Current knowledge about prostatic cancer a proposal for a common therapy protocol

Ukupna učestalost karcinoma prostate znatno premašuje učestalost klinički dokazanog karcinoma, iako je to najčešći rak u muškaraca. Dijagnoza kliničkog raka prostate postavlja se danas na osnovi sigurnih i neizbježnih pokazatelja. To su: rektalni pregled, UZV pregled transrektalnom sondom, povišene vrijednosti prostatičnog specifičnog antigena (PSA) u serumu i transrektalna punkcijska biopsija. Suvremena klasifikacija mora odvojiti lokaliziranu bolest od uznapredovale i diseminirane bolesti. Kako veliki dio karcinoma prostate predstavlja stacionarnu bolest, potrebno je utvrditi prediktore malignog potencijala s pomoću kojih će se odvojiti slučajevi agresivnog karcinoma koji zahtijevaju terapiju. To su: povećanje limfnih čvorova zdjelice, povišeni PAP, veličina primarnog tumora, niskodiferencirani epitel primarnog tumora i stanična aneuploidija. Lokalizirani agresivni karcinom prostate, uz ispunjene opće uvjete operacije, zahtijeva radikalnu prostatektomiju. Uznapredovali karcinom ili diseminirana bolest diktiraju kombiniranu terapiju kojoj je osnova potpuna androgena blokada. To se u prvoj fazi terapije postiže orhidektomijom + analozi GnLH + antiandrogeni. Druga se faza terapije osniva na fosforiliziranim esterima stilbena (Honvan i Estracyt), treća na citostaticima i posljednja na suzbijanju boli.General frequency of prostatic cancer (including incidental and undetected) outnumbers clinical prostatic cancer, although this one is by far the most frequent cancer of man. Current diagnosis of clinical prostatic cancer is based on digital examination, rectal ultrasound, serum prostatic specific antigen level and transrectal biopsy. Modern classification has to separate localized from advanced and disseminated disease. A high percent age of prostatic cancer is inactive disease whose mortality does not outnumber the man lethality without cancer. Today, we have some concrete factors indicating the disease aggressive potential, e.g. regional lymph node growth, high PSA and PAP levels, primary tumor size, high grading and nuclear aneuploidy. With them, the cases requiring therapy can be differentiated from those with inactive cancer. Localized aggressive prostatic cancer with general conditions for operation fulfilled indicates radical prostatectomy. The advanced and disseminated disease is an indication for paliative therapy, which is based on complete androgen deprivation. This is achieved in the first phase of therapy with orchydectomy + GnLH analogues + antiandrogens. The next therapeutic phase (after new disease progression ) consists of phosphorilized stilbens, such as Estracyt and Honvan. The final, exclusively symptomatic therapy should be preceded by chemotherapy

