Testicular cancer masquerading as an incarcerated inguinal hernia – A case report

An incarcerated inguinal hernia is a surgical emergency. Testicular tumors can present with scrotal swelling, hence they could easily be mistaken for a hernia. Both conditions, if left untreated, are life-threatening and lead to severe complications

Pelvic inflammatory disease and surgical treatment over a ten years period; single institution experience

Background: In our study, we examined the frequency of surgical procedures due to the acute presentation of the pelvic inflammatory disease (PID) in regard to all gynecological procedures in a single institution. We also wanted to present patients\u27 age range and type of surgical approach as well as surgical extension. Materials and methods: This retrospective study investigated a total of 10,175 surgical procedures, out of which 103 were due to acute PID. The study included 101 patients. We obtained data from surgical procedures performed from September 2009 to September 2019. Results: In the observed ten years period, the frequency of surgical procedures due to the acute PID was 1.01%. It was found that women were mostly older than 25 (85.15%). Laparoscopy was performed in 52.43% of cases and laparotomy in 37.86% of cases. Laparotomy incisions were transverse in 26.67% of cases and vertical in 42.22% of cases. The most radical procedures were performed in 17.48% of cases in which patients underwent a subtotal or total hysterectomy with unilateral or bilateral adnexectomy. Conclusion: In conclusion, although rare, surgical procedures in PID are relevant because they are, according to our data, more common in patients older than 25, and surgical procedures tend to be more extensive

External and a four-act internal pelvic fixation in a patient with polytrauma

Fractures of the pelvic ring carry a high mortality and morbidity rate due to possibly great blood loss and abdominal organ trauma. However, external pelvic fixation can stabilize the patient enough to undergo emergency surgeries when treating a patient with multiple life-threatening injuries

Recurrent retroperitoneal dedifferentiated liposarcoma

Liposarcomas (LPS) are malignant tumors deriving from the adipocytic differentiation process. They are divided into four subtypes of LPS – well-dif ferentiated (WDLPS), dedifferentiated (DDLPS), myxoid (MLPS), and pleomorphic (PLPS). Regarding histological subtype and molecular pathology, tumors have different recurrence rates, radiosensitivity, and chemosensitivity, representing a challenge to every physician involved in their treatment decision. DDLPS commonly appears as a focal outgrowth of a WDLPS lesion

Gigantski, brzorastući lipom Retziusovog prostora

U 57-godišnje, prethodno zdrave postmenopauzalne žene suprapubična tvorba otvorene etiologije viđena je tijekom redovnoga ginekološkog ultrazvučnog pregleda. U razmaku od 50 dana tri transabdominalna ultrazvuka (UZV) i kompjuterizirana tomografija (CT) pokazale su rapidan porast u masi i veličini (od 5,6 x 1,1 cm do 11 x 6 cm na UZV, 19 x 11 cm na CT). Anamnestički, bolesnica je imala trombocitopeniju (1 x 109/L) i intrauterini uložak (IUD) s hormonalnim otpuštanjem. Karcinoembrijski antigen (CEA) bio je blago povišen (4.1 IU/L). Abdominalni CT s intravenskim kontrastom opisao je inkapsuliranu masu intenziteta masnog tkiva bez jasnoga primarnog sijela. Nije bilo znakova infiltracije ili invazije okolnih organa. Diferencijalna dijagnoza uključivala je lipom i low-grade liposarkom. Nakon eksplorativne laparotomije i kompletne ekstirpacije tumora (24 x 19 x 7 cm) iz Retziusovog prostora, patohistološka dijagnoza bila je lipom s negativnim estrogenskim i progesteronskim receptorima. Postoperativni tijek bio je uredan te je nakon godinu dana magnetna rezonancija (MR) pokazala da nema recidiva

CHILD PORNOGRAPHY ON THE INTERNET – DETERMNINATS OF CONVICTED OFFENDERS

Štetne aktivnosti koje nastaju upotrebom modernih tehnologija uključuju i one štetne kontakte gdje je dijete ciljano izabrano kao žrtva od odrasle osobe. U radu će biti riječi upravo o skupini štetnih kontakata koja se odnosi na sudjelovanje u aktivnostima vezanim uz dječju pornografiju na internetu uz pomoć prikaza preliminarnih rezultata istraživanja. Istraživanjem je analizirana dokumentacija probacijske službe 76 predmeta osuđenih počinitelja kaznenog djela iskorištavanja djece za pornografiju na internetu. Prikaz rezultata uključuje informacije o počiniteljima i vrsti kaznenog djela te ostale podatke koji će doprinijeti boljem razumijevanju kaznenih djela na štetu djece i maloljetnih osoba u području dječje pornografije i elektroničkog nasilja čime će se čime će se pridonijeti oskudnom istraživačkom području.Harmful activities by means of modern technology also include detrimental contacts when a child is targeted and chosen as a victim by another child or adult person. The paper deals with presentation of preliminary research results concerning the group of harmful contacts that pertain to the involvement in activities related to the Internet child pornography. The research analyzed the probation service documentation of 76 cases of convicted perpetrators of child exploitation for purposes of the Internet pornography. The presentation of the results includes information on the perpetrators and type of offenses, in addition to other data which will contribute to better understanding of criminal offenses that harm children and juveniles through child pornography and electronic violence. The presentation of the results aims at objectives analysis but also contributes to the sparse field of research

