Measurement of Tooth Extraction Forces in Upper Incisors

A new method, applied for the first time in this research, was used for measurement of tooth extraction forces. The research has been done in a group of 50 examinees to whom the tooth extraction has been done with lower premolar forceps – forceps »13« and in the control group of 54 examinees in whom the tooth extraction has been done with upper incisive forceps – forceps »1«. The measurement instrument registered the extraction forces values in both types of forceps. There was no difference in any parameters in these two groups except in used pressure. While using the forceps »13«, a significantly lower tooth extraction force was measured than the force measured while using the forceps »1« (p<0.001). This means that in clinical work we can already apply noticeably less force using the lower premolar forceps for the extraction of the upper incisors (in the moments of rotation up to 70%). These results are meaningful, because they lead to better and improved instrument solutions and working techniques

Application of Wound Closure Molndal Technique after Laparoscopic Cholecystectomy – Initial Comparative Study

Because of a possible delayed wound healing, critical colonization and infection of wounds present a problem for surgeons1–3. Colonized and infected wounds are a potential source for cross-infection1–3. Molndal technique of wound dressing has proven to be effective in prevention of infection. Also the wound heal better and faster3–5. In our study we wanted to describe the benefits of the Molndal technique wound dressing after laparoscopic cholecistectomy compared to traditional wound dressing technique. Molndal technique consisted of wound dressing with Aquacel Ag – Hydrofiber (ConvaTec, Dublin, Ireland). Traditional technique was performed using gauze compresses and hypoallergic adhesives. We analyzed the results of 100 patients after laparoscopic cholecystectomy. 50 patients were treated by Molndal technique and 50 patients by the traditional technique of wound dressing. In the group trated by Molndal technique only 1 (2%) patient has revealed a wound infection, proven by positive microbiological examination and suppuration, mostly in the subumbilical incision. In the traditional technique group 7 (14%) patients developed wound infection also predominantly in the subumbilical incision. The difference was statistically significant (p<0.01). Our results are clearly showing that Molndal technique is effective in preventing the infection of subumbilical incision wound and is to by recommend for regular use at designated site after laparoscopic cholecistectomy

Transrectal Sonography in Prostate Cancer Detection – Our 25 Years Experience of Implementation

Prostate cancer is a leading public health problem of male population in developed countries. Gold standard for prostate cancer diagnosis is true cut biopsy guided by transrectal ultrasound1–5. Aim of this study was to determine sensitivity, specificity, accuracy, positive and negative predictive value of transrectal sonography (TRUS) in prostate cancer detection. The analysis was made for two time periods, before and after routine implementation of prostate specific antigen (PSA) in prostate cancer diagnostics. From 1984 to 1993 TRUS guided prostate biopsy was performed in 564, and from 1994 to 2008 in 5678 patients. In the second period PSA was routinely used in prostate cancer diagnostics. In the first period by TRUS we have made an exact diagnosis of prostate cancer in 18.97% of patients what was confirmed by biopsy. 4.61% ware false positive and 11.34% ware false negative. In the second period prostate cancer was recognized in 30.34% of patients, confirmed by biopsy. False positive cases ware 6.11% and false negative 29.31%. Sensitivity of transrectal sonography in the first period was 62.57%, specificity 94.2%, accuracy 86.2%, positive predictive value 80.45% and negative predictive value 87.72%. In the second period sensitivity was 50.87%, specificity 91.93%, accuracy 73.84%, positive predictive value 83.24% and negative predictive value 70.39%. Based on our experience we can conclude that prostate cancer is mostly found in the peripheral zone. Smaller tumors are hipoechoic and bigger tumors are hiperechoic. Prostate cancer lesions are impossible to differentiate from chronic prostatitis only by TRUS. Implementation of PSA has significantly decrease sensitivity, accuracy and negative predictive value of TRUS in prostate cancer detection. TRUS guided true cut biopsy is a gold standard in prostate cancer diagnostics

