Metastatski karcinom bubrežnog parenhima

Renal cell carcinoma is the third leading urologic cancer. Thirty percent of patients with renal cell carcinoma have metastatic disease at the time of diagnosis. The most frequent locations of metastases from renal cell carcinoma are the lungs, mediastinum, bone, liver, and brain. There are several treatment modifications for metastatic renal cell carcinoma, with varying results. Surgical therapy is contraindicated in patients with multiple metastases, due to poor survival. Relief of pain and other symptoms poses a serious problem in patients with metastases.Karcinom bubrežnog parenhima je treći po učestalosti među urološkim karcinomima. U trećine bolesnika u trenutku otkrivanja primarnog tumora prisutna je diseminacija bolesti. Adenokarcinom bubrega najčešće metastazira u pluća i u medijastinum, zatim po učestalosti slijede koštane metastaze, metastaze jetre i mozga. U terapiji metastatskog adenokarcinoma upotrebljavaju se različiti pristupi s promjenjivim rezultatima. Kirurška terapija je kontraindicirana u bolesnika s višestrukim metastazama zbog slabog preživljavanja. Velik problem u bolesnika s metastazama predstavlja i ublažavanje simptoma

Uloga transuretralne resekcije površinskih tumora mokraćnog mjehura

Thirty percent all primary superficial bladder cancers do not recur at all, and hence do not need adjuvant treatment. Therefore, the most important is use is proper selection of patients who need adjuvant measures. Cystoscopy findings three months after transurethral resection (TUR) are of paramount importance. If there is no recurrence, patients are in a good prognosis group and need no further prophylactic measures. Recurrence assessed at that point requires maintance therapy. Because of the low toxicity and defendable scientific background after any TUR of a tumor that appears superficial to the clinician, a single administration of a chemotherapeutic agent can be used within three days of operation in order to prevent tumor cell seeding in the wound bed or elsewhere in the bladder. After resection of any pT1 (grade III) or Tis tumor, BCG maintenance therapy is appropriate. The remainder of pTa/pT1 (grade I and II) patients should be treated with intravesical chemotherapy in case of recurrence at three months. For patients who fail to respond to BCG treatment of pT1 ( grade III) or Tis and who are candidates for radical cystectomy, a new oral agent bromopirin with interferon inducing properties appears to offer some new hope. Patients with persistent positive high grade malignant citology are candidates for this new treatment.Trideset posto svih primarnih površinskih tumora mokraćnog mjehura uopće ne recidiviraju, stoga ne zahtijevaju dodatno liječenje. Iz tih razloga je vrlo važan odabir onih bolesnika koji zaista trebaju dodatne mjere liječenja. Od velikog značenja je prvi kontrolni cistoskopski nalaz, tri mjeseca nakon transuretralne resekcije mokraćnog mjehura zbog tumora. Ne nađu li se znakovi recidiva osnovne bolesti, prognoza bolesti takvih bolesnika je povoljna te oni ne zahtijevaju dodatno liječenje. Ako se nađe recidiv bolesti, treba razmotriti daljnje modalitete liječenja

ELECTROSTIMULATION OF NEUROGENIC BLADDER

U članku se opisuju metode i načini elektrootimulacije neurogenog mokraćnog mjehura nastalog nakon traumatske ozljede leđne moždine. Opisane su prednost i nedostaci pojedinih metoda elektrostimulacije koje se danas upotrebljavaju u rehabilitaciji neurogenog mjehura. Opisana je i metoda intravezik<rlne elektrootimulacije neurogenog mokraćnog mjehura koja se od nedavno počela primjenjvati u Zavodu za rehabilitaciju, fizikalnu medicinu i balneologiju Stubičke Toplice.ln this article the author describes methods and ways of the elecl!rootimilation of the neurogenIk bladder which was brought about as the result of a traumatic injury of the spina! cord. Advantages and disadvantages of some method that have now-a-days been used in the rehabdlitation of neurogenic bladder are described as well as the method of intravesical electrootimulation according to Katona which has recently been introduced at th Insrt:itut of physical medicine, rehabilitation and balneology in Stubičke Toplice