COVID-19 i kolorektalni karcinom – toksične poveznice i kako ih prekinuti: KBC Zagreb, iskustvo tercijarnog centra

Colorectal cancer (CRC) is one of the most prevalent oncological diseases globally, taking 3rd place in incidence in the general population. High in mortality, it is also a form of cancer whose outcome is highly dependable on its stage at diagnosis. Therefore, many countries have adopted a more or less successful screening process to ensure early diagnosis and, in turn, higher survival rates and better results overall. The COVID-19 pandemic has altered the established medical routines worldwide, with massively postponing diagnostic procedures and elective surgeries. This study aims to measure the effect the pandemic has had on colorectal cancer treatment in our Institution. Variables such as deferral time from diagnosis to commencement of treatment, lapse of time between different phases of the treatment process, time of presentation (elective versus emergent surgery), the physical status of the patient at the time of surgery (ASA classification) and metastatic index (positive lymph node ratio), were taken into account. We juxtaposed data from patients treated at the Surgical Department of Clinical Hospital Center in Zagreb in 2019 and 2020, the latter being heavily affected by the pandemic. In 2019 and 2020, 347 and 314 patients, respectively, with C18-C20 diagnoses (International Statistical Classification of Diseases and Related Health Problems ICD-10), have been treated at our Hospital. With exclusion criteria applied, the patient count falls to 173 for 2019 and 157 for 2020. These numbers include operated cases with or without an anastomosis formation and with or without neoadjuvant chemotherapy applied. From the analysis we excluded patients with recurrent colorectal tumors, synchronous and metachronous tumors, and patients treated palliatively. Furthermore, colorectal adenomas were also excluded from the study. Our data shows significant difference between observed variables in the two patient groups, attributed to the COVID-19 pandemic. Since there is still no reliable way to predict the duration of this global health crisis, it is imperative to implement strategies to lessen the damaging effect the pandemic has had on favourable oncosurgical treatment outcomes in colorectal cancer patients.Kolorektalni karcinom jedna je od najčešćih onkoloških bolesti u svijetu. Uz visoki mortalitet obilježena je i ovisnošću ishoda liječenja o stadiju bolesti u trenutku dijagnoze. Mnoge su države stoga usvojile više ili manje uspješne programe probira kako bi osigurale ranu dijagnozu, bolje stope preživljenja te generalno optimalnije ishode liječenja. Pandemija COVID-19 u kratkom je roku promijenila temelje medicinske svakodnevice uz nemale odgode dijagnostičkih procedura i elektivnih zahvata. Cilj ovog rada jest procijeniti utjecaj koji je pandemija imala na liječenje kolorektalnog karcinoma u našoj ustanovi. Uspoređivana su dva jednogodišnja razdoblja – 2019. i 2020. od kojih je potonja godina bila značajno pogođena COVID 19 pandemijom. Uspoređivali smo podatke pacijenta liječenih na Zavodu za kirurgiju Kliničkog bolničkog Centra Zagreb, vođenih pod MKB dijagnozama C18-C20. U 2019. godini na našem je Zavodu liječeno 347 pacijena s kolorektalnim karcinom, po primjeni kriterija isključenja ta brojka pada na 173. Bolesnika s operiranim karcinomom koloektuma u 2020. godini u našoj je ustanovi bilo 314, po primjeni kriterija isključenja 157. Praćeni parametri uključivali su vremensku odgodu od incijalne dijagnoze do početka liječenja, vrijeme proteklo između različitih etapa onko kirurškog liječenja, odnos elektivnih i hitnih zahvata, fizičku spremnost pacijenata u vrijeme operacije (ASA klasifikacija) te metastatski index (udio pozitivnih metastatskih limfnih čvorova u dobivenim preparatima). U studiju su uključeni bolesnici neovisno o primjeni neoadjuvantne kemoterapije te neovisno je li intraoepracijski uspostavljen kontinuitet probavne cijevi. Recidivni tumori, metakroni i sinkroni tumori, palijativno liječeni pacijenti, reoperirani te pacijenti operirani uslijed kolorektalnog adenoma nisu uključeni u ovu studiju. Naši podaci pokazuju značajne razlike među praćenim parametrima u dva razdoblja te se iste uvelike pripisuju utjecaju COVID-19 pandemije. Kako su budućnost i trajanje ove medicinske krize još uvijek neizvjesni, potrebno je što prije usvojiti strategije kojima bi se smanjio razorni utjecaj pandemije na ishode liječenja bolesnika sa kolorektalnim karcinomom

