AS between men and women: rubber-ball phenomenon (p=0.002), flat chest (p=0.002), diastasis of rectus abdominis muscle (p=0.002), skiing position (p=0.000), syndesmophytes (p=0.009) and ligamentous ossification (p=0.030) in thoracic and lumbar spine. Onset of first disease symptoms (> 20 years of age) is significantly associated with radiological changes in thoracic spine (ligamentous ossification, p=0.015) and cervical spine (vertebral squaring, p=0.032). Longer disease duration (>10 years) is significantly associated with the appearance of particular clinical features: rubber-ball phenomenon, p20 years of age) and longer disease duration (>10 years) are associated with the higher risk of developing particular clinical signs and radiological features in sacroiliac joints and axial skeleton

Primary osteosarcoma of bladder diverticulum mimicking intradiverticular calculus: a case report

There is a well-documented relationship between urinary bladder diverticula and intradiverticular neoplasms. The great majorities of these tumors are urothelial carcinomas, but may also be of glandular or squamous type. Sarcomas occurring within bladder diverticula are exceptionally rare and highly malignant lesions, with only 20 well documented cases published in the literature to date (including carcinosarcomas). We report a case of osteosarcoma of the bladder diverticulum in a 68-year old man, which clinically mimicked intradiverticular calculus. To our knowledge, this is the second case described in the literature to date, and the first in English literature

Neobična manifestacija koštano-zglobne tuberkuloze: prikaz bolesnice

Although osteoarticular tuberculosis is usually presented as monoarthritis of the large, weight-bearing joints (predominantly hip, knee or ankle joint), or in the form of spinal disease, it is rarely seen as oligoarthritis. In this article, we present case history of a female patient with tuberculous oligoarthritis of the right talocrural joint and left talocalcaneal joint. A 77-year-old female patient was admitted to our department due to the symptoms of painful and swollen right talocrural joint and left talocalcaneal joint accompanied with fever, general weakness and night sweating. Laboratory findings, including erythrocyte sedimentation rate, whole blood count, liver and kidney functional tests showed no significant changes. Plain x-rays and magnetic resonance imaging of the affected joints showed demineralization, significant narrowing of joint space, erosions of articular surfaces, numerous calcifications, and ankylosis of both right talocrural and left talocalcaneal joint. Synovial biopsy confirmed the diagnosis of tuberculous arthritis. Our patient underwent triple tuberculostatic therapy with rifampicin, isoniazid and pyrazinamide, which resulted in the resolution of arthritis.Iako se koštano-zglobna tuberkuloza najčešće prezentira kao monoartritis velikih zglobova koji prenose težinu (osobito kukovi, koljena ili gležanj) ili zahvaćenošću kralježnice, rijetko se javlja u obliku oligoartritisa. U ovom članku daje se prikaz bolesnice s tuberkuloznim oligoartritisom desnog talokruralnog zgloba i lijevog talokalkanealnog zgloba. Sedamdeset- sedmogodišnja bolesnica je primljena u našu Kliniku zbog bolova i otekline desnog talokruralnog zgloba i lijevog talokalkanealnog zgloba popraćenog tresavicom, općom slabošću i noćnim znojenjem. Laboratorijski nalazi, uključujući sedimentaciju eritrocita, kompletnu krvnu sliku, jetrene i bubrežne testove, nisu pokazali nikakva odstupanja. Konvencionalni rendgenogrami i magnetska rezonanca zahvaćenih zglobova pokazali su demineralizaciju, značajno suženje zglobnog prostora, erozivne promjene zglobnih površina, brojne kalcifikate i ankilozu desnog talokruralnog zgloba i lijevog talokalkanealnog zgloba. Biopsija sinovije je potvrdila dijagnozu tuberkuloznog artritisa. Kod bolesnice je provedena trojna tuberkulostatska terapija rifampicinom, izonijazidom i pirazinamidom koja je dovela do povlačenja artritisa

