Prostatitis Syndrome

Sindrom prostatitisa čest je klinički entitet i naziv je za niz poremećaja funkcije prostate. O sindromu prostatitisa govorimo stoga što je etiologija bolesti nepoznata, a dijagnostički kriteriji nisu čvrsti. Klinički se očituje simptomima donjeg dijela urogenitalnog trakta i perineuma. Osnovni kriterij za podjele unutar sindroma prostatitisa su klinički simptomi i znakovi te prisutnost leukocita i bakterija u selektivno uzimanim uzorcima mokraće i u eksprimatu prostate metodom koju su opisali Meares i Stamey. Antimikrobno liječenje indicirano je u bolesnika s akutnim bakterijskim prostatitisom, kroničnim bakterijskim prostatitisom i kroničnim upalnim nebakterijskim prostatitisom kojeg je dio i bakterijski prostatitis s uzročnikom nedokazanim klasičnim metodama. Bolesnike s akutnim bakterijskim prostatitisom i s akutnom egzacerbacijom kroničnoga bakterijskog prostatitisa treba odmah liječiti empirijskom antimikrobnom terapijom. U bolesnika s kroničnim bakterijskim prostatitisom treba pričekati mikrobiološki nalaz te primijeniti ciljanu antimikrobnu terapiju. Zbog širokog spektra djelovanja te farmakodinamskih i farmakokinetskih osobitosti, antimikrobna sredstva prvog izbora za liječenje upalnih bolesti prostate su fluorokinoloni: ciprofloksacin i ofloksacin. Efikasnost provedenog antimikrobnog liječenja treba kontrolirati 4-6 tjedana (rano praćenje) i 6 mjeseci (kasno praćenje) nakon završene antimikrobne terapije. Liječenje sindroma kronične neupalne boli u zdjelici bez dokažljive infekcije uključuje fitoterapiju, higijensko-dijetetske mjere, mikrovalnu termoterapiju, alfaadrenoreceptorske antagoniste, mišićne relaksanse, analgetike, nesteroidne antiflogistike, inhibitore 5-alfa-reduktaze, promjenu načina života, psihoterapiju i spazmoanalgetike. Svim bolesnicima s kroničnim oblicima sindroma prostatitisa savjetuje se izbjegavanje alkohola, gaziranih pića, jakih začina, vožnja biciklom, izbjegavanje hladnoće, posebice sjedenje na hladnome.Prostatitis syndrome is a frequent clinical entity, comprising a series of functional disorders in prostate. We speak about this syndrome because its etiology is still unknown and diagnostic criteria are not firmly established. It is clinically manifested with the symptoms of lower urogenital tract and perineum. The basic criterion for classification within the prostatitis syndrome are clinical symptoms and signs, as well as the presence of leukocytes and bacteria in selectively taken samples of urine and in prostate exprimate by using the method described by Meares and Stamey. Antimicrobic treatment is indicated in patients with acute bacterial, chronic bacterial, and chronic inflammatory non-bacterial prostatitis, a part of which is bacterial prostatitis with cause unproved by classical methods. Patients with acute bacterial prostatitis and acute exacerbation of chronic bacterial prostatitis must be immediately treated with empirical antimicrobic therapy. In patients with chronic bacterial prostatitis, microbiological finding must be obtained and then target antimicrobic therapy should be applied. Due to the wide spectrum of activity, as well as pharmacodynamic and pharmacokinetic properties, antimicrobic drugs of the first choice for the treatment of prostate inflammatory diseases are fluorokinolons, ciprofloxacin and ofloxacin. The efficacy of performed antimicrobic therapy should be followed up 4-6 weeks (early follow-up) and 6 months (late follow-up) after the completed antimicrobic treatment. The treatment of chronic non-inflammatory pelvic pain syndrome without provable infection includes phytotherapy, hygienic dietary measures, microwave thermotherapy, alpha-adrenoreceptor antagonists, myorelaxants, analgesics, non-steroid antiphlogistics, 5-alpha reductase inhibitors, change of life style, psychotherapy and spasmoanalgesics. All the patients with chronic types of prostatitis syndrome are advised to avoid alcohol, carobanted beverages, strong spices, cycling, coldness, particularly sitting on cold surfaces