Direct Identification of Urinary Tract Pathogens by MALDI-TOF/TOF Analysis and De Novo Peptide Sequencing

For mass spectrometry-based diagnostics of microorganisms, matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) is currently routinely used to identify urinary tract pathogens. However, it requires a lengthy culture step for accurate pathogen identification, and is limited by a relatively small number of available species in peptide spectral libraries (≤3329). Here, we propose a method for pathogen identification that overcomes the above limitations, and utilizes the MALDI-TOF/TOF MS instrument. Tandem mass spectra of the analyzed peptides were obtained by chemically activated fragmentation, which allowed mass spectrometry analysis in negative and positive ion modes. Peptide sequences were elucidated de novo, and aligned with the non- redundant National Center for Biotechnology Information Reference Sequence Database (NCBInr). For data analysis, we developed a custom program package that predicted peptide sequences from the negative and positive MS/MS spectra. The main advantage of this method over a conventional MALDI-TOF MS peptide analysis is identification in less than 24 h without a cultivation step. Compared to the limited identification with peptide spectra libraries, the NCBI database derived from genome sequencing currently contains 20, 917 bacterial species, and is constantly expanding. This paper presents an accurate method that is used to identify pathogens grown on agar plates, and those isolated directly from urine samples, with high accuracy

Comparison of preoperative ultrasound, intraoperative, and histopathological compatibility of gallbladder polyp diagnosis

UVOD:Kolecistektomija je jedna od najčešće izvođenih operacija abdominalne kirurgije. Najčešće indikacije su bilijarna diskinezija, simptomatska kolelitijaza te akutni i kronični kolecistitis. U slučaju da se ultrazvučnim pregledom abdomena otkrije polip žučnjaka, ovisno o njegovoj veličini preporuča se redovito praćenje ili kolecistektomija, zbog moguće maligne alteracije. Hipoteza istraživanja je da je većina polipa otkrivenih ultrazvučnim pregledom u stvarnosti manji kolelit ili gusta žuč. ----- CILJ: Cilj istraživanja je usporediti podudarnost ultrazvučnog, intraoperativnog i patohistološkog nalaza polipa žučnjaka i utvrditi učestalost polipa žučnjaka u promatranom uzorku. ----- ISPITANICI I METODE: Retrospektivnom analizom svih kolecistektomija u tercijarnoj ustanovi u periodu od pet godina uspoređene su ultrazvučne, intraoperativne i patohistološke dijagnoze polipa žučnog mjehura. Matične liste, nalazi ultrazvuka, operacijske liste i patohistološki nalazi pregledani su i prikupljeni traženi podaci. ----- REZULTATI: Primarni uzorak činilo je 3651 bolesnika. Primjenom kriterija isključenja utvrđen je konačni uzorak od 3445 bolesnika. Ultrazvučnim pregledom polip je zabilježen u 206 (5.97%) slučajeva, makroskopskim intraoperativnim pregledom operateri su zabilježili 46 (1.33%) polipa, dok je 7 (0.20%) polipa potvrđeno patohistološkim pregledom. ----- ZAKLJUČAK: Ultrazvučni, intraoperativni i postoperativni nalaz polipa žučnog mjehura vrlo su malo podudarni te je učestalost polipa žučnog mjehura u promatranom uzorku niska.INTRODUCTION: Cholecystectomy is one of the most commonly performed abdominal surgery operations. The most common indications are biliary dyskinesia, symptomatic cholelithiasis, and acute or chronic cholecystitis. If ultrasound examination of the abdomen reveals a gallbladder polyp, regular monitoring or cholecystectomy is recommended, depending on its size and possibility of malignant alteration. The research hypothesis is that the majority of polyps detected by ultrasound examination are in fact smaller coleliths or thick bile. ----- AIM:The aim of the study is to compare whether ultrasonographic, intraoperative and pathohistological findings of gallbladder polyps correlate with each other and determine the frequency of gallbladder polyps in the observed sample. ----- SUBJECTS AN METHODS: A retrospective analysis of all cholecystectomies in a tertiary institution over a five-year period compared ultrasonographic, intraoperative, and pathohistological diagnoses of gallbladder polyps. Registers, ultrasound findings, surgery lists and histopathological findings were reviewed and the required data were collected. ----- RESULTS: The primary sample consisted of 3651 patients. A final sample of 3445 patients was determined after applying the exclusion criteria. Ultrasound examination revealed polyps in 206 (5.97%) cases, macroscopic intraoperative examination revealed 46 (1.33%) polyps, and 7 (0.20%) polyps were confirmed by histopathological examination. ----- CONCLUSION: Ultrasonographical, intraoperative and postoperative pathohistological diagnosis of gallbladder polyps widely differ and the frequency of gallbladder polyps in the observed sample is low