„Large nested” varijanta urotelnog karcinoma – prikaz bolesnika

Urotelni karcinom čini oko 90% malignih tumora mokraćnog mjehura, sa sklonošću raznolike diferencijacije. Različiti podtipovi imaju jedinstven histološki izgled i klinički tijek. Među podtipovima, jedan od najnovijih i rjeđih entiteta uvrštenih u najnoviju Klasifikaciju Svjetske zdravstvene organizacije (SZO) jest tzv. „large nested” varijanta urotelnog karcinoma koju karakterizira s jedne strane dobroćudan histološki izgled, a s druge agresivan klinički tijek te stoga predstavlja dijagnostički problem. Ovdje donosimo prikaz slučaja pacijenta obrađivanog zbog bezbolne makrohematurije

Secular Changes in Growth and Obesity in Perinatal Population

The survey was conducted during the last 25 years and included 2414 healthy women who delivered in »Sestre milosrdnice« University Hospital Center in Zagreb, Croatia and their newborns. The aim was to establish the secular trend of some anthropological factors through two generations. Anthropological features such as pre-pregnancy weight, body mass index before pregnancy, height, age, place of residence, educational level, parity and the newborn weight were registered. The study was randomized. The mothers from the city of Zagreb and the surrounding villages, rural areas are examined. The women age was different and also different levels of education and socioeconomic status. The study included women who had not given birth yet, who had delivered once, twice, and three or more times. Maternal height in 25 years increased by 3.1cm. and increases with education. The pre-pregnancy weight increased 2.8 kg and increases with age, parity and rural life. The body mass index (BMI) which the women had before pregnancy was calculated, and according to its value the participants were divided in three groups: with normal weight, overweight and fat. Among the studied periods BMI does not differ significantly, but does differ significantly with respect to the ordinal number of births, parity, age and living environment. Higher BMI was associated with deliveries to heavier children

Akutni rekurentni pankreatitis izazvan hiperlipidemijom tip IIb

Hypertriglyceridemia is a known but underestimated cause of acute pancreatitis. Although the connection between acute pancreatitis and type I, IV, and V hyperlipoproteinemia has been described, using Fredrickson’s classification, the connection between type IIb hyperlipoproteinemia and associated pancreatitis has only been reported in a few more rare cases. That is why we present a female patient with recurrent hyperlipidaemic pancreatitis with type IIb hyperlipidaemia.Hipertrigliceridemija je poznat, ali podcijenjen uzrok akutnog pankreatitisa. Iako je već opisana veza između akutnog pan-kreatitisa i hiperlipoproteinemije tipa I, IV i V, korištenjem Fredricksonove klasifikacije, veza između hiperlipoproteinemije tipa IIb i pridruženog pankreatitisa zabilježena je samo u još nekoliko rijetkih slučajeva. Upravo zbog toga prikazujemo pacijenticu s rekurentnim hiperlipidemijskim pankreatitisom s hiperlipidemijom tipa IIb

The Mutagenic Potential of Chloroform, Orange Oil, Eucalyptus Oil and Halothane by Salmonella/Microsome Assay

Svrha rada bila je ispitati mutagenu aktivnost četiriju komercijalno dostupnih otapala gutaperke Salmonella/mikrosomskim testom. Ispitana su bila otopala: kloroform, narančino ulje, eukaliptusovo ulje i halotan u količinama od 10 μl, 30 μl, 50 μl, 100 μl i 200 μl. Upotrijebljen je standardni Ames test inkorporacije na ploči pri čemu su rabljene bakterije Salmonella typhimurium soja TA 98 i TA 100 s metaboličkom aktivacijom enzimom S9. Rezultati istraživanja pokazuju citotoksičnu aktivnost eukaliptusova ulja u svim koncentracijama, narančina ulja u koncentracijama od 50 μl i većima. Kloroform je pokazao citotoksičnost u koncentracijama od 100 μl i 200 μl. Niti jedno otapalo gutaperke nije pokazala mutagenu aktivnost Ames testom u ispitivanim koncentracijama.The aim of this study was to examine mutagenic activity of four commercially available gutta-percha solvents by means of the Salmonella/ microsome assay. The examined solvents were: chloroform, orange oil, eucalyptus oil and halothane in amounts of 10 μl, 30 μl, 50 μl, 100 μl and 200 μl. Standard plate incorporation Ames test was preformed by using two tester strains of Salmonella typhimurium, TA 98 and TA 100, with metabolic activation of S9. The results showed toxicity of eucalyptus oil in all aliquots, orange oil in aliquots of 50 μl and above and chloroform in aliquots of 100 μl and 200 μl, but all four substances responded negative to the Ames test. These results indicate that the tested solvents do not possess mutagenic activity toward the Salmonella strains used

