Wünderlich syndrome as a first manifestation of renal cell carcinoma – case report

Cilj: Prikazati spontano, netraumatsko perirenalno krvarenje (Wünderlich sindrom) kao prvu manifestaciju karcinoma bubrega te dijagnostički i terapijski postupak kod takvog bolesnika. Prikaz slučaja: Bolesnica stara 37 godina je došla na hitni medicinski trakt s intenzivnim, naglo nastalim bolovima u lijevom lumbalnom predjelu abdomena; uredno mokri, negira traumu i nema makrohematuriju. Zbog općeg lošeg stanja bolesnica je poslana na hitnu višeslojnu kompjuteriziranu tomografiju (Multi-slice computed tomography, MSCT) abdomena i zdjelice na kojoj je utvrđena inhomogena formacija u gornjem polu lijevog bubrega uz zaključak radiologa da se radi o perirenalnom krvarenju, najvjerojatnije uzrokovanog angiomiolipomom. Urolog se odlučio za hitni operacijski zahvat koji uključuje djelomičnu nefrektomiju lijevog bubrega te evakuaciju hematoma. Patohistološki pregled uputio je na karcinom bubrega kromofobnog tipa koji je uzrokovao krvarenje. Bolesnica se redovito kontrolira, nema znakova recidiva. Zaključak: Wünderlich sindrom je rijetka, potencijalno životno ugrožavajuća manifestacija karcinoma bubrega koja zahtijeva hitni operacijski zahvat. MSCT abdomena i zdjelice je radiološka metoda izbora za akutnu abdominalnu/lumbalnu bol u hemodinamski nestabilnog bolesnika.Aim: To present a case with spontaneous, non-traumatic, perirenal haemorrhage (Wünderlich syndrome) as a first manifestation of renal cell carcinoma. Case report: A 37-year-old female was admitted to the emergency unit with sudden and severe pain in the left lumbar area of abdomen. She has normal voiding, without macrohaematuria or trauma in her medical history. Because of her generally instable state she was referred to emergency multi-slice computed tomography (MSCT) exam of the abdomen and pelvis which reveals inhomogeneous mass in the upper pole of the left kidney. Radiology report indicated perirenal haemorrhage most likely caused by an angiomyolipoma. The patient was operated on by urologist who performed a partial nephrectomy of the left kidney and evacuation of haematoma. Samples were taken for histopathology and cromophobe renal cell carcinoma which caused the perirenal haemorrhage was diagnosed. Our patient is controlled on regular basis, without signs of tumour recurrence. Conclusion: Wünderlich syndrome as the first manifestation of renal cell carcinoma is a very rare but life-threatening manifestation of renal cancer that warrants urgent surgery. MSCT of the abdomen and pelvis is a method of choice in haemodynamically unstable patients with acute abdominal/lumbar pain

SERUM 25 HYDROXY VITAMIN D LEVEL RELATIONSHIP WITH BLADDER CANCER IN NORTHERN COASTAL REGION OF CROATIA

Vitamin D se smatra prohormonom čiji aktivni oblik koji nastaje u koži ljudi djelovanjem ultraljubičastog zračenja tipa B djeluje kao hormon, odnosno kao signalna molekula koja, vežući se na unutarstanične receptore za vitamin D koji se nalaze u gotovo svim tkivima u tijelu, utječe na različite fiziološke funkcije. Glavninu svojih funkcija obavlja povećavajući intestinalnu apsorpciju i renalnu reapsorpciju kalcija i fosfata sudjelujući na taj način u održavanju njihove homeostaze. U brojnim studijama je pokazano da vitamin D ima protektivni učinak u razvoju određenih malignih tumora, uključujući i maligne tumore mokraćnog mjehura koji su deveti najčešći malignitet u svijetu dok se u Hrvatskoj u muškaraca nalaze na 5. mjestu. Sudionici ove studije su podijeljeni u dvije grupe; jedna se sastojala od 236 pacijenata oboljelih od karcinoma mokraćnog mjehura, dok je druga grupa bila kontrolna grupa od 83 sudionika koji su povezani s prvom grupom na osnovi dobi, a regrutirani su kao urološki pacijenti koji ne boluju od karcinoma mokraćnog mjehura. Svi sudionici su ispunili upitnik koji se sastojao od 4 dijela s otvorenim i zatvorenim pitanjima te su dali svoj uzorak krvi. Cilj ovog rada bio je dokazati povezanost serumske razine 25-hidroksi vitamina D i karcinoma mokraćnog mjehura u sjevernom priobalju Hrvatske. Ovom studijom pronađena je korelacija između visoke serumske razine vitamina D i nižeg rizika razvoja karcinoma mokraćnog mjehura u grupi pacijenata koji obitavaju u sjevernom priobalju HrvatskeVitamin D is considered a prohormone whose active form, which is synthesized in the skin by ultraviolet light type B, acts as a hormone – a signal molecule that affects different physiological functions by binding to vitamin D receptors in different body tissues. Most of its functions are done through mediating an increase in intestinal apsorption and renal reapsorption of calcium and phosphates. It has been shown in many studies that vitamin D has a certain protective effect when it comes to development of some malignant tumours, including malignant tumours of the bladder which are the ninth most common malignancy in the world and fifth in Croatia's male population. The participants of this study were divided into two groups; one consisted of 236 patients with bladder carcinoma while the other group consisted of 83 participants which were connected with the first group based on age and were recruited as urologic patients which did not have bladder carcinoma. All participants have filled a questionnaire which consisted of 4 parts with open-ended and close-ended questions and they all gave their blood sample for analysis. The aim of this study was to find a connection between serum level of 25-hydroxy vitamin D and bladder carcinoma in the northern coastal region of Croatia. With this study a correlation between high serum level of vitamin D and lower level of risk of development of bladder carcinoma has been found among a group of patients in the northern coastal region of Croatia