Mini percutaneous nephrolithotripsy as treatment modality for kidney stones

Cilj: Prikazati naše rezultate u liječenju pacijenata s bubrežnim kamencima metodom miniperkutane nefrolitotripsije (miniPCNL). Pacijenti i metode: Retrospektivnim istraživanjem obuhvatili smo pacijente Klinike za urologiju, Kliničkog bolničkog centra u Rijeci koji su između 1. kolovoza 2015. i 31. prosinca 2016. godine zbog bubrežnih kamenaca liječeni metodom miniPCNL-a. Rezultati: U promatranom razdoblju u našem centru operirano je 6 pacijenata ovom metodom, od kojih je jedan bio s transplantiranim bubregom. U svih pacijenata uspješno je učinjena litotripsija s holmium-laserom. Na kontrolnom RTG-u nije bilo ostatnih fragmenata. U četvoro pacijenata poslijeoperativno je došlo do razvoja febriliteta koji je uspješno liječen antibiotskom terapijom. Niti u jednog pacijenta nije bila potrebna reoperacija, dodatne procedure niti potreba za davanjem krvi. Zaključak: Miniperkutana nefrolitotripsija je minimalno invazivna metoda koja se pokazala uspješnom i sigurnom u liječenju nefrolitijaze.Aim: To present our results in the treatment of nephrolithiasis using mini percutaneous nephrolithotripsy (miniPCNL). Patients and methods: We retrospectively analyzed all patients with nephrolithiasis treated with miniPCNL in Department of Urology, University Hospital Rijeka from August 1st 2015 to December 31st 2016. Results: In observed period 6 patients were operated with this novel method and one has transplanted kidney. In allpatients lithotripsy was successfully performed with holmium laser. On the control x-ray the residual fragments were not found in any patients. Postoperatively, in four patients febrility was noticed and successfully treated with antibiotics. Neither the one patient need reoperation, auxiliary procedures or blood transfusion. Conclusion: Mini percutaneous nephrolithotripsy is a minimally-invasive method which is successfull and safe method in the treatment of kidney stones

Extracorporeal shock wave lithotripsy

Izvantjelesno mrvljenje kamenaca (ESWL) je novija terapijska metoda u liječenju urolitjaze. Temelji se na uporabi šok-valova koji se stvaraju u generatoru, fokusiraju i usmjeruju na kamenac u tijelu pacijenta. Razbijanje kamenca je posljedica nekoliko različith efekata tih valova na sam konkrement. Razbijanjem nastaju manji fragmenti koji se moraju izmokriti. ESWL se korist u liječenju bubrežnih kao i kamenaca u mokraćovodu. Metoda je izbora za liječenje bubrežnih kamenaca manjih od 2 cm te onih u proksimalnom dijelu mokraćovoda veličine do 1 cm. Komplikacije su rijetke i najčešće klinički beznačajne. Efkasnost ove metode ovisi o veličini kamenca, njegovom sastavu, kanalnom sustavu bubrega te o iskustvu i vještni urologa. Velika prednost ove metode je da nije potrebna anestezija, za razliku od drugih minimalno invazivnih metoda. Tretman ESWL-a može se ponavljati više puta. Do sada nije dokazan štetan učinak na bubrežnu funkciju, a može se koristiti i u dječjoj populaciji.Extracorporeal shock wave lithotripsy (ESWL) is a novel method for the treatment of urolithiasis. It is based on the use of shock waves that are generated in the generator, focused and directed to the stone in the body of the patent. Cracking of the stone is the result of several different effects of these waves. It results with stone fragmentation and spontaneous elimination of fragments. ESWL is used in the treatment of kidney stones and stones in the ureter. These method is the method of choice for treating kidney stones smaller than 2 cm, and those in the proximal part of the ureter up to 1 cm. Complicatons are rare and usually clinically insignificant. The effectiveness of this method depends on the stone size, its compositon, the renal system morphology and the experience and skill of the urologist. The great advantage of this method is that anesthesia is not needed, unlike other minimally-invasive treatements. Also, the ESWL treatment can be repeated several times. There is no proven damaging effect on the renal function and can be used for treatment of stones in the children