Neobična manifestacija koštano-zglobne tuberkuloze: prikaz bolesnice

Although osteoarticular tuberculosis is usually presented as monoarthritis of the large, weight-bearing joints (predominantly hip, knee or ankle joint), or in the form of spinal disease, it is rarely seen as oligoarthritis. In this article, we present case history of a female patient with tuberculous oligoarthritis of the right talocrural joint and left talocalcaneal joint. A 77-year-old female patient was admitted to our department due to the symptoms of painful and swollen right talocrural joint and left talocalcaneal joint accompanied with fever, general weakness and night sweating. Laboratory findings, including erythrocyte sedimentation rate, whole blood count, liver and kidney functional tests showed no significant changes. Plain x-rays and magnetic resonance imaging of the affected joints showed demineralization, significant narrowing of joint space, erosions of articular surfaces, numerous calcifications, and ankylosis of both right talocrural and left talocalcaneal joint. Synovial biopsy confirmed the diagnosis of tuberculous arthritis. Our patient underwent triple tuberculostatic therapy with rifampicin, isoniazid and pyrazinamide, which resulted in the resolution of arthritis.Iako se koštano-zglobna tuberkuloza najčešće prezentira kao monoartritis velikih zglobova koji prenose težinu (osobito kukovi, koljena ili gležanj) ili zahvaćenošću kralježnice, rijetko se javlja u obliku oligoartritisa. U ovom članku daje se prikaz bolesnice s tuberkuloznim oligoartritisom desnog talokruralnog zgloba i lijevog talokalkanealnog zgloba. Sedamdeset- sedmogodišnja bolesnica je primljena u našu Kliniku zbog bolova i otekline desnog talokruralnog zgloba i lijevog talokalkanealnog zgloba popraćenog tresavicom, općom slabošću i noćnim znojenjem. Laboratorijski nalazi, uključujući sedimentaciju eritrocita, kompletnu krvnu sliku, jetrene i bubrežne testove, nisu pokazali nikakva odstupanja. Konvencionalni rendgenogrami i magnetska rezonanca zahvaćenih zglobova pokazali su demineralizaciju, značajno suženje zglobnog prostora, erozivne promjene zglobnih površina, brojne kalcifikate i ankilozu desnog talokruralnog zgloba i lijevog talokalkanealnog zgloba. Biopsija sinovije je potvrdila dijagnozu tuberkuloznog artritisa. Kod bolesnice je provedena trojna tuberkulostatska terapija rifampicinom, izonijazidom i pirazinamidom koja je dovela do povlačenja artritisa

Strano tijelo u mokraćnom mjehuru kao ishod samokateterizacije: prikaz slučaja

Foreign bodies inside urinary tract are a relatively rare condition in our practice. There are several reports published and in most cases the reason for self insertion of an object was autoerotic stimulation or psychiatric illness. Self treatment by homemade instruments is a rarely seen scenario. A 62-year-old man presented to our department complaining of lower urinary tract symptoms. On examination, a foreign body was detected inside the urinary bladder. Urethral stricture was also detected for which the patient had been previously treated on several occasions. The patient stated that he had attempted self catheterization using a homemade catheter. He had succeeded in emptying his bladder; however, the catheter entered the bladder completely and was irretrievable to him. Sachse urethrotomy was performed following retrieval of the foreign body. No psychiatric illness was detected in our patient. The patient’s postoperative course was uneventful.Strana tijela unutar mokraćnog sustava su relativno rijetko stanje u našoj praksi. U većini objavljenih slučajeva razlog umetanja stranog tijela je autoerotska stimulacija ili psihijatrijska bolest. Umetanje stranog tijela kao povod za rješavanje mokraćne opstrukcije je rijedak događaj. Bolesnik u dobi od 62 godine javio se na našu kliniku zbog simptoma donjeg mokraćnog trakta. Tijekom pregleda otkriveno je strano tijelo unutar mokraćnog mjehura. Kod bolesnika je u više navrata rađena unutarnja uretrotomija, a jednom otvorena operacija uretre s terminoterminalnom anastomozom. Bolesnik je naveo da je pokušao samokateterizaciju s improviziranim kateterom. Uspio je riješiti mokraćnu opstrukciju, no dio stranog tijela je zaostao u mokraćnom mjehuru. Nakon dodatne obrade učinjena je unutarnja uretrotomija po Sachseu s ekstrakcijom stranog tijela iz mokraćnog mjehura. Psihijatrijskih bolesti se kod bolesnika ne nalazi

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