SERUM 25 HYDROXY VITAMIN D LEVEL RELATIONSHIP WITH BLADDER CANCER IN NORTHERN COASTAL REGION OF CROATIA

Vitamin D se smatra prohormonom čiji aktivni oblik koji nastaje u koži ljudi djelovanjem ultraljubičastog zračenja tipa B djeluje kao hormon, odnosno kao signalna molekula koja, vežući se na unutarstanične receptore za vitamin D koji se nalaze u gotovo svim tkivima u tijelu, utječe na različite fiziološke funkcije. Glavninu svojih funkcija obavlja povećavajući intestinalnu apsorpciju i renalnu reapsorpciju kalcija i fosfata sudjelujući na taj način u održavanju njihove homeostaze. U brojnim studijama je pokazano da vitamin D ima protektivni učinak u razvoju određenih malignih tumora, uključujući i maligne tumore mokraćnog mjehura koji su deveti najčešći malignitet u svijetu dok se u Hrvatskoj u muškaraca nalaze na 5. mjestu. Sudionici ove studije su podijeljeni u dvije grupe; jedna se sastojala od 236 pacijenata oboljelih od karcinoma mokraćnog mjehura, dok je druga grupa bila kontrolna grupa od 83 sudionika koji su povezani s prvom grupom na osnovi dobi, a regrutirani su kao urološki pacijenti koji ne boluju od karcinoma mokraćnog mjehura. Svi sudionici su ispunili upitnik koji se sastojao od 4 dijela s otvorenim i zatvorenim pitanjima te su dali svoj uzorak krvi. Cilj ovog rada bio je dokazati povezanost serumske razine 25-hidroksi vitamina D i karcinoma mokraćnog mjehura u sjevernom priobalju Hrvatske. Ovom studijom pronađena je korelacija između visoke serumske razine vitamina D i nižeg rizika razvoja karcinoma mokraćnog mjehura u grupi pacijenata koji obitavaju u sjevernom priobalju HrvatskeVitamin D is considered a prohormone whose active form, which is synthesized in the skin by ultraviolet light type B, acts as a hormone – a signal molecule that affects different physiological functions by binding to vitamin D receptors in different body tissues. Most of its functions are done through mediating an increase in intestinal apsorption and renal reapsorption of calcium and phosphates. It has been shown in many studies that vitamin D has a certain protective effect when it comes to development of some malignant tumours, including malignant tumours of the bladder which are the ninth most common malignancy in the world and fifth in Croatia's male population. The participants of this study were divided into two groups; one consisted of 236 patients with bladder carcinoma while the other group consisted of 83 participants which were connected with the first group based on age and were recruited as urologic patients which did not have bladder carcinoma. All participants have filled a questionnaire which consisted of 4 parts with open-ended and close-ended questions and they all gave their blood sample for analysis. The aim of this study was to find a connection between serum level of 25-hydroxy vitamin D and bladder carcinoma in the northern coastal region of Croatia. With this study a correlation between high serum level of vitamin D and lower level of risk of development of bladder carcinoma has been found among a group of patients in the northern coastal region of Croatia

Clinical Approach to Patients with COVID-19 and Unrecognized Obstructive Sleep Apnea

Purpose: We conducted a retrospective case series of seven male COVID-19 patients with respiratory failure and suspected OSA based on clinical features to evaluate the effects of undiagnosed obstructive sleep apnea (OSA) on COVID-19 outcomes and the response to a continuous positive airway pressure (CPAP) treatment. Cardiorespiratory polygraphy (CRP) and a continuous positive airway pressure treatment were used for diagnosis and management. They confirmed severe obstructive sleep apnea in all patients (apnea/hypopnea index > 30) and improved overnight oxygenation and symptoms at the 1-month follow-up. Conclusions: Undiagnosed obstructive sleep apnea may negatively impact COVID-19 outcomes by exacerbating respiratory failure. Recognition and treatment with continuous positive airway pressure can optimize the management of such patients

Haemoptysis in breath-hold divers; where does it come from?