From foundation hospital to University hospital centre in Osijek

Početak razvoja Kliničkoga bolničkog centra u Osijeku vezanje uz Huttler Kohlhoffer Monspergerovu zakladnu bolnicu, osnovanu 1874. godine, koja je tada bila najmodernija bolnica na jugoistoku Europe. Naredbom Vlade 1895. godine postaje „Sveobća i javna Huttler Kohlhoffer-Monspergerova zakladna bolnica pod Zemaljskom upravom u Osieku“. U vrijeme Prvoga svjetskog rata Zakladna bolnica skrbi o ranjenima i bolesnima. Poslije Prvoga svjetskog rata otvaraju se novi bolnički odjeli. Osim Kirurgije i Interne medicine, novi su odjeli Oftalmologija, Otorinolaringologija, Dermatovenerologija, Epidemiološkohigijenski zavod i Dispanzer za tuberkulozu. Daljnji razvoj prekinuo je Drugi svjetski rat. U teškim prilikama razvijen je poseban način medicinskoga rada, osobito u pogledu zbrinjavanja ranjenika i bolesnika, poduzimanja protuepidemijskih mjera, medicinskog opskrbljivanja i si. Nakon Drugoga svjetskog rata obnavlja se Opća bolnica Osijek i započinje moderan ustroj kao temelj razvoja buduće kliničke bolnice. U razdoblju 1980. - 1990. godine provode se stručna usavršavanja na svim područjima, objavljuju se brojni znanstveni i stručni radovi, razvija izdavačka djelatnost, što pridonosi stvaranju obrazovno nastavne djelatnosti i znanstveno-istraživačkoga rada. Posebno treba istaknuti razdoblje Domovinskoga rata u kojem je bolnica časno izvršila sve svoje zadaće u liječenju ranjenih i bolesnih. Stoga joj je dodijeljena nagrada „Medicina . Godine 1992. stekla je naslov Klinička bolnica Osijek. Daljnjim razvojem, izgradnjom, opremanjem i napredovanjem djelatnika u znanstvena, nastavna, znanstveno nastavna i stručna zvanja, 2009. godine postaje Klinički bolnički centar. Klinike i odjeli Kliničkoga bolničkog centra u Osijeku nastavna su baza Medicinskoga fakulteta Sveučilišta J. J. Strossmayera u Osijeku.Beginnings of the University Hospital Centre in Osijek were related to Huttler Kohlhoffer Monsperger Foundation Hospital, which was founded in 1874 and was the most modern hospital in the south-east Europe at the time. By the Government legislation in 1895 it became "General and public Huttler Kohlhoffer Monsperger Foundation Hospital under Country\u27s management in Osiek". Foundation hospital was taking care of the wounded and sick during the World War 1. New hospital departments were opened after the World War I. Apart from Surgery and Internal Department; new departments were Ophthalmology, Otorhinolaryngology, Dermatovenereology, Epidemiological and Hygienic Institute and Tuberculosis Clinic. Further development was interrupted by the World War II. A special way of performing medical work developed in those hard times, especially regarding taking care of the wounded and sick, taking epidemic precaution measures, medical supplying, etc. After the World War II General Hospital Osijek was renovated and modern organization began, which was a basis for development of the future university hospital. In the period 1980 - 1990 professional educations in all areas were implemented, many scientific and professional papers were published, publishing developed, what contributed to creating educational and teaching activities, as well as scientific and research work. Period of the War for Croatian Independence, in which the hospital honourably performed all its duties regarding treating wounded and sick, especially needs to be pointed out. For those activities it was rewarded with "Medicine" reward. In 1992 it became University Hospital Osijek. By further development, construction, and equipment and by promoting its employees to scientific, teaching, scientific teaching and professional titles, it became University Hospital Centre in 2009. Clinics and Departments of the University Hospital Centre in Osijek are the teaching base of the Faculty of Medicine, Josip Juraj Strossmayer University of Osijek

Intervention radiology at the Osijek clinical hospital

Intervencijska radiologija (IR) je značajan dio kliničke radiologije čiji je cilj primjena terapijskih zahvata u liječenju bolesti različitih organskih sustava uz pomoć konvencionalnih rendgenskih uređaja, uređaja za ultrazvučnu dijagnostiku, kompjutoriziranu tomografiju i magnetsku rezonancu. Prikazanje povijesni razvoj intervencijske radiologije u okviru Kliničke bolnice Osijek, sadašnje stanje i procjena mogućeg razvoja u novom izuzetno atraktivnom dijelu kliničke radiologije.Intervention radiology (IR) makes up a significant part of clinical radiology, aiming at applying therapeutic procedures in the treatment of various body systems by means of conventional X-ray devices and the equipment for ultrasonographical diagnostics, computerized tomography and magnetic resonance imaging. A historical review of the intervention radiology within Osijek Clinical Hospital is given as well as the present state of affairs and estimated future development

Intervention radiology at the Osijek clinical hospital

Intervencijska radiologija (IR) je značajan dio kliničke radiologije čiji je cilj primjena terapijskih zahvata u liječenju bolesti različitih organskih sustava uz pomoć konvencionalnih rendgenskih uređaja, uređaja za ultrazvučnu dijagnostiku, kompjutoriziranu tomografiju i magnetsku rezonancu. Prikazanje povijesni razvoj intervencijske radiologije u okviru Kliničke bolnice Osijek, sadašnje stanje i procjena mogućeg razvoja u novom izuzetno atraktivnom dijelu kliničke radiologije.Intervention radiology (IR) makes up a significant part of clinical radiology, aiming at applying therapeutic procedures in the treatment of various body systems by means of conventional X-ray devices and the equipment for ultrasonographical diagnostics, computerized tomography and magnetic resonance imaging. A historical review of the intervention radiology within Osijek Clinical Hospital is given as well as the present state of affairs and estimated future development

Correlation of x-ray findings and radioisotope changes in children with vesicoureteral reflux