Dual kidney transplantation

Cilj: Transplantacija bubrega metoda je izbora u liječenju bolesnika s terminalnim kroničnim bubrežnim zatajenjem. S obzirom na nesrazmjer između broja primatelja i darivatelja organa, kako bi se povećao broj darivatelja, počeli su se koristiti i bubrezi takozvanih marginalnih donora. U njih spada i korištenje obaju bubrega darivatelja u istog primatelja (dvostruka transplantacija bubrega). U ovom radu prikazujemo prvi slučaj bilateralne dvostruke transplantacije bubrega u KBC-u Rijeka i Republici Hrvatskoj. Prikaz slučaja: Primatelj je 75-godišnji muškarac koji je 15 godina bio na hemodijalizi zbog kroničnog bubrežnog zatajenja uzrokovanog kroničnim glomerulonefritisom. Darivatelj bubrega bila je 78-godišnja žena, čiji je uzrok smrti bilo intrakranijalno krvarenje. Bubrezi su transplantirani bilateralno, ekstraperitonealno, u ilijačne jame. Poslijeoperacijski tijek protekao je uredno, bez kirurških i imunoloških komplikacija. Korištena je trojna imunosupresivna terapija. Godinu nakon transplantacije oba presatka uredno funkcioniraju. Rasprava i zaključak: S obzirom na to da je preživljenje bolesnika s dvostrukom transplantacijom bubrega veće nego u bolesnika koji se liječe hemodijalizom, smatramo kako se korištenjem organa ove skupine donora može povećati broj transplantacija.Aim: Kidney transplantation is the method of choice for treatment of patients with end-stage renal disease. Because of disparity between donors and recipients, the use of marginal donors was established to increase the number of donors. Dual kidney transplantation represents using two kidneys from the same donor for one recipient. In this case report we present the first case of bilateral dual kidney transplantation in KBC Rijeka and Croatia. Case report: The recipient was a 75-year-old man who was on hemodialysis for 15 years. The cause of end-stage renal disease was chronic glomerulonephritis. The donor of kidneys was a 78-year-old woman with cerebral death caused by intracranial bleeding. The kidneys were transplanted bilaterally and placed extraperitoneally in the iliac fossa. Postoperative course was uneventful, without surgical and immunological complications. Triple immunosuppressive therapy was used. One year after transplantation both kidneys have good function. Discussion and conclusion: As survival of patients with dual kidney transplantation is better than on haemodialysis, we believe that using kidneys from expanded criteria donors can possibly increase the number of kidney transplantations

MINI-PERCUTANEOUS NEPHROLITHOTRIPSY – OUR FIRST EXPERIENCE

Urolitijaza je važan problem u razvijenim zemljama svijeta jer se broj ljudi s konkrementima povećava. Prije nekoliko desetljeća kirurško liječenje urolitijaze provodilo se samo putem otvorene kirurgije, dok su danas dominantne minimalno-invazivne metode. Jedna od njih je i miniperkutana nefrolitotripsija. U ovom radu prikazana su četiri bolesnika u kojih je učinjena miniperkutana nefrolitotripsija. U svih bolesnika konkrement se nalazio u pijelonu desnoga bubrega. U troje bolesnika konkrement je bio u nativnom bubregu, a u jednoga u transplantiranome. U svih bolesnika uspješno je učinjena laserska litotripsija konkremenata. Na kontrolnom RDG pregledu nije bilo ostatnih fragmenata. Miniperkutana nefrolitotripsija jest minimalno-invazivna metoda koja se pokazala uspješnom u liječenju nefrolitijaze i u nativnim bubrezima i u transplantiranom bubreguUrolithiasis is a significant problem in the developed countries due to the increased number of patients with stones. Just a few decades ago open surgery was the only surgical treatment which is today, in most cases, replaced with minimally-invasive methods. One of these new methods is mini-percutaneous nephrolihotripsy. We present four patients in whom mini-percutaneous nephrolithotripsy was performed. In all patients the stone was located in the renal pelvis. In three patients the stone was in the native kidney and in one in the transplanted kidney. In all patients laser lithotripsy was successfully performed. On the control x-ray the residual fragments were not found in any patients. Mini-percutaneous nephrolithotripsy is a minimally-invasive method which is successfull in the treatment of nephfrolithiasis in native and transplanted kidneys

Incidence, clinical evaluation and surgical treatment of patients with renal cell cancer: 40-years of experience in the University Hospital Rijeka