Primarni ekstragonadni tumori zametnih stanica u odraslih: prikaz triju slučajeva

Primary extragonadal germ cell tumors are rare neoplasms affecting young males. They usually present with abdominal retroperitoneal, mediastinal mass with varying symptoms. The rarest among these rare extragonadal germ cell tumors are embryonal cell carcinomas. Three cases of embryonal cell carcinomas are presented to show that the clinical presentation of this treatable tumor in this patient population may be quite unusual and difficult to diagnose. Differentiation between primary extragonadal tumors and metastasis of testicular primary tumor is essential but may be difficult in many instances.Primarni ekstragonadni tumori su rijetke neoplazme koje pogađaju uglavnom mlađe muškarce. Obično se očituju kao abdominalne retroperitonejske ili medijastinalne mase s različitim simptomima. Najrjeđi među rijetkim ekstragonadnim tumorima zametnih stanica su embrionalni karcinomi. Tri prikazana slučaja embrionalnih karcinoma pokazuju da kliničko očitovanje ovih tumora može biti neuobičajeno, a postavljanje dijagnoze otežano. Razlikovanje primarnih ekstragonadnih tumora i metastaza primarnog tumora testisa je ključno, ali u mnogim slučajevima problematično

Novi izgledi za kronični prostatitis

Nowadays we may be overlooking an ever more common and most likely infectious disease of uncertain etiology - prostatitis. The field of chronic prostatitis was stagnant for some three decades; however, the state of affairs has changed dramatically over the last few years. Prostatitis is the most common prostate disease in the younger population, which results in more physician visits than either benign prostatic hyperplasia or prostate cancer. Despite its high prevalence, chronic prostatitis as a disease and its etiology have been understudied. This article is concentrated on the entity of chronic prostatitis, which is the most controversial, diagnostically most imprecise, and most frustrating diagnosis in medicine in general. Also, it is the most common ailment in men worldwide. The knowledge about the disease is now progressing at a higher pace, especially concerning its etiology and pathogenesis. Along with a review of the latest findings, an update is provided of the classification, diagnosis, treatment and epidemiology of chronic prostatitis. It is emphasized that the disease should be recognized more often, or at least, epidemiologically speaking, it should be paid more attention.Danas možda previđamo prostatitis, sve češću i najvjerojatnije zaraznu bolest neutvrđene etiologije. Područje kroničnog prostatitisa stagniralo je kroz nekoliko desetljeća, da bi se stanje dramatično promijenilo posljednjih nekoliko godina. Prostatitis je najčešća bolest prostate u mlađoj populaciji, koja rezultira većim brojem liječničkih pregleda nego benigna hiperplazija prostate ili rak prostate. Usprkos učestalosti kroničnog prostatitisa, premalo je istraživanja kroničnog prostatitisa kao bolesti, kao i njegove etiologije. Ovaj je članak usredotočen na entitet kroničnog prostatitisa, koji predstavlja najkontroverzniju, najneprecizniju i najviše zbunjujuću dijagnozu u čitavoj medicini. To je također najčešća bolest u muškaraca širom svijeta. Danas se sve brže poboljšavaju saznanja o ovoj bolesti, poglavito o njezinoj etiologiji i patogenezi. Prikazan je pregled najnovijih nalaza i saznanja o klasifikaciji, dijagnostici, liječenju i epidemiologiji kroničnog prostatitisa. Isto tako, smatramo kako bi ovu bolest trebalo više uvažavati ili joj barem s epidemiološkog stajališta poklanjati više pozornosti

Istodobna pojavnost primarnog karcinoma bubrežnih stanica i njegove polipoidne intraluminalne metastaze u tankom crijevu: prikaz slučaja