Trends in prostate cancer incidence and mortality in Croatia, 1988 to 2008

AIM: To describe and interpret prostate cancer incidence and mortality trends in Croatia between 1988 and 2008. ----- METHODS: Incidence data for the period 1988-2008 were obtained from the Croatian National Cancer Registry. The number of prostate cancer deaths was obtained from the World Health Organization mortality database. We also used population estimates for Croatia from the Population Division of the Department of Economic and Social Affairs of the United Nations. Age standardized incidence and mortality rates were calculated by the direct standardization method. To describe time trends of incidence and mortality, joinpoint regression analysis was used. ----- RESULTS: Average age-standardized incidence rate between the first and last five-year period doubled, from 19.0/100,000 in 1988-1992 to 39.1 per 100,000 in 2004-2008. Age-standardized mortality rate increased by 6.9%, from 14.5 to 15.5 per 100,000. Joinpoint analysis of incidence identified two joinpoints. The increasing incidence trend started from 1997, with the estimated annual percent of change (EAPC) of 12.9% from 1997-2002 and of 4.1% from 2002-2008. Joinpoint analyses of mortality identified one joinpoint. Mortality trend first decreased, with EAPC of -3.0% from 1988-1995 to increase later with EAPC of 2.0% from 1995-2008. ----- CONCLUSION: The incidence of prostate cancer in Croatia has been on the increase since 1997. Trend in mortality is increasing, contrary to the trends in some higher-income countries. An improvement in the availability of different treatment modalities as well as establishing prostate cancer units could have a positive impact on prostate cancer mortality in Croatia

Basic Princyples Therapy of Prostatis

Izbor lijeka i duljina liječenja bolesnika sa sindromom prostatitisa ovisni su o težini i trajanju prisutnih kliničkih simptoma i znakova te o etiologiji bolesti. Bolesnici s upalnim oblicima sindroma prostatitisa liječe se antimikrobnom terapijom, a lijek prvog izbora je ciprofloksacin (Cipromed, PLIVA). Azitromicin (Sumamed, PLIVA) primjenjuje se prvenstveno ako je infekcija prostate uzrokovana klamidijom trahomatis i urogenitalnim mikoplazmama.The choice of medication and duration of treatment in patients with prostatitis syndrome depend on the severity and duration of clinical symptoms and signs, and on the etiology of the disease. Patients with inflammatory type of the syndrome are treated with antimicrobic therapy, and the drug of the first choice is ciprofloxacine (Cipromed, PLIVA). Azythromicine (Sumamed, PLIVA) is applied primarily if the prostate infection is caused by clamidia trahomatis and urogenital microplasmas

OCT4 imunohistokemija nakon laparoskopske limfadenektomije kod bolesnika s tumorom testisa