Remaining Filling on the Root Canal Walls after Retreatment with Three Gutta-percha Solvents

Svrha istraživanja bila je utvrditi količinu zaostale gutaperke i cementa na stijenkama korijenskoga kanala nakon uporabe triju različitih otapala gutaperke: eukaliptusova ulja, halotana i narančina ulja. Sedamdeset jednokorijenskih zuba je instrumentirano «step back» tehnikom te ispunjeno gutaperkom i Diaket cementom tehnikom hladne lateralne kondenzacije. Nakon 180 dana pohrane u fiziološkoj otopini uzorci su podijeljeni u tri skupine. Revizija je napravljena ručnim instrumentima s dodatkom otapala. Postupak je završen kada nije bilo tragova gutaperke i cementa na instrumentu ili na papirnatome štapiću. Zubi su raskoljeni te snimljeni kamerom montiranom na steromikroskop. Površina zaostale gutaperke i cementa izračunane su računalnim programom «ISSA». Najviše je punila zaostalo na stijenkama korijenskoga kanala nakon revizije s narančinim uljem (3,85 ±3,15 mm2), zatim s halotanom (3,72 ±2,52 mm2), a najbolji su rezultati postignuti s eukaliptusovim uljem (2,82 ±1,31 mm2), ali bez statistički znatne razlike.The aim of the investigation was to evaluate the amount of remaining gutta-percha and cement on dentine walls of the root canal after retreatment with three different gutta-percha solvents: eucalyptus oil, halothane and orange oil. Seventy one-rooted teeth were instrumented by “step-back” technique and filled with gutta-percha and Diaket cement using a cold lateral condensation technique. After 180 days storing in saline solution the samples were divided into three groups. Retreatment was done by hand instruments with the addition of solvent. The procedure was considered finished when there were not obvious traces of guttapercha and cement on the instrument or paper point. The teeth were split and photographed by camera mounted on a stereomicroscope. The area of remaining gutta-percha and cement was calculated by computer program “ISSA”. The greatest amount of remaining root canal filling was found after retreatment with orange oil (3.85 ±3.15 mm2), followed by halothane (3.72 ±2.52 mm2), and the best result was achieved with eucalyptus oil (2.82 ±1.31 mm2), but without statistical significance

Primary acantholytic squamous cell carcinoma of the cecum: a case report

<p>Abstract</p> <p>Background</p> <p>Acantholytic squamous cell carcinoma (ASCC) is an uncommon histopathologic variant of SCC, characterized by marked acantholysis, wherein the tumor cells demonstrate defective cohesion to one another in the cancer nest leading to a pseudoglandular or pseudovascular appearance. The most common site of ASCC is the sun-exposed areas of the skin. Sporadic cases of ASCC have also been reported in various mucosal membranes and organs but to our knowledge this is the first case of primary ASCC of the large bowel.</p> <p>Case presentation</p> <p>A 59-year-old woman underwent right hemicolectomy due to large tumor in cecum and initial part of the ascending colon. Microscopically, the tumor consisted of nests of focally keratinizing large, atypical, squamous epithelial cells. Approximately 70% of the tumor showed acantholytic changes and acantholysis was equally distributed through the entire tumor. Immunohistochemically tumor cells were diffusely positive for cytokeratin (CK) AE1/AE3 and focally positive for epithelial membrane antigen and syndecan 1. All other tested antibodies (CK7, CK 20, CK MNF116, E-cadherin, beta-catenin, p63, p16, CD31, CD34, CEA, estrogen, progesterone) showed negative reaction. Periodic acid Schiff and alcian blue staining showed no intracellular or extracellular mucinous material in the tumor. The diagnosis of acantholytic squamous cell carcinoma of the cecum was suspected and additional examination was recommended to exclude possibility of metastatic carcinoma. Extensive clinical examination which also included whole-body PET/CT scan showed no additional tumors. After the exclusion of possible metastatic disease the diagnosis of primary acantholytic squamous cell carcinoma of the cecum was confirmed. Six months after surgery the metastasis in small intestine and recurrence in the abdominal cavity at the site of surgery appeared and had the same morphological characteristic as the primary tumor in the cecum.</p> <p>Conclusion</p> <p>We report a unique case of ASCC arising in cecum and on this way expands the range of tumors originating in colon. Reports of more cases of colonic ASCC would possibly help to elucidate origin, clinical behavior and therapy of these tumors.</p