A case is reported of metastatic renal cell carcinoma in the wall of the small bowel. The patient presented with abdominal pain, hematuria and fever. Exploration during radical nephrectomy revealed a metastatic tumor into the small bowel, which was resected at once. Pathologic examination showed stage T4N2M1 renal cell carcinoma, nuclear grade G4, containing sarcomatoid and clear cell areas. Clinically, metastasis of renal cell carcinoma into the small bowel is a rare disease. To our knowledge, only a few cases have been reported to date.Prikazan je slučaj karcinoma bubrega koji je metastazirao u tanko crijevo. Bolesnik je došao s bolovima u abdomenu, hematurijom i povišenom temperaturom. Za vrijeme radikalne nefrektomije otkriven je metastatski tumor u tankom crijevu, koji je odstranjen. Patohistološka analiza pokazala je stadij T4N2M1 bubrežnog karcinoma koji je bio građen od vretenastih i svijetlih stanica. Metastaziranje bubrežnog karcinoma u tanko crijevo dosta je rijetko. Prema našem saznanju opisano je samo nekoliko slučajeva

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

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

Prikaz cističnog, multilokularnog metanefričkog adenoma bubrega: kliničke, radiološke i patološke osobitosti

A case of multilocular, cystic metanephric adenoma in a 34-year-old man is presented to increase awareness among urologists and radiologists of this rare entity. Metanephric adenoma of the kidney is an uncommon benign epithelial tumor that may present at any age. To our knowledge, only few cases of cystic manifestation have been reported. Metanephric adenoma is extremely rare and its diagnosis should be considered in a patient with well circumscribed multilocular renal tumor and paraneoplastic syndromes. Its appearance on sonography, intravenous pyelography and magnetic resonance is described. Distinct pathologic features are also discussed. Radiologic and clinical features of the tumor are nonspecific, and histopathologic examination is essential to establish definitive diagnosis. Its recognition may facilitate nephron-sparing surgery.Prikazan je slučaj cističnog, multilokularnog metanefričkog adenoma u 34-godišnjeg bolesnika. Metanefrički adenom je izrazito rijetka benigna epitelna neoplazma bubrega koja se može javiti u bilo kojoj dobi. Prema našim saznanjima prikazano je samo nekoliko slučajeva cistične manifestacije metanefričkog adenoma u literaturi. Prikazane su radiološke i patohoistološke značajke tumora. Kliničke značajke tumora su nespecifične i za definitivnu dijagnozu potrebna je patohistološka analiza. Djelomična resekcija odnosno enukleacija tumora terapijska je metoda izbora

Istodobna pojavnost primarnog karcinoma bubrežnih stanica i njegove polipoidne intraluminalne metastaze u tankom crijevu: prikaz slučaja

A case is reported of metastatic renal cell carcinoma in the wall of the small bowel. The patient presented with abdominal pain, hematuria and fever. Exploration during radical nephrectomy revealed a metastatic tumor into the small bowel, which was resected at once. Pathologic examination showed stage T4N2M1 renal cell carcinoma, nuclear grade G4, containing sarcomatoid and clear cell areas. Clinically, metastasis of renal cell carcinoma into the small bowel is a rare disease. To our knowledge, only a few cases have been reported to date.Prikazan je slučaj karcinoma bubrega koji je metastazirao u tanko crijevo. Bolesnik je došao s bolovima u abdomenu, hematurijom i povišenom temperaturom. Za vrijeme radikalne nefrektomije otkriven je metastatski tumor u tankom crijevu, koji je odstranjen. Patohistološka analiza pokazala je stadij T4N2M1 bubrežnog karcinoma koji je bio građen od vretenastih i svijetlih stanica. Metastaziranje bubrežnog karcinoma u tanko crijevo dosta je rijetko. Prema našem saznanju opisano je samo nekoliko slučajeva