Introduction: The aim of reporting these two cases is to present visual evidence by bronchoscopy of the origin of haemoptysis in two elite breath-hold divers. Case reports: Two male elite breath-hold divers of similar physical characteristics presented to our clinic after performing dives of up to 75 and 59 meters of seawater depth for 2:30 and 2:35 (minutes:seconds) respectively. Both patients presented with haemoptysis. Lung ultrasound was performed. The first patient had crackles on chest auscultation, overt pulmonary oedema clinically and 90 ultrasound lung comets. The second patient had no oedema or crackles, but presented with 20 ultrasound lung comets. Video bronchoscopy was performed which showed traces of blood coming from all three segments of the right upper lobe in both patients. The rest of the airways and lungs were intact. Conclusions: These finding suggest that the apical parts of the lungs are the most prone to deep-dive induced damage. The precise mechanism of lung barotrauma and haemoptysis in breath-hold divers remains to be elucidated. These findings may be of importance for a better understanding of the underlying pathology of haemoptysis

Arterial blood gases’ analysis in elite breath-hold divers at extreme depths

Purpose To showcase results of arterial blood gases' analysis in elite breath-hold divers sampled at depths where their total lung capacities are below their residual lung volume on surface. Methods Three male elite breath-hold divers performed body plethysmographies to determine their lung volumes. Two dives were performed, one on normal inhalation to 60 m of depth and the second on complete exhalation to 10 m of depth. Blood samples were taken on five occasions; before the first dive, at 60 and 10 m of depth and immediately after resurfacing after both dives. Results Arterial blood gases' analysis at 60 m of depth showed an increase in partial pressures of oxygen and carbon dioxide, a consequent decrease in pH and an increase in concentration of HCO3-. After resurfacing, in two divers, values mostly returned to normal; hypoxemia was observed in one diver. At 10 m of depth, all values showed similar variation, and hypoxemia was observed in the same diver but at depth. Upon resurfacing, all values returned to normal. Conclusion This is the first study performed at depths where the total lung capacities of participants are below their residual lung volumes at the surface. Partial pressure of carbon dioxide increases at depth to higher than normal values causing pH to decrease thus exceeding the buffering potential of the blood. In addition, previous assumptions that maximum depth in breath-hold divers is where total lung capacity is reduced to their residual volume proved wrong as our group of divers had no symptoms after resurfacing

Slagalica nasljeđa : priručnik za opismenjavanje iz medicinske genetike

"Slagalica nasljeđa" - priručnik za opismenjavanje iz medicinske genetike ima tri namjene. Prije svega, on je edukativna slikovnica za studente, liječnike i pacijente, ali i druge zainteresirane pojedince jer su u njoj kroz ilustracije objašnjene osnove genetike čovjeka, kao i osnove medicinske genetike. Od toga kako prepoznati osobu s genetičkim poremećajem, kako nastaju i koje vrste genetičkih poremećaja postoje pa sve do toga na koji ih način možemo dijagnosticirati. Nadalje, nakon svake ilustracije na pojedinoj stranici nalaze se definicije 79 pojmova iz medicinske genetike koje čine tezaurus za studente, liječnike i pacijente koji se na bilo koji način susreću s genetičkim poremećajima. Naposljetku, ova knjiga sadrži i primjere rečenica u koje su ubačeni stručni pojmovi iz medicinske genetike, a koji su namijenjeni studentima prilikom savladavanja komunikacijskih vještina na kolegiju Medicinska genetika, ali i liječnicima prilikom informiranja svojih pacijenata o (mogućem) genetičkom poremećaju. Uz kreatoricu ideje i urednicu izdanja, doc. dr. sc. Ninu Perezu, autori izdanja su studenti šeste godine Integriranog preddiplomskog i diplomskog sveučilišnog studija Medicina i prof. dr. sc. Saša Ostojić

Slagalica nasljeđa : priručnik za opismenjavanje iz medicinske genetike

"Slagalica nasljeđa" - priručnik za opismenjavanje iz medicinske genetike ima tri namjene. Prije svega, on je edukativna slikovnica za studente, liječnike i pacijente, ali i druge zainteresirane pojedince jer su u njoj kroz ilustracije objašnjene osnove genetike čovjeka, kao i osnove medicinske genetike. Od toga kako prepoznati osobu s genetičkim poremećajem, kako nastaju i koje vrste genetičkih poremećaja postoje pa sve do toga na koji ih način možemo dijagnosticirati. Nadalje, nakon svake ilustracije na pojedinoj stranici nalaze se definicije 79 pojmova iz medicinske genetike koje čine tezaurus za studente, liječnike i pacijente koji se na bilo koji način susreću s genetičkim poremećajima. Naposljetku, ova knjiga sadrži i primjere rečenica u koje su ubačeni stručni pojmovi iz medicinske genetike, a koji su namijenjeni studentima prilikom savladavanja komunikacijskih vještina na kolegiju Medicinska genetika, ali i liječnicima prilikom informiranja svojih pacijenata o (mogućem) genetičkom poremećaju. Uz kreatoricu ideje i urednicu izdanja, doc. dr. sc. Ninu Perezu, autori izdanja su studenti šeste godine Integriranog preddiplomskog i diplomskog sveučilišnog studija Medicina i prof. dr. sc. Saša Ostojić