Twenty to thirty percent of patients with clinical stage I testicular tumor have metastases in the retroperitoneum. The aim of this study was to evaluate the role of OCT4 immunohistochemistry in histopathologic diagnosis of lymph node metastases in patients with nonseminomatous germ cell testicular tumors. All clinical stage I patients with staging laparoscopic retroperitoneal lymphadenectomy from 2001 until 2009 were included. Archived materials of dissected lymph nodes were reassessed and additional immunohistochemical staining with OCT4 antibody was performed in patients diagnosed as free from metastases. Each slide was visually estimated for the percentage of tumor cells showing nuclear immunoreactivity for OCT4. The study included 93 patients, of which 30 (32.3%) had initially positive retroperitoneal lymph nodes. Of the remaining 63 patients, materials were missing for 5 patients, so additional immunohistochemical staining was performed in 58 patients. Of these, two (3.4%) patients were OCT4 positive, suggesting a conclusion that they were initially misdiagnosed as stage I and metastasis free. OCT4 proved its value in detecting retroperitoneal metastases. Staging laparoscopic retroperitoneal lymphadenectomy for nonseminomatous germ cell testicular tumors in clinical stage I is a reasonable option for selected patients.Dvadeset do trideset posto bolesnika s tumorom testisa kliničkog stadija I. ima metastaze u retroperitoneumu. Cilj ovoga istraživanja bio je utvrditi vrijednosti OCT4 u patohistološkoj dijagnostici metastaza u limfnim čvorovima dobivenih laparoskopskom retroperitonealnom limfadenektomijom za utvrđivanje proširenosti bolesti. U istraživanje su uključeni bolesnici kliničkog stadija I. koji su operirani u razdoblju od 2001. do 2009. godine. Učinjena je ponovna procjena arhiviranih patohistoloških materijala pričem su uzorci bolesnika za koje je prvobitno utvrđeno da nemaju metastaza dodatno imunohistokemijski obrađeni protutijelima OCT4. Za svako stakalce vizualno je procijenjen postotak tumorskih stanica jezgre kojih su pokazale imunoreakciju za OCT4. Istraživanjem su uključena 93 bolesnika od kojih je 30 (32,3%) inicijalno imalo metastaze u retroperitonealnim limfnim čvorovima. Od preostala 63 bolesnika pet ih nije imalo dostupne materijale za analizu te je imunohistokemijsko bojenje učinjeno za 58 bolesnika. Među njima dijagnosticirali smo dva (3,4%) bolesnika koji su imali limfne čvorove pozitivne na OCT4. Njima je inicijalno utvrđen krivi stadij bolesti, čime smo zaključili kako je OCT4 potvrdio svoju vrijednost u otkrivanju retroperitonealnih metastaza. Laparoskopska retroperitonealna limfadenektomija u svrhu utvrđivanja stadija bolesti predstavlja razumnu opciju za probrane bolesnike u kliničkom stadiju I. neseminomskih tumora zametnih stanica testisa

Urogenital Infections Caused by Chlamydia Trachomatis

Početkom 1998. godine oformljena je grupa stručnjaka za istraživanje urogenitalnih infekcija uzrokovanih Chlamydiom trachomatis. Istraživanje je planirano do kraja 2002. godine. Glavna dosadašnja postignuća su u više objavljenih radova: 5 u Current Contents, 2 u Excerpta Medica, 1 u Index Medicus, jednom magisteriju, jednoj disertaciji, te prihvaćene teme za izradu još četiriju magisterija. Eventualno prepoznatljive preporuke o višim dozama azitromicina i novim indikacijama za primjenu azitromicina u području spolno prenosivih bolesti nisu službena preporuka PLIVE, nego one proizlaze iz rezultata ovog još nezavrπenog znanstvenoistraživačkog projekta. Postojeća registracija Sumameda u terapiji spolno prenosivih infekcija je 1 gram jednokratno.Early in 1998, a group of experts was formed in order to do research on urogenital infections caused by Chlamydia trachomatis. The study was planned to last till the end of 2002. Major achievements reached so far were published in several journals (indexed in the following databases: 5 in Current Contents, 2 in Excerpta Medica, one in Index Medicus), in one master’s thesis, one doctoral dissertation, and are to be reported in four additional master’s thesis. Possible recognizable recommendations for higher doses of azithromycin and new indications for azithromycin administration in the treatment of sexually transmitted diseases are not the official position of PLIVA, but they are implied by the results of this still unfinished scientific and research project. Current recommended dosage of Sumamed in the treatment of sexually transmitted infections is a single dose of 1 g

Strijelna ozljeda abdomena

Ozljede donje šuplje vene oduvijek su nosile visoki mortalitet. Iako se smrtnost tijekom vremena smanjila, njihovo zbrinjavanje ostaje značajan kirurški izazov. Prikazujemo slučaj 21-godišnjeg muškarca koji je zadobio ustrijelnu ranu u desnoj lumbalnoj regiji. Pokazali smo kliničku sliku pacijenta pri dolasku, tijek postupanja na Zavodu za HMP KBC-a Zagreb te način kirurškog zbrinjavanja. Usporedili smo naše rezultate s onima iz trenutno dostupne literature zbog identifikacije prediktivnih faktora koji bi mogli utjecati na povoljniji ishod. Cilj nam je bio pokazati kako promptna reakcija, brza kiruška intervencija i iskusan kirurški tim mogu dovesti do povoljnog ishoda, također prikazanog u ovom radu