Cilj: Ispitati učestalost, kliničku evaluaciju i kirurško liječenje pacijenata s karcinomom bubrega (KB). Pacijenti i metode: Retrospektivnim istraživanjem bili su obuhvaćeni svi pacijenti u Kliničkom bolničkom centru Rijeka koji su između 1. siječnja 1972. i 31. prosinca 2012. godine operirani zbog KB-a. Rezultati: U promatranom razdoblju u našem centru zbog KB-a bilo je operirano 1045 pacijenata. Broj pacijenata se tijekom vremena povećao, s 5 pacijenata godišnje početkom 70-ih godina na preko 50 posljednjih nekoliko godina. Broj asimptomatskih pacijenata povećao se s 6 % na 75 %. Prosječna dob pacijenata bila je 63 godine (raspon 21 – 86 godina). Nefrektomija je učinjena u 95,3 % pacijenata, u 2,6 % parcijalna nefrektomija, a u 2,1 % eksplorativna lumbotomija. U promatranom razdoblju 5-godišnje preživljenje bilo je u 64 %, a 10-godišnje preživljenje 47 %. Zaključak: Učestalost KB-a se tijekom posljednja četiri desetljeća višestruko povećala. Novije dijagnostičke metode omogućuju njegovo otkrivanje u ranijoj fazi, a samim time se omogućuje poštednije kirurško liječenje, ne umanjujući onkološki učinak.Aim: To evaluate incidence, clinical evaluation and surgical treatment of our patients with renal cell cancer (RCC). Patients and methods: We retrospectively analyzed all patients with RCC operated in University Hospital Rijeka from January 1st 1972 to December 31st 2012. Results: In observed period 1045 patients were operated because of RCC. Number of operated patients has increased during time from 5 in the begining of 70-ties to more than 50 in the few last years. The number of asymptomatic patients has increased from 6% to 75%. The mean age was 63 years (range 21-86). Nephrectomy wasperformed in 95.3% patients, nephron sparing surgery in 2.6% and explorative lumbotomy in 2,1% of patients. The 5-year survival was 64% and 10-year survival 47%. Conclusion: The incidence of RCC substantialy increased during time. The new diagnostic methods found RCC in earlier phase and the nephron sparing surgery can be performed without negative influence on oncological outcome

Transurethral Incision of the Bladder Neck in a Woman with Primary Bladder Neck Obstruction after Kidney Transplantation

Voiding dysfunction is frequently seen in the early posttransplant period. Among other causes, this condition can arise due to bladder outlet obstruction. Primary bladder neck obstruction (PBNO) is a possible but very rare cause of bladder outlet obstruction. We present the case of a 52-year-old woman who, after kidney transplantation, presented with PBNO. The diagnosis was established based on symptoms, uroflowmetry, and multichannel urodynamics with electromyography. The transurethral incision of the bladder neck was made at the 5- and 7-o’clock position. After the operation, the maximal flow rate was significantly increased, and postvoid residual urine was decreased compared to the preoperative findings. The patient was followed for 5 years, and her voiding improvement is persistent. This is the first reported case of PBNO treated with a transurethral incision of the bladder neck in a posttransplantation female patient

Dual kidney transplantation

Cilj: Transplantacija bubrega metoda je izbora u liječenju bolesnika s terminalnim kroničnim bubrežnim zatajenjem. S obzirom na nesrazmjer između broja primatelja i darivatelja organa, kako bi se povećao broj darivatelja, počeli su se koristiti i bubrezi takozvanih marginalnih donora. U njih spada i korištenje obaju bubrega darivatelja u istog primatelja (dvostruka transplantacija bubrega). U ovom radu prikazujemo prvi slučaj bilateralne dvostruke transplantacije bubrega u KBC-u Rijeka i Republici Hrvatskoj. Prikaz slučaja: Primatelj je 75-godišnji muškarac koji je 15 godina bio na hemodijalizi zbog kroničnog bubrežnog zatajenja uzrokovanog kroničnim glomerulonefritisom. Darivatelj bubrega bila je 78-godišnja žena, čiji je uzrok smrti bilo intrakranijalno krvarenje. Bubrezi su transplantirani bilateralno, ekstraperitonealno, u ilijačne jame. Poslijeoperacijski tijek protekao je uredno, bez kirurških i imunoloških komplikacija. Korištena je trojna imunosupresivna terapija. Godinu nakon transplantacije oba presatka uredno funkcioniraju. Rasprava i zaključak: S obzirom na to da je preživljenje bolesnika s dvostrukom transplantacijom bubrega veće nego u bolesnika koji se liječe hemodijalizom, smatramo kako se korištenjem organa ove skupine donora može povećati broj transplantacija.Aim: Kidney transplantation is the method of choice for treatment of patients with end-stage renal disease. Because of disparity between donors and recipients, the use of marginal donors was established to increase the number of donors. Dual kidney transplantation represents using two kidneys from the same donor for one recipient. In this case report we present the first case of bilateral dual kidney transplantation in KBC Rijeka and Croatia. Case report: The recipient was a 75-year-old man who was on hemodialysis for 15 years. The cause of end-stage renal disease was chronic glomerulonephritis. The donor of kidneys was a 78-year-old woman with cerebral death caused by intracranial bleeding. The kidneys were transplanted bilaterally and placed extraperitoneally in the iliac fossa. Postoperative course was uneventful, without surgical and immunological complications. Triple immunosuppressive therapy was used. One year after transplantation both kidneys have good function. Discussion and conclusion: As survival of patients with dual kidney transplantation is better than on haemodialysis, we believe that using kidneys from expanded criteria donors can possibly increase the number of kidney transplantations