Gigantski liposarkom mezenterija miješanog tipa

Primary mesenteric liposarcomas are very rare, especially when they are of mixed histologic pattern. Patient prognosis is based upon the most aggressive histologic type of liposarcoma. A case is reported of a 77-year-old man with a history of slowly increasing abdominal volume over 3 years. The diagnosis of giant intra-abdominal mass suspect of liposarcoma was confirmed by computed tomography and ultrasound scans. The patient underwent resection of 24 tumor masses weighing together 23.5 kg. The microscopic diagnosis was mixed-type liposarcoma of the mesentery. Although this type of tumor is rare, tumor tissue should be thoroughly collected and analyzed on histologic examination to reach definitive diagnosis. Recognition of the underappreciated subtype of liposarcoma is important for proper prognosis and treatment of the patient. According to our knowledge, this is the largest size of mixed-type mesenteric liposarcoma described in the English literature.Primarni liposarkomi mezenterija su rijetki, osobito ako su miješanog histološkog izgleda. Prognoza pacijenta ovisi o najagresivnijem histološkom tipu liposarkoma. Prikazujemo slučaj 77. godišnjeg muškarca s anamnezom spororastućeg volumena abdomena tijekom 3 godine. Dijagnoza ogromne intra-abdominalne mase suspektne na liposarkom potvrđena je CT-om i ultrazvukom. Pacijentu su resecirane 24 tumorske mase koje su zajedno težile 23.5 kg. Histološka dijagnoza je bila miješani tip liposarkoma mezenterija. Iako je ovaj tip tumora rijedak, tumorsko tkivo treba pomno preuzeti i pregledati histološki kako bi se postavila ispravna zaključna dijagnoza. Pronalazak nepovoljnog tipa liposarkoma je važan zbog točne prognoze i daljnjeg liječenja pacijenta. Prema našim saznanjima, ovo je najveći opisani liposarkom mezenterija miješanog tipa u engleskoj literaturi

Selective Portal Vein Embolization as Introduction in Major Surgery

In the period between the December 2000 and September 2004, altogether 13 patients underwent preoperative portal vein embolization (PPVE); 9 patients with colorectal metastases and 4 patients with hepatocellular carcinoma. The indirect splenic portography was performed after catheter was introduced into superior mesenteric artery via femoral artery approach. The portal vein was punctured percutaneously transhepatic under fluoroscopy. Following portography, selected portal vein segments were embolized by injecting polyvinil alcohol (PVA) particles until stasis of blood flow was achieved. Proximal parts of branches and the channel in the liver parenchyma were occluded with Gelfoam particles. The increase of the remnant liver parenchyma was measured by magnetic resonance imaging. Two patients experienced post-embolization syndrome and another one had subcapsular hematoma. The volume of the liver parenchyma increased minimally for 8% and maximally for 109%. Altogether, 10 patients underwent surgical resection. In two patients, the disease progressed and carcinoma spread to the previously healthy liver lobe and in one there was no hypertrophy and we decided for artery chemoembolization (AC). The results show that PPVE triggers a strong regenerative response resulting in hypertrophy of normal liver parenchyma and expand possibilities of curative surgery for patients who would not otherwise have been candidates for extended resection