Strijelna ozljeda abdomena

Ozljede donje šuplje vene oduvijek su nosile visoki mortalitet. Iako se smrtnost tijekom vremena smanjila, njihovo zbrinjavanje ostaje značajan kirurški izazov. Prikazujemo slučaj 21-godišnjeg muškarca koji je zadobio ustrijelnu ranu u desnoj lumbalnoj regiji. Pokazali smo kliničku sliku pacijenta pri dolasku, tijek postupanja na Zavodu za HMP KBC-a Zagreb te način kirurškog zbrinjavanja. Usporedili smo naše rezultate s onima iz trenutno dostupne literature zbog identifikacije prediktivnih faktora koji bi mogli utjecati na povoljniji ishod. Cilj nam je bio pokazati kako promptna reakcija, brza kiruška intervencija i iskusan kirurški tim mogu dovesti do povoljnog ishoda, također prikazanog u ovom radu

Pilot study of the association between the HLA region and testicular carcinoma among Croatian patients

OBJECTIVES: To analyze the distribution of HLA alleles and HLA microsatellite alleles in Croatian patients with testicular carcinoma, compare it with that of healthy controls and investigate whether the polymorphism within the HLA region could be associated with the development of testicular cancer. ----- METHODS: Genomic DNA was isolated from the peripheral blood of 24 patients with testicular germ cell tumors (TGCT). Patients and controls were typed for HLA class I and class II polymorphism by the PCR-SSO method. Nine HLA microsatellites were analyzed by PCR and electrophoresis in an automated sequencer. ----- RESULTS: No significant deviation in the distribution of frequencies at HLA class I alleles was observed between patients and controls. Among HLA class II alleles, a statistically significant increase in the frequency of the HLA-DPB1*1701 allele was found among patients. The frequency of the HLA-DRB1*07-DQA1*0201-DQB1*0202 haplotype was increased in patients in comparison to the controls. Analysis of HLA microsatellites showed an increased frequency of D6S291-3 allele (p(corr) = 0.0455, OR = 3.05) among patients. ----- CONCLUSIONS: The observed association of the disease and the DPB1*1701 allele as well as with the D6S291-3 allele suggests that this part of the HLA region might be involved in the pathogenesis of TGCT. Our data provide a basis for further studies about the correlation between the HLA region and testicular cancer

Laparoscopic partial nephrectomy with diode laser: a promising technique

OBJECTIVE: The aim of this study was to evaluate application of diode laser in laparoscopic partial nephrectomy (LPN), and to question this technique in terms of ease of tumor excision and reduction of warm ischemia time (WIT). ----- BACKGROUND DATA: LPN is the standard operative method for small renal masses. The benefits of LPN are numerous, including preserving renal function and prolonging overall survival. However, reduction of WIT remains main challenge in this operation. In order to shorten WIT, many techniques have been developed, with variable results. ----- PATIENTS AND METHODS: We performed a prospective collection and analysis of health records for patients who were operated on between March 2011 and August 2012. Inclusion criteria were single tumor ≤ 4 cm, predominant exophytic growth and intraparenchymal depth ≤ 1.5 cm, with a minimum distance of 5 mm from the urinary collecting system. ----- RESULTS: We operated on 17 patients. Median operative time was 170 min. In all but two patients, we had to perform hilar clamping. Median duration of WIT was 16 min. Pathohistological evaluation revealed clear cell renal cancer and confirmed margins negative for tumor in all cases. Median size of the tumor was 3 cm. Median postoperative hospitalization was 5 days. Average follow up was 11.5 months. There were no intraoperative complications. One postoperative complication was noted: perirenal hematoma. ----- CONCLUSIONS: Laser LPN is feasible, and offers the benefit of shorter WIT, with effective tissue coagulation and hemostasis. With operative experience and technical advances, WIT will be reduced or even eliminated, and a solution to some technical difficulties, such as significant smoke production, will be found