Od 1982. godine naovamo ispitivali smo u 18-ero djece, sa vezikoureteralnim refluksom, korelaciju rendgenoloških nalaza i radioizotopnih pretraga, sa ciljem utvrđivanja stupnja funkcionalne bubrežne lezije. Kod rendgenološki još nevidljivih upalnih promjena nalazimo već depresiju bubrežne funkcije u smislu redukcije tubularne mase ili drenažnih smetnji u eliminatornom segmentu, koje, nažalost više ni operativni zahvat u većini slučajeva ne može zaustaviti. Stoga smatramo da je baš radioizotopno ispitivanje bubrežne funkcije neobično važno u slu­čajevima bez rendgenološki vidljivih upalnih promjena u cilju postavljanja pravovremene indikacije za operativni zahvat.Since 1982 the correlation of x-ray findings and radioisotope treatments was investigated in 18 children with vesicoureteral reflux. Its aim was to determine the level of functional renal lesion. With radiologically still invisible inflammatory changes a depression of renal function is already present. It is found either as reduced tubular mass or drainage hindrances in eliminatory segment which unfortunately cannot be, in majority of cases, stopped by a surgery. Therefore the radioisotopic investigation of renal function is of the utmost importance in cases without radiologically visible inflammatory changes in order to indicate a surgery in time

Correlation of x-ray findings and radioisotope changes in children with vesicoureteral reflux

Od 1982. godine naovamo ispitivali smo u 18-ero djece, sa vezikoureteralnim refluksom, korelaciju rendgenoloških nalaza i radioizotopnih pretraga, sa ciljem utvrđivanja stupnja funkcionalne bubrežne lezije. Kod rendgenološki još nevidljivih upalnih promjena nalazimo već depresiju bubrežne funkcije u smislu redukcije tubularne mase ili drenažnih smetnji u eliminatornom segmentu, koje, nažalost više ni operativni zahvat u većini slučajeva ne može zaustaviti. Stoga smatramo da je baš radioizotopno ispitivanje bubrežne funkcije neobično važno u slu­čajevima bez rendgenološki vidljivih upalnih promjena u cilju postavljanja pravovremene indikacije za operativni zahvat.Since 1982 the correlation of x-ray findings and radioisotope treatments was investigated in 18 children with vesicoureteral reflux. Its aim was to determine the level of functional renal lesion. With radiologically still invisible inflammatory changes a depression of renal function is already present. It is found either as reduced tubular mass or drainage hindrances in eliminatory segment which unfortunately cannot be, in majority of cases, stopped by a surgery. Therefore the radioisotopic investigation of renal function is of the utmost importance in cases without radiologically visible inflammatory changes in order to indicate a surgery in time

Evaluation of the diagnostic value of static brain chintigraphy in detection of brain tumors

U radu se daje usporedna nuklearno-neurološka, neuroradiološka i oftalmološka studija 55 bolesnika s tumorima mozga, čija je dijagnoza patohistološki potvrđena. Procijenjena je dijagnostička vrijednost statičke scintigrafije mozga i njezina podudarnost s nalazima fundusa, elektroencefalografije, cerebralne angiografije i kompjutorizirane tomografije u otkrivanju moždanih tumora i njihovih recidiva. Preoperativna dijagnostička senzitivnost statičke scintigrafije mozga iznosi 92%, a nešto je niža za otkrivanje recidiva nakon učinjene kirurške ekstirpacije tumora (85%). Postoperativna je specifičnost pretrage za recidiv manja od njezine osjetljivosti (66%). Međutim, zahvaljujući različitom vezivanju radiofarmaka u moždanim lezijama, istaknuto je da statička scintigrafija mozga, osim anatomskopatoloških, mo­že dati i patofiziološke diferencijalnodijagnostičke podatke o svojstvima tumorskog tkiva, značajne za planiranje kirurškog zahvata. Ova metoda, zbog svoje neinvazivnosti, mogućnosti ambulantnog izvođenja i malog radijacijskog opterećenja bolesnika, ostaje vrlo dobra screening metoda u otkrivanju moždanih tumora.In this study, nucleo-neurologic, neuro-radiologic and opthalmologic findings of 55 patients with pathohistologically verified diagnosis were analyzed. The diagnostic value of brain scinthigraphy and its complementarity with the findings of fundus examination, electroencephalography, cerebral angiography and computerized tomography in the detection of brain tumors and their postoperative recurrence were estimated. Preoperative diagnostic sensitivity of static brain scintigraphy was 92%, but it was somewhat lower in the detection of recurrence after surgical tumor removal (85%). The postoperative specificity of this procedure was lower than its sensitivity (66%). Yet, due to different binding of radiopharmacenticals within brain lesions, static brain scintigraphy could apart from anatomicopathologic data, provide important pathophysiologic differential diagnostic data on the tumor tissue, essential for determination of the surgical procedure. This method remains a very good brain screening technique, due to its non-invasiveness, possibility of ambulatory procedure and low patient iradiation